Donorcycles and Near Drowning

Spring never came, summer looked as if it might skip New England entirely and it has been raining for a month. At last, the sun is out and warm weather, it seems, has finally stuck the landing here in the Artic Tundra of the northeast. Every SUV has a dog's head sticking out of it, mine included. Tina, my dog, is happily chasing chipmunks in the woods. Yesterday, I'm not lying, there were two ducks sitting in a tree in my backyard bog. That was a first for me, so I had to Google "Do ducks perch in trees" just for laughs....guess I'm not the only one to wonder since there was quite an extensive amount of informtion to be had on ducks perching in trees. Mr. EDnurseasauras was not best pleased to be awakened to see this once in a lifetime sight, though. Oh, and the grass is green and my eyes are watering. Other sure signs of warm weather are yard sale signs; I saw a sign on a tree in one neighborhood advertising "Puppy's For Sale". Puppy's what? Being a stickler for spelling and grammar, that really annoyed me. The hot dog stand in town advertised with this hastily written sign, in magic marker on a poster board:

"Hot Dog $1.50 withacanofcoke" kind of squished in. Hurryupandeat.

Being the first actually really hot day means that all the pale skin that hasn't seen the light of day since Labor Day is going to get roasted. Pass the melanoma please.

Bikes, skateboards and other devices invented for challenging the fragility of the human body are being dusted off so that we who work in the ER have job security. We have lots of sutures and tetanus, and have stockpiled slings, casting material, splints, bandages and crutches.

And the sure sign of spring: motorcycles are back on the road for all of the seasonal drivers (Simplysweet, I'm talking 'bout chu...). Indeed, they are everywhere. In this Live Free and Die Stupid state, the mandatory use of helmets is not a law...more of a suggestion, actually. Of course, those of us who care for such idiots who choose not to wear protective headgear and wind up in my ER could tell you a few stories about ruined bodies, ruined lives and ruined families. Here's a small public service announcement for anyone who doesn't wear a brain bucket; some may believe it is just another means of thinning the herd, but scraping your brains off the highways and byways is someone's job. I guarantee it does not make anyone's day. Let me walk you through a couple of scenarios.

Patient A is traveling along the road on a bright sunny afternoon on his Harley, wearing jeans, a T shirt, and sneakers; he is not wearing a helmet. At a speed of 40 MPH, for whatever reason, he hits a patch of dirt, a rock in the road, swerves to avoid a squirrel and loses control of the bike. He is brought to the ER unconcious with a big bleed in his head. This turns out to be a really bad day for him because, despite our best efforts, he dies of his injuries.

Patient B, while riding his Harley on a lovely summer day also hits a patch of dirt, swerves to avoid a squirrel and loses control of his bike. He is brought to our ER concious and alert, but with a big crack in his helmet. That helmet saved his life. I don't know anyone who has sustained an injury without a helmet and survived who persists in riding without one. I am sure they are out there, though.

Another equally stupid idea is to let kids ride those ATV's. I don't know the law on this but it just doesn't seem to make sense to let a kid behind the wheel of something so heavy that he would be powerless to get it off if landed on him..........provided he was still alive. When you bring in your 9 year old covered in blood from an ATV crash telling me he has been riding since he was 4 merely signals me that you are an idiot and should be locked up.

Two separate but related incidents tended to bring out the sighing, eye rolling and lecturing old nurse in me.

We heard the radio call from MAC base on our scanner about a 3 year old who had fallen in the river not far from our facility

"We won't get that, will we?" asked Cathy, my Southern Girl coworker.

"Maybe. If the patient needs an airway we will, it he's coding we will, and if it was more of a swim than an actual near-drowing we will". I get out the warming blanket just in case.

Sure enough 20 minutes later we get the patient, a little cold (the river is frigid this time of year) and his mother who went in after him. His head went under for seconds before she brought him out spluttering and crying. An eyewitness said she was reading a magazine when the kid went in. So it turned out lucky, and thus the weak members of civilized societies propagate their kind. This was reinforced after I met the dad.

He appeared to be a combination of Colonel Sanders and Mark Twain, complete with beard and straw hat to go with his portly appearance. He had no trouble telling his kid, loudly, about all of his experiences in the ER.

("This one time, at band camp...")

Seriously dude, I do not care if you had a broken toe or a bee sting. Neither does your kid, and where were you when your wife was reading a magazine while your son decided to go for a swim in the Swift River? I really just hate in when people act like a parent for my benefit. I already know you're an idiot, just shut the hell up. Sheesh.

Two weeks later, in rush the Parents of the Year with the little swimmer. "I think he cut his finger off!", Mom shrieked. Dad, affable as ever helped the situation not one bit by trying to tell the kid how he cut his finger when he was 5; all while we are trying to get information about how the injury happened, etc.

The child was playing with a disposable razor. Yes. A. Disposable. Razor. The excuses this time included, "well, the cap was on, and he's played with them before. He likes to pretend he's shaving".

Oh, that's different. Perhaps you'd like to give him a knife to stick into an electrical outlet when he gets home? It should be OK if the knife has a wooden handle. Pour a little water on the floor too. And hey, instead of a sticker, please let him help himself to a fun Bic lighter; we have an array of colors to choose from.

Yikes. The finger wasn't cut off, only needed a few stitches. Ever helpful, Dad retained the focus on himself the entire time, not getting the hint when I suggested he could maybe talk to his son to keep him calm. Finally I had to say "Dude, pay attention to your kid, please! This isn't the time to share your diarrhea problem with the class!". Idiot.

Discharge instructions included (no lie) "Do not allow child to play with razors", and "Choose appropriate toys". Oh and expect a visit from social services at some point.

Now calling.....

"Smith?"

I called out in the waiting room for the next patient on the hitlist.

This had been preceded by a discussion about how to pronounce the patient's first name.

Dayseanne.

"Could it be, um, Daisy Anne?" my Southern girl coworker mused.

"Doubt it. It's a male".

"Day Shawn, maybe?" wondered Sherry.

"I won't take a chance, since he's 11. I'll go with the last name"

"Good call".

Turns out it was pronounced Day Sheen. The fact that he will be spelling if for the rest of his life is probably secondary to telling people how to pronounce it.

CPR Recert

Every year or two (depending on where I'm working and what the rules are) all nurses have to recertify CPR (more accurately BLS, basic life support). This is a something I have done every year since CPR was invented and it became illegal to allow people to die a natural and dignified death without pounding their chest and breaking a few ribs. Something to think about when you have decisions to make about familiy members, I can tell you.

Back in the early 70's, things were sometimes a little unclear as to who got CPR and who didn't, but we all learned it anyway. I worked as a nurses aide (now called LNA's or licensed nursing assistants) for a year out of high school before I went to nursing school, but that is a story for another day. Anyway I think the first CPR class I attended was in 1972 or '73. That's a helluva long time to be poundin' away on the dummy every year or so. It was a lot more complicated then, now it's pretty streamlined.

The first time a patient died on my watch was when I was a puppy nurse, out of school less than a year. I was the 3-11 charge nurse on a 40 bed rehab floor, although they were mostly chronics; brain injured individuals without much rehab potential and things like that. It was kind of a nursing home floor really. I was the only licensed individual, but oddly my 3 year diploma program which people are so condescending about prepared me for a leadership position 3 months out of school when the average ADN and BSN students were still in orientation. That's not a slam, just a statement of truth.

I was feeding an elderly woman, I'll never forget it, mashed potatoes. Some of it dropped onto her lap and I had lost the napkin. I stepped out of the room to the kitchenette across the hall and returned in about 20 seconds. She was gone, sitting bolt upright and holding onto her spoon as if she planned to continue using it. I did have to do post-mortem care with the policy book propped open on the bedside table. One of those life experiences I guess. But CPR? It was a rarity at that place.

I taught CPR for about 15 years later on and got pretty well burnt out doing it. I taught scouts, dental offices, teachers (they are the worst for performance anxiety), business offices, restaurants, EMS, and the usual hospital inhabitants of nurses, respiratory therapists, lab and xray, unit secretaries, EKG techs and doctors of course. Doctors were the worst because most of them a)sucked at it and b) just weren't interested in doing it right at all. I guess that was OK, during a code you would much rather have a doc who knew their ACLS (advanced cardiac life support) shit than BLS. Nurses and EMT's mostly did CPR anyway; Call me crazy, but I thought it was important for the docs to know proper technique so that they could evaluate CPR in progress for effectiveness since they are the ones running the codes.

I don't mind jumping through hoops as long as they are reasonable. I'm not a young woman anymore, and the knees just won't tolerate being on the floor slaving over a hot CPR dummy. The education team had kindly provided cushy mats to ease the stress. The child and infant mannequins were on tables for our convenience, also a plus. As far as I know we were all nurses, EMT's, paramedics. The last thing we want is someone who has never performed one minute of CPR in their lifetime on a living person nit picking the depth of compressions. You always know who they are because it goes something like this:

"You need to make a tighter seal" or "You need to compress faster" or "You didn't yell help" or "You forgot to blah blah blah blah".

Sigh. It was the same today, there is always one yutz in the pack who pecks away at every minuscule detail and holds up the entire line.

I'm happy to tell you she had nothing to nit-pick with me (smug expression).

I waited for my turn behind a new EMT, young, probably about 11 years old judging by the look of him; they get younger every year for some reason. The poor kid had to perform after he became completely unnerved by the young woman in front of him.

The very attractive young lady had on white capri's made out of some interestingly rather sheer material; unfortunately she was obviously wearing a thong (blue).

Picture this; if you have never seen CPR performed, go to Youtube and try to imagine what this poor young EMT had to witness. Think about this attractive young woman with her back to us, kneeling next to the mannequin in her see-through white capri's, pumping (yes, pumping) from the shoulders and bending at the waist. Up, down. Up, down. Up, down.

Are you getting a mental image? Good, because that was likely the only image in the EMT's head as he fumbled through his demonstration. He left rather quickly afterward.

So that's CPR for this year, now I'm all set.

Repeat Business

I think I've said it before.


My ER is quite a magnet for repeat business for dental pain, migraineurs and various other narcotic seekers. It's quite a business.

Some of our docs and a couple of the nurses work at other ER's and see the same people from time to time. It's funny how they kind of just walk out when a nurse who took the same complaint (word for word) looks at the chart and says "Hmmm. I know you were give a 'script for Pen VK and Vicodin last Friday evening at Mt. Seaside. Are you not taking them?"


One girl claimed her backpack was stolen. Which contained her prescription for Percocet. One guy said he lost his prescription (at least his fifth for 20 Vicodin in the last 2 months). Another claimed her 3 year old threw her Percocet in the toilet. And the old standby "I knocked them into the sink".

How refreshing would it be to have someone come in and say, "Look, I'm addicted to painkillers" instead of devising these ridiculous fairy tales. A young guy I remembered from 2 or 3 months ago came in and told the exact same story about how he saw the dentist, he has an abcess and was told to come to the ER for antibiotics (and pain pills) and blah blah it will cost him $700 to pull his tooth and he doesn't have the money. Same story exactly, I looked it up because I remembered he had an unusual name. Funny that this time he had a different last name. He was invited never to return.


We have an unusual group of co-dependent migraineurs. A couple of them take turns driving each other (we don't let 'em drive after they get their fix for obvious reasons). One doc gave a migraineur VALIUM for cripes sake along with 100 mg out of the usual 150 mg of Demerol they normally receive. Now they all want it.


Speaking of driving under the influence of mind altering drugs, one of the chronic migraineurs got her meds, got on the phone for her ride, and said she would wait outside on the bench as he would be right along. OK. We were busy, but I was suspicious. I know what she drives, too, and I checked the parking lot. Nope, no van. No patient on the bench either.


I popped into my bosses office which has an expansive view of the back parking lot where we employees park. Oh, look.....there is my patient 15 feet below me starting her van and driving away.


Oh, doctor, guess who just lied and drove home?
Wanna talk liability?


That's it, he says. She's not getting another narcotic from me, and let the record show that she was observed driving after she said she had a ride.


Three days later she came back, parked her van in the back and got............NOTHING.


This is not to be mean or vindictive. Do you want to put your loved ones, both on and off the road at risk with this nutbag driving with a boatload of narcotics onboard? Didn't think so. I sure don't.

One of our newer docs refuses to give Demerol. At all, which is kind of interesting. She might order morphine, with a Vistaril chaser (which stings like a mad bastard when you inject it I might add). One of the co-dependents now claims morphine as an allergy.


I will say that some of the other docs are interested in coming up with unified plan. We are all feeling like pushers.


Come to find out, without fanfare and without warning the hospital pharmacy had decided to take Demerol out of the formulary as of June 1 (basically a list of meds the hospital carries....we aren't CVS, you know).


Apparently one of the migraneurs was forewarned, and must have thought it meant that we were no longer stocking Demerol in our satellite ER only, because low and behold, there she was on June 1............at the downtown main ER. Hmmmmmm.

Adventures in Little Old Lady Land

She was 100 years old.
Arriving by ambulance from an assisted living facility complaining of hip pain. She smiled beatifically as she was wheeled in by the EMS crew who had gone to fetch her, her pale little face peeking out from beneath a halo of white blankets.

The crew had gotten to know her pretty well on their brief ride from her facility and let us know she had fallen the night before, but was up and around; there was no overt sign of hip fracture, sometimes a death sentence for the aged. She lived in her own room and was able to get herself to the dining room for her meals; she managed her own medication, contingencies for her assisted living arrangement where there was no professional staff. Up until a couple of years ago she drove a car, but gave up her license following a motor vehicle crash. "Not my fault!" she piped in, bright and alert and spry......although very, very hard of hearing


Sherry and I and the paramedics oh so gently transferred her from the ambulance gurney to the bed as if she were made of porcelain. I can't recall seeing these big guys move someone with so much care. They carefully tucked n her blankets and bid her farewell.


We undressed her with utmost care, and I inspected her soft white skin, so transparent; this skin is 100 years old, I marveled to myself. "It burns", said Alice, our centenarian, rubbing her hip; there were no bruises or swelling as she pointed to the area righ above her hip bone.


"Shingles", Sherry and I mouthed simultaneously to each other.

"Did you fall down ?", Sherry asked. "Yes, I live in town", replied Alice.


I just grinned.


We xrayed Alice's hip and found nothing. We got her up to be sure she could walk; we found a walker so she we could more accurately assess her ability to ambulate. Alice did just fine, and asked to sit in a chair. We covered her with blankets, got her a little snack.


"We're going to send you home! Do you want anything for pain?", Sherry yelled.


"No, I don't like to take pills, not even Tylenol. I'm fine", Alice said in her little bird-like voice. "I want to go home with my daughter".


The local ambulance service is usually one way, and they weren't able to get her home.


We called the daughter. She said she wasn't able to accomodate her mother, and couldn't give her a ride home. That was just as well since I found out she was 80 and probably shouldn't be driving Miss Daisy.


Alice, now that she was upright, called out "Nurse!?" every few minutes. Sherry asked if she would like to sit in our tiny waiting area to watch TV, and she thought that was a good idea while she waited for her ride. We got her completely dressed, again carefully putting on her clothes including her 20 year old Reeboks. Seriously. We wheeled her to the waiting room which is literally 10 feet from our nurses station.


While in the waiting room, instead of calling "Nurse!?" when she had to go, she stood herself up out of the wheelchair and peed on the waiting room chair; and got back in the wheelchair.


I felt bad but that didn't prevent me from laughing. Her person from the assisted living facility brought a change of clothes.


"G'night, Alice!"