Today's Last Patient of the Night......

.......was a 32 year old male who just wanted to ask a question about whether or not he should be seen, thus incurring an ER charge.  His 5 day old tattoo was looking a little red and swollen even though he had scrupulously treated it as directed by his tattoo artist with A&D ointment. 

Here is a teachable moment: as always, if you are already in my ER and "just want an opinion if I should be seen", the answer is, with few exceptions, yes.  Liability.  Even if it is for a stupid reason.  This was not a stupid reason, and he did have an infection.  Antibiotics.

Interesting conversation overheard between the patient and Cripes:
Tattoo guy: "Yeah, I have some tattoos so I know how they should be treated.  The place I go is really clean and uses all sterile stuff.  I've never gotten an infection before"
Cripes: "Well, it's good you came in"
Tattoo guy: "I have been getting a few tattoos over the last couple of years.  I used get piercings when I was younger but I've found that tattoos are more socially acceptable than piercings, more main-stream, ya know?  You're more likely to find business people with tats, see.  I work a lot with the public"
Cripes: "Oh, what do you do?"
Tattoo guy: "Auto salvage.  And I have quite a car collection.  Are you a car guy, Doc?  What do you drive?"
Cripes: "Oh, I have a Tundra"
Tattoo guy: "I have a 1945 Blah, a 1957 Blah Blah, a sweet 1960 Blah Blah Blah a..." (he listed about 6 more classic cars). 

I don't know, like, or care about cars.  Someone talks about cars or golf and I start doing the multiplication tables in my head or fake a seizure.  Booooooooooooooooooooooring.  But I did think the guy's take on the social implications of piercings....insightful.

PS  Aren't you dying to know what kind of tattoo he had?

It was a a horse.  Ya know, like on those sports cars?

Found on the Bathroom Bulletin Board

My religious hospital is always having some kind of fund raiser, asking for money, donations of time, collecting for Christmas baskets and back-to-school-backpacks, food pantries, the Lenten diaper drive, soliciting for nine different kinds of cancer, Sister Mary Clarence's beer fund, inner city victory gardens, windmills over Holland, employees with acute need, orphans in third world countries, etc, etc, etc.  It is something every single week, literally.  For a non-profit, they seem to want to squeeze every last penny out of the people who work there.  I pick my battles and one or two things a year.  I prefer to choose my own charities mostly.

So as I perused the Potty Notes, I came across this interesting nugget:

"Collecting Items for the Homless (sic)"

sweatshirts
toiletries
sleeping bags
tents
socks
hats
shirts
sweatpants
blankets
crockpots

Crockpots? Ooooooooooooookay!

Keep Honking, I'm Reloading

Many of the Really Sick walk in. That is what we are there for, we are the closest help for evaluation/treatment/stabilization and transfer to a tertiary care facility.  Sometimes, people who somehow manage to get themselves into a car will subsequently have difficulty getting out, due either to confusion or firmly held beliefs about when it is and is not appropriate to call 911. This is a behaviour peculiar to many an older adult, but is rampant among the Old Yankee population.  A penny saved is a penny earned; if I can breath, I can walk; if it ain't cut off, it's only a flesh wound. 

Sometimes family members will simply request a wheelchair.  Sometimes they will come in and calmly request assistance, and we will trudge into the parking lot regardless of rain, snow, sleet or dark of night.  But when there are only two of us nurses to tote that barge and lift that bale it can be a strain on the back; we are not superhuman.  And we are none of us spring chicks.  The youngest of us is 42.  The eldest is......well, me, with three of my colleagues within a couple of years.  Lab and xray on the evening shift?  Same boat.  The docs?  Again, same boat.  Gil already has a couple of stents, and though younger, Bobo is downright fragile.

 We used to have an elderly post stroke lady who could barely walk who would to beeeeeeeeeeeep her car horn incessantly so we could come out and drag inside her equally mobility-challenged and even older husband by wheelchair for a catheter change.  That was a treat.  I think that was Second in Commands doing: "Sure, just beep the horn!  We have curb service!".  Not.  I think he died or is in a nursing home. 

When patients comes into the ambulance bay laying on the horn, though, we pay attention.  Recent treks to the parking lot for assistance include:
"She's having a seizure"
"My husband has severe pain"
"My mother is short of breath"
"My daughter can't move her leg"

As for the above, none of them were exactly as advertised, and turned out to be more of a panic situation than anything life threatening.  Seizure?  Tremors in a Parkinson's patient who was either under-dosed or had missed their Sinemet.  Severe pain?  OK, that one was kidney stone, painful and scary;  way more painful in men than women.  Or more common anyway.  Short of breath?  COPD, always short of breath and still smokes.  Daughter who couldn't move her leg?  Soccer playing teenage girl.  Drama, drama, drama.  I usually make a bet that the teen will be on her cell phone within 5 minutes, and that at the conclusion of the visit she will hop up from her death bed and miraculously walk.  Nobody will take my bet anymore because I am always right.  The mechanism of injury is never commensurate with the level of disability portrayed.  Also, they are uniformly poor actresses.

People in an absolute panic get pissed when ER nurses don't exhibit the same level of panic.  They think that by remaining calm and in control we are complacent and uncaring.  Really?  Do do you think anything will get accomplished if I am jumping up and down screaming?  Seriously?  I will get out the Dope Slap machine and set it to stun if necessary.

And, although I operate on the principle that it is not time to panic until it's time to panic, once in a while someone will get my adrenaline pumping.

BEEEEEEEEEEEEEEEEEEEEEEEP!  BEEEEEEP!  BEEEEEP!  BEEEEEEEEEEEEEEEP!!!!

New Cathy and I beheld an enormous SUV, engine still running, stopped diagonally across our ambulance bay and blocking the parking lot entrance because it was attached to a large trailer.  The trailer was partially  in the street. The 70ish man in the driver's seat was pale and sweaty and breathing rapidly.  Wow, I thought.  He's having the Big One.  "Sir, what's  wrong?  Are you having pain?  Are you diabetic?"

"Call.  The police.  Secure.  The guns."

WTF?  Guns?

I reached in, put the car in park and turned off the engine lest we be run over.  New Cathy and I hauled him into the wheelchair (he could, fortunately, briefly stand).  All the while he muttered, "Secure.  The guns.  I.  Have a.  License.  Legal.  Need to.  Lock.  Them.  Up". 

He was diabetic, had a cardiac history, and was dehydrated having driven most of the day from some gun show.  He wasn't having the Big One that day, but he was admitted anyway. 

The guns?  All legal.  The local police came over to move the SUV and secure the weapons, locking them up at the station.  BEEEEEEEEEEEEEEEEEEEEEEEEEEP!!!!

Just a Thought

I pass by a local church daily on my way to work.  For days and days parishoners with heavy equipment worked on extending their parking lot by excavating a hill.  After endless grading and preparation, it was ready for asphalt.

I envisioned a sign for the project:
"Jesus Paves".

Darwinism...

......the process by which, via natural selection, unfit specimens remove themselves from the gene pool

A few candidates who are genetically hanging by a thread for your entertainment.  There will be a quiz at the conclusion of this presentation:

A.  40 year old man came in complaining of "really bad burns".  He had been at a local bonfire/pep rally or some crap, and was tending to the fire.  He had some 1st and 2nd degree burns on his right hand and arm, and the backs of both legs.

Me: "How did this happen?"
Guy: "I threw some gasoline on the fire"
Me: (blurted before I could stop myself), "WHY??"

Did I mention that he had three or four kids under the age of 12 with him?  Um, yeah.

B.  33 year old who used heroin for the first time.  At work. That's all I have to say about that.

C.  42 year old who had a couple of beers at lunch and went back to work.  As a roofer. Using a nail gun, he buried a couple of inches metal into his proximal femur. THIS CLOSE to his femoral artery

D.  36 year old nearly removed his own knee cap with a chain saw.  He admitted to taking a "butt load" of oxy's daily for his chronic pain condition for which he is disabled.  Let me also mention he weighed over 300 pounds and had stopped at Burger World (as evidenced by paper sack he was toting) and had a blood pressure of Patent Pending/100.  A more cynical person than I might wonder how in hell he imagined using a chain saw in his debilitated condition was a good decision. 

Which of the following statements is true: (I told you there would be a quiz)

1.  They are all men
2.  They have all made galactically stupid decisions
3.  Antibiotics cure viruses.

A.  1 & 2 only
B.  All of the above
C.  1 & 3.
D.  None of the above