Didn't think there was going to be a ton of opportunities to do this, but there are an astounding number of people who think it is OK to condemn their children to a life-long sentence of instructing the world how to spell and/or pronounce their stupidly spelled name.
Thanks to all of the disciples in my circle who are now alert to this phenomenon and provide me with ever more outlandish names.
Lisle (Lyle)
MeKinnah
Eryck
Bryannah
Alyjah (Elijah)
Paislee
Arndrea (Andrea)
Cleao
Skyla
Blissany
Cessylia
Sigh.
Tuesday, March 13, 2018
Monday, March 12, 2018
Soylent Green is People!
I hate to keep harping on it, but there can be no doubt as to why we are a nation of obese morons.
Yesterday I had the following actual patients:
Vomiting for 3 days,
New onset atrial fib
General weakness and chest pain
Flu-like symptoms
Diarrhea
Abdominal pain (2 patients)
Detox from alcohol and vomiting
All of which had the same overarching concern, having NOT EATEN A SINGLE THING ALL DAY, and wanting food, wonderful hospital food before zofran, diltiazem, or ruling out a heart attack.
Many patients comment on how awful the food is in the hospital, but sheesh, they can't wait to stuff it in their mouths. Mostly it's the specific diet food trays that seem to be lacking in imagination and is why patients ignore the healthy food choices and send their family scurrying for buckets of Kentucky Fried Chicken.
The cardiac and diabetic patients get Pale Trays. There are restrictions on both, but without any discernible distinction of the food on either. They consist of:
Some kind of chicken, probably baked. It is boneless, skinless and....pale. So, so pale. Perhaps with a sprinkling of dried green stuff. Could be parsley, could be green plastic shavings from tiny plastic green toy army men, who knows. The chicken is accompanied by some kind of pale starch, possible canned potatoes of some description. Maybe some kind of fruit cocktail, which is also pale, but comes with a cherry, providing a bit of color in a wee plastic container, or some yellowish colored canned fruit. The pale cherry, the color of which does not appear in nature, sits on top. And some vanilla pudding. The latter two will be sugar free.
The psuicidal psych patients are only allowed "finger foods". They don't get disposable plastic utensils, they get cardboard spoons that can't be fashioned into a weapon. So it's burgers and fries, pizza, chicken fingers, sandwiches. But the burgers ALWAYS COME WITH A SIDE OF RED ONION. Which smell bad when left about in the ER. Red onions should be banned from the ER.
Regardless of how bad the food is, ER patients will complain about being hungry above all else. If the chest pain is 5, the hunger level will be 10.
Pet peeve. Aside from the disgusting stench of people who smoke 3 packs a day and leave their stink in my cubicle of a triage room, I also have issues with the food odors. Sacks of burgers and fries often accompany patients to the ER, it being just too difficult to pass a fast food joint when loved ones have chest pain or abdominal pain. Or other similar emergency. That counter you just placed your feast on is where the urine samples go. Yep, there, in front of the vomit sacks. Sure, just put that right down there. And your greasy French fry finger can go right here in my oximeter. I'll just disinfect it.
Urp.
Yesterday I had the following actual patients:
Vomiting for 3 days,
New onset atrial fib
General weakness and chest pain
Flu-like symptoms
Diarrhea
Abdominal pain (2 patients)
Detox from alcohol and vomiting
All of which had the same overarching concern, having NOT EATEN A SINGLE THING ALL DAY, and wanting food, wonderful hospital food before zofran, diltiazem, or ruling out a heart attack.
The cardiac and diabetic patients get Pale Trays. There are restrictions on both, but without any discernible distinction of the food on either. They consist of:
Some kind of chicken, probably baked. It is boneless, skinless and....pale. So, so pale. Perhaps with a sprinkling of dried green stuff. Could be parsley, could be green plastic shavings from tiny plastic green toy army men, who knows. The chicken is accompanied by some kind of pale starch, possible canned potatoes of some description. Maybe some kind of fruit cocktail, which is also pale, but comes with a cherry, providing a bit of color in a wee plastic container, or some yellowish colored canned fruit. The pale cherry, the color of which does not appear in nature, sits on top. And some vanilla pudding. The latter two will be sugar free.
The psuicidal psych patients are only allowed "finger foods". They don't get disposable plastic utensils, they get cardboard spoons that can't be fashioned into a weapon. So it's burgers and fries, pizza, chicken fingers, sandwiches. But the burgers ALWAYS COME WITH A SIDE OF RED ONION. Which smell bad when left about in the ER. Red onions should be banned from the ER.
Regardless of how bad the food is, ER patients will complain about being hungry above all else. If the chest pain is 5, the hunger level will be 10.
Pet peeve. Aside from the disgusting stench of people who smoke 3 packs a day and leave their stink in my cubicle of a triage room, I also have issues with the food odors. Sacks of burgers and fries often accompany patients to the ER, it being just too difficult to pass a fast food joint when loved ones have chest pain or abdominal pain. Or other similar emergency. That counter you just placed your feast on is where the urine samples go. Yep, there, in front of the vomit sacks. Sure, just put that right down there. And your greasy French fry finger can go right here in my oximeter. I'll just disinfect it.
Urp.
How to class up your delivery and get VIP service in the ER
Repost, because it made me laugh.
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"
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.
Monday, February 26, 2018
ER Nurses Guide to the Universe
I pretty much live in triage since I almost always work 3-11, a shift that attracts newer ER nurses as opposed to the dayshift dinosaurs. There is a mandatory triage course but it requires AT LEAST two years of working independently in our ER, AND demonstrating the ability to consistently make good decisions.
Also an ability to separate the the truly sick from the truly non-sick, regardless of how much the patients/family members whine or demand a bed "right now", because their mother's brother in law is king of the hospital. There is a lot of that kind of thing, name dropping and what-not. Threatening to call your own doctor or chief of surgery has no bearing on the wait time if there is not an urgent need of care. And guess what? I'm the gatekeeper, literally the one who decides how quickly you need to be seen. As one of my favorite doctors says, every ER visit is relative. It may be your worst illness or injury EVER (for YOU), but it may not be the worst thing in the ER AT THAT MOMENT. Needing to pick the kids up at the bus does not fast track the visit.
Sadly, there are those that will employ underhanded means to get themselves to the head of the line. High drama, embellishing symptoms, and outright lying to move up the visit food chain more quickly. These are not the squeaky wheels who demand, scream, and threaten bodily harm, but the truth benders for whatever personal gain they might derive. It's never a good idea. It could compromise your care, perhaps even your life. Or someone else's life, come to that. So as a public service, may I suggest you not lie to your triage nurse. Just don't.
Some top reasons for lying:
Embarrassment
Don't lie if you have medical issues but choose not to take your prescribed meds. Yes, we will think you are a dumb ass, but if you are supposed to be on medication for your diabetes or hypertension, we will not waste valuable time and resources trying to figure it out. We can just go to the damage control and/or treatment phase. Cutting to the chase is always best, and allow us to move on to the next patient who needs help.
Don't lie about whether or not you've been drinking, or how much. We automatically at least double the amount you tell us, for example, if you say 2 beers, we know it's probably a six pack. If we smell alcohol and you say you have not been drinking, we know your BAL is 260 at least. If you say you don't drink heavily every day like we suspect, because you have the look of someone who drinks every day, we will be waiting for you to withdraw. Hope you don't have a seizure.
Don't lie about your opioid use. You've been here before. We used Narcan on you yesterday. Those track marks on your arm are not "years old". Your antecubital MRSA "spider bite" is a dead giveaway.
If your pain doctor has fired you for lying, we know.
"I just fell on it." C'mon.
Laziness
There are far too many ER visits due to laziness. Especially for people who aren't paying for it, but that's another whole issue.
Don't come to the ER because you didn't bother to contact your doctor for a refill of meds you use each and every day and tell us you "couldn't contact your doctor, been calling for days and my call has not been answered".
Please don't come because you "didn't have time" to call your pediatrician for a condition that your child has had all day or all weekend, such as an earache or sore throat, and it is now 9 PM. Or got sent home from school at noon with a stomach ache, had lunch and a play date, and after dinner has a stomach ache. Also consider that to us, a "high fever" of 100 is not a high fever. If you haven't bothered to take the temperature because you are too lazy to buy a 1.00 thermometer and the child "feels warm" and you still didn't give any Tylenol, you will be waiting a long time. Your child was not "lethargic" when he was jumping off the chairs in the waiting area. He still isn't as he tears apart the triage office. His "difficulty breathing" is real, though. His nose is full of snot because you couldn't be bothered to wipe it away as you whiled away your time in the waiting area on your cell phone.
Your doctor is a douche if he told you "just go to the ER and tell them you need an MRI". You won't get it, I promise, although it is not my responsibility to tell you that in triage. You will have to wait a couple of hours and hear it from the provider. It's above my pay grade.
It is really not cool to come to the ER if you are pregnant and say you are having vaginal bleeding so you can get a million dollar workup and picture of your baby. Please go to the $1.00 store and purchase yourself a pregnancy test, and demonstrate some level of responsibility before you and your baby daddy sign up for all the freebies on the State Sponsored Breeding Program.
Denial
Nobody wants to believe they have a serious medical issues. Heart attack. Cancer. Don't lie about how long you have had the symptoms. Your significant other knows and will rat you out. Don't waste time that way.
If your doctor has put you on medication for your blood pressure, congestive heart failure and diabetes, please don't stop taking your medication. You were already sick, the meds didn't make you sick. None of these issues is going to get magically better. In fact, you will get worse and probably die since you have refused to be admitted or follow a reasonable plan of care.
Here is a thought, on the issue of denial. This is your son's third visit to the ER since the beginning of his pee wee sports program (usually football). Might be a head bang, might be a leg or arm injury. Your kid is 12 and weighs about 50 pounds, his diagnosis is going to be "Not Suited for Contact Sports". Think about it, and please let him do something else, I beg you. He is going to get killed and he knows it, he's trying to save his own life.
Also on the issue of denial, your teen daughter had a mild allergic reaction to some antidepressant weeks ago. Bringing her in for the last 3 nights at the same time with "difficulty breathing", and "it's happening again", with normal vital signs, fake gasping and wheezing to be treated by Ativan is not actually a breathing problem, madam. Your kid is probably having other issues as evidenced by the meds she's on. She is having anxiety and no amount of you trying to make it a medical issue, and thus "easily treatable" is going to make it so. Start counseling immediately. And for god's sake, call the school.
You have an agenda
We are experts at determining who just wants narcotics. Seriously. There is no story we have not heard. If you say your drugs were stolen we will expect that you have filed a police report. Bringing a note from your doctor, copies of scans, and empty prescription bottles is laughable to us. Bringing your kids with you is a rookie move. Further, if your chief complaint is one of the Holy Trinity of pain complaints (back pain, dental pain, migraine) you are already suspect. FYI, we are now RARELY prescribing narcotics for ANYTHING. I'm sorry if your doctor told you to go to the ER. Please put on your big boy pants and make an appointment. And yes, dental care is EXPENSIVE , but you only get one set of permanent teeth. Judging by the condition of yours you have not made it a priority, brushing and flossing being just soooooo tedious.
Work notes are handy to have when you have failed to go to work because you are sick. Please understand that your work note will just say "seen in the ER today and OK to go to work", it will not explain why you have been out for a week.
One woman's chief complaint was "I'm really short of breath and I'm going to be homeless", and seeking a medical hotel admission which is basically someone to wait on her. She then proceeded with concierge demands (sandwiches, juice, hot blankets, more pillows, phone charger). She was kicked out eventually because there was no reason to admit her, although the social worker went to great lengths to help her with her situation. The next day, she presented as suicidal in hopes of an inpatient psych admission. Sorry, no beds for days. What you will be getting is a 24 hour suicide watch in the ER, paper plates, no food that cannot be eaten with your fingers as we don't allow utensils (so you aren't tempted to stab yourself in the jugular with a plastic fork). Also, no TV, limited phone privileges, and a hard, uncomfortable ER cot. Difference between a 4 star accommodation and a Motel 6.
Embellishment (to appear sicker, thus garnering a bed and hastening access)
An ambulance ride does not automatically guarantee you an immediate bed in the ER.
Don't call an ambulance if you don't need it. This is the worst thing to do to your neighbors and community. If your family members, all 15 of them, have preceded your arrival, please feel free to join them in the waiting room. If your EMS providers patch in on the radio and tell us "well known to your facility", "normal vital signs", we will ask if you are appropriate for triage. And out you go to join the queue.
Don't lie if you've been to another hospital and claim that you don't know why there are bruises on the arms and sticky residue from adhesive tape and monitor leads. You didn't "just get blood drawn". That's three days worth at least, right there. If you walk in on crutches that are about 10 years old and have tea towels on the arm pads, and claim that you "just got them", your nonsense knee injury will be deemed bullshit and you will not be receiving the Percocet you claim is the only thing that works.
We have seen caregivers of every type and description bring their patients to the ER with everything from seizure to altered mental status to weakness to pulled out feeding tube. Often these caregivers scarper at the first opportunity and are never seen again. Some local nursing homes have been known to send a challenging patient or two to the ER on a Friday afternoon with "fever", which is non-existent on arrival. When the patient is ready to back, they claim "their administration won't take the patient back because they are too disruptive/demented/violent". We usually win the administrative sumo wrestling, our patient services rep is a more of a pit bull than your corporate clipboard. The patient will return to your facility and you will have to deal with it on Monday, sorry.
Worst of all, DON'T EVER, EVER lie about chest pain. If you are in the ER for chronic back pain, do not say you have chest pain to get seen quicker. That is the ultimate dick move, and will not be treated kindly. You will likely not die of the chronic back pain for which you have run out of pain meds, but somebody may while we attend to your nonsense. And it will be well documented for your next visit for something potentially bad.
Karma. It will get you.
Also an ability to separate the the truly sick from the truly non-sick, regardless of how much the patients/family members whine or demand a bed "right now", because their mother's brother in law is king of the hospital. There is a lot of that kind of thing, name dropping and what-not. Threatening to call your own doctor or chief of surgery has no bearing on the wait time if there is not an urgent need of care. And guess what? I'm the gatekeeper, literally the one who decides how quickly you need to be seen. As one of my favorite doctors says, every ER visit is relative. It may be your worst illness or injury EVER (for YOU), but it may not be the worst thing in the ER AT THAT MOMENT. Needing to pick the kids up at the bus does not fast track the visit.
Sadly, there are those that will employ underhanded means to get themselves to the head of the line. High drama, embellishing symptoms, and outright lying to move up the visit food chain more quickly. These are not the squeaky wheels who demand, scream, and threaten bodily harm, but the truth benders for whatever personal gain they might derive. It's never a good idea. It could compromise your care, perhaps even your life. Or someone else's life, come to that. So as a public service, may I suggest you not lie to your triage nurse. Just don't.
Some top reasons for lying:
Embarrassment
Don't lie if you have medical issues but choose not to take your prescribed meds. Yes, we will think you are a dumb ass, but if you are supposed to be on medication for your diabetes or hypertension, we will not waste valuable time and resources trying to figure it out. We can just go to the damage control and/or treatment phase. Cutting to the chase is always best, and allow us to move on to the next patient who needs help.
Don't lie about whether or not you've been drinking, or how much. We automatically at least double the amount you tell us, for example, if you say 2 beers, we know it's probably a six pack. If we smell alcohol and you say you have not been drinking, we know your BAL is 260 at least. If you say you don't drink heavily every day like we suspect, because you have the look of someone who drinks every day, we will be waiting for you to withdraw. Hope you don't have a seizure.
Don't lie about your opioid use. You've been here before. We used Narcan on you yesterday. Those track marks on your arm are not "years old". Your antecubital MRSA "spider bite" is a dead giveaway.
If your pain doctor has fired you for lying, we know.
"I just fell on it." C'mon.
Laziness
There are far too many ER visits due to laziness. Especially for people who aren't paying for it, but that's another whole issue.
Don't come to the ER because you didn't bother to contact your doctor for a refill of meds you use each and every day and tell us you "couldn't contact your doctor, been calling for days and my call has not been answered".
Please don't come because you "didn't have time" to call your pediatrician for a condition that your child has had all day or all weekend, such as an earache or sore throat, and it is now 9 PM. Or got sent home from school at noon with a stomach ache, had lunch and a play date, and after dinner has a stomach ache. Also consider that to us, a "high fever" of 100 is not a high fever. If you haven't bothered to take the temperature because you are too lazy to buy a 1.00 thermometer and the child "feels warm" and you still didn't give any Tylenol, you will be waiting a long time. Your child was not "lethargic" when he was jumping off the chairs in the waiting area. He still isn't as he tears apart the triage office. His "difficulty breathing" is real, though. His nose is full of snot because you couldn't be bothered to wipe it away as you whiled away your time in the waiting area on your cell phone.
Your doctor is a douche if he told you "just go to the ER and tell them you need an MRI". You won't get it, I promise, although it is not my responsibility to tell you that in triage. You will have to wait a couple of hours and hear it from the provider. It's above my pay grade.
It is really not cool to come to the ER if you are pregnant and say you are having vaginal bleeding so you can get a million dollar workup and picture of your baby. Please go to the $1.00 store and purchase yourself a pregnancy test, and demonstrate some level of responsibility before you and your baby daddy sign up for all the freebies on the State Sponsored Breeding Program.
Denial
Nobody wants to believe they have a serious medical issues. Heart attack. Cancer. Don't lie about how long you have had the symptoms. Your significant other knows and will rat you out. Don't waste time that way.
If your doctor has put you on medication for your blood pressure, congestive heart failure and diabetes, please don't stop taking your medication. You were already sick, the meds didn't make you sick. None of these issues is going to get magically better. In fact, you will get worse and probably die since you have refused to be admitted or follow a reasonable plan of care.
Here is a thought, on the issue of denial. This is your son's third visit to the ER since the beginning of his pee wee sports program (usually football). Might be a head bang, might be a leg or arm injury. Your kid is 12 and weighs about 50 pounds, his diagnosis is going to be "Not Suited for Contact Sports". Think about it, and please let him do something else, I beg you. He is going to get killed and he knows it, he's trying to save his own life.
Also on the issue of denial, your teen daughter had a mild allergic reaction to some antidepressant weeks ago. Bringing her in for the last 3 nights at the same time with "difficulty breathing", and "it's happening again", with normal vital signs, fake gasping and wheezing to be treated by Ativan is not actually a breathing problem, madam. Your kid is probably having other issues as evidenced by the meds she's on. She is having anxiety and no amount of you trying to make it a medical issue, and thus "easily treatable" is going to make it so. Start counseling immediately. And for god's sake, call the school.
You have an agenda
We are experts at determining who just wants narcotics. Seriously. There is no story we have not heard. If you say your drugs were stolen we will expect that you have filed a police report. Bringing a note from your doctor, copies of scans, and empty prescription bottles is laughable to us. Bringing your kids with you is a rookie move. Further, if your chief complaint is one of the Holy Trinity of pain complaints (back pain, dental pain, migraine) you are already suspect. FYI, we are now RARELY prescribing narcotics for ANYTHING. I'm sorry if your doctor told you to go to the ER. Please put on your big boy pants and make an appointment. And yes, dental care is EXPENSIVE , but you only get one set of permanent teeth. Judging by the condition of yours you have not made it a priority, brushing and flossing being just soooooo tedious.
Work notes are handy to have when you have failed to go to work because you are sick. Please understand that your work note will just say "seen in the ER today and OK to go to work", it will not explain why you have been out for a week.
One woman's chief complaint was "I'm really short of breath and I'm going to be homeless", and seeking a medical hotel admission which is basically someone to wait on her. She then proceeded with concierge demands (sandwiches, juice, hot blankets, more pillows, phone charger). She was kicked out eventually because there was no reason to admit her, although the social worker went to great lengths to help her with her situation. The next day, she presented as suicidal in hopes of an inpatient psych admission. Sorry, no beds for days. What you will be getting is a 24 hour suicide watch in the ER, paper plates, no food that cannot be eaten with your fingers as we don't allow utensils (so you aren't tempted to stab yourself in the jugular with a plastic fork). Also, no TV, limited phone privileges, and a hard, uncomfortable ER cot. Difference between a 4 star accommodation and a Motel 6.
Embellishment (to appear sicker, thus garnering a bed and hastening access)
An ambulance ride does not automatically guarantee you an immediate bed in the ER.
Don't call an ambulance if you don't need it. This is the worst thing to do to your neighbors and community. If your family members, all 15 of them, have preceded your arrival, please feel free to join them in the waiting room. If your EMS providers patch in on the radio and tell us "well known to your facility", "normal vital signs", we will ask if you are appropriate for triage. And out you go to join the queue.
Don't lie if you've been to another hospital and claim that you don't know why there are bruises on the arms and sticky residue from adhesive tape and monitor leads. You didn't "just get blood drawn". That's three days worth at least, right there. If you walk in on crutches that are about 10 years old and have tea towels on the arm pads, and claim that you "just got them", your nonsense knee injury will be deemed bullshit and you will not be receiving the Percocet you claim is the only thing that works.
We have seen caregivers of every type and description bring their patients to the ER with everything from seizure to altered mental status to weakness to pulled out feeding tube. Often these caregivers scarper at the first opportunity and are never seen again. Some local nursing homes have been known to send a challenging patient or two to the ER on a Friday afternoon with "fever", which is non-existent on arrival. When the patient is ready to back, they claim "their administration won't take the patient back because they are too disruptive/demented/violent". We usually win the administrative sumo wrestling, our patient services rep is a more of a pit bull than your corporate clipboard. The patient will return to your facility and you will have to deal with it on Monday, sorry.
Worst of all, DON'T EVER, EVER lie about chest pain. If you are in the ER for chronic back pain, do not say you have chest pain to get seen quicker. That is the ultimate dick move, and will not be treated kindly. You will likely not die of the chronic back pain for which you have run out of pain meds, but somebody may while we attend to your nonsense. And it will be well documented for your next visit for something potentially bad.
Karma. It will get you.
Sunday, February 4, 2018
Dobby is free
In the midst of the busiest of busy days ever, this little germ pops into the ER for evaluation of
"I can't feel my toes".
As this was a person in her late 20's, I was not concerned about anything truly serious until I saw that she was wearing a post op shoe. (AKA, Ugly Shoes: sizes small, medium and large).
"What happened to your foot?"
"Well I broke it a couple of weeks ago, and that is fine. I was shoveling out my car from the snow, though, and now I can't feel my toes. The officer who helped me thought I should get it checked".
She apparently did so in the last 20 minutes while wearing a sock and the post op shoe. On one of the coldest days.
"I see. Is your sock wet?"
"yes, I didn't have time to change it".
"Ah. Well, here is a pair of dry hospital fuzzy socks and a warm blanket. Take off the post op shoe and the wet sock. It is about a 3 hour wait".
Moron.
For the amusement of Fil, I documented the following:
"Ednurseasauras has given Emily a sock"
"I can't feel my toes".
As this was a person in her late 20's, I was not concerned about anything truly serious until I saw that she was wearing a post op shoe. (AKA, Ugly Shoes: sizes small, medium and large).
"What happened to your foot?"
"Well I broke it a couple of weeks ago, and that is fine. I was shoveling out my car from the snow, though, and now I can't feel my toes. The officer who helped me thought I should get it checked".
She apparently did so in the last 20 minutes while wearing a sock and the post op shoe. On one of the coldest days.
"I see. Is your sock wet?"
"yes, I didn't have time to change it".
"Ah. Well, here is a pair of dry hospital fuzzy socks and a warm blanket. Take off the post op shoe and the wet sock. It is about a 3 hour wait".
Moron.
For the amusement of Fil, I documented the following:
"Ednurseasauras has given Emily a sock"
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