Thursday, April 24, 2014


The happy couple strolled into my last remaining critical room about 2 hours before the end of my shift.
Headache.  All day.  Woke up with it.  Not like usual migraine because he didn't have any vomiting.  But he thought that as long as he was in the area because of his shopping trip to Target that he should get it checked out.  No, he didn't take anything for the pain.

Wife was apparently in need of most of the attention and interrupted every question with observations about how her difficulties with pregnancy had caused her to come to the ER 4 times.

"They are breeding", I whispered, horrified, to my work partner.
"I noticed.  She already told me 3 times that it is usually her who is seen for her problems of pregnancy".

Namely vomiting

Headache Man received Toradol and the complimentary head CT.  Wife was quick to point out that she was allergic to Toradol, it made her nauseous.  The two of them laughed and carried on in the room for awhile.  Wife wiggle the IV tubing and touched the monitor a lot.  For no apparent reason.

BEEP.  I answered the call light.  "His blood pressure is 170/120!  That has to be really dangerous"

Me: "Yes, it can be.  I will just check that again manually".  120/66.

Wife: "It dropped a lot, that can't be good!"

Me: "With the arm bent and tightened like that, it would be higher.  I will reset the monitor to check it every 30 minutes instead".  He told me about the transient nausea that had been caused by his wires allergy to Toradol.  But he was apparently feeling fine as evidenced by his use of his cell phone to take selflies.

With a heroin overdose and a GI bleed, the People Who Care Committee were busy for the next 2 hours.  Headache Man and his wife were apparently not getting the requisite attention they apparently felt they deserved as Wife was on the call light complaining about the high blood pressure, the lateness of the hour, the need to get home, the long wait, etcetera, etcetera.  Wife sighed and complained and stood in the doorway, which drives me nuts but does noting to expedite the discharge process.

Headache Man got tired of complaining and decided to appeal to my intelligent rather than my non-existent caring side by revealing that he had an IQ 3 points shy of genius level.

I shared that little gem with my Work Partner.
"Wow.  How did you keep a straight face?"
"Oh, years of practice nodding and smiling.  And then I asked him if it was scaled for humans on this planet"

Work Partner: "Wow, Interplanetary Mensa material.  Cool".

Wednesday, April 23, 2014

It's All in the Timing

I hate getting up early but agreed to a 4 hour 7 AM princess shift at BWOM.  Bad idea.

At 80 minutes prior to the beginning of my shift, I arose having gotten about 5 hours of sleep after leaving my other job at midnight (1 hour late).  I had a 20 minute drive home.  I made it through 27 stop lights without getting a single red one, a personal best for me.

At 45 minutes prior to the beginning of my shift, I left my house to start my 35 minute drive to BWOM with a quick stop of coffee.  I hoped that the fact that it was lightly snowing would not interfere with my drive but forgot that I also had to stop for gas.  Damn.  No coffee.

At 5 minutes prior to the start of my shift, I arrived without coffee and grumpy, but found my 4 assigned rooms and 6 patient beds delightfully empty.  Coffee was my only plan for the next few minutes.  I checked my emergency carts and supplies while I sipped.  It wasn't Dunk's, but it was hot and black and nobody wanted to talk to me just then which suited me just fine.

At  30 minutes into my shift I got a single frequent flyer psych patient with a simple medical problem.

At 2 hours into my shift I got a different assignment and inherited a COPD patient bound for the ICU who had been there for about 6 or 7 hours.  Admissions generally take forever at this hospital, there just does not seem to be any sense of urgency.  

At one hour prior to the end of my shift the hospitalist had finally seen the patient and I was ready to get her out of the ER.  Frustrated with 2 computers that were frozen for 25 minutes and unable to get the Tech Monkey on the phone, I was unable to complete the mountain of computer entries (about 500 for one ICU admission) so I could transfer my patient to her Comfy Bed.  This sucked because I had timed it perfectly to coincide with my expected arrival time in the unit according to the Gospel of BWOM Admission Policies, Procedures, Unwritten and Implied Codes of Behavior, Safety and Floor Nurses Lunch Schedules.

The procedure is to fax the report, 10 minutes later the ER nurse would call to confirm receipt of said fax and give the receiving nurse the opportunity to ask questions or for clarification.  After 30 minutes the patient goes away.

I started this nonsense 1 hour prior to the end of my shift.  Plenty of time to get my patient transferred to the floor within 30 minutes of faxing the SBAR, right?   Figure 10 minutes to bring the patient to the floor,  return to the ER, 10 minutes to tidy the room, give report to the oncoming nurse, pee, and boogie home.  60 minutes.

NOPE.  The SBAR report that I had faxed to the floor 30 minutes prior to my expected arrival time was, as usual "not received" by the ICU nurse.  Re-faxed, which resets the 30 minute window.  This window is not in effect for 90 minutes around the change of shift at any time because the floor nurses are getting report and making rounds.  Fair enough.  Which means two hours, generally.  Also another 90 minutes during the middle of the shift for lunch.  Not that we ever get lunch in the ER.  

So 10 minutes after I re-faxed the report that I had written out I gave a FULL, DETAILED VERBAL REPORT to the ICU nurse,  regardless of the fact that the information is readily available in the computer.  This is where my extremely detailed and copies notes may found about my patient assessments, IV infusions, meds, labs, cultures, vital signs, I&O's, pretty much everything the astute nurse needs to know about the patient they are about to receive.  More wasted time and effort, documenting in 2 places and giving verbal report as well.  Brilliant system.

At 20 minutes before the end of my shift  I spent about 10 minutes looking for the pieces to the rarely used portable monitor and throw a few curses to the computer because NOW I CANNOT FINISH THE COMPUTER ENTRY THAT HAS TO BE MADE BEFORE THE PATIENT LEAVES THE DEPARTMENT.

I proclaimed loudly "Well, I can't fix this".
Boss Lady ran by enroute to another important meeting throwing a " yes you can!" over her shoulder as she raced by,  as if I merely need encouragement instead of a cudgel or someone who can actually fix the problem.  It wasn't happening as the Tech types were also at lunch.

At 10 minutes past the end of my shift,  I brought the patient to the ICU by myself, because there was nobody to help as usual.  The ICU nurse futzed about with the patient's bed weight that she couldn't quite figure out (you need to zero the bed first, honey),  fluffing, figuring out which monitor leads are mine and which are hers, chatting pleasantly with the patient, answering phones, putting on a different sheet, and blocked my egress from the room by holding me hostage with the patient still on my ER stretcher.

At 30 minutes past the end of my shift I returned to the ER  to find two more patients in my rooms, but the relieving nurse, having been 10 minutes late arriving for the day, had condescended to take responsibility for them.  Unfortunately, she had not as yet received report on my remaining patient and busied herself caring for the two new patients, one of which was a kid who needed stitches.  I could not, in good conscience, drag her away from that.

At 90 minutes past the end of my shift I left the hospital, forgetting to pee, and with a 35 minute drive home.

And the charge nurse went to lunch.

Tuesday, April 22, 2014

He Said It

ER tech was carefully mining for a vein in an old dude with multiple co-morbidities with shortness of breath.  In CHF. Who refused to take his hat off.

Old Dude: (between gasps for breath) "I.  Have.  Really.  Bad. ……Veins.  Go.  Ahead and.  Slap it"
ER tech: (therapeutically conversational, but focused on the task and milking arm veins): "Well, I really just kind of think that massaging it seems to work better.  I'm more of a stroker than a slapper"


Tuesday, April 8, 2014

Numbers Game

Statistics explained.  Best pie chart ever
I had racked up a some unimpressive stats one day and shared my concerns with the coordinator.

"Not happy with these statistics.  25% of my patients went to the OR,  25% left without being seen, 25% died, and 25% survived my nursing care and went home.  I need to take all the patients for the rest of the night to improve my numbers".  I had seen a total of four patients.

Coordinator: "Let's just take a page out of the "Hospital Administrator's Guide to Skewing Statistics" and see if we can make it all better.  We'll start off with an easy one.  How many IV's sticks were successful?"

Me: "100%".  I had done one all day.

Coordinator: "Good.  And how many codes did you have all day?"

Me: "None.  My patient who died was a DNR"

Coordinator: "And how many patients who were NOT a DNR died?"

Me: "None"

Coordinator:  "So, 100% of your DNR patients were appropriately allowed to die with dignity according to their wishes.  That's excellent.  And 100% of your non-DNR patients are alive and well, either saved in the OR, home to their family, or taking their 4 year old to buy another pack of cigarettes and a six pack".

Me: "I like this game".

Coordinator:  "I know, right?  So now, what percentage of your patients who left without being seen are likely to receive a survey and complain about having to wait 29 minutes while you did end of life care?"

Me: "Um, none.  I didn't give her one"

Coordinator: "Strong work. Of the 25% of your patients who left without being seen, how many had no legitimate need to be seen today in the ER?"

Me: "100%",  I said, feeling  proud of myself.

Coordinator: "See, it's not nearly as bad as you thought.  Everything is all sunshine and Skittle-pooping unicorns, right?"

Me: "Yep.  Taste the rainbow"

Coordinator: "Ok, so will you take the 24 hour position now?"

Me: "No"

Coordinator: "I thought you were looking for hours?"

Me: "Looking, possibly.  But not aggressively.  I mean,  I'm not willing to hunt them down and kill them"