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"
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Pirate: "She is sufferering from Half-a-deck-a-cardia"
(as in not playing with a full deck)
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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.
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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"
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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?"
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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.