Be Prepared...Just Sayin'

0-60 MPH in this ER.  23 patients one night, 5 the next.  Even the phone calls were boring; the Lady on Elm anonymously called to see if Sherry was working although I knew it was her.  Nervous Lady called to see what time we closed.  Then called back to see how late she could come in for x-rays.  Then called back to see what time the lab opens.  She does this several times per week, we suspect she is really a mole for the Suits to try and catch us in a lie.

My hospital mandated competencies were all up to date, People magazine was read, and the place was stocked and tidy.  There is only so much internet surfing you can do since most sites are blocked.  That left us generally free to listen to the scanner and catch up on all the delightful antics of the community in which I work.

There were about 5 calls for local police / ambulance to a nearby apartment complex for this and that; fall on floor, unresponsive but breathing, back ache, suspicious activity.  Annika, a lovely per diem radiology tech was taking advantage of the quietude to make a phone call on the veranda (ambulance bay) when she noted the Whole Nine Yards speeding by with lights and sirens; 2 ambulances, an undetermined number of fire apparatus, every police car in town.  Double overdose in the same apartment complex.  Now would be a good time to commit a crime in town, but not to have a medical emergency.

The victims were known to abuse lorazepam according to dispatch.  Well, I though as I got out the IV drug handbook.  Let me read about administering flumazenil and how to reverse benzodiazepine overdose since I haven't done that in years.  Just on the off-chance that the patient might be brought to my ER.  Remote, but possible.

Mac noticed the commotion outside and inquired as to what the call was; he also noted that I was looking up drug reversal recipes.

"Where is your I-O stuff?" he asked.  "If we get it ready, we won't need it"

Good call.  We amused ourselves with code cart stuff while we waited.  And waited.  And waited.

We didn't need either the I-O stuff or the flumazenil, but at least I put my down-time to good use.

What's the Temperature?

SIC was reading some study about temporal vs. oral temperatures that she just had to share, I wasn't really listening since I was reading the latest issue of People magazine.  The study said something about oral temperatures being more accurate on kids aged 3 months to three years, although a rectal temp is the gold standard for babies.  That caught my attention since why anyone would bother even attempting to take an oral temp. on a 3 month old defies all logic so I wrote the data-reporting off as bogus and stopped listening altogether.

Until my next patient limped in with her veterinary tech boyfriend with a stubbed pinky toe, who said she had an extra foot bone that periodically dislocates and it felt like it was out of place.  Vet tech had actually wrapped the foot in several yards of purple vet wrap; we have the same thing for humans but we call it Coban, sort of an elastic self-sticking tape that comes in all different colors.  Paeds nurses used to yell at us when we used it to secure the IV's of admitted babies, but it works great on them.  Dogs too I imagine.   I suppose stubbed pinky toe was grateful that vet tech boyfriend didn't have any other stray veterinary equipment lying around such as this:

"Why??!!!"

Vet tech was fascinated with the temporal thermometer, and commented on how awesome it would be to be able to use something like that on dogs instead of rectal.  And then my mind started to wander envisioning dog-wrangling and trying to get a temporal thermometer to work.

Me: "Yeah, I guess rectal temps will remain the gold standard for dogs", which sort of put into perspective the whole oral temp on babies thing.  And then my mind wandered again and I thought about how awesome it would be for dogs if Vet wrap was bacon flavored....

Thumbthing Wicked

Story time; unusually quiet night.  SIC talked about a patient who had scarred her for life with a particularly horrible thumb amputation, some kind of outdoor industrial-type accident that occurred during a below-zero day here north of the Arctic Circle.  It was so cold that she had to peel off 8 layers consisting of orange day-glo vest, other vest, jacket, coveralls, flannels, long sleeved shirt, long underwear shirt and silk underwear before discovering that not only was he missing a thumb, but his ulna and radius were poking through the skin.  Then she described having to retrieve the thumb from the front seat of his truck (he drove himself to the ER) and having to shake the amputated thumb out of the glove.  Urp.

I once had a man chop off his own thumb with an axe (fairly common), except he came to the ER without the amputated part.  It was missing.  His family was searching for it.  The search lasted for nearly an hour and feared that the family canine had absconded with the the thumb.  Fortunately  it was found near some canned goods in the basement.  The thumb, not the dog.  Bobo was concerned that the family should know exactly how to transport the thumb.  Yes, I told them to put it in a baggy.  Yes, I told them to put the baggie on ice.  Yes, I told them not to put the thumb directly on the ice.  Finally the family calls to alert us that the thumb has been located and is on the way; the dog is in the clear.  I relay this information to Bobo, who is a genetically humorless individual.

Me: "So, the wife has located the thumb and is on her way in"
Bobo: "Ok, good; they have it on ice, I heard you telling them how to pack it"
Me: "Yep.  I have just one question though"
Bobo: "What's that?"
Me: "Do I have them register the thumb as a new patient?"

Bobo actually laughed for about 2 seconds before he composed himself.  I don't believe anybody has ever heard him so much as snicker.

I know.  I have a dark gift.

Working Together, Yeah.

I don't let people abuse the registration staff and encourage them to simply excuse themselves from confrontational individuals and let me or the other nurses handle it .  I have even rescued Wednesday from rabid patients.  For one thing, I just don't give a rat's fat  ass how long the out-patients are waiting if there are ER patients;  that is the lab's problem and something they need to fix.  It is not the fault of the registrars if the barely-there phlebotomist decides to have lunch at 2:30 PM every day and the lab manager allows this regardless of how many blood draws there are.  FYI, that is a very busy time of day for both ER and lab.  Work with us, please.  Still, it is unacceptable to treat any member of the staff disrespectfully.  Manners: get you some.

Eeyore is usually pretty good at deflecting things; Ellen has a tendency to get flustered and apologize all over the place, then come and find me when the yelling starts.  It makes it more difficult if I intervene late in the game, but that's my job I guess. I have no trouble firmly but unsmilingly telling people to calm down because the registrars are doing their best to accommodate their rude asses, while I am mentally telling them to take a double flying fu*k at a rolling donut.  And then I add 10 minutes to their wait time.  I am not at all passive aggressive.


There are some hot-button questions that seem to rankle, as if we are making things up just to piss them off.  Really?  Don't you think if we had any control over these things we would streamline the process more?  Or at least ask more fun questions, such as "What color is a red house?", and "If a monkey can climb a greased pole in 10 seconds, how much does a pound of butter weigh?".

But no.  Mostly it is the mundane that set people off.  That, and unrealistic expectations.

You asked for all this information last time
Yes, I know.  Gets boring doesn't it?  So does your excuse for failing to have an ID.  Or insurance.  Or  an address other than a PO box 2 hours away.  Because we all we are really trying to do is catch you in a lie, right?

My doctor's office has all of this information on record
Your doctor's office computer thingy doesn't speak to ours.  It is a 9-5 computer thingy anyway, and since it is after 5 PM, it has gone night-night.

My doctor told me this was an emergency and I should be seen right away.
When I called your doctor's office (thus wasting 10 minutes of my life I will never get back) to ask them (to take time out of their day) to fax me your medicine list (that you should know yourself), they informed me that you had (but didn't think you should wait an additional 90 minutes) for your scheduled "urgent same day appointment" (for something stupid).  You have just guaranteed that you will not be seen before then.  FYI,  99 degrees Fahrenheit is not a high fever, and saying you "felt warm all day" confirms that you are an idiot.

"Are you going to rob me?"
 Asked of  Ellen by a complete douche-tard during the obligatory request for insurance information. Highly unlikely since you have no insurance.  Or any ID.  Or have given us a bogus address.  More like you robbing me since you have no intention of paying your bill.

You don't understand why I'm calling the police?
You just threatened to "go off on me" and "make me sorry I was ever born" if you were not seen immediately.  Buh bye.  Have a nice day.

Which brings me to the Last Word in conflict negotiation.  The Last Resort.   I am eternally grateful for all the support our local police gives us.  It happens often enough that it is necessary to call them, usually when the decibels exceed polite levels and violence is threatened.  The prospect of the special little "adult time-out room" with the metal bars almost always takes things down several notches.  I especially like it when they say, "Now, is there anything you want to say to the nice nurse who is just doing her job?" as they are led away.

Really.  Buh bye.

I'll Be Calm When You Leave. I Promise.

The working environment in an ER is labile, obviously.  ER nurses wouldn't want to work there unless there was some variety now, would we?  Most of us could never work anywhere else, but that doesn't mean it's all wonderfully sunshiny and glittery.  There are no unicorns defacating  rainbow colored poop, let's be clear.   And let us not forget about the DRRRAAAAAAAAMA.  Distraught patients and families, unfulfilled drug-seekers, and teenagers are not the sole providers of drama.

As for drama, I personally  don't care if the world is going to hell in a hand cart patient-wise as long as I am working with people who are calm and orderly as well.  I do not respond well to individual mayhem, chaos, and people spinning will-nilly in their own disorganized orbits.  Just take a breath.  It is not time to panic until it is time to panic.

Gil likes it calm; we enjoy taking a deep breath together as the day shift leaves, taking their chaos with them.    I like my own inner peace to prevail even if I am racing from task to task.  There are some combinations and groups of people who work cohesively, work as a team, and make the experience pleasant.  If nothing else there is a common hatred of management bullies and company bullshit.  The more "big personalities", "lone wolves", "chronic complainers" and "debbie downers" who are part of  the work environment, the more unpleasant it becomes, which has a tendency to mess with my inner calm.

Things that generally fu*k with my chi:

1.  Wednesday, the lab tech.  She is like nails on a blackboard.

2.  Eeyore on a day after she calls in sick because she just fu*king whines and I want to hit her.

3.  The air conditioning on the fritz.  For the entire weekend.

4.  Patients who come in five minutes before we close for crap that's been going on all day/week/month/year.

5.  Coworkers who whine about the schedule because they didn't get to it first.  Haha.

6.  The Lady on Elm St. calling for the 4th time.  In one hour.

7.  Patient's with silly reasons for being in the ER who want warm blankets, 3 pillows, an ice pack, an additional 4 more "something I forgot to mention's", are talking on their cell phone and want change for the vending machine because they need a little snack, coloring books and crayons for their demon spawn and are pissed about the wait, all in the first 10 minutes of the visit before the physician has a chance to see them.

8.  Any shift with Parvati because she yells orders to the universe in general and calls me Nancy repeatedly.  Which I ignore because my name isn't Nancy.


Quit fu*king with my chi.  Honestly.  We'll all be happier.
Now just go breathe somewhere else, there's plenty of oxygen over there.