Social Media and the Over Share

Actual Facebook status sent to me by my daughter, with identifiers removed:

Which prompted the following series of texts between us:

Silver Lining, Fortune Cookie Edition

Still alive here.  Still employed for now.

After many crappy weeks I have learned a few things about how people cope with situations over which they have no control.

I listened as all but one of my coworkers speculated fruitlessly about every aspect of the anticipated changes.  The mysterious changes.  Sooooo secret.   Very few details were shared and for months all we heard was "we don't know".  The most important,  the "when" has finally been settled.  I will be done soon, as will most of my friends.  Instead of the promised seniority rule and the same pay, every nurse was invited to apply for one of the few positions, without any guarantee, for fewer hours and benefits.  Oh, and to work 12 hour shifts.  Or take severance.  It's Plan B for me.

Most of my co-workers stayed in denial for a long time, trusting that the company would make good decisions for their employees and the community, "live the mission", do unto others, treat their people with honor, integrity, compassion.  I knew immediately that was not going to happen so I never went into that little bubble that might have safeguarded my sanity for a little while.   Me?   I went right to angry and stayed there...while also grieving.  I eventually came to the realization that  the really hard part was having absolutely no control over what the hospital does.  The bad decisions they make?  So what.  I won't be working there.  I went to one interview with the attitude that I could care less if I got the job.  It was too far away anyhow, but I needed to do it just to get it done.  It's been over 3 months.   I guess they don't want me as much as I don't care if I get the job.

I will be happy to collect my nearly 500 hours of earned time and "generous" severance pay.  After 500 hours the accrual ceases.  I will be about 2 hours shy of 500 hours.  I will also enjoy not working Christmas.

A tremendous burden has been lifted now that the specter of death no longer nebulously looms thanks to a confirmed date of  execution.   I have become the unaccustomed ray of fu*king sunshine at work while my colleagues sing the blues, wring their hands and play the "what if" game.  I am happy and joyful, my sense of humor fully restored.  Tra-la-la.

Jane (my boss):"Who are you??"

Oddly, not one of the nurses bailed.  We optimistically filled out our schedules through the holidays although I put "ha! ha!" next to the notation that I was working New Years Eve.  We are 2 1/2 docs down, the departed being unwilling to sail on the Titanic II.  Wisely recognizing that the band is playing "Nearer My God to Thee" while the deckhands put out a few more chairs, they were not buying the pig in a poke that the ship was unsinkable. My response to that:

"She's made of iron, sir! I assure you, she can... and she will. It is a mathematical certainty".  

The Pirate moved on to greener pastures, one doc has 1/2 foot out the door from pure apathy, and another is on medical leave.  That leaves us with plenty of shifts with Parvati and too many with Bobo.  Bobo still talks to his clavicles and continues to be a non-joy to work with.  I have perfected the fish-eyed stare and monosyllabic response when he is around.  I will not miss Bobo.

 I will not miss this dysfunctional employer so much.

I will miss my friends.

I've Just....Checked Out

I worked a princess shift in return for a favor from Partner in Crime, which got me home in plenty of time to eat the Chinese food that I had picked up on my way.  It was too hot to eat,  I mean thermally, quite a new experience and quite nice I must say; most occasions when I order out at work I get to eat it 2 hours later.  Which means cold.  At the restaurant, the hostess at the desk greeted me by name, which is probably an indication that I have ordered there a little too often.  Ah, well.  Stress eating continues unabated.

So I've been mourning this whole loss of job thing for about a month now.  I am stuck at angry.  Kind of.  When did filling out applications become so tedious?  Does anybody really care that I made $5.50 per hour in my first job after passing my boards?  Is it even relevant?  Does anybody who works in human resources have opposable thumbs or return phone calls?  Do nurse managers really let these people do the hiring?

Rumors, rumors, rumors.  Never mind a No Spin Zone, there is not even gravity with nothing concrete from management, which has somehow decided that my entire department was unworthy to participate in the employee satisfaction survey.  Mine would have been just as negative as the last one, but wow.  Just...wow.

I have cast my net wide in my search for employment.  My co-workers and I have exchanged information for the purpose of references, each of us naming the others "charge nurses", which is bullshit because we are all charge nurses and collect the whopping $1.50 per hour on an equal basis.  Hopefully we won't be called on any jobs for which more than one of us are apply.  That would be  Awwwwkwarred!!! Only two of us seem to be actively searching, but there isn't much out there.  I even bullied Gil into giving me his phone number for a reference with the promise that when we worked together over the weekend it might improve my attitude.  Don't hold your breath on that one, bro.  He laughed and told me it would all work out OK.  Umm, nope.

I have pretty much lost my sense of humor at work.  No, I am not OK.  I'm not OK with any of this. My attitude sucks, and I don't see any improvement coming in the next weeks.   I seem to lack the gene for seeing the glass as 1/2 full right now.  I am disengaging, putting paid to this chapter in preparation for moving on.  I kind of just do that, I might talk to people for months, a few years perhaps.  Mostly my work friends have just faded into the past with the exception of one or two whom I regard as most likely to call if I need to bury a body; you might not see them for a few years, but you know they will always come running.  It's harder this time because the community is disintegrating and scattering to the four winds; there will not be any core group of people to return to or visit with.

So.

I have mentally just....checked out.

Due to Budget Constraints, the Light at the End of the Tunnel Has Been Extinguished

It's all about the Benjamins (or in our case, the Georges). My little ER, without any concrete plans except "it's going to happen", is going Urgent Care at some point in the next 3 or 4 months.  I will be out of a job.

No need for critical care nurses in that setting.  Certainly they can get cheaper staff.  Hours of operation will be slashed.  There will be one nurse.  Good bye, lab peeps.  The will only need phlebotomists.  See ya, X-ray techs.  You're losing hours as well.  Congratulations PT you get to keep your jobs.

Stress eating at work has become the new hobby, along with speculation, gallows humor, and the stages of grief.  We sent Beth out for ice cream the other night and she came back with three gallons, along with hot fudge, whipped cream and potato chips.  Screw the ice cream, chips dipped in hot fudge with whipped cream?  DELICIOUS!!!

I have to say that the one silver lining is that my resume is updated annually at tax time, so I am in a better position than some of my colleagues who haven't had one in years.

I'm sad.  I'm not ready to job hunt at age 58.  I can't physically do 12 hour shifts.

My job has become a Death Watch.

Thank You...

...to patient satisfaction surveys and Press Gainey for giving the public the means to bitch when their every wish is not magically granted in the ER.  Too bad Dr. Google doesn't have office hours because THAT is some sound medical practice.  I'm sorry....you didn't get that MRI Dr. Google recommended?  What a shame.  Your best friend's sister's boyfriend the veterinary tech said you needed Percocet for that two week old sore ankle?  Oh pooh.  Your mother convinced you that you needed antibiotics for that cold?  Tsk Tsk.   I want, therefore I will get it.....NOT necessarily.

My boss handed me a survey today with a scathing review of the individual's care.  I was the nurse.
He had punched a wall but lied to me and told me he fell down.  I knew it was bullshit but I generally leave it to the provider to explain why some little knowledge of physics is required in order to fabricate a mechanism of injury.  In other words telling him his story is bullshit.

"I don't want to call him", Jane said.  She is responsible for calling all the bullshit whiners and people who are verbally abusive to staff and squeaky wheels in general in order to make them feel like we deeply regret that their 10/10 pain was not sincerely addressed.  This is in accordance with Bible of Upper Management Bullshit, specifically the Crap According to Clipboarders verse:

'Your wife will become a harlot in the city, your sons and your daughters will fall by the sword, your land will be parceled up' 

oh, sorry, wrong one.  This is it:

" and unto them a discount shall be given"

Accordingly, being less than truthful with minimal outward damage and negative xrays will not garner one an automatic narcotic pain prescription.  So the respondent went home with a prescription for Motrin and was pissed off.

"That Dr. XX was a moron.  All I got was a $150.00 bill and MOTRIN!!  Who goes to the ER and gets Motrin???  I am telling everyone I know that the care SUCKS there.  But the nurse was OK"

I am sure it was waaaaaaaaay more than $150.00.

File this under "Things that will ultimately reveal themselves to be Galactically Stupid ideas.  Sort of like this, which has been bothering me for quite some time:

"Hey, does this solar system make my ass look big?"

Thank you, NASA....for sending this into the solar system and including our address, so that extraterrestrials  might visit us in our naked and unarmed glory with raygunz and sh*t
This message was obviously sent out before they voted Pluto out of the Solar system.  We'll send that correction right out.

You're It

I have decided not to do any more EKG competencies because they are stupid and a waste of time.  Screw that.  This is my last one:

Go Away

I have just had it with the attention whores of the world.  I'm sure you can relate, not just to the ER but to everyday experience.  They are having loud cell phone discussions in the grocery store.  They demand attention with their nonsense.  They have the most pressing problems ever.   They are black holes that suck you right out of your zone and into their chaotic crap.

I went to the salon to have a mani and pedi, something I don't do often enough apparently because the little owner of the shop greeted me by name with a big hug and said it had been a long time.  Well....October to be exact where I used to visit twice a month.

There were a few changes, "Golden Girls" and music videos on their big screen TV had been replaced by X Games.  Cool.  One of the owners son's was looking at knives online.  Slightly disturbing, but OK.

I had settled in enjoying the relative peace and quiet when the inevitable attention whore swept in with her entourage of unkempt children.  She opened by loudly asking how long the wait would be for a manicure for one of her teens like she was one cupcake away from total starvation.  Oh, right away.  She probably could have used a shower more than a manicure I'm thinking.

Then the phone calls started.  Attention Whore spent the next 20 minutes loudly discussing an impending auto purchase on her cell phone.  Names were named, prices were uttered.  She was apparently trading in some shitbox that the dealer wasn't interested in and wasn't that crying shame.

I had started the afternoon with a hope for Serenity Now and concluded it with Murder in My Heart.

Go away, loud lady.

"Hear that?  The fat lady is singing you out of the building"

They were probably relatives of the patient who came in by ambulance with a bug in her ear.  Yes.  A. Bug.  Drama, drama, along with 4 of her equally dramatic and attention seeking family members.  This crap would customarily be, at best, simply a pain in the ass.  Add  2 transfers, a possible ectopic, and a walk in chest pain and you can tell how far down on the list Bug in the ER had fallen.  I kicked them all out with a "you can pick one buddy, everyone else goes to the lobby".  Gil swept in with a curt nod and slammed the door shut for good measure.

"Oh", sniffed a relative, "where we laughing too loud?  It didn't look like it was very busy.

Just to be clear ( NEWSFLASH) if you have to ASK if you are being inappropriate you probably are.  And it isn't worth my valuable time to explain why or make you feel all warm and fuzzy because I just don't feel like it.

They Paved Paradise, Put Up A Parking Lot

This mess is part of our parking lot.  It is a dirt pile in the summer, receptacle of piled snow in the winter, and in spring.....a bog.

People will often drive or walk right over it.  Occasionally people park there.  It is unsightly and dangerous considering its proximity to the handicap spot.

Beth has complained about it for years. I think there have been a few children lost in that swamp, but I'm not sure.  One or two winter boots.  An umbrella.

Nothing we can do about it, says the grounds department.

I have a few suggestions:

This would add some LOVELY ambiance as well as practicality

A nice touch.  Who can resist throwing pennies in a wishing well?

"Pay toll...for no reason".  

Too scary.  And not indigenous to the climate here in the Arctic

My first choice, but a few more.  

Oh, yeah.

 

Get away evil pink flamingo!  You're scaring the gnomes!

No....

This isn't my car.

But it COULD be

That Explains the Blackout

Today's fun involved a female patient with numerous visits.  While she has some actual real physical problems (not that she takes care of them) and is supposed to be on THE COUMADIN  she would much prefer to take copious quantities of  Percocet rather than THE COUMADIN because, you know can die from chronic pain but not, apparently, from multiple blood clots.  Whatever.  On her last visit she presented with a rash.  Well, she had sunburn.  She yelled at me because I was rude for saying she looked like she had been in the sun;  NOBODY, nobody should be asking her about sunburn, it's not the reason why she was here.  All crap.

Mostly this patient gets shut down because her complaints are stupid and she is already so stoned she is slack jawed and drooling.  Mostly the visits end in rage (hers, not mine) because she fails to get what she wants so she feels screaming, name calling and threats will be successful.  Thanks to the Pirate's helpful hints about documenting the exact language used by patients, my documentation of such encounters is now quite colorful.  On the two or three occasions when the patient was  lucid to make good her threats and use a phone to complain, her own words were read back to her.  Of course she yelled at the patient rep that I was a liar.  This gets old after awhile.

Today, though, The Pirate gave her Dilaudid for her headache because she is allergic to NSAIDS and can't take Tylenol because of her liver and she is allergic to everything else.  Sigh.  But she got shipped down for a complimentary head CT before she was kicked to the curb.  The Pirate is relatively new, you see.  And we are ever mindful that just because someone is a drug seeking, low life, abusive, suck-the-life-out-of-you attention whore does not mean that they might not have a life threatening problem, see.

Report to the next nurse went along splendidly because she was well known to the staff there.  When I got to allergies, which were numerous, the nurse replied, "Yeah, I know, when you click on her allergy tab on the EMR, (electronic medical record) the lights in the whole city dim out"

Yeah.  Narcotics were prescribed by 11 different providers in the last month according to the pharmacist.

Quotables

Ellen: "I can't believe somebody ate all my "I Can't Believe It's Not Butter!"
Me: "Unbelievable"
*************************
Pirate: "She is sufferering from Half-a-deck-a-cardia"
(as in not playing with a full deck)
*************************
Patient's Significant Other: "This is an emergency!  Why isn't anybody getting all excited??"
(as in life-threatening finger boo-boo)

Let me just add a personal  note to this last one:  the more excited you get, the less excited I become.  And I think I can speak for most ER nurses and add a  sidebar to the general public:  If I AM excited, you had better be afraid.....very afraid.
**************************
Partner in Crime: "Why do people call the ER when they have been sick for three days and ask if they should come in?"
Me: "Because when you are a douchebag, the world is your oyster"
**************************
Me: "So how many sutures was that in total" (for charging purposes of course, like we don't have better things to do
Parvati" "Well, three on the outside of this one, no, four.  Um, 16"
Me: "So....I guess I should figure the value of X?"
****************************
T-shirt of a wonderfully vibrant, health and active 80 year old woman: "In Dog Years, I Would Dead Now"

You're Killing Me Smalls

It has been about a year since my facility rolled our JCAHO mandated  Electronic Medical Record, AKA the Shittiest Computer Program Ever Devised (SCPED).

Every so often there will be an update to SCPED that entails shutting down the system for 12 or more hours, during which the entire electronic charting and ordering system is unavailable.  Which means:

1.  All charts will be paper charts
2.  All orders will be written by hand, a copy made and delivered to the lab/xray/pharmacy, which will then
3.  Enter all the orders on each of their separate systems which apparently don't get updated

Of course paper generated charts just means more work for everyone. Each patient gets a pre-determined ID number.  Those ID numbers are HAND LETTERED (does that make them artisanal, Dr. Grumpy?) on labels to be used for a variety of things.  Like X-ray and lab draws.  The secretary does this, adding to the already cumbersome registration process.

A couple of weeks prior to SCPED updates there will  bulletins, notices, reminders and memos announcing DOWNTIME procedures.  Basically, to brush up on DOWNTIME protocol and stock up on paper and prepare for Electronic Armageddon.

During the most recent SCPED update there were specific instructions for removing current patients from the tracking board so that they would not be irretrievably committed to THE VOID, which had occurred during the previous update.  In order to prevent this, all patient charts were to be printed off 30 minutes prior to DOWNTIME.  I personally received calls from 6 different people each giving me a different deadline for the paper festivities before I told the secretary to just take a message.  It is no wonder there is such chaos.

"OK, downtime starts at 10:00 PM....print off the records about 20 minutes prior to that"
"OK, do this.  Any patients who come in after 9:30 PM, just do a paper record.  Don't start them in the computer.  Start printing any patients in the department at that time"
"Did you get that last message?"
(Different tech weasel) "You should print off starting at about 9:15 PM.
(Still another tech weasel)  "Probably should start going paper about 9:00 PM"

Me, to Ellen: "Next time someone calls, just tell them we're already on downtime".  It was 5:00 PM.

Following updates computers slow down to crawl or outright freeze.  None of the updates goes well with our elderly operating systems.

Pirate: "Jeez, it's like we have the first version of Windows, like  Windows 1.2.
Me: " Our versions of Windows are so old that it is more Porthole".

For added fun updates are always done on a weekend when only the people who actually take care of patients work.  This gets extremely frustrating; patients don't like the little signs posted by the tech weasels any more than we do.

"Thank You For Your Patience While Our Computers Are Updating!".  The clever little hopping frog graphic was immediately replaced by me.  With a picture of a snail.

That about covers the Shittiest Computer Program Ever Devised tutorial.  Although there is some hope.  We are updating all the computers with a newer (but not the newest) version of Windows within 2 years.  And an entirely new Electronic Medical Record System will be up and running....in 3 years.

Psyched.  Now if the computers  could be updated maybe we wouldn't have to trip over all these wires.

Can't we have a nice little Mac? 

Does this look safe?

I'm Free and It's So Easy to Get By Cause I Don't Try

As we must co-sign every ml. of narcotics from an unused vial that is not ordered for a patient, we have a tendency to sort of stack them up until 1.  the patient goes home, or 2. we have a minute to reconcile with each other.  This is so the hospital can rest assured that we nurses aren't taking all that perfectly good morphine or dila-la and selling it on the street.  Trust me: I could fill a fountain with the stuff I've wasted over the years.  Sadly, there are health care workers who use the stuff themselves but that is not today's subject.

Policy demands we must always have a paper trail to follow, mustn't we?  So when we are busy and we have a moment to sort track and co-sign each others wasted sh#t we refer to it as "cocktail hour".

And so, another name for waste narcotics is born.

"Dilaud-a-tini":  5 separate vials of Dilaudid to be wasted.

And because there were too many to put in a med cup, all the extra was stacked up in a paper cup.  Paper trail, paper cup.  Not a Red Solo Cup.  Please enjoy this musical interlude by "The Fifth Dimension".

 The lyrics are messed up but oddly go well when you think about a bunch of Dilaudid in a paper cup ready to be thrown away.

Here inside my paper cupEverything is lookin' upNo one comes in, no one goes outNothin' to get hung up about
I'm free and it's so easy to get by'Cause I don't try
In my paper cup, I have installedA shower stall across the hallRunning water and a denIt's looking just like home again
I'm free and I've installed refrigerated airYou'd have to look insideBefore you know that I was there
And everybody says I'm quite insaneAnd someday I'll be going down the drainI know they're right but I don't careI feel no pain
Here inside my paper cupEverything is lookin' upNo one goes out, no one comes inIt's lookin' just like home again
I'm free and it's so easy to getThe things I've always wanted'Cause I don't really want 'em anymore
An' living ain't so bad without a rudderAn' life is kinda groovy in the gutterIf you know how, and I doYeah, and I do, we do too
So if you'd like to come alongWe'll sing a little paper songAbout a lonely paper plateWho couldn't find a paper mate
I'm free, yes I'm free
And my life is lookin' upFrom inside my paper cupAnd I'm always lookin' upFrom inside my paper cup
And my life is lookin' upFrom inside my paper cupAnd I'm always lookin' upFrom inside my paper cup

Is This the Same Thing?

Hello, anybody there?

**crickets**

Lots of stuff going on, none of it of any real significance but enough to keep me from composing any new fascinating posts.  I have lots of stories.  Oh, so many stories.

Part of my posting absence has been physical.  On Easter Sunday I sliced off the tip of my right index finger with the Mandolin blade.  Yes, I know, stupid.  Stupid.  Stupid.  The Mandolin has been sitting on the top shelf of the cabinet for over 2 months.  I was scared of it before; now I am outright terrified.

My wound healed just fine, the fingernail grew back in, but typing.....now that's a little bit of a problem.  I type so much at work that it just isn't fun when I try to get my own thoughts down.  It still hurts, but less every week.  In the grand scheme of things, it is pretty insignificant but it is annoying that only 5 mm of tender flesh can have such an impact.  Ah well.

I leave you with this:

After suturing a finger laceration, Parvati told the young guy to have sutures removed in about 10 days. Clueless friend:  "Or I could just cut them off, haha!"
Parvati:  "Or he could come here, and we could do it"
Clueless friend: "His mom could do it, she's a doctor"
Parvati: "Really?"
Clueless friend: "Well, she's a vet tech.  Same thing"

Wow.

So, using this logic

Being a nurse is the same as being a waitress
Being a pharmacist is the same as being a bar tender
A respiratory therapist is the same as an HVAC technician
A lab tech is the same as a chemist.  Although in Wednesday's case being a lab tech is the same as being Alice in Wonderland.

Lady Games

The Lady on Elm St. is still alive.  I won't say she is well.  But as cockroaches will survive a nuclear holocaust, so Lady will survive all maladies real and imagined until....well...her ticket gets punched.

Lady's nonsense urgent attention-seeking issues have logged hundreds of annual calls to 911.   Dispatch has been heard to simply say "head on over to Elm St for complaint", which means Lady's apartment, for things she sees out the window like moths, meteor sightings, or a well-being check request on a neighbor who has simply gone out for lunch.  One would think Lady has a pretty full schedule with all that silliness yet she manages untold amounts of time bitching out patient services and carping about EMS to whoever will listen.  Of course her numerous outpatient visits for various maladies are certainly time consuming, and I failed to mention that she is on 25 DIFFERENT MEDICATIONS which surely takes up a good portion of her day.

But no, she still has lots of free time to call the ER pretty much daily, usually on the evening shift.

It is a pattern of ramping up the calls, either for escalation of some chronic complaint or for a new boo-boo that the average person would handle easily.  It culminates with 911 drama and the inevitable ride to the ER in the Big White Taxi with the Flashy Lights

It is our policy not to give out the names and schedules of the doctors.  It's pretty obvious when individuals are "shopping" for a doc who gives out narcotics or are looking to avoid the doc who piss tests first.  This is not the case with Lady.  She has her favorites, and those she can't stand, usually because they have had the temerity to bring up the subject of her weight, the elephant in the room; no pun intended.

When she doesn't call, or we don't identify any police response to "Elm Street, apartment X" on the scanner for a deer sighting or some such,  then we know we are probably in for an evening visit.  High drama.  No reason to be there. And we are always busy.

She is not fond of me.  I have honestly tried with her, but when your best effort gets rewarded with some bullshit complaint, well, sorry.  You get the bare minimum from me especially if I have an Actual Sick Patient to deal with.  I don't want to chat or talk about your day.  Or mine.  Partner in Crime talks to her a lot and nearly always tells her to call her doctor in the morning.  Still, Lady likes Partner in Crime.

I drew the short straw when Lady was brought in by EMS.  She rolled by on the super-duper heavy weight cart like she was the Queen of the May on her parade float, waving and smiling, surrounded by her contingent of EMS personnel as reluctant honor guards.   She was making the usual sarcastic remarks meant to be funny (they weren't) and behaving as if we were all bosom friends.

"Where is Partner in Crime?", Lady bellowed as she was wheeled in, proving that she wasn't in fact having any of the life-threatening shortness of breath which precipitated her 911 call.  "I want Partner in Crime for my nurse, she understands me".

"Sorry, she's busy with an Actual Sick Patient and you don't get to pick your nurse.  Here is a nebulizer treatment since you are speaking in full sentences, have normal skin color, have a normal oxygen saturation and your lungs are clear.  Dr. Parvati will be along shortly"

Parvati might be abrupt, lack communication skills, be blind to the fact that she is a generally a piss-poor team player but she is never unkind on purpose.  However much we might want to kill her I have to give her that.

Parvati dealt with Lady's BS complaint empathetically with the therapeutic equivalent of patting her on the shoulder and telling her she was just perfect in every way.   Which is not what Lady wants to hear generally because it would mean she would have to take up a new hobby to fill her days.  But I guess she appreciated Parvati's delivery because she was eventually happily kicked to the curb like she is 99.99% of the time.

As usual it took Lady about 15 minutes to vacate the room, and then there was the requisite lurking at the desk to engage Partner in Crime and grill her about some activity that occurred 12 visits ago.   Partner in Crime was too busy to play though, so Lady turned her attention to Parvati on her excruciatingly slow egress from the department.

She paused dramatically before heading out,  planted herself in the middle of the hallway, raised her arms like the Mayor of Munchkinland (and equally proportioned) and her dramatic announcement, "This is the best doctor of all time".  The speech was punctuated by bestowing upon  Parvati a big smelly hug before she left waddled to the waiting room.

I wish I could feel bad for Parvati but I just...don't.

Sounds Like....

Anxious Twitchy woman who said her heart was beating fast:

"I have had the symptoms before but they never found anything even though I wore a halter top"

HOLTER MONITORS are devices used to record heart rhythms.

HALTER TOPS are garments that should never be worn by anyone over a certain age or bra size.

Same Anxious Twitchy woman:

"I have had an over-ectomy"

OOPHERECTOMY is the removal of an ovary.

"...and a colonic"

Perhaps a COLONOSCOPY.

Yikes.

Valid Question

Phone advice requested from a night shift worker:  "I am confused about Dayquil and Nyquil.  If I work nights, which one should I take in the morning?"

Even a Blind Squirrel Will Find an Acorn Now and Then.

I occasionally speak of squirrels, of which I have two; they are small plastic creatures that sit on my desk and mock me.

When one of our regulars comes in for the usual tedious complaints requiring a narcotic script for the 20th time in the last two months, the squirrels dance. They recognize kindred spirits.  My personal mantra regarding squirrels: 

If you feed them, they will come 

My co-workers have, sadly, adopted my irreverent view of drug seeking complaints. Sometimes they will return from triaging and pick up one of the squirrels, or simply make chittering noises.  Sometimes I will be asked if I have such a thing as an acorn about.  Silly stuff.

it is not the first time that squirrels have been a running joke in my life.  "You should have bought a squirrel" has long been a favorite tag line among my skating ladies thanks to a long bus trip and the movie "Rat Race".  Google it, it's pretty funny. A few years later, Suzu the Squirrel, a pretty life-like but decidedly creepy hand puppet became a mascot for another group of skating ladies.  And, I have 1/2 pair of cute squirrel earrings given to me years ago as a Psecret Psycho gift.

More recently I was given a fun pair of socks from a co-worker:

Last year I devised the "Golden Squirrel Award":

Shocking that this one did not get stolen off the big fake tree in the lobby

Around Christmastime this past year, someone brought in a miniature Charlie Brown Christmas tree for our desk.  I loved it so much I immediately purchased one for my son and left it on the door of his apartment since it is the size of a phone booth and he would otherwise not have one.  As for the one on the desk I decreed that it should remain year round as a haven for my squirrels.  New Cathy, self-appointed Decorating Ninja, has dressed it up for Valentine's Day:

Ellen added the bird with the acorn cap because she actually thought it was a squirrel.

Ellen is usually stuck out front, but sees the squirrels, squirrel signs and things like this:

I blanked out my name and was too lazy to type in "EDnurseasauras"

and thinks that I have a passion for and/or collect squirrels.  Inevitably it is assumed that I am the Expert on All Things Squirrel, when in fact I am merely the one who pushes the snowball off the cliff.  A few weeks ago she sent me this text when she started hearing noises in her chimney:

Ellen did, in fact have a a squirrel removed by the critter control.  It didn't have a whole lot of fight left in it

Ellen pointed out that, coincidentally, January 21 is National Squirrel Appreciation Day.

My final squirrel note got my dog, Tina, into the act.  As a terrier, she is all about sniffing out squirrels and chipmunks. She is relentless, but it's winter and there just aren't any critters around just now. Imagine my surprise that on one of the coldest nights of the year, she brought home a dead frozen squirrel.  I made a nice "thunk" when she dropped it on the deck outside the back door.  Mr. EDnurseasauras apparently didn't chuck it far enough away because she retrieved the same cold, dead squirrel the following night.

"Good girl!"

Oh Look! EDNurseasuarus Has a Blinking Skeleton!

How do I turn that annoying thing off?  It never USED to blink, then one day, suddenly, I have have a blinking skeleton inside the body of my dinosaur.  If you know how to get it to quit I would appreciate the information.  Thanks!

Always a Nurse

Text exchange with Partner in Crime, who had the weekend off:

PIC: So here I am at the Mexican Restaurant and I can't even drink in peace.  One of the line cooks has a seizure and my sister volunteers my assistance.

Me: WTF?!  You go girl!  I hope they comp your tab

PIC:  Me too!  I have had two beers since then

Me:  "I don't often have seizures.....but when I do, I prefer Dos Equis"

PIC: Hahahahaha!

Nor'easter Notes

Ever wonder who goes to the ER in the middle of "The Storm of the Century"?

1.  Plow-guy who cut his hand in a snow blower

2.  Man Cold

3.  15 year old not-sick girl with "sores in my mouth for two days since I drank out the glass of somebody at school who I found out had mono".  Mom didn't want to wait around for the mono test because "The steak house is closing in an hour and I don't want to have to cook".

4.  16 year old who had "bladder pain" for 10 minutes.  Because she was prostrate with pain and walked like the letter "C" between texting her friends and updating her Facebook status, she bought herself an abdominal pain workup.   When she asked if the IV would hurt, I said, "well, it's a needle, it's gonna pinch for a second".  Mom, on the other side of the bed grasping her daughter's hand and smoothing her hair assured her "it's just a tiny needle, they need to find out what's wrong with you", while the daughter moaned loudly, "I DON'T WANT AN IV!  I DON'T WANT AN IV!  TAKE ME HOME"  whereupon mom told her, "Well, we need to know what's going on in case you need surgery"...WTF??  Who said anything about surgery?  which made the kid ramp right up.  This 16 year old SHRIEKED when the IV was started and continued to sob about how awful it was for a long time,  completely forgetting about her horrible bladder pain.  I vaguely remember muttering something about putting on big girl panties and handed mom a couple of People magazines suggesting that perhaps she could read her daughter something to distract her as constantly calling attention to the issue clearly wasn't helping.  She was WAY over the top drama and mom was enabling.  

"Is she completely unstable?" I asked New Cathy, who merely rolled her eyes.  She eventually got Ativan and a completely negative workup.  She was our last patient of the night 3 hours before we closed.

The two of us, plus the doc, stayed overnight and worked the day shift.  The secretary called in snowbound but we had a contingency lined up for that.  We didn't count on Wednesday, that moron, staying over, sleeping in until 9:30 or so, hanging around and not cleaning 2 feet of snow off her car.  Did I mention she wasn't even working?

We never saw a soul until 11:30 AM because people wisely stayed off the road, all the ambulance calls went straight downtown as ACTUAL EMERGENCY patients, and the Lady on Elm St. had already already used up her Big White Taxi with the Flashy Lights Ticket the day before.

I was actually bored.

The Crayzee Whisperer

Picture, if you will, the crazy Area 51 mad scientist in the movie "Independence Day".  Ok, don't bother; I'll just show you.

This was the face that caused a bunch of ruckus, yelling and shouting and intimidating our new secretary.  Never mind that the guy was in his 70's, Gil did it; he called police to help the man regain control.     It was very busy so he cooled his heels until I came on shift about an hour later. Yeah, sure send in the one nurse in the department LEAST likely to de-escalate an irate human being.

He was a cellulitis recheck and IV antibiotic patient who apparently didn't really understand that retrning to the ER for a reevaluation doesn't mean the following: being seen immediately and ahead of sicker patients, or the visit taking less than 30 minutes (especially if there is not an existing IV).  Here life often moves at the speed of paperwork, which I had some trouble accessing since Mr. Doe had been previously seen downtown.  I rapidly straightened it out and went to talk with him having been elected the Christian to step into the arena with the lions.

I introduced myself and told him what I was going to do, whereupon he launched into an accounting of how he had the cops called on him and wanted to know who did it.  He was pretty sure it was the doctor whom he referred to as "that putz"

Me: "Oh, I'm not sure.  I just came in, I heard that you were a little upset though.  I apologize for the wait"

Mr Doe was understandably angry, but tried very hard not to direct it to me: "I understand that it's not your fault.  It's unbelievable really.  It's like one big Kafka novel".

Me: "You're having your own private metamorphosis?"  It's the only Kafka I have read.  Not a fan, really.  The idea of a giant insect gave me bad dreams.

Mr. Doe: "No, no, it's the surrealism.  We're at the whim of the bureaucrats, pushing paper, making rules and decrees..."

He continued in this vein for some time while I nodded and smiled and said "Oh, sure", and "that's very interesting".

Mr. Doe had lots of interesting things to say, most of which seemed to be rambling.  "We would be arrested in 13 nations for saying anything about the Holocaust", having a diverse opinion would cost him tenure, how he had written books.  Some of it had a ring of truth to it, some not so much.

He seemed to have forgotten his earlier ire and warmed up to me, and by the time he was finished I had him eating out of my hand.  I was the greatest thing since sliced bread and he was going to speak to my boss about getting me a raise.  He apologized for scaring people but still harbored some animosity toward Gil.

"Ok, that's cool. I'm here tomorrow after 3 PM, so when you come back for your recheck ask for me and I'll get you right back to a room, mmmkay?"

The following day he arrived on schedule and asked for me, "the best nurse who works here".  Jules was horrified when I asked, "So, where are you on the Grumpy meter today?".  She had not seen that he was actually wearing a bright green  tshirt with a picture of Grumpy with a meter to measure his grumpiness.  He smiled mischievously and asked if "the Putz" was working today.

Nope.

Always After Me Lucky Charms

Being ill simply doesn't fit in with most individuals' plans.  Nobody has the time or patience to let nature take its course.  Heaven forbid people inconvenience themselves long enough to contact their primary care provider or wait for an appointment when it is so much easier to go to the ER.   Even having seen their primary care, members of Instant Gratification Nation wait about 5 hours on average, then naturally it's off to the ER to obtain the pill that makes them Magically Better.  Guess what, we don't have one.

Of course one could always fall back on magic. In fact, I am considering adding Do You Believe in Magic? to mandatory screening questions I ask at triage along with Do you smoke, drink, use seat belts, have unprotected sex, use coffee, or in an abusive relationship.  That would save some time.  Discharge instructions could then include such choices as:

1. Adding a daily serving of  Lucky Charms, which are Magically Delicious.

2.  Make a visit to the Magic Kingdom.  Lots of magic there.

3.  Listen to the Beetles Magical Mystery Tour.

4.  Gotta have you some Magic Beans

On Watching Your Language

Gotta love The Pirate.

The Pirate lost his first psych patient who ran out the door shouting, "Fuck you!  I'm not staying in the fucking hospital!" After allegedly taking an overdose and adding another couple of cutting notches to her arm she "just wanted to be stitched up and go home".

The Pirate, who does proof-read his dictations, charted exactly those words.

I always used to chart the profanity patients used until I was told by some Clip Board nurse that I really should not be charting the actual profanity.  I should just write "patient used the F word" or some shit like that.

"I went to a seminar with a bunch of lawyers who said I should absolutely write what the patient said in quotes because it's about the last thing anyone wants read aloud in court".

Word.  My charts are gonna look a whole lot more interesting from now on.

Ooooh......Pretty!

Partner in Crime had already spiked a bag of Avelox when Parvati changed her mind...two more times.

Which is why we no longer take any more verbal orders from Parvati.

Anyhoo, we kept the bag of expensive IV antibiotic around hoping we would be able to use it for another patient, but alas, it was not to be.  

"Let's put it in the refrigerator and see what happens", I suggested.  "It says not to because it causes precipitation"

24 hours later this is what we got.  Looks like feathers to me (note my Magic 8 Ball and Sarcasm Ball in the background)

Questions?

Reap This

Today I walked into a day-shift shit storm as they were transferring a successful (read: "alive") code enroute to higher level of care.  There were lots of people waiting, some of whom had been waiting quite a while.  There was a handful of nice respectful individuals who were aware that a life-death situation was occurring.  They were calmly and appropriately waiting their turns.

Then there was Angry Woman.  She had a cat scratch.  She had been waiting over an hour.  SHE WAS AT RISK FOR INFECTION and creating all kinds of ruckus to the point where my boss became involved as my co-workers labored to transfer the nearly expired patient.

Yawn.

Jane: "I made nice with her.  She is waiting for Parvati to see her.  And she wants her B12 shot, she usually gets that as an outpatient, she doesn't have an order for it soIcalledovertoeherprimarycareandI'mwaitingforafax", she finished rapidly, probably hoping I didn't hear it.

Me: "So, let me get this straight.  She has an emergent cat bite and came in for an emergent B12 shot for which she doesn't have an order and she has made a scene and threatened to leave if she doesn't get it in the next five minutes and you have placated her, is that correct?"

Jane: "Um, yes?"

Me: "OK, I lost interest in that 5 minutes ago.  I'm going to do EKG's and line and lab a syncope patient.  Have fun with the douchey Angry Woman".  I walked off to retrieve the IV bucket and EKG machine, but not before I asked Angry Woman to take her Loud Hallway Douchey Telephone Yelling Session With Her Primary Care Provider's Office out of my hallway and into a room.  Eventually she stalked out, but Jane had told Angry Woman that she would call when the order came in.

 I politely told Jane that if I was busy with ACTUAL EMERGENCY patients that I would not be calling the shrew.   It was not pertinent to emergency care.

About 20 minutes later Ellen brought me a fax referencing Angry Woman from her primary care that read: "Re: Vitamin B 12.  Angry Woman called from the ER and stated that she would leave if the order was not faxed in 5 minutes"

Hahahahaha!

Me: "Um, that's not an order, Jane"

Jane: "Sure it is....isn't it?"

Me: "Jane.  No diagnosis, no dosage, no route.  Not signed.  Definitely not an order"

Jane: "Her primary care office said she was a mumblemumblemumble"

Me: "Excuse me?"

Jane: "They said she was a bitch difficult"

Me: "As ye sow, blah, blah blah"

Sometimes squeaky wheels just get the well-deserved shaft.

Cat and Mouse, 2.1

Yes, this is a mouse.  Under the old computer in the kitchen at work.  Its presence was detected by our little weekend housekeeper.

"Missus!  Missus!  There's a mouse in the kitchen!"
Esma insists on calling me Missus even though I've repeatedly told her to call me by my first name; we don't stand on ceremony here.  Maybe she just can't be bothered to learn everybody's names.  Anyway, Missus it is.

I walked back to find the offending critter who, having evaded the numerous traps placed and forgotten months ago by the pest control people, was now emboldened to storm the kitchen.  I moved a box to see the little rodent perched under the monitor.

We stared at each other for a  moment.  Critter twitched his whiskers nonchalantly.  "Hmmm....Esma, watch him for a minute I'm going to get my phone".  It has become the most obvious thing to do in this electronic era.  Take a picture.

He posed quite contentedly for several minutes until I got bored and tried to poke him into the trash bucket with the mop handle, all the while Esma laughing and squealing, "Get it!  Get it!".

Off it ran into my boss's office on the loose once again.  I sent her the above picture with the following text of her adorable little guest.

It is still out there......somewhere.

Shorts

Stinkiferous: describing lingering, sometimes noxious odor in a treatment room long after the individual(s) have departed.  Examples are hockey and football equipment and feet, soccer shin pads, and any patient who works at the local candle factory.

I have had enough of posters and sign up sheets for fund raisers.  FYI: I will not be doing any further collection of books, clothing, or winter camping gear that will then be distributed by the hospital for bragging rights for the wonderfulness of their humanitarian efforts.

Also,   I will not be running any charity 3K's or 5K's for any more causes unless it is for a definitive cure for stupid.

Gil: "It's going to be a six hammer night".  Reference: sometimes people need to be beaten with a hammer.  Please note that I am not talking about patients.

Wonderful World of Speech-to-Text Dictations in which Mac Does Not Proof-Read:

"The patient has recurrent tooth pain.  Her only problem be self once she has her teeth extracted.  However there does not appear to be readily feasible or likely to happen"

"UV strep test and flu tests were negatibe as likely to have the same upper respiratory infection however he is been sick now for about a week longer continue to uese the Zofran as necessary for nausea and robitussin with codeine 1 teaspoon every 6 hours as necessary for cough if in 5-7 days Asian R 20 better adn the cough persists started on Zithromaz as directed once daily follow up with your doctor in 7-19 days if not market lee better"

Asian R 20?  Market lee better?  7-19 days? WTF?

On Venting

Nurses know there is only so much of work you can bring home.  I recognize the signs in Mr. EDNurseasauras when he has had enough and doesn't want to listen anymore;  the glazed expression, the wandering eyes.  I can't blame him, but other than writing and spewing my frustrations, there just is no other outlet sometimes.  The crew I work with now are unlikely to want to get a drink after work, unfortunately.  I miss those days with my Utopia Hospital and Pseudocity Medical Center people.  There was always someone who didn't feel like going directly home, which led to beer call or 'rita rounds.  There were frequent opportunities to vent at one or another social occasion.  At Utopia Hospital an evening at one of my co-worker's homes turned into a venting session that some of my less experienced staff desperately needed following the ER death of a SIDS child.  We just don't have a ton of opportunity for socializing since we are a small shop.

I go in spurts with this blog thing as evidenced by the paucity of posts in November and December.  While  I may have a lot to say in general, some days I just don't even want to think about work let alone write about it.  It's been one of those spells where I am just not motivated.  Nobody at work knows I have a  blog, it would just be too awkward.  "I journal a lot" I offer blandly as I jot things down on a paper towel and stow it in my pocket.  I write a lot of stuff down because I have a pretty piss-poor memory when it comes to writing all these witty posts. I come home with a few scraps of paper or a post-it note or two which sit in a pile until the urge to write something is overwhelming. Sometimes it's a funny remark, sometimes it's just a "moment" that makes me laugh, think, or just shake my head.  Once in a while it develops into a full blown rant.

Some time around December of last year I began amassing an enormous pile of notes.  They piled up  on a table next to my chair for a few months while I sat uninspired, until I opened the adjacent window to let in a little springtime fresh air.  There went any semblance of organization.  I have yet to plow through them.  And the notes keep on coming.

On occasion, I pick one up and look at it.  Here is one that I can reach:

"The key to good care is poking holes in people"
This is a reference to a conversation Sherry and I had about people who actually require no care at all because there is either nothing wrong, or there is really nothing we can do for them.  In that case, people get downright pissed that we aren't really doing anything other than to reassure them that they are not dying....crazy is another whole story.  "Poking holes" means starting an IV and giving a liter of saline which amounts to the same as doing nothing when the alternative is doing.....nothing.  We do this a lot.

So that is one post-it note down and 4,000 to go.