Madness has a dual perspective on living with a family member with chronic headaches, and having to deal with those who show up regularly in the ER with same in order to get narcotics. I pretty sure every ER has them. We are told that people's pain is people's pain, and who are we to say they do or do not experience what they say they are? Give them what they want and they will go away and give us great customer service reviews.We are just supposed to treat it and move on.
We do. But it gets more and more difficult when it is clear that the habit is like feeding squirrels. Give them a prescription and kick them to the curb. The docs aren't here all the time and so it may be weeks or months before they see the patient again. We nurses are having to deal with the drama and bullshit, the manipulative behavior, and the enablers with bad manners. And feel like pushers to boot.
Stopping at ER has become just another part of the routine for some; drop off the dry cleaning, get a pedicure, make a deposit at the bank, pick up dog food, lunch with a friend, then stop at the ER for a quick dose of dilaudid. Oh wait, let me get that extra large iced coffee first, and my cell phone needs to be plugged in, what outlet can I use.
Our newest doc gives out few narcotics. Mac is all about being reasonable, and things like whacking your shin on the bathtub 10 minutes ago with no bruise and no swelling doesn't necessarily get you Percocet. Especially if there are multiple visits for pain-related complaints. He doesn't feed the drama, and like Gil, likes a nice, Zen sort of ER. LOVE him. He is a great addition to the ER family.
Now if I can just get Parvati to drink that particular Kool-Aid my life would be so much simpler, sigh.
Thursday, July 21, 2011
Tuesday, July 19, 2011
Um...
I watched on the monitor while a young man in his early 20's walked across the parking lot. By the time he reached the door he was hunched over and moaning. Back pain.
10 minutes later, I watched another young man, also in his early 20's do the exact same thing. Back pain.
Neither had insurance.
Neither had ID.
Neither could remember their temporary local "new" address or phone number. They both gave a different a different permanent address, same town in another state.
No, they didn't know each other.
They said they were both roofers. One of them listed "seizure disorder" as a medical problem. The Talker sent them out with whateva pain meds and a work note.
"REALLY?? I said. REALLY??! Fraud and bullshit aside, a roofer with a SEIZURE DISORDER?? Seriously??!"
"Oh. I didn' t pick up on that".
WTF?
10 minutes later, I watched another young man, also in his early 20's do the exact same thing. Back pain.
Neither had insurance.
Neither had ID.
Neither could remember their temporary local "new" address or phone number. They both gave a different a different permanent address, same town in another state.
No, they didn't know each other.
They said they were both roofers. One of them listed "seizure disorder" as a medical problem. The Talker sent them out with whateva pain meds and a work note.
"REALLY?? I said. REALLY??! Fraud and bullshit aside, a roofer with a SEIZURE DISORDER?? Seriously??!"
"Oh. I didn' t pick up on that".
WTF?
Monday, July 18, 2011
Curb Service
I am always leery when people come to the door asking for a wheelchair. Hauling people out of cars is not my favorite activity for several reasons; I am not a young woman, my back is fragile from years of abuse, and mostly women work at my facility. Except for Brian and possibly the Talker, there aren't any really manly men available to do the heavy lifting. Bobo is just useless, Gil has a heart condition and Cripes has a bad back; the rest are women. Most importantly, I simply do not possess the superhuman strength required to prevent someone extraordinarily weak ( or large) from hitting the pavement. My back is not going to pay the ultimate sacrifice; I have many more years to work until I can retire. Even though it is very often more of a case of high drama than multiple trauma, I will not risk a patient's well being or mine trying to get them out of a vehicle safely. If there is an overabundance of drama or a legitimate reason, I will go the EMS route. Emergency Medical Services peeps are the extrication experts, and I don't hesitate to call them for assistance when the situation warrants. However, for the most part, if you hauled your fat ass into the car, you can damn well haul it out. I will hold the wheelchair and guide you.
The wife came in looking for help to get her husband out of the car; it wasn't quite clear what he had done, but Kate and I trudged out to the car with our trusty wheelchair. "He's an amputee, has one leg", the wife informed us.
"AAAAhhhhhhhh, AAAAAARRRRRGHHHHHHHH, OOOOOOOOOOORRRRRRRROWWW, ah, FU*#! Jesus, aaaaahhhhhhhhhhhh, gggggaahhhhhhhhh! This hurts so fu*#ing much!"
I saw three little blond heads and three pairs of enormous blue eyes staring at me from the back seat.
He fell down some stairs apparently.. His elbow hurt. So with one leg and one arm he effortlessly transferred himself from the car to the wheelchair, all the while spouting a steady stream of profanity and owwy noises. I decided to talk to the kids instead.
"Hi guys! What's up? This isn't your grandfather, is it?" He had looked to be about 40 years old, the wife a little younger; she snorted with suppressed laughter but didn't say anything..
The three little blond heads shook in disagreement. The oldest said, "He's my papa; he says he fell down. I didn't see him, though", while the littlest, a girl of about 4 stuck her thumb in her mouth. The wife had a subtle air of "been there, done that, now done with this" about her. Interesting.
"It's OK, Kate and I are just going to take him inside and put a bandaid on him, alright?" Three little blond heads nodded silently. They didn't smile.
Once inside, Ralphie continued to make a whole bunch of owwy noises as we did our triage. He lost his leg in a motorcycle accident. Couldn't remember any of his meds; pain was 30 out of 10.
Through the magic of electronic medical records we discovered that Ralphie was on a shitload of meds. Pain meds. Can't remember my ass.
He got an Xray (negative) which appeared to have been therapeutic since he was using both of his arms to transfer himself without any difficulty from the wheelchair to the gurney. Still making with the owwy noises and profanity though. He got a shot of Toradol for his trouble. By that time he was hopping around on his one leg and opening the cabinet doors in the treatment rooms.
The wife wisely stayed in the car with the kids. If I was the wife, I would have just driven off with those cute, blond, silent little kids and never looked back.
The wife came in looking for help to get her husband out of the car; it wasn't quite clear what he had done, but Kate and I trudged out to the car with our trusty wheelchair. "He's an amputee, has one leg", the wife informed us.
"AAAAhhhhhhhh, AAAAAARRRRRGHHHHHHHH, OOOOOOOOOOORRRRRRRROWWW, ah, FU*#! Jesus, aaaaahhhhhhhhhhhh, gggggaahhhhhhhhh! This hurts so fu*#ing much!"
I saw three little blond heads and three pairs of enormous blue eyes staring at me from the back seat.
He fell down some stairs apparently.. His elbow hurt. So with one leg and one arm he effortlessly transferred himself from the car to the wheelchair, all the while spouting a steady stream of profanity and owwy noises. I decided to talk to the kids instead.
"Hi guys! What's up? This isn't your grandfather, is it?" He had looked to be about 40 years old, the wife a little younger; she snorted with suppressed laughter but didn't say anything..
The three little blond heads shook in disagreement. The oldest said, "He's my papa; he says he fell down. I didn't see him, though", while the littlest, a girl of about 4 stuck her thumb in her mouth. The wife had a subtle air of "been there, done that, now done with this" about her. Interesting.
"It's OK, Kate and I are just going to take him inside and put a bandaid on him, alright?" Three little blond heads nodded silently. They didn't smile.
Once inside, Ralphie continued to make a whole bunch of owwy noises as we did our triage. He lost his leg in a motorcycle accident. Couldn't remember any of his meds; pain was 30 out of 10.
Through the magic of electronic medical records we discovered that Ralphie was on a shitload of meds. Pain meds. Can't remember my ass.
He got an Xray (negative) which appeared to have been therapeutic since he was using both of his arms to transfer himself without any difficulty from the wheelchair to the gurney. Still making with the owwy noises and profanity though. He got a shot of Toradol for his trouble. By that time he was hopping around on his one leg and opening the cabinet doors in the treatment rooms.
The wife wisely stayed in the car with the kids. If I was the wife, I would have just driven off with those cute, blond, silent little kids and never looked back.
Saturday, July 16, 2011
Kids Eat, but it Ain't Free
Tonight was my night to wrangle kids with lacerations.
I hate restraining kids. In fact, I really don't even like kids all that much. Actually, I take that back; the kids are fine, it's the parents who suck. That was why I stopped school nursing.
Kid 1: 2 years old and screeching blue murder. He had a wooden splinter in the bottom of his foot. It took Henrietta 20 minutes to get it out. It was near the big toe. Even wrapped in a sheet with both parents sitting on him and me holding down the foot, that big toe just couldn't be immobilized; it was like trying to nail Jello to a tree. At least his parents were intelligent, helpful beings with realistic expectations. They were tremendously helpful. I stuck a Cars bandaid on his foot and he seemed happy with that.
Kid 2: 10 years old with a teeny, tiny laceration on her thumb from the top of a dog food can. Crying, crying and crying, albeit silently. 2 stitches. Had to work around mom who threw herself onto the stretcher like it was an open casket. Made a WAY bigger deal out of it than necessary. The little girls older sister was more of an adult than the mother.
Kid 3: 18 months old with a chin laceration. It was 50/50 whether it needed sutures or not. Clearly, this child had never heard "no" a day in his life. Mom was busy getting out a picnic basket full of snacks and drinks in triage. I warned her not to feed him ( they cry so hard they usually vomit) but she would have none of it; "how else am I going to keep him occupied?". (Um, I don't know, read him a book, play a game of Parcheesi?). We were busy, it was about an hour before we could take care of him. I refused to put him in the room until Henrietta was ready to see him the minute he went in, By that time mom had moved through the picnic basket and was feeding him a Kit Kat. Mom was, predictably, less than helpful. I wrapped him in a sheet and as soon as Henrietta put in the local he screamed so much he vomited like Mt. Vesuvius. Surprise, surprise. This is why we tell you not to feed them.
But wait, there's more. The kid kept screaming, but in a kind of "It makes me feel better to make noise", self- soothing kind of way. Mom sang, really badly although you could tell she was thinking she could really sing, "The Wheels on the Bus". Only when she got to the "round and round" part, it sounded like a cat in blender.
"The wheels on the bus go MMMMRRRRRRRREEEEEEEEEEEOUUUWW and round,
MMMMRRRRRRRREEEEEEEEEEEOUUUWW and round,
MMMMRRRRRRRREEEEEEEEEEEOUUUWW and round...."
and the kid would MMMMRRRRRRRREEEEEEEEEEEOUUUWW in his own way at the same time, so he sounded like
MmmmmmmmmmMMMMMMMMMMMMMMMMM MMMMRRRRRRRREEEEEEEEEEEOUUUWW
MMMMRRRRRRRREEEEEEEEEEEOUUUWW
MmmmmmmmmmMMMMMMMMMMMMMMMMM
Mom naturally wanted 4 pounds of antibiotic ointment and 100 bandaids upon discharge. Um, yeah.
Kid 4: Little girl, 5 years old. An older sibling had shut her index finger in a door, avulsing the nail. Both parents, two other kids, grandparents, aunts, uncles, and an endless parade of concerned general citizens came and went. By this time Gil had come in to work and he rapidly did a digital block since the kid was screaming like a banshee. Mom yelled at him because after he injected one side of the finger, he said "another pinch, dear". "DON'T TELL HER WHEN YOU ARE GOING TO STICK HER!!! IT DOESN'T HELP!". Oh, ok. She had about 300 questions, none of which had anything to do with her daughters aftercare instructions. She was very pissy, mostly I think because she had absolutely no control.
Kid 5: Dental pain, 7 years old. Really?? Seen by the dentist yesterday. Given antibiotic. Not Magically Better pills don't seem to be working because it's 10 PM and he can't sleep. Mom gave him Tylenol. Yesterday. Are you serious? A dose of Tylenol and OTFD*. Sorry, we do not give out prescriptions for Common Sense in a BottleTM
*Out the fu**ing door
I hate restraining kids. In fact, I really don't even like kids all that much. Actually, I take that back; the kids are fine, it's the parents who suck. That was why I stopped school nursing.
Kid 1: 2 years old and screeching blue murder. He had a wooden splinter in the bottom of his foot. It took Henrietta 20 minutes to get it out. It was near the big toe. Even wrapped in a sheet with both parents sitting on him and me holding down the foot, that big toe just couldn't be immobilized; it was like trying to nail Jello to a tree. At least his parents were intelligent, helpful beings with realistic expectations. They were tremendously helpful. I stuck a Cars bandaid on his foot and he seemed happy with that.
Kid 2: 10 years old with a teeny, tiny laceration on her thumb from the top of a dog food can. Crying, crying and crying, albeit silently. 2 stitches. Had to work around mom who threw herself onto the stretcher like it was an open casket. Made a WAY bigger deal out of it than necessary. The little girls older sister was more of an adult than the mother.
Kid 3: 18 months old with a chin laceration. It was 50/50 whether it needed sutures or not. Clearly, this child had never heard "no" a day in his life. Mom was busy getting out a picnic basket full of snacks and drinks in triage. I warned her not to feed him ( they cry so hard they usually vomit) but she would have none of it; "how else am I going to keep him occupied?". (Um, I don't know, read him a book, play a game of Parcheesi?). We were busy, it was about an hour before we could take care of him. I refused to put him in the room until Henrietta was ready to see him the minute he went in, By that time mom had moved through the picnic basket and was feeding him a Kit Kat. Mom was, predictably, less than helpful. I wrapped him in a sheet and as soon as Henrietta put in the local he screamed so much he vomited like Mt. Vesuvius. Surprise, surprise. This is why we tell you not to feed them.
But wait, there's more. The kid kept screaming, but in a kind of "It makes me feel better to make noise", self- soothing kind of way. Mom sang, really badly although you could tell she was thinking she could really sing, "The Wheels on the Bus". Only when she got to the "round and round" part, it sounded like a cat in blender.
"The wheels on the bus go MMMMRRRRRRRREEEEEEEEEEEOUUUWW and round,
MMMMRRRRRRRREEEEEEEEEEEOUUUWW and round,
MMMMRRRRRRRREEEEEEEEEEEOUUUWW and round...."
and the kid would MMMMRRRRRRRREEEEEEEEEEEOUUUWW in his own way at the same time, so he sounded like
MmmmmmmmmmMMMMMMMMMMMMMMMMM MMMMRRRRRRRREEEEEEEEEEEOUUUWW
MMMMRRRRRRRREEEEEEEEEEEOUUUWW
MmmmmmmmmmMMMMMMMMMMMMMMMMM
Mom naturally wanted 4 pounds of antibiotic ointment and 100 bandaids upon discharge. Um, yeah.
Kid 4: Little girl, 5 years old. An older sibling had shut her index finger in a door, avulsing the nail. Both parents, two other kids, grandparents, aunts, uncles, and an endless parade of concerned general citizens came and went. By this time Gil had come in to work and he rapidly did a digital block since the kid was screaming like a banshee. Mom yelled at him because after he injected one side of the finger, he said "another pinch, dear". "DON'T TELL HER WHEN YOU ARE GOING TO STICK HER!!! IT DOESN'T HELP!". Oh, ok. She had about 300 questions, none of which had anything to do with her daughters aftercare instructions. She was very pissy, mostly I think because she had absolutely no control.
Kid 5: Dental pain, 7 years old. Really?? Seen by the dentist yesterday. Given antibiotic. Not Magically Better pills don't seem to be working because it's 10 PM and he can't sleep. Mom gave him Tylenol. Yesterday. Are you serious? A dose of Tylenol and OTFD*. Sorry, we do not give out prescriptions for Common Sense in a BottleTM
*Out the fu**ing door
Wednesday, July 13, 2011
Riveting TV
Now that I am no longer a slave to schoolwork, you would think that I would have so much more time to add blog entries.
Not so. I am finding that when I am home of an evening, instead of being on my computer I am actually starting to watch some of the programming that has captivated Mr. Ednurseasauras during my academic incarceration. Not just sporting events, mind you, although I have written hundreds of papers while watching many a Red Sox, Bruins, or Patriot's game. More accurately, I was mostly pretending to watch, usually it is just white noise. Mr. EdN is an inveterate channel surfer and is addicted to the Discovery and History Channels as well as some of the political and economic pundit programming. He has a tendency to avoid the fluff; you know, premium channel train-wreck TV so ridiculous you just can't turn away. This is anything on MTV or VH1 (unless it is a movie like "Eddie and the Cruisers" or "The Buddy Holly Story"). He abhors anything having to do with Jersey Whores, Kardashian Krap, 257 Kids and Counting, or Kate Plus 8 and Jon Gets the Gate. I confess that in contrast, I never miss an episode of Toddlers and Tiaras. Ultimate train wreck CRAYZEE parents, which makes you feel good about raising normal well adjusted kids without spray tanning, fake eyelashes and big hair.
Instead of being shackled to my online classroom, I have been enlightened by such riveting shows as Swamp People, Swamp Logger's, and Ice Road Truckers. Then there's Pawn Stars, Billy the Exterminator, Dual Survivor, The Alaska Project, Everest Beyond the Limit.....etc., etc,. etc. Tonight we watched two hours of Navy Seal shows dedicated to the killing of Osama Bin Laden. That was pretty interesting, but what I really wanted to watch was True Blood. That's OK; the magic of On Demand allows me watch it in the morning while I have my coffee.
Most of these shows are pretty ridiculous, but one in particular I must single out as being the most pointless in pursuit of the loftiest goal. Whale Wars. Yep. Now, don't get your panties in a wad. I love animals and on paper it might seem like a grand idea to participate in the high seas equivalent of poking a hornet's nest with a stick in order to save whales from being harvested by the Japanese. I am not taking a stand on the legal issue of commercial whaling here; oh no. Whaling in pursuit of scientific research apparently IS legal; the Japanese emphasize that their activities are legal by holding up signs on their deck as they process their kill that announce "We're Weighing Stomach Contents"or "We're Taking Tissue Samples". In English. So the helicopter can see it. What boggles my mind is that the captain and crew of the Sea Shepherd are bumbling idiots. Referred to by some as "eco-terrorists", or "vigilantes", they roam the waters off the coast of Antarctica attempt to disrupt their "enemy" by taunting, cutting across their bow, throwing stink bombs, and tampering with their propeller . And sometimes getting rammed in order to indignantly cry "foul". Their actions just seem juvenile and impulsive while being more of a threat to human beings than actually seeming to accomplish whale salvation. I find myself rooting for the Japanese, frankly.
Without a doubt a more effective option than the Jackasses of the High Seas would be to put the Navy Seals in charge of disrupting whaling activities. Yeah.
Not so. I am finding that when I am home of an evening, instead of being on my computer I am actually starting to watch some of the programming that has captivated Mr. Ednurseasauras during my academic incarceration. Not just sporting events, mind you, although I have written hundreds of papers while watching many a Red Sox, Bruins, or Patriot's game. More accurately, I was mostly pretending to watch, usually it is just white noise. Mr. EdN is an inveterate channel surfer and is addicted to the Discovery and History Channels as well as some of the political and economic pundit programming. He has a tendency to avoid the fluff; you know, premium channel train-wreck TV so ridiculous you just can't turn away. This is anything on MTV or VH1 (unless it is a movie like "Eddie and the Cruisers" or "The Buddy Holly Story"). He abhors anything having to do with Jersey Whores, Kardashian Krap, 257 Kids and Counting, or Kate Plus 8 and Jon Gets the Gate. I confess that in contrast, I never miss an episode of Toddlers and Tiaras. Ultimate train wreck CRAYZEE parents, which makes you feel good about raising normal well adjusted kids without spray tanning, fake eyelashes and big hair.
Instead of being shackled to my online classroom, I have been enlightened by such riveting shows as Swamp People, Swamp Logger's, and Ice Road Truckers. Then there's Pawn Stars, Billy the Exterminator, Dual Survivor, The Alaska Project, Everest Beyond the Limit.....etc., etc,. etc. Tonight we watched two hours of Navy Seal shows dedicated to the killing of Osama Bin Laden. That was pretty interesting, but what I really wanted to watch was True Blood. That's OK; the magic of On Demand allows me watch it in the morning while I have my coffee.
Most of these shows are pretty ridiculous, but one in particular I must single out as being the most pointless in pursuit of the loftiest goal. Whale Wars. Yep. Now, don't get your panties in a wad. I love animals and on paper it might seem like a grand idea to participate in the high seas equivalent of poking a hornet's nest with a stick in order to save whales from being harvested by the Japanese. I am not taking a stand on the legal issue of commercial whaling here; oh no. Whaling in pursuit of scientific research apparently IS legal; the Japanese emphasize that their activities are legal by holding up signs on their deck as they process their kill that announce "We're Weighing Stomach Contents"or "We're Taking Tissue Samples". In English. So the helicopter can see it. What boggles my mind is that the captain and crew of the Sea Shepherd are bumbling idiots. Referred to by some as "eco-terrorists", or "vigilantes", they roam the waters off the coast of Antarctica attempt to disrupt their "enemy" by taunting, cutting across their bow, throwing stink bombs, and tampering with their propeller . And sometimes getting rammed in order to indignantly cry "foul". Their actions just seem juvenile and impulsive while being more of a threat to human beings than actually seeming to accomplish whale salvation. I find myself rooting for the Japanese, frankly.
Without a doubt a more effective option than the Jackasses of the High Seas would be to put the Navy Seals in charge of disrupting whaling activities. Yeah.
Subscribe to:
Posts (Atom)