Tuesday, December 20, 2011

Status Update

Our electronic patient status board lists all patients in the department so we can tell at a glance  which ones are  waiting to be seen, who is in what room, which doctor or nurse is assigned, what tests are finished or pending.  Kind of like Facebook.    It is the nurses' responsibility to discharge the patients off the board when they leave the department for good.  For added fun, last week the word "dirty" popped up on the status board when the patient was discharged.  Just to add 20 more steps to an already cumbersome and non-user friendly system, this necessitated entering "clean" when, obviously, the room was ready for another patient. 

We complained, of course, since the nurses at this facility have to do the discharging, cleaning, and removal from the status board.  The Information Techies must have been having a slow week taking turns offering Kudos to themselves on the Bitch Board about  how awesome and effective their department is because they got right on it. 

Now, to enhance the happy, happy, joy, joy, how wonderful for us to use only positive language, our status board no longer pops up the "dirty" notation.

Now it says "Unclean". And we still have 20 oh-so- convenient steps to change it. 
Dislike.  Bastards.

Monday, December 19, 2011

Just Thinking...

We had a discussion of how much is too much for Christmas when it comes to grown-up kids. I put a halt to Christmas stockings this year for both of my kids and Mr. Ednurseasauras. They are fun, but I invariably find the contents of the stocking stashed in a bag in March (or June, or September). I found several years of assorted stocking stuff for K in a box recently which didn't make me happy. At least J always takes his stuff with him.

Sherry has two married step-kids in their mid to late 30's, one of whom has a young child. She also has a daughter with her first husband who was recently married who is in her early 20's. Sherry's plan was to get some kind of bigger ticket household item for the one couple with the kid, and knit a Christmas stockings for the other. Since Sherry had just hosted her wedding, the recently married kid was getting nothing. Sherry thought this seemed equitable. Her rationale was that she was putting a lot of time and effort into the Christmas stocking

"Wrong. Wrong. Wrong. Wasn't the older kid just saying last week that she didn't feel like a close family because she felt like you and your husband excluded her and favored your daughter? And wasn't this after she had a lovely wedding of her own last year? Jeez, she's nearly 40! Of COURSE she's not going to think a Christmas stocking is equal. Sad but true"

Sherry: "You're probably right. (I have learned that this response is code for not necessarily agreeing with me). When she was growing up the older one's mother didn't allow to have Barbie dolls. When Ella got one, she went ballistic. She was 13 and Ella was 3. She's never forgiven us for it"

Ah, the Barbies. I wasn't allowed to have one either. They were too....grown up. I had a "Tammy" doll, which I never knew until recently was only made for a few years and is considered very collectible. Tammy had more innocent features and a body that looked like way less of a Ho than Barbie's. That also meant that Tammy could never wear the more glamorous Barbie outfits.

 I never really quite "got" playing dolls, dressing and undressing them for hours seemed like a pointless activity, and I quickly tired of playing "prom", "date" and "wedding". Me and my Tammy were perennial wedding guests, never even a bridesmaid let alone the bride.  I would rather have read a book.

If I had a choice of playing dolls or poking needles into my eyes I would play dolls, but not graciously.

In the 1960's, girls didn't have multiple Barbies. They had one. If they were really lucky, they might have a Ken. The thing I coveted most of all was the little sister Skipper doll because she had long, brushable golden hair.   I would have traded Tammy and both of her outfits, as well as the homemade poncho and scarf in a heartbeat to be able to play with Skipper.  There was some scandal about someone's brother's cutting off  dolls' hair to make hay for the horses when they were playing circus, but it wan't any of mine.  I didn't have that many dolls. 

My daughter K had lotsa Barbies, which have found a permanent home in an old gym bag in my basement.  J, or course, didn't play dolls.  But he inherited a big trash bag of Master's of the Universe figures from that Beckett kid who lived on the next street.  His whack job father simply decided he didn't want them in the house anymore.  Dad probably should have been paying more attention to the fact that Beckett was, at 6, regularly peeing in the bushes in my back yard.  They were....odd people. He would have played with Barbies I think, but would have been the one to pull the legs off and bury them in the garden.    

Saturday, December 17, 2011

More Head-Shaking Lady News

Sherry got out her knitting, which is generally an invitation for the masses to come streaming in. Since we were working with Parvati, the simplest dispositions become an all-out attempt to keep the patient there as long as possible by racking up a high number of diagnostic testing points. Some people have just one more visit before they win a toaster.

But Sherry was determined. "I have to make 3 hats, finish a Christmas stocking, and I'm working on a pair of socks. I will never get it all done in time for the holiday", she said.

We discussed the Christmas Madness Project, in detail. She shamefacedly told me she had bought a few items for the Lady on Elm St. Slippers, a pair of sweatpants, a nightgown and a couple of other things.

Excuse me? WTF??

Sherry: "I know, I know. I just feel really bad for her".

Well, so do I. Yes, why not pass the hat. Again. But Sherry had forgotten one very important point.

Me: "Sherry, how are you going to get that stuff to her? She takes offense at everything we do to try and help her"

Sherry: "Jane thinks we should just leave the box on her doorstep with a note, From Your Friendly Neighborhood Health Care Providers. Either that, or send it through the mail. Or my husband can drop it off, she doesn't know him"

Me: "She can't know we sent it, she would consider it a giant 'Up Yours from your good friends, the Peeps at the Health Center'. We should just do it anonymously"

Sherry: "Maybe you're right. We will know if she got the package only because she will probably be wearing the stuff next time she comes in"


As if to illustrate my point, this gem was heard on the police scanner:
"75 year old female with suicidal thoughts, X Elm St. apt 12. Called in by a neighbor residing at apt 14 who went to check on her". That would be none-other than the Lady on Elm St. She sits and waits. And knows exactly what is going on in the neighborhood, which is why sneaking up on her with a big box of Christmas presents would not work well.

A recent meeting about the Lady on Elm St. revealed that she is more vigilant (and crazy) than we ever thought.  It is important to note that the meeting was not for planning how to best address Lady's needs or to provide better care.  It was conducted by Idiots in Charge of Stupid Sh*t so that we drooling morons who actually provide the care could "express our feelings". 

Isn't that what blogs are for?

Lady reported to have used 911 over 100 times in the last calendar year, including 7 times in one day for nonsensical complaints. She also has Patient Services on speed dial since she had logged 23 complaints in the last 18 months.The Patient Services rep. is the proud recipient of her very own Lady complaint since she had apparently also failed to take Lady's call right away one time. As Lady didn't feel her earth-shatteringly dire complaint wasn't accorded the instantaneous attention she felt it
deserved, she immediately called the CEO's office. Said rep was summoned to explain why Lady's call was being so rudely ignored.

I can just hear the complaint now. "You people did WHAT??! You sent a box of slippers, nightgowns and sweatpants?? How could you be so rude and insensitive!".

Friday, December 16, 2011

Another Great WTF Moment

I was removing sutures on a patient's index finger.  Mac, who is famous for using running sutures (that I don't want to fu*k with) had fortunately only placed regular old interrupted sutures, but there were a lot of them.  The patient happened to be a pilot, and he marveled that my old and decrepit eyes could see them let alone remove them so expeditiously. 

Pilot: "I've been noticing that I have been having more difficulty with seeing things.  Sometimes on approach, things don't always seem that clear so I have to rely on instruments"
Me: "Captain, that is the kind of sh*t the public doesn't want to hear".  Seriously?

Which airline was that?

Wednesday, December 7, 2011

Secure. The. Manger

Gil was apparently doing some cleaning around the homestead and offered his Nativity set to the department to display this Christmas season.  Christmas.  I said Christmas.  CHRISTMAS!!!!  It's a religious hospital so we don't have to be politically correct.

Gil's Nativity set is a behemoth of a thing about 3 feet by 2 feet and stands about 18 inches high; it was hand made by his grandfather and has a nice, Christmas-in-the-backwoods-of-Maine kind of feel to it.  It's rustic and....stable-like.  And appopriately enclosed on three sides, with a slanted roof and filled with hay.  It is kind of a family heirloom I guess, so I was concerned about its contents if it was to be placed in our waiting area.

You may recall that last year our own pathetic Nativity set was the victim of light fingered douche baggery as both the Jesus and Mary (pretty much the whole reason for the season) were purloined from our waiting room.  Gil had already thought of that and had purchased a piece of Plexiglas to screw into the front of the manger to keep the pieces from being removed.  As Gil prepared his tools,  I examined this scheme for loopholes.  While I was at it, I placed the Wise Men in the hay loft with the animals, and the Baby Jesus on the roof.  As it should be.  The only problem I could see was that once the Plexiglas went on, the figurines would not be secured.  Nothing would prevent someone either shaking it like a Polaroid picture or knocking the whole thing off the table. 

We shall see what kind of fu*kery people get up to with that Nativity set.

On another note, I am feeling a little less humbuggy as we nurses have decided against giving the docs a bottle of wine, or monogrammed bottle stopper or some shit this year.  We will instead be giving a donation to the Wounded Warrior Project in the name of their physician's group. 

Tuesday, December 6, 2011

Top 10 Christmas Annoyances

10.  Finding a tree. 
I used to love to find the perfect tree when my kids were young.  The perfect height, just the right amount of bushiness, and with branches that really hold both lights and heavy ornaments.  As the kids got older and less interested in finding a tree let alone decorating it (and taking it down) it became more of a chore.  I was almost ready to get a table top model this year, but settled for a 5 footer.  It is more cute than magnificent, and I'm pleased as punch that it should take 30% fewer ornaments.
9.  The mall. 
After Black Friday I go no where near the mall on weekends as it is absolute insanity.  I prefer to shop local or cyber shop.   If I get bored with that, I can just stick sharp needles in my eyes to get the same experience.
8.  Charities.
I guess it is probably a wonderful thing to buy a llama, or a goat, or a small herd of chickens for villages in third world countries.  If that is your thing, that's fine.  But I would prefer to give my money to the locals. Until this year. See previous post on Christmas giving and don't get me started.
7.  Finding a really good partridge in a pear tree. 
You can always find a serviceable partridge, and a fine pear tree, but a nicely matched set...impossible. 
6.  My neighbors' excessive Christmas Beast lights and lawn menagerie. 
They have about 30 or 40 different things, it makes no sense and has no central theme.  There are deer, snowmen, a train, some flashy thing I can't quite tell what it is, and...
"What's that?", I asked Mr. Ednurseasauras.  "Second to the right of the blue snowman".
"Ummm...dunno.  Does it have a cane and a red scarf?"
"Can't tell.  Is it an....angel?"
"No.  I think it's a bear (Gets up and looks out the window)
"Is it a goose?"
"Nope, it's just what I said. A bear with a red scarf, and either a cane or a stick."
"Why would it have a cane or a stick?  That doesn't make any sense"
"Maybe it's doing a tap dance"
I don't know why I expect anything my neighbor does to make any sense.
5.  Christmas Cards.
I don't send 'em, yet people inexplicably continue to send them to me.  I'm not counting my family, not even one of my sisters-in-law whose goal is always that hers is the first card received.  She sends them earlier and earlier each year.  Now we get it the day before Thanksgiving. That's OK, I enjoy seeing the photos of my nieces and nephews and have them saved to embarrass them later.  My own kids refused to pose for the annual Christmas photo when they were about 8 or 9, but a couple of years ago I put some Christmas lights on Tina and printed a Christmas card out of the photo which I sent to the family.  My mother thought I had finally lost it.
4.  Having to work the holiday.
I get that nurses, along with police and fire and other public servants, have to work 24/7 and we all have to take a turn.  What chaps my ass is that Clip-board nurses and Suits get to take an extra day off when Christmas  falls on a weekend
3.  Catalogs.
Really annoying since I get hundreds of them beginning in October.  Because it is necessary to recycle, they must all go to the dump, to end up in appropriately coded bins.  I am placing my recycle bin under the mailbox.  No wonder the Postal service is going broke. 
2.  Christmas Muzak
It starts in October, right around the same time I start getting the catalogs.  For that matter, who wants to see Christmas decorations along side Halloween candy?
1.  Christmas wreaths and reindeer antlers/red noses on cars.
This, to me, says, "I have more than enough time on my hands and absolutely no imagination".  My friends think it is hysterical that this makes me so crazy.  Linda and Dede gave me one of those antler thingies last year as a joke, but I put it on Sue's car.  I hope she is presently enjoying it on her car as much as I enjoy not having it. 

Monday, December 5, 2011

Christmas Giving

During the holiday season, our building "adopts" a needy family.  In past years we have shared this opportunity with the therapy department.  It always includes some modest requests such as pajamas or a specific toy or two for the kids, perhaps a jacket, winter hats and gloves, jeans and other necessary items.  Occasionally it will include such things as shampoo, soap, toilet paper.  We always donate either gift cards or foods to provide the makings for Christmas dinner.  The hospital provides the turkey to all the Christmas families. 

Last year, it was decided that we would also donate gits and food items to one of the community's elder citizens.  Slippers, nightwear, a sweater, gloves were some of the items.  We found out that the recipient also had a cherished elderly cat so we included cat food.

I don't know how it went horribly wrong this year.  We have not one, but THREE families, and no elder citizen.  Each of these families has three kids, most of whom are teens.  I would love to know how these families were screened or chosen. 

Our employees started asking about the needs list weeks ago.  It finally went up December 1 after it took 4 phone calls to one of the families to get sizes and specifics.  FOUR.  Sherry said that the husband talked about being suicidal during two of her calls.  The list of wants and needs included such things as:
Ugg Boots
Abercrombie T shirts
4x pants
Leather gloves
Movies, a laptop computer, and a snowboard.

Really??  This has gotten completely out of hand.  There is also the Christmas dinner to provide for with check-off sheets for each family; each of these lists is a full sheet of paper long.  There are about 27 employees in the building, and most of us have been forced to curtail our own Christmas madness. 

The Christmas project is a Big Deal to Ellen; she loves to provide as many needs as she can off the list, it gives her tremendous joy.  But this year poor Ellen is beside herself. She took me aside and tearfully said she was having a lot of difficulty with the enormity of the list because she just didn't have the money to give this year.  I know Ellen lives from paycheck to paycheck but she would never in a million years consider herself as a person in need of anything. She was proud that she managed to turn a jar of spare change into 23.98 when she found herself broke two days before payday and needed gas and a few groceries, and to buy stamps for her Christmas cards.  She gives and gives and gives, and then she'll check the couch cushions for spare change so she can give more, using her last buck to buy flour to make cookies for someone's birthday.  I stick a $20 in her purse every now when I think I can get away with it. 

How can you tell such a giving person that these are less needs than demands?  I don't care how needy you are, I would never ask for anything for myself if it meant that my kids would have to go without warm clothes, or a pair of boots, or have absolutely nothing under the tree.  I used to think that any parent would think that way.  What a chump I am.  I guess it is what we  have allowed as a society, to encourage people to grab for what they can with both hands.  When it comes to Christmas giving the magic is gone when people who are identified as those being in need of the basic necessities of life have no problem shooting for the stars and hoping to land on the moon.

I haven't had a problem with the Christmas project before now, so I hope you'll excuse the humbug attitude this year.  There is a BIG difference between "needs" and "gotta haves" when everyone else is tightening their belts.  I guess I'm just a terrible person. 

Thursday, December 1, 2011


Marketing  refused to  give up the ghost on their search for the elusive beige cart.  This  second appeal appeared on the company website:
"The Marketing Department has lost the Marketing cart somewhere within the hospital- have you seen it? I am totallyy lost without it.  It is tan in color and says marketing on the side of it.  If you can provide tips to the whereabouts of this cart, a warm fleece reward awaits you.  Call me at ext. XXXXXX and I will gladly come and get it.  Thanks!"

I believe "fleece" is also a name for counterfeit crack.  Just sayin'.  But it was nice that they were willing to heat it up. 

We had a field day with this.  Kate, Lee, Lynne, Kerry and I took pictures of various carts and emailed them to marketing over a couple of days.  It took awhile for them to realize we were being humorous, but hey, they still think they're getting their cart back.  "No, not our cart but thanks" was the response to images of the code cart (both adult and pedi), TV cart, suture cart, laundry cart and computer cart. I'm pretty sure it was the picture of the shopping cart that tipped them off, but it was surely the hot dog cart photo that pushed them over the edge.  No response to that one. 

Next week, we're going to start sending pictures of carts Photoshopped in places like the beach, bars, amusement parks, and the Statue of Liberty with interesting commentary on what an exciting time the cart is having instead of being cooped up in marketing.  I think he best way to end it will be to open a Beige Marketing Cart Facebook page and friend the head of marketing.  Too bad social media is blocked on hospital computers.

Friday, November 25, 2011

Snatch Purse

Ellen was the one who cut the article out of the local paper.  One of our frequent patients had been arrested for stealing money from her friend in the amount of $2000.  She ran to a neighbor's garage where police recovered about $120 in a bottle of ant killer.  Although she denied stealing any money, having any money on her person, or having any connection whatsoever with cash in the bottle she later copped to having hidden roughly $1,654 in her vagina.  She was taken into police custody after turning the cash over to the police.  Nasty.

This, of course, prompted a discussion of the  possible denominations she had managed to secret upon her skanky person as we pondered the required capacity. 

"'l'll bet it was 16 hundreds, 2 twenties, 1 ten and 4 ones"
"Maybe it was all in silver dollars"
"How about a Traveler's check?"
"Nah, it had to have been $1,654 ones."
"Gold doubloons!"

I am only using my debit card from now on.  My mother is right, money is dirty.

Saturday, November 19, 2011

Actual Dictation

"Patient is a 23 year old female well nourished and well developed in no acute distress.  She is a recent graduate from collagen but is seeking employment".

No doubt her job hunting is in the field of esthetics.

Friday, November 18, 2011

You Might Be a Squirrel If....

1.  Your husband gives your date of birth when I ask you for same along with the correct spelling of your last name as a patient identifier before I administer your meds, and
2.  He also assures me, as you describe you 10/10 pain, that you "have a really high pain threshold and tolerance to pain meds" and
3.  I had to ask you to get off your cell phone when I  entered your darkened room.

The next guy
1. You are slumped dramatically in the chair and state you have "pain everywhere", you always have pain and that your foot injury from three weeks ago "brings tears to your eyes".  Your foot injury that you never had checked, and
2.  The only medication you can take is Dilaudid, your pain doctor only gives you a 'script for 12 at a time, you took your last Dilaudid yesterday, and
3.  You didn't volunteer any of this; I had to pry it out of you, and
4.  Your pain is "15/10". 

Thursday, November 17, 2011

Happy Blogiversary to Me!

Hard to believe it has been four years since I started this blog.  Where has time gone?

What started out  as rant/journal/self-expression/writing exercise has evolved into an empire: NY Times Best Seller, international acclaim and personal appearances, and now a lucrative movie deal.  Actresses under consideration to play the role of EDNurseasauras are Glenn Close, Kathy Bates,  Helen Mirren (with an American accent of course), and Olympia Dukakis.  Those of you who know me personally may have some ideas. 

Yeah, right.  It amazes me that anyone actually reads any of this or that I haven't run out of things to say.  Oh sure, I 've taken time off from time to time but have always come back.

And so have you, dear readers.  I thank you.

Friday, November 11, 2011


I found this on the company website:
Marketing needs your help!! We are missing our beige pushcart that has the words "Marketing Department" written on the side of the cart. If you have seen this cart can you please return it to the "Marketing Department" on the ground floor next to the Credit Union or call XX at ext. XXXXX. Thanks.

Hey "Marketing Department":
Someone has "appropriated" your beige pushcart.  It is not coming back anytime soon.  Today the push cart, tomorrow your entire department.  You suck.  Get a clue. 

Tuesday, November 8, 2011

On Gilding the Lily

 It doesn't take a genius to figure out the scammers.  Drug seekers will often have an elaborate story, which just as often doesn't add up.  Striving for the perfect combination of symptomatology and believability that will yield a score takes talent and experience.  The newbies are spotted a mile away. 

One misguided very young female and her skievey male accomplice in search of the ever-elusive narcotic script said she had "blacked out" while at  Subway 5 days ago.  She had been taking Tylenol and Advil for her terrible headache ever since.

I backed up the bus.  "Blacked out?"
Woman: "I was waiting to order.  My head has been really hurting ever since"
Me: "Did you lose consciousness?"
Woman: "Yes. The top of my head is where it hurts.  And I feel dizzy"
Me: "Did you hit your head?", "Did you go to the ER or see your doctor?"
Woman: "I was told I hit it on the counter.  No, I didn't see doctor.  I've been trying to take care of my really bad headache on my own.  But I've had the headache for 5 days now non-stop"
Me: "Were you at all concerned about blacking out?"
Woman: "Not really.  I'm more concerned about the headache"

Sigh.  She answered yes to the presence of nausea, photophobia, lightheadedness, aversion to sound, having no appetite, and allergy to cats, bees, codeine, Tramadol, Imitrex (although she denied a history of migraines).  She also reminded me three more times about her 9/10 headache.

See, she way overshot the mark here and simply added too much embellishment.  Concern about "Blacking out" and head injury trumps persistent headache. This will not garner narcotics,  but it WILL buy head CT. 

Saturday, November 5, 2011

Power Up

It has been a rough week here in the northeastern US thanks to Snowtober, or the Hallow-easter.  Snow before Halloween, what's up with that.  Didn't care much that Trick or Treating was postponed since I didn't buy any candy, but I never get any kids anyway. The heavy snow caused downed trees, tree limbs and power lines snapped off, which shut down everything.  Power outages have lasted anywhere from several hours to days, with varying levels of inconvenience  Mine was out for 3 1/2 days, bad enough but not as awful as being without for 6 or 7 days.  Still, 3 days of cold, powerless, flushless captivity can get the best of anyone.  The generator was handy for running a little heater since our pellet stove was on the fritz, but is was mainly boredom and cold.  I spent hours in my car driving around to nowhere in particular.

The building where I work has quite a nice shower available for use in the evenings and was quickly dubbed "the spa".  The main topic under discussion at any gathering was, of course, power and the lack thereof. 
Early in the week, the questions were ordered thus:
1.  "Do you have power?" 2.  "Do you have a generator?".  3.  "Do you have heat?
Mid week:
1. "Did you lose power?"  2.  "When did you get it back?"  3.  "Do you have a generator?"
Late in the week:
1.  "Still no power?"  2.  "When are you buying a generator?"
After day 7 without power:
"You must be really pissed".

Ah, the generator.  A household must that never crossed my mind to procure before I moved to the Frozen Tundra.  When it comes to generators, there is an order of supremacy. First, there are the "haves" and the "have-nots".  People without generators are the have-nots, pitiful souls at the mercy of the elements, doomed to move to a hotel or worse, the in laws.  Those with the foresight and just plain good old Yankee common sense and Boy Scout-level of preparedness...well, obviously those are the haves.  As in having heat, water and flush toilets, a fridge, some lights, a way to charge the cell phone, DVD's for the kiddies who can't read or otherwise haven't the first clue on how to entertain themselves, and maybe even....the Internet".
(cue Angelic choir and Heavenly light).

It is not enough simply to OWN a generator,but rather how big it is and how it is utilized.  There is Generator Envy, the bigger and more powerful the better.   It is a guy thing.  Like cars, which I don't care about.

The top of the line, Whole House generator (again, cue Angelic choir and Heavenly light) apparently requires only an insignificant flick of a switch and presto!  You have power without skipping a beat.  It is pretty pricey, the top dog for generator supremacy. 

Many people go for the less expensive option, the portable, gasoline powered generator in order to plug a few extension cords.  It works just fine. The problem with a gas-powered generator, we discovered, is that in a widespread power outage GAS IS INACCESSIBLE BECAUSE IT REQUIRES POWER TO PUMP GAS.

There are alternative fuel sources like natural gas.  Mr. Ednurseasauras had already scheduled an electrician to install a transfer switch in the basement so that 6 or 7 different electrical...things... could be run off the generator without using 20 extension cords.  Unfortunately, it was scheduled for the day after we got our power back, but hey, we are all set if it happens again.  That, and the 40 gallons of gas he plans to have just in case. 

Of course, turning on the generator with this new set up could be dicey.  When the electrician left, Mr. Ednursesauras wanted to show me how to run it....just in case.
Me: "Nah, I don't want to learn right now"
Mr. EdN: "It's easy"
Me: "Yeah, right that's what you said about turning off the generator.  As I recall, you also said that about the snow blower"

I am envisioning two sets of launch codes, confirmation codes, a variety of pre-launch procedures and checklists,and simultaneous turning of identical keys to get the generator started.  After confirming, of course, that the power outage is genuine and not simply a drill.

Friday, November 4, 2011

Cry Me a River

I don't mind people using the Internet to look stuff up except when they are too stupid to use the information correctly, then try to tell me I'M the idiot. 

Ms. Dumass: "I have a severe lacrimation*"
Me: "You have....watery eyes?"
Ms. Dumass: "No!  Don't you know medical terminology??  I have a bad cut on my foot!"
Me: "Ah, I apologize.  I thought you said 'severe lacrimation'"
Ms. Dumass: "Yes, of course, that's what I said, a lacrimation!"

Some days it's just not worth bothering to try to educate nasty people who are dumber than a box of rocks.  Please don't use big words you don't understand, it merely serves to emphasize your stupidity.  Thank you. 

*For non-medical types, that would be an excessive secretion of tears.  Cut=laceration.  So very dissimilar.

Monday, October 31, 2011

Cautionary Tale

It's fine to help your kids with their science projects, but that doesn't mean  doing it for them. 

Mom cut herself with  a pair of scissors while cutting a twig so the 12 year old wouldn't.  Why she needed to use the scissors in the first place was beyond me since the project entailed creating a primitive tool.  I don't think primitive people used scissors to fashion tools.

As she received 5 sutures mom commented: "We better get an A on this project".

WTF?  I never got a lot of  help on my projects from my parents except to cart it to and from school.  Unless it involved power tools, then I wasn't allowed to use the chain saw.  Lame Styrofoam solar systems or exploding volcanoes were otherwise my responsibility. 

Once I had to do a working digestive system.  I traced my little brother's outline on a piece of plywood, then filled in the esophagus, stomach, intestines etcetera. My dad drew a profile (face only) of Lucy (Peanuts Lucy, not I Love Lucy...although THAT would have been interesting).  My little brother was upset that I put Lucy on his body but he got over it.  I got some plastic tubing that I stapled  gingerly on the plywood being careful not to poke holes in it.  Thus I was able to demonstrate the fascinating journey of food, using Kool-Aid, through the body from start to finish.  Everyone thought it was gross, but that's fourth grade for you.  I got an A on the project. "We" didn't get an A.

Sunday, October 30, 2011

Got Flu for You

 It's official: "Go directly to the ER at the first sign of flu" season is upon us.

One guy wasn't feeling great, "felt warm" (um, his thermometer didn't work), kinda tired, and had a sore arm because he had a flu shot yesterday.  Perfectly healthy guy.  Came from work.  Home with common sense generic remedies.  I think the CDC should start keeping statistics on ManFlu.

I did three flu swabs today, and not a single one was positive.  Nobody was sick enough for the ER, trust me.

One mother of a 6 year old called first to make sure we did flu tests and we could give her kid Tamiflu if needed.  Yes to the test, no to the Tamiflu.  We don't stock it, and the pharmacies are closed now.  Call your pediatrician for flu guidelines, no I can't say whether we will or will not give it to your kid anyway.  The advice she ignored.  The kid wasn't really sick other than a low grade fever.  He was otherwise healthy. But he did have a birthday in a few days and mom's goal was that she wanted him healthy for the party.

Negative flu test.  No Tamiflu.  Cancel the party.

Saturday, October 29, 2011

Being Nosy

A three year old little girl was brought in by mom.  "She stuck something up her nose"

Tonight's foreign body was a little piece of plastic that came out with relative ease.  I always have some fun with this kind of thing.  Sometimes the parents know what the object might be, sometimes not.  . 

Here are a few examples of the responses I have gotten when I asked the kiddo WHAT was up nose:
"An eraser!"
"A Barbie shoe!"
"A cat treat!"
"A flower!  I was smelling it and it just stuck there!"
"Nothing!  Just boogers!"

I trust you have seen the image of the little girl who suffered for years with recurrent sinus problems who, it turns out, had a safety pin lodged up there in her sinus cavity.  Google "girl with safety pin in nose" to see it, I'm too lazy to post a link.  It's an impressive example of the kinds of shenanigans kids can get up to when you turn your back on them for like, 2 seconds.  When I was a school nurse one of my favorite kindergarten teachers brought two adorable little 5 year olds fresh from the playground.

Mrs. J: "Lacey, tell Mrs. EdN why we came to see her today"
Lacey: "I put a pebble up my nose!"
Me: (coughing to hide a laugh) "Lacey, how come you put a pebble in your nose?"
Lacey: "'Cause it was little!"
Mrs. J: "Now, Gina, will you please tell Mrs. EdN why we came to see her?"
Gina: "I put a pebble up my nose too!  I was showing Mrs. J. how Lacey did it!"
Me: (really, really trying not to laugh but really, really not succeeding) "Oh, I understand.  So the pebbles are still stuck up your nose?"
Lacey: "No, mine came out!"
Gina: "Mine fell out when I sneezed!"
Me: "Well that's good.  Let me just look and make sure, then I'll call your moms.  No more anything up the nose though, right girls?"
Lacey and Gina: (in little sing-song voices) "Noooooooo!!
Mrs. J: "And why don't we want to put anything up our nose?"
Lacey and Gina: "Because it's BAAAAAAAAD!!!"

Definitely everything we need to know we learned in kindergarten, sometimes the hard way.

Friday, October 28, 2011

The Long and Short

Whenever a patient says, "...to make a long story short", I know I should probably get a snack and settle in becuase it will be anything but short.

Mr. Yada: "Well it all started 2 weeks ago......blah blah fever 1 0 days ago....blah blah.....urinary/prostate problem....saw my primary care...blah blah yada yada....testicles hurt.....mumble snort.....pain when I urinate.....yada yada blabity blabity blabity yada...."

He went on for 10 minutes in spite of my attempts to pry the Reader's Digest abridged version out of him.

Me: "So, sir, to summarize, you have had intermittent fever for 10 days, testicular pain and swelling for 5 days, and urinary symptoms for 4 days?  Is that correct?"

Mr. Yada: " Um....yes, I would say that sums it up nicely.  How did you do that?"

Me: "Active listening and a scary ability to condense".

Wednesday, October 26, 2011

Opiate Entrepreneur (def):

(n) individual with an unreasonable number of  ER visits for bogus medical complaints, frequently involving improbable, nonsensical, or fictitious injuries causing severe unrealistic pain who seeks narcotics for the purpose of resale. See also: squirrel. 

This is nothing new except they are more aggressive and are more likely to get what they want thanks to hospital mandates on patient satisfaction.  This is behavior what turns ER nurses cynical and suspicious.  The docs see these people ocasionally; the nurses work every day and can usually recall at least a couple of their visits.  Today I had 6 of them within 2 hours.  What they had in common:

1.  More than 12 visits each for pain-related complaints
2.  No job.
3.  No insurance
4.  No ID
5.  No credibility
6.  No intention to pay anything for the visit.
7.  They left empty handed

Tuesday, October 25, 2011


I am not really a girly girl, but I do like to get my nails done every couple of weeks and indulge in a pedicure every 5 or 6 weeks; maybe more often in the warmer months. Hey, I deserve it. I walk my dog every day and spend 8 hours on my feet at minimum. You only get two feet.

 I have been going to my present salon for nearly 7 years.  I am not all that fussy about who does them because they all know what they are doing.  Plus they can always fit me in the same day, which is good.

There is a  TV in the salon; it is always on.  When I first started going there, it was constant music videos, the owners favoirites being concerts of the Eagles, Celine Dion, Tina Turner, ABBA, and, oddly, J Lo.  I have heard all of these many times.  When they got a bigger TV it was movies for awhile.  Now, it is daytime talk shows and soaps, CNN, reruns of The Golden Girls and other boring stuff depending on what time of day I hit the salon.  It is generally quiet and calm, low conversation and the staff not overly chatty.  Just the way I like it.

Today I stepped into a Bizarro World; a new nail tech flirted shamelessly with one of the male technicians.  One woman shrieked into her cell phone incessantly (you know how I love that).  A whiny woman complained about the smell of acetone (seriously??  WTF did you expect in a nail salon, moron?).  Worse still was a man and wife duo getting pedicures and talking about the benefits of cosmetic surgery while "The Replacement Killers" movie was on TV. So NOT relaxing.

What's the world coming to? Next time it will probably be "Kill Bill", with the odor of acetone replaced with Old Spice.  If this turns into a men's nail salon, I'm outa here.

Monday, October 24, 2011

If He Could Only Go Back in Time

It has been at least three months since I have had to work with Bobo and I can't say I've missed the little twerp in the slightest.  Since he is the antithesis of team player he is always such a pleasure to work with.  Especially annoying is that he is still like a rabid squirrel on the 20 minute or less door-to-doc time. 

Most of the time the patients see the physician within the allotted (and heavily marketed) time frame.  Mostly the delay lies in the minor detail of the registration process as it is unwieldy and takes a ton of time.  There used to be two registration clerks, but  the Brain Trust that is administration actually cut secretarial hours after 3 PM so now there is only one until 7 PM when outpatient services close.  Brilliant.  This has resulted in ridiculous waits for the appointment-making and insurance-having outpatients as well as walk-in routine blood draws.  On 3-11 it can get pretty busy since both the ER and outpatient department business picks up.  It doesn't help that a couple of the secretaries are deadly sloooooow.  Thorough, but slow.  There is apparently no way for the Suits to speed up this process although I know it is MUCH faster at Pseudocity Hospital.  Probably faster at any hospital  that has a vision of rapid registration as a simple but effective means of improving satisfaction scores. But that would just make sense, what do I know.

So to recap, patients are triaged promptly but often fall down the rabbit hole of registration.  That gets Bobo's tighty whities in a wad.  He used to say is was because the nurses were taking too long to triage.  WTF?  I wasn't taking that lying down, so  I began adding the time "triage competed" boldly next to the triage time.  In most cases it was less than 5 minutes.  He probably noticed that I only did this when he was working, and that I had instigated the other nurses to do the same.  Thus endeth the discussion of how long nurses take to triage.  But did it do anything to speed up registration?  Um, no.  I learned to make copies of complicated med lists for the above average patient who came equipped with such because we must HAND WRITE med lists or we get dinged, another stupid time waster.

Some of the other docs fail to write down the times of their first interaction with the patient and leave it to the nurses. It is usually a guess as we are also responsible for noting the following in addition to triage time:  time to room, time physician sees patient, time of labs, xrays, EKG's and discharges in addition to the obvious like meds given, IV starts, vital signs, pain scale, blah, blah, blah.   I've mentioned that Bobo obsessively writes his own times down, and gets testy if we fail to write down time to room.   I think he gets a prize for having the fastest door-to-doc times, even if it means going out to triage and seeing the patient first if the nurses are in the middle of something he can't drag us away from.  I have occasionally found him in triage if we are especially busy, so that his time-to-patient  is earlier than the triage time.  I don't think he has realized that this doesn't help his numbers at all as "door" time is calculated as "triage" time; the system won't calculate a minus.  It also doesn't take into consideration that there is sometimes as much as a 20 minute wait for triage.   

Last night I thought Bobo would have a stroke.  There were sick and complicated patients, multiple admissions and transfers, endless phone calls ("You have asked me to make 3 phone calls, start 2 IV's, and splint a kid; which would you like me to do first?"), the death of an end stage liver patient who's family was in denial which entailed even more calls and tied up a room for 3 hours (with the ER wake/viewing), and one nurse-accompanied transfer necessitating calling our boss in to cover for an hour. 

Notice to all the non-urgents in the waiting room who expected rapid service: due to circumstances and Actual Emergencies beyond our control, 20 minute door-to-doc is suspended for the evening.

Sunday, October 23, 2011

You Might Be Having a Bad Day If.....

....you are burned by falling "into" a bonfire.  While you are wearing spiked heals and drinking tequila
....you get into a car accident while enroute to the ER.  With a tick bite.
....you are fake-vomiting into the toilet (ie, sound effects and  spitting). Then your brand new I phone falls in.
...."you just can't get hold of" your doctor and you need an emergent narcotic refill.  He is here in the ER and  says he fired you a year ago.
....your friend pierced your navel for you after you were forbidden to have it done.  You are not 18 for another week and we need parental permission to treat you for that infection. 
...you come into the ER for back pain so bad you needed to be out of work today and will need to be out for the weekend.  I did not triage you. But you did wait on me at the drive-up window at Dunkin' Donuts about an hour ago.  Nice to see you again.
...your dog is startled by a cat and bolts, you pulled off your feet, and your head hits a rock.  You are 71 and have a fractured skull.

Which one is the worst Bad Day?

Saturday, October 22, 2011

Today's Last Patient of the Night......

.......was a 32 year old male who just wanted to ask a question about whether or not he should be seen, thus incurring an ER charge.  His 5 day old tattoo was looking a little red and swollen even though he had scrupulously treated it as directed by his tattoo artist with A&D ointment. 

Here is a teachable moment: as always, if you are already in my ER and "just want an opinion if I should be seen", the answer is, with few exceptions, yes.  Liability.  Even if it is for a stupid reason.  This was not a stupid reason, and he did have an infection.  Antibiotics.

Interesting conversation overheard between the patient and Cripes:
Tattoo guy: "Yeah, I have some tattoos so I know how they should be treated.  The place I go is really clean and uses all sterile stuff.  I've never gotten an infection before"
Cripes: "Well, it's good you came in"
Tattoo guy: "I have been getting a few tattoos over the last couple of years.  I used get piercings when I was younger but I've found that tattoos are more socially acceptable than piercings, more main-stream, ya know?  You're more likely to find business people with tats, see.  I work a lot with the public"
Cripes: "Oh, what do you do?"
Tattoo guy: "Auto salvage.  And I have quite a car collection.  Are you a car guy, Doc?  What do you drive?"
Cripes: "Oh, I have a Tundra"
Tattoo guy: "I have a 1945 Blah, a 1957 Blah Blah, a sweet 1960 Blah Blah Blah a..." (he listed about 6 more classic cars). 

I don't know, like, or care about cars.  Someone talks about cars or golf and I start doing the multiplication tables in my head or fake a seizure.  Booooooooooooooooooooooring.  But I did think the guy's take on the social implications of piercings....insightful.

PS  Aren't you dying to know what kind of tattoo he had?

It was a a horse.  Ya know, like on those sports cars?

Thursday, October 20, 2011

Found on the Bathroom Bulletin Board

My religious hospital is always having some kind of fund raiser, asking for money, donations of time, collecting for Christmas baskets and back-to-school-backpacks, food pantries, the Lenten diaper drive, soliciting for nine different kinds of cancer, Sister Mary Clarence's beer fund, inner city victory gardens, windmills over Holland, employees with acute need, orphans in third world countries, etc, etc, etc.  It is something every single week, literally.  For a non-profit, they seem to want to squeeze every last penny out of the people who work there.  I pick my battles and one or two things a year.  I prefer to choose my own charities mostly.

So as I perused the Potty Notes, I came across this interesting nugget:

"Collecting Items for the Homless (sic)"

sleeping bags

Crockpots? Ooooooooooooookay!

Monday, October 17, 2011

Keep Honking, I'm Reloading

Many of the Really Sick walk in. That is what we are there for, we are the closest help for evaluation/treatment/stabilization and transfer to a tertiary care facility.  Sometimes, people who somehow manage to get themselves into a car will subsequently have difficulty getting out, due either to confusion or firmly held beliefs about when it is and is not appropriate to call 911. This is a behaviour peculiar to many an older adult, but is rampant among the Old Yankee population.  A penny saved is a penny earned; if I can breath, I can walk; if it ain't cut off, it's only a flesh wound. 

Sometimes family members will simply request a wheelchair.  Sometimes they will come in and calmly request assistance, and we will trudge into the parking lot regardless of rain, snow, sleet or dark of night.  But when there are only two of us nurses to tote that barge and lift that bale it can be a strain on the back; we are not superhuman.  And we are none of us spring chicks.  The youngest of us is 42.  The eldest is......well, me, with three of my colleagues within a couple of years.  Lab and xray on the evening shift?  Same boat.  The docs?  Again, same boat.  Gil already has a couple of stents, and though younger, Bobo is downright fragile.

 We used to have an elderly post stroke lady who could barely walk who would to beeeeeeeeeeeep her car horn incessantly so we could come out and drag inside her equally mobility-challenged and even older husband by wheelchair for a catheter change.  That was a treat.  I think that was Second in Commands doing: "Sure, just beep the horn!  We have curb service!".  Not.  I think he died or is in a nursing home. 

When patients comes into the ambulance bay laying on the horn, though, we pay attention.  Recent treks to the parking lot for assistance include:
"She's having a seizure"
"My husband has severe pain"
"My mother is short of breath"
"My daughter can't move her leg"

As for the above, none of them were exactly as advertised, and turned out to be more of a panic situation than anything life threatening.  Seizure?  Tremors in a Parkinson's patient who was either under-dosed or had missed their Sinemet.  Severe pain?  OK, that one was kidney stone, painful and scary;  way more painful in men than women.  Or more common anyway.  Short of breath?  COPD, always short of breath and still smokes.  Daughter who couldn't move her leg?  Soccer playing teenage girl.  Drama, drama, drama.  I usually make a bet that the teen will be on her cell phone within 5 minutes, and that at the conclusion of the visit she will hop up from her death bed and miraculously walk.  Nobody will take my bet anymore because I am always right.  The mechanism of injury is never commensurate with the level of disability portrayed.  Also, they are uniformly poor actresses.

People in an absolute panic get pissed when ER nurses don't exhibit the same level of panic.  They think that by remaining calm and in control we are complacent and uncaring.  Really?  Do do you think anything will get accomplished if I am jumping up and down screaming?  Seriously?  I will get out the Dope Slap machine and set it to stun if necessary.

And, although I operate on the principle that it is not time to panic until it's time to panic, once in a while someone will get my adrenaline pumping.


New Cathy and I beheld an enormous SUV, engine still running, stopped diagonally across our ambulance bay and blocking the parking lot entrance because it was attached to a large trailer.  The trailer was partially  in the street. The 70ish man in the driver's seat was pale and sweaty and breathing rapidly.  Wow, I thought.  He's having the Big One.  "Sir, what's  wrong?  Are you having pain?  Are you diabetic?"

"Call.  The police.  Secure.  The guns."

WTF?  Guns?

I reached in, put the car in park and turned off the engine lest we be run over.  New Cathy and I hauled him into the wheelchair (he could, fortunately, briefly stand).  All the while he muttered, "Secure.  The guns.  I.  Have a.  License.  Legal.  Need to.  Lock.  Them.  Up". 

He was diabetic, had a cardiac history, and was dehydrated having driven most of the day from some gun show.  He wasn't having the Big One that day, but he was admitted anyway. 

The guns?  All legal.  The local police came over to move the SUV and secure the weapons, locking them up at the station.  BEEEEEEEEEEEEEEEEEEEEEEEEEEP!!!!

Saturday, October 15, 2011

Just a Thought

I pass by a local church daily on my way to work.  For days and days parishoners with heavy equipment worked on extending their parking lot by excavating a hill.  After endless grading and preparation, it was ready for asphalt.

I envisioned a sign for the project:
"Jesus Paves".

Friday, October 14, 2011


......the process by which, via natural selection, unfit specimens remove themselves from the gene pool

A few candidates who are genetically hanging by a thread for your entertainment.  There will be a quiz at the conclusion of this presentation:

A.  40 year old man came in complaining of "really bad burns".  He had been at a local bonfire/pep rally or some crap, and was tending to the fire.  He had some 1st and 2nd degree burns on his right hand and arm, and the backs of both legs.

Me: "How did this happen?"
Guy: "I threw some gasoline on the fire"
Me: (blurted before I could stop myself), "WHY??"

Did I mention that he had three or four kids under the age of 12 with him?  Um, yeah.

B.  33 year old who used heroin for the first time.  At work. That's all I have to say about that.

C.  42 year old who had a couple of beers at lunch and went back to work.  As a roofer. Using a nail gun, he buried a couple of inches metal into his proximal femur. THIS CLOSE to his femoral artery

D.  36 year old nearly removed his own knee cap with a chain saw.  He admitted to taking a "butt load" of oxy's daily for his chronic pain condition for which he is disabled.  Let me also mention he weighed over 300 pounds and had stopped at Burger World (as evidenced by paper sack he was toting) and had a blood pressure of Patent Pending/100.  A more cynical person than I might wonder how in hell he imagined using a chain saw in his debilitated condition was a good decision. 

Which of the following statements is true: (I told you there would be a quiz)

1.  They are all men
2.  They have all made galactically stupid decisions
3.  Antibiotics cure viruses.

A.  1 & 2 only
B.  All of the above
C.  1 & 3.
D.  None of the above

Tuesday, October 11, 2011

On Falling

I was asked to cover a couple of hours for Kerry on a day off so she could go to a meeting, or buy chickens or something; sure!  2 hours=1/2 of a princess shift.

I took care of only one (one!  ONE!) patient for 2 hours and 20 minutes.  Young.  No job, no insurance and had applied for Medicaid when she found out she was pregnant; I don't know why she wasn't already on it since she had only one arm, a congenital condition.  She seemed like someone who had, or would soon be, falling through the cracks. 

She didn't know what to do: she was by herself and scared.  She had just had a "screening" ultrasound at a free clinic during her first pre-natal visit; her baby had stopped growing and had no heartbeat, she said.  She did not know what to do next since she wasn't bleeding or cramping.  The clinic kicked her to the curb with some phone numbers.  She was worried about the cost.

We did the usual blood tests and an ultrasound that confirmed fetal demise at about 8 weeks gestation.  Twins.  I arranged an appointment for her that very afternoon with the OB to discuss her options.  She elected not to keep it because she had to get home so her boyfriend could get to school.  I tried very hard to get her to change her mind

"I guess everything happens for a reason", she said.  "It would have been almost impossible with one baby, let alone two".

I made two phone calls to her over the weekend which went unanswered.  She didn't call either.

The next sound you hear will be someone falling through the cracks.

Thursday, October 6, 2011


The 93 year old cardiac arrest rolled in without  advanced airway or IV access.  No drugs.  Asystole.  CPR was halfheartedly in progress.  The young man who had found her on the floor was living in the house, a friend of the patient's great grandson.  The patient was supposed to be DNR.  Why, then, was she in our ER?  The young man called 911 in a panic, and could not produce the DNR or any documentation. Since none of the actual family members were at home, CPR was initiated by EMS.  She was pronounced dead moments after her arrival in the ER since she had an advanced directive on file and the family member called us.  Good; we didn't have go all out on the Poor Dear, and the end of life wishes not to be kept alive by artificial means were (sort of) followed. 

Note to self and others: discuss end of life plans.  Have one in place.  Keep the DNR handy.  If there is a terminal illness, understand what to do if the family member dies at home.  This was a case of good intentions, just a tad short on follow through.

It fascinates me that although death is inevitable, so few families are prepared for it.  We don't often discuss it.  Terminal illness aside, it seems as if by ignoring the Reaper, he will ignore us. 

I can't stress this enough.  Everyone deserves to be treated with dignity, yet there is little dignity  when an elder loved one dies in an ER, worse still when it isn't their wish to be kept alive with heroic measures.   I would hate to have my last image of a loved one lying lifeless in an ER. 

Tuesday, October 4, 2011

Squirrel Count

I love Gil.  Some of the other nurses thinks he orders too many tests, but I don't.  He likes taking good care of patients, likes to educate, and always has something interesting to share.  Having worked with him for about 2 1/2 years we've come to know him will.  He used to be a little hyper, but he's over it.  We talked about that the other day. 
Gil: "I remember when I first started here, I was kind of ramped up.  At least you guys know when I need a time out".
Me: "Yeah, the first few months were....challenging at times.  Not that you weren't likable, that wasn't the problem.  And it wasn't a time out you needed:  a couple of times I just wanted to slap the shit out of you.  Calm.  I like calm and focus.  Breath in, breath out.  This is not Chicken Little ER".
Gil: "Always some bumps in the road with new docs, huh?"
Me: "Mmmmmhmmmmmmmmm".

Loe the guy, but he's a squirrel feeder.

"If you feed the squirrels, they will keep coming back".  This refers to narcotic seeking individuals.  Gil's solution is to give them, say, 2 Percocet to go and no prescription.  He may think he has shut off the squirrels, but he is still giving them acorns even if it's one at a time.  Besides, it just makes us nurses have to sign them out, put them in a little envelope, and write "one tablet every 4-6 hours as needed for the severe, excruciating and debilitating pain that has brought you to the ER like 20 times this year.  This is all you get, don't ask for more".  Well, not the last part.  Anyway, Gil just keeps on feeding those squirrels.  Last night's squirrel count as follows:

Case 1:
Complaint: Butt pain
Goal:  Narcotics
Plan: Home with narcotics
Female with a bruised butt from a fall down the stairs presenting with 20/10 pain on a scale where 10 is the max.  So bad she took Tylenol about 20 minutes before arriving. She was observed on camera as she walked normally to the door where she then proceded to mmmmmmmmmmmooooooooooovvvvvvvvvvvveeee iinnnnnnnnnnnnnnnnnnn sssssssssssssllllooooooooooooooooooooowwwwwwwwwwww mmmmmmmmmmmmmooooooootion.  Really.  It was like a 78 RPM record being played at 33 RPM.  And if you don't have any idea what I am talking about, ask your......grandfather.  After she got what she came in for, her gait was back to speed as observed on our trusty Spy Cam. I would be so sad if that stopped working.  Very entertaining.

Case 2:
Complaint: Back pain
Goal: Narcotics
Plan: Home with narcotics
Another young female who had been treated for sciatica and dental pain in 4 visits to the ER this month and had received Percocet for each of those visits.

Case 3:
Complaint: Acute knee pain.  I had to get her out of the car 'cause she couldn't walk
Goal: Pain relief, rule out fracture, and not to have to use crutches
Plan: Home with narcotic pain 'script and crutches.
This one was a middle aged woman who thought karma was working against her as she had said just yesterday that she would never use a walker.  Hah.  People make plans, the universe laughs.  We were completely out of knee immobilizers so I wrapped an ace bandage and gave her crutches.  I worked with her for 20 minutes but at the end of the session she said, "I'm not going to use them anyway".  Observed via Spy Cam walking normally in parking lot with the crutch tips pointing to Heaven.

Case 4:
Complaint: Man-cold with sore throat.  Oh, and back pain.
Goal: Narcotics and work note.
Plan:  Home with Tramadol and work note.
Don't get me started on man-cold.  It is the season for most men to become a quivering puddle of sniffling, whining, hacking, helpless, miserableness.  "I don't feeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeel goooooooooooood!"  Percocet for a cold and sore throat of 4 hours??  Seriously?  Are you fu*king out of your mind? 

Here's an aside: a friend of mine who works in Endoscopy (AKA, the Bum-Lookup nurse) says that thanks to Michael Jackson's doctor, they are required to tell patent's that they will not be getting Propofol.  Thank you.

Saturday, September 24, 2011

Get Off the Phone

I may put on a happy face in triage, but when things get ugly I can take it right back off.  Nothing ticks me off more than people who just can't put down the fu**ing cell phone. So sorry to interrupt your oh-so-important text messaging so that I may triage YOUR emergent ER visit for say, dental pain or rash.  Fever of 99.4 ("My normal temperature is 97.5, so that is BURNING UP  for me!")

 Me: "Hi, what can we do for you today?"
Loser: (continues with phone texting activities and doesn't respond)
I waited exactly 7 seconds.
Me: "Excuse me".  I walked out of triage.  I was really busy, so I made her wait awhile.
When I eventually went back in, I said "Are we all done updating the Facebook status?"
If they are too stupid to know they are rude, it is unlikely they will notice if I am....annoyed.

I do not sit in a triage room eagerly awaiting your visit.  I have other patients upon which to do EKG's, clean wounds, and start interventions along with myriad other technical, secretarial and janitorial tasks (beds don't make themselves, and I certainly don't mind emptying trash and linen when it is overflowing).  There may even be one or two patients with ACTUAL EMERGENCIES for whom it may be necessary to transfer out in a hurry.

I shouldn't have to tell people to shut off their damn phone, but common courtesy is non-existent.  Hell, MANNERS are non-existent.  Parents certainly aren't teaching the basics at home, and teachers are too busy just trying to get the little shits to sit in their seats without damaging their fragile self-esteem.  Don't get me started on HATS.  The last time I was at a public event where the National Anthem was played, the announcer actually told men to remove their hats.  Pathetic.

I never never encourage people to answer their cell phone in my presence in fact I just don't even acknowledge their moronic ring tone.  Like the Rocky theme.  If it is a teen or a kid playing a video game I tell them to put it away.

What happened to respectful human interaction?

Gone by the wayside:
1.  Saying please, thank you, and excuse me.
2.  Waiting your turn.
3.  Making eye contact 
4.  Teaching kids to have respect
5.  Taking responsibility for your actions

Thus ends today's rant.

Friday, September 23, 2011

Feed Me

You have 35 (WTF!) visits to our ER alone this year for migraine, I have no doubt that this is drug seeking.

Gil: "Well, I know he's here a lot.  I'm suggesting that he make his own appointment at Up State Big Hospital, and keep a log of his migraine activity.   I think he  really does have  migraines"

Me: "That makes one of you".  

We nurses know who has had at least one visit per week, sometimes multiple visits in one day.  We know all of your little dramas, which lies you have told, and when you park your car around back after telling us your ride will be "right along".  

 I dutifully prepare your dose of the "d" medicine after ascertaining that your usual cadre of medication allergies was unchanged.  Toradol.  Tramadol.  Codeine.  Phenergan.  Imitrex.  Fioricet.

Within seconds of the administration of your meds, your photophobia has resolved.  You are a magically a different person and you try to engage me in a conversation about the Patriot's.  I get it; you really are just normal, friendly  guy. 

I'm sure you are.  But I don't give you anything to work with.  I'm sorry to be in a hurry to wrap this up as I have a vomiting 80 year old with an anxious family to deal with, as well as an infant with an uneducated single mother in need of teaching.  You understand.  Neither you nor the doctor has any interest in addressing your addiction, we are rubber-stamping this visit and leaving it for the next person to handle.  You have gotten what you wanted, so really, my time is better spent on caring for someone who actually wants help.  Sorry, but that's the way it is.  If you actually asked for help I would go the distance for you, and I mean that sincerely.  But until you have burned all the bridges and hit rock bottom, there is little I can do.  And it makes me feel like an ass each time you come in and play your little game. 
Feeding squirrels.  If you keep feeding them, they will surely return.  What happens when the acorns run out?

Thursday, September 22, 2011

Cuts and Cutting Remarks

New Hampshire hospitals have been scrambling to come up with millions of dollars in budget shortfalls.  The state legislature in its infinite wisdom voted to cut Medicaid reimbursements along with many other cuts to state and local agencies and programs.  The impact to hospitals involves money that had been counted on during budget planning for the coming year, but now the rug has been pulled out from under. 

The state  taxes hospitals 5.5 percent on  patient revenues, but returns the amount of the tax in matching federal Medicaid funds so they effectively lost no money.  That's out now, and hospitals have been cutting jobs all summer, the latest round of layoffs occurring about a week ago. 

We lost a number of positions, none of which were clip board personnel or Suits in Charge of Stupid Shit, not surprisingly.  I get to keep my job.  But there were several LPN's who lost their jobs.  Just axed.  Some genius in the public relations department of another hospital, who also cut their LPN's, justified cutting them  since, "LPN's are really just glorified nursing assistants".  Really??  Talk about adding insult to injury.

I have never worked in a hospital that employs LPN's in the ER, but I have worked with my fair share in many other areas.  Some were good, some were great. 

The first one I ever worked with was Mrs. Maccaione.  I don't know if she had a first name, you either called her Mrs. Maccaione, or "Mac".  In 1973 she had to be in her mid-sixties.  Mac wore whites from the top of her starched cap to the polished perfection of her white Clinic shoes.  She was as broad around as she was tall, and at 5 feet was an imposing and intimidating poster child for Crusty Old World War II Nurse.  With her rolling bandy-legged gait and the whoosh! whoosh! of her pudgy thighs in their snow white support hose, she bore down on me and the other two nursing assistants like a ship under full sail; usually with guns a-blazing.   She was NO NONSENSE in the flesh.  She really did try and bounce quarters off of draw sheets.  Mac was well known for her scrutiny of top sheets for precise hospital corners.  Woe to you if you were caught resting a pillow under your chin to apply a pillow case.  You would hear about it in spades if your patients weren't  bathed in a timely manner or their immediate environment was not spotlessly clean.  We were scared to death of her.

In the early 1970's, day surgery was non-existent.  If you had a cholecystectomy or appendectomy, you were in the hospital for about a week.  A tonsilectomy?  Two nights.  Wisdom teeth?  That involved checking in to the hospital the night before your surgery and staying all day.  Sometimes patients went home, sometimes they could "elect" to stay another night, like if they were vomiting or whatever. 

Mac always greeted the patients and oriented them.  This was a job that needed to be DONE RIGHT.  She strode into the room and  stood at parade rest. 

"Good afternoon!  Welcome to Unit F.  I'm Mrs. Maccaione-call me Mac.  You are scheduled for _____surgery tomorrow at 0800 hours.  Today, you will be getting a visit from the anesthesiologist and having whatever testing may be deemed necessary, if any.  You will be signing a surgical consent if you have not already done so.  For today, you will be given a regular supper, served between 5 and 5:30 PM along with a light snack at approximately 8 PM. Visiting hours conclude at 8 PM, so plan accordingly.  At this time, the switchboard will not put through any incoming phone calls to the rooms.  Lights out in this unit is generally between 10 and 11 PM; you will be needing your rest.  At 12 midnight, you will be NPO: Latin, Nothing By Mouth until after your surgery.  You will be awakened at 5:45 AM to prepare you for your surgery.  Questions?"

This monologue was delivered  rapid-fire.  I'm sure most patients didn't dare ask questions of Mac. Most of the doctors were scared of her. 

But you should have seen her in action when it came to encouraging a fresh post-op and making them feel cared for.  Or getting another 6 feet of corridor out of a tired newly ambulatory patient with a big belly wound (remember Scultetus binders?).  There was nothing she couldn't get from the kitchen staff if she thought it would entice a finicky eater to take nourishment.  For all her brusque and bossy affect she was a hell of a nurse; you would want her to take care of your family.  I learned a hell of lot from her. 

Just a "nursing assistant"?  Oh, HELL no.

Wednesday, September 21, 2011

From Out of the Blue

Sherry was curious about a little kid she had sent to the Big City Kid's Hospital with a forearm fracture from a few nights ago.  We rarely get any follow up on people we transfer to other places unless we call them, or they have some kind of complaint or lost a slipper or some shit.

The parents, who were very, very anxious, were thrilled with the excellent care at Big City Kid's where he had a closed reduction under sedation.  It was a long night, but he did well.  They were also grateful for the care he had received at our facility.  He was, however, almost out of pain medicine.  Long story short, Cripes, who had seen the kid the other night was willing to write a 'script for the same pain medicine to tide the kid over for another day or two. 

Dad came in to pick up the prescription and had this to say.

"Thank you for taking such good care of us the other night.  You can't know everyone's story and what's gone on in their past.  I just wanted you to know that how you treat people really does make a difference.  Fifteen years ago, I had a son who didn't make it.  I walked the halls at Big City Kid's.  You remember the people, the doctor's and nurses, who reached out and tried to make a connection, a kind word.  Some encouragement.  Or helped us prepare for the worst.  How you treat people matters.  I was back walking the halls like I have for the last fifteen years.  Thank you for caring about us".

I never cry at work.  This made me cry.

Monday, September 19, 2011

Stop Bugging Me

"I think I have  a bug in my ear", said the guy in triage.  "I was mowing my lawn and brushed against a rose bush and it feels like something is in my ear canal.  I didn't dare poke it with a Q tip"

Good plan.  Every time I get someone with a complaint like this, I think of the old Night Gallery episode hosted by that creepy guy Rod Serling.  Some guy gets and earwig planted in his ear which then proceeds to munch its way through the brain (being unable to reverse direction), reducing the poor bastard to a shrieking mass of agony until it crawls out the other side.  Whereupon the doctor informs him that it was, in fact, a female....which had laid eggs. Shudder.  All of which is myth.

OK, I'm being dramatic.

So the guy wasn't having any particular difficulty while I was triaging.  As I a walked him to registration, he freaked and started screaming.


I grabbed him by the t-shirt and dragged him into the nearest treatment room.  Kate went to grab some lidocaine to immobilize whatever was in his ear.  Suddenly, the guy stopped screaming and  froze.

"It stopped". 

No shit.  "Let me see if I can see anything", I told him.  As I pushed back his longish hair, I saw it: a GIANT Japanese beetle sitting in his outer ear.  "Don't move for a second", I said.  Trying not to either panic the guy or lose sight of the bug I reached for a glove or 4x4 gauze on the counter behind me.  In the nanoecond I took to glance behind me, the beetle...was gone.

"Did you see anything?  Is there anything there?  Is it a bee?  Did you get it?"

Shit.  No, wait!  There it is up on the very tip of his little, pointy elfen ear!

WHACK!  I smacked the flap of his ear with my hand.  Yes, I struck my patient.  A first for me.

The beetle crawled on the floor unconcerned.  I scooped it up with a wad of 4x4's.

"Oh, thankyouthankyouthankyou!  You saved my life!"

Gil wandered in and wanted to know what all the shouting was about.

"This brave nurse saved my life!  She got a beetle out of my ear, I thought I would go crazy!  She's a genius"

Gil:  "Oh, that's great!  Did you use lidocaine?"

Me: "Nope.  I just told it to go to the light, so it did"

Gil: "Hahaha!"

Saturday, September 17, 2011

Two More Reasons to have a Crappy Attitude

1.  Mandatory flu shots, or wear a mask from December 1 to the end of March for every employee whether they work in a clinical area or not (note: the docs are not employed by the hospital).  It's not that I object to getting a flu shot per se,  I simply have a problem with authority.

2. My co-workers have decided to do the schedule through MID JANUARY, so as to get their holiday requests in.    I can't stand it.  I am boycotting the schedule until Halloween.

Friday, September 16, 2011


I got a phone call from one of the adult overnight dormitory staff at Wicked Expensive Alternative Prep School around 9:00 PM.  He wanted to know if it was appropriate to bring one of the boys for dental pain.

Sure, come on down.  No, we don't have a dentist "on call".  No, I have not idea what treatment he will get. Yes, he will be fully evaluated by the physician.  No, I can't tell you how long the visit will be.  Yes, we have some medicines available for patients to use until the pharmacy is open.  Yes, in most cases we can call in a prescription provided you use a pharmacy that has an overnight answering machine.  No, I do not have the power to order the pharmacist to open the store for you.  Just get off the phone and get the kid here, huh?

Wicked Expensive Alternative Prep School has kids from all over the country and a large contingent of international students.  There is a nurse who lives there, but I guess they give her a night off every once in a while.  I think that along with the usual college prep courses, the kids are encouraged to pursue other interests not usually found at regular schools.  Like, if they wanted to learn unicycling or something, or pottery, or start a social networking site or learn to juggle.  Whatever, good for them to encourage independence and exploration.  They are big on tapping into the genius of the faculty for ideas and guidance for their students' pursuits.  I guess they figure the parents are paying enough money for the expertise, if they want to learn tie dyeing or candle making, fine.

Not impressed with the dorm guy, though.  He forgot all the kid's paperwork that included parental permission to treat him.  He wanted to know if we had someone on staff who could speak Mandarin (??).  The very sweet young man spoke perfect English and oh, by the way, was KOREAN.

Does anyone but me find it disturbing that when he finished the registration process, the dorm guy wanted to know "where we put the Chinese kid?"

Thursday, September 15, 2011

Bored I Guess

For years and years I worked at least two and often three jobs at the same time, but at at least one was always in the ER. I have had lots of different experiences.  I've worked in schools, as a camp nurse, in home care, employee health, a travel clinic, a same day surgery unit, pediatrics, telemetry, and med surg.  I have worked in large medical centers and community hospitals.  I been a staff nurse, charge nurse, supervisor, director.  I have done independent QA audits, worked for an agency. I have worked days, evenings, nights, weekends and holidays.  I have worked from within walking distance to my job or traveled over and hour.  I have worked with individuals who have become lifelong friends and others whose names I can't remember.  I have been both student and a teacher.  Sometimes I have felt unsure of myself and terrified, but have grown enough as a nurse to feel comfortable and competent, smart enough to know that I don't know everything.  I have done a lot, seen a lot, learned a lot.

I  have been restless and not altogether happy with my job lately.  For the last 3 years, it has been my only job.  It is close to home and I work with a small group of nice, accommodating people in a small ER.

I have been thinking that maybe it is too small.  I feel as though I am losing my skills as an ER nurse.  Few codes, trauma as rare as hen's teeth.  I am SO TIRED of the constant parade of drug seekers and the pressure to just make everyone happy, even if what they want isn't what they need.  Want antibiotics for a virus?  Sure!  An Xray for your three week old ankle injury that you insist must be broken?  No problem!  Dilaudid for your migraine of 10 minutes?  Absolutely!  Why do you need doctors with experience and expertise when you have WebMD?  All we ask in return is positive customer satisfaction scores.

I have never felt less valued as a professional nurse anywhere.  It's not my boss, she's great. It's the organization we work for.  Our director talks a good game, but there is no visible support for the activities of nursing.  There is a part-time research nurse, nobody really knows what she does and I have never seen her.  Committees?  The same dull people with the same dull ideas. 

I have a really crappy attitude and no real goals since finishing school.  For the first time in a long time I have no concrete plans to move on, move up, or move out.  Maybe it is because I am working only one job in a small town, I don't know.  I am in a real rut.  I have to work about 10 more years until I can retire and that pisses me off.  I can't see myself doing what I'm doing for another 10 years.

I keep telling myself I am lucky to have a job.

Sunday, September 11, 2011

My Children of 9/11

10 years ago I was working as a school nurse for the sixth graders' annual 5 day Nature Camp trip.  This was always a fun experience for all, and highly anticipated by those of us fortunate enough to go.  The week was carnival time for faculty, a "Get Out of Jail Free" pass or a Wonka Golden Ticket.  It was five days of  not sitting in a classroom.  The kids were our responsibility for three meals and overnight, but otherwise they were herded like sheep from activity to activity and supervised by the camp staff for purposes of learning and soaking up the nature.  Compared to school, it was a free for all.  There was plenty I could have done instead of going; the first couple of weeks of school were always busy.  Lots of consultations with parents and doctors, meetings with teachers, health plans for some of the more fragile kids.  I had already spent two weeks prior to the first day of school preparing for the trip as well as for the kids in my school with health needs.

These 6th graders had just moved on to the middle school, but I knew them well; they had been my responsibility for grades 3-5, with their health problems, adjustment issues and daily boo-boos. Although there was a camp nurse who distributed meds, my presence was pretty much redundant.  It was my guarantee of being there that sealed the deal for parents that their kids would be safe and well cared for.  Oh, I  checked peak flows and did asthma checks so as not to be awakened for nebs in the middle of the night for wheezy kids.  I located the kids who forgot to show up for meds.  I could tell by a look who needed special attention or a pep talk.  I managed the diabetics exclusively.  On occasion I made a trip to the ER for a few stitches (those kids always got treated to a burger or ice cream on the way back to camp but were sworn to secrecy).   I always had a few kids who had never left home for as much as a sleepover, kids who were on the verge of illness, or kids who were allergic to everything including clouds.  Every year there was one or two new kids who had moved to town and didn't have a single friend and arrived with some sort of medical issue.  I gave the really nervous parents my cell phone number since we usually left for the trip only 3 days into the school year and the mostly middle school faculty were new to the kids.  Up until that year, no one had ever called me although I did make a few calls home so they wouldn't worry too much.  Since the kids were forbidden to use the phone, it was always appreciated.

My own kids were nearly grown; my daughter was 21 and had already started her 3rd year of college the week before.  My son was starting his first year at a Boston area college the day after I returned.  It was going to be a busy week and weekend, but it was all under control.

On that day, September 11, 2001, the kids were settling into their second day of after-breakfast activities with their camp leaders.  The other 9 teachers and I had a precious 2 hours and 15 minutes until we were needed to chaperon free play time and then lunch for the kids.  We were enjoying the beautiful sunny day on the deck overlooking a sparkling blue lake.  It was summer still, but with that unmistakable crispness that meant fall would not be far behind.  I remember how we admired the color of the sky and the green of the surrounding mountains, dotted with just a touch of red and yellow of early-changing leaves and how pretty it was as the view was reflected in the lake.  Some teachers were milling around, reading the paper on the deck and enjoying a peaceful cup of coffee or just sitting and chatting.  Two of my good friends were 5th grade teachers.  We were making a plan to escape to Dunkin' Donuts for some adult time and maybe taking out a few sailboats later in the afternoon when the kids were with their learning groups.  Joe, a grade 4 teacher drove up in his car.

"Hey", said Joe, "Something really bad happened in New York at the World Trade Center.  A plane crash.    I'm going down to the rec room TV to check on it".

We quickly followed, collecting most of the other faculty en route.  I remembered that there had been a bomb attack maybe ten years earlier.  I thought about the logistics of evacuating those buildings and what a nightmare it must have been.  In my wildest dreams I could not have imagined the horror that was to come.

We sat riveted and in shock as the events of the day unfolded.  It was like a bad dream; many of the teachers had tears streaming down their faces.  One teacher was married to a National Guardsman, another to a federal agent; both wondered not if but when and where their husbands would be called to duty.

At some point, it occurred to us: "What do we tell the kids?".

I suggested that we tell them nothing.  There were 10 of us, how could we handle the emotional needs of 180 kids who might have a grandfather who works in one of the towers, or whose aunt lives in New York, or
whose cousin works for an airline or the fire department?

Joe agreed.  He suggested that we talk to the school principal; after all, it should ultimately be their decision.  We could be called home right away.  Parents would be calling the school and the camp.  We had to be prepared for an onslaught of parents driving the two hours to scoop up their kids and bring them home and who could blame them? 

Cathy was a 5th grade teacher who worried about the safety of us all.  With planes targeting the Pentagon and White House as well as the Twin Towers, who knew what could be next?  Was it safe to even be on the roads?

Two 6th grade teachers, Sally and Carl were the undisputed team leaders.  They thought the best plan was to keep things as normal as possible until we heard otherwise.   As a group we agreed, then scattered to meet up with our kids before lunch for 45 minutes of free time.

Joe went to find the camp director; Sally tried to contact the school principal and/or the superintendent's office.  Overloaded telephone systems and a serious lack of cell phone service prevented her from reaching anyone.  For the next several hours, in fact for the next three days, we were cut off from the world and on our own. 

During the lunch break the camp staff taken off and briefed by their director, who ordered them to keep things as normal as possible for our kids.  Some were unhappy about that, but we were insistent. They would stick to the program.

It was late afternoon before Sally was able to speak to anyone from school administration.  They agreed with our course of action; they had had a meeting with parent organizers and the consensus was that as long as we, the  faculty, were OK with staying, the kids would remain at camp; the only difference was that we would leave after breakfast on Friday and arrive home before 1 PM instead of 5 PM.  Teachers on all three buses would brief the kids on the way home. 

And so, as our country grieved for the lives lost, the threat to our freedom, and the near-destruction of our piece of mind, our kids learned and played.  They bonded with teachers and classmates as a group, communed with nature, and made memories.  They missed home a little, and school not so much.  They had the freedom to eat peanut butter and jelly instead of veggie burgers, and some enjoyed their sloth, showering and wearing clean clothes only when compelled to do so.  For three more days our students did  all the normal things they had a right to do as kids.  They did not have any access to TV's or newspapers; our only link with the outside world was a few moments of news casts several times per day and newspapers, which we kept hidden.  The kids were isolated, not having access to either.  We, their teachers, protected their innocence for just a few more days, shielded them from fear and from the rest of the world.

That Friday as I drove home, it seemed as though I had landed in another world; I had never seen so many flags flying from homes, schools, fire stations, police stations, public buildings.  Hand made signs and banners proclaimed that we as Americans were still strong, that nothing would break us.  There were pleas for vengeance and retribution. There were prayers for peace and for the families of the victims. 

For Baby Boomers like me, the assassination of President Kennedy was a tragedy that changed a generation.  For this generation, it is September 11, 2001.

But for our kids, our 180 students, our group of 11 year olds who had left home on a Monday and returned to a changed world on Friday, their experience was significantly different.  In their before and after world of 9/11, there was a big pause filled with childish things, a right of passage unmarred by those attacks in our own backyard.  The world stood still for most of us, but for these sixth graders life was as it should be.

I've often wondered how their  experience at Nature Camp may have shaped their future; perhaps in a completely different way from most kids their age as they played and learned with their classmates in isolation from the sadness of the rest of the country.

I cherish a note written by one of the parents to the 10 of us who were with their children during one of the darkest moments in history to thank us for what we had done to shield them from the horrors of reality:

"Our kids did not watch TV; they did not see the horrible images or the constant replay of planes striking the Twin Towers.  Thanks to you, our kids got to experience normalcy and innocence in a way that none of the other kids at school did, perhaps not anywhere in the country.   We are so fortunate to have such dedicated individuals who put the needs of our children first when there was so much uncertainty in the world.  Surely you feared for your own families, but never showed it to our kids.  Thanks to you, we had 180 of the happiest kids in America".

Thursday, September 8, 2011

In Terrorum

Ms. Annoying, one of our very frequent fliers, came in the other day having been MIA for about 4-5 months.  Her many, many visits were always an energetic pursuit for narcotics for one of the Holy Trinity of Chronic Pain ComplaintsTM (back pain, dental pain, migraine) but that was not why she had come in.  She was having some kind of allergic reaction and suspected a new antidepressant.   She has always been known for disruptive behavior and abusive language when she doesn't get what she wants.  This time she seemed pretty normal.  It seemed odd to me that she had no complaints of any type of pain, but people don't always disclose the "actual reason" for their visit in triage.

After an evaluation by the Mac, I went over her discharge instructions with her that included only a prescription for Prednisone.  Apropos of nothing she said: "I am totally off narcotics.  I was in rehab for three months".


I was floored.  "I'm happy for you.  That is such an accomplishment, it must have been very difficult"

She told me her story of three very intense months.  She had lost her children but found the strength to persevere.    She had been in the process of rebuilding her life one step at a time.  Good for her, I hope she can keep it up and I mean that sincerely. 

"I know I must have been a nightmare when I came in here before.  It is a terrible thing, addiction.  It consumes you, and that stuff is poison.  Nobody should put those drugs into their mouth unless they have cancer.  Tell all the doctor's; narcotics are the devil".

Well, of course they are when they are abused.  I am thinking that this might be an effective strategy in a religious hospital.  "I'm sorry, ma'am,  I regret that we cannot give you any percocet as they are Satan's handiwork.  Here is some ibuprofen".


Thursday, August 25, 2011

Not That it Matters, but....

I was on the other side of the health care delivery system recently, having a relatively minor surgical procedure.  Which took me just a little longer to bounce back from, but no matter.  I am on the mend and back to most of my exciting physical activities.  Except I am not allowed to lift my kayak for another week or so.

I was more than happy with the care that I received from start to finish, from checking in to the pre-op area to the next day follow up phone call.  I have to say that I did not use my own health care facility for this procedure, even though the surgeon is there more days per week than at the "other" place.  Why?

They piss me off.  For one thing, the PACU nurse manager is a moron who apparently doesn't think ER experience is enough of a critical care criterion for working in a same-day surgery unit.  For another, I just couldn't see myself as a patient where administrative types are so totally clueless they don't value or even have the ability to recognize that people are working really hard.  I am sick to death of the constant reminders and whip cracking.  That not giving 100% every second of every day is going to doom us all, given that we are experiencing layoffs and all.  The buzz word is "Strive for 5", (as in 0-5) a reference to Press-Ganey  five-point scale that patients use to grade our attentiveness and care.  They just don't get that people, especially nurses, are doing way more than the best they can.   Guess what, you are not the number one hospital and never will be because you have a lot of deadwood making stupid decisions and fail to listen to the people who make good scores happen.

Because we feel like we are always being beaten up, there are days when you just don't feel like Strivin' for  5.
It might feel like "No More Than 4"
or "Three is Fine for Me"
or "Two Will Do"
or (rarely) "One and I'm done"

It was interesting to be on the other side of the fence.  I knew that care would be good if not great because I used to work there.  I liked it well enough, certainly the ER was better organized and managed.  I took my current position because it worked out with school and all.  But, I'm no longer in school (at least, not for the moment) and it might be time for a change.