Today was the day I was going to get everything done as far as shopping for gifts.
I started the day early; I had my lists. I checked them twice. Family. Friends. Skating buddies. An impoverished family that my co-workers and I have adopted with a miles long wish-list of necessities. I had my plan of attack, mapped out in order of location along with what items I needed. But first I had to work a four hour princess shift from 11 AM to 3 PM.
Dr. Cruella had the duty today; she really isn't cruel, just decisive and focused. She is a favorite amongst the nursing staff because she has no tolerance for drug seekers and generally sends them packing without narcotics.
Cruella had a cold; a really bad sneezing, sniffling, stuffy head, Rudolph-nose, gravelly voiced, gonna-give-this-shit-to-everyone kind of cold. I honestly didn't even want to touch any of her paperwork because they were literally crawling with microbes. I kept a supply of masks on the desk for her to use along with a 50 gallon dispenser of hand sanitizer. She probably should have stayed home since she was likely sicker than any of the patients we saw, but we in health care in general fail to use our sick time for actual illness. It is a lose-lose situation; nurses/docs who call in sick are vilified by their co-workers, and if a weekend or holiday, it is never forgotten. Yet if they show up sick, people complain that they are sharing their illness. Go figure.
I had the pleasure (gag) of working with Second in Command (SIC) today. She told an interesting (yawn) story of her first year as a nurse working a double shift on New Year's Eve; she coughed so badly that one of the patients was overheard saying, "I don't know which nurse is coughing, but I hope she isn't mine". So true on several levels I'm sure.
My first Christmas as an RN began with emesis so severe that I think I vomited several internal organs. Of course I dragged myself to work at 3 PM; I was the only RN on along with one LPN and 4 aides. However, since I was an unnatural shade of green and a whiter shade of pale combined, my co-workers immediately started making panicked phone calls to summon a replacement as I lolled semi-conscious at the nurses station, vowing to start giving meds "in just a minute". Ho ho ho indeed.
So after a quick stop at home to burn my scrubs and boil my skin, off I went to shop 'til I dropped. I did get a lot done, but not quite everything. I started running out of gas about 5 hours into my marathon because I was starting to sneeze and feel sniffly. Stuffy headed. And very, very tired. Yawn.
Thanks, Cruella.
I stopped at the pharmacy for cold remedies instead of shopping for stocking stuffers. Guess I will have to rely on the fact that I will live to shop another day.
Thursday, December 16, 2010
Tuesday, November 30, 2010
Rapid Door- to- Doc Update
I had no small amount of fun with Dr. Roboto the other day as I did a 4 hour Princess shift. Because he disdains hanging out at the nurses' desk with the rest of us lower life forms, he always scurries back to his office in the back between patients; we use an intercom to call him; me more obnoxiously than others, obviously.
Roboto is absolutely insistent that patients are put into rooms and he is called immediately; no problem. There is, as previously noted, quite often a lag between the completion of triage and the completion of registration. This was remedied by simply putting the unregistered patients in the rooms and calling him to come see them. We were really busy; so, after awhile he was so confused he didn't know whether to shit or wind his watch since, say it with me TRIAGE IS MUCH QUICKER THAN REGISTRATION. I had every room filled and nobody registered. Not that I was trying to prove a point or anything.
Not having anyone to blame but himself for this, he tried to take it out on nurses, shocker. All these times are noted on discharge; triage time, time to room, time of doc visit, etc., etc. Many of the docs note their times on a worksheet which is usually kept with the chart; Roboto, being the secretive weasel that he is, prefers to keep his notations to himself and hides them in some secret pocket of his prissy little lab coat. Then he keeps it for quite awhile, many times until long after the patients are discharged off the computer, which is a nursing task. For sanity's sake, we nurses try to keep track of the time that the doc visits. Or we make it up. Whatever. I am usually pretty good about those notations, but Roboto, now pissy because we are pummeling him, said we shouldn't be putting any times down unless it coincides with his exact time. I said we can't do that because you hide your notes it slows everything down on our end, besides, I can look at a clock to see what time you enter a room.
Challenge time; says he, "What time did you put for that patient I just discharged then, since you weren't at the desk?"
I looked at my note; "1:46 PM. What did you write?"
(Addressing left clavicle)"mmm, hrmm, mumble mumble....1:46 PM".
Roboto is absolutely insistent that patients are put into rooms and he is called immediately; no problem. There is, as previously noted, quite often a lag between the completion of triage and the completion of registration. This was remedied by simply putting the unregistered patients in the rooms and calling him to come see them. We were really busy; so, after awhile he was so confused he didn't know whether to shit or wind his watch since, say it with me TRIAGE IS MUCH QUICKER THAN REGISTRATION. I had every room filled and nobody registered. Not that I was trying to prove a point or anything.
Not having anyone to blame but himself for this, he tried to take it out on nurses, shocker. All these times are noted on discharge; triage time, time to room, time of doc visit, etc., etc. Many of the docs note their times on a worksheet which is usually kept with the chart; Roboto, being the secretive weasel that he is, prefers to keep his notations to himself and hides them in some secret pocket of his prissy little lab coat. Then he keeps it for quite awhile, many times until long after the patients are discharged off the computer, which is a nursing task. For sanity's sake, we nurses try to keep track of the time that the doc visits. Or we make it up. Whatever. I am usually pretty good about those notations, but Roboto, now pissy because we are pummeling him, said we shouldn't be putting any times down unless it coincides with his exact time. I said we can't do that because you hide your notes it slows everything down on our end, besides, I can look at a clock to see what time you enter a room.
Challenge time; says he, "What time did you put for that patient I just discharged then, since you weren't at the desk?"
I looked at my note; "1:46 PM. What did you write?"
(Addressing left clavicle)"mmm, hrmm, mumble mumble....1:46 PM".
Monday, November 29, 2010
Maxine Lives!
I have nothing especially newsworthy or bizarre enough to post about. I offer an older entry for your perusal and enjoyment.
You know Maxine; the cartoon character that graces numerous emails (especially from my mother- she just LOVES Maxine). She is that crazy old bat with the bunny slippers who dispenses knowledge from the bottom of a wine glass. One of my patients turned out to be a seeming prototype for Maxine, minus the bunny slippers. I happened to pick up the phone for a patient advice call. We get dozens of these every day, and since the bottom line is come to the ER because we aren't allowed to give any actual common sense information, we tend to take turns. The caller said that she had experienced bilateral wavy lines in her vision which lasted about 30 seconds, and she had a mild headache. She said that she called her opthamologist who told her she should get right to the ER because she could be having a stroke. Sound advice. She was looking for confirmation, I guess, and also wanted to know if she would "be sitting in the waiting room for hours and hours". After informing her that the visit would take as long as was necessary, she agreed to think about it.
About 2 hours later she lands in my room. Longish gray hair, hiking boots instead of bunny slippers, but I'd know that sneer anywhere: yup, it's Maxine in the flesh. And cantankerous as hell. Won't get undressed. Won't let me draw blood. Won't let me start an IV. Won't let me do an EKG. Won't even sit on the bed. Stands in the doorway with arms folded across her chest. She is ANGRY. Dr. Dewshe Bagghe takes this one (oh, joy), talks with her for a bit and gets her to agree to 1) an EKG, 2) Labs, and 3) a head CT.
The tech accomplishes the bloods and EKG, but Dr. Dewshe, master of communication that he is, conveniently forgets to tell me the CT is with IV contrast, so in I go to start a good-sized line. That done, it is time for her CT. I tell her she needs to take off her hair appliances, earrings, necklaces, etc. She asks if the CT is "the one that's a tube". I explained the CT, and she seems a bit more relaxed. I told her I needed to take her to CT in a wheelchair, expecting a huge fight, but she relented. I notice a book she has in her lap, and ask her how she is liking it as it is something I have read (some off-beat fantasy about dragons, I have eclectic tastes in lit.). We chat about books on the way to her test, and I tell her I will see her in about 10 minutes.
Upon her return, I check her vitals which are all normal, and comment that at 74, she appears many years younger than that. This prompted a really great conversation about life and living it, how she walks the woods with her 3 dogs daily, is an avid reader, and manages to learn something new everyday. She was afraid she WAS having a stroke, and nothing made her more afraid than the prospect of losing her intellect, mobility or especially her independence. I thought she and my mom would get along great. Now, my mom is 75 and another go-getter who will sneak a flask onto the senior citizen bus trips; they tend not to serve ETOH. God forbid mum and her cronies don't have a little wine with lunch. Actually, I want to be just like her and raise as much hell as she does when I am her age. Her Christmas card was her on the back of a motorcycle on her 75th b'day, an event at which she and 6 of her friends drank the rest of us under the table. And remained pretty sober at that; maybe they were just pickled.
Anyway, Miss Maxine was given the good news that her CT was fine. Naturally she was opposed to hospitalization and signed out AMA. But before she left, she kissed me on the cheek (2nd time in 32 years I've allowed that), thanked me profusely for being so kind, and went on her merry way.
I hope she is out there raising hell.
You know Maxine; the cartoon character that graces numerous emails (especially from my mother- she just LOVES Maxine). She is that crazy old bat with the bunny slippers who dispenses knowledge from the bottom of a wine glass. One of my patients turned out to be a seeming prototype for Maxine, minus the bunny slippers. I happened to pick up the phone for a patient advice call. We get dozens of these every day, and since the bottom line is come to the ER because we aren't allowed to give any actual common sense information, we tend to take turns. The caller said that she had experienced bilateral wavy lines in her vision which lasted about 30 seconds, and she had a mild headache. She said that she called her opthamologist who told her she should get right to the ER because she could be having a stroke. Sound advice. She was looking for confirmation, I guess, and also wanted to know if she would "be sitting in the waiting room for hours and hours". After informing her that the visit would take as long as was necessary, she agreed to think about it.
About 2 hours later she lands in my room. Longish gray hair, hiking boots instead of bunny slippers, but I'd know that sneer anywhere: yup, it's Maxine in the flesh. And cantankerous as hell. Won't get undressed. Won't let me draw blood. Won't let me start an IV. Won't let me do an EKG. Won't even sit on the bed. Stands in the doorway with arms folded across her chest. She is ANGRY. Dr. Dewshe Bagghe takes this one (oh, joy), talks with her for a bit and gets her to agree to 1) an EKG, 2) Labs, and 3) a head CT.
The tech accomplishes the bloods and EKG, but Dr. Dewshe, master of communication that he is, conveniently forgets to tell me the CT is with IV contrast, so in I go to start a good-sized line. That done, it is time for her CT. I tell her she needs to take off her hair appliances, earrings, necklaces, etc. She asks if the CT is "the one that's a tube". I explained the CT, and she seems a bit more relaxed. I told her I needed to take her to CT in a wheelchair, expecting a huge fight, but she relented. I notice a book she has in her lap, and ask her how she is liking it as it is something I have read (some off-beat fantasy about dragons, I have eclectic tastes in lit.). We chat about books on the way to her test, and I tell her I will see her in about 10 minutes.
Upon her return, I check her vitals which are all normal, and comment that at 74, she appears many years younger than that. This prompted a really great conversation about life and living it, how she walks the woods with her 3 dogs daily, is an avid reader, and manages to learn something new everyday. She was afraid she WAS having a stroke, and nothing made her more afraid than the prospect of losing her intellect, mobility or especially her independence. I thought she and my mom would get along great. Now, my mom is 75 and another go-getter who will sneak a flask onto the senior citizen bus trips; they tend not to serve ETOH. God forbid mum and her cronies don't have a little wine with lunch. Actually, I want to be just like her and raise as much hell as she does when I am her age. Her Christmas card was her on the back of a motorcycle on her 75th b'day, an event at which she and 6 of her friends drank the rest of us under the table. And remained pretty sober at that; maybe they were just pickled.
Anyway, Miss Maxine was given the good news that her CT was fine. Naturally she was opposed to hospitalization and signed out AMA. But before she left, she kissed me on the cheek (2nd time in 32 years I've allowed that), thanked me profusely for being so kind, and went on her merry way.
I hope she is out there raising hell.
Addendum: I saw this lady recently, she is alive and well, and raising her own hell. Good for her! Also, she remembered me and made it a point to tell me how much she appreciated my effort to keep her informed without making her feel like an idiot. Good for me!
Saturday, November 27, 2010
??
Triage complaint of the day:
"Not Better"
The 16 year old with the hysterical mother had a sore throat and had been on antibiotics about 16 hours, was not febrile, drooling or sicker; just not better.
Guess you didn't actually fill the prescription for the "Magic Pills"
"Not Better"
The 16 year old with the hysterical mother had a sore throat and had been on antibiotics about 16 hours, was not febrile, drooling or sicker; just not better.
Guess you didn't actually fill the prescription for the "Magic Pills"
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