New Year's Eve was fairly steady. By 7 PM we had seen a number of patients, all of whom were pleasant, polite, in real need of emergency care and in general, a pleasure.
Usually on holidays, you get the extreme version of the Sick and the Stupid.
To recap, the Sick consist of any patients who should be in the ER; that would be lacerations that require suturing, chest pains, head injuries, fractures and the like. The Stupid are those patients who should emphatically NOT be in the ER for any reason; that includes rash for 3 weeks, any chronic pain, fever of 100 degrees as the chief complaint, ear wax, or any who has a doctor's appointment the same day but just doesn't feel like waiting.
As I said, on holidays it is the extreme version; REALLY sick or REALLY stupid. This I categorize as complaints that range from Illness to Idiocy. Same rules apply.
The gentleman who should have been in the ER like yesterday for blood sugars above 600 would qualify, as well as the man who nearly severed his thumb while decapitating Mr. Thomas Turkey, AKA, New Year's day dinner, with a hatchet. Nothing like fresh poultry I guess....hmm, what is that in my stuffing? Thumbthing wicked this way comes.... Honestly, who has turkey on New Years Day?
So I was more or less prepared for trouble when one of the local regular customers strolled in. At least he waited until we had dinner. He is known for being rude, often aggressive and I have personally thrown him out at least once. He got into it with the doc in the past because the doc wouldn't write him a 'script for 120 Valium like the last doctor. WTF.
Tonight he complained of a rash, convinced it was bedbugs, or hives, or MRSA, or plague.
He is especially nasty to women, and we usually try to protect our secretaries from his bullshit because they are all really nice and don't deserve it; not that anyone does. On the other hand, he has had a run-in or two (and been thrown out) by my usual co-worker, AKA my "work husband", Dan; he is 6 foot 5 and takes no bullshit from anyone. Dan was already ramping up as soon as he caught sight of the guy so I went in to triage him. Must have been a good day for him because he gave me no trouble; asicd from failure to make eye contact, which drives me nuts.
As he passes by Dan, he mumbles to his friend "That's the guy gave me bullshit last time I was in here"; Dan rises to the occasion and returns fire, "Yep", he says, "I recall you told me to polish up my resume; I'm still here".
I cringe and resist the urge to dive! dive! dive! under the desk.
The man and his friend get all huffy so I took the higher ground. "Why don't you have a seat in the room, the doctor will be in to see you shortly; we all just need to be respectful of each other and you will get your problem taken care of" I offered.
They grumbled into the room, he got his 'script for prednisone and hydroxyzine for his itchy pseudobugs or MRSA or galloping crud, and went outside to smoke.
"His companion wants to check in too", said my doc of the eve.
Frig.
The 20 year old female claimed the guy as a family friend. Her complaint was abdominal cramping; she was 4 months pregnant, having discovered this fact after taking an ambulance ride downtown to our mother ship in the last couple of weeks for the exact same problem. No prenatal care. No insurance.
She had not followed up with an OB as instructed. I quickly deduced that she wanted pre-natal vitamins and an ultrasound...in other words a picture of her baby.
She was a little skittish. I entered the room to draw her blood, and she decided she felt really nervous and wanted to step outside for some fresh air.
OK.
"Just a few minutes, though, OK? If we need to send you downtown (for an ultrasound) we should get this show on the road"
I waited about 10 minutes and decided she needed a kick in the ass; I went out the door to discover her smoking a butt.
I coaxed her inside and prepared my various tubes and assembled equipment, and explained what I was going to do. She proceded to tell me what awful veins she had and how she was terrified of needles and how "sum nurse" dug around for her vein for over and hour trying to draw blood.
Uh huh. I love a challenge and nothing gives me more pleasure than a successful venipuncture on the first try; I rather pride myself on it, actually. I attribute my success to the countless pedi IV starts when I worked at Utopia Hospital.
But I digress. The young lady said, "I'm just really anxious about my baby, I am scared there might be something wrong with it".
"If you are really concerned about your baby, you should quit smoking immediately".
"Well, I've really cut down since I found out I was pregnant".
"Your baby doesn't know from cutting down. You are at risk for having a low birth weight baby. Do you know what that means?"
"Having a small baby? Wouldn't that be better for delivery?"
Arrgh. This kid is doomed.
As the festivities began to wind down we were hopeful that we might get out at 11PM, our usual closing time. I triaged a sore throat at 10:20 PM, then a febrile, inconsolable, wheezing 8 month old who was afebrile, sleeping and had no wheezing. But did have an ear infection and didn't wake up during the exam or when I put Oticaine in followed by a cotton ball.
At 10:40 PM local EMS was toned out for a lethargic 4 year old with special needs, not otherwise specified. We know most of the medically fragile kids in the area and the address we heard over the scanner was unfamiliar. Moments later, we heard that CPR was n progress.
"Should we stick around to see if they need to come here?" I wondered aloud.
"They know what time we close", offered the secretary.
"I know, but a pedi code is anxiety provoking, they won't be thinking about it in the field", I responded.
I asked our doc who was an ex Greatest EMT in the history of the world, before he went on to become World's Greatest Paramedic before he got kicked out of the Air Force Academy for being a big mouth, followed by the designation of Most Intellectual ED Doc in the Universe. But good to work with when we can keep him focused.
"Wait and see".
By 11:05 PM we had heard nothing. "We're closed" said our doc. I wasn't sure, but it was his call. Still, we knew he would sit in the parking lot for a few minutes.
Since we nurses and other lower life forms park out back in a lower parking lot, Lisa and I made our way down the back elevator, alarmed the building and went outside into gently falling snow. We had gone a half a dozen steps across the lot when we heard the siren. Lisa and I froze in our tracks. The ambulance approached, got closer and louder. I fumbled in my coat pocket for the key and tried to remember how to disarm the system to get back inside as I listened.
We held our breath. One block away. Outside our ER.
And continued toward the city.
Thursday, December 31, 2009
Wednesday, December 23, 2009
It's Magnetic
"Have you looked at this?" asked my husband, Mr. Ednurseasauras
"What?", I asked, busy warming my hands in front of the pellet stove.
"This discount card from your hospital. You can go online and print discount coupons and look for deals at a bunch of different stores and restaurants. It says 'Perks Card' ", he said
Like what?", I asked, becoming interested. I hardly ever read anything that comes from my hospital.
"Well, let's see: Dougie's House of Onions, Sally's Books 'n Toasters, Elemental Crankshaft...um, Lamps, Socket Wrenches and Diapers's, ... and Arby's".
"Big Whoop. I never heard of any of those except for Arby's, and I don't think there's one of those for 50 miles...why would I even bother?"
"I thought you might be pleased since the hospital cut your educational reimbursement by 50% and your shift differential fifty cents an hour", my husband replied, not without a note of sarcasm.
Ah, I thought, he's baiting me.
"OK, I see where you're going with this. For one thing, it is no skin off their teeth if they give discounts to obscure places that nobody ever goes to; in fact, I find it insulting. You can put a turd on bread and call it lunch, but it's still a turd".
"Good analogy".
It's still a big old stinking turd.
I'm still pissed that Scary Catholic Medical Center did both of those things as well as completely cutting the employer contributions to the 401K. These occurred after the Magnet Survey in August
Bastards.
Magnet Recognition is a designation bestowed on any hospital that works hard enough to jump through the necessary hoops. It is given by the American Nurses Credentialing Center (ANCC) , a wholly owned subsidiary of the American Nurses Association (ANA). Magnet Recognition is given to a hospital that "satisfies a set of criteria designed to measure the strength and quality of their nursing. A Magnet hospital is stated to be one where nursing delivers excellent patient outcomes, where nurses have a high level of job satisfaction, and where there is a low staff nurse turnover rate and appropriate grievance resolution. Magnet status is also said to indicate nursing involvement in data collection and decision-making in patient care delivery. The idea is that Magnet nursing leaders value staff nurses, involve them in shaping research-based nursing practice, and encourage and reward them for advancing in nursing practice. Magnet hospitals are supposed to have open communication between nurses and other members of the health care team, and an appropriate personnel mix to attain the best patient outcomes and staff work environment". (From the Center for Nursing Advocacy).
It's a lot of documentation, and sounds like it should be a good thing. I guess it is except that the astute nurse recognizes it as window dressing. Nurses are largely brain washed into into thinking that a Magnet designation is anything other than a marketing tool. Those nurses are then lined up, questioned by the representatives of the ANCC who are convinced that the candidate hospital is the Best in the Entire World in attracting and retaining the World's Best Nurses because the hospital cares deeply and passionately about Nursing Issues.
Bull.
Shit.
I was forced by my nurse manager to attend a Magnet Dinner; there were about 12 of us with 4 Magnet Representatives. After we finished rubber lasagna, wilted salad, soggy garlic bread, and soda, the examiners went around the room and asked each of us; where we worked, what projects we were involved in, what educational or leadership expertise the administration had encouraged us to participate in and what UAC's we were involved in.
Huh?
Let me put it this way; I go to work to earn enough money to pay for my expenses. After 33 years, I feel pretty much as if I've done my time with Unit Advisory Committees. Waste of time. I have all I can do to do my assigned hours, attend an occasional staff meeting, be a mover and shaker behind the scenes and scramble to complete my BSN before I chuck the entire plan and follow my friend Anne into hair dressing. Really. Or learn to play the drums, whatever.
To the Magnet representative I spoke about my years of nursing experience in the ER at various levels from staff to leadership positions, went on at length about completing my nursing education and plan for grad school and ultimately teach nursing in some capacity. I spewed some lie about working on a nursing assessment form that pretty much everyone had worked on as well; I recognized a nice young ER nurse from our mother ship and dragged her under the bus with me as I said, "Erin, you probably had lots of input in that too, didn't you?".
Erin grabbed at the lifeline as she clearly had no UAC commitment either and rambled her own bull shit. I silently flung the bird at my nurse manager for putting me in this position.
Two weeks before the hospital got its Magnet designation, the aforementioned budgetary cuts were made; all affected clinical nurses. While merit raises were cut, no management positions were cut, reduced or eliminated. No administrative positions were eliminated. No administrators took a pay cut. This is a demonstration of how much a Magnet Hospital values its nurses.
Magnet my ass. Use the nurses for gaining some sort of marketing edge and then, in this economy cut tuition reimbursement and pay. Yikes.
I can't wait for the Magnet Peeple to come back, but that will be a few years.
The hospital is, however, required to conduct satisfaction surveys either once a year, or once every two years. They can pretty much depend on me to lower their satisfaction scores.
I just love surveys. The first couple of surveys I completed I complained about the crucifixes in every treatment room; that and the joining of hands, being forced to pray and sing Kumbaya at the conclusion of orientation. I though this was offensive in a facility that seemed to pride itself on cultural diversity. How does this welcome members of other cultures and religions while ramming their ideals down someone else's throat?
Within 2 weeks the crucifixes disappeared. Interesting.
Bring on that Magnet satisfaction survey; unless our tuition reimbursement is fully restored, along with shift differential and merit raises. And, while you're at it Scary Medical Center, fire 50% of your administrators and other dead weight. I want the CEO right here tonight. I want him brought from his happy holiday slumber over there on Melody Lane with all the other rich people and I want him brought right here, with a big ribbon on his head, and I want to look him straight in the eye and I want to tell him what a cheap, lying, no-good, rotten, four-flushing, low-life, snake-licking, dirt-eating, inbred, overstuffed, ignorant, blood-sucking, dog-kissing, brainless, dickless, hopeless, heartless, fat-ass, bug-eyed, stiff-legged, spotty-lipped, worm-headed sack of monkey shit he is! Hallelujah! Holy shit! Where's the Tylenol? *
Me, bitter? Nah.
*Thank you Clark Griswold, although I stole this from Jules.
"What?", I asked, busy warming my hands in front of the pellet stove.
"This discount card from your hospital. You can go online and print discount coupons and look for deals at a bunch of different stores and restaurants. It says 'Perks Card' ", he said
Like what?", I asked, becoming interested. I hardly ever read anything that comes from my hospital.
"Well, let's see: Dougie's House of Onions, Sally's Books 'n Toasters, Elemental Crankshaft...um, Lamps, Socket Wrenches and Diapers's, ... and Arby's".
"Big Whoop. I never heard of any of those except for Arby's, and I don't think there's one of those for 50 miles...why would I even bother?"
"I thought you might be pleased since the hospital cut your educational reimbursement by 50% and your shift differential fifty cents an hour", my husband replied, not without a note of sarcasm.
Ah, I thought, he's baiting me.
"OK, I see where you're going with this. For one thing, it is no skin off their teeth if they give discounts to obscure places that nobody ever goes to; in fact, I find it insulting. You can put a turd on bread and call it lunch, but it's still a turd".
"Good analogy".
It's still a big old stinking turd.
I'm still pissed that Scary Catholic Medical Center did both of those things as well as completely cutting the employer contributions to the 401K. These occurred after the Magnet Survey in August
Bastards.
Magnet Recognition is a designation bestowed on any hospital that works hard enough to jump through the necessary hoops. It is given by the American Nurses Credentialing Center (ANCC) , a wholly owned subsidiary of the American Nurses Association (ANA). Magnet Recognition is given to a hospital that "satisfies a set of criteria designed to measure the strength and quality of their nursing. A Magnet hospital is stated to be one where nursing delivers excellent patient outcomes, where nurses have a high level of job satisfaction, and where there is a low staff nurse turnover rate and appropriate grievance resolution. Magnet status is also said to indicate nursing involvement in data collection and decision-making in patient care delivery. The idea is that Magnet nursing leaders value staff nurses, involve them in shaping research-based nursing practice, and encourage and reward them for advancing in nursing practice. Magnet hospitals are supposed to have open communication between nurses and other members of the health care team, and an appropriate personnel mix to attain the best patient outcomes and staff work environment". (From the Center for Nursing Advocacy).
It's a lot of documentation, and sounds like it should be a good thing. I guess it is except that the astute nurse recognizes it as window dressing. Nurses are largely brain washed into into thinking that a Magnet designation is anything other than a marketing tool. Those nurses are then lined up, questioned by the representatives of the ANCC who are convinced that the candidate hospital is the Best in the Entire World in attracting and retaining the World's Best Nurses because the hospital cares deeply and passionately about Nursing Issues.
Bull.
Shit.
I was forced by my nurse manager to attend a Magnet Dinner; there were about 12 of us with 4 Magnet Representatives. After we finished rubber lasagna, wilted salad, soggy garlic bread, and soda, the examiners went around the room and asked each of us; where we worked, what projects we were involved in, what educational or leadership expertise the administration had encouraged us to participate in and what UAC's we were involved in.
Huh?
Let me put it this way; I go to work to earn enough money to pay for my expenses. After 33 years, I feel pretty much as if I've done my time with Unit Advisory Committees. Waste of time. I have all I can do to do my assigned hours, attend an occasional staff meeting, be a mover and shaker behind the scenes and scramble to complete my BSN before I chuck the entire plan and follow my friend Anne into hair dressing. Really. Or learn to play the drums, whatever.
To the Magnet representative I spoke about my years of nursing experience in the ER at various levels from staff to leadership positions, went on at length about completing my nursing education and plan for grad school and ultimately teach nursing in some capacity. I spewed some lie about working on a nursing assessment form that pretty much everyone had worked on as well; I recognized a nice young ER nurse from our mother ship and dragged her under the bus with me as I said, "Erin, you probably had lots of input in that too, didn't you?".
Erin grabbed at the lifeline as she clearly had no UAC commitment either and rambled her own bull shit. I silently flung the bird at my nurse manager for putting me in this position.
Two weeks before the hospital got its Magnet designation, the aforementioned budgetary cuts were made; all affected clinical nurses. While merit raises were cut, no management positions were cut, reduced or eliminated. No administrative positions were eliminated. No administrators took a pay cut. This is a demonstration of how much a Magnet Hospital values its nurses.
Magnet my ass. Use the nurses for gaining some sort of marketing edge and then, in this economy cut tuition reimbursement and pay. Yikes.
I can't wait for the Magnet Peeple to come back, but that will be a few years.
The hospital is, however, required to conduct satisfaction surveys either once a year, or once every two years. They can pretty much depend on me to lower their satisfaction scores.
I just love surveys. The first couple of surveys I completed I complained about the crucifixes in every treatment room; that and the joining of hands, being forced to pray and sing Kumbaya at the conclusion of orientation. I though this was offensive in a facility that seemed to pride itself on cultural diversity. How does this welcome members of other cultures and religions while ramming their ideals down someone else's throat?
Within 2 weeks the crucifixes disappeared. Interesting.
Bring on that Magnet satisfaction survey; unless our tuition reimbursement is fully restored, along with shift differential and merit raises. And, while you're at it Scary Medical Center, fire 50% of your administrators and other dead weight. I want the CEO right here tonight. I want him brought from his happy holiday slumber over there on Melody Lane with all the other rich people and I want him brought right here, with a big ribbon on his head, and I want to look him straight in the eye and I want to tell him what a cheap, lying, no-good, rotten, four-flushing, low-life, snake-licking, dirt-eating, inbred, overstuffed, ignorant, blood-sucking, dog-kissing, brainless, dickless, hopeless, heartless, fat-ass, bug-eyed, stiff-legged, spotty-lipped, worm-headed sack of monkey shit he is! Hallelujah! Holy shit! Where's the Tylenol? *
Me, bitter? Nah.
*Thank you Clark Griswold, although I stole this from Jules.
Wednesday, November 4, 2009
Bite Me
It is absolutely essential that I have a laugh at work. For that matter, I pretty much have to laugh wherever I go. I have been called witty, but when I'm together with my brothers the zingers fly. It is nice that my two adult children have the confidence to step into that arena now. They are both VERY funny; my son J is dry as a bone. K, my daughter also has a great sense of humor. We do laugh a lot together.
The ER is just ripe for funny stuff. Not that we are laughing at the patients, but sometimes the stuff that comes out of people's mouths, well, you just have to laugh.
I often say whatever is on my mind, and I like to make the patients laugh a little when I can. I am a big Monty Python fan, and frequently I will throw out a line just to see if anyone will bite. A patient came in with a hamster bite, and I asked if the the little ratly creature was prone to such behavior or this was an aberration. As I swabbed the puncture I mumbled running commentary along the lines of "It's only a harmless hamster" (note Holy Grail reference) and the guy picked right up on it and responded in kind. Before you know it, we were bantering lines back and forth and laughing like idiots. Good thing it wasn't busy. Spam, spam, spam, spam...
Another animal bite victim comes in, this time a dog bite. We heard a dog barking from somewhere in the neighborhood; "Did they bring in the dog?" asked Cathy, my Southern nurse accomplice
"Nope. Just the head", I kidded. "Wanna know his name"?
"Ok, what is the dog's name" she said, bracing for impact.
"John the Baptist".
Ouch.
Dog bites are epidemic, and we get another one. This one had a chunk of skin missing from the space between the thumb and forefinger. This one struck for "no reason".
My partner loves dogs and just had to have a conversation about English sheep dogs. Dog bites to the hand are usually not sutured; risk of infection.
The other day a woman was out in her yard hanging laundry and minding her own when she was attacked by a woodchuck who tried to take a chunk out of her leg. No, they didn't catch it. My neighbor had one living under her front porch, and I tell you, they are mean. I was walking my dog and the thing sat brazenly on the front steps in the middle of the afternoon and screamed at us. Good thing the dog was on leash or she could have been killed. Scary damn creatures.
Sometimes people just go looking for Trouble. I mean, they practically out and out take an ad in the Lost and Found section of the paper they want Trouble so bad. The think about Trouble, if you go looking for it you can generally find it quite easily in Plain Sight. Here is an excellent example.
One guy came in with a farily nasty bite on his hand because he tried to PET A FERAL CAT.
He told us all about his rescue attempt of a SKUNK WHO HAD BEEN HIT BY A CAR.
Are you kidding?
"Yeah", he said, "That thing scratched me up pretty good, but as soon as I put it in my car the thing SPRAYED me!"
We really aren't supposed to say "What th fu*k?", it's not too professional. I couldn't help but ask "Um, what did you have in mind when you put that wild creature into your car?" to which he replied. "Well if we had called animal control, they would have just killed it".
Oh, of course I completely understand now.
I live in a semi-rural area; I'm not talking Allagash here, but the houses on my street are at least 3 acres apart and is bordered by woods. One of my neighbors who lives at the end of my cul-de-sac- was attacked by some sort of 4 legged critter--in broad daylight. It was first thought to be a fox, then a coyote, then a fisher cat, then a wolf. Whatever it was, it was going after their horses; they are beautiful draft horses, and let me tell you they are BIG. The family also has some unidentifiable large dog the size of a pony, but they kept that in the house. The woman went out with a stick and started yelling at it while one of the kids called 911. Whatever it was, the animal turned on her and latched on just above the elbow; she was literally beating at it with the stick but it wouldn't let go. She finall managed to pick up a rock and bashed it in the nose; it let go and ran off. She said it couldn't have been more than 15 seconds, but it seemed like hours. The whole time she was afraid one of her kids would come out to join the fracas. We cleaned her up, did some xrays, updated her tetanus, and started the rabies series. A few days later when she came back for her next dose she was a mass of bruises. And, she said, the critter had returned but they had managed to scare it off with a BB gun and her son's slingshot, but from the back porch. Whatever works I guess.
The ER is just ripe for funny stuff. Not that we are laughing at the patients, but sometimes the stuff that comes out of people's mouths, well, you just have to laugh.
I often say whatever is on my mind, and I like to make the patients laugh a little when I can. I am a big Monty Python fan, and frequently I will throw out a line just to see if anyone will bite. A patient came in with a hamster bite, and I asked if the the little ratly creature was prone to such behavior or this was an aberration. As I swabbed the puncture I mumbled running commentary along the lines of "It's only a harmless hamster" (note Holy Grail reference) and the guy picked right up on it and responded in kind. Before you know it, we were bantering lines back and forth and laughing like idiots. Good thing it wasn't busy. Spam, spam, spam, spam...
Another animal bite victim comes in, this time a dog bite. We heard a dog barking from somewhere in the neighborhood; "Did they bring in the dog?" asked Cathy, my Southern nurse accomplice
"Nope. Just the head", I kidded. "Wanna know his name"?
"Ok, what is the dog's name" she said, bracing for impact.
"John the Baptist".
Ouch.
Dog bites are epidemic, and we get another one. This one had a chunk of skin missing from the space between the thumb and forefinger. This one struck for "no reason".
My partner loves dogs and just had to have a conversation about English sheep dogs. Dog bites to the hand are usually not sutured; risk of infection.
The other day a woman was out in her yard hanging laundry and minding her own when she was attacked by a woodchuck who tried to take a chunk out of her leg. No, they didn't catch it. My neighbor had one living under her front porch, and I tell you, they are mean. I was walking my dog and the thing sat brazenly on the front steps in the middle of the afternoon and screamed at us. Good thing the dog was on leash or she could have been killed. Scary damn creatures.
Sometimes people just go looking for Trouble. I mean, they practically out and out take an ad in the Lost and Found section of the paper they want Trouble so bad. The think about Trouble, if you go looking for it you can generally find it quite easily in Plain Sight. Here is an excellent example.
One guy came in with a farily nasty bite on his hand because he tried to PET A FERAL CAT.
He told us all about his rescue attempt of a SKUNK WHO HAD BEEN HIT BY A CAR.
Are you kidding?
"Yeah", he said, "That thing scratched me up pretty good, but as soon as I put it in my car the thing SPRAYED me!"
We really aren't supposed to say "What th fu*k?", it's not too professional. I couldn't help but ask "Um, what did you have in mind when you put that wild creature into your car?" to which he replied. "Well if we had called animal control, they would have just killed it".
Oh, of course I completely understand now.
I live in a semi-rural area; I'm not talking Allagash here, but the houses on my street are at least 3 acres apart and is bordered by woods. One of my neighbors who lives at the end of my cul-de-sac- was attacked by some sort of 4 legged critter--in broad daylight. It was first thought to be a fox, then a coyote, then a fisher cat, then a wolf. Whatever it was, it was going after their horses; they are beautiful draft horses, and let me tell you they are BIG. The family also has some unidentifiable large dog the size of a pony, but they kept that in the house. The woman went out with a stick and started yelling at it while one of the kids called 911. Whatever it was, the animal turned on her and latched on just above the elbow; she was literally beating at it with the stick but it wouldn't let go. She finall managed to pick up a rock and bashed it in the nose; it let go and ran off. She said it couldn't have been more than 15 seconds, but it seemed like hours. The whole time she was afraid one of her kids would come out to join the fracas. We cleaned her up, did some xrays, updated her tetanus, and started the rabies series. A few days later when she came back for her next dose she was a mass of bruises. And, she said, the critter had returned but they had managed to scare it off with a BB gun and her son's slingshot, but from the back porch. Whatever works I guess.
Speaking of biting critters, one of my co-workers, Sherry, goes to Alaska every summer to canoe down random wilderness rivers above the arctic circle. She and her husband are gone weeks at a time. They eat a lot of jerky and soup because they neither fish nor hunt; they are very concerned about their carbon footprint. Sherry and hubby have done these trips for years, loving peace and solitude, the beauty of their surroundings and usuallythe abundance of wildlife.
They have never had the kind of chilling close encounters with grizzly bears they experienced this year. Apparently there was some kind of grizzly bear convention because this year, not only were the bears present in unprecidented numbers but they were very curious; one might even say they were stalking my friends. This went on for days; they would make camp and bears would always be nearby. One even started running her way, far enough but still too close for comfort. Apparently, because they were without any kind of weapon except Grizzly Bear Spray in a can for REALLY close encounters, they largely deterred these creatures with a whistle or shouts. I wouldn't have closed my eyes. Ever.
"How can you go into the wilderness without a gun?" I asked.
Sherry was so completely unnerved by the memory of charging grizzlies that she told her husband that she didn't think she could do the trip next summer. Her husband thought it would be a good idea if they brought a gun next year because he really wants Sherry to go and feel comfortable. He even said he would learn how to shoott.
"Well, you need to learn too!", I exclaimed.
"Oh, I grew up around guns. My Dad still hunts. I know how to shoot", she replied. Yikes. Apparently her husband is the pacifist, and was begining to see the danger inherent in this situation in a new light.
I thought that as the weeks and months went by Sherry and her husband would take a more assertive approach to procuring a firearm. Unfortunately, the epiphany was short lived and her husband is backing off and losing his resolve. Sherry, on the other hand, just bought a can of pepper spray, which you don't need a permit to carry in this Shoot Pepper Spray and Live Free or Die state. Today pepper spray, tomorrow protection against grizzlies.
Good luck Sherry! Guess your husband will simply have to continue to use harsh language voicing his extreme displeasure in unequivocal terms while taking care not to damage the self esteem of the native ursus arctos horibilis.
Read to the bottom for full hilarious effect. Love it!
Tuesday, November 3, 2009
The Patient is the One With the Disease
The lady who rushed into the ER last night after having her forearm punctured by her cat's sharp little teeth was in the department again less than 24 hours later when I got to work. She had gotten her wish: because she neglected to take the proferred antibiotic for 15 hours she developed the cellulitis that she insisted she was going to get. This was fairly predictable since she pretty much wanted to be admitted last night when she came in. When there was no redness or swelling. She wanted to be admitted prohylactically. I don't know about you, but such individuals just creep me out. There is an alarmng population of individuals who revel in their illness, delight in their disability and can't wait for complications. It is all about the attention, either from health care workers or family and friends.
Lots of people will fake pain so they can get narcotics; some are addicted, some sell them to get other drugs. The majority of these adopt a "pitch 'til you win" strategy. They make the rounds of every ER until they get what they want. Since we close at 11 PM, unless we have patients in the department, many have figured out that if they come in at 10:50 PM we will be more likely to give them the Vicodin or Percocet. Sometimes it backfires. One of the docs will only give Tramadol, which is fairly useless to the hard-core narcotic seekers. Let me assure you, though, we do evaluate everyone individually for their pain issues; sometimes we actually get someone who has 1) legitimate pain, which we 2) relieve
Still, some people have some pretty elaborate stories; it goes like this:
"So I've had this pain in my tooth for about 2 weeks, tylenol doesn't work, aspirin doesn't work, ibuprofen doesn't work (fill in time of last over the counter pain med administration, usually sometime yesterday). I have an appointment with the dentist next (fill in the day and date) because I had to reschedule from (fill in the last 6 dates for alleged cancelled appointments). The pain is really bad, it goes into my jaw and into my neck. It's 10 out of 10, I can't eat or sleep. I had some Percocet but i finished them. Does my face look swollen? It feels swollen. If I could get some more Percocet to tide me over until I see the dentist that would be great. Did I mention my pain is 10 out of 10? It's really bad No, I didn't call the dentist to see if I could get an earilier appointment"
Because I have many years of experience and generally know how to synopsize most complaints, my triage not says simply:
"Dental pain. Requests Percocet"
That about covers dental pain. It makes me lose interest really quickly, especially when we've seen the patient 5 times in the last 3 weeks, and it's always the same story. Many times the patient will get a 'script for Vicodin AND Penicillin. Guess which 'script never gets filled?
My favorite doc is keenly interested in relieving dental pain; he will do an injection of local anesthetic just like the dentist does. Not all of them do this, but I think for the legitimate dental paineurs it is a great option to buy them some time to get to the store for one of those temporary filling kits. Alas, some people refuse this option as you can imagine.
Not all the docs have the training to do this, which is why I think my friend Debbie, who teaches this skill to hygienists and dentists, should come up and do a training session. She could clean up $$ wise. Must remember to talk to her about it, several of the docs were very interested. It sort of seperates the wheat from the chaff if you get my drift.
Lots of people will fake pain so they can get narcotics; some are addicted, some sell them to get other drugs. The majority of these adopt a "pitch 'til you win" strategy. They make the rounds of every ER until they get what they want. Since we close at 11 PM, unless we have patients in the department, many have figured out that if they come in at 10:50 PM we will be more likely to give them the Vicodin or Percocet. Sometimes it backfires. One of the docs will only give Tramadol, which is fairly useless to the hard-core narcotic seekers. Let me assure you, though, we do evaluate everyone individually for their pain issues; sometimes we actually get someone who has 1) legitimate pain, which we 2) relieve
Still, some people have some pretty elaborate stories; it goes like this:
"So I've had this pain in my tooth for about 2 weeks, tylenol doesn't work, aspirin doesn't work, ibuprofen doesn't work (fill in time of last over the counter pain med administration, usually sometime yesterday). I have an appointment with the dentist next (fill in the day and date) because I had to reschedule from (fill in the last 6 dates for alleged cancelled appointments). The pain is really bad, it goes into my jaw and into my neck. It's 10 out of 10, I can't eat or sleep. I had some Percocet but i finished them. Does my face look swollen? It feels swollen. If I could get some more Percocet to tide me over until I see the dentist that would be great. Did I mention my pain is 10 out of 10? It's really bad No, I didn't call the dentist to see if I could get an earilier appointment"
Because I have many years of experience and generally know how to synopsize most complaints, my triage not says simply:
"Dental pain. Requests Percocet"
That about covers dental pain. It makes me lose interest really quickly, especially when we've seen the patient 5 times in the last 3 weeks, and it's always the same story. Many times the patient will get a 'script for Vicodin AND Penicillin. Guess which 'script never gets filled?
My favorite doc is keenly interested in relieving dental pain; he will do an injection of local anesthetic just like the dentist does. Not all of them do this, but I think for the legitimate dental paineurs it is a great option to buy them some time to get to the store for one of those temporary filling kits. Alas, some people refuse this option as you can imagine.
Not all the docs have the training to do this, which is why I think my friend Debbie, who teaches this skill to hygienists and dentists, should come up and do a training session. She could clean up $$ wise. Must remember to talk to her about it, several of the docs were very interested. It sort of seperates the wheat from the chaff if you get my drift.
Friday, October 30, 2009
Today's Last Patient of the Night
From time to time I will try to keep you amused with stories about our final patient before we close. Last night we had the young man whose chief complaint was:
"I went to the bathroom and there was a bug"
The young man stated that he got really drunk and had a one night stand. He was so drunk, he said, that he couldn't even remember when it happened. Having casual, unprotected sex while intoxicated gave him a nice souvenir of the occasion. Even if he couldn't remember it. Or the woman. In fact, it gave him several hundred souvenirs.
He was in his 20's, and he was: With. His. Mother. She sat right there in triage and kept saying disgustedly "I can't believe you got drunk and caught critters"
Really. All things considered, I can't believe he actually had sex.
I never want to examine these type of complaints too carefully because the little buggers can jump; I leave that to our highly paid board certified emergency physicians. Besides, I would have had to put on my glasses and really PEER intently at his crotch. Frankly, I don't get paid enough to do that.
He went on his merry way with his prescription for Kwell with Mom still berating him. I felt kind of bad for him cause he was a little clueless. Still can't believe he had sex.
"I went to the bathroom and there was a bug"
The young man stated that he got really drunk and had a one night stand. He was so drunk, he said, that he couldn't even remember when it happened. Having casual, unprotected sex while intoxicated gave him a nice souvenir of the occasion. Even if he couldn't remember it. Or the woman. In fact, it gave him several hundred souvenirs.
He was in his 20's, and he was: With. His. Mother. She sat right there in triage and kept saying disgustedly "I can't believe you got drunk and caught critters"
Really. All things considered, I can't believe he actually had sex.
I never want to examine these type of complaints too carefully because the little buggers can jump; I leave that to our highly paid board certified emergency physicians. Besides, I would have had to put on my glasses and really PEER intently at his crotch. Frankly, I don't get paid enough to do that.
He went on his merry way with his prescription for Kwell with Mom still berating him. I felt kind of bad for him cause he was a little clueless. Still can't believe he had sex.
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