Is That an African or European Swallow?

We always get tons of calls looking for advice.  We are not a free advice service and are prohibited from giving any by our employers other than "if you think you need to be seen, come to the ER".   To be honest, these calls are largely an annoyance; we get 10-15 per shift.  They pull us away from caring for people who have already made the decision to be evaluated.  Don't you get annoyed when you have been waiting patiently in a store or business, only to have your turn for service trumped by a phone call?  The most important customer is the one right in front of you.

Sometimes the call is driven by fear or denial and instead of calling 911, people will call us.  Easy answer.  Hang up and call 911, or I will get the address and call dispatch for them if they are too hysterical. Most of the time though the are all about convenience or lack of common sense.  People get truly pissed off because we refuse to give them any practical information.  It is a liability.  I get that you don't want to talk to your PCP after hours, or it didn't occur to you to call your PCP in the morning before you went to the gym.  Perfectly understandable that although you have already called your PCP, you think it is stupid that you were advised to go to the ER and you just want to check and make sure.  Unfortunately most PCP's have the same bottom line in the decision tree that we do.  Go to the ER.

Some of secretaries are comfortable giving people the standard response: we don't give advice.  If the nurses are busy they can at least screen calls for us and give us a head's up before we pick up the receiver.  We take turns.  Sometimes the calls can be quite amusing, and we award them meaningless points.  Everything is made up and the points don't matter though.

I Rock, Paper, Scissored with Lisa and lost on an advice call.  We had been forewarned by Jules:

Mr. Outdoors: "Hi, I just have a question.  Yesterday I was out mowing my lawn, and I had my iPod on my belt, now today I feel kind of warm.  And I have a little bit of a headache (and 4 other symptoms like finger pain and grass stains).  Then I noticed that around where my iPod was touching my skin it seems a little red.  Is it because I was outside and it was hot?  Could it be a burn?  Should that happen?  Would it also cause the other symptoms?  How late are you open?  Should I come right down or should I wait until tomorrow to call my PCP?"

-15 points for asking more than just the one question you originally proposed

+5 points for mowing the lawn

+10 points for remembering you had a PCP

-20 points for having 3 or more symptoms

+50 points for me for knowing what....is the airspeed velocity of an unladen swallow.

Bonus points for finding out what was on his iPod

How to Class Up Your Delivery and Get VIP Service in the ER

Polite society has certainly gone the way of the hoop skirt.  Pardon my sainted bloomers, but the ability to express oneself in a reasonably polite and courteous manner, keep civil when one's opinion differs, or engage in respectful dissent is non-existent.  Many people unapologetically present their problems thus: "I have a pain in my ass" instead of "low back pain" without shame.  Descent into name calling and profanity to make their point is the new norm.  You can't reason with people, and it isn't just because they are dumber than a bag of hammers.  It is strictly ignorance because THEY THINK NOTHING IS WRONG WITH THE WAY THEY SPEAK.  Don't get me started on how they talk to their kids.

Hospitals have scripting and behavioral expectations for staff, why should we not hold patients to a higher standard?  How about a little accountability for unacceptable language, profanity, and inappropriate expressions?

I offer a guide for alternative language; scripting for patients if you will.

Instead of: "Why do you have to ask so many fu*king questions?
You might try: Forgive my impatience, my good woman.  Would you kindly assist me in understanding why you need to know what medicines I take and how it is relevant to any treatment I might receive for my chronic, debilitating, and narcotic-requiring back problem?  I would like to be an active participant in my care.

Instead of: "I have a mother-fu*king toothache, my pain is through the roof.  I can't afford no fu*ing dentist.  Just hook me up with pain pills, bitch"
You might try: "Alas, dear lady,  I am irretrievably guilty of neglecting my dental health and am suffering from yet another exacerbation of uncontrollable pain.   I can imagine that it seems inconceivable that I have allowed this situation to deteriorate to this degree. I regret that my current financial situation severely curtails my ability to offer adequate  monetary compensation to a dental professional as I would be unable to purchase cigarettes, liquor, or marijuana.  Would it be at all possible to provide me with some additional narcotic pain relievers?"

Instead of: "I am sicker than anybody in this shit hole and I shouldn't have to wait for a room"
You might try: Please excuse me if I seem short-tempered, but might I respectfully request that my condition be re-assessed?  I understand that my man-cold is not especially urgent, but I do believe this  illness seems to have escalated in the 10 minutes I have been asked to repose in the anteroom"

Instead of: Any expressions such as  "Coochy pain",  "Kicked in the scrote",  "My girlfriend/boyfriend gave me some nasty-ass infection in my pu**y/dick".
You might try: I regret that I have a matter of some....delicacy to discuss.  Please forgive me if I offend you with any unacceptable slang, but...oh, I blush to say it...I have an injury/possible disease in my nether regions.  

Instead of: "I fired my doctor because he/she is the world's biggest douche bag.  He blew me off when I asked for an increase in my pain meds because he thinks I am full of shit".
You might try: I am currently between primary care providers, thank you.  We have come to an amicable parting of ways and I find myself in an unaccustomed awkward position.  Might I beg your indulgence in providing me with just a few of my usual analgesics just to tide me over until I have engaged another primary care provider?


Instead of: "What the hell am I waiting for?"
You might try: Excuse me, I completely understand that you are very busy caring for people much sicker than I am.  When you have a moment, might I trouble you for an update?


Instead of: "You are all a bunch of bitches/ c*ck suckers," etc.
You might try: I would just like to thank you so much for the excellent care you have provided me today.  I would love to let your administrators know how great my visit has been"

Let's raise the bar a little, people.

Dude!

Not a bad day at all except for the "Dirty 2:30", that time of day when all patients converge upon us.  They are usually pretty sick people that require a ton of stuff.  Gack.   I hate the day shift.  The only good thing was that Parvati was supposed to be working but she phoned in dead or rude or some sh*t.  Can't say that I missed her.

I had a nice 19 year old who came by with a foot laceration.  He was riding a little motorbike thing and not his usual dirt bike, although he was suited up in some sort of cool little biking ensemble.  A big stick had penetrated his tennis shoe.  Damn.  Meant to put on those boots, but forgot.  He had a nice big laceration with a small quantity of twig sticking out of it.  Dude had a couple of friends with him; sure, they can come in while we stitch you up.

19 year old boys can be quite funny.  Dude's buddies were like, snowboarding East Coast valley boys, or like some sh*t?  Dude's cut was  soooooo gross, you know?  Dude's friends, predictably, deployed their iPhones to snap photos and ER vid.  "I'd better not see this on, like,  Youtube?", I warned them, but smiled as I said it.  I adjusted the overhead light and put a paper ruler next to the laceration for the best photos.  I've done this a time or two.  Dude' one friend teased, like, the other one?  'Cause he, you know, hates blood?  Duuuuuuuuuuuude!!

Once he was stitched up I wrapped it up with a bunch of dressing material and gave him a post-op shoe.  Dude's friend was like, "Whoa, that's like really sweet wrappage!"

Yeah, gonna totally chart it that way.  Sweet.

Always Something

Tonight we had the great good fortune to work with my favorite relatively new employee in the lab.  Meet Wednesday Addams.  Wednesday apparently got the job because she is best friends with her manager, the stalwart Morticia, who never smiles.  I routinely hang up on her, along with EGK troll.  I don't expect either Morticia or Wednesday to last too long in their current positions.

Wednesday, though, incites another whole level of homicidal thoughts.  She lacks the ability to think outside the box.  In fact a box is probably the safest place for her.  She is constantly asking the secretaries, X-ray tech or nurses to do her job; make phone calls to doctors, patients, or other labs.  Do pediatric blood draws.  Find paper towels. Figure out computer stuff.  Turn on the faucet.  Here is an example:

Wednesday: "Hi I'm really busy, I have to (insert busy work here: QA's, outpatient's, finding stickers).  Do you know how to (insert query here: see above)?  Will you (insert task here: i.e., anything in her job description) for me?  

I don't mind helping, but it is not reciprocated; it never is.  She doesn't seem to want to learn how to empower herself, find out the answer by doing, trying, experimenting or calling one of her colleagues if she can't get her equipment to work.  Tonight Wednesday was unable to get some results to print, so...... did we know how to copy?

Kate:  (exasperated) "You mean like on the copy machine?  It's over there!"

Wednesday stared blankly at the copier for a few minutes, then asked nobody in particular, "Is this on?"  No doubt it seemed very complicated, with all of those dials, buttons, flashy lights and shiny knobs.

There it is.  Just what we've been searching for.  Thank you, Thing.

You Did NOT Just Say That

We sent out a woman several years younger than me for further testing.  Abdominal pain, nausea, fever.  She gave her stated weight as a conservative (I'd say overly generous) 375 at last weigh-in about 2 years ago.  I don't say this to be cruel or uncaring, but as a courtesy to the ambulance crew who was transporting; it would be uncool for them to drop people because they are unprepared with the right number of personnel.  Size does sometimes matter.  She was a very nice lady, and she was much more comfortable at the time of transfer thanks to minuscule doses of meds for pain and nausea.

The EMT/Paramedic crew took report, and agreed that an ACLS transport was unnecessary.  The paramedic was busy training a new guy anyway, so the ensuing conversation took place out of her earshot.  I wish it had taken place out of mine.

Male EMT to female EMT: "OK, do you want to drive or tech"
Female EMT: "It doesn't matter, whatever you want"
Male EMT: "Well, why don't you tech, since it is a female patient.  That way you can have the girl on girl action"

Dead silence (except for the sound of my head hitting the underside of the desk as I drove under it to muffle my laughter).