Monday, January 1, 2018

Tidbits from triage

Happy New Year!  Count down to retirement!  In 3 years, sigh.

Holiday weeks are either crazy busy or crazy slow.  This past week was the
Worst.  Week. Ever.

Limited office hours at overwhelmed primary care locations, urgent care and doc in the boxes just sending everybody with a pulse, stacks and stacks of people.  At no time was there any less tan 10 people awaiting triage and a four, five hour wait for care.  22 in the rack waiting to be seen by a doctor.  Thanks to protocols and docs trusting us nurses, the sickest were seen first and the kind-of-sick had EKG's, labs and X-rays in progress or completed.  It didn't exactly streamline things, but it was helpful to get stuff going.

Of course, when people are that sick in the waiting room, the squeaky wheels just make life more difficult.  Complaining about the wait.  Embellishing their symptoms (adding chest pain to the mix did not expedite their visit).  Fake vomiting didn't work either, there were no beds, just none.

I had one man voluble complaining that his 78 year old mother had been waiting 3 hours.
"Our doctor called about this!  It's ridiculous!  She's old and sick and needs to see a doctor right now!"

In response, the family member of another patient told him to sit down and be quiet.

"My mother is 85 and she's just as sick, and we've been waiting longer than that."

Hilarity ensued.  I called security and ducked back into my cubicle.

Drama alert.  I was told there was a woman who was in the bathroom and was screaming for a doctor right away.  A 17 year old was on the throne, moaning that her intestines were on fire, she couldn't get up, and wanted to have diarrhea and throw up at the same time.

I sent a couple of barf bags over the top and advised her that I would see her in triage when she was ready.

On the subject of "my doctor/urgent care/ called ahead":
We probably had 50 notifications on 3-11 shift alone.  Yeah, your doctor may have called.  Our doctors don't do what they say, they make their own decisions.   It changes nothing with the process of triage, and we are going to repeat most of the tests anyway, so there's that.  Also,
1.  I don't have a list of your medications.  You should
2.  My computer doesn't have the same information as your doctor.
3.  You are not getting an MRI today for your back pain.
4.  You may be admitted, or you may not.  Please leave your suitcase outside.

At five hours into my shift I elected to use the bathroom and eat some food.  Naturally, the next patient  gave me a snarky "Did you have a nice lunch?".

I responded pleasantly, "What kind of work do you do?"
He told me some office type occupation.
Me: "Oh, so you don't get lunch?"
Him: (haughtily) "I do, but I don't deal with life and death"
Me: (narrowing eyes and leaning forward slightly): "Exactly"

He was there for man-cold.  Enjoy your 5 hour wait.