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.