Sunday, January 29, 2012

Mac is either all-in or all-out when it comes to sketchy pain complaints.  He will do drug screening on some of the complaineurs of the Holy Trinity of Pain (back pain, migraine, and dental pain) if he has seen them a lot.  On occasion he will give them narcotics if they agree to the piss test.  Sometimes he just tells them to hit the road with ibuprofen.  It's still a pitch 'til you win situation since most will keep hacking away at us until they get what they want, day after day after day. 

Yesterday, a guy with chronic back and neck pain came in.  On top of the chronic pain, he had some sketchy injury and claimed to have difficulty moving his arm, as well as way increased pain.  Although he had no insurance and no primary care physician, he stated he had an MRI scheduled in two weeks.  Mac decided that this guy needed it sooner. 

Call to MRI (we NEVER do this); they had an opeining, send him down. It was stressed to him that time was of the essence since MRI was going to hold the spot for him. We did the appropriate paper work and sent the patient on his way by private car.  The procedure is that patients check into the ER, the test is ordered, and then the ER doc has the responsibility for giving the patient results and follow up.

Three hours later, we got a call from the ER that the patient never showed up and further more, when they called to see WTF was going on with that, the wife started yelling at them that they had FREE CARE, and her husband wasn't given gas money to get the 12 miles there and back. 

Wow, really?  First we heard of it, and what a lovely concept.  He didn't need an ambulance, although we could have gone that route but somebody would have had to pick him up.  If transport was a problem, we could have given him a cab voucher but again, you only get one per day and somebody would have had to pick him up.  The MRI that we so thoughtfully arranged was just not as much of a priority to him as it was to Mac.

 Lisa came in while this was being debated to work a few hours for Kate.  She had come directly from an appearance at Bear Went Over the Mountain ER which is 15 miles away. Guess who had showed up there about 40 minutes after we had discharged him?  Yep.   His story was similar except HE HAD A COPY OF AN MRI FROM ANOTHER HOSPITAL with him.  That is never, never fishy.  I'll give you one guess as to what he wanted;  if you guessed "gas money", you are incorrect. Two of the nurses had recalled that he had been a  dick at another visit, which is what we find to be one of the most endearing qualities about dealing with the public.  ER nurses have VERY long memories.

Saturday, January 28, 2012

Maybe You Should Quit Watching the News When You're Bored

What is wrong with people? Honestly, who really gives a crap what Demi smoked, shot up, snorted, or ingested?  Especially if it leads to her simply seeking help for "exhaustion" as opposed to substance abuse?  Seriously, making her 911 tape available to the public just gives people stupid ideas.  Monkey see, monkey do.

Overheard ambulance patch to our Mothershp last night:
EMS: "Transporting a 35 year old female complaining of nausea and shaking.  She reportedly smoked some 'herbal incense' about one hour prior to our arrival.  She is conscious and breathing.  Vital signs....."

ER: "Are you bringing the substance the victim smoked?"

EMS: "No, it was confiscated by police".

Just because you can roll it up, stick it in a bong or stuff it in a pipe doesn't mean you should. 

Tuesday, January 24, 2012

It's All About the Privacy

A 31 year old female came in with a female friend for a sebaceous cyst, a nice big ripe one behind the ear.  It had obviously been brewing for some time, so Bobo elected to I&D it.  But first, Ativan, then  nice big does of Dilaudid.  She screamed such a string of obscenities so inconsistent with what he was doing that the usually unflappable Bobo was unnerved; he who as a general practice gives out Percocets like Pez and is not stingy with the lidocaine or giving it time to work.  He actually mouthed, "WTF" to me.  I had to dive under the table on that one.

Eventually I managed to scrape her off the ceiling, apply a dressing and send her off to the pharmacy to fill her antibiotic and narcotic prescriptions.

Two hours later (and the woman had been in the department at least 2 hours), I got a phone call. 

"Hi, I'm calling to see if my girlfriend is there".
Me: "I'm sorry, I'm not allowed to give out that kind of information, it is against privacy laws" (in other words, stupid, she's not here for me to ask her if she wants to take a call or have me take a message).
Idiot: "Well, I know she came there, and I know she needs a ride home so just tell me if she's there or not"
Me: "I can't give you any patient information.  Sorry".  (You could also be a stalker, maybe she has a restraining order on you, maybe you have a gun, and maybe you are crazy.  Or not, but I don't really care)
Idiot: "Listen, I just have to know if she was there, um, I mean, I just need to know if I need to pick her up.  You don't have to be a bitch about it"
Me: "I'm hanging up, have a nice day"
Idiot:: "I'll just come down and see for my-..."
Click.  Hey she came in with a friend, obviously she doesn't tell him everything.

We walk a fine line with the kind of patient information we give out over the phone.  Obviously, we want to do what's best for patients.  We talk to caregivers, and lots of times we talk with family members.  Do we try to ask for permission first? We do if it is a non-urgent problem.  Are we going to talk to three aunts, a cousin and a grandparent for someone with a minor laceration?  No.  Are we going to talk to family members who have been alerted by the nursing home  that their demented  elderly loved one has has been brought in with stroke symptoms or chest pain?  Hell yes. 

We don't leave messages on routine call-backs or for lab tests, but do suggest they call us.  Nor do we give information for  such requests as "I just wanted to see what my girlfriend's/boyfriend's STD test showed".  Sorry, you'll have to that information from her/him.  But if you are worried about that nasty discharge, come on down.

Once I had a director of nursing at a big hospital call me, the charge nurse, looking for information about her adult daughter.  She was being seen in my ER for a non-urgent problem.    I told Mom that I was sorry, but  giving her any information would be a patient privacy violation and that she would have to ask the daughter.  She thanked me and agreed that it was.  My next move was an immediate call to my boss to cover my ass.  Five minutes after I hung up with her my boss called me back to say the director had called her to praise me for protecting patient privacy and to congratulate my boss on training her charge nurses so well; she was embarrassed that she had been so careless about this issue.  You would think she would have known better, but the Suits and Clipboard Nurses who make policy rarely have any idea how these things work in the real world. 

Sometimes it is just a ridiculous game that puts us in the middle of family issues.  An example of this is a 25 year old with a minor laceration who was know to be an IV drug user.  It was not an injury that in any way, shape or form would have needed narcotics, so he left an unhappy camper and was quite nasty about it.  An hour later his mother called saying how much pain her son was in so could she please come down and get a prescription?  And his tooth was hurting too.  I said I couldn't discuss her son's care without his permission.  A short time later Sonny called and said we could give the prescription to his mother but we weren't allowed to give any details about his care or any part of his medical record.  Um, no. You are still not getting a narcotic prescription.  You have my permission to talk to your mother.

Saturday, January 21, 2012

Code Rainbow

We don't have security.  When there is trouble the local police are but a 911 call away.  They are always prompt in coming to our aid to either kick ass or talk people out of a tree.  They also know what time we close, and unless they are really busy there is always an officer waiting for us as we alarm the bulding and disperse to our cars in a dark and secluded parking lot.

 It is nice that they are protective like that even if we rarely get the aggressive or dangerous patient.  Drunks?  Never come by ambulance.  Overdoses?  Occasionally thrown out of cars onto our doorstep, but they are the exception rather than the rule. I truly don't miss that about working in a city hospital. 

One night we got a 6 ft 2 inch 18 year old male whose parents had come home to find him lying on the floor, " not responding".  I don't know how, but he was  carried in by his father.  He could walk, but wasn't really doing what he was told; he also had slurred speech and was "not really cooperative" (he took a swing at me).  He was drunk, of course.  Shocker.  So I was concerned enough about my/our safety to call dispatch and have them send over some hefty police presence. 

Cripes: "Why did you do that?  Don't we have any leather restraints?"
Funny.  Real funny.

Cripes told us, "When I was in residency, I tackled a psych patient in the hallway.  We were wrestling around, and I yelled for the nurse to call a Code Grey for security.  She got all huffy and said, 'Well, that would be a Code Green'.  Seriously?"
Me: "Ha.  More like a Code Black and Blue".

I get it.  What Cripes was referring to was the method utilized by most health care facilities to immediately broadcast some sort of internal threat or emergency situation which are often color coded so that visitors and patients aren't  freaked out.  It would be chaotic and dangerous, especially to bed-bound patients if some things were broadcast in an overhead page like, "Bomb Threat, GET OUT IMMEDIATELY", or "FIRE!  As if anybody is fooled by an overhead "Code Red!  Code Red!  Code Red" even if it is just the ICU nurses burning popcorn. 

"Did you order the Code Red?"
"Your damn right I did!  But the popcorn is inedible!"

 A Code Red in our community also means a  reverse 911 system to notify citizens of school closings, tornadoes, or local flooding with road closures which we are prone to, and other natural and unnatural impending disasters.  I generally have a surge of adrenaline when I pick up the phone at home and hear "This is a Code Red alert!" when the water is up to the door of my barn and the road is impassable.  This usually means I have to find another way to get to work, but I can generally just look out the back door to determine that the creek is overflowed.  The car lying in a puddle up to its roof is a dead giveaway.

These codes are not standardized from place to place.  This makes it confusing so other than codes for a cardiac arrest or a fire I can never remember what some of the colors are. A Code White, Grey, Green, Yellow or Orange might be  used for different emergencies or not exist at all at some of the various facilities I have worked over the years.   Obviously we never use them where I am working now, but if I had to work at the Big House I would need a cheat sheet.  Good thing the codes are printed on my ID badge.

Super-secret codes for emergency situations in the hospital undoubtedly fool nobody.  The cat is kind of out of the bag when  "Dr. Ambu", "Code Blue", "Doctor Blue, Stat", and "Code 99" is paged for a cardiac arrest, especially when a dozen people rush by with an automotive cart trailing jumper cables.  I worked at the "Code 99" hospital for many years, and had more than a few adrenaline rushes at the  local supermarket when they paged "Code 9" for a manager check approval. 

There are codes of various colors used for things like Haz Mat alert, Internal Disaster, Mass Casualty, Missing Infant from the nursery (in which the entire hospital goes into immediate lock down), and others. Some of us added to the list over the years during times of intense boredom.  "Code Rainbow" referred to the choice of a liver entree in the cafeteria, notable for the lovely rainbow colors it took on when sitting in its un-appetizing-looking liquid.  One of the lab techs had an odd habit of wearing an entirely color-coordinated ensemble from head to foot.  If she was wearing red, for instance, she would have on red hose, shoes, jewelry, slip, hair appliances and underwear (we took her word for that).  We referred to some of her more bizarre outfits as a "Code Puce and Chartreuse" as she had a weird penchant for those particular shades of purpley-brown and yellow-green.

Among the  re-tooled  emergency codes include  "Code Squirrel",  when we are overrun with drug seekers, "Code Blah"  for something boring in the cafeteria, and "Code Chicken Little", which meant that the charge nurse was spinning in her own orbit and the sky was falling.

The latest code is an ID-10t.   Lisa started using it when dealing with persons of less than average intelligence.  I have since learned that it is actually a tech term humorously used to describe user errors in individuals with limited computer skills.   I have no idea where this originated, it wasn't me but I like it a lot.  Look at it.  It spells.....

Tuesday, January 17, 2012

That's Why the Lady is a....

I got an urgent phone call from Ellen on my day off.
"Hi, EDNurseasauras?  Sorry to call you but the nurses were very busy and asked me to go down the list.  Is there any possibility you could come in and help out?"
Me: "I'll be right there".

I have only gotten a call like this once at my current job.  My name is at the end of the alphabet and they usually find someone before they get to me. Usually Second in Command, whose name is at the beginning of the alphabet, gets this type of urgent call and jumps right on it because she is an Overtime Whore.  Me, not so much.  Except lately because Kate has been going through some health problems and I have pretty much made myself her personal bitch when it comes to covering her time.  Also because it annoys the crap out of Second in Command. 

I made it to work in about 7 minutes, expecting that there would be 2 Medflight choppers circling, simultaneous codes, any number of disasters.

Instead, I walked in to find 4 patients awaiting transfers because Inappropriate Drop paramedic was working today.  Among the things that shouldn't come to us but did thanks to Inappropriate Drop paramedic:
Head injuries
Probable hip fractures
End Stage COPD'ers (unless coding)
Transfers from doctor's offices with beds at the hospital.  The OTHER hospital
The Lady on Elm St. with vomiting.  I fu*ing hate Inappropriate Drop medic sometimes.

Not just regular vomiting.  Lying flat on her 400 pound back and just letting it rip like Mt. Vesuvius.  Because, she said, "Whatever I put in just comes right back up".

When things come right back up, it is probably an indication to stop putting stuff in.  Like Cheeto's.  Not a concept she'll be getting any time soon

Lady was the straw that broke the camel's back, a clean-up job requiring reinforcement nurses.

Friday, January 6, 2012

Quote of the Day

I still don't understand why people come to the ER in search of a pelvic exam.  This, the most personal and private exam a woman can be subjected to, and you want a total stranger to do it?  I guess some people just don't care and consider it the price to be paid for a prescription for Percocet for their 10th visit this year for "painful periods", "my ovarian cyst is bothering me", and "painful intercourse".


I have had a run of days working with Gil, who is an older guy.  After setting up the 4th patient of the night for a pelvic for a frequent drug seeking squirrel, Gil rolled his eyes.  "Doing a pelvic", he said, "is like going on a treasure hunt for really bad treasure".


Sunday, January 1, 2012

What Happened to September?

 Happy 2012 to all.  I don't know where 2011 went. 
I guess I have been slacking the last couple of weeks although the holiday season gave me plenty to write about.  I have tons of material, stacks and stacks of notes and pithy observations (ha!  I am not sure I am capable of such).  Some of them are actually humorous and possibly worth reading. 

It is equal parts lack of motivation, time, and resources.  It doesn't help that my laptop is on its last legs.  I have spent the last 4 1/2 years pounding the crap out of it and I have decided not to keep it alive with heroic measures.  I will eventually bury it at sea or run it over with my car. 

More soon.