Thursday, December 31, 2009

New Year's Rockin' Eve

New Year's Eve was fairly steady. By 7 PM we had seen a number of patients, all of whom were pleasant, polite, in real need of emergency care and in general, a pleasure.

Usually on holidays, you get the extreme version of the Sick and the Stupid.

To recap, the Sick consist of any patients who should be in the ER; that would be lacerations that require suturing, chest pains, head injuries, fractures and the like. The Stupid are those patients who should emphatically NOT be in the ER for any reason; that includes rash for 3 weeks, any chronic pain, fever of 100 degrees as the chief complaint, ear wax, or any who has a doctor's appointment the same day but just doesn't feel like waiting.

As I said, on holidays it is the extreme version; REALLY sick or REALLY stupid. This I categorize as complaints that range from Illness to Idiocy. Same rules apply.

The gentleman who should have been in the ER like yesterday for blood sugars above 600 would qualify, as well as the man who nearly severed his thumb while decapitating Mr. Thomas Turkey, AKA, New Year's day dinner, with a hatchet. Nothing like fresh poultry I guess....hmm, what is that in my stuffing? Thumbthing wicked this way comes.... Honestly, who has turkey on New Years Day?

So I was more or less prepared for trouble when one of the local regular customers strolled in. At least he waited until we had dinner. He is known for being rude, often aggressive and I have personally thrown him out at least once. He got into it with the doc in the past because the doc wouldn't write him a 'script for 120 Valium like the last doctor. WTF.

Tonight he complained of a rash, convinced it was bedbugs, or hives, or MRSA, or plague.

He is especially nasty to women, and we usually try to protect our secretaries from his bullshit because they are all really nice and don't deserve it; not that anyone does. On the other hand, he has had a run-in or two (and been thrown out) by my usual co-worker, AKA my "work husband", Dan; he is 6 foot 5 and takes no bullshit from anyone. Dan was already ramping up as soon as he caught sight of the guy so I went in to triage him. Must have been a good day for him because he gave me no trouble; asicd from failure to make eye contact, which drives me nuts.

As he passes by Dan, he mumbles to his friend "That's the guy gave me bullshit last time I was in here"; Dan rises to the occasion and returns fire, "Yep", he says, "I recall you told me to polish up my resume; I'm still here".

I cringe and resist the urge to dive! dive! dive! under the desk.

The man and his friend get all huffy so I took the higher ground. "Why don't you have a seat in the room, the doctor will be in to see you shortly; we all just need to be respectful of each other and you will get your problem taken care of" I offered.

They grumbled into the room, he got his 'script for prednisone and hydroxyzine for his itchy pseudobugs or MRSA or galloping crud, and went outside to smoke.

"His companion wants to check in too", said my doc of the eve.


The 20 year old female claimed the guy as a family friend. Her complaint was abdominal cramping; she was 4 months pregnant, having discovered this fact after taking an ambulance ride downtown to our mother ship in the last couple of weeks for the exact same problem. No prenatal care. No insurance.

She had not followed up with an OB as instructed. I quickly deduced that she wanted pre-natal vitamins and an other words a picture of her baby.

She was a little skittish. I entered the room to draw her blood, and she decided she felt really nervous and wanted to step outside for some fresh air.


"Just a few minutes, though, OK? If we need to send you downtown (for an ultrasound) we should get this show on the road"

I waited about 10 minutes and decided she needed a kick in the ass; I went out the door to discover her smoking a butt.

I coaxed her inside and prepared my various tubes and assembled equipment, and explained what I was going to do. She proceded to tell me what awful veins she had and how she was terrified of needles and how "sum nurse" dug around for her vein for over and hour trying to draw blood.

Uh huh. I love a challenge and nothing gives me more pleasure than a successful venipuncture on the first try; I rather pride myself on it, actually. I attribute my success to the countless pedi IV starts when I worked at Utopia Hospital.

But I digress. The young lady said, "I'm just really anxious about my baby, I am scared there might be something wrong with it".

"If you are really concerned about your baby, you should quit smoking immediately".

"Well, I've really cut down since I found out I was pregnant".

"Your baby doesn't know from cutting down. You are at risk for having a low birth weight baby. Do you know what that means?"

"Having a small baby? Wouldn't that be better for delivery?"

Arrgh. This kid is doomed.

As the festivities began to wind down we were hopeful that we might get out at 11PM, our usual closing time. I triaged a sore throat at 10:20 PM, then a febrile, inconsolable, wheezing 8 month old who was afebrile, sleeping and had no wheezing. But did have an ear infection and didn't wake up during the exam or when I put Oticaine in followed by a cotton ball.

At 10:40 PM local EMS was toned out for a lethargic 4 year old with special needs, not otherwise specified. We know most of the medically fragile kids in the area and the address we heard over the scanner was unfamiliar. Moments later, we heard that CPR was n progress.

"Should we stick around to see if they need to come here?" I wondered aloud.

"They know what time we close", offered the secretary.

"I know, but a pedi code is anxiety provoking, they won't be thinking about it in the field", I responded.

I asked our doc who was an ex Greatest EMT in the history of the world, before he went on to become World's Greatest Paramedic before he got kicked out of the Air Force Academy for being a big mouth, followed by the designation of Most Intellectual ED Doc in the Universe. But good to work with when we can keep him focused.

"Wait and see".

By 11:05 PM we had heard nothing. "We're closed" said our doc. I wasn't sure, but it was his call. Still, we knew he would sit in the parking lot for a few minutes.

Since we nurses and other lower life forms park out back in a lower parking lot, Lisa and I made our way down the back elevator, alarmed the building and went outside into gently falling snow. We had gone a half a dozen steps across the lot when we heard the siren. Lisa and I froze in our tracks. The ambulance approached, got closer and louder. I fumbled in my coat pocket for the key and tried to remember how to disarm the system to get back inside as I listened.

We held our breath. One block away. Outside our ER.

And continued toward the city.