Nice Day, Nice for Some

A very nice day brings out the kid in people I guess. It also brings out the douche mongers, like this guy:

He dragged himself with a very high degree of drama (missing only the audio, which was "Oh, woe is me!!! Woe is me!!!) into the triage area ever so slowly before plopping into the chair breathlessly. Wife started doing the talking until I shut her up.

"I fell. In Rite Aid parking lot on ICE! Can you believe they don't do anything about ice in the parking lot of a pharmacy where sick and injured patients need to walk?? It's a travesty!!!"

(um, no, I can't imagine. it makes no sense. it is New Hampshire, one of the coldest and snowiest winters on record where there remains no place to put the snow and SHOCKER, here, there is ice. Just so you know, we have had similar falls and insignificant injuries from a number of equally tort-minded, upstanding, non-working, disability-having, suck -the- life-out-of-the-system douchebags such as yourself).

Me: " Yup. Did you take any pain relievers, elevate or use ice?"

DB: "No, we came right over!"

Me: "I see.
And what is it that you've hurt today?"

DB: "My head, shoulder, wrist, elbow, hand, little finger, hip, knee, ankle and foot"

Me: "Did you hit your head?"

DB: "No! it just missed the bumper of the car! But now I have a migraine!"

Me: (completely losing interest). "Well, you've certainly had an eventful last 8 minutes"
(that was sarcasm, but I bet you knew that; he didn't)
help. police. murder.

This was the first patient of the evening and my eyes are already rolling out of my head.

The day shift, Kelly and Lisa, are finishing up what was not a good day with Gil. They think he orders too many tests and gets all up in people's business unnecessarily. Maybe he does, but they're not going to change him so I just go with it, expect to be busy and make a lot of phone calls on his behalf and no schoolwork done. I like the guy; he's smart and funny and totally gets my sense of humor. Things get done; it's not time to panic 'til it's time to panic. I like that.

I'd much rather work with Gil than Parvati who wants to put an IV in every chronic paineur and drug-seeker and give them Dilaudid; that gets really old, really fast. Her cultural "sky is falling" affect sometimes annoys the crap out of me. I frequently wait until she barks 10 orders at me (at least 5 of them conflicting or redundant) and then just list them back. She changes her mind often, but doesn't always share. ALSO WHEN SHE TALKS IT IS LIKE IT IS ALL IN CAPITALS WITH AN EXCLAMATION POINT! I JUST CAN'T GET THAT EXCITED! A FOLEY CATH IN A PATIENT WITH AN 02 SAT OF 85% IS NOT THE PRIORITY!

The other day a lady came in with "atrial fibrillation". At least, that's what she thought it was; "it's never been documented", she said. "Well", I said to her, "it has now." It was supraventricular tachycardia, or SVT

In a couple of minutes Mikki and I had set the patient up with an IV; she was monitored, on O2 and the EKG was in my hand. I walked into the room next door where Parvati was telling the patient about her daughter's wedding and wordlessly handed it to her.

Parvati came in like Chicken Little ("the sky is falling! the sky is falling!").
She had a few words with the patient and did a cursory exam, then told us "LET'S GIVE SOME CARDIZEM!!"
Me: " I have 6mg of Adenosine ready to go unless you prefer Cardizem; perhaps I missed a really fast atrial fib?" (I never believed it for a minute; I know my SVT)
Parvati: "NO! YOU ARE RIGHT! YES! YES! LET'S GIVE 6 MG OF ADENOSINE! IT HAS TO BE GIVEN FAST!"

Sigh. I know. She is a little wearing, but kind to the patients. And she does dental blocks, so that is kind of fun. We see fewer dental paineurs when she is on.

Anyway, remember the whiny gone-to-ground douchetard in triage? I parked him at the registration desk, and a young man comes in swathed with what looks like several slings and a couch cushion; he is being lead by his Dad who was wearing ski boots. The nearest ski area is at least 30 minutes away.

I waved them directly into a treatment room, which didn't go over well with the douchetard based on the pained expression he shot me.

Long story short; the kid had a fracture/dislocation of his shoulder. Nice kid, nice family. The dad shook my hand about 90 minutes later on their way out, with pain relief, xrays, reduction and follow-up accomplished; he thanked us for taking care of them so quickly. It was the first of two shoulder fractures and one really nasty tibia fracture, 3 admissions and two transfers.

The tibia fracture was Cripe's fav patent of the night. In answer to the question "How did you hurt yourself"came the following responses:
1. "I fell down the stairs. I had a few beers."
2. "I fell off a stool, I was just sitting on it; I had a couple of six packs".
3. "I was just dancing around to reggae music; I've been drinking all day, I think I killed close to a case".

He was admitted for surgery, poor guy. I felt bad because he was also having some social issues (no, really?) centered around his choice of roommates. Whose name he didn't know. Who refused to leave. And who apparently was not paying him rent (although he WAS paying in beer. Not an ideal arrangement).

So, by now I'm sure you're DYING to know how many fractures the douchetard had sustained, how long in traction, how many days out of work, etc, etc, etc.?

Not. One. But Cripes gave him a single Percocet to make up for his long wait while we took care of the young man's shoulder. Him so good!