Ho, Ho, HO

Well, Christmas has come and gone, and for once I didn't work one second of it. Not Christmas Eve, not Christmas Day. What a treat it was, and well deserved as I have worked each and every Christmas since I was 13 years old; believe me that was a LONG time ago. I must say I did not miss being in the ER and having to take care of the usual sick and stupid. Actually, on Christmas it is more like the critically ill and the galactically stupid; extremes are the norm.



In addition to not working on the holiday, I am also on break from school until the middle of January, so I had a nice relaxing few days. Returning to work today was a pleasure, right up until Last Call when a member of the Better Living Through Chemistry Club came in with a migraine and demanded the only drugs that work for her: Toradol, Demerol and Phenergan. I work at a couple of ER's in the area so I poked my head in the room just to say hi. Her reaction can best be summed up by a parody of a credit card commercial:
Cost of ER visit to the patient: $Zero
Cost of ER visit to you and I because she has Medicaid: $400.00
Meeting the nurse who took care of your worthless ass last week in another ER: PRICELESS.

Old Nurses Never Die..They Just Go Back To School

At the age of...well old, I have gone back to school to get my degree. I went to nursing school when the choice for nursing education was a 2 year ADN program, a 4 year baccalaureate program or a three year hospital based diploma program. I chose the three year route. Good or bad, it was over 30 years ago. Now that I am old and creaky, I realize that I do not want to spend the waning years of my career pushing around stretchers containing farm animals. I believe I would have a lot to offer in terms of educating the next generation of nurses, so I am pursuing my BSN and then my masters in nursing. Unless I just decide to work at Chilli's.

To date, in addition to the 45 credits I was given for being an RN, I have taken five courses and received credit for two others that I took a few years ago. I get no credit for any of the lab science I took, and I have to take chemistry and two math courses. Not looking forward to that. At the rate I am going, it will take me 2 more years to get my degree, and who knows, 2 years for a masters. Why is this made so difficult?

With the looming nursing shortage and the paucity of masters-prepared nursing educators this country is going to be in big trouble in a couple of years when nurses my age retire. Or work at Chilli's. I realize that I need to get the necessary degrees, but sheesh.

There plenty of programs for individuals with a BA or BS in another field making it significantly more easy for someone who has never worked in the field to get into nursing as a second career. It is even possible, in 2 years, to become a nurse and get a masters degree. Does this make any sense, a brand new nurse with a masters degree? To do what? Certainly not teach! I interviewed one for a position in the ER at Utopia Hospital. She had literally no clinical experience and would have been a disaster; not to mention it would have been setting her up for failure in a fast-paced ER where, I'm sorry to say, my little friends were famous for Eating Their Young.

Psychosis is the Reason for the Season

The holidays are always a time to anticipate seeing more of those lost souls who Cannot Cope With Life. Like the bag on old St. Nick's sleigh, the ER's are filling up with with the depressed, the suicidal, the drug seekers, the alcoholics and the true psychotics. Now, before you get on your high horse, I have such individuals in my own family. They cannot cope with their lives either. They are the drug seekers, drug addicts, and other people who exist in a world that doesn't understand them and is sick of trying to help them because they are incapable of helping themselves. While this is sad, it just sucks the life out of ER staff to have to see these same people day, after day, after day. It is a waste of resources, really. The Scary Catholic Medical Center in Pseudocity where I occasionally moonlight (the crucifixes in every room creep me out a little, quite frankly) lets them sleep in the waiting room; they are allowed to sit and wait about 8 hours until they are sober or get bored and wander away. The genius is they have a warm place out of the weather, but the ER doesn't really have to take responsibility for them.

Icing

The first (of many) winter snowstorms in Frozen Tundra of NH always brings out the best and worst. The newly fallen snow covered treacherously hidden ice, causing many to go to ground. In the first 90 minutes of my shift in Tiny Satellite ER, local EMS delivered an ankle fracture and two shoulder fractures, a coccyx fracture, shoulder sprain, scalp lac and a variety of bumps and bruised egos. Naturally, it brings in someone for a med refill ("I know the pharmacy screwed up and didn't give me ALL the Ritalin I need, so now I've run out"), drug rash ("My three year old has had it for THREE DAYS, and it's much worse since our PCP saw it the last 2 days, what do you mean it's a two hour wait??"). It never fails to amuse and amaze that these people would take their lives (and their children's) in their hands, put on the galoshes and go out and drive around with the rest of the crazies here above the Arctic Circle.



The best was the Hover Mom: you know, standing in the doorway, asking for something every 5 minutes so you know she's concerned about her 9 year old who fell in the driveway and has a head bump. No LOC, but their PCP assured her that "a head injury would be a top priority and seen immediately" (um, your pediatrician is an idiot who lied to you, and he WAS seen immediately and appropriately triaged. I'm pretty sure he's not herniating). What posesses these PCP's to say make such blatently stupid statements and get everybody all riled up?



Anyway, after casting, splinting, slinging, stiching and icing all the boo-boos, it got very un-busy. I hesitate to use the Q word, because you never know when it will come back to bite you. And I have to work tomorrow, so I'll play it safe.

Meet Dr. Dewshe Bagghe

Since leaving Utopia ER, last year, I have come to accept that quality care (and quality ER docs) are a matter of perspective. One individual who should just hang it up I will refer to as Dr. Dewshe Bagghe. Cranky, sour, condescending, everything the experienced physician was, oh, say 35 years ago; which is about when he should have retired. He is just plain mean. Honestly, I feel sad for the patients who have the misfortune to have him for a doc. He actually said, not only in my presence but IN FRONT OF A PATIENT, "I hate this fucking job, it sucks". Nice. He hates me because I have a brain, 30 plus years of experience, and usually anticipate what he's going to do. If I get out a certain med, he won't want it. If I draw blood, he won't order any tests for awhile. If I order a cardiac workup, he'll cancel it. If I ask him for pain meds, he'll dance around the issue. He makes it the most unpleasant place to work. One night I had a sick 2 year old, a tough stick with a fever, vomiting, and a nervous mother who was used to getting her child's emergency care at Big Metropolitan Children's Hospital and not Regional Pseudocity Medical Center. A master of communication and a real team player, old Doc. Dewshe Bagghe told me to put a line in the child. OF COURSE he was going to order cultures and labs, he just neglected to tell me (or was waiting to give me enough line to hang myself with so he could confront me). And OF COURSE as I was drawing the blood anyway after a successful stick the Charge Blond comes barreling in to tell me to draw the bloods. Sorry, already on that. Ha!

I'm pretty sure the rest of the world has progressed to the point where this kind of behavior is not tolerated. I throw him under the bus whenever I can, though, so that's fun. When the patient's complain, I give them the name of my boss, the name and phone number of the administrator and encourage them to complain. Guess I will have to come up with something else though, because he's still there.