Friday, August 31, 2012

It's the Most Wonderful Time of the Year

School is about to start, so it's time to have all those rashes, bug bites and aches and pains checked that kids have had all summer.  It is also the time of year for requests for school and sports physicals, and immunizations to be updated which we do NOT do; lack of planning on the part of the parents does NOT constitute an emergency.  This is just laziness because I know the local school nurses send updates in the spring notifying each grade level to start making their summer pediatric appointments promptly because they book up three or four months in advance.  It is pretty hard to get an appointment once June rolls around, and by the end of August you are just crap out of luck and your kid won't be playing sports without that physical form.  So just do it already.  Some people will try to parlay a bogus injury into a comprehensive physical exam, but we are wise to that and won't sign the forms.

During the school year we see WAAAAAAYYYY too many school-age kids at 9:00 or 10:00 PM with injury sustained during the day.  It is one thing to try common sense remedies such as RICE (Rest, Ice, Compression, Elevate) for hours and then bring the kid in because it is very painful.  Most often the complaints of knee, foot, ankle pain are reported near bed time without any intervention.  After a full day of school, sports, playing and jumping on the trampoline for an hour the kid reports the injury as "not better" and the parents race to the ER for an x-ray, walking without difficulty.

So I am going to go out on a limb here and suggest, as a public service, that this school year a little common sense be deployed when it comes to breaking land speed records getting to the ER for a negative X-ray.  See RICE, above.

Also, crutches are really not fun after about an hour.

Thursday, August 30, 2012

I'm So Dizzy, My Head is Spinning

A 63 year old man walked in with dizziness.  Dizziness is always so vague; it is a gateway symptom to something else that's going on usually.  In this guy's case, there was also a bunch of other stuff, including leg swelling for months, and oh, yeah, this numbness in my face.  He hemmed and hawed and thought out loud about each and every question which just makes triage so much more difficult.

Dizzy Guy was accompanied by a female friend; close friend from the looks of it and the way she tried to answer every question.  Or contradict every response he made.  Or point out another symptom.  Or correct a time frame.  Or rat out yet another symptom.  Or embellish and speculate on every triage question.

Me:  Are you diabetic?

Dizzy Guy: Well, I haven't seen my doctor in about a year, so I could be...

Dizzy Girlfriend: He has to be...

Me: To be clear, you have never been diagnosed with diabetes or pre-diabetes and are taking no medication?

Dizzy Guy: Um, no, but sometimes my blood pressure is up.  I have some back pain, and I.....

Dizzy Girlfriend: He has been under a lot of stress at work; I want you to write that down.

Dizzy Guy: I'm FINE.  I'm NOT having a heart attack.

Dizzy Girlfriend: I want them to know everything and you don't tell them everything....

Dizzy Guy: I have been having some leg swelling, but I think I've been walking around a lot..

Dizzy Girlfriend: I think he's been trying to cover up the fact that he's been short of breath when he walks

Dizzy Guy: Not really, it was hot yesterday and I was...

Dizzy Girlfriend: Yes, I really think he was!  And he didn't eat as much as he usually does, and...

Me: Time out!  Let me just talk to Dizzy Guy for a minute, mmmmkay?

Dizzy Girlfriend: OK, I'll shut up.  Did he tell you about these little dots on his legs?  And why does it look like they are 2 different colors...

Me: Why don't you have a seat over there for a minute?

Dizzy Guy: She will drive you nuts.

Dizzy Girlfriend: I'm just looking out for you

This exchange was rapid-fire, neither one could focus.  And they kept interrupting each other AND me.  I became frustrated being unable to get a word in edgewise so I kinda lost it.

Me: OK, nobody talk but me, then I want the Reader's Digest abridged version unless I ask.  Got it?

Things deteriorated when the doc told them Dizzy Guy might be having a TIA.

Dizzy Girlfriend: (yelling into the phone) He could be having a TSA!  He has to go for a CAT scan!
Dizzy Guy: Is she driving you crazy yet?

Me: (banging head against desk) TIA!  TIA!  TIA!  TSA is at the airport!
Partner in crime: Well, at least they won't need the complimentary strip search.

I pulled a 7th grade Vocabulary Workshop word out of my a** and pronounced them garrulous.

As he was wheeled away, the paramedics offered him a blanket.

Dizzy Guy: Well, I don't know, I could.  I really don't need it, but I suppose I could take one and....
Me: Just take it!  It's a blanket, not an investment decision!

They were nice people, but exhausting.

Wednesday, August 29, 2012

Welcome to Acronym Hospital

Acronyms are, of course, wildly popular in health care.  I don't think the job would be nearly as much fun without them.  "Medical speak" is cumbersome and the average person usually doesn't know everything we are talking about even if we use the actual language.  It can be confusing for people in health care as well, but there are some basic acronyms that people are expected to know like in the first 10 minutes of their training.  Take Wednesday, for example; surprise, surprise.  She overheard Eeyore tell me that she had just put a patient in treatment room 2 with SOB.  This is one of the biggest jokes in health care since it means "shortness of breath", rather a garbage term for someone with any complaint ranging from cough / man cold to pulmonary edema.   Wednesday was aghast that Eeyore was so rude to refer to someone as a Son of a Bitch.  Right.  Bonehead.

At some point hospital administration jumped on the Acronym bandwagon.  Where I work not a week goes wherein the Suits in Charge of Stupid Shit does not devise a new set of "catchy" phrases to go along with their latest so-called motivational agenda.  SPIRIT and CARE are two of the latest to hit the hospital.  The Suits apparently spent months on those with little else to do after the massive reduction in force.  Then they wonder why their employee surveys suck.

It didn't take Kate and I months, but rather minutes to come up with new meaning for SPIRIT.

S  squirrels....'nuff said
P  plenty of Percocet for all!
I  if it is difficult, we might do it.  Impossible?  Fu*k it.
R  really??!! Your prescription for narcotics was lost / stolen / thrown away / eaten by wild dogs??
I  if assholes could fly, this place would be an airport
T  totally allergic to tylenol, tramadol and toradol.  But the dilalalalala stuff works purty gud.

Suits spend seemingly endless hours in useless meetings to try to devise work- arounds  to improve satisfaction scores.  They don't seem to get that better support of the nurses would reap ten-fold rewards in that arena.  They are not getting that people who genuinely believe that their management cares fu*k-all about them are not in the greatest position to be institutional cheerleaders.  Plus we know they think we are stupid and don't remember stuff.  Like, in this electronic age, why are you still doing employee mailers?  Stamps add up.  Or the cafeteria closes at 5 PM, now 2 hours earlier which says "screw you" to the evening shift.

Honestly, we just don't care about your so-called "Service Recovery" acronyms.  We spend lots of time enjoying making fun of them, though.  Same goes for "Key Words at Key Times", which will be tomorrows topic of conversation.

Service Recovery employs the HEART acronym.  It stands for HEAR the patient, EMPATHIZE, APOLOGIZE, RESPOND, and THANK them.  Seriously.  The following is an example of how we, as nurses, are expected to respond to rude behavior from patients and families.

"I understand that you are upset.  I know how frustrating this must be for you, and I will do everything I can to get you into a room as soon as possible.   I apologize for the long wait, but I promise you will get the same careful, comprehensive exam and care when it is your turn.  Thank you for choosing our health care organization"

Seems like a good idea on paper, but in actual fact it pulls nurses away from the bedside and rewards bad behavior.  Monkeys then copy that bad behavior so it is a losing battle to employ that kind of psychology.

So,  to put some perspective on this scenario, imagine that you are are a patient sitting in the packed waiting room with abdominal pain, a febrile child with an earache, or a deep laceration.  You are a reasonable person with reasonable expectations and expect that you may have to wait.  As a reasonable human being you *get* that other individuals may be sicker than you are, have life threatening illness, and might require more intervention thus stretching our limited resources.  So keeping my little speech in mind, now imagine that I am responding to a highly negative verbal assault, shouted in your presence or that of your young child.  You could not be aware that this individual has dozens of visits for the Holy Trinity of Chronic Pain Complaints, nebulous injury with severe pain requiring narcotics, and an affinity for being disruptive.

"This is bullshit!  I have been waiting 30 minutes!  I'm going to talk to my lawyer if I don't get some answers and see a doctor!  What is the name and number or your supervisor!  All you people do is give me the runaround!  I have real pain issues!  I'm leaving"

As a patient who is being reasonable, playing by the rules and waiting your turn, are you going to put up with my decision to reward this type of behavior by immediately taking him into a room?  No, you are going to be pissed unless you are one of those parents who tries to calmly explain to their 2 year old who is banging the dog on the head with a hammer why it is a bad idea to hit Fido on the head.

Instead I say something like "Ok, sir have a nice day there.  I'm calling the police"

Many thank me for my own brand of service recovery, tell me they appreciate the way I handle it, or simply applaud.

Thank you very much; the bullshit has left the building.

Tuesday, August 28, 2012

Stuff I Wake Up to After Dozing on the Couch After Work

OK, the sound was off.  I woke up and saw this on TV:

3 youngish looking guys. One of them is wearing Sally Jessy Raphael red glasses.  One looks like a Jonas brother.  One looks like a combination of  a so-called "Guido" from Jersey Shore and Uncle Jessie from Full House.

What are they singing?

A.  Girls Just Want to Have Fun
B.  Some Menudo song
C.  Opera.

Hint: it was a rerun of Kathie Lee and Hoda, which I wouldn't be watching at 11:00 AM, never mind at 3:00 AM.  It was really way past time to go to bed.

Monday, August 27, 2012

I Don't Flirt

A 42 year old guy came in for a suture removal.  Yes, we do this.  We used to do it for free, now I'm told it is something that gets billed.  It was a worker's comp, so whatever.

The guy was the tiniest bit goofy, and had a fairly androgynous looking kid with him of indeterminate tween age, I just couldn't tell if it was a boy or girl.  Turns out it was a girl.  "Will there be blood?", she asked as I got out the scissors.  Wasn't that a movie? 

After the sutures were removed and I prepared his walking papers, I teasingly asked the little girl if she saw any blood.

Dad: "Hey, you said that like you have kids"
Me:  "Oh, sure.  I have kids your age"
Dad: "What?!  That can't be true.  You're too young to have kids my age!"
Me:  "I had my first when I was about 12, so yeah.  About your age"
Dad: " No, go on!  You're joking, but you are just too cute"
Me: "Um, well thanks for making my day"

Flirting, me?  Yeah, no.  I was being a wise ass.  HE was flirting.

Sunday, August 26, 2012

Be Prepared...Just Sayin'

0-60 MPH in this ER.  23 patients one night, 5 the next.  Even the phone calls were boring; the Lady on Elm anonymously called to see if Sherry was working although I knew it was her.  Nervous Lady called to see what time we closed.  Then called back to see how late she could come in for x-rays.  Then called back to see what time the lab opens.  She does this several times per week, we suspect she is really a mole for the Suits to try and catch us in a lie.

My hospital mandated competencies were all up to date, People magazine was read, and the place was stocked and tidy.  There is only so much internet surfing you can do since most sites are blocked.  That left us generally free to listen to the scanner and catch up on all the delightful antics of the community in which I work.

There were about 5 calls for local police / ambulance to a nearby apartment complex for this and that; fall on floor, unresponsive but breathing, back ache, suspicious activity.  Annika, a lovely per diem radiology tech was taking advantage of the quietude to make a phone call on the veranda (ambulance bay) when she noted the Whole Nine Yards speeding by with lights and sirens; 2 ambulances, an undetermined number of fire apparatus, every police car in town.  Double overdose in the same apartment complex.  Now would be a good time to commit a crime in town, but not to have a medical emergency.

The victims were known to abuse lorazepam according to dispatch.  Well, I though as I got out the IV drug handbook.  Let me read about administering flumazenil and how to reverse benzodiazepine overdose since I haven't done that in years.  Just on the off-chance that the patient might be brought to my ER.  Remote, but possible.

Mac noticed the commotion outside and inquired as to what the call was; he also noted that I was looking up drug reversal recipes.

"Where is your I-O stuff?" he asked.  "If we get it ready, we won't need it"

Good call.  We amused ourselves with code cart stuff while we waited.  And waited.  And waited.

We didn't need either the I-O stuff or the flumazenil, but at least I put my down-time to good use.

Saturday, August 25, 2012

What's the Temperature?

SIC was reading some study about temporal vs. oral temperatures that she just had to share, I wasn't really listening since I was reading the latest issue of People magazine.  The study said something about oral temperatures being more accurate on kids aged 3 months to three years, although a rectal temp is the gold standard for babies.  That caught my attention since why anyone would bother even attempting to take an oral temp. on a 3 month old defies all logic so I wrote the data-reporting off as bogus and stopped listening altogether.

Until my next patient limped in with her veterinary tech boyfriend with a stubbed pinky toe, who said she had an extra foot bone that periodically dislocates and it felt like it was out of place.  Vet tech had actually wrapped the foot in several yards of purple vet wrap; we have the same thing for humans but we call it Coban, sort of an elastic self-sticking tape that comes in all different colors.  Paeds nurses used to yell at us when we used it to secure the IV's of admitted babies, but it works great on them.  Dogs too I imagine.   I suppose stubbed pinky toe was grateful that vet tech boyfriend didn't have any other stray veterinary equipment lying around such as this:


Vet tech was fascinated with the temporal thermometer, and commented on how awesome it would be to be able to use something like that on dogs instead of rectal.  And then my mind started to wander envisioning dog-wrangling and trying to get a temporal thermometer to work.

Me: "Yeah, I guess rectal temps will remain the gold standard for dogs", which sort of put into perspective the whole oral temp on babies thing.  And then my mind wandered again and I thought about how awesome it would be for dogs if Vet wrap was bacon flavored....

Friday, August 24, 2012

Thumbthing Wicked

Story time; unusually quiet night.  SIC talked about a patient who had scarred her for life with a particularly horrible thumb amputation, some kind of outdoor industrial-type accident that occurred during a below-zero day here north of the Arctic Circle.  It was so cold that she had to peel off 8 layers consisting of orange day-glo vest, other vest, jacket, coveralls, flannels, long sleeved shirt, long underwear shirt and silk underwear before discovering that not only was he missing a thumb, but his ulna and radius were poking through the skin.  Then she described having to retrieve the thumb from the front seat of his truck (he drove himself to the ER) and having to shake the amputated thumb out of the glove.  Urp.

I once had a man chop off his own thumb with an axe (fairly common), except he came to the ER without the amputated part.  It was missing.  His family was searching for it.  The search lasted for nearly an hour and feared that the family canine had absconded with the the thumb.  Fortunately  it was found near some canned goods in the basement.  The thumb, not the dog.  Bobo was concerned that the family should know exactly how to transport the thumb.  Yes, I told them to put it in a baggy.  Yes, I told them to put the baggie on ice.  Yes, I told them not to put the thumb directly on the ice.  Finally the family calls to alert us that the thumb has been located and is on the way; the dog is in the clear.  I relay this information to Bobo, who is a genetically humorless individual.

Me: "So, the wife has located the thumb and is on her way in"
Bobo: "Ok, good; they have it on ice, I heard you telling them how to pack it"
Me: "Yep.  I have just one question though"
Bobo: "What's that?"
Me: "Do I have them register the thumb as a new patient?"

Bobo actually laughed for about 2 seconds before he composed himself.  I don't believe anybody has ever heard him so much as snicker.

I know.  I have a dark gift.

Thursday, August 23, 2012

Working Together, Yeah.

I don't let people abuse the registration staff and encourage them to simply excuse themselves from confrontational individuals and let me or the other nurses handle it .  I have even rescued Wednesday from rabid patients.  For one thing, I just don't give a rat's fat  ass how long the out-patients are waiting if there are ER patients;  that is the lab's problem and something they need to fix.  It is not the fault of the registrars if the barely-there phlebotomist decides to have lunch at 2:30 PM every day and the lab manager allows this regardless of how many blood draws there are.  FYI, that is a very busy time of day for both ER and lab.  Work with us, please.  Still, it is unacceptable to treat any member of the staff disrespectfully.  Manners: get you some.

Eeyore is usually pretty good at deflecting things; Ellen has a tendency to get flustered and apologize all over the place, then come and find me when the yelling starts.  It makes it more difficult if I intervene late in the game, but that's my job I guess. I have no trouble firmly but unsmilingly telling people to calm down because the registrars are doing their best to accommodate their rude asses, while I am mentally telling them to take a double flying fu*k at a rolling donut.  And then I add 10 minutes to their wait time.  I am not at all passive aggressive.

There are some hot-button questions that seem to rankle, as if we are making things up just to piss them off.  Really?  Don't you think if we had any control over these things we would streamline the process more?  Or at least ask more fun questions, such as "What color is a red house?", and "If a monkey can climb a greased pole in 10 seconds, how much does a pound of butter weigh?".

But no.  Mostly it is the mundane that set people off.  That, and unrealistic expectations.

You asked for all this information last time
Yes, I know.  Gets boring doesn't it?  So does your excuse for failing to have an ID.  Or insurance.  Or  an address other than a PO box 2 hours away.  Because we all we are really trying to do is catch you in a lie, right?

My doctor's office has all of this information on record
Your doctor's office computer thingy doesn't speak to ours.  It is a 9-5 computer thingy anyway, and since it is after 5 PM, it has gone night-night.

My doctor told me this was an emergency and I should be seen right away.
When I called your doctor's office (thus wasting 10 minutes of my life I will never get back) to ask them (to take time out of their day) to fax me your medicine list (that you should know yourself), they informed me that you had (but didn't think you should wait an additional 90 minutes) for your scheduled "urgent same day appointment" (for something stupid).  You have just guaranteed that you will not be seen before then.  FYI,  99 degrees Fahrenheit is not a high fever, and saying you "felt warm all day" confirms that you are an idiot.

"Are you going to rob me?"
 Asked of  Ellen by a complete douche-tard during the obligatory request for insurance information. Highly unlikely since you have no insurance.  Or any ID.  Or have given us a bogus address.  More like you robbing me since you have no intention of paying your bill.

You don't understand why I'm calling the police?
You just threatened to "go off on me" and "make me sorry I was ever born" if you were not seen immediately.  Buh bye.  Have a nice day.

Which brings me to the Last Word in conflict negotiation.  The Last Resort.   I am eternally grateful for all the support our local police gives us.  It happens often enough that it is necessary to call them, usually when the decibels exceed polite levels and violence is threatened.  The prospect of the special little "adult time-out room" with the metal bars almost always takes things down several notches.  I especially like it when they say, "Now, is there anything you want to say to the nice nurse who is just doing her job?" as they are led away.

Really.  Buh bye.

Tuesday, August 21, 2012

I'll Be Calm When You Leave. I Promise.

The working environment in an ER is labile, obviously.  ER nurses wouldn't want to work there unless there was some variety now, would we?  Most of us could never work anywhere else, but that doesn't mean it's all wonderfully sunshiny and glittery.  There are no unicorns defacating  rainbow colored poop, let's be clear.   And let us not forget about the DRRRAAAAAAAAMA.  Distraught patients and families, unfulfilled drug-seekers, and teenagers are not the sole providers of drama.

As for drama, I personally  don't care if the world is going to hell in a hand cart patient-wise as long as I am working with people who are calm and orderly as well.  I do not respond well to individual mayhem, chaos, and people spinning will-nilly in their own disorganized orbits.  Just take a breath.  It is not time to panic until it is time to panic.

Gil likes it calm; we enjoy taking a deep breath together as the day shift leaves, taking their chaos with them.    I like my own inner peace to prevail even if I am racing from task to task.  There are some combinations and groups of people who work cohesively, work as a team, and make the experience pleasant.  If nothing else there is a common hatred of management bullies and company bullshit.  The more "big personalities", "lone wolves", "chronic complainers" and "debbie downers" who are part of  the work environment, the more unpleasant it becomes, which has a tendency to mess with my inner calm.

Things that generally fu*k with my chi:

1.  Wednesday, the lab tech.  She is like nails on a blackboard.

2.  Eeyore on a day after she calls in sick because she just fu*king whines and I want to hit her.

3.  The air conditioning on the fritz.  For the entire weekend.

4.  Patients who come in five minutes before we close for crap that's been going on all day/week/month/year.

5.  Coworkers who whine about the schedule because they didn't get to it first.  Haha.

6.  The Lady on Elm St. calling for the 4th time.  In one hour.

7.  Patient's with silly reasons for being in the ER who want warm blankets, 3 pillows, an ice pack, an additional 4 more "something I forgot to mention's", are talking on their cell phone and want change for the vending machine because they need a little snack, coloring books and crayons for their demon spawn and are pissed about the wait, all in the first 10 minutes of the visit before the physician has a chance to see them.

8.  Any shift with Parvati because she yells orders to the universe in general and calls me Nancy repeatedly.  Which I ignore because my name isn't Nancy.

Quit fu*king with my chi.  Honestly.  We'll all be happier.
Now just go breathe somewhere else, there's plenty of oxygen over there.

Monday, August 20, 2012

Not Time for Lyme

Non-stop madness, no time for anything and we get about 3 people at once for "tick bite", "I think I have a tick bite", and "is this a Lyme disease rash".  One turned out to be a mole, one was a mosquito bite and the rash?  Who knows.   Not Lyme.

You would think that if people were living in one of the biggest Lyme corridors in the country that they would educate themselves on what to do if they encounter a tick on or near their person.  Sometimes people bring ticks they have recovered from their PETS to have them "analyzed to see if it is a deer tick".  No.  We don't do that.  Mostly it's unidentifiable tick parts.  Or spiders.

Even if they have consulted Dr. Google, people seem to skim over the bits about how tick-borne illness is acquired and  symptoms to watch for.  But they still come screaming into the ER as if they had just found a black widow spider in their Underroos, paying no attention to the fact that the Lyme disease tick is quite tiny.

Just a general informational tidbit here: ticks cannot fly.  If it has wings, it is NOT a tick.
It depends on the doctor how much of an intervention will be carried out in the ER.  Mostly we just give them a dose of antibiotics and kick them to the curb.

The tick may be removed with a little plastic spoon with a notch cut into it.  Or a 20 gauge needle.
The area might be anesthetized and the tick removed with a scalpel

The patient may or may not have a Lyme titre done.  This is kind of useless as an indicator for Lyme if a tick has been on your body for 10 minutes.

Not to be an alarmist but there are many, many more tick borne illnesses to be afraid of.  Very afraid.  Don't even get me started on rabies exposure.

Sunday, August 19, 2012

Listing and Such

Just one more reason why the fun and creativity is sucked right out the job:  I am no longer allowed to number medical complaints what with the new-fangled eeeeelectronic  medical records keeping system and all.  For some inexplicable reason any triage complaint chosen from a pre-loaded list gets immediately coded.  We are discouraged from adding multiple complaints because it opens up a couple of cans of worms.  In the past, I would simply do this for multiple frivolous complaints:

1.  Man-cold
2.  Rash x 3 years
3.  Requests psych med/pain med refill
4.  Work excuse
5.  Ingrown toenail

Succinct.  Easy to read.  Says, "I'm listening, but not very hard right now", and says a lot about the patient without really having to say anything, right?

So now I could just put it all in a free-text stream.  It doesn't look as eye-catching when I write:
Pt. states: Cold, rash x 3 years, wants medication refill, a work excuse and an ingrown toenail.

See?  Just not as effective.

Along with a litany of complaints that I am now no longer allowed to number was a female, age 30, with:

Facial pain.  Low back pain.  Knee pain.  Constipated.  "Feeling weird".  "Feeling warm" (not febrile).  Peeing less.

She did have a number of medications for anxiety, chronic shoulder pain and fibromyalgia.

Except she pronounced it Fiber Mal-Eye-Ja.

Really.  Yes, she was a native English speaking individual.  She also mispronounced Klonopin (Klonda-keen), Gabapentin (Gabro-my-pentathol), Lorazepam (Lora-pm).

Saturday, August 18, 2012

Loon in a Box Indeed

I wasn't really watching some show as I drowsed on the couch after a ridiculous shift, but it had something to do with Maine (State) Warden Services.  I thought I saw a guy plowing a driveway with a plow blade on a bicycle, but I could have been dreaming.

I live in the north;  not Maine, but I can relate to Maine.   I'm not getting why one of these guys (I might have fallen asleep) was stalking an apparently injured loon across the snow, staking him/her out in an under-the-ice hidey-hole cavern in a rushing stream where he proceeded to lure him/her out with a loon...yodel.  Next the warden took what appeared to be a plastic storage box from Home Depot and attempted to capture the bird.  Oh, I thought as he waded across a snow-covered stream...this will end badly; blood and guts and feathers, everywhere, all over the ice.  And a sodden hypothermic warden for sure.

But no.  He somehow managed to get the bird corraled in the box and placed a lid on it, whereupon he proudly displayed it to the camera:

"There you go; loon in a box".

Did I dream that?  Maybe.  But all I dreamed about all night was hooting loons.


Thursday, August 16, 2012

A 29 year old with a recent cholecystecomy, history of alcohol abuse etc, cirhosis, etc, comes in because he...surprise, surprise...ran out of oxycodone.

Because of the liver disease, he was careful to tell me, he couldn't take acetaminophen.  But because of the pain and no oxy's since yesterday he had had a few beers in spite of the fact that his discharge instructions clearly said "STOP DRINKING".

I couldn't help it.  I blurted, "You're a dumbass"

He looked guilty. "Well, but I didn't think just a couple of beers would really make that much difference"

I felt bad for him.  I felt bad that I called him a dumbass.

I told Mac what I had done.  He cocked his head to one side, considering for a moment.  "Well", said Mac, "he IS a dumbass".

As I was discharging him I tried to get into his head a little.  I apologized for calling him a dumbass.

"Oh, I am a dumbass, my wife says it to me too.  I know it.  I realize that even one beer is too many"

Me: "I don't say this to everyone.  But I'm an old woman with kids older than you are, and I am seriously concerned about you.  You're too young for this.  Do you have kids?"

"Yeah, two, and one on the way.  The oldest one is 6"

Me: "Those babies need their daddy.  I hope you can get the help you need to be there for them"

The saddest thing is that I don't think he will be around long.  It's sad.  He seemed like a nice kid who just went off the rails.

Wednesday, August 15, 2012

Son of Misqoutes

A 2 year old was brought in with a crayon stuck in her nose.

Why?  "It was GREEN!"

It was easily removed with a Katz Extractor.  Man, I wish I invented that thing.

The following dictation was not proofread by the attending:

"The patient was stabilized in an Extractor which was inserted in the right nares and a small cranium was removed".

Crayon.  CRAYON.  CRAYON!!  I'm certain she is going to be needing that cranium sometime in the near future even if it is quite tiny.

This next one, courtesy of Dr. I Never Check My Dictations, details the very minor complaints of a young man who had been in an MVA.

"This young man suffered no loss of consciousness, but reports a headache which sex has resolved"

What?!  I had to point that one out once I stopped laughing, but not before I wrote it down.

FYI he meant "which SINCE has resolved".  


Thursday, August 2, 2012


The Talker takes the cake for the number of amusing misquoted dictations, he of the legendary "anal screw" dictation (ambulance crew).  He is a bit of a low talker which doesn't help.  Heck, I can't hear 3/4 of what he says.  I have never, ever heard him raise his voice about anything and he rarely gets excited.  That is to say a raised voice which would be in the normal human conversation range, and excitement....just couldn't picture it.

"Poni ice to affected area 20 minutes per hour".  Not the ice of regular sized horses, it must be poni ice.  Poni= apply

"You must quit soaking".  Dry out, you're all wet.  Soaking=smoking.  

"Watch for signs of injection"  Because they can sneak up on you.  Injection=infection

"History of My Grain Clinic"  It must have been somewhere in the Mid-West.  My Grain Clinic=migraine headache.

"...append ass us".  We will just stick it on the end of the butt.  appendicitis

By far the funniest thing I've seen or heard in awhile occurred while I was buying my new this past week, a story for another day since I am still on an adrenaline rush.  Be calm.  Breathe.  Drink more wine.

Anyway, a sales person who was not mine was dealing with an obviously disgruntled customer for whom English was not a native language and who was having some sort of difficulty with a series of repairs on a used car she had purchased.  I was too busy trying to get my calculator to work, but heard this much:

Sales guy: "So what's up, girl?"

Woman: "Yeah, I'm gonna have to talk to a lawyer or sump thin, these things are not being fixed".

Sales guy: "What's going on"

Woman: "You know, the blah blah is this, and the blah blah is that"

Sales guy: "What have the repair guys told you, and what do they propose to resolve the problem?"

Woman: "Yeah, it's a thing with the asshole, you know, I don't know anything about cars.  The asshole,  man, there's a problem with that"

Sale's guy (to his credit doesn't even blink): "I think you mean the axle"

I stuck my head in my purse to hide the laughter, but not before the sales guy winked at me.

Wednesday, August 1, 2012

Shark Tale

So, I'm sitting here watching the news, a follow up story from the other day in which a man on vacation was horribly bitten by a shark in front of his son while body surfing .  The man survived, and was alive and well enough to give commentary on how incredibly lucky he felt.  No, it didn't ruin his vacation because now he would have a story to tell.

A story to tell??  Um, I have a slightly different take.

I am too lazy to do the research or the statistics, but I would think that the odds of getting attacked by a shark for someone who casually swims in the ocean a few times per year are far fewer than someone who swims in shark infested waters all the time.  So on the bright side, this guy's chances of getting attacked by a shark a second time  IN HIS LIFETIME are slim.  To none.

Getting attacked by a shark and surviving is like getting struck by lightening.

But what about the odds of getting attacked by a shark and surviving, and SUBSEQUENTLY being struck by lightening???

This gives me a headache, think I will have another glass of wine.