Today's Last Patient of the Night....from the other night...

happened to be the Lady on Elm St. We heard the ambulance tone out for leg pain to her address on the scanner, so we knew what was coming. I looked up her last several visits to see if she had been seen recently: nope, just a bunch of outpatient stuff. Whatever.

The paramedics who brought her in were an interesting team; Drew is somewhat of an ass bordering on douchebaggery, but seems to be growing up a little of late. He is making fewer insensitive comments, actually asks intelligent questions and has been less condescending than usual to the patients whom he deems beneath him, or less deserving of his vast array of knowledge. Or taking pictures with his I Phone of random stupid stuff. ("Oh! Want to see a picture of an icicle that looks like Larry the Cable Guy?"....um, no. But thanks for asking).

Lady was on an insulin that I hadn't seen before along with her 25 other daily meds (not total doses, total meds....not including the PRN pain meds that she routinely takes and just doesn't seem to get around to adding to her med list). Drew took the time to look it up on his fancy phone.

So, Lady had been given an antibiotic for a 2 cm. red area on her leg the day before. Gee, it's not better. Wow.

Bobo gave her another antibiotic and I dispatched her via comped cab to her home in near record time, a happy camper. But since it was the night before Valentine's Day, I decided to have some fun with Bobo in case he had received a funny bone transplant recently.

Lady had given Cripes a Valentine the week before; a nice long, flowery valentine, for which he received an enormous ration of shit. Lady just LOVES Cripes, and even gave him a big hug to prove it.

I took a plastic heart off the wall and wrote:
"Dear Dr. Roboto,
You are the best doctor in the world. I am so glad that I had you to take care of me today. If you give me your schedule, I will come in every time you are working.
Love and Kisses,
Lady"

After she left, I handed it to him
"Here, Lady left this extra special valentine for you"

He took it, read it, blushed and said, "She really did this?"

Me: (laughing) ".Um, no, not really. I just knew that Cripes had received one and didn't want you to feel left out".

He had the good grace to laugh. "Guess I'm a little slow on the uptake. That's pretty funny".

Me: "I'm going to put it in your call room for everyone to see".

Bobo: "Haha, they will all be jealous".

Naturally I left it for Mikki and Sherry who called me early in the morining when Bobo was back to work the early shift with them Not thinking or believing that I had the guts not only to do it but to show it to him, they left it for Bobo along with a chocolate heart. It kind of backfired since it was already played. But they did get a laugh out of it.

Huh?

Bobo: Did you triage room 2?
Me: Nope. Why?
Bobo: I can't read what's written under "LMP"*
Me: It says, "wrist"
Bobo: Ummm.....
Me: You're welcome!

* last menstrual period

We are Here for You!

My co-worker, Lisa, moonlights at other ER's. Today, she was at the Bear Went Over the Mountain Regional Hospital ER about 20 miles away. Many of our more mobile, but less intelligent, frequent med seeking individuals with the Holy Trinity* of narcotic-gettin' complaints will shop there. Unbeknownst to them, Cripes occasionally works there as well as Lisa and a few other nurses from the Mother Ship. That is three of the four hospitals in the immediate area; guess we have surveillance covered.


Lots of times the individuals will take one look at either Cripes or Lisa (or others) and skedaddle like a rat leaving a ship on fire; sometimes they will swear to God they have never been seen for this or any other problem. That is pretty stupid, but then these aren't the brightest bulbs in the box. Just add it to the list of Great Moments of WTF-ery.

Lisa just happened to mention that one of our more challenged narc-seekers came up with a particularly tasty little nugget during her triage interview at Bear Went Over the Mountain ER. He had been seen at my ER (by Lisa) over the weekend.

"Oh no, I couldn't have been seen over the weekend (where he received a 'script for Percocet) because THAT ER is always closed on Saturdays and Sundays".

Note that we are open 365 days per year.

Lisa just wanted to know if she was going to be paid for working the weekend if we were closed, and how that would affect her every-other-weekend committment.



*Holy Trinity = back pain, migraine, dental pain.

Stuff I Found Behind the Ice Machine

As pretty much everything in our ER is old, old, old, it should come as no surprise that our ice machine is a model about 30 years more elderly than this specimen. It works pretty well, though and we always have a steady and abundant supply of ice cubes (not that crushed crap). These are solid particles that weigh heavily in a plastic bag and conform nicely to those swollen body parts; not to mention providing refreshing iced coffee whenever we need it.

There are only two problems; it occasionally makes a helluva racket and takes up a ton of space. The first problem is easily rectified with a well-placed kick just below the grate; the second is not rectifiable. But since there is so much room behind and next to it, I made a couple of amazing discoveries when I dropped a sleeve of cups behind it; really, it was like a trip in a time machine.

Apparently nobody ever cleans in there.

I found a box of gloves; they were latex which we haven't had in a long time. A few of old souffle-type med cups. An ice pick. 17 cents in change. A dessicated cookie. A garter (ha! haha!) do you even know what that is? A bottle cap from RC Cola. A golf tee (WTF?) A couple of pens. Lots of dust. Several old washcloths and one slipper sock. An old, old, wooden ship (nah, just kidding).

Oh, and THAT's were the MAST trousers went! ERP, I have them if you need them! Haven't used them since the 1980's, or maybe the 70's.

The HVAC apparatus is also elderly. It provides heat in the summer and refreshing air conditioning in the dead of winter. It is essential to dress in layers.

The duct that lies directly above our heads in the nurses' station was rerouted while I was away last week so that it continuously blows either freezing cold air or cool to lukewarm air. All. The. Time. The HVAC monkeys, I swear, just mess with it. There was also a new digital thermostat in the waiting room that I'm pretty sure does absolutely nothing.

Mikki and Sherry tried taping cardboard over it. Unsuccessfully.

Lisa adhesive taped a folded towel over it. Unsuccessfully.

I took a staple gun to it and unloaded a full round onto the edges of the towel. Somewhat successfully. Then I found a bunch of screws and pounded them into the squishy ceiling. That looked GREAT. But it worked, that towel nice and tight.

Today I came in to find that the duct had been rerouted again, so no more breezes. I am afraid of what will happen this summer.

Reel it In

As reams of mandated, useless, and repetitive paperwork take more and more time away from patient care it becomes increasingly difficult to sit with patients and discuss their discharge plans. One of the best things about working in a smaller facility is that we generally have plenty of time to spend with patients doing the kind of teaching that is rapidly becoming a thing of the past. We do our best to provide detailed instructions and an opportunity to ask as many questions as needed.

Sometimes, though, it just doesn't matter because the public just lacks manners and common sense.

Me: (entering patient's room): I have your discharge instructions and I would like to go over them with you.

Patient: (speaking on cell phone) I have to go, the nurse is here with my discharge. What? No. How did that happen? (to me): Just a sec. (to cell phone): What are you talking about? No, I don't have any prescriptions yet......

Me: (Leaves the room and closes the door).

Patient: (10 minutes later, opens the door). I thought you were going to give my my papers, I've been waiting for 10 minutes.

Me: I was waiting for you to finish your phone call so that I could have your undivided attention (restrains an expletive as co-worker kicks me under the desk).