Thursday, June 4, 2009

Now calling.....


I called out in the waiting room for the next patient on the hitlist.

This had been preceded by a discussion about how to pronounce the patient's first name.


"Could it be, um, Daisy Anne?" my Southern girl coworker mused.

"Doubt it. It's a male".

"Day Shawn, maybe?" wondered Sherry.

"I won't take a chance, since he's 11. I'll go with the last name"

"Good call".

Turns out it was pronounced Day Sheen. The fact that he will be spelling if for the rest of his life is probably secondary to telling people how to pronounce it.

CPR Recert

Every year or two (depending on where I'm working and what the rules are) all nurses have to recertify CPR (more accurately BLS, basic life support). This is a something I have done every year since CPR was invented and it became illegal to allow people to die a natural and dignified death without pounding their chest and breaking a few ribs. Something to think about when you have decisions to make about familiy members, I can tell you.
Back in the early 70's, things were sometimes a little unclear as to who got CPR and who didn't, but we all learned it anyway. I worked as a nurses aide (now called LNA's or licensed nursing assistants) for a year out of high school before I went to nursing school, but that is a story for another day. Anyway I think the first CPR class I attended was in 1972 or '73. That's a helluva long time to be poundin' away on the dummy every year or so. It was a lot more complicated then, now it's pretty streamlined.
The first time a patient died on my watch was when I was a puppy nurse, out of school less than a year. I was the 3-11 charge nurse on a 40 bed rehab floor, although they were mostly chronics; brain injured individuals without much rehab potential and things like that. It was kind of a nursing home floor really. I was the only licensed individual, but oddly my 3 year diploma program which people are so condescending about prepared me for a leadership position 3 months out of school when the average ADN and BSN students were still in orientation. That's not a slam, just a statement of truth.
I was feeding an elderly woman, I'll never forget it, mashed potatoes. Some of it dropped onto her lap and I had lost the napkin. I stepped out of the room to the kitchenette across the hall and returned in about 20 seconds. She was gone, sitting bolt upright and holding onto her spoon as if she planned to continue using it. I did have to do post-mortem care with the policy book propped open on the bedside table. One of those life experiences I guess. But CPR? It was a rarity at that place.
I taught CPR for about 15 years later on and got pretty well burnt out doing it. I taught scouts, dental offices, teachers (they are the worst for performance anxiety), business offices, restaurants, EMS, and the usual hospital inhabitants of nurses, respiratory therapists, lab and xray, unit secretaries, EKG techs and doctors of course. Doctors were the worst because most of them a)sucked at it and b) just weren't interested in doing it right at all. I guess that was OK, during a code you would much rather have a doc who knew their ACLS (advanced cardiac life support) shit than BLS. Nurses and EMT's mostly did CPR anyway; Call me crazy, but I thought it was important for the docs to know proper technique so that they could evaluate CPR in progress for effectiveness since they are the ones running the codes.
I don't mind jumping through hoops as long as they are reasonable. I'm not a young woman anymore, and the knees just won't tolerate being on the floor slaving over a hot CPR dummy. The education team had kindly provided cushy mats to ease the stress. The child and infant mannequins were on tables for our convenience, also a plus. As far as I know we were all nurses, EMT's, paramedics. The last thing we want is someone who has never performed one minute of CPR in their lifetime on a living person nit picking the depth of compressions. You always know who they are because it goes something like this:

"You need to make a tighter seal" or "You need to compress faster" or "You didn't yell help" or "You forgot to blah blah blah blah".

Sigh. It was the same today, there is always one yutz in the pack who pecks away at every minuscule detail and holds up the entire line.
I'm happy to tell you she had nothing to nit-pick with me (smug expression).
I waited for my turn behind a new EMT, young, probably about 11 years old judging by the look of him; they get younger every year for some reason. The poor kid had to perform after he became completely unnerved by the young woman in front of him.
The very attractive young lady had on white capri's made out of some interestingly rather sheer material; unfortunately she was obviously wearing a thong (blue).

Picture this; if you have never seen CPR performed, go to Youtube and try to imagine what this poor young EMT had to witness. Think about this attractive young woman with her back to us, kneeling next to the mannequin in her see-through white capri's, pumping (yes, pumping) from the shoulders and bending at the waist. Up, down. Up, down. Up, down.
Are you getting a mental image? Good, because that was likely the only image in the EMT's head as he fumbled through his demonstration. He left rather quickly afterward.

So that's CPR for this year, now I'm all set.

Wednesday, June 3, 2009

Repeat Business

I think I've said it before.

My ER is quite a magnet for repeat business for dental pain, migraineurs and various other narcotic seekers. It's quite a business.

Some of our docs and a couple of the nurses work at other ER's and see the same people from time to time. It's funny how they kind of just walk out when a nurse who took the same complaint (word for word) looks at the chart and says "Hmmm. I know you were give a 'script for Pen VK and Vicodin last Friday evening at Mt. Seaside. Are you not taking them?"

One girl claimed her backpack was stolen. Which contained her prescription for Percocet. One guy said he lost his prescription (at least his fifth for 20 Vicodin in the last 2 months). Another claimed her 3 year old threw her Percocet in the toilet. And the old standby "I knocked them into the sink".

How refreshing would it be to have someone come in and say, "Look, I'm addicted to painkillers" instead of devising these ridiculous fairy tales. A young guy I remembered from 2 or 3 months ago came in and told the exact same story about how he saw the dentist, he has an abcess and was told to come to the ER for antibiotics (and pain pills) and blah blah it will cost him $700 to pull his tooth and he doesn't have the money. Same story exactly, I looked it up because I remembered he had an unusual name. Funny that this time he had a different last name. He was invited never to return.

We have an unusual group of co-dependent migraineurs. A couple of them take turns driving each other (we don't let 'em drive after they get their fix for obvious reasons). One doc gave a migraineur VALIUM for cripes sake along with 100 mg out of the usual 150 mg of Demerol they normally receive. Now they all want it.

Speaking of driving under the influence of mind altering drugs, one of the chronic migraineurs got her meds, got on the phone for her ride, and said she would wait outside on the bench as he would be right along. OK. We were busy, but I was suspicious. I know what she drives, too, and I checked the parking lot. Nope, no van. No patient on the bench either.

I popped into my bosses office which has an expansive view of the back parking lot where we employees park. Oh, look.....there is my patient 15 feet below me starting her van and driving away.

Oh, doctor, guess who just lied and drove home?
Wanna talk liability?

That's it, he says. She's not getting another narcotic from me, and let the record show that she was observed driving after she said she had a ride.

Three days later she came back, parked her van in the back and got............NOTHING.

This is not to be mean or vindictive. Do you want to put your loved ones, both on and off the road at risk with this nutbag driving with a boatload of narcotics onboard? Didn't think so. I sure don't.

One of our newer docs refuses to give Demerol. At all, which is kind of interesting. She might order morphine, with a Vistaril chaser (which stings like a mad bastard when you inject it I might add). One of the co-dependents now claims morphine as an allergy.

I will say that some of the other docs are interested in coming up with unified plan. We are all feeling like pushers.

Come to find out, without fanfare and without warning the hospital pharmacy had decided to take Demerol out of the formulary as of June 1 (basically a list of meds the hospital carries....we aren't CVS, you know).

Apparently one of the migraneurs was forewarned, and must have thought it meant that we were no longer stocking Demerol in our satellite ER only, because low and behold, there she was on June the downtown main ER. Hmmmmmm.