Friday, June 29, 2012

I Hereby Sentence You....

Mrs. 100 Watt brought in one of her dirty unruly kids for yet another seemingly silly reason.  Inexplicably she had taken one of them to another ER recently where he was admitted for an appendectomy, days after he started saying his stomach hurt.  Normally Mrs. 100 Watt will wait a grand total of 10 minutes before bringing the kids to the ER for various boo-boos; something more serious and she waits days, of course.  

As she prattled on endlessly about this harrowing experience, she informed us that the surgeon who operated on her son thought she was so astute to have had the son seen in such a timely manner that she "should be condemned as a mother".

SHE said it.  She did.  Commendation vs condemnation, just give yourself a pat on the back.  Or a bat. Or whatever.

Thursday, June 28, 2012

Yeah, This is How I Operate

If I have to mix medication drips I generally make a big mess.  Yes, we mix our own.  The pharmacy doesn't live here.  Cabinets open, drawers open, syringes and wrappers, papers, calculators.  Usually people know to stay out of  my way when I am mixing anything.

This is my kitchen.  I also make messes at home, so at least I am consistent. I am one of those cooks who, a)doesn't like it, b) isn't good at it and c) cooks all over the kitchen.  As evidenced by the sheer quantity of stuff laying about.

You must be wondering what extremely complicated and amazing dish I was creating to have made such a hash out of my kitchen, right?  Well, it was French toast.  For me.  See that little stack of jam over there?  I made that last week.  The kitchen was in WAY worse shape than this.

Wednesday, June 27, 2012

Roll Tape

Our new electronic medical record system has been in place for awhile, and although I have refused to wear my awesome, neat, super-rad, peachy cool SUPER USER! t-shirt, I continue to pick up a little something new everyday.

Today's conundrum entailed figuring out how the doc could get "buddy taping" written as an order for say, a broken toe.  Can't imagine why the hospital would even bother with this, but if they can charge $400 for the doc to write the order it should certainly cover the nurse applying a 12 cent piece of tape.  Go figure.

Cripes just gave up.  "I don't care if it's ordered, and I am not going to free-text it.  It's too much of a pain"

Well, I like a challenge as much as the next person so tried every combination I could think of: tape, splint, buddy tape, buddy splint.  Nope, none of those.  Nurse tape, finger tape, boo-boo tape, toe tape, duct tape, toe shoes.  Micropore splint.  Nope, none of those either.

Suddenly, I pulled "Anatomic Splint" out of my a**.

Bingo.  That will be $400, and it's not even that cool colorful duct tape like this:

I left a roll of zebra duct tape on Kate's locker.  After I disguised this squirrel in zebra camouflage:

Because some days are just a fun-filled zebra safari.  Hark!  Behind you!  Hoof beats!!

Tuesday, June 26, 2012

SHOULD Old Acquaintance Be Forgot?

Harry: What does this song mean?  My whole life, I don't know what this song means.  I mean, "should old acquaintance be forgot"?  Does that mean we should forget old acquaintances, or does it mean if we happened to forget them, we should remember them, which is not possible because we already forgot?

I recently reconnected with an old high school friend via social media.  We exchanged brief Hi, how are your, how have you been?.  I ventured a Want to get together for coffee and rehash old times since we live about 2 hours away from each other?  I got no response to that.  I was a feeling a little...miffed.

I guess having no contact with someone for 39 years puts a bit of perspective on the issue....what was the issue?  Something stupid, can't even remember.  Obviously it involved feeling hurt and betrayed on my part.  Maybe hers, too.  Carrie was my best friend in high school even though I always knew she was a little....odd.  Not bucket of pig blood and torch the prom odd.  Still, she came from a difficult family and was affected by life-long marination in her family's history-steeped greatness, local legend status, and exceedingly high expectations.

Carrie and I stopped getting together on school breaks and weekends as we first grew apart and then, separately, grew up.  Certainly not having any contact in nearly 40 years there is not so much a void but a monstrous, massive black hole.  High school was a blip on the radar, nothing more; looking back we essentially started drifting  away from each the day we graduated.  Oh, we wrote newsy letters back and forth our first year, she from college, me from my childhood home.  I worked for a year before I started nursing school, the best thing I could ever have done although at the time I felt like an isolated loser.  I chafed that I was missing out on all those college experiences that my peers were having and living away from home, but I am convinced it kept me from flunking out of school in the first week.

Over the years, I fleetingly wondered about Carrie.  She did not attend either of the class reunions I managed to go to; it seemed she had dropped off the face of the earth.  I know she is doing something she loves, discovered via her blog detailing her experiences as a teacher. She is positive and passionate.  Good for her.   I did not relate my blog experience simply because I prefer to keep my identity to a chosen few.  I can count on two puny fists people who know me although a former colleague once sent me an email linking this blog, thinking it sounded a lot like my sense of humor.

I can count on those same two puny fists the number I count as close friends, the  ones you could unhesitatingly call in the middle of the night; the friends who will show up, no questions asked, with either a bottle of tequila and a lime; or a shovel and bag of lime.  I have been fortunate to become closer to my nursing school friends and remain close to my skating ladies, all of whom have been an amazing part of my life and who know where a lot of bodies are buried*.  I did not go to high school with any of them.

I guess Carrie's disinterest disappointed because I expected the same type of instant reconnection with a high school friend that I have enjoyed in the past.  Wow, yes, dinner, drinks, a weekend away.  WOOT!  That got me thinking about how high school was the ultimate forgettable experience for a lot of  people.  Yep, that would be me.  Guess I will just let those sleeping dogs lie; 39 years is probably not enough beauty rest anyway.

Tequila, anyone?

*Disclaimer: metaphorically speaking.  No actual bodies were buried.

Monday, June 25, 2012

Is That an African or European Swallow?

We always get tons of calls looking for advice.  We are not a free advice service and are prohibited from giving any by our employers other than "if you think you need to be seen, come to the ER".   To be honest, these calls are largely an annoyance; we get 10-15 per shift.  They pull us away from caring for people who have already made the decision to be evaluated.  Don't you get annoyed when you have been waiting patiently in a store or business, only to have your turn for service trumped by a phone call?  The most important customer is the one right in front of you.

Sometimes the call is driven by fear or denial and instead of calling 911, people will call us.  Easy answer.  Hang up and call 911, or I will get the address and call dispatch for them if they are too hysterical. Most of the time though the are all about convenience or lack of common sense.  People get truly pissed off because we refuse to give them any practical information.  It is a liability.  I get that you don't want to talk to your PCP after hours, or it didn't occur to you to call your PCP in the morning before you went to the gym.  Perfectly understandable that although you have already called your PCP, you think it is stupid that you were advised to go to the ER and you just want to check and make sure.  Unfortunately most PCP's have the same bottom line in the decision tree that we do.  Go to the ER.

Some of secretaries are comfortable giving people the standard response: we don't give advice.  If the nurses are busy they can at least screen calls for us and give us a head's up before we pick up the receiver.  We take turns.  Sometimes the calls can be quite amusing, and we award them meaningless points.  Everything is made up and the points don't matter though.

I Rock, Paper, Scissored with Lisa and lost on an advice call.  We had been forewarned by Jules:

Mr. Outdoors: "Hi, I just have a question.  Yesterday I was out mowing my lawn, and I had my iPod on my belt, now today I feel kind of warm.  And I have a little bit of a headache (and 4 other symptoms like finger pain and grass stains).  Then I noticed that around where my iPod was touching my skin it seems a little red.  Is it because I was outside and it was hot?  Could it be a burn?  Should that happen?  Would it also cause the other symptoms?  How late are you open?  Should I come right down or should I wait until tomorrow to call my PCP?"

-15 points for asking more than just the one question you originally proposed

+5 points for mowing the lawn

+10 points for remembering you had a PCP

-20 points for having 3 or more symptoms

+50 points for me for knowing the airspeed velocity of an unladen swallow.

Bonus points for finding out what was on his iPod

Sunday, June 24, 2012

How to Class Up Your Delivery and Get VIP Service in the ER

Polite society has certainly gone the way of the hoop skirt.  Pardon my sainted bloomers, but the ability to express oneself in a reasonably polite and courteous manner, keep civil when one's opinion differs, or engage in respectful dissent is non-existent.  Many people unapologetically present their problems thus: "I have a pain in my ass" instead of "low back pain" without shame.  Descent into name calling and profanity to make their point is the new norm.  You can't reason with people, and it isn't just because they are dumber than a bag of hammers.  It is strictly ignorance because THEY THINK NOTHING IS WRONG WITH THE WAY THEY SPEAK.  Don't get me started on how they talk to their kids.

Hospitals have scripting and behavioral expectations for staff, why should we not hold patients to a higher standard?  How about a little accountability for unacceptable language, profanity, and inappropriate expressions?

I offer a guide for alternative language; scripting for patients if you will.

Instead of: "Why do you have to ask so many fu*king questions?
You might try: Forgive my impatience, my good woman.  Would you kindly assist me in understanding why you need to know what medicines I take and how it is relevant to any treatment I might receive for my chronic, debilitating, and narcotic-requiring back problem?  I would like to be an active participant in my care.

Instead of: "I have a mother-fu*king toothache, my pain is through the roof.  I can't afford no fu*ing dentist.  Just hook me up with pain pills, bitch"
You might try: "Alas, dear lady,  I am irretrievably guilty of neglecting my dental health and am suffering from yet another exacerbation of uncontrollable pain.   I can imagine that it seems inconceivable that I have allowed this situation to deteriorate to this degree. I regret that my current financial situation severely curtails my ability to offer adequate  monetary compensation to a dental professional as I would be unable to purchase cigarettes, liquor, or marijuana.  Would it be at all possible to provide me with some additional narcotic pain relievers?"

Instead of: "I am sicker than anybody in this shit hole and I shouldn't have to wait for a room"
You might try: Please excuse me if I seem short-tempered, but might I respectfully request that my condition be re-assessed?  I understand that my man-cold is not especially urgent, but I do believe this  illness seems to have escalated in the 10 minutes I have been asked to repose in the anteroom"

Instead of: Any expressions such as  "Coochy pain",  "Kicked in the scrote",  "My girlfriend/boyfriend gave me some nasty-ass infection in my pu**y/dick".
You might try: I regret that I have a matter of some....delicacy to discuss.  Please forgive me if I offend you with any unacceptable slang, but...oh, I blush to say it...I have an injury/possible disease in my nether regions.  

Instead of: "I fired my doctor because he/she is the world's biggest douche bag.  He blew me off when I asked for an increase in my pain meds because he thinks I am full of shit".
You might try: I am currently between primary care providers, thank you.  We have come to an amicable parting of ways and I find myself in an unaccustomed awkward position.  Might I beg your indulgence in providing me with just a few of my usual analgesics just to tide me over until I have engaged another primary care provider?

Instead of: "What the hell am I waiting for?"
You might try: Excuse me, I completely understand that you are very busy caring for people much sicker than I am.  When you have a moment, might I trouble you for an update?

Instead of: "You are all a bunch of bitches/ c*ck suckers," etc.
You might tryI would just like to thank you so much for the excellent care you have provided me today.  I would love to let your administrators know how great my visit has been"

Let's raise the bar a little, people.

Saturday, June 23, 2012


Not a bad day at all except for the "Dirty 2:30", that time of day when all patients converge upon us.  They are usually pretty sick people that require a ton of stuff.  Gack.   I hate the day shift.  The only good thing was that Parvati was supposed to be working but she phoned in dead or rude or some sh*t.  Can't say that I missed her.

I had a nice 19 year old who came by with a foot laceration.  He was riding a little motorbike thing and not his usual dirt bike, although he was suited up in some sort of cool little biking ensemble.  A big stick had penetrated his tennis shoe.  Damn.  Meant to put on those boots, but forgot.  He had a nice big laceration with a small quantity of twig sticking out of it.  Dude had a couple of friends with him; sure, they can come in while we stitch you up.

19 year old boys can be quite funny.  Dude's buddies were like, snowboarding East Coast valley boys, or like some sh*t?  Dude's cut was  soooooo gross, you know?  Dude's friends, predictably, deployed their iPhones to snap photos and ER vid.  "I'd better not see this on, like,  Youtube?", I warned them, but smiled as I said it.  I adjusted the overhead light and put a paper ruler next to the laceration for the best photos.  I've done this a time or two.  Dude' one friend teased, like, the other one?  'Cause he, you know, hates blood?  Duuuuuuuuuuuude!!

Once he was stitched up I wrapped it up with a bunch of dressing material and gave him a post-op shoe.  Dude's friend was like, "Whoa, that's like really sweet wrappage!"

Yeah, gonna totally chart it that way.  Sweet.

Friday, June 22, 2012

Always Something

Tonight we had the great good fortune to work with my favorite relatively new employee in the lab.  Meet Wednesday Addams.  Wednesday apparently got the job because she is best friends with her manager, the stalwart Morticia, who never smiles.  I routinely hang up on her, along with EGK troll.  I don't expect either Morticia or Wednesday to last too long in their current positions.

Wednesday, though, incites another whole level of homicidal thoughts.  She lacks the ability to think outside the box.  In fact a box is probably the safest place for her.  She is constantly asking the secretaries, X-ray tech or nurses to do her job; make phone calls to doctors, patients, or other labs.  Do pediatric blood draws.  Find paper towels. Figure out computer stuff.  Turn on the faucet.  Here is an example:

Wednesday: "Hi I'm really busy, I have to (insert busy work here: QA's, outpatient's, finding stickers).  Do you know how to (insert query here: see above)?  Will you (insert task here: i.e., anything in her job description) for me?  

I don't mind helping, but it is not reciprocated; it never is.  She doesn't seem to want to learn how to empower herself, find out the answer by doing, trying, experimenting or calling one of her colleagues if she can't get her equipment to work.  Tonight Wednesday was unable to get some results to print, so...... did we know how to copy?

Kate:  (exasperated) "You mean like on the copy machine?  It's over there!"

Wednesday stared blankly at the copier for a few minutes, then asked nobody in particular, "Is this on?"  No doubt it seemed very complicated, with all of those dials, buttons, flashy lights and shiny knobs.

There it is.  Just what we've been searching for.  Thank you, Thing.

You Did NOT Just Say That

We sent out a woman several years younger than me for further testing.  Abdominal pain, nausea, fever.  She gave her stated weight as a conservative (I'd say overly generous) 375 at last weigh-in about 2 years ago.  I don't say this to be cruel or uncaring, but as a courtesy to the ambulance crew who was transporting; it would be uncool for them to drop people because they are unprepared with the right number of personnel.  Size does sometimes matter.  She was a very nice lady, and she was much more comfortable at the time of transfer thanks to minuscule doses of meds for pain and nausea.

The EMT/Paramedic crew took report, and agreed that an ACLS transport was unnecessary.  The paramedic was busy training a new guy anyway, so the ensuing conversation took place out of her earshot.  I wish it had taken place out of mine.

Male EMT to female EMT: "OK, do you want to drive or tech"
Female EMT: "It doesn't matter, whatever you want"
Male EMT: "Well, why don't you tech, since it is a female patient.  That way you can have the girl on girl action"

Dead silence (except for the sound of my head hitting the underside of the desk as I drove under it to muffle my laughter).

Thursday, June 21, 2012

Chicken 'n Chips

Ever have one of those days at work when the level of pissed-off ranges from simmer to rolling boil?

Constant interruptions are nothing new but some days are worse than others.  Kate and I always manage to work well together, but sometimes the other combinations of  co-workers doesn't 

Eeyore and Beth are a perfectly bad pair, both being negative, complainers, and glass-half-empty types.

Plus, when they are together they sound like chickens....cluck, cluck, cluck..CLUCK CLUCK CLUCK CCCCCCLUUUUUCCKKKKK!!!!!  Complaining about everything and harassing the new housekeeper mostly.  That took up a good bit of their time.

So annoying.  Between the two of them in my right ear, and the mother in the room to my left who insisted on HIGH DECIBEL PARENTING* the kid with an earache I was ready to poke my eyes out.  

Me (quietly, so that only Kate could hear):  shut up, shut up, shut up, shut up, shut up, shut up.

Kate (moaning): "Oh why won't they shut up??  They are hurting my ears!"

Me: "I am ordering a wood chipper"

Mac: "I don't get it"

Kate: "You know....Fargo?"

Mac: "You mean like North Dakota?"

Me: "You've never seen that movie?  How can that be?"

Mac: "Oh.  Is it any good?"

Kate launches into a synopsis, including the wood chipper scene. "It's pretty funny".

Me: "Heartwarming as hell" 

Mac: "So not a family movie?"

Me: "Depends on your family values"

Yeah it was kind of a wood chipper day.

*High Decibel Parenting consists of a parent who insists on speaking to their child as if they were two rooms away.  This is done for our benefit so that we can hear how what a caring, concerned, enlightened parent they are.  

Monday, June 18, 2012

You just know it's gonna be a bad shift when....

...they only saw 3 patients during the day

...the Lady on Elm St. already called the ER twice and the Complaint Line once

...the doc was working on his 3rd double in five days.

... the last song I heard on the radio on my way to work at the religious hospital was "Sympathy for the Devil"

Wednesday, June 13, 2012

Kids Can Be Tricky

Contrary to popular belief, I actually like kids;  at least the well behaved ones.  These are becoming increasingly rare.

Sometimes nurses have to be the heavy and hold a kid down for sutures, give injections, or start IV's.  It is not pleasant, and I always try to get the parent on board.  I have picked up a few tricks of the trade.

"You just give her a big hug; we will do the rest.  You always have the option of stepping into the waiting room if you like".  Parents rarely take that option, but they do occasionally trade off with the other parent if they are feeling less than supportive, nauseous, or look pale.

Hug= wrap both arms around those legs and hang on for dear life.  You cannot reason with an 18  month old when it comes to sticking them with a needle, trust me.

I have no use for a parent who tells me their kid "just won't take the medicine".
Really?  If you can't get Tylenol into a kid at 3 you have no prayer of control when they are in middle school.

I'm a reasonable person, so kids generally have a choice with me: "Take the medicine", or "Take the medicine".  They always do, and parents are awestruck that I can get a med as foul tasting as prelone into their kid.  You'd think I'd required them to eat broccoli.   Unlike broccoli, though, if you give it all at once to a shrieking, mucousy kid you will get it right back up in a jiffy.  Some finesse is required.  I just don't think there is anything wrong with having expectations for kids in the ER and communicating them clearly to the child as well as the parent.

Sometimes we come across a kid so cute even I get sucked into the Adorable Zone with the rest of my gooey co-workers.  It is like a tractor beam.

This little one was about 8 months old.  Just "cunnin" as my grandmother would say (look it up).  The other nurses made googly-eyes and baby noises.  Step away from the baby.   Don't make eye contact.  Don't....make....eye contact...

"Can you hold her for a minute?", asked mom.  "I need to run to the lady's".
Me: "Sure"

I took her into my arms as she regarded me with interest;  huge bright blue eyes and long black lashes framed by a tiny pink cap.  Little pouty rosebud mouth.  Must....resist.....

"Hello", I said.  "Want to go for a ride in the linen cart?"
Ms. Baby: (grinning hugely) "Hah!"

Tuesday, June 12, 2012

EDNurseasauras...On Answering the Phone on her Day Off

Apparently I answered the phone, told my boss I would come in to work and promptly fell back into a stupor whereupon I dreamed that I had just agreed to come to work.

I called the ER.

Me:  "Jane, did you call and ask me to come to work or was it a dream?  Please tell me it was a dream".

Jane: "Haha, yes you said you could work and you would be in soon.  Are you still coming?"

Me: "Weird.  I really thought it was a dream"

And so, Jane has learned that if she calls me early enough on my cell phone my subconscious will not only answer the phone but say yes to an extra shift.


Saturday, June 9, 2012


Sometimes text to speech programs can spit out some pretty interesting stuff.  Here are a few that I caught:

"Pt will present to All Natural eye associates after having been treated at Middle Finger medical center."
.....or we will just extend the middle finger.  Whatever.

"The patient appeared to be much older than stated age, frail and emancipated"
... but I'm FREEEEEEE!!!!!

"Pt was transported to XX hospital via anal screw (ambulance crew)"

Yeah, that last one is going to be hard to top.

Friday, June 8, 2012

Ellen....on Answering the Phone on her Day Off

"It's so hard to say no", said Ellen after she was bullied into working a Sunday.  Eeyore, who by choice is supposed to work every weekend, routinely calls in sick at least twice a month.  Ellen has such loyalty and dedication (not to mention guilt) that she usually gets suckered into working since Eeyore's idea of finding a replacement is to look around her pantry ("Nope, nobody in here!').

Me: "Ellen, just say you have plans"
Ellen: "Well, sometimes I really do have plans"
Me: "Just don't answer the phone"
Ellen: "Oh, I couldn't do that!"
Me: "Well, say you couldn't possibly work because you just finished a bottle of wine"
Ellen: "At 10:AM?"
Me: "OK, then say you just had a pitcher of bloody Mary's at brunch"
Ellen: (giggling) "Oh, that would go over well.  I couldn't lie about that!"
Me: "Don't lie then.  Every Sunday morning, just put a splash of champagne into your orange juice and when they call, say you are celebrating Lucky Charms.  Tell them and you do it every week and maybe they will stop calling".

Thursday, June 7, 2012

Poll: What REALLY Made You Decide on Nursing?

I got kind of tired of the usual stock answers.  Yes, we all wanted to help mankind.  Yes, we are all "people persons".  Yes, we all wanted to make a difference.

But what was the impulse?  It had to be something.  C'mon, spill it and feel free to add to this.  Here is a collection of thoughts by my co-workers, somewhat tongue-in-cheek, but not entirely without a few grains of truth.

"I wanted to be an LPN because a really nice one took care of me when I was in the hospital at age 7.  My parents wanted me to go to college.  I compromised on a three year school for my RN"

"I thought it would be fun to give shots;  I was thinking revenge"

"The opportunity to see blood...and guts"

"I really wanted to be a paramedic, actually; I was obsessed by that show Emergency! in the 70's"

"Capes and nursing caps, baby"

"I wanted to be a pediatric nurse until I realized I really didn't like kids all that much"

"I liked the science of nursing first"

"Because we were programmed to aspire to wifedom and motherhood as career goals and there were limited interim choices for women: teacher, secretary, nun.....nurse"

" I read a book called Candy Stripers about 30 times when I was in 2nd grade.  Seemed like a good idea at the time"

"I WAS a Candy Striper.  I spent one entire summer working 9-12 AM in the hospital coffee shop making toast and pouring coffee.  The closest I got to any patients was being promoted to flower delivery and filling water pitchers for one week.  Pinafores with gathered skirts was not a good look on me.  A white uniform seemed like a huge improvement"

"I think it was just always assumed that I would be a nurse because my mother is"

"I was a hair dresser for 20 odd years.  Then became an LPN.  Then an RN.  It was kind of a long convoluted path.  I'm still on my feet all the time, but the money is better"

Your turn.

Wednesday, June 6, 2012

Not Baby Talk

I cared for a sweet three-year old.  We had this conversation while I wrapped up his boo boo.  He apparently thought that all nurses were present at his birth

Little Voice: "Nurse?"
Me: "Yes?"
Little Voice: "Were you there when I was borned?"
Me: "No, honey, that wasn't me"

A short time later: "Um...nurse?"
Me: "Yes?"
Little Voice: "Were you a nice nurse who helped my mommy when she was sick?"
Me: "No, sweetie, that was another nurse"
Little Voice: "You're a nice nurse.  You didn't give me any shots.  Do all nurses help people?"
Me: "As much as we can, baby"

Little Voice (after pausing to consider if I was trustworthy of his secret) "Do you know that my mommy went to heaven to be with the angels?"

Umm...gulp.  No, I really do have something in my eye.

Tuesday, June 5, 2012

Postal Notes

In my monstrously large ER consisting of about 10 nurses and where communication should not be an issue, the most common method is by post-it note.  These are numerous and routinely decorate the area around the nursing station.  Changes in policy, (management fu*kery), mistakes, ("wall of shame"), or reminders (endless little notes telling us"don't forget to do blah, blah, blah" ) would pile up to the point of ridiculousness....unless I removed them.  That is my mission in life.


Parvati always speaks in caps.  Yes, she is shouting.  I treat most of these requests as I would for a kid who asks for a pony for her birthday; I yes her to death and throw it away.

Sometimes it is a legitimate request for equipment that we actually need that might be in low supply such as this:

"Dr G wants 4-5 knife handles, please"

And since we just can't help ourselves, written below:

I want an ice cream, no...make that a hot fudge sundae!

Step away from the Ginsu

I would like a bike.

Always pass a knife handle-first to avoid amputation.  This has been a very important Public Safety Announcement.

World peace, please domination

I want to buy this place after I win the lotto.  And I want a pony.

Who is writing the note is more important than what is written.  Or some sh*t.

Friday, June 1, 2012

PS, **** You

Lisa routinely begs me to leave her "love notes", humorous little observations about the absurdities of our job and/or irreverent comments about upper management (these are numerous).   I managed, after a crushingly busy evening shift in which I did not get to the rest room for 7 hours, eat dinner, or do anything other than fix other people's mistakes, to pen this:

Sorry it is such a mess.  We were here until after midnight charting.  I had a fight with Mac because he was being pissy.  It was his fault for working a 16 hour shift and not being able to figure out how to electronically order stat meds so he just left it for me.  What a shit-show.  Cathy and I are both quitting.  I'm not answering my phone so don't bother call.  Have a nice day.