At 10:41 PM, a 20-something female wanders in to be seen.
1. Cold symtoms 2. Foul vaginal discharge, and 3. Sore tatoo
She had no primary care provider, no insurance, and no driver's license or other identification.
Pick one, please; "Have it Your Way ER" closes at 11:00 PM
Thursday, September 16, 2010
Tuesday, September 14, 2010
Second in Command (SIC) has some issues. She has no authority over anyone except by virtue of being the boss's best friend. Lisa, Mikki and I can't stand her. Lisa has a tendency to make snide comments about the number of "love notes" SIC leaves for everyone. WTF? There are 10 nurses who work here. There is absolutely no need for most of these idiot notes.
I don't mind an occasional reminder if I've forgotten something, but you can usually count on SIC to leave a mountain of notices; they are never about clinical issues, but about the myriad busy work/ non-clinical/ secretarial-type tasks that have been simply forgotten. Believe me, none of these things are terribly important, at least when you compare them to taking good care of the patients and getting that part right.
My typical I-don't-give-a-shit attitude occasionally gets me into trouble. After finding about 1/2 dozen notices one day, I started leaving little notices of my own; I pretty much went postal with Post-It Notes.
On a memo: "who writes this shit?"
On a notice reminding people not to clock in before 5 minutes prior to the start of shift (we have two, day shift and evening shift mind you): "if the day shift insists on clocking out at ten minutes of 3, I will be clocking in to take report. Thanks again for withholding raises this year".
On a sign up sheet for a hospital sponsored community health day (thank you, marketing) on a Saturday: "do we get paid for this fiesta? and will that include weekend differential?". The response was an exasperated "YES!" by my boss.
On a reminder for a UAC (Unit Advisory Meeting, more Magnet bullshit):
"boycotting UAC's until raises are reinstated".
On a note reminding nurses to keep the blanket warmer filled: "sorry, we ran out of blankets so we just filled it with paper towels; hope it helped!"
On the Wall of Death (there have been a number of deaths of staff and relatives in the last couple of years; some of which I have written about in previous posts. All the death notices and pictures of the deceased are on a bulletin board in the kitchen, which is macabre and depressing. I made Dan promise me that if anything happened to me that he would prevent any posting on the Wall of Death, but the bastard quit): "please, this place is depressing enough. It is time to remove this memorial"
Note: the Wall of Death was dismantled. In its place is now the "Circle of Life", which has graduation pictures of some of our staff and kids. Much better.
One Saturday when SIC was off, Sherry and Mikki surprised me with a GINORMOUS sign, decorated with stickers and art work "EDnurseasauras, please sign the narcotic sheet! Thank You! Love, Mikki and Sherry. This was clearly a case of ragging on SIC.
I laughed for 10 minutes, I thought it was hysterical. Mikki and Sherry were a little nervous that I would be offended. Me?, Nah. In fact, i told them that we should leave it up except for the fact that it was covering the opening to two cabinets. Too bad!
I don't mind an occasional reminder if I've forgotten something, but you can usually count on SIC to leave a mountain of notices; they are never about clinical issues, but about the myriad busy work/ non-clinical/ secretarial-type tasks that have been simply forgotten. Believe me, none of these things are terribly important, at least when you compare them to taking good care of the patients and getting that part right.
My typical I-don't-give-a-shit attitude occasionally gets me into trouble. After finding about 1/2 dozen notices one day, I started leaving little notices of my own; I pretty much went postal with Post-It Notes.
On a memo: "who writes this shit?"
On a notice reminding people not to clock in before 5 minutes prior to the start of shift (we have two, day shift and evening shift mind you): "if the day shift insists on clocking out at ten minutes of 3, I will be clocking in to take report. Thanks again for withholding raises this year".
On a sign up sheet for a hospital sponsored community health day (thank you, marketing) on a Saturday: "do we get paid for this fiesta? and will that include weekend differential?". The response was an exasperated "YES!" by my boss.
On a reminder for a UAC (Unit Advisory Meeting, more Magnet bullshit):
"boycotting UAC's until raises are reinstated".
On a note reminding nurses to keep the blanket warmer filled: "sorry, we ran out of blankets so we just filled it with paper towels; hope it helped!"
On the Wall of Death (there have been a number of deaths of staff and relatives in the last couple of years; some of which I have written about in previous posts. All the death notices and pictures of the deceased are on a bulletin board in the kitchen, which is macabre and depressing. I made Dan promise me that if anything happened to me that he would prevent any posting on the Wall of Death, but the bastard quit): "please, this place is depressing enough. It is time to remove this memorial"
Note: the Wall of Death was dismantled. In its place is now the "Circle of Life", which has graduation pictures of some of our staff and kids. Much better.
One Saturday when SIC was off, Sherry and Mikki surprised me with a GINORMOUS sign, decorated with stickers and art work "EDnurseasauras, please sign the narcotic sheet! Thank You! Love, Mikki and Sherry. This was clearly a case of ragging on SIC.
I laughed for 10 minutes, I thought it was hysterical. Mikki and Sherry were a little nervous that I would be offended. Me?, Nah. In fact, i told them that we should leave it up except for the fact that it was covering the opening to two cabinets. Too bad!
Friday, September 10, 2010
Douche Baggage and Luggagegate
Mr. Ednurseasauras and I were en route home from a fabulous vacation in Alaska and waiting in Seattle for the second leg of our flight homw. We were slaphappy from lack of sleep as we observed the antics of a full flight of dip shits as they try to weasel out of paying the baggage fee on Continental with their over sized, overfilled, truly non-regulation sized "carry-on" bags.
First of all, I just have to say that every airline that charges a fee for baggage sucks; if they also charge for carry-on bags, they suck doubly.
Mr. Ednursesauras and I are flying on Continental, which deserves the "Profiles in Customer Disservice" award; the so-called customer service representative directed a woman with a cane to go AROUND the podium and into the cattle chute instead of letting her save a few steps and cutting across. Booooo! You get an F for that.
The other gate keeper announced that since the flight was full, EVERY carry on suitcase would be required to be properly sized in the, well, sizing thingy.
Mr. EdN and I amused ourselves by predicting which bags would get the heave-ho into the dungeon of checked baggage.
Seriously? Some of the bags were TWICE the legal size; no way was it fair to have them stuffed into the overhead. Yet people were actually ARGUING about, which is when it got really funny. To us, of course.
One woman had a purple trapezoid shaped bag; yep, I said trapezoid. She kept insisting, "but really, see? It's squishy, it'll fit!". This was after she had removed a computer and some dirty laundry from the bag.
Lady,no matter if you put brought that bag into the cabin empty, the base is STILL too wide to fit. NEXT!
"Oh, look. This next one is huge! No way that gets in. I think it weighs about 50 pounds."
"I think it probably contains frozen fish; what if it melts and starts stinking?"
"What is wrong with these people?"
It occurred to me that these are probably the same self-centered and needy people who frequent ER's, and that it would probably be fun to compare notes with some of these airline people. Over cocktails, of course.
The pseudo-sick public sucks. The traveling public sucks equally. I think, though, that because flight/gate attendants have the final say on who gets on and who doesn't they might have the advantage over ER nurses. At least they are being evaluated on customer service, not nursing care which has somehow been lumped into customer service. Not to mention the advantage of having air marshalls who REALLY have the last word. It is no wonder that a veteran flight attendant, after a verbal altercation with a passenger that should have been ejected/arrested/flogged, made a public farewell announcement, grabbed a couple of beers, and fled down the emergency chute. He deserves a fecking medal.
First of all, I just have to say that every airline that charges a fee for baggage sucks; if they also charge for carry-on bags, they suck doubly.
Mr. Ednursesauras and I are flying on Continental, which deserves the "Profiles in Customer Disservice" award; the so-called customer service representative directed a woman with a cane to go AROUND the podium and into the cattle chute instead of letting her save a few steps and cutting across. Booooo! You get an F for that.
The other gate keeper announced that since the flight was full, EVERY carry on suitcase would be required to be properly sized in the, well, sizing thingy.
Mr. EdN and I amused ourselves by predicting which bags would get the heave-ho into the dungeon of checked baggage.
Seriously? Some of the bags were TWICE the legal size; no way was it fair to have them stuffed into the overhead. Yet people were actually ARGUING about, which is when it got really funny. To us, of course.
One woman had a purple trapezoid shaped bag; yep, I said trapezoid. She kept insisting, "but really, see? It's squishy, it'll fit!". This was after she had removed a computer and some dirty laundry from the bag.
Lady,no matter if you put brought that bag into the cabin empty, the base is STILL too wide to fit. NEXT!
"Oh, look. This next one is huge! No way that gets in. I think it weighs about 50 pounds."
"I think it probably contains frozen fish; what if it melts and starts stinking?"
"What is wrong with these people?"
It occurred to me that these are probably the same self-centered and needy people who frequent ER's, and that it would probably be fun to compare notes with some of these airline people. Over cocktails, of course.
The pseudo-sick public sucks. The traveling public sucks equally. I think, though, that because flight/gate attendants have the final say on who gets on and who doesn't they might have the advantage over ER nurses. At least they are being evaluated on customer service, not nursing care which has somehow been lumped into customer service. Not to mention the advantage of having air marshalls who REALLY have the last word. It is no wonder that a veteran flight attendant, after a verbal altercation with a passenger that should have been ejected/arrested/flogged, made a public farewell announcement, grabbed a couple of beers, and fled down the emergency chute. He deserves a fecking medal.
Tuesday, August 24, 2010
Liar, Liar
We have been seeing a young man with escalating frequency for several years for breakthrough migraines; he is always brought in by his father, who is aggressive and impatient. He berates the staff if his darling boy has to wait his turn or is not seen ahead of chest paineurs, individuals with difficulty breathing or other mundane complaints such as diabetic emergencies. The kid is polite but suffers from the father's bad behavior; Daddy is a doorway-leaner and hallway stalker, frequently interrupting us by demanding to see the doctor and telling us how much pain the kid is having. Therefore,we keep them in the waiting room, bringing them to a treatment room at the last minute when we are sure the doctor is ready to see them, and not one minute before. The father has only himnself to blame.
I noticed that his visits in the last year were actually down; only 6 or 7 compared to the 22 visits the previous year. I realized that the kid had been away at college and his ER visits coincided with Winter, Spring and Summer breaks. Interesting, yes?
Demerol was the kids usual poison until we stopped stocking it. Now he gets one shot of morphine and is immediately sent home. Every case is different, of course, but this is how most of the frequent migraineurs are treated; they are told up front that we give them one shot, then it is out the door. It is their responsibility to follow up with their provider for definitive long-term management of their chronic problem. We have learned not to sit on these because it always turns into a tug of war. Give a shot of narcotic, wait 30 minutes (usually while they sleep), wake them up for vital signs, "pain still 20/10", start an IV, give them a liter of saline and more narcotics, etc, etc,. Generally after a couple of hours the docs will get tired of it, give them just one more med and send them home to sleep it off. An argument always ensues because their pain is not completely gone. This just sucks the life out us, drains our energy, and often our last remaing reserves of compassion. It is best for the patient and for us to be clear on what the patient can expect, disabusing them of the notion that what they want is not necessarily what they will get; this is especially important when the expectation is enough narcotics to easily tranquilize a bull moose.
On this particular day we were working with the Talker. He is a great doc; he loves to spend lots of quality time teaching. His sincerity and genuine caring is apparent; he does not automatically give the patient what they want and/or thinks they need, and is very patient with the Web MD self-diagnosticians. He does not automatically xray every boo boo that walks through the door, even though the patient expects it. He does a careful exam, and if the mechanism of injury does not warrant, he will not expose the patient to radiation needlessly just because they think they should have it. He spends lots of time talking about ibuprofen, ice, elevation, etc. He spends lots of time with his patients in general, and many ask if he has a private practice because he listens. I love to work with him because I always learn something new. Also, because his goal is always good medical care and not necessarily good customer service it makes me think a little before I just order patient tests before the patient is seen by the doc. Thinking, "What would the Talker do?" frequently guides my decisions; also common sense.
The young man with the migraine came in alone for this visit, which was really unusual. He was seen and examined promptly because 1) it wasn't busy and 2) his annoying father was not present. After the Talker spent about 15 minutes, the patient received morphine. He assured us that his father was in the car waiting, which was proven to be a lie since he was observed getting into the drivers side and driving off.
But he had left his wallet behind; a call to the boys home was answered by the father, who said the kid was at work. We told him that the Talker would like a word with his son when he had the chance.
Monday, August 23, 2010
Two Men Enter, One Man Leaves
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.
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.
Subscribe to:
Posts (Atom)