.....must have been a REALLY slow news day in China.
Tuesday, November 30, 2010
Rapid Door- to- Doc Update
I had no small amount of fun with Dr. Roboto the other day as I did a 4 hour Princess shift. Because he disdains hanging out at the nurses' desk with the rest of us lower life forms, he always scurries back to his office in the back between patients; we use an intercom to call him; me more obnoxiously than others, obviously.
Roboto is absolutely insistent that patients are put into rooms and he is called immediately; no problem. There is, as previously noted, quite often a lag between the completion of triage and the completion of registration. This was remedied by simply putting the unregistered patients in the rooms and calling him to come see them. We were really busy; so, after awhile he was so confused he didn't know whether to shit or wind his watch since, say it with me TRIAGE IS MUCH QUICKER THAN REGISTRATION. I had every room filled and nobody registered. Not that I was trying to prove a point or anything.
Not having anyone to blame but himself for this, he tried to take it out on nurses, shocker. All these times are noted on discharge; triage time, time to room, time of doc visit, etc., etc. Many of the docs note their times on a worksheet which is usually kept with the chart; Roboto, being the secretive weasel that he is, prefers to keep his notations to himself and hides them in some secret pocket of his prissy little lab coat. Then he keeps it for quite awhile, many times until long after the patients are discharged off the computer, which is a nursing task. For sanity's sake, we nurses try to keep track of the time that the doc visits. Or we make it up. Whatever. I am usually pretty good about those notations, but Roboto, now pissy because we are pummeling him, said we shouldn't be putting any times down unless it coincides with his exact time. I said we can't do that because you hide your notes it slows everything down on our end, besides, I can look at a clock to see what time you enter a room.
Challenge time; says he, "What time did you put for that patient I just discharged then, since you weren't at the desk?"
I looked at my note; "1:46 PM. What did you write?"
(Addressing left clavicle)"mmm, hrmm, mumble mumble....1:46 PM".
Roboto is absolutely insistent that patients are put into rooms and he is called immediately; no problem. There is, as previously noted, quite often a lag between the completion of triage and the completion of registration. This was remedied by simply putting the unregistered patients in the rooms and calling him to come see them. We were really busy; so, after awhile he was so confused he didn't know whether to shit or wind his watch since, say it with me TRIAGE IS MUCH QUICKER THAN REGISTRATION. I had every room filled and nobody registered. Not that I was trying to prove a point or anything.
Not having anyone to blame but himself for this, he tried to take it out on nurses, shocker. All these times are noted on discharge; triage time, time to room, time of doc visit, etc., etc. Many of the docs note their times on a worksheet which is usually kept with the chart; Roboto, being the secretive weasel that he is, prefers to keep his notations to himself and hides them in some secret pocket of his prissy little lab coat. Then he keeps it for quite awhile, many times until long after the patients are discharged off the computer, which is a nursing task. For sanity's sake, we nurses try to keep track of the time that the doc visits. Or we make it up. Whatever. I am usually pretty good about those notations, but Roboto, now pissy because we are pummeling him, said we shouldn't be putting any times down unless it coincides with his exact time. I said we can't do that because you hide your notes it slows everything down on our end, besides, I can look at a clock to see what time you enter a room.
Challenge time; says he, "What time did you put for that patient I just discharged then, since you weren't at the desk?"
I looked at my note; "1:46 PM. What did you write?"
(Addressing left clavicle)"mmm, hrmm, mumble mumble....1:46 PM".
Monday, November 29, 2010
Maxine Lives!
I have nothing especially newsworthy or bizarre enough to post about. I offer an older entry for your perusal and enjoyment.
You know Maxine; the cartoon character that graces numerous emails (especially from my mother- she just LOVES Maxine). She is that crazy old bat with the bunny slippers who dispenses knowledge from the bottom of a wine glass. One of my patients turned out to be a seeming prototype for Maxine, minus the bunny slippers. I happened to pick up the phone for a patient advice call. We get dozens of these every day, and since the bottom line is come to the ER because we aren't allowed to give any actual common sense information, we tend to take turns. The caller said that she had experienced bilateral wavy lines in her vision which lasted about 30 seconds, and she had a mild headache. She said that she called her opthamologist who told her she should get right to the ER because she could be having a stroke. Sound advice. She was looking for confirmation, I guess, and also wanted to know if she would "be sitting in the waiting room for hours and hours". After informing her that the visit would take as long as was necessary, she agreed to think about it.
About 2 hours later she lands in my room. Longish gray hair, hiking boots instead of bunny slippers, but I'd know that sneer anywhere: yup, it's Maxine in the flesh. And cantankerous as hell. Won't get undressed. Won't let me draw blood. Won't let me start an IV. Won't let me do an EKG. Won't even sit on the bed. Stands in the doorway with arms folded across her chest. She is ANGRY. Dr. Dewshe Bagghe takes this one (oh, joy), talks with her for a bit and gets her to agree to 1) an EKG, 2) Labs, and 3) a head CT.
The tech accomplishes the bloods and EKG, but Dr. Dewshe, master of communication that he is, conveniently forgets to tell me the CT is with IV contrast, so in I go to start a good-sized line. That done, it is time for her CT. I tell her she needs to take off her hair appliances, earrings, necklaces, etc. She asks if the CT is "the one that's a tube". I explained the CT, and she seems a bit more relaxed. I told her I needed to take her to CT in a wheelchair, expecting a huge fight, but she relented. I notice a book she has in her lap, and ask her how she is liking it as it is something I have read (some off-beat fantasy about dragons, I have eclectic tastes in lit.). We chat about books on the way to her test, and I tell her I will see her in about 10 minutes.
Upon her return, I check her vitals which are all normal, and comment that at 74, she appears many years younger than that. This prompted a really great conversation about life and living it, how she walks the woods with her 3 dogs daily, is an avid reader, and manages to learn something new everyday. She was afraid she WAS having a stroke, and nothing made her more afraid than the prospect of losing her intellect, mobility or especially her independence. I thought she and my mom would get along great. Now, my mom is 75 and another go-getter who will sneak a flask onto the senior citizen bus trips; they tend not to serve ETOH. God forbid mum and her cronies don't have a little wine with lunch. Actually, I want to be just like her and raise as much hell as she does when I am her age. Her Christmas card was her on the back of a motorcycle on her 75th b'day, an event at which she and 6 of her friends drank the rest of us under the table. And remained pretty sober at that; maybe they were just pickled.
Anyway, Miss Maxine was given the good news that her CT was fine. Naturally she was opposed to hospitalization and signed out AMA. But before she left, she kissed me on the cheek (2nd time in 32 years I've allowed that), thanked me profusely for being so kind, and went on her merry way.
I hope she is out there raising hell.
You know Maxine; the cartoon character that graces numerous emails (especially from my mother- she just LOVES Maxine). She is that crazy old bat with the bunny slippers who dispenses knowledge from the bottom of a wine glass. One of my patients turned out to be a seeming prototype for Maxine, minus the bunny slippers. I happened to pick up the phone for a patient advice call. We get dozens of these every day, and since the bottom line is come to the ER because we aren't allowed to give any actual common sense information, we tend to take turns. The caller said that she had experienced bilateral wavy lines in her vision which lasted about 30 seconds, and she had a mild headache. She said that she called her opthamologist who told her she should get right to the ER because she could be having a stroke. Sound advice. She was looking for confirmation, I guess, and also wanted to know if she would "be sitting in the waiting room for hours and hours". After informing her that the visit would take as long as was necessary, she agreed to think about it.
About 2 hours later she lands in my room. Longish gray hair, hiking boots instead of bunny slippers, but I'd know that sneer anywhere: yup, it's Maxine in the flesh. And cantankerous as hell. Won't get undressed. Won't let me draw blood. Won't let me start an IV. Won't let me do an EKG. Won't even sit on the bed. Stands in the doorway with arms folded across her chest. She is ANGRY. Dr. Dewshe Bagghe takes this one (oh, joy), talks with her for a bit and gets her to agree to 1) an EKG, 2) Labs, and 3) a head CT.
The tech accomplishes the bloods and EKG, but Dr. Dewshe, master of communication that he is, conveniently forgets to tell me the CT is with IV contrast, so in I go to start a good-sized line. That done, it is time for her CT. I tell her she needs to take off her hair appliances, earrings, necklaces, etc. She asks if the CT is "the one that's a tube". I explained the CT, and she seems a bit more relaxed. I told her I needed to take her to CT in a wheelchair, expecting a huge fight, but she relented. I notice a book she has in her lap, and ask her how she is liking it as it is something I have read (some off-beat fantasy about dragons, I have eclectic tastes in lit.). We chat about books on the way to her test, and I tell her I will see her in about 10 minutes.
Upon her return, I check her vitals which are all normal, and comment that at 74, she appears many years younger than that. This prompted a really great conversation about life and living it, how she walks the woods with her 3 dogs daily, is an avid reader, and manages to learn something new everyday. She was afraid she WAS having a stroke, and nothing made her more afraid than the prospect of losing her intellect, mobility or especially her independence. I thought she and my mom would get along great. Now, my mom is 75 and another go-getter who will sneak a flask onto the senior citizen bus trips; they tend not to serve ETOH. God forbid mum and her cronies don't have a little wine with lunch. Actually, I want to be just like her and raise as much hell as she does when I am her age. Her Christmas card was her on the back of a motorcycle on her 75th b'day, an event at which she and 6 of her friends drank the rest of us under the table. And remained pretty sober at that; maybe they were just pickled.
Anyway, Miss Maxine was given the good news that her CT was fine. Naturally she was opposed to hospitalization and signed out AMA. But before she left, she kissed me on the cheek (2nd time in 32 years I've allowed that), thanked me profusely for being so kind, and went on her merry way.
I hope she is out there raising hell.
Addendum: I saw this lady recently, she is alive and well, and raising her own hell. Good for her! Also, she remembered me and made it a point to tell me how much she appreciated my effort to keep her informed without making her feel like an idiot. Good for me!
Saturday, November 27, 2010
??
Triage complaint of the day:
"Not Better"
The 16 year old with the hysterical mother had a sore throat and had been on antibiotics about 16 hours, was not febrile, drooling or sicker; just not better.
Guess you didn't actually fill the prescription for the "Magic Pills"
"Not Better"
The 16 year old with the hysterical mother had a sore throat and had been on antibiotics about 16 hours, was not febrile, drooling or sicker; just not better.
Guess you didn't actually fill the prescription for the "Magic Pills"
Friday, November 26, 2010
Today's Last Patient of the Night....
...had been "allegedly assaulted": translation, someone beat the crap out of him; says he, "they cheap shotted me". Uh huh. He had a bloody nose, a lacerated lip and the beginnings of a nice shiner. Nope, he didn't want to report it to the local constabulary. It was a struggle for New Cindy to triage him because he was on his phone. Incessantly. I loathe this type of behavior and don't tolerate it myself. Must be the school nurse in me, but I have no problem telling a 24 year old to quit acting like an ass. Since we were looking at xrays and sutures we wanted to get this show on the road so we could finish and leave sometime before 1 AM. Keep in mind that we won't hurry through care, but we do like to actually get to the treatment part of the festivities expeditiously. For those of you with a cell phone glued to your ear and who can't go more than 4 seconds without texting your oh-so- important minutiae, listen up: unless you are Steve Jobs, Bill Gates or are on the verge of discovering either life on Mars or a cure for cancer, IT CAN WAIT. Seriously.
We were working with a relatively new doc, Parvati; she is so great. She loves having the opportunity to work in a less frenetic ER because it gives her time to actually talk with the patients. For someone who has been working in a ER for years and years as I have, her viewpoints and attitude towards patients and patient care are refreshing. Many people are so impressed with her that they ask if she has a private practice.
Parvati saw the patient immediately and ordered the appropriate xrays. The whole time the phone was hanging off his ear like an appendage. Mary took him around the corner to get started on his films.
10 minutes later, Mary came out, clearly frustrated. The patient was not cooperative and had been putting her off in order to "take this one call, it's important". Um, no. You do not have a job, children or anything going for you at present. Your "cheap shot" was likely the result of a drug deal gone bad.
Now pissy, I marched down to the radiology department and in mybitchiestmost persuasive command voice advised him that he needed to put the phone away NOW, and that the doctor was waiting to treat him. Besides, I told him, "you are being extraordinarily rude". He put the phone away and Mary got to work.
Since our doors are literally locked at 11 PM, I was quite surprised to hear the outer door open. The patient's mom and dad had opened the door to let in an equally annoying younger brother. I admonished them not to open the door for anyone without checking with me first since we were actually closed; besides we just are not comfortable with random people wandering around when there is no secretarial staff to keep an eye on things in the waiting room. Secretaries get to leave at 11 PM unless we really need them. Along with windows, we nurses just don't do registration, it's complicated and frankly, I don't want to learn it since I already have a fair amount of secretarial work that takes away from nursing tasks.
Parvati had a happy little talk with the idiots parents about what she was going to do and mentioned howrude and obnoxious talkative he was on his phone. It should come as no surprise that the idiot parents thought it was funny; "Oh, that's our moronic progeny little darling, he LOVES to talk, haha!".
Um, did I mention that he had no insurance? 1 hour of weekend and night shift differential at time and 1/2 for 2 nurses and an x-ray tech as well as high quality medical care for which we will not see one thin dime. Yeah.
God Bless America!
We were working with a relatively new doc, Parvati; she is so great. She loves having the opportunity to work in a less frenetic ER because it gives her time to actually talk with the patients. For someone who has been working in a ER for years and years as I have, her viewpoints and attitude towards patients and patient care are refreshing. Many people are so impressed with her that they ask if she has a private practice.
Parvati saw the patient immediately and ordered the appropriate xrays. The whole time the phone was hanging off his ear like an appendage. Mary took him around the corner to get started on his films.
10 minutes later, Mary came out, clearly frustrated. The patient was not cooperative and had been putting her off in order to "take this one call, it's important". Um, no. You do not have a job, children or anything going for you at present. Your "cheap shot" was likely the result of a drug deal gone bad.
Now pissy, I marched down to the radiology department and in my
Since our doors are literally locked at 11 PM, I was quite surprised to hear the outer door open. The patient's mom and dad had opened the door to let in an equally annoying younger brother. I admonished them not to open the door for anyone without checking with me first since we were actually closed; besides we just are not comfortable with random people wandering around when there is no secretarial staff to keep an eye on things in the waiting room. Secretaries get to leave at 11 PM unless we really need them. Along with windows, we nurses just don't do registration, it's complicated and frankly, I don't want to learn it since I already have a fair amount of secretarial work that takes away from nursing tasks.
Parvati had a happy little talk with the idiots parents about what she was going to do and mentioned how
Um, did I mention that he had no insurance? 1 hour of weekend and night shift differential at time and 1/2 for 2 nurses and an x-ray tech as well as high quality medical care for which we will not see one thin dime. Yeah.
God Bless America!
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