Parenting is Only a Part Time Job

We were having a nice, steady night with Brian.  Brian works quickly and unfailingly manages to get all of his dictations done right after he finishes with the patient's care.  This strategy assures that when 11 PM rolls around and there are no patients, he is out the door.  Works for me.

We had already sent two patients with abdominal pain down to the Mother Ship for CT scans and seen three garden variety frequent flier dental paineurs who got antibiotics and Percocet (the only thing I really don't like about Brian....it's like feeding squirrels, they always come back for more).  He had put Orthoglass splints on two little girls with buckle fractures and it was only 5 PM.  Wham, bam, thank you ma'am.  In and out.

My next triage was a plus-sized young woman with 10/10 abdominal pain that she had been having for the better part of a year.  No other symptoms. No insurance.  She was supposed to have followed up with her gynecologist, but apparently paying for her artificial nails, her IPhone, and her Coach bag were more important. 

Me: So, what is different about your pain level today?
Pt:: I just thought it was time to do something about it.
Me: Uh huh.

The woman had with her an adorable 3 year old whom she consistently parented poorly. 

"Sit down.  Sit down!  SIT!  RIGHT NOW!  What did I tell you?  Do you want mommy to spank you?  I told you...no, Aaron, don't do that!  Get down off there!  What did you...did you just put something in your mouth?  Spit that out!  How many times do I have to tell you to....come here....come over here right now.....AARON!  GET OVER HERE!  You are such a pain!  I can't take you anywhere!  AARON!  Are you listening to mommy?"

Clearly he is not.
Aaron continued to terrorize the treatment room, and all we could hear was mom yelling at him behind closed doors. Brian ordered some of the usual tests; pregnancy test, urine, etc, but I knew the pelvic exam was coming, and I tried to mentally prepare myself.  I was having some trouble with that, though.

To Brian: " I would rather have you professionally poke out both my eyes with an 18 gauge needle than chaperon you with that pelvic exam".

Brian, laughing: "I know, I'm not looking forward to it either".

When the time came, Aaron had parked himself on the stool at the business end of his mother. He could not be budged, not even with the Beanie Baby that we keep for emergencies.  Brian got tired of coaxing darling Aaron, so he finally picked him up and deposited him on a chair; he immediately scrambled out and stood, again, in a posture of interest in front of his mother's crotch.

Me (to Brian): "Is he trying to crawl back into the womb?"

Brian finally just nudged him out of the way and did what was necessary. 

She left with Vicodin.  Yikes.

I understand that not everyone who gives birth is an ideal parent, in fact  some are downright appalling  as evidenced by the number of screwed up kids in the world.  But this just bothered me.  Having children is enough of a crap shoot as it is even with good parenting.  I just couldn't help but think that this kid is doomed.

Manic Marathon Monday

I'm sitting here watching coverage of the Boston Marathon on TV while avoiding schoolwork and Tina-walking.  Pretty crayzee stuff, that.  These are super human beings.  I have friends who have worked in the medical tent at the conclusion of the race, but have never done it.  It might be fun to do sometime, though.

Years ago when I worked at an ER close to Boston, we would occasionally get a Boston runner hours after the elite runners had finished.  These runners were not world class, but had run their race in 4, or 5 hours and had muscle cramping or dehydration.  It was fun to hear about the start in Hopkinton.

About 8 days ago we had a gentleman who had fallen in his yard and opened up a nasty gash on his knee.  He was training for Boston.

The Talker and he bonded over a mutual love of running while he stitched the wound.  As I bandaged it with my usual somewhat bulky first dressing, the patient wondered how he was going to run with it next day; with 8 days to go before the marathon, the distance running was done and now he was doing shorter training runs.

Me: I imagine that you would be putting a big band-aid over it if you are running tomorrow, hmm?

The patient laughed and admitted that was his plan.  That's ok, it's his first marathon; it is a big deal for New Englanders because the weather is such a factor in training.  We had a most miserable winter in New Hampshire, so I can imagine the adverse conditions that he faced.  He was not going to let a little laceration stop him.

We wished him luck and, as always, invited him back for (free) suture removal in 10 days.  I've been looking for him, but since he is not an elite runner I will not be seeing him on TV.  I hope he does well.

Goodbye, Mikki

Well, Mikki quit; she's moving on to be a bum-look-up-nurse in Endoscopy full time for a little bit of money but no nights, weekends or holidays. I would rather work at Chile's, frankly, but it is a good move for her. Naturally the vultures are fighting over her day shift hours. They can have them; I hate working days, given that SIC is about to become even more unmanageable. Jane has taken on some added responsibility and will be helping out at the hospital's version of VNA (visiting nurses) to get their dismal leadership situation in hand. Yeah, good luck with that. Jane hates confrontation. Me and the other cool kids have vowed to quit en masse if SIC is given any responsibility that even whispers at a management role.

So, we on the evening shift will be acquiring a new player. The rumor is that it will be someone from the Mother Ship. Is it me? I lost one co-worker who died, my work husband quit, now this. Perhaps I should buff up my resume.

Both Cathys, Sherry, Mikki and I went out to lunch to wish Mikki bon voyage and good luck with her new job; Kerry and Lisa were both working. We did invite SIC but she chose not to come.

I will miss Mikki. But it does put me first in line for getting July 4th off.

Some Things Can't be Unseen

Kerry called me on my cell the other day while I was driving and caught me in a weak moment; could I PLEASE work 4 hours on Saturday morning so she could go to her son's playoff game, pretty please, please, puh-leeeeeeeeeeeeeeeeeze???! Sigh. OK. At least I got to work with Lisa who is funny as hell; we are a bad combination attitude-wise but usually manage to have more than a few laughs. What I didn't count on having to work with Parvati, who is painful to work with and who just feeds into people's drama unnecessarily. "WHAT? YOU HAVE VOMITED ONCE AND BEEN SICK FOR 15 MINUTES? YOU NEED IV FLUIDS AND LAB WORK TO MAKE SURE YOU ARE NOT DEHYDRATED!!". Um, no. You really don't. What you need is a prescription for common sense. With Parvati, everyone is treated as if they really ARE as sick as they think they are.

Like Whiny Cough Lady ("I have really bad roll-y veins.....do you have to put the IV there?....IV's don't ever hurt me that much..... can I have another straw?.....I don't liiiiiiiiiiike being siiiiiiiiiiiicccccccccccck......Don't you think I am the sickest and most pathetic creature on the planet who had bronchitis everrrrrrrrr??!!). Bleecch. She really didn't need to tie up my last remaining bed for two hours; didn't need any of that. What I needed was a bed for a teenager with a broken ankle. We are an ER, not a hotel.

Then there was Migraine Lady #1, 298 who was apparently put out that her 10/10 headache was not treated immediately with Dilaudid. She walked out prior to the completion of her care without a word to anyone, although she got IV fluids, Toradol and Compazine. I did all the things I was supposed to; offered her crackers and juice, took her vital signs, dimmed the lights, got her a toasty warm blanket or three, and reassessed her pain after I had medicated her. Too bad she left, because Parvati had just written an order for her to have her much desired narcotics. She scarpered when I was busy with an overdose, but unfortunately with the IV still in her arm. Her Skanky Neighborhood phone number was.....disconnected, surprise, surprise. Oh, no work number because she is unemployed. Ah, no insurance so you and I will take the hit on this.

But it is bad when people leave with IV's in their arm; liability.

So I called dispatch to see if they could send a police officer or animal control officer to politely ask her to return; we really don't want IV drug users running around unsupervised with expertly and hygienically placed venous access. Not that she was, but still.

Me: 'Hi, this is EDNurseasauras at the ER. One of our patients left with an IV in, her phone number is disconnected and I was hoping you could send an officer to her house to encourage her to return for its removal"

Dispatch: "Sure, no problem. What's her name and address?" I gave him the particulars; he said he would get back to me. We heard the call go out on the scanner. A short time later, the dispatcher called me back:

Dispatch: "I guess she hasn't made it home yet; what was she wearing?"

Me: "Is this a recorded line?"

Dispatch: "No, it's not".

Me: "OK, good. She was wearing a horrendous neon pink jogging suit, the likes of which should never be seen in public, never mind being displayed on a woman that size"

Dispatch: (muffled laughter), "OK, um. Ok. Hold on.. (more muffled laughter). Is it pink on top and bottom?"

Me: "Yes, except for the parts where the material doesn't cover the tattoos on her muffin top"

Dispatch: (strangled noise, muffled snorting), "Um, OK, sure. I'll send and officer to see if he can spot her on foot".

Me: "Shouldn't be too hard to miss".

She never showed up, another big surprise.

Jane calls all the patients who leave before they are discharged; most of the time it's because the wait is too long, or they have to pick up their kids, or they see who the doctor is and realize they will probably not be getting any Vicodin this visit. Migraine Lady said "we were mean to her and didn't care about her pain". Translation for the uninitiated: "I didn't get any @%^&!ing narcotics!"

Jane: "Oh, it's too bad you left before getting the Dilaudid that Dr. Parvati prescribed for you; the ER was very busy at that time with a critically ill patient that, unfortunatley tied up the nurses; sorry for the inconvenience. Hope you feel better, have a nice day".

Translation: @%^&! off.

Slipper-y Slope

I just don't tolerate being yelled at, especially on the phone.

Some old guy who had left the department with his wife about 10 minutes before I got there called, all agitated.

"I AM AT THE END OF MY ROPE! YOU PEOPLE CALLED ME AND TOLD ME MY WIFE LEFT HER SLIPPERS AND I COULD PICK THEM UP AT THE FRONT DESK! SHE HAD THEM WHEN SHE LEFT THERE IN THE AMBULANCE; NOW NOBODY KNOWS ANYTHING ABOUT IT! I NEED TO TALK TO LISA, SHE TOOK CARE OF MY WIFE TODAY! ARE YOU LISTENING? I CAN'T LOOK FOR SLIPPERS AND TAKE CARE OF MY WIFE TOO; IS THE DOCTOR THERE, I NEED TO TALK TO HIM!"

In the middle of his rant, I calmly but firmly said, "Sir I need you to stop yelling at me and calm down; I can't help you if you continue to raise your voice because I will be terminating this conversation; do you hear me sir? I need you to lower your voice right now and tell me that you understand"

The Talker rarely hears me use my Command Voice; he raised an eyebrow.
Meanwhile, the agitated old may continues to scream through my Noise Abatement Procedure.

Big sigh. "OK. I'm not yelling. My wife lost her slippers between there and the Mother Ship. I got a call from someone telling me I could pick them up at the front desk. I don't know which front desk, if it's at the hospital, or there, or at the ambulance. Can you find out"

"Sure, give my your phone number and I will try to find out. I can tell you that the slippers are not here (because I put the phone down and looked in the dirty utility room while you were busy trying to blow an aneurysm). I will call you soon"
I took down his number and called the ER at the Mother Ship.

I spoke to Katelyn, who went through the motions and was not very helpful, but she didn't have the slippers either. She said she would look out for them, though.

30 minutes later, I got a phone call from the Missus of Agitated Husband. She very calmly told me the same story. I explained that they were not in my department, nor were they located in the ER downtown. I gave her Katelyn's name and number though, because payback is a bitch.

ANOTHER 30 minutes later, Agitated Husband came to the ER and started yelling at Ellen. As always, trying to protect Ellen, I jumped up and ran around to the front desk; Julie was already on it. She takes no shit from anyone, but does it in a nice way. She told him to sit in the waiting room while she investigated, but he insisted on sitting at her desk.

Now I am all about helping people out, but come on; slippers? What is it with these slippers? What could possibly cause such angst? What the hell, are they the original Ruby Slippers? Diamond encrusted? Made of cats? Mink? Sheesh, take a chill.

By now I was bored with the whole ridiculous scenario so I took $10 out of my wallet, prepared to give it to the guy to buy the wife a new pair of blue fuzzy slippers to replace the old, worn out, filthy, stinky, cat hair laden, piss sodden slippers.

Julie, meanwhile, discovers an important piece of information that both the patient and Agitated Husband neglected to tell me; that the patient was admitted to the hospital as an inpatient FOUR DAYS AGO; her slippers are at the front desk on the 4th floor.

"Oh", says Agitated Husband, now mollified. "I'm not driving down there today".