From the "Strange Tales" Files

Patient complains of abdominal pain x 5 days and comes to the ER.

Since said patient was wearing pink zip up hoodie with some kind of girlie logo, pony tail with pink scrunchy, and named Kelly, I naturally asked the date of the LMP and was told "I don't have periods, I'm male".

Pregnant pause.

Oh. Sorry.

Thirty-odd years of nursing intuition should have told me that if it looks like a duck, walks like a duck and quacks like a duck, it must be a...rooster. Damn, I'm a bad mind reader after all!

Salt 'n Pepper Nursing

EDNuresesauras' gradution photo, circa 1888. That's me, top row, 4th to the left.

The caps that we used to wear, once the hallmark of the profession, have been obsolete for longer than many of the nurses I work with have been on the earth. I can remember wearing my cap for the first few years. I can also remember sailing said cap into a corner as soon as the nursing supervisor left. I don't miss the cap, they were probably pretty germy, but I do wonder at the changes since I started doing this job.

A young colleague, a nurse with two or three years of experience recently asked my opinion on how to deliver a complicated bit of nursing care. After I had explained what he needed to do, he looked at me admiringly and said, “You salt and pepper nurses know so much, I hope I have that someday”. I thought he was referring to actual gray hair, although I have none. He explained that he was speaking of “my years of accumulated wisdom”(haha!), clinical excellence, a desire to share it with others, and a non-threatening way in which to share it. This meant a lot to me, and I was quite touched to have been thought of in this way. The respect of colleagues is a pearl beyond price.

So much in nursing has changed over the years. ERNursey hit the nail right on the head with her back to basics nursing observations. I do think that we, as nurses all want to do what's best for patients, but there are so many obstacles to providing even basic care well that it has become increasingly frustrating. Dealing with difficult patients, demanding family members, unruly drunks, drug seekers, and violent psych patients are only part of the problem. What breaks the heart and ultimately the spirit is the "do more with less" mantra from MBA's who don't know a bedpan from a party hat. What we are hearing is "we don't care about what you do, you are only as important as high satisfaction scores". Good nurses are leaving the bedside in droves because they are sick and tired of compromising; literally the care is being forcibly extracted from nursing care. You can only do so much before something has to give.

So, excuse me while I "close the curtain for privacy" and shed a tear or two over the poor prognosis for nursing care.

Human Piggy Bank

I really thought it was an April Fools joke.

The father of an 18 month old in triage stated his child had swallowed a coin.

18 month old promptly vomits 28 cents. One quarter and three pennies.

"I feel all better. Can I hab gum now?"

Would You Like Some Cheese With Your Whine?

As the acuity in the waiting room plummets, the drama factor rises exponentially. There must be an equation for this; please post it if you can think of it. Whine, whine, whine, that's all I heard today. What is wrong with these people? I spent eight hours in my beloved triage box, and it was one bonehead after the other. A number of people presented with cold symptoms. Has there been some new ad in Good Housekeeping that encourages people to go directly to the nearest ER with a runny nose lasting more that 2 days? There were quite a few with vomiting. Tough call on vomiting and when it is appropriate to go to the ER, but I will say that nausea and vomiting x 1 before heading out will bump you down the acuity list. It will further be downgraded if you are asking for change for the snack machine or eating Cheetoh's.

It is a sad commentary on the art of triage that one's flair for drama sometimes gets a bed before others when all else is of equal (and low) acuity. By far the Academy Award went to a young woman who moaned, groaned, wailed, cried, carried on as if an alien baby was about to burst forth from her chest. I guess vomiting for 5 months will do that to a person. Her enabler / mouthpiece husband was right there to lend support and advocacy. Although she had normal vital signs, I had to get her out of the waiting room because she was Causing a Scene. Later I found out that she Caused a Scene about being discharged, and was admitted with an order for NO NARCOTICS OR BENZOS, and a psych consult. Good, I am glad her problems will be addressed and that she wasn't just kicked to the curb with more pain meds.

Dream Sign for Triage (well, it IS customer service, isn't it?)

Heh, heh. I had to chuckle at Girlvet's triage warfare.

Here is my dream sign for triage:

1. Please do not ask how long the wait is. We are doing our best to serve you.

2. Patients are seen in the order of severity of illness or injury, not "first come, first served"

3. Lack of planning on your part does not constitute an emergency. If you need a prescription refilled or have a chronic problem, please see your PCP.

4. Triage is not a popularity contest, nor does the person who wails the loudest automatically get in ahead of someone who is legitimately ill or just very quietly suffering.

5. Save the drama for your Mama. See #3.

6. If this is your third or more visit with the same non-urgent complaint this week and you have not followed any of your discharge instructions from your previous visits, we probably can't do anything more for you. Most of our advice is based on common sense, and there is no prescription for a congenital absence thereof.

7. If you are checking in with abdominal pain or vomiting, please do not avail yourself of the delicious snacks in the vending machine. For that matter, please do not eat the Big Mac you have brought with you.

8. Please be courteous to the staff and others who share the waiting area; screaming and using foul language only serves to piss us off, and Pseudocity Police station have way less comfy beds in their holding cells. And your bail will be more than your co-pay. Not that you'd pay it anyway.

9. Please do not inquire as to why someone has been brought in to be seen ahead of you. The triage nurse is very experienced, and if she thought you were as sick as you think you are, you would be in a bed too. Besides, it is none of your business and privacy laws exist to protect, well, privacy.

10. If your condition has changed or become worse, please do let us know and we will be happy to reassess you. Please be aware that the decision of the triage nurse is final, and faking a seizure is not cool.

11. Please watch your own children and be responsible for their needs. We cannot give everyone a turkey sandwich. Your medical care may be paid for by the government, but if you can afford cigarettes, a cell phone, and a videogame for each of your 5 children, you are expected to feed them.

12. "Pregnancy test" is really not a reason to come to the ER.