A very nice day brings out the kid in people I guess. It also brings out the douche mongers, like this guy:
He dragged himself with a very high degree of drama (missing only the audio, which was "Oh, woe is me!!! Woe is me!!!) into the triage area ever so slowly before plopping into the chair breathlessly. Wife started doing the talking until I shut her up.
"I fell. In Rite Aid parking lot on ICE! Can you believe they don't do anything about ice in the parking lot of a pharmacy where sick and injured patients need to walk?? It's a travesty!!!"
(um, no, I can't imagine. it makes no sense. it is New Hampshire, one of the coldest and snowiest winters on record where there remains no place to put the snow and SHOCKER, here, there is ice. Just so you know, we have had similar falls and insignificant injuries from a number of equally tort-minded, upstanding, non-working, disability-having, suck -the- life-out-of-the-system douchebags such as yourself).
Me: " Yup. Did you take any pain relievers, elevate or use ice?"
DB: "No, we came right over!"
Me: "I see.
And what is it that you've hurt today?"
DB: "My head, shoulder, wrist, elbow, hand, little finger, hip, knee, ankle and foot"
Me: "Did you hit your head?"
DB: "No! it just missed the bumper of the car! But now I have a migraine!"
Me: (completely losing interest). "Well, you've certainly had an eventful last 8 minutes"
(that was sarcasm, but I bet you knew that; he didn't)
help. police. murder.
This was the first patient of the evening and my eyes are already rolling out of my head.
The day shift, Kelly and Lisa, are finishing up what was not a good day with Gil. They think he orders too many tests and gets all up in people's business unnecessarily. Maybe he does, but they're not going to change him so I just go with it, expect to be busy and make a lot of phone calls on his behalf and no schoolwork done. I like the guy; he's smart and funny and totally gets my sense of humor. Things get done; it's not time to panic 'til it's time to panic. I like that.
I'd much rather work with Gil than Parvati who wants to put an IV in every chronic paineur and drug-seeker and give them Dilaudid; that gets really old, really fast. Her cultural "sky is falling" affect sometimes annoys the crap out of me. I frequently wait until she barks 10 orders at me (at least 5 of them conflicting or redundant) and then just list them back. She changes her mind often, but doesn't always share. ALSO WHEN SHE TALKS IT IS LIKE IT IS ALL IN CAPITALS WITH AN EXCLAMATION POINT! I JUST CAN'T GET THAT EXCITED! A FOLEY CATH IN A PATIENT WITH AN 02 SAT OF 85% IS NOT THE PRIORITY!
The other day a lady came in with "atrial fibrillation". At least, that's what she thought it was; "it's never been documented", she said. "Well", I said to her, "it has now." It was supraventricular tachycardia, or SVT
In a couple of minutes Mikki and I had set the patient up with an IV; she was monitored, on O2 and the EKG was in my hand. I walked into the room next door where Parvati was telling the patient about her daughter's wedding and wordlessly handed it to her.
Parvati came in like Chicken Little ("the sky is falling! the sky is falling!").
She had a few words with the patient and did a cursory exam, then told us "LET'S GIVE SOME CARDIZEM!!"
Me: " I have 6mg of Adenosine ready to go unless you prefer Cardizem; perhaps I missed a really fast atrial fib?" (I never believed it for a minute; I know my SVT)
Parvati: "NO! YOU ARE RIGHT! YES! YES! LET'S GIVE 6 MG OF ADENOSINE! IT HAS TO BE GIVEN FAST!"
Sigh. I know. She is a little wearing, but kind to the patients. And she does dental blocks, so that is kind of fun. We see fewer dental paineurs when she is on.
Anyway, remember the whiny gone-to-ground douchetard in triage? I parked him at the registration desk, and a young man comes in swathed with what looks like several slings and a couch cushion; he is being lead by his Dad who was wearing ski boots. The nearest ski area is at least 30 minutes away.
I waved them directly into a treatment room, which didn't go over well with the douchetard based on the pained expression he shot me.
Long story short; the kid had a fracture/dislocation of his shoulder. Nice kid, nice family. The dad shook my hand about 90 minutes later on their way out, with pain relief, xrays, reduction and follow-up accomplished; he thanked us for taking care of them so quickly. It was the first of two shoulder fractures and one really nasty tibia fracture, 3 admissions and two transfers.
The tibia fracture was Cripe's fav patent of the night. In answer to the question "How did you hurt yourself"came the following responses:
1. "I fell down the stairs. I had a few beers."
2. "I fell off a stool, I was just sitting on it; I had a couple of six packs".
3. "I was just dancing around to reggae music; I've been drinking all day, I think I killed close to a case".
He was admitted for surgery, poor guy. I felt bad because he was also having some social issues (no, really?) centered around his choice of roommates. Whose name he didn't know. Who refused to leave. And who apparently was not paying him rent (although he WAS paying in beer. Not an ideal arrangement).
So, by now I'm sure you're DYING to know how many fractures the douchetard had sustained, how long in traction, how many days out of work, etc, etc, etc.?
Not. One. But Cripes gave him a single Percocet to make up for his long wait while we took care of the young man's shoulder. Him so good!
Wednesday, March 9, 2011
Monday, March 7, 2011
Please, Just Read the Sign!
Worked with Cripes last night, always a treat. Stuff gets done, people are seen quickly, and he's a hoot to work with. But still, it was busy not only in the ER, but for all of the outpatient crap as well.
Because of a call-out we only had one secretary to register the boat-load of both out-patients and ER patients. None of which had any actual emergent condition:
Flu-like symptoms, seen yesterday by PCP; not magically better
Sore throat, seen yesterday by PCP; not magically better.
Dental pain
Dental pain
Chronic abdominal pain, nausea and vomiting, "I have a bowel obstruction"; 3 visits in last week, one hospital admission, abusing laxatives and enemas, taking oxy's.
And, same guy:
NO evidence of bowel obstruction and refuses CT scan.
On Medicare which won't pay for Zofran which is what he comes in for.
Does NOT want pain meds.
Wants surgery and "can't find" a surgeon.
Talks continuously about surgery and insists, insists, insists it is the last thing he wants. Suspect Munchausen, which we won't be fixing this in the ER.
The sign-in list is for out-patients, not ER patients. Nobody ever reads the signs. At least once (maybe 5 or 6 times if we are really busy and people are inordinately stupid) a day someone signs in when they should be an ER patient.
Mary, trying to be helpful, waded into the mass of humanity in the waiting room to ask if anyone had any xray orders.
She discovered that an ER patient with some completely non-emergent problem (that had now missed their pediatrician's appointment, haha) had been waiting an hour for registration. Mary got right on her high horse, adamant that the signage was not clear.
Me: "Mary, the signs are crystal clear; the douchtards just don't take the time to read them".
Mary: "My daughter signed in and waited and she needed to be seen in the ER"
Me: "Mary, your daughter is an engineer; clearly she didn't read the sign".
Mary: "Yes she did, she thought she was an outpatient".
Me: " It VERY CLEARLY states what comprises outpatient status, lab, x-ray, mammo, etc".
Mary: "Well, it says those things in small letters written beside it"
Me: "This is a pointless argument; I am going to draw circles on this paper and ignore you until you go away".
I wrote up another sign.
If nothing else, it will keep people busy. I don't see any loopholes or inconsistancies, do you?
Because of a call-out we only had one secretary to register the boat-load of both out-patients and ER patients. None of which had any actual emergent condition:
Flu-like symptoms, seen yesterday by PCP; not magically better
Sore throat, seen yesterday by PCP; not magically better.
Dental pain
Dental pain
Chronic abdominal pain, nausea and vomiting, "I have a bowel obstruction"; 3 visits in last week, one hospital admission, abusing laxatives and enemas, taking oxy's.
And, same guy:
NO evidence of bowel obstruction and refuses CT scan.
On Medicare which won't pay for Zofran which is what he comes in for.
Does NOT want pain meds.
Wants surgery and "can't find" a surgeon.
Talks continuously about surgery and insists, insists, insists it is the last thing he wants. Suspect Munchausen, which we won't be fixing this in the ER.
The sign-in list is for out-patients, not ER patients. Nobody ever reads the signs. At least once (maybe 5 or 6 times if we are really busy and people are inordinately stupid) a day someone signs in when they should be an ER patient.
Mary, trying to be helpful, waded into the mass of humanity in the waiting room to ask if anyone had any xray orders.
She discovered that an ER patient with some completely non-emergent problem (that had now missed their pediatrician's appointment, haha) had been waiting an hour for registration. Mary got right on her high horse, adamant that the signage was not clear.
Me: "Mary, the signs are crystal clear; the douchtards just don't take the time to read them".
Mary: "My daughter signed in and waited and she needed to be seen in the ER"
Me: "Mary, your daughter is an engineer; clearly she didn't read the sign".
Mary: "Yes she did, she thought she was an outpatient".
Me: " It VERY CLEARLY states what comprises outpatient status, lab, x-ray, mammo, etc".
Mary: "Well, it says those things in small letters written beside it"
Me: "This is a pointless argument; I am going to draw circles on this paper and ignore you until you go away".
I wrote up another sign.
If nothing else, it will keep people busy. I don't see any loopholes or inconsistancies, do you?
Sunday, March 6, 2011
Sunday Funnies (not)
I am beyond pissed.
I have been shut out of, and apparently withdrawn from, my online course Holistic Professional Nursing (which, stupidly, is recycled public health nursing; same book, same instructor). Without warning. For an alleged financial deficit.
This is my last course. I have been taking courses for almost 4 years and have always paid IN CASH. There is no extra work on the part of the university to scrape money from the government or others who are reluctant to pay their bills; I have not been forced to sell my kidney (yet). I have managed to keep it going. I don't even do FAFSA forms. My financial interview went something like this:
Accountant: How do you intend to pay? Will you be taking out loans, applying for scholarships, reimbursement from an employer, state grant, selling a child or any of your internal organs?
Me: Cash
Accountant: Oh, I see. Do you need a payment plan? We could work out a monthly draw from your checking account or a credit card...
Me: I'll make it simple. You tell me how much I owe per class. Then I'll pay it. Does that work?
I have been paid up in full with a zero balance for two weeks. Since my final course was a bit of an ambush, the course was only partially paid; but it was a weekend, and my payment posted a few days later. That was two weeks ago.
My instructor says I am withdrawn from the roster; she had no notification, but said she would work with me once I straightened it out. Of course, there is NOBODY working weekends anywhere in the college. I can't even get a human being on the phone except for tech support, and they are useless. Even for tech issues. No, they don't know the name of the administrator on call.
I spoke to my advisor on Friday before this happened and she sent the forms for graduation. In June. In Savannah. As I understand it, I must have a zero balance on account before that information can even be sent out to the graduate. Two days later, I am still looking forlornly at my account with a ZERO BALANCE while Imourn my 4.0 course GPA grow anxious about the work I can't do since my instructor ignored the part of my email about forwarding the grading rubric. I just don't want to restart this course at the end of the month because some illiterate hamster pushed the wrong button then went home for the weekend, la la la.
As a sacred cash cow, I certainly expected better treatment.
Someone's gonna get an earful tomorrow.
But today, I am doing something much more fun; the taxes! Yes, just go ahead and kick me while I'm down. Annually, I would rather have hot sharp steel needles poked in both my eyes than do the taxes. I get extraordinarily pissy; Mr. Ednurseasauras generally starts sending out feelers in January to get me used to the idea gradually:
"So....with your schedule, I'm thinking that January nearly gone, and your skating trip and studies, February is not a good month for taxes?" (walking on eggshells)
Me: "Let me get a couple of weeks of this course going, then we can look at them".
Now, the requests become more specific:
"So....you're off this weekend?"
Me: "Yup. I am taking a salsa dance class with Southern Cathy on Saturday then going to the mall to buy granny underwear"
Mr. Ednurseasauras: "Um, okay, yeah (misses the granny underwear reference). How do you feel about looking at the taxes on Sunday?" (ducks behind the couch with the dog in case I decide to throw my coffee cup)
Me: "Well. Ok, but it will end badly, you know it does. We have to do something fun later to make up for it".
Mr. Ednurseasauras: "OK, sure. Whatever you want"
Me: "I really want to go bowling" (I don't, really. I'm just messing with him)
Mr. Ednurseasauras: "I will get stuff organized then". This requires that reams and reams of paper come out and are stacked in organized piles around the living room. Out comes the file box; Mr. Edn mutters, makes notes, gets up to look for something, comes back with another document, makes a phone call. This goes on for a while. In the meantime, Meet the Press (a show which just really sets my teeth on edge) is on, and Mr. Edn occasionally looks up to follow what's going on. Me? I am surfing the web on my laptop, on Facebook and blogging. There is no schoolwork to do, so I'm doing the academic equivalent of nothing.
Me: (after about an hour) "How are we doing over there?"
Mr. Ednurseasauras: (muttering and shuffling) "Alright"
Me: Sigh. "Should I take the dog out?"
Mr. Ednurseasauras: "I need about another 10 minutes of mutter, mutter, grumble, then I should be done"
Then the fun should begin.
Me: "What's all the ruckus about? Aren't you just organizing stuff?"
Mr. Ednurseasauras: "It's the bank interest, it's not totaled. And if you don't have that marked down on the tax form, the bank interest, it gets shot down. all that for a total of.....(consults calculator), $2.25. Between the two banks"
Me: "Couldn't we just make it up?"
Mr. EDn: "I don't think so".
************************************************************************************
2 1/2 hours later and the taxes are, mercifully, done. Nobody has died, except maybe Tina out of pure boredom, or even sustained injury from flying coffee cups. Eerily civilized I must say. Even his Massachusetts state taxes which are enormously painful and usually requires an accounting degree to figure out; no wonder Mass. is in such dire straits and the economy sucks so bad. I read Mr. Edn my rantings from earlier and he is mildly amused.
Mr. Edn: "How often do you write stuff about me? What are you typing, everything I say?"
Me: "Hold on....(typing)...'everything I say?'....what?, no, I'm just writing random stuff about how you kicked the file box across the room"
Mr. Edn: "What? I did not! You really do make this stuff up!"
Me: "Just enough to protect the innocent".
Mr. Ednurseasauras ever so lightly kicked the file box.
Me: "OK, well I guess I'll just do something really fun now, like the laundry so the day isn't entirely wasted".
I have been shut out of, and apparently withdrawn from, my online course Holistic Professional Nursing (which, stupidly, is recycled public health nursing; same book, same instructor). Without warning. For an alleged financial deficit.
This is my last course. I have been taking courses for almost 4 years and have always paid IN CASH. There is no extra work on the part of the university to scrape money from the government or others who are reluctant to pay their bills; I have not been forced to sell my kidney (yet). I have managed to keep it going. I don't even do FAFSA forms. My financial interview went something like this:
Accountant: How do you intend to pay? Will you be taking out loans, applying for scholarships, reimbursement from an employer, state grant, selling a child or any of your internal organs?
Me: Cash
Accountant: Oh, I see. Do you need a payment plan? We could work out a monthly draw from your checking account or a credit card...
Me: I'll make it simple. You tell me how much I owe per class. Then I'll pay it. Does that work?
I have been paid up in full with a zero balance for two weeks. Since my final course was a bit of an ambush, the course was only partially paid; but it was a weekend, and my payment posted a few days later. That was two weeks ago.
My instructor says I am withdrawn from the roster; she had no notification, but said she would work with me once I straightened it out. Of course, there is NOBODY working weekends anywhere in the college. I can't even get a human being on the phone except for tech support, and they are useless. Even for tech issues. No, they don't know the name of the administrator on call.
I spoke to my advisor on Friday before this happened and she sent the forms for graduation. In June. In Savannah. As I understand it, I must have a zero balance on account before that information can even be sent out to the graduate. Two days later, I am still looking forlornly at my account with a ZERO BALANCE while I
As a sacred cash cow, I certainly expected better treatment.
Someone's gonna get an earful tomorrow.
But today, I am doing something much more fun; the taxes! Yes, just go ahead and kick me while I'm down. Annually, I would rather have hot sharp steel needles poked in both my eyes than do the taxes. I get extraordinarily pissy; Mr. Ednurseasauras generally starts sending out feelers in January to get me used to the idea gradually:
"So....with your schedule, I'm thinking that January nearly gone, and your skating trip and studies, February is not a good month for taxes?" (walking on eggshells)
Me: "Let me get a couple of weeks of this course going, then we can look at them".
Now, the requests become more specific:
"So....you're off this weekend?"
Me: "Yup. I am taking a salsa dance class with Southern Cathy on Saturday then going to the mall to buy granny underwear"
Mr. Ednurseasauras: "Um, okay, yeah (misses the granny underwear reference). How do you feel about looking at the taxes on Sunday?" (ducks behind the couch with the dog in case I decide to throw my coffee cup)
Me: "Well. Ok, but it will end badly, you know it does. We have to do something fun later to make up for it".
Mr. Ednurseasauras: "OK, sure. Whatever you want"
Me: "I really want to go bowling" (I don't, really. I'm just messing with him)
Mr. Ednurseasauras: "I will get stuff organized then". This requires that reams and reams of paper come out and are stacked in organized piles around the living room. Out comes the file box; Mr. Edn mutters, makes notes, gets up to look for something, comes back with another document, makes a phone call. This goes on for a while. In the meantime, Meet the Press (a show which just really sets my teeth on edge) is on, and Mr. Edn occasionally looks up to follow what's going on. Me? I am surfing the web on my laptop, on Facebook and blogging. There is no schoolwork to do, so I'm doing the academic equivalent of nothing.
Me: (after about an hour) "How are we doing over there?"
Mr. Ednurseasauras: (muttering and shuffling) "Alright"
Me: Sigh. "Should I take the dog out?"
Mr. Ednurseasauras: "I need about another 10 minutes of mutter, mutter, grumble, then I should be done"
Then the fun should begin.
Me: "What's all the ruckus about? Aren't you just organizing stuff?"
Mr. Ednurseasauras: "It's the bank interest, it's not totaled. And if you don't have that marked down on the tax form, the bank interest, it gets shot down. all that for a total of.....(consults calculator), $2.25. Between the two banks"
Me: "Couldn't we just make it up?"
Mr. EDn: "I don't think so".
************************************************************************************
2 1/2 hours later and the taxes are, mercifully, done. Nobody has died, except maybe Tina out of pure boredom, or even sustained injury from flying coffee cups. Eerily civilized I must say. Even his Massachusetts state taxes which are enormously painful and usually requires an accounting degree to figure out; no wonder Mass. is in such dire straits and the economy sucks so bad. I read Mr. Edn my rantings from earlier and he is mildly amused.
Mr. Edn: "How often do you write stuff about me? What are you typing, everything I say?"
Me: "Hold on....(typing)...'everything I say?'....what?, no, I'm just writing random stuff about how you kicked the file box across the room"
Mr. Edn: "What? I did not! You really do make this stuff up!"
Me: "Just enough to protect the innocent".
Mr. Ednurseasauras ever so lightly kicked the file box.
Me: "OK, well I guess I'll just do something really fun now, like the laundry so the day isn't entirely wasted".
Saturday, March 5, 2011
Not today...but someday
New Cathy and I heard the call go out on the scanner for a 48 year old female; CPR in progress. We waited for the radio transmission from the field, fully expecting that the code would be brought our way.
It came: 3 rounds of drugs, intubated, EJ blown but a working IO.
"We'll be a little bit yet; we are still working on extrication"
What!!??? Extrication!!??? No, it couldn't be. Cathy and I stared at each other in mute horror.
I grabbed the phone and punched in dispatch.
"What's the address of that code??"
Not Elm St.
It came: 3 rounds of drugs, intubated, EJ blown but a working IO.
"We'll be a little bit yet; we are still working on extrication"
What!!??? Extrication!!??? No, it couldn't be. Cathy and I stared at each other in mute horror.
I grabbed the phone and punched in dispatch.
"What's the address of that code??"
Not Elm St.
Thursday, March 3, 2011
He said....What??
Southern Cathy: I can't believe you didn't filet that guy for saying that. I have never seen you so calm when someone is rude to you; are you on new happy pills or something?
Me: Hmm, what? I was taking his blood pressure, I didn't hear a thing. OK, what was it he said then?
Southern Cathy: (turning pale) I, umm... well, what I mean to say is.....well....he said....
Me: Spit it out!
Southern Cathy: He said...."IN ANOTHER MINUTE I'LL BE MAKING LOVE WITH THIS NICE NURSE"! Sorry! I though you heard it, jeesh, if I'd known you hadn't I never would have mentioned it!
Me: Cath, he's 80 fucking years old; at most he would get an over-the-top-of-the-glasses stare. Get a grip.
Me: Hmm, what? I was taking his blood pressure, I didn't hear a thing. OK, what was it he said then?
Southern Cathy: (turning pale) I, umm... well, what I mean to say is.....well....he said....
Me: Spit it out!
Southern Cathy: He said...."IN ANOTHER MINUTE I'LL BE MAKING LOVE WITH THIS NICE NURSE"! Sorry! I though you heard it, jeesh, if I'd known you hadn't I never would have mentioned it!
Me: Cath, he's 80 fucking years old; at most he would get an over-the-top-of-the-glasses stare. Get a grip.
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