Our Witch Melted, Can We Have a New One? and other random stuff

That is actually a paraphrasing of a blog, LOVE the name.  You could check it out.  But it IS an appropriate sentiment for the 100+ degree heat here in the Northeast and the potential for problems.  You know, like dehydration, heat stroke and other such heat related issues, many of which can be prevented from becoming a MEDICAL EMERGENCY by following a few common sense tactics: stay hydrated, keep cool and STAY THE HELL OUT OF THE HEAT, MORON!

I worked a princess day shift, my 10th shift in 9 days and I am done with it.  I am sitting in my living room with an icy cold brew with both the air conditioner and fan on.  In a sundress (which I would never wear outside in public unless I was, literally, on fire).  Tina went out for 10 seconds and was ready to come in immediately, so not like her.  Mr. EDNurseasauras and I will not be heading to the lake for the weekend as planned.  We will take a day trip, but there  is no airconditioning there and we just suffer too much without it.  Wah, wah, wah.

"With record high temperatures, the heat is on!" (isn't that clever, I thought.  Not!). "Medical personnel are on high alert!", intoned the 6 PM news reporter.

 "I'm not", I informed Mr. EDN.  "I'm on exceedingly LOW alert".

The local TV channel had a reporter at Fenway Park giving tips about how to stay cool while at the game.  It is over 100 degrees Fahrenheit, the highest temperature in about 80 years.....they were using some sort of heat seeking, satellite directed, laser guided thermometer to take the temperature of the plastic seats in the bleachers.  118 degrees.  WTF?  The concrete steps?  148 degrees!!  You could literally fry chicken on that thing, and you want people to sit out there?  Madness!

Here's a tip for staying cool while watching the Red Sox:  STAY HOME.  Or go to a bar with this new-fangled thing called air conditioning.  Yikes. 

I was on the phone (on hold) when a well-dressed woman walked into the department carrying one of those Styrofoam beer coolers containing bottled water.  It was our Director of Nursing.  "I know there is no water fountain, and want you all to stay hydrated".  Nice.  How many of y'all's bosses toted in water?  I was impressed.

I was even more impressed that since we had run out of enema bags she went across to the pharmacy and picked up a couple.

Just....no words for that.  I sense a great new marketing campaign:

"Record high temperatures may cause dehydration and heat injury.  But by far the most dangerous problem is....constipation.  When you need an emergency enema, go directly to the Emergency Room. Your God-given right to a comfortable bowel movement should be your number one (not number two) reason to come to the ER when it is about as hot outside as the surface of Mercury. Because the heat is so much easier to tolerate when you can just take a good crap".

Eh?

Me: (after blowing a shit load of water into the ear of a young man with waxy buildup, 2nd stupidest reason on earth to go to the ER after "constipation"):
"CAN YOU HEAR ME NOW?"

Oh, the pain

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.

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?

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.