This is why my soul has been sucked out

I discharged one frequent flyer drunk at 6 PM, only to have him return at 10:35.  He joined my other two frequent flyer drunks in my corner of Drunk and Pissy land, where the floor is your toilet, your needs supersede anyone else's, and you have a constitutional right to as many turkey sandwiches as you desire.

My reward was  earning a coveted "Drunk and Disorderly Hat Trick" for the evening.
Which does not include any sort of prize.

But he has 65 visits for the year, each and every one of them via the Big White Limo with the Pretty Flashy-Light Thingies.

Guess who pays?

Blogiversary, where has the time gone?

8 years.  Can't believe it.  Although I have been an inconsistent blogger at best.

Mostly I just howl at the moon.

Dear Attention Seeking "insincere detox" person….

I get that you have a problem.  I'm sorry for that, and I do want you to get the help you need.

You have been through this before, as evidenced by the detox playbook you seem to be using.
But the ER is just not the place for you to expect that all of your dreams will come true, and I'm just too damned busy right now to deal with your toxic lack of coping skills.

You arrived around noon-time, having consumed your breakfast beer and wine.  And you reek of pot.

Because you also claimed to be suicidal,  you ensured that you will be immediately whisked into a room, changed into paper safety jammies, your belongings locked up,  and one-to-one or video surveillance 100% of the time.  In record time your drug and alcohol (and pregnancy test because you are a female of child bearing age) urine and blood tests are collected.  By all means let me get the concierge to get started on your list of demands urgent life saving interventions needs right away:

-your lunch order,  turkey sandwich with mayo, lettuce and tomato on whole wheat, with french fries, fruit, and ice cream for dessert.  Per your specifications.
-endless ginger ale with "just a little ice", because you are just so parched
-the use of your cell phone (always at the discretion of your nurse….me. I have other patients, but more on that shortly)
-ativan, ativan, ativan for your "shakes", although you seem to forget that we have a video camera on at all times, and your "shakes" are not in evidence until someone walks into the room.
-extra pillows and warm blankets
-the TV remote
-the lights dimmed
-taking your order at 3 PM for supper, even though you have just eaten lunch
-asking for all of your daily scheduled meds because "you didn't have time to take them before you came"
-repeated requests to see the doctor, for your headache, finger boo-boo, sore back.
-repeated requests to see the social worker (who won't even look at you until your blood alcohol is at the required level and not one minute before.  Also there are four people ahead of you, it will be 6 hours at least)
-repeated requests to see the nurse for updates on lab results and to use your cell phone
-request for another pair of slippers
-request to take a shower
-asking for a Nicoderm patch.
-another vomit bag because "I threw up in this one".  Um, nope, that's spit.  Spitting into a bag does not equal vomit.  Vomit would have also included the groceries you just threw down your neck 40 minutes ago
-puzzled, then pissed because I removed the food from your room because now you claim to be nauseous
-asking yet again to see the social worker sooner rather than later because you have "been through this before, and I would really like to be cleared here and admitted to the Psych Unit before bed time"

This has been in the last 2 hours.  Thankfully I have a nursing assistant who can deflect some of these demands  requests, although she makes me aware of each and everyone.  She is a lovely woman, but the way, not that you care, but know that her eyes are rolling each time you push your buzzer.  Every 30 seconds.

You are not my only drunk today, dear.  I have two others who are fortunately sleeping it off before they get their turkey sandwich and are ready to head back to the bar since they are not suicidal and don't want detox.  Again.  And, since this is not a psych holding unit but an emergency department, I have medical patients who need me too.

I know you don't give a rat's ass, but you self-centered nonsense has sucked my attention away from a woman having a miscarriage of twins.  She chose none of that, and she deserved some of my empathy today, I obviously had a surplus since you killed all I had in reserve for you.

I'll end by being classy, maybe something you could work on for your next visit to the Detox Hotel.

Sincerely,
EDNurseasauras

You're welcome

You're welcome…..

newish ER nurse who took over my assignment, all except for the transfer to Big City Trauma Center.  That one I kept.   I saw the petrified look in your eye because my patient, pending transfer to Big Trauma Center who rolled in 30 minutes before the end of my shift, was a shit show.

Because we both know I can never just walk away from that.

But….

Instead of treating it like a learning experience, maybe checking to see what you could do for me, pull meds, make a phone call…..you sat on your ass and ate the hamburger you bought on the way in while I, who did not get dinner, ran around like a chicken with my head cut off.  Then I left work 90 minutes after my shift ended, having packed off said shit-show and given report to the transfer medics and transfer hospital.

Lazy, lazy, lazy.

I will not be quick to help you out with any future shit shows.  Curtain closed.

Deary me

One of the best things about being an elderly (age-wise only) clinical ER nurse is that I can get away with saying shit I never could at a younger age.    I can pretty much tack on a  "dear", "honey", or "sweetie" at the end of any sentence and, like magic, the sting is removed from any admonishment, rebuke, or refusal.

Seriously.  Like magic, I tell you.

I have further discovered that the use of "dear", et al makes it possible to drastically cut down on the amount of spin required for any given situation.  Particularly when accompanied by a pat on the hand, a squeeze of the toes beneath the blanket, and a regretful tone for added effect.

 "I need juice and a turkey sandwich and a charger for my iPhone".
 "Can I have a taxi voucher?"
"I'm not getting a narcotic prescription???"

"not just now, dear"
"I'm afraid not, dear"
"not today, dear"

Sometimes a well placed "young man/woman" (I refuse to use the term lady, because I haven't met one in about 10 years) serves to remind the rude ones that I am a card carrying member of AARP and deserve respect.  It mostly works.

My ace in the hole?  "I'm sure your mother would be very disappointed in your rude behavior", along with the delivery of a perfectly executed fish-eyed stare over the top of my glasses.

I'm so intimidating.  

Recert Blues

I have recently taken both my semi-annual PALS and ACLS recertifications for the 15th time (possibly 16th, can't recall).  It has always, ALWAYS been a source of tremendous stress for me.  Nothing strikes fear into my heart more than the word "MEGACODE".  Seriously.  More than "woman in labor".

This stems from the olden days when ACLS was taught by paramedics with one mission: to fail each student.  I was so paranoid about possibly failing this course that I paid a bunch of money to take my initial certification at a Big Town university, many miles away from my tiny hospital so that if I did fail, I could do so in obscurity.  I passed the megacode portion, a one-on-one situation in those days, but I was so traumatized that I promptly failed the written portion and had to return the following evening for a retake.  Thus I suffer from ACLS induced PTSD.

Pseudocity does not run ACLS recert classes.  Oh no.  They offer online review, and then you must make an appointment for Megacode with one of the educators.  I just couldn't fit it in, so I jumped at the chance to take the recert with Best Paramedic on the Planet (BPOP) at a location right near my home.  Piece of cake, right?

Always, more complicated than it seems.  Class consisted of me, another nurse and 10 paramedics.  After the requisite DVD viewing, airway station, CPR run-through (that I just did 2 weeks ago), and a too long break for pizza lunch, it was time for the dreaded Megacode.

For added fun, Best Paramedic set it up as a field experience.  Victims (mannequins) set up, ambulance with equipment on scene, back boards, monitors, med boxes.  The other nurse and I could not have been more out of our element.  Plus, she was wearing a dress.

First scenario, "52 year old man climbed up a flag pole after drinking a bottle of vodka and a couple of energy drinks, felt dizzy and fell.  Complains that his butt hurts" ( the butt hurting thing was a common complaint in these fictional scenarios, I was later to discover).  Group leader  was expected to run the scenario like a regular call, something all the pre-hospital types do 100 times a day.  Other Nurse and I were all,  "which one is the first response bag?", "where do you keep the c-collars?", "how do you get the drug box opened?".  We were useless.  Best Paramedic excused us from that portion of the exercise and just let us do our own (gentle version) of Megacode in the back of the ambulance, but even that was intimidating.  I could feel the internal eye rolls of the medics as I stuttered my way through an easy v-fib to PEA to asystole scenario and had to list all the H's and T's.  Like I said, megacode makes me paranoid.  One year I was so nervous I gave my maiden name although at that point I had been married over 30 years.  But I digress.

BPOP  was anxious for my feedback on including nurses in the megacode portions of the course set up for paramedics as we were the first two guinea pigs.  I had to tell him that, personal nerves aside, it was eye opening for an ER nurse

Ambulances are mysterious things to nurses who have never worked in them, and even in a short handed ER there are always resources.  Not so in the back of a moving ambulance.  Sure, I have been on transfers, but it generally consisted of sit here, don't touch that, push that med, is that IV running type of thing.  Never really had to do too much and spent that time finishing up my charting or whatever.  And I didn't enjoy it, except for that time we did the CPR Marathon back in the 80's.  That was fun.

Observing experienced medics in their natural habitat was an interesting and invaluable experience, and they occupy a spot on my pedestal, just a little higher up now.

As to the PALS recert?  Given by the education department and included 3 office pediatricians who haven't run a code in 20 years, a pediatric office nurse who was essentially a new grad, and me.   I felt like a rock star.

Holidays….'n Sh*t

Ah,  the holidays.
I usually work on Halloween.  I really have no use for this particular holiday even though my daughter says "Halloween is the best!  It's my Christmas!".  Whatever.   I have not had a kid come to the door in the last 10 years in spite of leaving a dish of candy out.  Well, one year I did, then had to eat the candy.  I would just rather work, it's easier.

I asked a co-worker last year if the nurses in our ER tended to get dressed up for Halloween.

"Of course!", she chortled.  "Well, I do!  I dress up everyday!"

The other nurse in the med room during this exchange grinned and shrugged.

"Ok, I mean does anybody OTHER THAN YOU dress up for Halloween?  Like teeny devil horns, or a spider on my headband?"

"No, not really.  But lots of people have halloween scrubs".

That's what I thought, I asked exactly the wrong person.

This fashionista nurse has an extensive and varied scrub wardrobe (scrubdrobe?) and by far surpasses this gal.  I don't think she has a single repeat, even for the "everyday" variety.  As for holidays, they are numerous.  There is even a collection of Hello Kitty attire, which I though was a riot and so wrong for a woman of her age, yet…she pulls it off.

Then there are the accessories.

For the hair, there are bows, barrettes, and headbands.  There are bracelets, earrings and necklaces.  There are tennis shoes, clogs, and nursing shoes of every color and description.  Watches.  Pens.

The day after Halloween, before the candy corns had a chance to become stale, her  Christmas and winter wardrobe came out.  Turkeys and cornucopias and snow globes, oh my.

We were subjected to hearts, hearts and more hearts signaling the end Christmas scrub season, around January 7.  And round and round, St Patrick's day, spring, Easter, Flag Day, Arbor Day.  There was not one holiday or observance left uncelebrated by some sort of attire.

Out of curiosity I once asked how many holidays and seasonal sets of scrubs she had.  I rarely see a repeat, I had to do it.  She had no idea.

 "A lot!", she grinned.

I was invited to her house after work for a drink, and I got an idea of how many sets of scrubs she had. Hundreds.  Literally.  Hundreds.

Which is exponentially more than my 3 sets: one navy, one ciel, one black.  And a black fleece vest which I pair with a 3/4 sleeve rolled cuff shirt.  Height of fashion.

I figure since I have been working back here at Pseudocity more than 1 1/2 years, I should go ahead and order the fancy vest with hospital logo and my name on it.  4 years to retirement.  Guess I'll get my money's worth.  But no holiday scrubs, rest assured.

Well, so...

I haven't actually run out of gas, just motivation to finish pretty much anything I start.    I have volumes of posts that I can't quite….wrap up.  Or can't remember why I started them in the first place.   Or that I think are stupid…mostly that.  As well as a shit load that I haven't even started yet.

I wrote a book, of sorts, culled mainly from some of my more ridiculous observations of my 42 years working in health care.  I suppose it's  entertaining.  It ends somewhat abruptly because I can't finish that, either.  To quote John Irving, "A sentence boiled in her, but she can not yet see it clearly". (The World According to Garp)

I am down to two jobs, both per diem.  I dropped BWOM Hospital out of the rotation about 6 months after I started….5 months later the Director called me to ask if I wanted any shifts for the holidays.  Yeah, no.  So, quit by default.  I tried to make it until the first of this year just so I could put on any future resume that I had worked there for a year, but….didn't finish out that way.   Although actual hire date was in December, my paperwork said January 2014.  So 11 months.  Whatever.

I have not worked at the Med Center in about 5 months, so I expect I will be getting the inevitable call about holiday shifts, or if I want to work there anymore.  Actually I would, but 1) I refuse to work 12 hour shifts, and 2) my badge, computer access, and payroll codes no longer work.  That is a potentially ominous sign, but I lack the initiative to rectify it.  Or give them my updated BLS, PALS, ACLS cards and flu shot affidavit.  So I suppose that the writing is on the wall.

At Pseudocity, there is no paucity of available shift work as I prefer 3-11.  I will accept a rare 12 hour shift and avoid the 11A-7 P as much as possible.  The added incentive to work extra on designated premium shifts means that some weeks I wind up, through requested switches or coming in a bit early on a weekend with about 8-12 hours of DOUBLE TIME pay.  I have never heard of an ER paying double time, but what the heck, it will not last too much longer as the very young orientees will be finishing their precepted shifts just in time to eliminate all double time for the holidays.

Selecting shifts is easy as my boss is a procrastinator, and filling in the per diems like me is a piece of cake.  "What days do you want to work?" is texted from my boss a couple of times a month, and I just tell her, "Oh, Mon, Wed, Fri, Tues, Thurs Sat on the next sched", or "Whatever, your choice", or "Any day but the 13th, weekend of the 20th, or ___ date  because I have a dental appointment".  This seems to work quite well for both of us.  Keep in mind that I also get multiple daily texts or calls from panicked charge nurses who ask me to come in early ("PREMUIM PAY!!!"), stay late, work an extra day, cover a sick colleague; plus requests from nurses who need last minute time off for a kids' game, recital, or spousal liver transplant.  I can be accommodating, to a point, but you know, sometimes the money is not worth the wear and tear on the body.   I am so much better at saying no these days, while still retaining my cool kid status.

But it is so busy.  Almost too busy when you run from task to task and just try to get stuff done, with my aching knees, shoulder pains, and need to actually toilet from time to time.  Which is why I don't get much done at home; I sleep as late as I want, sometimes until 9 AM.  Have coffee and a leisurely breakfast, then take the dog out for minimum of an hour, sometimes 2.  By that time, I need to get ready to go to work.  The job is not 4 minutes away anymore, so no more jumping into the shower 40 minutes before I'm scheduled to be at work.  That cuts in on my motivation too.

Well, I guess that's all the update I have for now, if anyone still stops by.  The porch lights are on.  My motivation for this post?  Aesop has "dormant" next to my blog link.