Make Mine Fried, Please

An older lady with dementia had been parked in one of my rooms for the entire day when I took over her care.  Because she had a habit of reporting that her care givers beat her, which turned out to be the dementia talking, she had pretty much burned bridges everywhere and now she had no place to go.  Her estranged elderly husband was willing to take her, but there was a small matter of a restraining order to be dealt with first, which was some big misunderstanding according to the many parties involved.  Somehow the restraining order was vacated by a judge in record time.  Gotta love small town America.

The poor wandering lady had been fed, watered, toileted, walked, sung to, chatted with and entertained.   She was kind of entertaining herself as she kept up a steady stream of consciousness.  Every few minutes she asked where her husband was, and that she was tired of waiting.  Mostly she talked nonsense, but once in awhile she seemed to make sense, even if momentarily.

"Have you seen my bird?"
"No, I have not.  Where did you see it last?"
"I had it here, it was in the bag when I came here"
"What kind of bird, can you describe it?"
"It was a green bird, with blue feathers and small red feet,  I fed it some birdseed.  Do you have any chocolate?"
"I have some Lorna Doones.  Your bird sounds pretty, was it a big bird or a small bird?"

She indicated the size with her hands.

"Oh, about the size of a chicken?"

"Yes, like a chicken".  She fiddled with her bracelet, folded a washcloth, and placed the kleenex box on the center of the table.  She sighed loudly.  "I've been waiting hours and hours! Is my husband coming?"

"He said in about a half hour.  It shouldn't be long now"

Another big sigh.  "He should come now!  He is taking too long, if he doesn't come soon……
I will kill him like a chicken"

Me: "I didn't hear that"

The social worker in the next room actually giggled.
But props to her for getting the wheels of justice turning to get the lady a safe place to go.

Dirty Secrets

I had some fun with the infection control nurse, a pompous and self righteous D-bag,  who harangued us with the usual hand washing stuff.  I asked about disinfection of things like stethoscopes, and she rather snidely told me that, of course, they should be routinely disinfected, before launching into a lecture on precautions, MRSA, and disposable stethoscopes.

I was bored.  So I started it.

Me: "Mmm-hmm.  What about ID badges?  Do you have any policy on disinfecting those?  I mean, they are at chest height, in the sneeze and cough zone, dangle onto patient's skin, onto sheets, they go to every patient room and are never washed or disinfected…it seems to me they would be just a germ farm".  I pointedly glanced at her ID badge, on a nylon lanyard, which was covered with 27 pieces of flair.

Blank stare.  She was gob-smacked.  "I've never thought of that".

Yeah. ID badges are filthy things.  Think about it.  Along with watches, rings, bracelets (which I never wear to work) and neckties on the men.

Name badges are mandatory.  It goes everywhere the nurse goes.   It gets touched 150 times per day because they always flip around so that my various passwords are showing instead of my name.   It gets handled and scanned for glucometers and to enter/exit certain areas.  It is used for the time clock.  It goes into the bathroom, the poopy patient's room, and the cafeteria.  Into.  Every.  Patient.  Room.

Yesterday I had a horrifying thought.  BWOM hospital issues clip-on visitor badges, which are never, to my knowledge, washed or disinfected.

Eeew.

Just so you know, I do bleach-wipe my name badge every day.  Always have.  Always will.  
And now you will, too.

You're welcome.

Tao of Scrubs

I have 3 different colors of scrubs.  Navy, black, and the standard ciel blue.  I have no pink, lime green, or tiger stripes.  My scrubs do not have cute rainbows or unicorns on them.  If that is your preference, power to you.  It's not mine.   I choose to be simple.  If I wear black pants, I wear a black top.  Sometimes I mix it up and wear the ciel with the black, or navy with the ciel, but that is rare and only if I have laundry issues.  I used to have one scrub jacket that commemorated winter, but no holiday stuff.  I am frequently called on this.  "Where is your holiday spirit?"  "Don't you have anything orange and black?", (or red, white and blue, you get the picture).  Again, no.  For ME, I just don't feel like a woman of my age can be taken seriously while wearing teddy bears.  Someone once mentioned to me that when doing CPR, people can look down a scrub shirt and see your boobs, so I generally wear a long sleeved shirt of a different color underneath no matter the season, which can be considered a slight holiday nod.  Actually I just hate for my arms to be bare because of the old lady jiggle.

I find it interesting that the staff in different facilities have widely varying preferences in the variety of scrubs they choose….provided they are fee to choose.  I think it is enormously detrimental for nurses not to be able to choose what they wear to work unless the hospital plans to purchase and launder them.  Then I wouldn't care so much, but I think it is bull shit to be required to wear a certain color or style so the idiot public can differentiate between nurses and non- nurses, especially since my name badge identifies me as a nurse.  Also because the badge "RN" that I am also required to wear is the size of a dinner plate.  One size does not fit all.   At one time a co-worker at the Bait Shoppe was rabidly advocating for all the nurses to wear teal colored scrubs; I  shut her down with a curt "NO".  To this day I have no idea why it was so important to her, unless it was because I hijacked her idea to get  fleece vests with the company logo on it.  I did this because I have narrow preferences for vests and, selfishly, wanted to get what I wanted.  It worked out well because nurses decided on one color, the secretaries decided on another, and the X-ray techs still another.  I liked that we chose our own without a fight.  We could wear them whenever and with whatever we wanted to.  Plus they were a good deal at the time.

BWOM nursing employees are free to choose what they want.  They are a stylish bunch.  There is lots of pink, lots of bunnies.  I have seen all manner of the latest styles with these gals.  A couple of the nurses seem to change their nail polish to go with whatever they happen to be wearing.   Boss Lady shows up everyday in plain boring ciel scrubs even though I have not personally seen her do any patient care in awhile, although she is ready to go when called upon.  Which is great.  Most bosses just wear their business attire with a lab coat thrown over it, although why they are compelled to do so is puzzling since they never, ever touch humans.  I find a white lab coat with heels and hose is insincere somehow, but if that is what you want to wear, fine with me.

Sometimes the match thing can get out of hand, though.  I have to say the the prize for most color coordinated attire in the At Work in the ER category is Newchelle.  Always with a matching set of scrubs and jacket.  Prints, stripes, bright colors, she has it all.  If there is a set of scrubs in any color of the rainbow, she has them.  She has earrings to match all her outfits and seems seems to put all of her money into accessorizing her look with colored or patterned  clogs or tennis shoes.  Lately she has been taking her look to a new, and perhaps, more obsessive level.

She has several different hair pieces with colored barrettes or headbands, one with a big fat flower on it.  WTF.  I think we will be seeing more of the flowers, just a hunch.  She can be counted on to wear a coordinating lanyard for each outfit.

Yesterday her pens were the perfect shade of fuchsia to match her pants and shirt.

I don't want to know if she had matching underwear.  It is disturbing enough.

Test

The happy couple strolled into my last remaining critical room about 2 hours before the end of my shift.
Headache.  All day.  Woke up with it.  Not like usual migraine because he didn't have any vomiting.  But he thought that as long as he was in the area because of his shopping trip to Target that he should get it checked out.  No, he didn't take anything for the pain.

Wife was apparently in need of most of the attention and interrupted every question with observations about how her difficulties with pregnancy had caused her to come to the ER 4 times.

"They are breeding", I whispered, horrified, to my work partner.
"I noticed.  She already told me 3 times that it is usually her who is seen for her problems of pregnancy".

Namely vomiting

Headache Man received Toradol and the complimentary head CT.  Wife was quick to point out that she was allergic to Toradol, it made her nauseous.  The two of them laughed and carried on in the room for awhile.  Wife wiggle the IV tubing and touched the monitor a lot.  For no apparent reason.

BEEP.  I answered the call light.  "His blood pressure is 170/120!  That has to be really dangerous"

Me: "Yes, it can be.  I will just check that again manually".  120/66.

Wife: "It dropped a lot, that can't be good!"

Me: "With the arm bent and tightened like that, it would be higher.  I will reset the monitor to check it every 30 minutes instead".  He told me about the transient nausea that had been caused by his wires allergy to Toradol.  But he was apparently feeling fine as evidenced by his use of his cell phone to take selflies.

With a heroin overdose and a GI bleed, the People Who Care Committee were busy for the next 2 hours.  Headache Man and his wife were apparently not getting the requisite attention they apparently felt they deserved as Wife was on the call light complaining about the high blood pressure, the lateness of the hour, the need to get home, the long wait, etcetera, etcetera.  Wife sighed and complained and stood in the doorway, which drives me nuts but does noting to expedite the discharge process.

Headache Man got tired of complaining and decided to appeal to my intelligent rather than my non-existent caring side by revealing that he had an IQ 3 points shy of genius level.

I shared that little gem with my Work Partner.
"Wow.  How did you keep a straight face?"
"Oh, years of practice nodding and smiling.  And then I asked him if it was scaled for humans on this planet"

Work Partner: "Wow, Interplanetary Mensa material.  Cool".

It's All in the Timing

I hate getting up early but agreed to a 4 hour 7 AM princess shift at BWOM.  Bad idea.

At 80 minutes prior to the beginning of my shift, I arose having gotten about 5 hours of sleep after leaving my other job at midnight (1 hour late).  I had a 20 minute drive home.  I made it through 27 stop lights without getting a single red one, a personal best for me.

At 45 minutes prior to the beginning of my shift, I left my house to start my 35 minute drive to BWOM with a quick stop of coffee.  I hoped that the fact that it was lightly snowing would not interfere with my drive but forgot that I also had to stop for gas.  Damn.  No coffee.

At 5 minutes prior to the start of my shift, I arrived without coffee and grumpy, but found my 4 assigned rooms and 6 patient beds delightfully empty.  Coffee was my only plan for the next few minutes.  I checked my emergency carts and supplies while I sipped.  It wasn't Dunk's, but it was hot and black and nobody wanted to talk to me just then which suited me just fine.

At  30 minutes into my shift I got a single frequent flyer psych patient with a simple medical problem.

At 2 hours into my shift I got a different assignment and inherited a COPD patient bound for the ICU who had been there for about 6 or 7 hours.  Admissions generally take forever at this hospital, there just does not seem to be any sense of urgency.  

At one hour prior to the end of my shift the hospitalist had finally seen the patient and I was ready to get her out of the ER.  Frustrated with 2 computers that were frozen for 25 minutes and unable to get the Tech Monkey on the phone, I was unable to complete the mountain of computer entries (about 500 for one ICU admission) so I could transfer my patient to her Comfy Bed.  This sucked because I had timed it perfectly to coincide with my expected arrival time in the unit according to the Gospel of BWOM Admission Policies, Procedures, Unwritten and Implied Codes of Behavior, Safety and Floor Nurses Lunch Schedules.

The procedure is to fax the report, 10 minutes later the ER nurse would call to confirm receipt of said fax and give the receiving nurse the opportunity to ask questions or for clarification.  After 30 minutes the patient goes away.

I started this nonsense 1 hour prior to the end of my shift.  Plenty of time to get my patient transferred to the floor within 30 minutes of faxing the SBAR, right?   Figure 10 minutes to bring the patient to the floor,  return to the ER, 10 minutes to tidy the room, give report to the oncoming nurse, pee, and boogie home.  60 minutes.

NOPE.  The SBAR report that I had faxed to the floor 30 minutes prior to my expected arrival time was, as usual "not received" by the ICU nurse.  Re-faxed, which resets the 30 minute window.  This window is not in effect for 90 minutes around the change of shift at any time because the floor nurses are getting report and making rounds.  Fair enough.  Which means two hours, generally.  Also another 90 minutes during the middle of the shift for lunch.  Not that we ever get lunch in the ER.  

So 10 minutes after I re-faxed the report that I had written out I gave a FULL, DETAILED VERBAL REPORT to the ICU nurse,  regardless of the fact that the information is readily available in the computer.  This is where my extremely detailed and copies notes may found about my patient assessments, IV infusions, meds, labs, cultures, vital signs, I&O's, pretty much everything the astute nurse needs to know about the patient they are about to receive.  More wasted time and effort, documenting in 2 places and giving verbal report as well.  Brilliant system.

At 20 minutes before the end of my shift  I spent about 10 minutes looking for the pieces to the rarely used portable monitor and throw a few curses to the computer because NOW I CANNOT FINISH THE COMPUTER ENTRY THAT HAS TO BE MADE BEFORE THE PATIENT LEAVES THE DEPARTMENT.

I proclaimed loudly "Well, I can't fix this".
Boss Lady ran by enroute to another important meeting throwing a " yes you can!" over her shoulder as she raced by,  as if I merely need encouragement instead of a cudgel or someone who can actually fix the problem.  It wasn't happening as the Tech types were also at lunch.

At 10 minutes past the end of my shift,  I brought the patient to the ICU by myself, because there was nobody to help as usual.  The ICU nurse futzed about with the patient's bed weight that she couldn't quite figure out (you need to zero the bed first, honey),  fluffing, figuring out which monitor leads are mine and which are hers, chatting pleasantly with the patient, answering phones, putting on a different sheet, and blocked my egress from the room by holding me hostage with the patient still on my ER stretcher.

At 30 minutes past the end of my shift I returned to the ER  to find two more patients in my rooms, but the relieving nurse, having been 10 minutes late arriving for the day, had condescended to take responsibility for them.  Unfortunately, she had not as yet received report on my remaining patient and busied herself caring for the two new patients, one of which was a kid who needed stitches.  I could not, in good conscience, drag her away from that.

At 90 minutes past the end of my shift I left the hospital, forgetting to pee, and with a 35 minute drive home.

And the charge nurse went to lunch.