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I work with a few of the docs who had moved on from the Bait Shoppe but remembered many of my coworkers fondly.  They do not remember Bobo fondly, thinking him as much of a tool as I do.

Rocket Scientist is a doc I always enjoyed working with, and he enthusiastically welcomed me back on my first day.  We don't get much chat time because it is just too darned busy, but he exuberantly waved to me when I arrived the other day.

Rocket: "Hey EDnurseasauras!  I got a call from Bobo to expect a patient!  What exactly can they do at the Bait Shoppe now?"

Me: "Not much.  A little point of care testing.  No labs, so they don't usually send patients with IV access unless they send 'em by ambulance.  And no more pesky transfer forms"

Rocket: "So it's more like an office practice without bells and whistles?"

Me:  "No bells.  No whistles.  No narcotics."

Rocket: "Seems kind of a waste".

Heh.

Walk...Don't Walk

I worked a fun-filled shift in the urgent care pod.

It is an interesting place, 2 providers, 2 nurses, a secretary, registration clerks, and our very own LNA.  it was kind of like the med center when it was an ER, except with more help.  And a CT scan for all the abdominal  pain work-ups.  At one point I had 4 people out of 12 drinking the contrast.

Sometimes you can get pretty sick people depending on the acuity of the department as a whole.  Sicker patients overall means sicker patients in urgent care, that's the trickle down effect.

But we still get a steady stream of boo-boo's, hoppers and limpers, head bangs, kids with fever, and the Holy Trinity of Chronic Pain complaints (back pain, migraine, toothache).  And career drug seekers.

Partner assisted someone to the door and watched a couple stroll down the street and across the parking lot.  She intuited that they would be seen in our ER.  She guessed for back pain.  Correctly.

Thus she observed the reverse miracle.  An upright patient, walking with a spring in his step, became a bent-over, shuffling, moaning, miserable piece of humanity before her eyes.

I've seen lots of miracles.  In fact the med center had some lovely shrubbery that we called "Lourdes".  We would frequently find crutches, slings, air casts etc in those bushes.  Miraculous.

Call Me….Maybe

Got into a minor MVC, sideswiped by a guy in a pickup at 60 MPH.  No injuries, thankfully, but I  did lose my passenger side mirror along with scuff marks all along the right side of my 2 year old vehicle.  Sigh.  Of course it could not be my 10 year old SUV that got banged up, right?  We both drove home to deal with the insurance.

With multiple phone calls expected, I tried to make it clear that could not take personal phone calls at work.

Insurance Lady:  "What?  No personal calls at work, how perfectly awful!  You must works for a real slave driver!"

No, not really.  But it is frowned upon to answer your cell phone during a cardiac arrest.  People who work in offices just don't seem to get that.

Your'e Soaking in It

At Pseudocity we nurses work in pods.  We share rooms and general work areas,  and are given about 3-4 patients to care for (not including hallway beds which increases individual patient load).  It is meant to cut down on confusion and running around in general.  Some pods are more acute by nature because there are two critical rooms.  It is also a way to prevent one nurse from having, say, 4 chest pains, or 4-5 psych holds, or 3 or for vag bleeds at a  time.  Of course they try, but there is never any way to make all the assignments absolutely equal.  Some days you're the dog, some days the hydrant.

My pod mate and I had somehow gotten 3 of the nastiest  drunken frequently flyers. Their collective blood alcohol numbers equaled the national debt.

My change of shift assessment included the notation that my patient was pissing between the side rails onto  the floor.  And asking for a sandwich, and a change of socks whilst insincerely apologizing for pissing on the floor.

My partner found her personal drunk, who had spent the previous night and was discharged just 5 hours previously, standing at the sink.  Pissing.  And missing it badly.

"Um, you know, sir, people have to wash their hands in that.  Not cool.  And no, you are not getting any pain medication", said my partner.  

You would think that individuals who have had the equipment their entire lives would better be able to operate it, even while intoxicated.  Just saying.

Number 3 drunk, whom we shared because he was particularly nasty, insisted on a commode to piss in.    He actually managed to get some in it, but also took a monstrous dookie and used the  pillow case to clean himself up.

Me: "Hi, housekeeping?  I have 3 rooms that need to be cleaned.  Actually, they are flooded…..no, with urine…..do you have boots?  I'm thinking a firehouse would be good"

Note: I burned my shoes and scrubs in the driveway and took a shower with the backyard hose.  Needed new clogs anyway.

OK, So It's New to ME

I learned a new word today: incarceritis.  It's been around for some time, I'm told.  Guess I have just lived under a rock.

I heard it from the officer who brought in the individual from the courthouse after allegedly having  a seizure immediately following his sentencing (note:  I never want to know their offenses.  Besides, it just isn't relevant.  All I need to know is "violent", "grabby", or "just do what you need to do from the doorway").  

I try not to be judgmental but, when all the officers and EMS people tell me that is a stone-cold case of incarceritis before the patient even hits the room, it can be difficult.  Shaky Dude was rolled by (in shackles) and placed in a hallway bed.  My partner eyed this dramatic scene over the top of her ever-present half-glasses as she sipped her coffee.    "Incarceritis", she said knowingly.  She is rarely impressed by the antics of the general population.

Paramedic Pete:  "He wouldn't let me do vital signs, wouldn't let me do a fingerstick glucose because he didn't want me to cause him any pain, ditto on the IV.  Couldn't get any history, allergies, or med history"

Why?

Paramedic Pete: "He has been shaking the side rails, whipping his head back and forth, and faking a seizure, while also telling me he couldn't talk to me right now because he is having….a seizure".

Officer: "Yep.  A clear cut case of incarceritis if ever I saw one"

Alrighty, then.

My triage note included the patients first words to me, upon asking him what happened today

Shaky: "I need to make a phone call"

Me: "Not my decision to make, sir, this gentleman with the badge is the boss of your extra-medical activities this evening.  He says no phone calls until you get to the jail".

Eventually the doc saw him and suggested the complimentary head CT for aberrant behavior along with the usual assortment of lab tests for various medical maladies (and the presence of drugs in his system), whereupon Shaky stopped shaking and became perfectly lucid.  "Nope, I don't want any of that.  I'm fine.  I need to make a phone call, just let me make a fu*king phone call!"

Doc: "No sir, the officer has said you can do that when you get to where you are going.  Are you refusing any treatment or diagnostic testing that I have determined is  necessary for your seizure-like activity?  Because if so I will have you sign out Against Medical Advice"

Bye.  Incarceritis.  Use it in a sentence today.

This Post Brought to You By the Letters : A, B, C….

It's been my week for unhappy patients.  I collect them like dust.   Would that we could devise our own survey for difficult patients, wouldn't THAT be a hoot.

Some people just hit the door itching for a fight, pre-programmed to have some kind of issue. These individuals quite frequently come with potty mouth, bad manners, and a lack of patience in general.    They are disrespectful of staff and other patients.  Maybe it is defensive, based on a past experience or just having  a bad day in general.  I get it,  for many people it is literally the worst day of their life.

Or maybe they are just an entitled A-hole.

Regarding the Worst Day people, I give them a lot of slack and take it in stride.  As for the others, not so much.

A-holes seem to have a lot of similar characteristics, many of which, interestingly enough, begin with the letter A.  The Big A.  Which is just the beginning of the alphabet.

Some lead off with a clearly defined AGENDA, and  are often ARGUMENTATIVE.
They know exactly what they want, even if it is ABSURD.

 Some have lots of ALLERGIES.
 Usually to NSAIDS or every narcotic except Dilaudid.

Often they ANTICIPATE a fight for what they want specifically, and use words like "horrible bedside manner", "letter to administration", and "calling my lawyer" when they don't get it.

Lots of patients become a strong  ADVOCATE for their pre-determined diagnosis and treatment plan, no matter how bad an idea it might be.  It has all been spelled out for them thanks to Dr. Google (note:  I am not talking about informed patients who have done some research.  Calm down.).  They simply need a provider to write for their desired antibiotics or a therapeutic X-ray.  Some sign in to the ER with the complaint,  "Need an MRI".  They do not get one.  Hilarity ensues.

ALIBI  is not a reason to come to the ER, but it happens a lot.  Roommate stole your Adderall?  Need a prescription refill?  Need documentation for missing a court date?  Too busy to wait for a PCP appointment for rash cream?  C'mon down.

Rarely, after using foul language and creating a hostile atmosphere which does not produce the desired outcome, there will come an APOLOGY for their bad behavior.  Not often.

Moving on, I present my top selections of the letters B-E.

Talking smack and BADMOUTHING about previous providers who did them wrong, be it in the community, another hospital,  may have fired them for being an A- hole, or not helping them just because they broke their pain contract.   Also they may refer to the last nurse who started an IV on their track-mark tattooed arms "that bitch that stuck me 11 times".  

CUSSING:  Uses the F bomb a lot.  Complains about "the wait is f*cking ridiculous, my f*cking pain is f*ing out of control, this place is bulls*it".  They don't "f*ing care if it's busy" or if people in the next room are trying to die.

DEMANDING, DILAUDID, DISRESPECTFUL, DRAMA:  The first two self explanatory.  Some examples of DRAMA?  Sighing loudly.  Moaning loudly.  Banging the sides of the bed.  Yelling out to the nurses every two minutes.  Throwing themselves around on the bed.  Whining, lots of that.

EXPLANATIONS, in which the patient is intent on convincing everyone that their particular problem is an original complaint, never before thought of in the history of scamming for narcotics.  The pain scale does not apply to them, and usually it is 11 or more.

FAKE CRYING: See DRAMA.  I need to see actual tears.  Sorry.

I could move on to the rest of the alphabet, but….nah.