Monday, September 22, 2008

My New Baby

This is Tina, my new dog. She is a ton of fun, energetic, smart, LOVES to run and chase a ball or frisbee. She is the only reason I get up and walk a mile before I go to work in the morning, something I have just not been able to motivate myself to do.

She is a very sweet girl, 3 years old, part terrier and part beagle. I have had her for about 5 weeks, having adopted her from a family who no longer wanted her for reasons that are unimportant. Tina's picture was on the break room bulletin board for oh, about a month. One day I happend to ask if she had found a new home; nope, and by the way she would be making a visit to the ER that very afternoon. Long story short, to save her from being put to sleep, sap that I am, the dog comes home with me.

Now, I used to have the world's best border collie up until a few years ago when he had to be put down for illness. It just about killed Mr. EDNurseasauras, who vowed never to get another dog for the rest of his life. After a couple of years without one, I was ready. While he never said no, my husband always had good reasons why getting another dog was not a good idea. I never disagreed with him, but still , dog was on my agenda.

Fast forward to 5 weeks ago. I brought the dog home about 6:30 PM. Tina was skittish, fearful, mistrusting....of me. The cat she ignored. She had obviously been neglected and she smelled. I threw her into the tub and spent the next hour petting her and talking to her. She settled in.

Until my husband came home. Tina barked and barked at him as he came up the stairs onto the back deck with a large box. "Well", he observed, "you have a dog". "Yep", I replied, "You have a 37 inch TV. It appears we have a stalemate". I promised myself that I wouldn't fall in love with her, and if it didn't work out, I would try to find a good home for her. I hoped that my husband could manage to make friends with the dog and gain her trust. Believe me he loves animals and wouldn't harm a fly.

Tina continued to bark at my husband, and all males, for the next week. She barked at him if he left the room to get a snack. She barked at him if he got up in the middle of the night to get a drink of water. She barked at him when he got up in the morning. I was the one she ran to, hid behind and followed. She had decided she was my dog, although she liked my daughter a lot. All animals and babies love my daughter so it was not surprising.

"Two weeks", I said. "Let's give it two weeks. If she can't get used to you, well....I'm Gonna Miss You (I sang). Just kidding. We can't have a dog that doesn't trust you, I know that. Just be patient with her".

He was. He worked it and worked it. Coaxed her to come to him, but she was so heartbreakingly submissive I wanted to cry. She rarely made eye contact. After a week she stopped barking.

After three weeks she jumped up on the couch when he called so he could pet her.

Last week she got up with him in the morning and let him feed her instead of waiting for me.

Today she wagged her tail, danced, licked his face, and was excited to see him for the first time.

Hook, line and sinker. He's as in love with her as I am.

Tuesday, September 16, 2008

Violence in the ER

I know it happens in every ER; someone gets the shit kicked out of them by a patient or visitor who is unruly and abusive, usually under the influence of drugs or alcohol, or because the voices tell them to do it. Granted it is an unpleasant and inevitable aspect of the job, but it sucks to go to work and fear for your physical safety particularly if the security guards are elderly and not in the best shape. I thank the Psuedo City PD for their always prompt response to our 911 calls.

It's no different anywhere. At my last job at Utopia Med Center, we had a 3 room psych corner which I referred to as Area 51. Each room was equipped with 1. a bed, 2. a TV behind a plexiglass screen mounted out of reach near the ceiling, and 3. a closed circuit TV. It was nice and quiet, all three rooms located behind a sliding glass door that we rarely used. Each of the three individual rooms had a door with safety glass, and internal louvers for privay that could only be operated from the outside. The only design flaw that I could see was that it was a little out of the way for the stupendously drunk, but we did have a good crop of behavioral techs or security (strapping young lads all)to assist us when required.

The integrity of the plexiglass was tested on the very first night Area 51 was opened for business. One of the frequent psychotic flyers picked up a chair and heaved it at the TV...yep, plexiglass remained intact, but the chair broke in half creating a nice little weapon. Miss Thang was treated to four point restraints with a face shield since she was unable to curtail the spewing of spit in our general direction.

One night, another patient literally launched herself at the plexiglass window in the door guessed it...blew it out completely. This thing must have weighed close to 40 pounds. The window struck one of my nurses on the back of the leg, causing a very deep and painful laceration and damage to her achilles tendon which put her out of work for 1o days.

I don't know if these things run in cycles, because here at Pseudo City Med Center there has been a proliferation of violent acts. One nurse was choked near to unconciousness by a crayzee. Another lashed out with a heavily booted foot at a pregnant nurse; fortunately his aim sucked. A couple of the chronic paineurs have become bored with the usual whining and become quite threatening; one actually went nose to nose with the security guard (an ex cop, bless him) and shoved him. This act just bought him a ticket to Psuedo City police station.

This increase in violence has spread to the inpatient units. Yesterday there was an overhead page for a code green, for employee distress up on one of the floors. One of the chronic insincere detox / suicidal regulars threatened a nurse and got up in her face. She was backed into a corner of the room; this is a paricularly tough cookie, so for her to push the panic button must have meant she was shaken to the core. When an employee distress code is called, the plan is for every able bodied male in the place to respond. Unfortunately, the only able bodied males who didn't respond was security. The individual was subdued and the nurse was safe, so it all worked out.


There is a problem here. Clearly, security is used to responding to the ER, but not to the inpatient units. With more crayzees and violent individuals being admitted medically instead of to a forensic psych unit where they belong (and where there is adequate trained staff to deal with them SAFELY) the security staff is stretched pretty thin. Assuring the safety of the staff does not seem to be a priority for the the Bean counters; when an incident occurs, they are all about damage control, but it seems to be more of a case of following protocol than actually caring about what happens. Having a nurse choked nearly to unconciousness was not enough of an incentive to clamp down on violent offenders nor was the sign in the waiting room "Zero Tolerance Policy for Physical or Verbal Abuse of Hospital Personnel" much of a deterrent.

I would be happy with a Taser purchase for ER use PRN. With proper instruction, of course.

Sunday, September 14, 2008

No Words

At 12 noon, those of our rooms that were filled looked like this:
Rm 2: ETOH (BAL 390)
Rm 3: Seizure (from ETOH withdrawal, from jail)
Rm 4: Seizure (ETOH withdrawal, not from jail)
Rm 10: Depression (with suicidal ideation)
Rm 11: Depression (without suicidal ideation)
Rm 12: Depression (from jail; made slashing with finger across throat, and mimed a gun pointed at head. Suicidal ideation
Rm 13: Abdominal pain (17th visit this year for same)
Rm 15: Abdominal pain (2oth visit this year, 3rd in last week. Known for narcotic seeking behavior)
Rm 16: ETOH abuse, depression, and thinks he might have a seizure. Oh, and chronic back pain.
Rm 17: Intoxicated man found sitting on the curb in downtown area. He quite charmingly pisses on the floor. Lovely.

At 12:20 PM we get a patch for "37 year old female. Hearing voices"

At 12:50 PM, we get what appears to be our first actual emergency patient of the day, a 52 year old female with hypertension and severe headache. This turns out to be a frequent flier who routinely doesn't take her antihypertensives, cranks her BP up to a nice healthy 220/120 and complains of intractable headache in order to get Dilaudid and hopefully admitted for more Dilaudid. Or at least she did until admin. devised a treatment plan that included admission only if her BP doesn't come down. I love lopressor.

At 1:30PM we get advanced notification that we are getting a code: 62 year old male, witnessed cardiac arrest after complaining of shortness of breath. Bystander CPR initiated immediately by co-worker who also happens to be an EMT. This sounds as promising as such things do when the right things happen in a tmely manner.

At 1:42 we get the patch: Pt in PEA (pulseless electrical activity), and IV access is two IO's (intraosseous).

By 2:10 PM we have done all we can do. The patient does not survive.

The worst thing is that in order to see their loved one, the poor man's family has to run the gauntlet of alcoholic assholes yelling for food, cigarettes, their rights, their lawyers, and cab vouchers.

Sometimes there are just no good things to say. So I won't.