A three year old little girl was brought in by mom. "She stuck something up her nose"
Tonight's foreign body was a little piece of plastic that came out with relative ease. I always have some fun with this kind of thing. Sometimes the parents know what the object might be, sometimes not. .
Here are a few examples of the responses I have gotten when I asked the kiddo WHAT was up nose:
"An eraser!"
"Kleenex!"
"A Barbie shoe!"
"Playdoh!"
"A cat treat!"
"A flower! I was smelling it and it just stuck there!"
"Nothing! Just boogers!"
I trust you have seen the image of the little girl who suffered for years with recurrent sinus problems who, it turns out, had a safety pin lodged up there in her sinus cavity. Google "girl with safety pin in nose" to see it, I'm too lazy to post a link. It's an impressive example of the kinds of shenanigans kids can get up to when you turn your back on them for like, 2 seconds. When I was a school nurse one of my favorite kindergarten teachers brought two adorable little 5 year olds fresh from the playground.
Mrs. J: "Lacey, tell Mrs. EdN why we came to see her today"
Lacey: "I put a pebble up my nose!"
Me: (coughing to hide a laugh) "Lacey, how come you put a pebble in your nose?"
Lacey: "'Cause it was little!"
Mrs. J: "Now, Gina, will you please tell Mrs. EdN why we came to see her?"
Gina: "I put a pebble up my nose too! I was showing Mrs. J. how Lacey did it!"
Me: (really, really trying not to laugh but really, really not succeeding) "Oh, I understand. So the pebbles are still stuck up your nose?"
Lacey: "No, mine came out!"
Gina: "Mine fell out when I sneezed!"
Me: "Well that's good. Let me just look and make sure, then I'll call your moms. No more anything up the nose though, right girls?"
Lacey and Gina: (in little sing-song voices) "Noooooooo!!
Mrs. J: "And why don't we want to put anything up our nose?"
Lacey and Gina: "Because it's BAAAAAAAAD!!!"
Definitely everything we need to know we learned in kindergarten, sometimes the hard way.
Saturday, October 29, 2011
Friday, October 28, 2011
The Long and Short
Whenever a patient says, "...to make a long story short", I know I should probably get a snack and settle in becuase it will be anything but short.
Mr. Yada: "Well it all started 2 weeks ago......blah blah fever 1 0 days ago....blah blah.....urinary/prostate problem....saw my primary care...blah blah yada yada....testicles hurt.....mumble snort.....pain when I urinate.....yada yada blabity blabity blabity yada...."
He went on for 10 minutes in spite of my attempts to pry the Reader's Digest abridged version out of him.
Me: "So, sir, to summarize, you have had intermittent fever for 10 days, testicular pain and swelling for 5 days, and urinary symptoms for 4 days? Is that correct?"
Mr. Yada: " Um....yes, I would say that sums it up nicely. How did you do that?"
Me: "Active listening and a scary ability to condense".
Mr. Yada: "Well it all started 2 weeks ago......blah blah fever 1 0 days ago....blah blah.....urinary/prostate problem....saw my primary care...blah blah yada yada....testicles hurt.....mumble snort.....pain when I urinate.....yada yada blabity blabity blabity yada...."
He went on for 10 minutes in spite of my attempts to pry the Reader's Digest abridged version out of him.
Me: "So, sir, to summarize, you have had intermittent fever for 10 days, testicular pain and swelling for 5 days, and urinary symptoms for 4 days? Is that correct?"
Mr. Yada: " Um....yes, I would say that sums it up nicely. How did you do that?"
Me: "Active listening and a scary ability to condense".
Wednesday, October 26, 2011
Opiate Entrepreneur (def):
(n) individual with an unreasonable number of ER visits for bogus medical complaints, frequently involving improbable, nonsensical, or fictitious injuries causing severe unrealistic pain who seeks narcotics for the purpose of resale. See also: squirrel.
This is nothing new except they are more aggressive and are more likely to get what they want thanks to hospital mandates on patient satisfaction. This is behavior what turns ER nurses cynical and suspicious. The docs see these people ocasionally; the nurses work every day and can usually recall at least a couple of their visits. Today I had 6 of them within 2 hours. What they had in common:
1. More than 12 visits each for pain-related complaints
2. No job.
3. No insurance
4. No ID
5. No credibility
6. No intention to pay anything for the visit.
7. They left empty handed
This is nothing new except they are more aggressive and are more likely to get what they want thanks to hospital mandates on patient satisfaction. This is behavior what turns ER nurses cynical and suspicious. The docs see these people ocasionally; the nurses work every day and can usually recall at least a couple of their visits. Today I had 6 of them within 2 hours. What they had in common:
1. More than 12 visits each for pain-related complaints
2. No job.
3. No insurance
4. No ID
5. No credibility
6. No intention to pay anything for the visit.
7. They left empty handed
Tuesday, October 25, 2011
Just...No
I am not really a girly girl, but I do like to get my nails done every couple of weeks and indulge in a pedicure every 5 or 6 weeks; maybe more often in the warmer months. Hey, I deserve it. I walk my dog every day and spend 8 hours on my feet at minimum. You only get two feet.
I have been going to my present salon for nearly 7 years. I am not all that fussy about who does them because they all know what they are doing. Plus they can always fit me in the same day, which is good.
There is a TV in the salon; it is always on. When I first started going there, it was constant music videos, the owners favoirites being concerts of the Eagles, Celine Dion, Tina Turner, ABBA, and, oddly, J Lo. I have heard all of these many times. When they got a bigger TV it was movies for awhile. Now, it is daytime talk shows and soaps, CNN, reruns of The Golden Girls and other boring stuff depending on what time of day I hit the salon. It is generally quiet and calm, low conversation and the staff not overly chatty. Just the way I like it.
Today I stepped into a Bizarro World; a new nail tech flirted shamelessly with one of the male technicians. One woman shrieked into her cell phone incessantly (you know how I love that). A whiny woman complained about the smell of acetone (seriously?? WTF did you expect in a nail salon, moron?). Worse still was a man and wife duo getting pedicures and talking about the benefits of cosmetic surgery while "The Replacement Killers" movie was on TV. So NOT relaxing.
What's the world coming to? Next time it will probably be "Kill Bill", with the odor of acetone replaced with Old Spice. If this turns into a men's nail salon, I'm outa here.
I have been going to my present salon for nearly 7 years. I am not all that fussy about who does them because they all know what they are doing. Plus they can always fit me in the same day, which is good.
There is a TV in the salon; it is always on. When I first started going there, it was constant music videos, the owners favoirites being concerts of the Eagles, Celine Dion, Tina Turner, ABBA, and, oddly, J Lo. I have heard all of these many times. When they got a bigger TV it was movies for awhile. Now, it is daytime talk shows and soaps, CNN, reruns of The Golden Girls and other boring stuff depending on what time of day I hit the salon. It is generally quiet and calm, low conversation and the staff not overly chatty. Just the way I like it.
Today I stepped into a Bizarro World; a new nail tech flirted shamelessly with one of the male technicians. One woman shrieked into her cell phone incessantly (you know how I love that). A whiny woman complained about the smell of acetone (seriously?? WTF did you expect in a nail salon, moron?). Worse still was a man and wife duo getting pedicures and talking about the benefits of cosmetic surgery while "The Replacement Killers" movie was on TV. So NOT relaxing.
What's the world coming to? Next time it will probably be "Kill Bill", with the odor of acetone replaced with Old Spice. If this turns into a men's nail salon, I'm outa here.
Monday, October 24, 2011
If He Could Only Go Back in Time
It has been at least three months since I have had to work with Bobo and I can't say I've missed the little twerp in the slightest. Since he is the antithesis of team player he is always such a pleasure to work with. Especially annoying is that he is still like a rabid squirrel on the 20 minute or less door-to-doc time.
Most of the time the patients see the physician within the allotted (and heavily marketed) time frame. Mostly the delay lies in the minor detail of the registration process as it is unwieldy and takes a ton of time. There used to be two registration clerks, but the Brain Trust that is administration actually cut secretarial hours after 3 PM so now there is only one until 7 PM when outpatient services close. Brilliant. This has resulted in ridiculous waits for the appointment-making and insurance-having outpatients as well as walk-in routine blood draws. On 3-11 it can get pretty busy since both the ER and outpatient department business picks up. It doesn't help that a couple of the secretaries are deadly sloooooow. Thorough, but slow. There is apparently no way for the Suits to speed up this process although I know it is MUCH faster at Pseudocity Hospital. Probably faster at any hospital that has a vision of rapid registration as a simple but effective means of improving satisfaction scores. But that would just make sense, what do I know.
So to recap, patients are triaged promptly but often fall down the rabbit hole of registration. That gets Bobo's tighty whities in a wad. He used to say is was because the nurses were taking too long to triage. WTF? I wasn't taking that lying down, so I began adding the time "triage competed" boldly next to the triage time. In most cases it was less than 5 minutes. He probably noticed that I only did this when he was working, and that I had instigated the other nurses to do the same. Thus endeth the discussion of how long nurses take to triage. But did it do anything to speed up registration? Um, no. I learned to make copies of complicated med lists for the above average patient who came equipped with such because we must HAND WRITE med lists or we get dinged, another stupid time waster.
Some of the other docs fail to write down the times of their first interaction with the patient and leave it to the nurses. It is usually a guess as we are also responsible for noting the following in addition to triage time: time to room, time physician sees patient, time of labs, xrays, EKG's and discharges in addition to the obvious like meds given, IV starts, vital signs, pain scale, blah, blah, blah. I've mentioned that Bobo obsessively writes his own times down, and gets testy if we fail to write down time to room. I think he gets a prize for having the fastest door-to-doc times, even if it means going out to triage and seeing the patient first if the nurses are in the middle of something he can't drag us away from. I have occasionally found him in triage if we are especially busy, so that his time-to-patient is earlier than the triage time. I don't think he has realized that this doesn't help his numbers at all as "door" time is calculated as "triage" time; the system won't calculate a minus. It also doesn't take into consideration that there is sometimes as much as a 20 minute wait for triage.
Last night I thought Bobo would have a stroke. There were sick and complicated patients, multiple admissions and transfers, endless phone calls ("You have asked me to make 3 phone calls, start 2 IV's, and splint a kid; which would you like me to do first?"), the death of an end stage liver patient who's family was in denial which entailed even more calls and tied up a room for 3 hours (with the ER wake/viewing), and one nurse-accompanied transfer necessitating calling our boss in to cover for an hour.
Notice to all the non-urgents in the waiting room who expected rapid service: due to circumstances and Actual Emergencies beyond our control, 20 minute door-to-doc is suspended for the evening.
Most of the time the patients see the physician within the allotted (and heavily marketed) time frame. Mostly the delay lies in the minor detail of the registration process as it is unwieldy and takes a ton of time. There used to be two registration clerks, but the Brain Trust that is administration actually cut secretarial hours after 3 PM so now there is only one until 7 PM when outpatient services close. Brilliant. This has resulted in ridiculous waits for the appointment-making and insurance-having outpatients as well as walk-in routine blood draws. On 3-11 it can get pretty busy since both the ER and outpatient department business picks up. It doesn't help that a couple of the secretaries are deadly sloooooow. Thorough, but slow. There is apparently no way for the Suits to speed up this process although I know it is MUCH faster at Pseudocity Hospital. Probably faster at any hospital that has a vision of rapid registration as a simple but effective means of improving satisfaction scores. But that would just make sense, what do I know.
So to recap, patients are triaged promptly but often fall down the rabbit hole of registration. That gets Bobo's tighty whities in a wad. He used to say is was because the nurses were taking too long to triage. WTF? I wasn't taking that lying down, so I began adding the time "triage competed" boldly next to the triage time. In most cases it was less than 5 minutes. He probably noticed that I only did this when he was working, and that I had instigated the other nurses to do the same. Thus endeth the discussion of how long nurses take to triage. But did it do anything to speed up registration? Um, no. I learned to make copies of complicated med lists for the above average patient who came equipped with such because we must HAND WRITE med lists or we get dinged, another stupid time waster.
Some of the other docs fail to write down the times of their first interaction with the patient and leave it to the nurses. It is usually a guess as we are also responsible for noting the following in addition to triage time: time to room, time physician sees patient, time of labs, xrays, EKG's and discharges in addition to the obvious like meds given, IV starts, vital signs, pain scale, blah, blah, blah. I've mentioned that Bobo obsessively writes his own times down, and gets testy if we fail to write down time to room. I think he gets a prize for having the fastest door-to-doc times, even if it means going out to triage and seeing the patient first if the nurses are in the middle of something he can't drag us away from. I have occasionally found him in triage if we are especially busy, so that his time-to-patient is earlier than the triage time. I don't think he has realized that this doesn't help his numbers at all as "door" time is calculated as "triage" time; the system won't calculate a minus. It also doesn't take into consideration that there is sometimes as much as a 20 minute wait for triage.
Last night I thought Bobo would have a stroke. There were sick and complicated patients, multiple admissions and transfers, endless phone calls ("You have asked me to make 3 phone calls, start 2 IV's, and splint a kid; which would you like me to do first?"), the death of an end stage liver patient who's family was in denial which entailed even more calls and tied up a room for 3 hours (with the ER wake/viewing), and one nurse-accompanied transfer necessitating calling our boss in to cover for an hour.
Notice to all the non-urgents in the waiting room who expected rapid service: due to circumstances and Actual Emergencies beyond our control, 20 minute door-to-doc is suspended for the evening.
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