Um, yeah. This was WAY too much drama me.
Man and woman, let's call them Dick and Jane, were brought in with relatively minor injuries from a car crash. They had been out drinking. Jane was driving. Jane was sufficiently toasted, wailing, "Where is my boyfriend Dick? Is Dick Ok? Why can't I see him? I'll kill myself if anything happens to him!"
Another man, let's call him Bob, came in looking for his wife; he had come across the wreckage of his wife's car, and was told by police that the driver had been taken to our ER. That would be Jane.
Of course, it was news to Bob that Jane had been out on a date instead of at the movies with girlfriends; needless to say the existence of Jane's boyfriend came as a complete surprise. Hearing Jane yelling drunkenly for her boyfriend was the tip off. Ooops. I was glad the police where there, even though we didn't need them.
I will say that Bob handled himself with aplomb; he never once raised his voice. He was dignified even though he must have been hurting terribly. I felt badly for him, but what can you say. He advised Jane that she was not welcome at home, and that he would contact her when she could pick up her things. Jane's response was to feign unconsciousness, if that is possible if you lack a conscience to begin with.
In my opinion he is well rid of her.
Monday, August 23, 2010
Friday, August 20, 2010
No Scabs Here
I had a phone message from some nursing agency calling for "nurses in all specialties" to work at a northwestern Mass. hospital for, get this, STRIKE coverage.
The offer included guaranteed 36 hours of pay, per diem, housing, travel, meal allowance, heck, probably even manicures and pedicures. My response?
DELETE.
Other than starvation (which,regretfully, wouldn't be happenin' anytime soon for me) there is not a single reason in the world that would entice me to cross a picket line. Not even for a million bucks.
The offer included guaranteed 36 hours of pay, per diem, housing, travel, meal allowance, heck, probably even manicures and pedicures. My response?
DELETE.
Other than starvation (which,regretfully, wouldn't be happenin' anytime soon for me) there is not a single reason in the world that would entice me to cross a picket line. Not even for a million bucks.
Monday, August 9, 2010
Well, What DID you think was gonna happen?
Jay Leno had a rather amusing segment called "What Did You Think Was Going to Happen?". There was a video clip with a young man straddled between the front bumpers of two facing cars, with his, er, um...junk.... stationed directly over a lit bottle rocket. Predictably, the bottle rocket lodges in his jeans at Ground Zero; hilarious hijinks ensue. What Did You Think Was Going to Happen indeed.
I silently ask the same question of many of our ER patients. There is a great dearth of common sense out there. A vast wasteland devoid of both common sense and, frankly, any sense at all. Of course, the patient's own agenda frequently defies any kind of sense or even native intelligence. Many simply have no brains at all.
It never ceases to amaze me how frequently ignorance is eclipsed by galactic stupidity.
There is no cure for the common cold. Only bonedheads and the uninsured/free care/I'm never gonna pay my bill crowd anyway show up at the ER for antibiotics to cure said cold. Two nights in a row. One guy was seen twice in 24 hours because his pneumonia wasn't better after 1 dose of antibiotics; he wasn't worse, just not miraculously better. Dumbass.
As you know from previous posts, many days I feel like the Narcotics Elf who works with Dr. Santa Claus. We see the same people over and over and over. Sometimes they hit the right doc, sometimes they leave with nothing but their pud in their hands. These are the "Pitch 'til You Win" repeat offenders. One of our more routinely presenting frequent drug-seeking flyers has apparently pushed even Dr. Santa Claus over the edge.
She had been seen by Gil earlier in the day for her really bad (yawn) migraine. He went off the board and gave her Fioricet, which is an OK drug for migraines but which does absolutely nothing at all for someone who just wants their vicodin or percocet. "Vikes or perky Percs" as my colleague Kerry calls them.
Anyway, she sent in one of her frequent flier co-dependents to scout out which doc was working and was busted by Sheila, the secretary. "Oh", she said, "I just wanted to see if Dr. Santa Claus was here tonight; I thought I would just say hi". Sheila kicked her out and told her that she was trespassing unless she wanted to see the doctor. Riiiiight. Way to go Sheila, booting her out, quite rightly. Well, what did you think was going to happen?
Play along with me now as we delve into the world of
"What Did You THINK Was Gonna Happen?"
You may vote for the most stellar example.
1. For three months in a row, the same idiot has come to the ER requesting refills of his extensive list of psychiatric medicines. For three months in a row, we have refused. He couldn't seem to understand why the result was not different for month four.
2. One woman has refused to take her antihypertensives or antidiabetic meds in six months. She is five foot nothing and weighs over 300 pounds. She smokes about 2 packs of cigarettes a day; everytime she comes in she has grande mocha Frappucino and a charming new tatoo to show us. Is anybody shocked and appalled that her BP is Patent Pending/130? I certainly am not. She routinely refuses admission (and yes, we have had a psych eval done) and claims that with all of her other expenses she can't afford her meds. Maybe holding off on the tatoos and Frappucino's would help, but I doubt it.
3. One young man came in with back pain; I often look up the previous visits when the story doesn't quite match the way the patient behaves in triage. For example, they might whine about how tight the blood pressure cuff is when they are texting with 10/10 pain. Or, not realizing that we have a camera in several areas of the building, we often watch patients exit their vehicle and walk normally across the parking lot, only to turn on the drama once they hit the door. I never say anything though I often will comment to the doc that I had observed a normal gait before entering the department. Hence the "look up".
This particular young man has not been seen in about 10 months; prior to that he had been seen at least 8 times in two months with various pain related complaints. On the final visit, he was give a script for 15 Percocet by Dr. Santa Claus. The pharmacist called, concerned that the "1" had been changed to a "4", so it looked like Santa Claus had written him for 45 Percocet; it's just not done. Nor do we give out narcitic 'scripts with refills. With a different colored pen. The phamacist was instructed to tear the 'script up and advise the patient that tampering with prescriptions was against the law. Dr. Santa Claus was kind enough to document this fact in the patient's chart for future reference. He is lucky he was not arrested. You can imagine that the kid was pretty pissed that he did not get any narcotics this visit.
4. Here's one from the lazy EMS from my own town, who called on the land line to say that they were bringing a 23 year old who had taken an overdose of Zyprexa (used to treat schizophrenia and bipolar disorders). He had stable vital signs and seemed "OK". That was the report. Are you fucking kidding?
Um, no, you won't. For one thing, any overdose is presumed to be a suicidal attempt until proven otherwise, regardless if it was accidental, ESPECIALLY with a history of psychiatric issues. That means that the patient must be watched continuously to assure his safety until he is determinied to be safe. Or shipped off to inpatient treatment. That means a security watch, which we emphatically do not have. We also do not have any social workers available at our facility to do an evaluation. The physician instructed them to take the patient to the Mother Ship. Lazy, like I said, to presume to do otherwise.
5. We actually had a teenager come in with testicular pain, brought in by his father. This occurred after the teen had some physical contact with his girlfriend; apparently not enough. He was diagnosed with blue balls; Dr. Cripes said he had to give a little birds and bees lecture to the mortified teen. I thought the father should be the one who was mortified. Cripes was at a loss as to how to come up with a medical diagnosis for blue balls; Google to the rescue. It is called vasocongestion. Don't try this at home.
I silently ask the same question of many of our ER patients. There is a great dearth of common sense out there. A vast wasteland devoid of both common sense and, frankly, any sense at all. Of course, the patient's own agenda frequently defies any kind of sense or even native intelligence. Many simply have no brains at all.
It never ceases to amaze me how frequently ignorance is eclipsed by galactic stupidity.
There is no cure for the common cold. Only bonedheads and the uninsured/free care/I'm never gonna pay my bill crowd anyway show up at the ER for antibiotics to cure said cold. Two nights in a row. One guy was seen twice in 24 hours because his pneumonia wasn't better after 1 dose of antibiotics; he wasn't worse, just not miraculously better. Dumbass.
As you know from previous posts, many days I feel like the Narcotics Elf who works with Dr. Santa Claus. We see the same people over and over and over. Sometimes they hit the right doc, sometimes they leave with nothing but their pud in their hands. These are the "Pitch 'til You Win" repeat offenders. One of our more routinely presenting frequent drug-seeking flyers has apparently pushed even Dr. Santa Claus over the edge.
She had been seen by Gil earlier in the day for her really bad (yawn) migraine. He went off the board and gave her Fioricet, which is an OK drug for migraines but which does absolutely nothing at all for someone who just wants their vicodin or percocet. "Vikes or perky Percs" as my colleague Kerry calls them.
Anyway, she sent in one of her frequent flier co-dependents to scout out which doc was working and was busted by Sheila, the secretary. "Oh", she said, "I just wanted to see if Dr. Santa Claus was here tonight; I thought I would just say hi". Sheila kicked her out and told her that she was trespassing unless she wanted to see the doctor. Riiiiight. Way to go Sheila, booting her out, quite rightly. Well, what did you think was going to happen?
Play along with me now as we delve into the world of
"What Did You THINK Was Gonna Happen?"
You may vote for the most stellar example.
1. For three months in a row, the same idiot has come to the ER requesting refills of his extensive list of psychiatric medicines. For three months in a row, we have refused. He couldn't seem to understand why the result was not different for month four.
2. One woman has refused to take her antihypertensives or antidiabetic meds in six months. She is five foot nothing and weighs over 300 pounds. She smokes about 2 packs of cigarettes a day; everytime she comes in she has grande mocha Frappucino and a charming new tatoo to show us. Is anybody shocked and appalled that her BP is Patent Pending/130? I certainly am not. She routinely refuses admission (and yes, we have had a psych eval done) and claims that with all of her other expenses she can't afford her meds. Maybe holding off on the tatoos and Frappucino's would help, but I doubt it.
3. One young man came in with back pain; I often look up the previous visits when the story doesn't quite match the way the patient behaves in triage. For example, they might whine about how tight the blood pressure cuff is when they are texting with 10/10 pain. Or, not realizing that we have a camera in several areas of the building, we often watch patients exit their vehicle and walk normally across the parking lot, only to turn on the drama once they hit the door. I never say anything though I often will comment to the doc that I had observed a normal gait before entering the department. Hence the "look up".
This particular young man has not been seen in about 10 months; prior to that he had been seen at least 8 times in two months with various pain related complaints. On the final visit, he was give a script for 15 Percocet by Dr. Santa Claus. The pharmacist called, concerned that the "1" had been changed to a "4", so it looked like Santa Claus had written him for 45 Percocet; it's just not done. Nor do we give out narcitic 'scripts with refills. With a different colored pen. The phamacist was instructed to tear the 'script up and advise the patient that tampering with prescriptions was against the law. Dr. Santa Claus was kind enough to document this fact in the patient's chart for future reference. He is lucky he was not arrested. You can imagine that the kid was pretty pissed that he did not get any narcotics this visit.
4. Here's one from the lazy EMS from my own town, who called on the land line to say that they were bringing a 23 year old who had taken an overdose of Zyprexa (used to treat schizophrenia and bipolar disorders). He had stable vital signs and seemed "OK". That was the report. Are you fucking kidding?
Um, no, you won't. For one thing, any overdose is presumed to be a suicidal attempt until proven otherwise, regardless if it was accidental, ESPECIALLY with a history of psychiatric issues. That means that the patient must be watched continuously to assure his safety until he is determinied to be safe. Or shipped off to inpatient treatment. That means a security watch, which we emphatically do not have. We also do not have any social workers available at our facility to do an evaluation. The physician instructed them to take the patient to the Mother Ship. Lazy, like I said, to presume to do otherwise.
5. We actually had a teenager come in with testicular pain, brought in by his father. This occurred after the teen had some physical contact with his girlfriend; apparently not enough. He was diagnosed with blue balls; Dr. Cripes said he had to give a little birds and bees lecture to the mortified teen. I thought the father should be the one who was mortified. Cripes was at a loss as to how to come up with a medical diagnosis for blue balls; Google to the rescue. It is called vasocongestion. Don't try this at home.
Saturday, August 7, 2010
Alaska Tails
Sherry is safely back from her annual back-country paddling trip in Alaska. You may recall that last year, she had a real problem being stalked by grizzlies. Her husband subsequently failed to keep his word by purchasing, and learning to use, the necessary weapon that would ensure their safety.
Fortunately it was a remarkably griz-free adventure this year; except for the last day.
Sherry and her husband are dropped off by a bush plane, paddle to a certain point and then rendezvous with the pilot at a pre-determined time and place. This year, because her husband was doing some type of observation for the Park Service they were given a satellite phone (and a Jr. Ranger badge). This would serve to be a fortunate happenstance.
At the end of their trip, Sherry and her husband Dick were awaiting pickup on the appointed day by a small float plane; a little pond was to be the landing area. Sherry told her story:
"The wind was blowing a gale, and there was quite a bit of chop on this pond; it was relentless. These float planes have to land precisely, otherwise they would tip over and crash. The pilot made three or four passes, and I knew he wasn't going to be able to land. Sure enough, he called us on the sat phone and said there was no way. He has to come from two hours away, so he said he would come back the following day, and for us to call him at 6:30 AM to let him know about the wind conditions".
"I didn't sleep all night. The wind kept howling, and I was concerned that we would be stuck another day. It was so bad we had the tent tied to the gear bags so it wouldn't blow away. Finally, just about 6:00 AM the wind died down. Dick called the pilot who said he would arrive about 9:00. I was relieved and settled back in to get a couple of hours nap at least".
"At about 8:30 I got up, and Dick and I packed up the tent. We were pretty much out of food, but had a couple of granola bars so we pulled them out to eat while we sat on the gear bags and deflated canoe to wait for our ride. That's when we saw it: a giant grizzly. It was down at the end of the pond eating a caribou. Dick and I kept our eyes on the bear, but he seemed pretty engrossed in his breakfast and didn't seem to notice us".
"About this time, the wind picked up again with a vengeance. Now I was nervous, as if I wasn't when I spotted the bear. Maybe 10 minutes later we spotted the plane. I was thinking we were in some pretty serious trouble if he couldn't land, because the wind was gusting."
"The pilot had to come in low, right over the bear in order to land, so I know he realized we had a serious situation. The bear was pretty pissed off about it, too, roaring and waving a paw at the plane. The pilot tried to land, twice, a third time, then a fourth; each time the bear was roaring. I really didn't think we were going to get out of there; I had no idea how much fuel was available to burn on failed landing attempts, so I was feeling pretty desperate by this time. All I could imagine was spending another night with this really angry bear in our back yard".
"Finally, there was a lull in the wind; I had a feeling that this was going to be the last attempt. The plane came in so low I thought it was going to hit the bear, who was definitely not happy. At this point,the bear did something really odd; it THREW the caribou at the plane! I have never seen this before, nor had the pilot.
"The plane landed safely, loaded us in and we were on our way. The bear retrieved the caribou and continued with his meal, paying no attention to us at all. It was a great trip, but boy, was I glad to get out of there".
We are all happy to have Sherry home safely, but the phrase "when caribou fly" has become our new favorite saying.
Fortunately it was a remarkably griz-free adventure this year; except for the last day.
Sherry and her husband are dropped off by a bush plane, paddle to a certain point and then rendezvous with the pilot at a pre-determined time and place. This year, because her husband was doing some type of observation for the Park Service they were given a satellite phone (and a Jr. Ranger badge). This would serve to be a fortunate happenstance.
At the end of their trip, Sherry and her husband Dick were awaiting pickup on the appointed day by a small float plane; a little pond was to be the landing area. Sherry told her story:
"The wind was blowing a gale, and there was quite a bit of chop on this pond; it was relentless. These float planes have to land precisely, otherwise they would tip over and crash. The pilot made three or four passes, and I knew he wasn't going to be able to land. Sure enough, he called us on the sat phone and said there was no way. He has to come from two hours away, so he said he would come back the following day, and for us to call him at 6:30 AM to let him know about the wind conditions".
"I didn't sleep all night. The wind kept howling, and I was concerned that we would be stuck another day. It was so bad we had the tent tied to the gear bags so it wouldn't blow away. Finally, just about 6:00 AM the wind died down. Dick called the pilot who said he would arrive about 9:00. I was relieved and settled back in to get a couple of hours nap at least".
"At about 8:30 I got up, and Dick and I packed up the tent. We were pretty much out of food, but had a couple of granola bars so we pulled them out to eat while we sat on the gear bags and deflated canoe to wait for our ride. That's when we saw it: a giant grizzly. It was down at the end of the pond eating a caribou. Dick and I kept our eyes on the bear, but he seemed pretty engrossed in his breakfast and didn't seem to notice us".
"About this time, the wind picked up again with a vengeance. Now I was nervous, as if I wasn't when I spotted the bear. Maybe 10 minutes later we spotted the plane. I was thinking we were in some pretty serious trouble if he couldn't land, because the wind was gusting."
"The pilot had to come in low, right over the bear in order to land, so I know he realized we had a serious situation. The bear was pretty pissed off about it, too, roaring and waving a paw at the plane. The pilot tried to land, twice, a third time, then a fourth; each time the bear was roaring. I really didn't think we were going to get out of there; I had no idea how much fuel was available to burn on failed landing attempts, so I was feeling pretty desperate by this time. All I could imagine was spending another night with this really angry bear in our back yard".
"Finally, there was a lull in the wind; I had a feeling that this was going to be the last attempt. The plane came in so low I thought it was going to hit the bear, who was definitely not happy. At this point,the bear did something really odd; it THREW the caribou at the plane! I have never seen this before, nor had the pilot.
"The plane landed safely, loaded us in and we were on our way. The bear retrieved the caribou and continued with his meal, paying no attention to us at all. It was a great trip, but boy, was I glad to get out of there".
We are all happy to have Sherry home safely, but the phrase "when caribou fly" has become our new favorite saying.
We saw 24 patients last night. This, in a 6 bed ER with two nurses and one doc. Plus, the doc was Gil. Lord love the guy, but he is a cautious soul and we had some sick patients. Plus at least 6 dental paineurs, of which two left because the wait was at least 90 minutes. Can you imagine?
The campers from the several overnight camps kept coming. I don't know, perhaps it is the first time in a year many of these kids have been outdoors; they have fractured fingers, been stung by bees/mosquitoes/ spiders and one camp hamster (a campster?). As my son used to say, "ham comes from a hamster".
One day a week we offer a free walk-in blood pressure clinic. Not too many people use it, maybe a dozen or so. But for some of these crusty Yankee old-timers, it is perhaps a day out; and free to boot. One of the cranky old ladies never remembers to bring in her little booklet, so she gets a new one every week. We give these out gratis; I envision her house with about 3,000 little booklets, each with one or two blood pressures written in it. I seriously doubt that her PCP ever sees these readings. Or anybody. She is a little ritualistic, needing to sit for at least 5 minutes to "settle", then another 5 minutes to rummage around for the booklet she does not have. Several minutes are expended in divesting "only the left arm!!" from about 4 sweaters. Finally, she will squint up at me suspiciously and ask me who I am, and if I am new. We go through this every week. After taking her blood pressure and writing it in the new booklet I have provided, and she clucks and mumbles and frets her way back into her clothing, she is out the door, pushing a walker sporting 4 tennis balls in the legs.
Having your triage area tied up for 20 minutes on a free service: priceless.
One woman came in who just wants me to check her O2 saturation. Why? "I just had an asthma attack and if the reading is normal I don't want to be seen".
OOOOOOOOOOkay. We offer a 15% discount on ER co-pays that are paid right away; we take major credit cards even. But, you can't collect on this type of time-wasting activity which included informing the patient to return if she stopped breathing. Or whatever.
New Cathy emerged from an extended visit with one patient. "Well, she wanted to know if I had found Jesus, and I couldn't get out of the room; any suggestions for next time?".
"As the token atheist at a Catholic hospital, I am perhaps the last one to ask; I could give you some talking points from my perspective, but I doubt it would go over well", I said drily.
Gil says, "That happened to me once; the patient was jumpig up and down, waving his arms and yelling, "Praise Jesus! Praise Jesus!", so I just started jumping up and down yelling "Praise Jesus!" too. Then security took over".
"My son suggested that this might be an effective way to deal with telemarketers; I can just imagine. 'Hello, I am calling from XX Loan Corporation, are you interested in refinancing your home?'. 'Why no, but have you found Jesus?'. Could work pretty well", I said.
The hits just kept on coming. One little guy, I don't know how he managed this, fell off his bike and cut the soft palate in his mouth pretty badly. The rubber grip on the handle bar was mostly worn away, exposing much of the hollow metal edge, which wound up piercing the roof of his mouth. He was so scared, but did OK. It could have been so much worse.
The Last Patient of the night (whom we finally saw about midnight) was actually having an anxiety episode. She insisted that it was "overactive kidneys". I was too tired to pursue that she perhaps meant "overactive adrenal gland" that is located ON the kidney. The adrenal gland produces cortisol, a hormone that is important for several body functions, such as blood pressure regulation and release of insulin; it is also released in increased amounts in response to stress. Also, it is responsible for anxiety reactions, which is pretty much a "flight or flight response" gone haywire. That is tonight's science lesson, class.
Ativan helped, and she left with happy adrenal glands.
The campers from the several overnight camps kept coming. I don't know, perhaps it is the first time in a year many of these kids have been outdoors; they have fractured fingers, been stung by bees/mosquitoes/ spiders and one camp hamster (a campster?). As my son used to say, "ham comes from a hamster".
One day a week we offer a free walk-in blood pressure clinic. Not too many people use it, maybe a dozen or so. But for some of these crusty Yankee old-timers, it is perhaps a day out; and free to boot. One of the cranky old ladies never remembers to bring in her little booklet, so she gets a new one every week. We give these out gratis; I envision her house with about 3,000 little booklets, each with one or two blood pressures written in it. I seriously doubt that her PCP ever sees these readings. Or anybody. She is a little ritualistic, needing to sit for at least 5 minutes to "settle", then another 5 minutes to rummage around for the booklet she does not have. Several minutes are expended in divesting "only the left arm!!" from about 4 sweaters. Finally, she will squint up at me suspiciously and ask me who I am, and if I am new. We go through this every week. After taking her blood pressure and writing it in the new booklet I have provided, and she clucks and mumbles and frets her way back into her clothing, she is out the door, pushing a walker sporting 4 tennis balls in the legs.
Having your triage area tied up for 20 minutes on a free service: priceless.
One woman came in who just wants me to check her O2 saturation. Why? "I just had an asthma attack and if the reading is normal I don't want to be seen".
OOOOOOOOOOkay. We offer a 15% discount on ER co-pays that are paid right away; we take major credit cards even. But, you can't collect on this type of time-wasting activity which included informing the patient to return if she stopped breathing. Or whatever.
New Cathy emerged from an extended visit with one patient. "Well, she wanted to know if I had found Jesus, and I couldn't get out of the room; any suggestions for next time?".
"As the token atheist at a Catholic hospital, I am perhaps the last one to ask; I could give you some talking points from my perspective, but I doubt it would go over well", I said drily.
Gil says, "That happened to me once; the patient was jumpig up and down, waving his arms and yelling, "Praise Jesus! Praise Jesus!", so I just started jumping up and down yelling "Praise Jesus!" too. Then security took over".
"My son suggested that this might be an effective way to deal with telemarketers; I can just imagine. 'Hello, I am calling from XX Loan Corporation, are you interested in refinancing your home?'. 'Why no, but have you found Jesus?'. Could work pretty well", I said.
The hits just kept on coming. One little guy, I don't know how he managed this, fell off his bike and cut the soft palate in his mouth pretty badly. The rubber grip on the handle bar was mostly worn away, exposing much of the hollow metal edge, which wound up piercing the roof of his mouth. He was so scared, but did OK. It could have been so much worse.
The Last Patient of the night (whom we finally saw about midnight) was actually having an anxiety episode. She insisted that it was "overactive kidneys". I was too tired to pursue that she perhaps meant "overactive adrenal gland" that is located ON the kidney. The adrenal gland produces cortisol, a hormone that is important for several body functions, such as blood pressure regulation and release of insulin; it is also released in increased amounts in response to stress. Also, it is responsible for anxiety reactions, which is pretty much a "flight or flight response" gone haywire. That is tonight's science lesson, class.
Ativan helped, and she left with happy adrenal glands.
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