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.


hoodnurse said...

Tramadol for a cold? Really? I thought it was generous when they gave me that for a boxer's fracture. But indeed, I hope to do a graduate research study on the phenomenon that is the man cold.
Also, I wish the hospital would buy us a spy cam.

SentWest said...

OMG the man-cold. Don't get me started. How come I can work and do chores and run errands with just a little Day/Nyquil assistance and the man (who gave me a hard time for crying when I broke my dang foot in half) lays in bed for a week with just enough energy to continuously whine and play XBox.

Arrrgh! Bunch of wimps...

CathRN said...

I was on loan to SICU recently and discharged a postop hysterectomy-gone-awry that bought a unit bed overnight but did well enough to go home next day.. Pt told me she was just angst-y and sore and tired and wanted to curl up in sweats and nap. She felt that was letting her family down. I asked what her husband would do in her shoes. "play xbox.". "Yeah, maybe after a week or so in bed. You feel a need for a few days of tea and comfy clothes after major identity-affecting surgery? GO FOR IT." LOVED the look on her face. One of my favorite nursing moments ever. Not slamming men. I love Em for what they are. Most are NOT strong when feeling ill.

imalittlebitcrunchy said...

I went to the ER a few years ago because of excruciating abdominal pain. They were absurdly busy, and I didn't get taken to a room for over an hour. No one saw me for quite some time after that, though I don't know how long exactly. By the time I saw a Dr., the pain had almost completely subsided. They did a u/s and blood work and whatever else ya'll do. Told me they had no idea what caused the pain, maybe a burst ovarian cyst. I said "What do you mean you don't know?" The Dr. visibly rolled his eyes, wrote me a script, which I was told to take if the pain re-occured. Then he left. It was a prescription for Vicodin. I was shocked that they would hand it out so easily, and insulted enough that I ripped it up and threw it in the trash before I left. It sucks that ER docs see so much of this that innocent people get caught in it. It still surprises me that it's not more difficult for an addict to get their fix.