Wednesday, October 31, 2012

On Halloween...

For safety Halloween was, by decree, delayed for a couple of days, which was kind of too bad because the sky looked pretty spooky right about sunset. 
We were very lucky in this area. No flooding, minimal power loss for my street, not a lot of wind damage.  We only lost power for about 6 hours which was surprising since normally we lose power for days at a time.  With so much devastation along the East Coast we were very fortunate indeed.  I can't imagine how awful it must be for many communities, and how awful it is going to be for quite some time.  Here's hoping that all emergency workers stay safe.  

I'm over Halloween though.  I haven't had a single kid come to my door for the past 7 Halloweens living here north of the Arctic Circle.  I live on a cul-de-sac;  there aren't any school-age kids or street lights, and the houses are a good couple of acres apart and set far back from the street.  Even if we were one of those neighborhoods that attracted the sort of mini-van drive-by street-cruising Trick-or-Treat ninja mamas, they would still have to drive from house to house.  It's apparently not worth the effort or gas for a paltry candy haul.  As for me, I usually try to work on Halloween, but failing that Mr. EDNurseasauras I will go out for the evening.  It's the best time to go out because there aren't many kids or crowds in the restaurants, and we aren't out late enough to have to deal with the bar crowd.  It's also the best plan to avoid having my dog go ape-shit with the doorbell and having all that leftover candy around calling my name.  OK, so I'm a Halloween Grinch.  

And shoot me if I've never liked costume parties.  There's just too much pressure.

Here is a Costume Fail I came across at a flea-market last weekend.  
What the quack??

My dog had a better costume wearing her hunting season walking attire.

"Where is my beret?"

Even at work I never dress up.  I once wore my cap, but I don't have seasonal scrubs with cute little ghosts or witches.  I have nothing against them, it's just personal preference.  I'm more comfortable in boring scrubs.

Partner in Crime does all the decorating and acquired this little craft-fair felt sign to hang up at work.
Me: "It says HAPS-PY"
PIC: "No, it says HAPPY"
Me: "Clearly, there's an S in there"
PIC: "That's part of the pumpkin vine, see there's leaves on the stem"
Me: "Why would it be carved up with a face if it was still on the vine?"

Argument for argument's sake.

So...Hapspy Halloween, even if the police chief says no Trick-or-Treating until Friday.  Stay safe.

Saturday, October 20, 2012

We Are Going to Need Some New Monkeys

This is a picture of a fenestrated drape.  It is sterile and, among other things, comes in a suture set.  It is made out of a kind of heavy paper towel type of material.  

The whole thing is sterile and kind of extends a sterile field.  If placed over say, a laceration that has been prepped and anesthetized, the laceration would poke through the middle.  This ensures that the suture material doesn't become contaminated by anything.  They are generally supplied by a manufacturer.  See that nice, neat, carefully centered hole in the middle?

Note that I said "middle".  Now, see this?

The hospital has been trying to save money by using making their own fenestrated drapes.  Clearly there are some employees unclear on the definition of "middle".

"Send this down to central supply with a note for the manager", said Gil.  "This is the 3rd one of these I have gotten today, that is so annoying".

To: Central Supply
Re: Fenestrated Drape
Houston, we have a problem.....

Friday, October 19, 2012

Cat and Mouse 2.0

Note: No mice have been hurt in the writing of this post

Our daytime secretary happened upon the newly placed mouse trap provided by the facilities people (not IT) and found...shriek!...A MOUSE.  She hyperventilated for awhile, then came up with an action plan.  Leslie picked up the trap wearing two pairs of gloves and stepped out the ambulance bay door into the shrubbery adjacent to the ER all the while saying Ew!  Ew!  Ew!  Ew!  While she felt a bit squeamish about rodent rescue, especially before she had her coffee, she didn't want it dead or suffering.  At first, she gingerly shook the trap to dislodge the mouse off the sticky stuff at the bottom of the trap.  When that didn't work, she shook a bit more vigorously.  Finally she managed to get the lid off and tossed the live mouse into the brush; Leslie was shrieking, the mouse fairly silent as it ran off into the woods probably to warn the rest of his mousey friends.  Traumatized, Leslie made herself a cup of coffee and sat down with a bagel.  I don't know about the traumatized mouse.  It has been at least 3 weeks since the traps were placed, now long forgotten by facilities.  These traps are apparently going to be there forever.  Naturally we have had a little bit of fun with them.

Helpful hints

No mice have been even remotely attracted to this.  

Thursday, October 18, 2012

Meet Pull-Toy

I have another student.  Yes, the powers-that-be have given me another young mind to mold and shape as I desire (insert evil laugh).  Bless her little heart.  It is pretty much a 2 month job shadow, but I can probably at least get her to change beds and fill ice packs.  Fun.

Last time I had a high school intern for more than a day she spent about 6 weeks mostly doing her homework; rather, she doing hers and me doing mine.  On her second to last night I gave her a syringe and a couple of 10ml vials of normal saline and taught her how to draw it up and remove the bubbles, etc.  She wore out the syringe doing it over and over and over; it kept her busy for about 2 hours.

Her final critique of the experience: "EDNurseasauras taught me how to put water in a syringe with a needle and take out the bubbles.  It was the best thing".  She had a whole little presentation on it.  I am famous at the high school.

Sigh.  (sniff).  They grow up so fast.

My new little pull-toy hasn't decided on nursing or medicine or what the hell-all she wants to do, which is great.  Her mind is like a fresh batch of cotton candy.

Pull-Toy wants to see and do it all and have lots of experiences.  I reminded her to journal and pick out the best and worst stuff of every night mostly because I thought I should be able to give someone some homework for a change; yeah I know, power trip.  Actually it would make her life easier when she has to do a presentation at the end of the year for her class.

Most of the doc's are pretty good with students, and when it isn't really busy will let them watch suturing and stuff.  I thought I would start Pull-Toy off with watching me apply a finger splint and went off to the closet to fetch it.  When I came back, Mac was quizzing Pull-Toy about which joint she thought would be proximal and which one distal.  I sent her off to look for tape instead.

Me: "Mac, maybe we should teach her the bones first before we worry about joints"
Mac: "Oh, yeah sure, wouldn't you learn that in nursing school before you start clinical exposure?"
Me: "Yeah, probably, but she doesn't graduate until June"
Mac: (astonished) "Eight months or so from graduation and she hasn't finished anatomy?? How can that be?"
Me: "Um, well she's a high school student"
Mac: "Ohhhhhhhh.  Ok.  That's cool"

Wednesday, October 17, 2012

Dewshe Bagghe of the NIght

In the middle of an absolute shitstorm  I became aware of the smell of....smoke.  Electrical?  Burnt popcorn in the microwave?  Wednesday thinking too hard?

No.  It's...cigarette smoke.

Where is it coming from?

Cardiac guy just sparked one in the bathroom.  While waiting for his telemetry bed downtown, his 3rd admission in a month.


Mac confronted the guy; tells him that his decision to light up in the unventilated bathroom was a selfish decision which has made the  environment toxic for patients and staff.

I was furious.  It is one thing if you have a death wish and want to poison your own body, have at it.  But please.  In a hospital, dude?  You could have gone outside which was a lot closer than the bathroom.

Mac: "He said he was sorry"
Me: "He can stick his sorries in a sack.  What a douche"

Smokey: "Hey!  Can I get some more of that dilaudid before I go in the ambulance?"

Dear facilities, I would like to request that a smoke detector be placed in the bathroom.....

Tuesday, October 16, 2012

A Sarcastic (no sh*t!) Open Letter

Dear Parent,
We are happy to provide you and your child with care today.  If there is anything we can do to make your visit extra-special or answer any questions, please ask any of us; we work as a team and automatically know the intimate details of your history, allergies, medications, and exactly how long the wait will be.  Feel free to ask our secretary and radiology tech also because they all have instantaneous access to this information as well as everything you have told the 3 nurses who have taken care of you today.  They are not at all inconvenienced by your requests for extra blankets and pillows, pain medicine, hovering at the nurses station or in the doorway in spite of having been given a call button and closing your door.  Patient privacy apparently just means YOUR privacy, so think nothing of it.

I know you are concerned about your son.  It is just awful that he stepped on a nail while wearing his tennis shoe, but forgive me if I need a little guidance in finding the puncture wound.  No, it neither appears red nor swollen to me as I have scrubbed it twice with antiseptic solution.

I do apologize for the 2 1/2 hour wait today, as you can see every room is filled.  I am reasonably sure that your son will not get "blood poisoning".  Thankfully you have kept such an eagle eye on it checking and updating us every 10 minutes about your observations, any trifling concerning redness and elevating it on the three pillows.  I can't say for certain, because I am just a stupid nurse, but I can tell you with some assurance that at the moment he does not have flesh eating disease.  Yes, I would bet my children on that.

I am happy to provide you with 6 warm blankets; no, I don't mind at all that you have used them all for your healthy 12 year old and that my 80 year old patient next door is now cold and without.  Not a problem; I have given her my fleece jacket, so it's all good.

Of course I think it is reasonable to wheel your son back and forth by wheelchair to the bathroom and to the snack machine in the lobby, after all, who knows what damage he may have done walking around (and from the parking lot) in the 3 hours since he injured himself; I'm sure it wasn't easy walking around at the high school football game.  It is absolutely not a problem that you prefer he be taken to xray that you insisted on by gurney because "he would be more comfortable";  I don't know how I could be so dense as to suggest that he could go by the wheelchair you have commandeered this afternoon for your son's exclusive use.  Perhaps I could now put the gentleman with cellulitis in it.

I am so heartened by your devotion, steadfastly sitting by his bedside and stroking his hair the entire time, it made the chunks rise up brought tears to my eyes. The only time you left was to make one of 20 phone calls and to smoke a cigarette or 10 during your wait.

Of course we will provide you with your son's first dose of antibiotic that you also insisted upon.  I understand how inconvenient it is that we don't have chewable tablets.  Yes, a lot of 9 year olds can swallow pills and some 12 year olds can't.  No, he shouldn't chew a capsule, I'm sorry that is all I have in that antibiotic.   I don't have "any chocolate chip ice cream lying around" and available for him to try and slide the capsule down.  I know that the pharmacy is open for another hour, but  of course it is reasonable for me to delay the EKG on the 65 year old woman with chest pain and send the hysterical mom with the 14 month old febrile seizure to the waiting room while I call that in for you.  It will "just take a minute".

Here are your discharge instructions.  A dressing will consist of a band aid.  Change it every day.  Watch for signs of infection.  Post-op shoe for comfort.  Wear it as long as you want.  Call your doctor tomorrow for recheck.  Antibiotic as written.  I promise I will not leave this room until you understand each and every word.  Really, I have time.

I completely understand that the post-op shoe is ugly but that is the only style it comes in: "ugly", small, medium and large.  The doctor sincerely believes that Tylenol with codeine is not appropriate for this injury, but here is one for you to take with you for tonight "just in case".

Finally, I think I would have just let him walk on the post-op shoe since it didn't really hurt, but if you want to get a hernia giving your 12 year old a piggy back, be my guest.

Until next time,

Monday, October 15, 2012

It's the Grinchiest Time of the Year

That Christmas items are out in stores before the pumpkins are even carved bugs the crap out of me.  Partner in Crime is a great one for decorating and will take down Easter posters and fuzzy bunnies that very night, etc, in order to get ready for Cinco de Mayo or whatever.  That's fine, I have never been one for overly enthusiastic decorating.  When I was a school nurse I had no trouble getting the 5th Grade Asthmatic Society girls to pull something out for my bulletin board, pretty much a school joke.  Teachers may live for that stuff but I hated to do it.  I could come up with a theme, but had absolutely no clue as to how to accomplish my vision.  The Girls hated to be outside on cold days, so it was a good deal for everyone.  It got a little rowdy when once I had 15 girls and their friends cutting stuff out of poster board and colorful construction paper, but damn if that bulletin board didn't look the bomb when they were through.

Which, in a round about way, brings to the subject of today's rant.  The Christmas Basket project.

You may recall that last December I went a little off the rails with the whole Christmas for Entitled Douchebags project.  This time I have hijacked the entire community gift giving thing and established rules.  My co-workers who are not terribly verbal have elected me spokesperson; my first order of business was to inform Beth that we were making some changes in the Christmas gift giving policy.

1.  No families, no teenagers, no brand names, and no electronics (unless it is an alarm clock).
Last years families requested things like IPods and Lucky Jeans, Ugg Boots and IPads.
There will be no repeat of this fiasco; perhaps people will then be free to focus on NEEDS.  Nobody needs Ugg boots.  I will cheerfully buy snow boots and mittens for kids, but that kind of greedy crap just did not fly with me.

2.  No makings for Christmas dinner; but gift certificates for the local market as well as for gasoline would be welcome.

Beth fought me on this one, but I prevailed
The ridiculous amount of "stuff" that was collected for the families to make one meal, their own Christmas dinner was just way, way overboard.  Included were things like potatoes, stuffing mix, canned gravy, turkeys (free from the hospital) and other fixin's; pie fillings, boxes of brownie mix, bags of walnuts, bags of chocolate chips, butter, flour, sugar and baking powder, etc.  There was just no way in hell any of these families needed any more sugar if we were buying xxxx and xx sizes for teenage boys and size 22 for a teenage girl and her mother.  One of the recipients was a diabetic.  Aren't we supposed to promote healthy eating?  The turkey was probably the healthiest item in the box, and each of the 3 families got two boxes.

3.  We are going to focus on two things: a couple of individuals in need, and the local food bank.
We will address any needs first; any leftover funds would be given, either by check or purchase of food, to the food bank in our town so people in our area could be better served.

4.  Any staff member is free to elect an individual or couple (or, ok, a family with small children) for the gift giving project.  We have charged Sherry with that task, which she has agreed to.  She is in the best position to do this as she also does a lot of community stuff.  In the event we receive more than a total of 4 people the final choice would be decided on as a group.

5.  The doctors are always generous and not only give us donations for the Christmas Basket, but give all the ER employees a cash gift.  This is such a wonderful gesture that is really appreciated by all.  Some of the nurses actually take that gift and donate it.  I would happily do that, but why not cut out the middleman?  We in turn gave a donation to Wounded Warriors in the name of the physician group instead of giving them something silly like personalized coasters.  This was very well received, and something I would like to repeat.  

6.  I proposed Christmas in October, but that didn't go over well.  Maybe next year.

Sunday, October 14, 2012

Just Doing my Job

My colleague Madness has a post up about the seasonal influx of patients with nausea, vomiting and diarrhea that are lining up in the ER.  She offers some (partially) tongue-in-cheek helpful hints for patients who aren't really sick enough to be in the ER.   Blame lack of common sense, blame a need for instant gratification or a magic bullet, blame lack of knowledge, but Madness is right on point:  patients with viral illness / vomiting, regardless of severity, do clog up the system.

However, one of her commenters took the pissy road.  He/she (anonymous, of course) snidely suggested that if ER's didn't want to be bothered with people who lacked the medical training to determine if they were sick enough to go to the ER, well then maybe hospitals should go on an information campaign to educate the public before they do something galactically stupid like go to the ER for frivolous reasons.

Excuse me.  Hahahahahahahahahah!  Haha!  HAAAAAAAAHAHAHAHAHAHAHAHA! (pauses to wipe tear from eye) HA!  HAHAHAHAHAHAHAHAHAHAH!!!!!!!!

That's rich.  Can you imagine any hospital endorsing that idea?  I can just see administrators foaming at the mouth on that one.  Public service announcements telling people NOT to go to the ER would be shooting themselves in the foot don't you think?

No, the responsibility for that task does not lie with hospitals, the ER, or ER nurses, at least not until people actually come in.  It would never work anyway, for several reasons:

1.  "I have been sick for 10 minutes" You  may be able to educate the stupid, but there is no cure for it.  Individuals who lack common sense are never going to be willing to do anything other than run straight to the ER at the first sign of a sniffle, so, vomiting?  Really?

2.  "My doctor told me to come" Many times patients do indeed do the right thing and phone their doctor for some advice about when they should worry. This is not unreasonable but they mostly talk to an office manager or triage nurse who then tells the patient go to the ER.  The office doesn't want vomiting people and there is a certain amount of liability telling people "it's a virus, you will get better".  This is enormously frustrating for people who, after enduring unnecessary labs, IV fluids, and hours of their lives are told, "it's a virus, you will get better".

3.  "Dr. Google told me to come".  People have access to all kinds of information online, watch way too much Dr. Oz,  and will often show up having already made their own diagnosis.  Information is not a bad thing, but when people come in with their treatment plan and choice of antibiotics already in place based on their research it can get ugly.  See, the problem is that we just don't see that much bubonic plague anymore.

4.  "YOU told me to come".  What I actually said was, "I cannot give any advice over the phone, if you feel like you need to be seen in the ER, we will see you".  For liability reasons,  I am obligated to end every single phone call to the ER for free advice in this manner.  Unless you are having crushing chest pain, then I might go off script and tell you if you were my family member I'd call an ambulance.  I understand that people want some guidance, but sorry, I'm just not allowed to give you any advice and every call ends up with the caller being frustrated and taking me away from the patient in front of me.

5.   "I am sick.  I'm never sick."People have their own individual perception of what constitutes an emergency.  Feeling crappy or scared, regardless of how minor a problem it seems to ER staff in the grand scheme of things is often a big deal to the patients.  People who are rarely ill can be frightened by vomiting.  As ER nurses we just don't get excited about some things, and remember, you may feel quite ill but you are probably not my sickest patient right now.  Perspective goes both ways.  It is important to note here, though, that being a drama queen about it does not endear you to my heart.  I can only reiterate Madness' wise words: "Man up".

6.  "I'm not dead yet".   Conversely, trying to educate people when and when not to go to the ER for their symptoms will not help someone who is insistent on going to work and spreading their germs around to others.  Some tough it out beyond their ability to cope.  These are very stoic people and people in New England who will simply stay away getting increasingly ill and dehydrated until it is late in the game.  Now not only are they really sick, but because they didn't lay low initially have infected dozens of others.  You can't change that mindset, it's useless to even attempt  doing so.

Please remember, people, we are speaking from a perspective of volume.  ER's are busy places, and are inundated with so many that don't really need to be there, as Madness pointed out.   Neither Madness nor I are referring to people who are genuinely ill, who are truly dehydrated and are physiologically unable to cope with their illness; the very young, the very old, the very compromised.  When people come into the ER and ask for change for the vending machine, well, maybe you can see why we are just a little frustrated at times.

Saturday, October 13, 2012


My Dad has been gone for 29 years.  On what would have been his 83rd birthday I realized that in the last year I passed a sad milestone; at age 57 I have lived more than half of my life without him.  As the oldest of five,  I was the last to hit this milestone.   
Dad only saw his two oldest get married.  Mine were the only two of his 12 grandchildren he ever met.  My ten nieces and nephews will only ever know Dad through our stories.

I've never been back to his gravesite in all these years.  It's not that I don't care, but I was never one for that kind of thing.  But I think about Dad a lot, especially when we are together as a family,  times he would have really enjoyed.  He had a great sense of humor and loved to laugh.  I wonder what books he would be reading now, what he would think about this presidential election;  what he would think about me as a person; if he ever would have forgiven me for those awful teen years.

Dad would have appreciated some of my ER tales having learned an awful lot as a medic in Korea.  He was a pharmacist who worked many years in a small neighborhood pharmacy back when it was called a "drug store" and he a "druggist".  He knew his patients well, and they loved him.  Everyone did.  He was the only genuine "people person" I have ever met.  I would love to know what he would have thought about the entitled a**holes, the chronic abusers of the system, the narcotic entrepreneurs that would now occupy his neighborhood if his little drug store wasn't now a real estate office.

I hope he would be proud of the adults his kids have become and the kinds of kids we have raised.  I know he would have loved to see those grandkids' school plays, learn to ride bikes, play sports, graduate, and become adults as much as he enjoyed those events as we kids grew up.

My brothers and I are lucky that our mom, at 80, is in good health and independent.  She has a more active social life than I do.  It wasn't easy for her though, having to go to work full time in her middle years just when the youngest of their children was ready to leave the house.  I know Mom misses him a lot.  She never got the chance for that "re-do" that I enjoy now, when the kids are on their own and it is just two people again.  The final sad milestone will be when, in a few months, my mom will have been without Dad longer than she was married to him.

Two of us have lived longer on this planet than Dad did although we don't talk about this, my brothers and I.  I'm sure we have all thought about it;  I was a little freaked the year I turned 54.   It's not that we don't talk about Dad, we do all the time.  We just don't talk about that particular hurdle.  We will never know exactly what caused Dad's sudden death, but I can assume that driving to work, turning off the car and simply ceasing to exist was not something that even remotely crossed his mind that day.  I can't speak for my brothers, but I try to mitigate the risk factors as much as I can.  We all live pretty active lifestyles perhaps keeping that fact in mind.  We were all athletes, and are in relatively good health although some of us might be carrying a few extra pounds.   But there are no guarantees in this life aside from the obvious, that no one gets out alive.

Which is why, I guess, we should enjoy every day above ground.  Happy birthday, Dad.

Friday, October 12, 2012

Pool Coup

Some months ago, Mr. Ednurseasauras an I joined a gym...excuse me, health club.  It is a pretty nice place, it has a good variety of stuff to do so there is no excuse for not going several times a week for classes, games, tennis, or whatever.  I enjoy several different exercise classes, pickleball and walleyball.  Unfortunately, I broke Mr. Ednurseasauras  on his first visit to walleyball; a torn calf muscle that took months to heal.  This is a man who hikes regularly, bikes, played hockey until he was 60, as healthy as  many 20 years younger, you get the picture.  It wasn't even an injury you could specifically blame on walleyball.  I mean, all he did was step forward on it so it could have happened anywhere; including the top of some mountain.  He was gracious about it but I blamed myself for badgering him into it as something we could do together.  Thus endeth any further campaigns on my part to ask him to do anything  but walk the dog.  He can go get hurt on his own time.   Which he does.   He is at present recovering and rehabbing from a patellar tendonitis.

On labor day weekend I had my own injury in an activity I have been doing since I was 10 years old; jumping out of a boat.  I had made a pretty bad job of docking the boat and leaped out to tie it, thus saving Mr. Ednurseasauras' knee; my own hyperextended in an explosion of pain.

 I spent the next several minutes dealing with both the pain and resulting near-syncope.  Mr. Ednurseasauras thought I was having a heart attack or stroke, which scared him very badly.  Long story short, I was fine, but the knee is still wobbly which has taken me out of court sports and exercise classes, and I didn't get to the gym for a month.  Tina doesn't get very long walks up rough terrain because I just don't trust that knee.

So, to do some kind of physical activity I started swimming in the lap pool, which seems to be just dandy for my knee.  I am presently doing 30 minutes of laps, then 30 minutes in the warmer pool vigorously treading water with just arms, or just legs and trying to get a workout out of both.

I lurked around one of the water aerobic classes for seniors to see if it was something I might like to try.  The first class seemed to consist of some ladies in their 70's floating on noodles with life belts and chatting.  Nope, didn't seem like it would be any kind of challenge.

The second class was lead by the same woman.  She had the participants raising their arms above their heads while kicking.  Still no challenge, and I had to leave the pool because one of the older gentlemen was straddling a pink noodle which extended out of the water in front of him so....I just couldn't look at that any longer.

Today the class seemed to be running over-time due to some earlier pool maintenance.  There was a small group of unruly home-schooled kids (the next class was advertised as being for home schoolers) anxious to get into the pool for lessons who were being disruptive.  They were sitting at the edge of the pool kicking and interrupting the flow of the class.  No parents in sight, surprise surprise.  One of the women, tired of kids fuc*ing with her chi yelled, "Hey!    You  have the rest of your life to get into the pool, most of us will be dead soon enough, so knock it off!"

Applause from the pool.  Silence from the crowd.

Wednesday, October 10, 2012

Important Announcement

Attention K Mart shoppers!

The will of the masses has prevailed!  ER gowns are now clown-free.

They are now covered with Pooh.

On a completely unrelated topic....what the hell is up with glow in the dark pull-ups???

That is all.

Please return to your regularly scheduled program.

Monday, October 8, 2012

Just One Click Away from Armageddon

All day long all I hear is:

"Arrrrrrrgghhh!  EDnurseasauras help!  My whole dictation is frozen! What should I do!"

"EDNurseasauras!  How do I figure out how to add to an e-chart if I already closed it?"

"Damn!  That's the 5th time I've entered this order!  It just keeps getting kicked out!  Now what?"

I can usually figure out and fix most computer charting errors, glitches, transfers, work-arounds and fu*k-ups. And it's not because I am a SOOOOOOper User.

Mac: "It's a good thing you're here or our fat would be in the fryer.  How did you get so adept with all these computer issues?"

Me: "I click on every button and tab 'til I either run out, figure it out,  or beat it into submission.  I have absolutely no fear of pushing buttons which is why I would be a really bad choice have on a nuclear submarine"

Mac: "Yeah.  Oops.  There goes Argentina"

Me: "Exactly"

Friday, October 5, 2012

Maybe I Should Patent This...

Many of our chronic dental painters / narcotic entrepreneurs have horrible teeth, no doubt about it.  While their "horrible pain and can't afford a dentist" will probably be treated without suspicion initially, the subsequent 6 or 7 visits a month for 10/10 pain smack of insincerity and scamming behavior.  Most dental pain is treated with antibiotics and pain medication.  The more visits, the less likely it is that percocet will be on the discharge menu.  After a few of these visits, the savvy patient starts adding allergies; first ibuprofen, then tramadol.  Then tylenol, which would then eliminate percocet as a choice.  Clever seekers will say they have no trouble with the oxydocone, but that effectively shoots them in the foot since we never, ever give out plain oxy's in the ER.

When the patient is diagnosed with abcess, sometimes they get IV antibiotics.  Mostly they leave with a script for penicillin and pain meds.  Some doctors will write notations on the script numbering the penicillin "1 of 2".  When only script #2 is presented at the pharmacy (the pain med) this prompts a call from the pharmacist asking what the 1st script was, because the patient can only afford one of them.  Definitely needs antibiotics, they are told; maybe they should buy that instead of cigarettes.  The patient usually just goes away, to try and play us another day.

Why not just combine the antibiotic AND the pain med?  Percocillin!  Everybody is happy!

Thursday, October 4, 2012

Cat and Mouse

Nobody has a sense of humor anymore, especially our IT people.

We are housed in an old building.  There are mice from time to time, tiny little field mice.  I haven't seen any in about 3 years, but one was spotted recently by a patient who got pretty upset about it and made all kinds of stupid demands, said she wasn't paying her bill, etc., etc., etc.

I got right on it.  I sent an internal request for someone to investigate our mouse problem.  Just for laughs, I sent it to IT.  I figured it would be a nice change from dealing with forgotten email passwords and taking turns writing about how wonderful they are on the hospital attaboy board.  I checked the box that said "mouse, wireless" and sent it on over.

Memo exchange follows:

TO: EDNurseasauras
From: IT
RE: Mouse Problem

IT is only responsible for hardware issues, computer programming malfunctions, Help Desk issues, and other system issues related to electronic charting, etc.  Your mouse problem does not fall under IT responsibility.  Please initialize request to facilities.

From: EDNursesasauras
RE: Mouse Problem

That's ok, I'm more of a do-it-yourselfer.  In the absence of a mouse trouble-shooting tutorial, what kind of cheese would you recommend I initialize?

TO: EDNurseasauras
From: IT
RE: Really, it's not our problem but I suppose peanut butter might work.

From: EDNurseasauras
RE: It is now

If I catch the mouse, should I just disable it? Would there be any point in reinstalling?

TO: EDNurseasauras
From: IT
RE: Really???

Now you're messing with me, aren't you?
Do you even have a mouse problem?

Yep.  Also I know the location of the beige marketing cart.  And Jimmy Hoffa.

Eventually the facilities department set traps.
More on that later.

Wednesday, October 3, 2012

Today's Last Patient of the Night....

....was about 5 years old.  He had a cough, the same cough he has had for about a week and for which he has already seen his primary care on two occasions.  Nothing new about the cough and no new alarming symptoms he was just not Magically Better.

Partner in Crime brought in a child-sized gown for him to change into an mom immediately burst into tears.  Not because she was fearful for her child's health or unable to pay the bill.

"Give him another gown!", she shrieked, "it has clowns on it!  Take it off!"

Ohhhhkay.  I'll take the red nose off, sheesh.

Partner in Crime noted that all the kids' gowns have clowns on them.