Nuggets of Awesomeness

There are usually two nurses in triage but I am frequently alone.  Just me against the world.

"You are out there alone again?!", gasps the Queen of Fast Track as I pass her station enroute to the triage area.  "Unacceptable!" she exclaims.  She is there every day.  She sees all, knows all, and it makes her crazy that anyone has to triage alone, especially when it's really busy.

Me:  "Walking the Mile, walking the Green Mile".

After triage each patient is escorted to an open room….as long as there are rooms open.  Thereafter the charts go into the rack for the charge nurse to room, pending bed availability.  I like this system a lot.  But it adds a layer of responsibility for the triage nurse, aside from finding the elusive open room,  to a). assess the acuity level (in general) of the department and find an available nurse who is b). in the rotation for, and willing, to take a patient (another post in itself) and c). provide a bullet report.  This occasionally works seamlessly.  More often than not there is a bit of salesmanship involved, such as, "You love to take care of sick babies!", and "I already did the EKG, and I put in a chest pain order set".   Sometimes nurses just check the board, anticipate the arrival of the patient, tell me "I read the triage note, I've got it".  This is a rare but most welcome occurrence.

My coworkers are a curious bunch and just can't help asking "why".  The most often asked question "why didn't they call their doctor?" The answer to that is one of several stock responses,  1. "they did and were told to go to the ER", 2. "they don't have a doctor", or 3. I respond with a rhetorical question of my own, or create a diversion, such as "Look!  Hayely's Comet!" and then sprint back to my box.  Sometimes I just say, "Why ask why?", usually accompanied by  slight shrug of the shoulders and a wry smile.

Occasionally I say it in French for added amusement.

Often there are requests for "nuggets", little bits of information about patients that aren't really all that important for triage.  Mostly patients are anxious to share every aspect of their illness and when I am really interested/amused/intrigued I like to pass on said nuggets of info.

Like, what was the kid's temperature at home?
"She felt warm to the mother, but I didn't ask to what she compared it.  Warmer than toast, perhaps?  Puppies?  Day old rice?"

What was the exact dose of Tylenol?
"Some.  A bit.  A bunch.  I'm pretty sure there was no tylenol given, actually"

My personal favorite is, "What does the urgent care expect us to do about that?"

Duh.  We get probably 40-50 phone calls daily from various free-standing urgent care type places, Convenient Doc in the Box, Drive Through Care, Taco Doc, etc.  There are lots of them in the area, some are good about faxing such important information as EKG's,  which we repeat anyway, and occasionally we are offered some amusing zebras to ponder.  But our docs like to make up their own minds, perhaps fashion their own zebra hunt.  They are funny that way.

Famiy members love to chime in with nuggets of their own, which is particularly frustrating when they contradict each and every statement made by the patient.

Me: "Do you have any allergies?
Patient: "No, I don't have any allergies"
Well-meaning family member:  "Yes he does, to key lime pie, birch trees and Legos".

Me:  "When did the pain start?"
Patient:  "Oh, about an hour ago"
Well-meaning family member:  "He has had this pain for 6 months!"

Me:  "I see that you have a history of opiod addiction, are you still in recovery"
Patient:  "Yes"
Well-meaning family member:  "No, he is not, he took 4 oxy's today and drank 12 beers".

With these nuggets comes a good bit of he said-she said along with the inevitable arguments, as you can see.

Sometimes I  manage to come up with few bite-sized nuggets to pass along.  Mostly I just give a bullet and run back to my cube to start the next one.

A young girl was sent from an urgent care for a cast on her broken tibia-fibula.  She arrived in a wheelchair.  With the leg hanging.  I was confused and asked the mother why she did not have a splint, an ace wrap, or even a piece of cardboard.

"They don't do casts, that's why they sent us here".  Like I'm the idiot.   Helpfully (not) they sent along a disk with a single view film and not so much as a Tylenol on board.  Poor kid.  Our PA called their PA to rip them a new one and suggest that they need a tutorial on splinting, or failing that  perhaps simply using an ace bandage, a pillow and some duct tape.  Well done.

Here is one more nugget:

"Why is the patient soaking wet?"
"She was having a seizure.  The family poured water on her to stop the seizure"
"That actually works??"
"Only if they are faking a seizure.  Then it works quite well".