Candace, the day xray tech had an outpatient whom, she said, "was nasty and had attitude". I guess he had asked her if she "saw" anything on his xray, which normally annoys the crap out of her.
Jane, my boss said, "Why don't you tell him you see plenty, but you won't tell him what?"
Candace didn't think it was funny; apparently there are strict rules on what they can tell patients, and she usually tells them "I am not allowed to read xrays; that is the responsibility of the radiologist". I guess a lot of patients just get douchy about it, and blame the tech; perhaps it is all in the way the rebuff is presented.
I suggested a few things Candace could tell patients who wanted to know if she "saw" anything:
1. "I once saw a solar eclipse"
2. "I saw the Sound of Music in the theater when I was 10"
3. "I saw an image of the Holy Family in a grilled cheese sandwich!"
4. "I see dead people?"
Candace doesn't have much of a sense of humor.
Wednesday, March 16, 2011
Tuesday, March 15, 2011
Another Seinfeld ER Moment
So, this guy brings in his 69 year old father with some back pain.
"He fell".
Sonny didn't know anything about his medical history except "High blood pressure, dementia and he got his legs cut off". The only med he knows for sure is oxycodone; for chronic hip and back pain.
The man, I'll call him Buck, has pretty piss-poor short term memory. I get him triaged and into a wheelchair and into the waiting room with sonny to await registration.
Moments later, Ellen comes looking for me.
Ellen: "Did that son leave? This gentleman doesn't even know his address, poor thing. Did he leave a number?".
Me: "Nope. Guess he's gone. No forwarding address, either".
I put Buck into a room and help him get undressed. He has all kinds of information to give me; about how a motor vehicle accident cut off both his legs, but they were able to sew them back on. About how his wife died. About how he doesn't drive anymore. About how he used to be an electrician.
What Buck can't tell me is how he fell or where his useless son went.
Cripes was a little busy tonight. He's been working a lot lately, seems like every other shift I get to work with him. It was a while before he was able to see Buck. By then the useless son has returned
"I had to give the car keys to my fiancee". Really. How...interesting.
Useless son continued to be on his cell phone, in and out of the department. "I had to talk to my fiancee". Really. You actually have a girlfriend?
Shortly thereafter, another call to the fiancee; "I had to tell my fiancee my work schedule". Really. Yawn. Dude, I really don't give a shit.
Useless son doesn't have much of an idea about what actually happened to Dad, which prompted yet another call to....you guessed it..."my fiancee to find out what happened".
What a specimen. "I wonder what happened to my fiancee. I know she's here somewhere. Have you seen my fiancee? Tell my fiancee I'm looking for her. I have lost my fiancee, the poor baby".
Me: Maybe the dingo ate your baby.
Buck was fine except for his useless progeny, who I still can't believe even had a girlfriend, let alone a fiancee. I guess there really is someone for everyone.
"He fell".
Sonny didn't know anything about his medical history except "High blood pressure, dementia and he got his legs cut off". The only med he knows for sure is oxycodone; for chronic hip and back pain.
The man, I'll call him Buck, has pretty piss-poor short term memory. I get him triaged and into a wheelchair and into the waiting room with sonny to await registration.
Moments later, Ellen comes looking for me.
Ellen: "Did that son leave? This gentleman doesn't even know his address, poor thing. Did he leave a number?".
Me: "Nope. Guess he's gone. No forwarding address, either".
I put Buck into a room and help him get undressed. He has all kinds of information to give me; about how a motor vehicle accident cut off both his legs, but they were able to sew them back on. About how his wife died. About how he doesn't drive anymore. About how he used to be an electrician.
What Buck can't tell me is how he fell or where his useless son went.
Cripes was a little busy tonight. He's been working a lot lately, seems like every other shift I get to work with him. It was a while before he was able to see Buck. By then the useless son has returned
"I had to give the car keys to my fiancee". Really. How...interesting.
Useless son continued to be on his cell phone, in and out of the department. "I had to talk to my fiancee". Really. You actually have a girlfriend?
Shortly thereafter, another call to the fiancee; "I had to tell my fiancee my work schedule". Really. Yawn. Dude, I really don't give a shit.
Useless son doesn't have much of an idea about what actually happened to Dad, which prompted yet another call to....you guessed it..."my fiancee to find out what happened".
What a specimen. "I wonder what happened to my fiancee. I know she's here somewhere. Have you seen my fiancee? Tell my fiancee I'm looking for her. I have lost my fiancee, the poor baby".
Me: Maybe the dingo ate your baby.
Buck was fine except for his useless progeny, who I still can't believe even had a girlfriend, let alone a fiancee. I guess there really is someone for everyone.
Saturday, March 12, 2011
Really??!
I thought I might share with you this nugget attached to my online classroom:
Tsunami Warning
At this time, although the tsunami conditions are continuing to be monitored, classes will proceed as normal.
Ok. Just to clarify:
1. The events in Japan are horrific and mind boggling; what does that have to do with a school located on the East Coast. Of the United States.
2. It is unlikely that the online environment will be affected, unless they want to blame tsunami on last week's electronic screwing over of a vast number of students due to non-existent "financial problem".
Seriously?
Tsunami Warning
At this time, although the tsunami conditions are continuing to be monitored, classes will proceed as normal.
Ok. Just to clarify:
1. The events in Japan are horrific and mind boggling; what does that have to do with a school located on the East Coast. Of the United States.
2. It is unlikely that the online environment will be affected, unless they want to blame tsunami on last week's electronic screwing over of a vast number of students due to non-existent "financial problem".
Seriously?
Wednesday, March 9, 2011
Nice Day, Nice for Some
A very nice day brings out the kid in people I guess. It also brings out the douche mongers, like this guy:
He dragged himself with a very high degree of drama (missing only the audio, which was "Oh, woe is me!!! Woe is me!!!) into the triage area ever so slowly before plopping into the chair breathlessly. Wife started doing the talking until I shut her up.
"I fell. In Rite Aid parking lot on ICE! Can you believe they don't do anything about ice in the parking lot of a pharmacy where sick and injured patients need to walk?? It's a travesty!!!"
(um, no, I can't imagine. it makes no sense. it is New Hampshire, one of the coldest and snowiest winters on record where there remains no place to put the snow and SHOCKER, here, there is ice. Just so you know, we have had similar falls and insignificant injuries from a number of equally tort-minded, upstanding, non-working, disability-having, suck -the- life-out-of-the-system douchebags such as yourself).
Me: " Yup. Did you take any pain relievers, elevate or use ice?"
DB: "No, we came right over!"
Me: "I see.
And what is it that you've hurt today?"
DB: "My head, shoulder, wrist, elbow, hand, little finger, hip, knee, ankle and foot"
Me: "Did you hit your head?"
DB: "No! it just missed the bumper of the car! But now I have a migraine!"
Me: (completely losing interest). "Well, you've certainly had an eventful last 8 minutes"
(that was sarcasm, but I bet you knew that; he didn't)
help. police. murder.
This was the first patient of the evening and my eyes are already rolling out of my head.
The day shift, Kelly and Lisa, are finishing up what was not a good day with Gil. They think he orders too many tests and gets all up in people's business unnecessarily. Maybe he does, but they're not going to change him so I just go with it, expect to be busy and make a lot of phone calls on his behalf and no schoolwork done. I like the guy; he's smart and funny and totally gets my sense of humor. Things get done; it's not time to panic 'til it's time to panic. I like that.
I'd much rather work with Gil than Parvati who wants to put an IV in every chronic paineur and drug-seeker and give them Dilaudid; that gets really old, really fast. Her cultural "sky is falling" affect sometimes annoys the crap out of me. I frequently wait until she barks 10 orders at me (at least 5 of them conflicting or redundant) and then just list them back. She changes her mind often, but doesn't always share. ALSO WHEN SHE TALKS IT IS LIKE IT IS ALL IN CAPITALS WITH AN EXCLAMATION POINT! I JUST CAN'T GET THAT EXCITED! A FOLEY CATH IN A PATIENT WITH AN 02 SAT OF 85% IS NOT THE PRIORITY!
The other day a lady came in with "atrial fibrillation". At least, that's what she thought it was; "it's never been documented", she said. "Well", I said to her, "it has now." It was supraventricular tachycardia, or SVT
In a couple of minutes Mikki and I had set the patient up with an IV; she was monitored, on O2 and the EKG was in my hand. I walked into the room next door where Parvati was telling the patient about her daughter's wedding and wordlessly handed it to her.
Parvati came in like Chicken Little ("the sky is falling! the sky is falling!").
She had a few words with the patient and did a cursory exam, then told us "LET'S GIVE SOME CARDIZEM!!"
Me: " I have 6mg of Adenosine ready to go unless you prefer Cardizem; perhaps I missed a really fast atrial fib?" (I never believed it for a minute; I know my SVT)
Parvati: "NO! YOU ARE RIGHT! YES! YES! LET'S GIVE 6 MG OF ADENOSINE! IT HAS TO BE GIVEN FAST!"
Sigh. I know. She is a little wearing, but kind to the patients. And she does dental blocks, so that is kind of fun. We see fewer dental paineurs when she is on.
Anyway, remember the whiny gone-to-ground douchetard in triage? I parked him at the registration desk, and a young man comes in swathed with what looks like several slings and a couch cushion; he is being lead by his Dad who was wearing ski boots. The nearest ski area is at least 30 minutes away.
I waved them directly into a treatment room, which didn't go over well with the douchetard based on the pained expression he shot me.
Long story short; the kid had a fracture/dislocation of his shoulder. Nice kid, nice family. The dad shook my hand about 90 minutes later on their way out, with pain relief, xrays, reduction and follow-up accomplished; he thanked us for taking care of them so quickly. It was the first of two shoulder fractures and one really nasty tibia fracture, 3 admissions and two transfers.
The tibia fracture was Cripe's fav patent of the night. In answer to the question "How did you hurt yourself"came the following responses:
1. "I fell down the stairs. I had a few beers."
2. "I fell off a stool, I was just sitting on it; I had a couple of six packs".
3. "I was just dancing around to reggae music; I've been drinking all day, I think I killed close to a case".
He was admitted for surgery, poor guy. I felt bad because he was also having some social issues (no, really?) centered around his choice of roommates. Whose name he didn't know. Who refused to leave. And who apparently was not paying him rent (although he WAS paying in beer. Not an ideal arrangement).
So, by now I'm sure you're DYING to know how many fractures the douchetard had sustained, how long in traction, how many days out of work, etc, etc, etc.?
Not. One. But Cripes gave him a single Percocet to make up for his long wait while we took care of the young man's shoulder. Him so good!
He dragged himself with a very high degree of drama (missing only the audio, which was "Oh, woe is me!!! Woe is me!!!) into the triage area ever so slowly before plopping into the chair breathlessly. Wife started doing the talking until I shut her up.
"I fell. In Rite Aid parking lot on ICE! Can you believe they don't do anything about ice in the parking lot of a pharmacy where sick and injured patients need to walk?? It's a travesty!!!"
(um, no, I can't imagine. it makes no sense. it is New Hampshire, one of the coldest and snowiest winters on record where there remains no place to put the snow and SHOCKER, here, there is ice. Just so you know, we have had similar falls and insignificant injuries from a number of equally tort-minded, upstanding, non-working, disability-having, suck -the- life-out-of-the-system douchebags such as yourself).
Me: " Yup. Did you take any pain relievers, elevate or use ice?"
DB: "No, we came right over!"
Me: "I see.
And what is it that you've hurt today?"
DB: "My head, shoulder, wrist, elbow, hand, little finger, hip, knee, ankle and foot"
Me: "Did you hit your head?"
DB: "No! it just missed the bumper of the car! But now I have a migraine!"
Me: (completely losing interest). "Well, you've certainly had an eventful last 8 minutes"
(that was sarcasm, but I bet you knew that; he didn't)
help. police. murder.
This was the first patient of the evening and my eyes are already rolling out of my head.
The day shift, Kelly and Lisa, are finishing up what was not a good day with Gil. They think he orders too many tests and gets all up in people's business unnecessarily. Maybe he does, but they're not going to change him so I just go with it, expect to be busy and make a lot of phone calls on his behalf and no schoolwork done. I like the guy; he's smart and funny and totally gets my sense of humor. Things get done; it's not time to panic 'til it's time to panic. I like that.
I'd much rather work with Gil than Parvati who wants to put an IV in every chronic paineur and drug-seeker and give them Dilaudid; that gets really old, really fast. Her cultural "sky is falling" affect sometimes annoys the crap out of me. I frequently wait until she barks 10 orders at me (at least 5 of them conflicting or redundant) and then just list them back. She changes her mind often, but doesn't always share. ALSO WHEN SHE TALKS IT IS LIKE IT IS ALL IN CAPITALS WITH AN EXCLAMATION POINT! I JUST CAN'T GET THAT EXCITED! A FOLEY CATH IN A PATIENT WITH AN 02 SAT OF 85% IS NOT THE PRIORITY!
The other day a lady came in with "atrial fibrillation". At least, that's what she thought it was; "it's never been documented", she said. "Well", I said to her, "it has now." It was supraventricular tachycardia, or SVT
In a couple of minutes Mikki and I had set the patient up with an IV; she was monitored, on O2 and the EKG was in my hand. I walked into the room next door where Parvati was telling the patient about her daughter's wedding and wordlessly handed it to her.
Parvati came in like Chicken Little ("the sky is falling! the sky is falling!").
She had a few words with the patient and did a cursory exam, then told us "LET'S GIVE SOME CARDIZEM!!"
Me: " I have 6mg of Adenosine ready to go unless you prefer Cardizem; perhaps I missed a really fast atrial fib?" (I never believed it for a minute; I know my SVT)
Parvati: "NO! YOU ARE RIGHT! YES! YES! LET'S GIVE 6 MG OF ADENOSINE! IT HAS TO BE GIVEN FAST!"
Sigh. I know. She is a little wearing, but kind to the patients. And she does dental blocks, so that is kind of fun. We see fewer dental paineurs when she is on.
Anyway, remember the whiny gone-to-ground douchetard in triage? I parked him at the registration desk, and a young man comes in swathed with what looks like several slings and a couch cushion; he is being lead by his Dad who was wearing ski boots. The nearest ski area is at least 30 minutes away.
I waved them directly into a treatment room, which didn't go over well with the douchetard based on the pained expression he shot me.
Long story short; the kid had a fracture/dislocation of his shoulder. Nice kid, nice family. The dad shook my hand about 90 minutes later on their way out, with pain relief, xrays, reduction and follow-up accomplished; he thanked us for taking care of them so quickly. It was the first of two shoulder fractures and one really nasty tibia fracture, 3 admissions and two transfers.
The tibia fracture was Cripe's fav patent of the night. In answer to the question "How did you hurt yourself"came the following responses:
1. "I fell down the stairs. I had a few beers."
2. "I fell off a stool, I was just sitting on it; I had a couple of six packs".
3. "I was just dancing around to reggae music; I've been drinking all day, I think I killed close to a case".
He was admitted for surgery, poor guy. I felt bad because he was also having some social issues (no, really?) centered around his choice of roommates. Whose name he didn't know. Who refused to leave. And who apparently was not paying him rent (although he WAS paying in beer. Not an ideal arrangement).
So, by now I'm sure you're DYING to know how many fractures the douchetard had sustained, how long in traction, how many days out of work, etc, etc, etc.?
Not. One. But Cripes gave him a single Percocet to make up for his long wait while we took care of the young man's shoulder. Him so good!
Monday, March 7, 2011
Please, Just Read the Sign!
Worked with Cripes last night, always a treat. Stuff gets done, people are seen quickly, and he's a hoot to work with. But still, it was busy not only in the ER, but for all of the outpatient crap as well.
Because of a call-out we only had one secretary to register the boat-load of both out-patients and ER patients. None of which had any actual emergent condition:
Flu-like symptoms, seen yesterday by PCP; not magically better
Sore throat, seen yesterday by PCP; not magically better.
Dental pain
Dental pain
Chronic abdominal pain, nausea and vomiting, "I have a bowel obstruction"; 3 visits in last week, one hospital admission, abusing laxatives and enemas, taking oxy's.
And, same guy:
NO evidence of bowel obstruction and refuses CT scan.
On Medicare which won't pay for Zofran which is what he comes in for.
Does NOT want pain meds.
Wants surgery and "can't find" a surgeon.
Talks continuously about surgery and insists, insists, insists it is the last thing he wants. Suspect Munchausen, which we won't be fixing this in the ER.
The sign-in list is for out-patients, not ER patients. Nobody ever reads the signs. At least once (maybe 5 or 6 times if we are really busy and people are inordinately stupid) a day someone signs in when they should be an ER patient.
Mary, trying to be helpful, waded into the mass of humanity in the waiting room to ask if anyone had any xray orders.
She discovered that an ER patient with some completely non-emergent problem (that had now missed their pediatrician's appointment, haha) had been waiting an hour for registration. Mary got right on her high horse, adamant that the signage was not clear.
Me: "Mary, the signs are crystal clear; the douchtards just don't take the time to read them".
Mary: "My daughter signed in and waited and she needed to be seen in the ER"
Me: "Mary, your daughter is an engineer; clearly she didn't read the sign".
Mary: "Yes she did, she thought she was an outpatient".
Me: " It VERY CLEARLY states what comprises outpatient status, lab, x-ray, mammo, etc".
Mary: "Well, it says those things in small letters written beside it"
Me: "This is a pointless argument; I am going to draw circles on this paper and ignore you until you go away".
I wrote up another sign.
If nothing else, it will keep people busy. I don't see any loopholes or inconsistancies, do you?
Because of a call-out we only had one secretary to register the boat-load of both out-patients and ER patients. None of which had any actual emergent condition:
Flu-like symptoms, seen yesterday by PCP; not magically better
Sore throat, seen yesterday by PCP; not magically better.
Dental pain
Dental pain
Chronic abdominal pain, nausea and vomiting, "I have a bowel obstruction"; 3 visits in last week, one hospital admission, abusing laxatives and enemas, taking oxy's.
And, same guy:
NO evidence of bowel obstruction and refuses CT scan.
On Medicare which won't pay for Zofran which is what he comes in for.
Does NOT want pain meds.
Wants surgery and "can't find" a surgeon.
Talks continuously about surgery and insists, insists, insists it is the last thing he wants. Suspect Munchausen, which we won't be fixing this in the ER.
The sign-in list is for out-patients, not ER patients. Nobody ever reads the signs. At least once (maybe 5 or 6 times if we are really busy and people are inordinately stupid) a day someone signs in when they should be an ER patient.
Mary, trying to be helpful, waded into the mass of humanity in the waiting room to ask if anyone had any xray orders.
She discovered that an ER patient with some completely non-emergent problem (that had now missed their pediatrician's appointment, haha) had been waiting an hour for registration. Mary got right on her high horse, adamant that the signage was not clear.
Me: "Mary, the signs are crystal clear; the douchtards just don't take the time to read them".
Mary: "My daughter signed in and waited and she needed to be seen in the ER"
Me: "Mary, your daughter is an engineer; clearly she didn't read the sign".
Mary: "Yes she did, she thought she was an outpatient".
Me: " It VERY CLEARLY states what comprises outpatient status, lab, x-ray, mammo, etc".
Mary: "Well, it says those things in small letters written beside it"
Me: "This is a pointless argument; I am going to draw circles on this paper and ignore you until you go away".
I wrote up another sign.
If nothing else, it will keep people busy. I don't see any loopholes or inconsistancies, do you?
Subscribe to:
Posts (Atom)