Saturday, July 28, 2012

No Medals for Poor Performance

Mr. Ednurseasauras called to inquire if I was able to watch any of the Olympic Opening Ceremony with doctor's and nurses jumping around and dancing with beds.  I had no idea what he was talking about until later.  "Nope.  I'm watching patients hit the fan".  This was not a literal statement, but I did have parents bring in a  baby whose head was struck by a  ceiling fan in motion as mom lifted him over her head.  No actual baby parts were injured.

A 19 year old female was observed exiting the car via Magic Cam and crossing the parking lot accompanied by a young male.  Said 19 year old then performed the oh-so-graceful-ever-so-gentle drop to the floor where she sat partially supported by the young male.  "She passed out!"

Yawn.  Wheelchair was deployed to lobby.  Young female is clearly not unconscious.  "Get up", I whispered loudly in her ear.  Young female complied and sat in the wheelchair.

Young female was apparently found "passed out" by her car in the driveway by Male companion.  She was nauseous yesterday.  Went to work today and didn't eat much, but managed to have a few sips of Budweiser for sustenance before taking a dive in the driveway.

Yawn, yawn.  Vital signs, EKG, labs, blood sugar all shockingly normal.  Not pregnant.  Run in a liter of saline.

She was pretty much ignored for the next hour since her arrival signaled the floodgates to open wide.  I was busy, busy.  Male companion had left the building also, becoming disinterested withYoung female's sub-standard dramatic acting skills.

Apparently Young female got bored because she wasn't getting enough attention, so she took out the generous 18g IV I had so graciously placed for her well being.   "I'm ready to leave", she said.

"Yeah, no. Sit.  Stay.  Good girl.  Be with you in a minute"

In the Possum Olympics, you have failed in the Qualifying Round and will not medal.

I love the Olympics, but I just can't watch the female weight lifting.  Those little tiny girls doing clean and jerk....I have to look away because I am expecting those weights to land on top of them and squash them like bugs.  Or that their arms will splinter like glass or their knees to pop out.

There isn't much I will try to lift these days as I have too many years of work ahead of me to risk injury.    For the most part,  I really don't have to lift much.  Most of the time it's drama like Young female.  It is fascinating that people can be compelled to RISE on command because I tell them I cannot support them: "You WILL hit the floor".   It is almost always women whose sense of self-preservation takes precedence over the need for attention.

Friday, July 20, 2012

The Lady Lies

Hard to believe that she is still alive, but the Lady on Elm is indeed alive and thriving.

And she still has the patient services representative on speed dial.

My boss plunked herself down at the desk and with eye's rolling detailed Lady's latest discourse of discontent, AKA complaint number 5,234.  There are two sides to this story but only one of them is the actual truth.

On one of those very busy nights in which all rooms were filled with mostly sick people, including two transfers and a death (with ER WakeTM) Lady started with her usual phone fu*kery.  She will ask who is on, if we are busy, and to speak to a specific nurse.  The secretaries all recognize her voice if she calls as she assumes they will; they are good at deflecting her if we are busy.  Lady is the single exception to my previous post on advice calls  that result in "go directly to the ER."  Our advice to her for her non-emergent complaints are usually "call your doctor in the morning".  However, Lady has her own decision tree; in fact it is some kind of game to get us to give her permission to come to the ER.  I envision her decision tree on poster board, thumb tacked to her kitchen wall; every thought she has, every question if it remotely concerns her maladies, her meds, or any fleeting thought that might potentially, even remotely, require a medical opinion or common-sensical response encourages her to  pick up the phone and/ or "go directly to the ER".  She doesn't drive and her family members are all sick and tired of her evening visits to the ER and have generally made themselves unavailable to her after sunset.  That leaves only the Big White Taxi with the Flashy Lights.

After several phone calls in which she was ignored, Lady got restless waiting for responses to her silly questions, so she skipped right to the "go to the ER" section of her poster.  She was tucked into a room by herself.  I don't know if she is capable of intuiting that there are other patients who are sicker or require more care, or if she just doesn't give a crap; several times she called out to me.  I would run in and stick a pulse ox on her finger or bring a glass of water or just wash my hands and give her whatever update I had time for.  Not much we could do for her anyway.  After about 2 hours she was diagnosed with a strep throat, sent home by taxi that we had to voucher with 2 doses of antibiotics since the pharmacies are always closed when she comes in. We had to wait 45 minutes for the cab to come from another town as the local cab was also closed at that time of night.  So we paid for her care, paid for her cab, gave her free antibiotics, and the hospital ate the overtime for 2 nurses while we twiddled our thumbs.  Nice.

 A subsequent visit during her usual one-stop shopping for outpatient lab work, x-rays, and buying loaves of Wonder Bread the next day also included a "check in" at the ER.  This confirmed that yes, she had strep throat.  Keep taking those antibiotics.

Two weeks later, Lady came in again with sore throat.  Yep, you guessed it.  Strep.

So as to the actual complaint.   Lady claims that prior to ER visit number 3, nobody ever told her specifically that she had strep. During each of her two previous visits.  Even though it is clearly written on her discharge instructions.

Me: "REALLY.  Well, that is very interesting because I was the nurse for both visits and I VERY SPECIFICALLY recall almost word for word the conversation I had with her about strep.  We had a deeply religious experience as we waited for her hospital-supported taxi transportation home".

Jane: "I know.  She lies.  She embellishes.  And the patient services rep is her bitch."

Me: "Well you can expect some very specific notes for all of her ER visits from now on.  You know how much I like to type.   I enjoy being creative, and since now she has been exposed as a liar I can say whatever I want".

Jane: "Yes, your notes are hilarious.  Very creative and descriptive.  You should write a blog"

Meh.  I should just finish my book.

Wednesday's Corner

Wednesday continues to make me shake my head; not a day goes by that she doesn't say or do something jaw-droppingly stupid.  I believe I will be making this the first of a Regular Feature here on EDNurseasauras, Still in the Trenches.

Wednesday's latest statement of WTF-ery was revealed after a meeting regarding the Clarification and Scope of Everybody's  job.  Wednesday thinks that all the work not specifically spelled out in her job description belongs to someone else.  That is, except actually putting the little test-tube thingies in the machine and waiting for the computer fairies to magically sprinkle results and glitter out of their butts.  This was also apparently a belief held by Morticia, her boss.

Wednesday: "Is faxing, calling doctors, and entering orders in my job description?  Because I can't see that those things are included"

Morticia: "No.  Therefore it is the job of the ER secretary by default"

Jane (my boss): "Um, it is still your job; if you look carefully you will see that there is a section that covers other unspecified duties that are required to provide optimum patient care.  We can certainly rewrite your job description to provide painful and minute detail if it is unclear to you".

Reasonable people will do whatever is reasonably necessary; nobody is asking either of them to scrape vomit off the rug or fill the soap dispensers.  

I know that my job description doesn't say "answer the phone if the secretary is busy".

I am sure that the secretary's job description doesn't say "fill the stapler", "order supplies", or "clean the rooms if the nurses are busy" or a hundred other duties.

I know for certain that the x-ray tech's job description does not include "fax records to the ER" or "help the nurses in whatever way you can if there is a code"

WE are a team.  Wednesday and her boss are apparently not on our team, not in our league, and in fact do not play the same sport.  

Actually, they are unaware that working as a team in any way, shape or form refers to them.  What a pair.

I am now retreating into my trench and pulling the dirt in on top of me.  

Thursday, July 12, 2012

On Playing Possum

Many have tried to emulate a possum in the ER, but it rarely works out.  For one thing, most people who take this route are supremely bad actors.  For another, TV doesn't really clearly depict this type of scenario; actual unconsciousness is a bit more complicated than the individual of sub-par attention-seeking intelligence is able to muster.  Finally, faking seizures does not entail grabbing onto the side rails of the gurney and shaking them while moaning loudly and whipping your hair like Cher.

Thanks for playing possum, but your interpretation is an EPIC FAIL.

It will also not get you any narcotics.

Wednesday, July 11, 2012

Smell You Later

Repost, with an update.  Because I'm bored.

I have one hard and fast rule from which I never, ever deviate.  No matter how compelling or earnest the entreaty or convincing the argument, I refuse to be swayed.

When someone asks me to "Smell this"?  I. Will.  Not.  Do. It.

In fact, when I go to work I will spend 8 hours (or more) breathing through my mouth.  Only when I am safely in my car will I take a deep breath through my nose.

I hate foul smells almost as much as I hate raw chicken.  I can't help it, but I'd rather deal with most of the guts, gore and bodily fluids from any orifice, natural or man-made, than handle raw chicken.

I don't know when it started, but if I have to cut up chicken I can't eat it.  These days I can't tolerate any chicken I buy unless it is already cooked.  Oh, I like chicken well enough and I don't have any problem with eggs.  There is just something sooooooooo gross to me about slimy, nasty raw chicken in a package.

Things I would rather do than handle raw chicken:

gut fish
put live lobsters in a pot of boiling water
put worms on a hook
ladle chum
(can you tell I grew up on the ocean?)

I have a point, I promise.

Given my phobia of raw chicken and intense dislike of foul smells, you can probably understand why I went just a little apeshit when Mr. Ednursasauras took a package of chicken out of the fridge and said,
"Smell this"


Except it seems to be getting worse, this, this….bad smell thing.  I have been googling brain tumors and such because it seems I am always smelling the odor of years of cigarette smoke and unwashed human, even it it has been days since I have been closeted in a phone-booth sized triage cubicle with same.

The most recent olfactory assault has been the aroma of some kind of perfume.  Could be conditioner or hairspray.  It's sickly sweet and just WAFTS, this heavy cloying scent.  Not sure what it is, but I was trying to explain it to Mr. Ednurseasauras yesterday while we were wandering around the grocery store.
Naturally I immediately smelled it and surreptitiously pointed out the offender.

Me:  "There it is.  It's awful, walk behind that woman in the black coat and zebra boots.  The one with the really bad hair cut, see, she's taking down a box of oatmeal.  Go smell it and tell me what you think.  It's like that BO episode of Seinfeld; it's like an entity"

Mr. Ednurseasuras: "I'm not going to follow around some lady to smell her.  I will just have to take your word for it"

OK, fine.  I see your point.  Later while we were waiting in the pharmacy for a prescription I decided to smell all of the hair products to determine which brand smelled the most like Shampoo and Death.

Monday, July 9, 2012

...and it's only Monday

In this corner I have Wednesday.  She will do anything to get out of doing her job.  Won't call anyone in her own department to ask a question, "I don't know" seems to be her personal credo, can't seem to figure anything out on her own.  Is definitely more comfortable having someone else do it.  Is definitely not an out-of-box thinker, although I am beginning to suspect a dumb-like-a-fox mentality.  She is a sidler, too.  She sidles right up next to me.  If I am at a computer and typing madly (almost always a triage note or something patient related) Wednesday seems to think that is the perfect time to ask me about my weekend.  Or how much she likes my clogs.   She definitely bugs the shit out of me.  

She also bugs the shit out of Eeyore, the secretary, in the other corner.  Ye Gods, I don't think I have ever heard Eeyore  say one positive thing.  Ever.  And I thought I was the negative one. The interaction between Wednesday and Eeyore should, by all rights, be  kind of funny to watch if it wasn't so distracting, because then Eeyore complains to me.  Eeyore's method of not doing her job is simply to call in sick, but she does her job well when she is there most of the time.  Wednesday persists with her inane questions even if Eeyore is busy assisting other customers.

 Between the two of them I was ready to kill.  Instead, I wrote this:

"Ode to Wednesday", or, "Cereal?  Can you eat it like that, right out of the box?" 

I eat hot dogs with just mustard
How does one work a spoon?
Oh, look!  It's Haley's Comet!
Are there 30 days in June?

You must fax this, I made cupcakes,
Is this stapler out of date
Can you operate this toaster
Do hot-air balloons deflate?

Are you busy? Is that copper?
Have you ever played guitar
I like cheese but only cheddar
I once dropped a pickle jar

My boss is named Morticia
We be just like family
Although it would be more productive 
To hire a chimpanzee.