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.