Arrrrrrrrrrgh

Billy was brought in by his mother with a really nasty laceration through his eyebrow and into the eyelid.  He had stepped on a water bottle, lost his balance and fell while on his deck, busting through the railing he broke en route to the backyard four feet below.  Amazingly, he had no loss of consciousness. Billy weighed 250 pounds at 5ft 4 inches.  That he did not break his neck is likely attributable to the 8 or 9 beers he had consumed during the course of the evening. His list of medical problems included high blood pressure, chronic back pain, more chronic pain issues.  Billy was 46 and lived at home. I would add alcoholism to his list, but that's just me.

I have absolutely no idea how Mrs. Billy's Mom got him to the ER on her own, but she deserves some serious props.  Hope she had a GREAT Mother's Day.

Billy moaned and groaned and moaned and groaned.  Then he groaned s'more.  To quote Dean Wormer, "fat, drunk and stupid is no way to go through life, son".  Nor is living with your mother at 46.

Billy's biggest concern, though, was how much of a scar his laceration would leave; Bobo said he would certainly have a scar. I advised Kate that she better grab this one before he was snapped up; quite a catch.

Billy: " yeah, how big a scar do you think?"

Bobo: "It's difficult to say"

Billy: "Well, how would it compare to these?"

Billy lifted his shirt and displayed some impressive scarring on his equally impressive gut.

Bobo did a double take.  "What are those from?"

Billy: "Well, I got shot here, stabbed...stabbed again...I ran with a pretty rough crowd when I was young"
Seems more like the crowd ran over him.

Bobo scrutinized the jigsaw puzzle on Billy's torso and indicated the scar on the left side of his chest: " Wow, looks like the gunshot there just missed your heart"

Billy: " Yep, I'm lucky to be alive.  So, how about that scar; I have to be looking good for the ladies"
Bobo: "Probably not that bad by comparison"

Um, yeah.  I am thinking he might just be able to pull off the pirate look when Billy nodded with approval.
"Yeah", he said, "the ladies will love that".

We sent him to the Mother Ship for a CT scan, which turned out just fine.  While there, he asked the unit secretary out.

Um, yeah.  See, I told you Kate, that kind of merchandise doesn't stay on the shelf long.

New Gal

Mikki is gone.  Goodbye to her as she heads off to greener work pastures.  Just remember there are no utopias in nursing, anywhere.  I am not sure that there can ever be a utopia in endoscopy where she headed.  For me, it would be the tenth circle of hell to spend all eternity (or until the end of my nursing career, possibly one and the same) as a bum look-up nurse.

So,  Southern Cathy has taken Mikki's day shift position, and I have a new partner imported from downtown: meet Kate.  She is disgruntled with the lack of leadership and general fuckery at the Mother Ship and is happy to roost with us.  Welcome, Kate!

She and I have similar backgrounds and experience and an eerily similar sense of humor; quite scary, actually.  We laugh a lot.  Bobo is doomed when we are both working, it is quite entertaining.

If our first ten minutes  together on shift is any indication, this looks like the beginning of a beautiful friendship.

I had triaged two individuals named Steve back to back.  Ellen is slow to register, so I went looking for their charts to bring them into a treatment room.

Me: "Hey, did Ellen bring those charts back?  I want to bring those two patients in"
Kate: "Ellen took them; she's bringing in the Steve's"
Me: "Bringing in the Steve's?"
Then I sang:"Bringing in the Steve's,
We shall come rejoicing"
by now Kate had joined in,
"Bringing in the Steve's!"
Then we laughed like idiots.

Kate: "What is a sheave, anyway?"
Me: "I think it is the little plastic piece at the end of a shoelace".
Kate: "Of course!  Shoe lace sheaves!  Brilliant!"

Yep, Kate is gonna work out fine.

National Shortage

You won't see this on any newscast.  It is a secret known only at the highest levels of government. 

There is a national shortage of mirrors. 

There has to be. I mean, some of the stuff people are wearing when they leave the house...it HAS to be that there is just no access to a mirror to see how they look.

Really??!!

It is the only reasonable explanation.  Unless people are in possession of magic mirrors in which they see only what they want to see. 

Here are some helpful hints for the mirror deficient:

If it feels tight, it probably is.  That doesn't mean that you have the figure to wear it.
It you bought it in the sleepwear section, get dressed in actual clothes before you leave the house.
If you cannot button your jeans, you need a bigger size; perhaps several sizes.  Really.
If you are not pregnant and cannot see your feet, please refrain from wearing a tank top.
Bra.  'nuff said.
Short shorts: just....don't.  Please.
If you have legs that look like potato stix (thanks to Sue for that characterization), leggings just really aren't the look for you
If you must walk near the railing on the upper level of the mall and are wearing a skirt, you should really consider wearing underwear.
If you are male and wearing a shirt that says "It's Not a Beer Gut, it's a Fuel Tank for a Sex Machine", you have no hope of a normal girlfriend in the near future. 

Dear Narcotic Seeker, an Open Letter...

I see you have had a number of visits for your Holy Trinity of Chronic Complaints (dental pain, back pain, migraine).  I make no apology for placing you in the waiting room.  Just so you know, the medical professionals upon whom you depend for your endless supply of prescriptions for Percocet are busy with actual emergencies today.  Two happen to be busy trying very hard not to die, one before we can get a helicopter here to transport her to Big City Hospital. 

Ellen, our secretary to whom you give the same information every time you come in, is busy trying to assist the professional staff by making phone calls and other duties since the nurses are up to their assholes in alligators.  It is inappropriate for you to lie on the floor in the waiting room and moan for a blanket. Frankly, we just don't care what you do or how much you act like a total douche; however, you are a distraction for Ellen, and you are making the small children and your fellow douchetards in the waiting area uncomfortable. 

If you sit in the chair like a grown-up and behave yourself, you might be seen by the doctor in the next two hours.  You might get one Percocet if you are a good little narc-seeker; however, telling me "Kiss my ass!" is not going to endear you to anyone.
With Disgust,
EDNurseasauras

When Stupid is Not a Concealed Weapon

New Cathy and I worked last weekend and I think we might have seen about 10 patients total, which amounts to DEADLY slow shifts. Wednesday, Thursday same thing. I managed to read about half of "1984", which I can't remember having read in high school but know that I did; I picked out lighting for my new kitchen and did most of my schoolwork for the week. And was bored out of my gourd, having to resort to watching a rerun of a ridiculous singing version of Gray's Anatomy; we saw in total 5 patients in 8 hours. All that quiet we have more than made up for in my last few shifts; it has been pants crappingly busy with actual REALLY SICK people.

I like to work with the Talker, he doesn't hurry people, which is why they love him.  He has no urgency to to boot them out the door no matter what the complaint.  This goes equally for dental paineurs (they get antibiotics only if they have more than one visit for same), antibiotic-seeking mothers whose kids have had a temp of 99 degrees for 10  minutes, back pain (chronic), and not-magically-better boo boos and viral illness after 12 hours. 

Of course this can backfire when it is really busy.  He largely ignores Bobo's mandate that all patients be seen within 20 minutes.  Sometimes it is as much as an hour.  Or more.  It gets complicated because the Talker doesn't automatically get xrays or order labs simply because the patient expects it; it is definitely not "Have it Your Way" ER when he is on.  If it will not affect how he will treat the complaint, he is all about not exposing patients to radiation or paying tons of money for lab work.  Have a UTI?  We dip it, he treats with antibiotics.  The common sense approach rules.

There were about 7 patients sitting in the waiting room; Ellen was buzzing around, dealing with a lot of non-emergent whining "how long is the wait".  This really bothers her because she hates to ask us when we are busy, and is just not hard-wired to be firm with the idiots.  Generally she is stuck in the middle where she never wants to be.

At 9:30 PM I looked over the charts in the rack:
Cough x 1 week in an 8 year old.  Not worse, just not better.

"Asthma attack" in a tween girl (drama, drama, drama).  Not wheezing, not coughing, not short of breath, sats 100% on room, lungs clear. Take a number honey, and get off your fucking cell phone.

Vomiting x 2 in a 20 year old frequent flier female who has been seen 8 times for "menstrual cramps" and always gets vicodin.  WTF.  Does not look sick and is drinking an iced coffee

Laceration in an 18 year old male.  Microscopic.  Will not require stitches.

"Flu-like symptoms"; nausea, no vomiting, no fever, no cough, no other symptoms except "I don't feel good".  History of fibromyalgia.

Dental pain, first visit for same; accompained by 23 year old boyfriend who has had innumerable visits for same

Dental pain, 10 visits between the us and the Mother Ship.  Known to have altered a presctiption in the past.

Of the patients in rooms and getting workups, two were being admitted with all the bullshit that entailed.  At least they would be gone by 11 PM.  One is getting antibiotics for cellulitis and is ready to leave.  One is awaiting disposition for a UTI.  Two kids with earaches waiting to be seen.  The Talker usually doesn't prescribe antibiotics for all earaches automatically. 

He spent 20 minutes in a circular argument patiently explaining to a woman who was strongly advocting for her 24 year old daughter for antibiotics for yet another viral illness.
"But we had them last time"
"She is not better so she needs them"
"If she doesn't have antibiotics how is she going to get better"
"But she had them last time and got better"
"She is sick, so she needs antibiotics"
"Couldn't you just give her some samples"
"She needs antibiotics because she is sick and not getting better"
"We will just come back tomorrow and get them"
You can't win any of these arguments when people are stupid

It may be time to start looking around for a new job.  At least in a regular ER, most of this time-wasting crap and parade of idiots would go to the fast-track.  Where I never want to work.