It's the Most Wonderful Time of the Year

School is about to start, so it's time to have all those rashes, bug bites and aches and pains checked that kids have had all summer.  It is also the time of year for requests for school and sports physicals, and immunizations to be updated which we do NOT do; lack of planning on the part of the parents does NOT constitute an emergency.  This is just laziness because I know the local school nurses send updates in the spring notifying each grade level to start making their summer pediatric appointments promptly because they book up three or four months in advance.  It is pretty hard to get an appointment once June rolls around, and by the end of August you are just crap out of luck and your kid won't be playing sports without that physical form.  So just do it already.  Some people will try to parlay a bogus injury into a comprehensive physical exam, but we are wise to that and won't sign the forms.

During the school year we see WAAAAAAYYYY too many school-age kids at 9:00 or 10:00 PM with injury sustained during the day.  It is one thing to try common sense remedies such as RICE (Rest, Ice, Compression, Elevate) for hours and then bring the kid in because it is very painful.  Most often the complaints of knee, foot, ankle pain are reported near bed time without any intervention.  After a full day of school, sports, playing and jumping on the trampoline for an hour the kid reports the injury as "not better" and the parents race to the ER for an x-ray, walking without difficulty.

So I am going to go out on a limb here and suggest, as a public service, that this school year a little common sense be deployed when it comes to breaking land speed records getting to the ER for a negative X-ray.  See RICE, above.

Also, crutches are really not fun after about an hour.

I'm So Dizzy, My Head is Spinning

A 63 year old man walked in with dizziness.  Dizziness is always so vague; it is a gateway symptom to something else that's going on usually.  In this guy's case, there was also a bunch of other stuff, including leg swelling for months, and oh, yeah, this numbness in my face.  He hemmed and hawed and thought out loud about each and every question which just makes triage so much more difficult.

Dizzy Guy was accompanied by a female friend; close friend from the looks of it and the way she tried to answer every question.  Or contradict every response he made.  Or point out another symptom.  Or correct a time frame.  Or rat out yet another symptom.  Or embellish and speculate on every triage question.

Me:  Are you diabetic?

Dizzy Guy: Well, I haven't seen my doctor in about a year, so I could be...

Dizzy Girlfriend: He has to be...

Me: To be clear, you have never been diagnosed with diabetes or pre-diabetes and are taking no medication?

Dizzy Guy: Um, no, but sometimes my blood pressure is up.  I have some back pain, and I.....

Dizzy Girlfriend: He has been under a lot of stress at work; I want you to write that down.

Dizzy Guy: I'm FINE.  I'm NOT having a heart attack.

Dizzy Girlfriend: I want them to know everything and you don't tell them everything....

Dizzy Guy: I have been having some leg swelling, but I think I've been walking around a lot..

Dizzy Girlfriend: I think he's been trying to cover up the fact that he's been short of breath when he walks

Dizzy Guy: Not really, it was hot yesterday and I was...

Dizzy Girlfriend: Yes, I really think he was!  And he didn't eat as much as he usually does, and...

Me: Time out!  Let me just talk to Dizzy Guy for a minute, mmmmkay?

Dizzy Girlfriend: OK, I'll shut up.  Did he tell you about these little dots on his legs?  And why does it look like they are 2 different colors...

Me: Why don't you have a seat over there for a minute?

Dizzy Guy: She will drive you nuts.

Dizzy Girlfriend: I'm just looking out for you

This exchange was rapid-fire, neither one could focus.  And they kept interrupting each other AND me.  I became frustrated being unable to get a word in edgewise so I kinda lost it.

Me: OK, nobody talk but me, then I want the Reader's Digest abridged version unless I ask.  Got it?

Things deteriorated when the doc told them Dizzy Guy might be having a TIA.

Dizzy Girlfriend: (yelling into the phone) He could be having a TSA!  He has to go for a CAT scan!
Dizzy Guy: Is she driving you crazy yet?

Me: (banging head against desk) TIA!  TIA!  TIA!  TSA is at the airport!
Partner in crime: Well, at least they won't need the complimentary strip search.

I pulled a 7th grade Vocabulary Workshop word out of my a** and pronounced them garrulous.

As he was wheeled away, the paramedics offered him a blanket.

Dizzy Guy: Well, I don't know, I could.  I really don't need it, but I suppose I could take one and....
Me: Just take it!  It's a blanket, not an investment decision!

They were nice people, but exhausting.

Welcome to Acronym Hospital

Acronyms are, of course, wildly popular in health care.  I don't think the job would be nearly as much fun without them.  "Medical speak" is cumbersome and the average person usually doesn't know everything we are talking about even if we use the actual language.  It can be confusing for people in health care as well, but there are some basic acronyms that people are expected to know like in the first 10 minutes of their training.  Take Wednesday, for example; surprise, surprise.  She overheard Eeyore tell me that she had just put a patient in treatment room 2 with SOB.  This is one of the biggest jokes in health care since it means "shortness of breath", rather a garbage term for someone with any complaint ranging from cough / man cold to pulmonary edema.   Wednesday was aghast that Eeyore was so rude to refer to someone as a Son of a Bitch.  Right.  Bonehead.

At some point hospital administration jumped on the Acronym bandwagon.  Where I work not a week goes wherein the Suits in Charge of Stupid Shit does not devise a new set of "catchy" phrases to go along with their latest so-called motivational agenda.  SPIRIT and CARE are two of the latest to hit the hospital.  The Suits apparently spent months on those with little else to do after the massive reduction in force.  Then they wonder why their employee surveys suck.

It didn't take Kate and I months, but rather minutes to come up with new meaning for SPIRIT.

S  squirrels....'nuff said
P  plenty of Percocet for all!
I  if it is difficult, we might do it.  Impossible?  Fu*k it.
R  really??!! Your prescription for narcotics was lost / stolen / thrown away / eaten by wild dogs??
I  if assholes could fly, this place would be an airport
T  totally allergic to tylenol, tramadol and toradol.  But the dilalalalala stuff works purty gud.

Suits spend seemingly endless hours in useless meetings to try to devise work- arounds  to improve satisfaction scores.  They don't seem to get that better support of the nurses would reap ten-fold rewards in that arena.  They are not getting that people who genuinely believe that their management cares fu*k-all about them are not in the greatest position to be institutional cheerleaders.  Plus we know they think we are stupid and don't remember stuff.  Like, in this electronic age, why are you still doing employee mailers?  Stamps add up.  Or the cafeteria closes at 5 PM, now 2 hours earlier which says "screw you" to the evening shift.

Honestly, we just don't care about your so-called "Service Recovery" acronyms.  We spend lots of time enjoying making fun of them, though.  Same goes for "Key Words at Key Times", which will be tomorrows topic of conversation.

Service Recovery employs the HEART acronym.  It stands for HEAR the patient, EMPATHIZE, APOLOGIZE, RESPOND, and THANK them.  Seriously.  The following is an example of how we, as nurses, are expected to respond to rude behavior from patients and families.

"I understand that you are upset.  I know how frustrating this must be for you, and I will do everything I can to get you into a room as soon as possible.   I apologize for the long wait, but I promise you will get the same careful, comprehensive exam and care when it is your turn.  Thank you for choosing our health care organization"

Seems like a good idea on paper, but in actual fact it pulls nurses away from the bedside and rewards bad behavior.  Monkeys then copy that bad behavior so it is a losing battle to employ that kind of psychology.

So,  to put some perspective on this scenario, imagine that you are are a patient sitting in the packed waiting room with abdominal pain, a febrile child with an earache, or a deep laceration.  You are a reasonable person with reasonable expectations and expect that you may have to wait.  As a reasonable human being you *get* that other individuals may be sicker than you are, have life threatening illness, and might require more intervention thus stretching our limited resources.  So keeping my little speech in mind, now imagine that I am responding to a highly negative verbal assault, shouted in your presence or that of your young child.  You could not be aware that this individual has dozens of visits for the Holy Trinity of Chronic Pain Complaints, nebulous injury with severe pain requiring narcotics, and an affinity for being disruptive.

"This is bullshit!  I have been waiting 30 minutes!  I'm going to talk to my lawyer if I don't get some answers and see a doctor!  What is the name and number or your supervisor!  All you people do is give me the runaround!  I have real pain issues!  I'm leaving"

As a patient who is being reasonable, playing by the rules and waiting your turn, are you going to put up with my decision to reward this type of behavior by immediately taking him into a room?  No, you are going to be pissed unless you are one of those parents who tries to calmly explain to their 2 year old who is banging the dog on the head with a hammer why it is a bad idea to hit Fido on the head.

Instead I say something like "Ok, sir have a nice day there.  I'm calling the police"

Many thank me for my own brand of service recovery, tell me they appreciate the way I handle it, or simply applaud.

Thank you very much; the bullshit has left the building.

Stuff I Wake Up to After Dozing on the Couch After Work

OK, the sound was off.  I woke up and saw this on TV:

3 youngish looking guys. One of them is wearing Sally Jessy Raphael red glasses.  One looks like a Jonas brother.  One looks like a combination of  a so-called "Guido" from Jersey Shore and Uncle Jessie from Full House.

What are they singing?

A.  Girls Just Want to Have Fun
B.  Some Menudo song
C.  Opera.

Hint: it was a rerun of Kathie Lee and Hoda, which I wouldn't be watching at 11:00 AM, never mind at 3:00 AM.  It was really way past time to go to bed.

I Don't Flirt

A 42 year old guy came in for a suture removal.  Yes, we do this.  We used to do it for free, now I'm told it is something that gets billed.  It was a worker's comp, so whatever.

The guy was the tiniest bit goofy, and had a fairly androgynous looking kid with him of indeterminate tween age, I just couldn't tell if it was a boy or girl.  Turns out it was a girl.  "Will there be blood?", she asked as I got out the scissors.  Wasn't that a movie? 

After the sutures were removed and I prepared his walking papers, I teasingly asked the little girl if she saw any blood.

Dad: "Hey, you said that like you have kids"

Me:  "Oh, sure.  I have kids your age"
Dad: "What?!  That can't be true.  You're too young to have kids my age!"
Me:  "I had my first when I was about 12, so yeah.  About your age"
Dad: " No, go on!  You're joking, but you are just too cute"
Me: "Um, well thanks for making my day"

Flirting, me?  Yeah, no.  I was being a wise ass.  HE was flirting.