I discovered that irrepressible Kate, my newest partner in crime had created the latest time wasting activity (in addition to coming up with songs for my "ER Complaint Soundtrack", more on that another day). It was a list of bogus initials to use when we input EKG's. It should be entertaining when the EKG wench calls to berate us for somehow managing to screw up and make all kinds of work for her. The list includes:
LOL
BFF
BRB
OMG
PIA
PID
WTF
IMO
IDK
Doing EKG's is kind of time consuming because there is lots and lots of important patient information that has to be typed in. In an actual emergency, it is possible just to put "911 chest pain" in and edit the particulars later. Because there are two different sets of 9 and 11 digit identifiers, on occasion there might be an error. Or a misplaced letter when we type it in (no scanners here). We make every effort to be accurate with these, but what can I say: we are human. Instead of merely making the changes in the EKG department where each study is wirelessly received (the wonders of modern technology!) the evil EKG troll has a hissy fit, way down in the EKG cave where she resides. I don't thing she sees daylight, or humans, that often. She will frequently file an error report and/or call us. She lacks adult social skills big time, and has a tendency to screech. I handle this type of rude telephone behavior with my usual professional skill. I simply hang up.
"This is EDNurseasauras, how can I help you?"
"YOU GUYS HAVE SENT 4 EKG'S THIS WEEK WITH MISSING OR INCOMPLETE INFORMATION!"
"Call me back when you are calm and can speak to me like a professional". Click.
Kate: "Did you hang up on EKG again?"
Me: "Yep. She still hasn't learned, but I remain hopeful"
Ellen, 30 seconds later: " EKG is on the phone. She wants to talk to whoever hung up on her. She didn't sound happy"
Me: "Ellen, was she rude to you? Seriously??" (I get really pissed when people are rude to Ellen)
Ellen: "Oh, well, heh heh. She was a little....high strung I guess"
Me: "This is EDNurseasauras. I will not tolerate your rudeness to me OR my staff. If you can lower your voice and communicate respectfully I'm happy to hear your complaint. "
YOU...YOU...YOU'RE ALWAYS HANGING UP ON ME! DO YOU HAVE ANY IDEA HOW MUCH OF MY TIME THIS WASTES WHILE I...."
Me: "Look, I'd love to chat with you about the logistics of your job, but mine involves actual patient care. In fact, I'm going to do CPR right now since my partner is signalling me to get off the phone. Have a nice day".
CLICK!
Kate (grinning and shaking her head): "Lady, you do love to poke that bear in the cage, don't you?"
Me: "That's no bear, it's hardly a trained monkey. But she does have opposable thumbs....I think".
The next call was from the nursing supervisor.
Supervisor: "EKG troll called me to complain that you keep hanging up on her"
Me: "Yes, that's true, but only twice today. Let me ask you: she was shouting, wasn't she? How long did it take you to calm her down so that you could get the story out of her?"
Supervisor:" Um..."
Me: "That's what I thought. I was perfectly polite to her, but she continued to use a raised voice and unprofessional communication technique. So I terminated the conversation. I will be happy to talk to her if she acts like a big girl. Please have her read her telephone manners guide. She needs to calm down before she pops an artery or something"
Supervisor: "Hahahahaha!"
I understand that her job doesn't involve much actual communication with people, but you would think that someone who has been working in this place for 10 years would be better trained. Perhaps the Clip Boards simply throw her a piece of raw meat every once in awhile, who knows.
So, getting back to the initials. Today I just used "SOB". I think EKG troll would agree with that.
Saturday, August 13, 2011
Friday, August 12, 2011
No Soup for You
An 18 year old male came in with a finger laceration, doing the drama dance. "It burns! It burns! The pain! I think I cut it to the bone!". I glanced at this monstrous wound to find a tiny little laceration on the pad of his finger after unwrapping it from within its nest of 1/2 of a cut off tube sock, and some blue string. It was a nothing injury, not even bleeding.
Next, he handed me some pharmacy labels. "I had a car accident and my back is really messed up. My doctor is on vacation, so can I get a prescription for these too?".
I don't know who would ever put an 18 year old on oxycodone, but my triage note read:
"1. Laceration. 2. Requests narcotic refill".
Most of the docs know that when I number the triage complaints there is probably a much longer story behind it. The most I have ever had was 6 sequentially insignificant complaints.
Parvati didn't even put glue on his booboo. But she did ask me to call the provider who was supposedly on vacation. Guess what? He wasn't. The office manager was kind enough to share with me that the patient had called their office only this morning with a similar request for meds, but gee, he had just been given a 'script only 5 days ago. He was told he would have to make an appointment since that was way too soon to be thinking about a refill. Did I still want to speak to the doctor?
Nope. You can just go ahead and make a notation in his medical record before he automatically gets the report of his patient's ER visit. Just another little service that we provide.
I put a bandaid on and prepared to kick him to the curb. But I did tell him that I had contacted his doctor, who now knows he is on the scam for more oxy. "I'm only sorry I can't call your mother since you are over 18", I said.
"Oh, that's not good", he said, hanging his head. He simply turned around and left, and I doubt he will be back...this week.
Thank you, Medicaid, for providing this young man with free doctor's visits, no-cost ER visits, and the means for an 18 year old to earn some cash this summer.
Yikes.
Next, he handed me some pharmacy labels. "I had a car accident and my back is really messed up. My doctor is on vacation, so can I get a prescription for these too?".
I don't know who would ever put an 18 year old on oxycodone, but my triage note read:
"1. Laceration. 2. Requests narcotic refill".
Most of the docs know that when I number the triage complaints there is probably a much longer story behind it. The most I have ever had was 6 sequentially insignificant complaints.
Parvati didn't even put glue on his booboo. But she did ask me to call the provider who was supposedly on vacation. Guess what? He wasn't. The office manager was kind enough to share with me that the patient had called their office only this morning with a similar request for meds, but gee, he had just been given a 'script only 5 days ago. He was told he would have to make an appointment since that was way too soon to be thinking about a refill. Did I still want to speak to the doctor?
Nope. You can just go ahead and make a notation in his medical record before he automatically gets the report of his patient's ER visit. Just another little service that we provide.
I put a bandaid on and prepared to kick him to the curb. But I did tell him that I had contacted his doctor, who now knows he is on the scam for more oxy. "I'm only sorry I can't call your mother since you are over 18", I said.
"Oh, that's not good", he said, hanging his head. He simply turned around and left, and I doubt he will be back...this week.
Thank you, Medicaid, for providing this young man with free doctor's visits, no-cost ER visits, and the means for an 18 year old to earn some cash this summer.
Yikes.
Thursday, August 11, 2011
"Heeeeere's Johnny!
I am ready for some R&R after the last 5 day stretch, seeing 23, 24 patients per shift. This wouldn't have been so bad if it hadn't been an endless parade of IV's, EKG's transfers, and nothing simple. What made my last few shifts unbearable was the presence of Parvati. The ex-surgeon in her likes to do her own dressings, but she is pretty helpless when it comes to actually finding anything:
"Where is the gauze?"
"Where is the bacitracin?"
"Where is lidocaine?"
"Where is the tape?"
"Where is the extra saline?"
Anxiety=cardiac workup, EKG, labs, etc.
Chronic migraines=IV fluids, narcotics, sometimes Toradol and then narcotics, anti-emetics and tying up a room for 3 hours. And a prescription for Percocet.
The "I need a refill of my Percocet" crowd usually goes away empty handed for some reason.
I usually ignore Parvati's rapid-fire verbal orders which annoys her; then she asks the other nurse, who also ignores her. This is not simply to be a pain, but she will frequently change her mind, which just makes work for me, inconveniences the patient with additional veinipunctures and makes me cranky. Ignoring her really amounts to saying, "Just go ahead and write the orders, I am doing the other 4,000 tasks you asked me to do; remember, there is only the two of us to do everything. It takes you two minutes to do the exam, but it takes us a lot longer to do these things. You need to be patient. Why don't you go eat dinner (and get out of my way?)".
Hilariously, Parvati hasn't complained about me yet. She did complain to our boss about Second in Command, who in her desperate attempt to appear competent and all-knowing comes across as be a little overbearing with new doctors. She will argue or give them her 2 cents about what they need, second guesses them and makes herself seem indispensable. I never argue unless I have a damn good reason so I
don't come off as a squeaky wheel. It's not time to argue until it's time to argue, a corollary to It's not time to panic until it's time to panic. That way, if tell a doc I am worried about this or that they actually listen to me. Parvati, though...doubt she listens to anyone since she makes way too much noise to hear anything anyway.
After three of the longest shifts of my life with Parvatti for ALL THREE SHIFTS I was feeling a tad....homicidal. Which accounted for my mutterings
REDRUM
REDRUM
REDRUM.
I suddenly have the urge to re-read "The Shining". And maybe buy an axe.
"Where is the gauze?"
"Where is the bacitracin?"
"Where is lidocaine?"
"Where is the tape?"
"Where is the extra saline?"
Anxiety=cardiac workup, EKG, labs, etc.
Chronic migraines=IV fluids, narcotics, sometimes Toradol and then narcotics, anti-emetics and tying up a room for 3 hours. And a prescription for Percocet.
The "I need a refill of my Percocet" crowd usually goes away empty handed for some reason.
I usually ignore Parvati's rapid-fire verbal orders which annoys her; then she asks the other nurse, who also ignores her. This is not simply to be a pain, but she will frequently change her mind, which just makes work for me, inconveniences the patient with additional veinipunctures and makes me cranky. Ignoring her really amounts to saying, "Just go ahead and write the orders, I am doing the other 4,000 tasks you asked me to do; remember, there is only the two of us to do everything. It takes you two minutes to do the exam, but it takes us a lot longer to do these things. You need to be patient. Why don't you go eat dinner (and get out of my way?)".
Hilariously, Parvati hasn't complained about me yet. She did complain to our boss about Second in Command, who in her desperate attempt to appear competent and all-knowing comes across as be a little overbearing with new doctors. She will argue or give them her 2 cents about what they need, second guesses them and makes herself seem indispensable. I never argue unless I have a damn good reason so I
don't come off as a squeaky wheel. It's not time to argue until it's time to argue, a corollary to It's not time to panic until it's time to panic. That way, if tell a doc I am worried about this or that they actually listen to me. Parvati, though...doubt she listens to anyone since she makes way too much noise to hear anything anyway.
After three of the longest shifts of my life with Parvatti for ALL THREE SHIFTS I was feeling a tad....homicidal. Which accounted for my mutterings
REDRUM
REDRUM
REDRUM.
I suddenly have the urge to re-read "The Shining". And maybe buy an axe.
Sunday, July 31, 2011
When it Just Isn't Fair, Part One
The world is full of people who don't take their meds for high blood pressure, don't follow a diabetic care plan, or are so obese they cannot walk. People have all sorts of reasons for not following a doctor's advice. Hey, it's a free country; people can do whatever the hell they want. As long as they are well informed about the possible consequences and are able to make their own decisions, let the chips fall where they may.
You never hear a patient say things like, "I didn't KNOW I wasn't supposed to smoke when I am on oxygen!". Clearly it is a decision that the patient makes on his/her own and damn the consequences. Even if the consequences include further complications, severe burns and/or blowing your home sky high in this case. No less deadly than deciding not to take care of diabetes and high blood pressure I suppose.
There is difference between outright irresponsibility, choosing not to take care of yourself and being unable to afford your treatment. So many people don't have insurance, so where does that leave them?
In one of two places.
Group one has no insurance and uses the ER for everything from a rash to a mosquito bite. Some are such frequent fliers we know what kind of car they drive, know their address when the ambulance tones out for their 143rd ER transport for abdominal pain this year, and can accurately predict their visits based on the day and date. I don't know how they survive because they are not, for the most part, working. They come late at night when they know they will be given a supply of meds to "tide them over" because the pharmacy is closed. They want every test possible and they want it now. They have no intention of paying their bills. They are usually heavy smokers.
Group two may have a job and no insurance. Or may not have a job at all. They are trying to make ends meet, cannot legitimately afford their care or their meds. They are undemanding and try hard to keep their costs as low as possible. They are the ones who will struggle for years to pay their medical bills. The hospital will hound them for $25 and send it to a collection agency.
It is especially tough on people who work for themselves. And hurt themselves while working. The double whammy is that not only are they not able to afford an ER visit, now they are out of work.
The system works so very well for some people and not at all for others. Why can't we fix this?
You never hear a patient say things like, "I didn't KNOW I wasn't supposed to smoke when I am on oxygen!". Clearly it is a decision that the patient makes on his/her own and damn the consequences. Even if the consequences include further complications, severe burns and/or blowing your home sky high in this case. No less deadly than deciding not to take care of diabetes and high blood pressure I suppose.
There is difference between outright irresponsibility, choosing not to take care of yourself and being unable to afford your treatment. So many people don't have insurance, so where does that leave them?
In one of two places.
Group one has no insurance and uses the ER for everything from a rash to a mosquito bite. Some are such frequent fliers we know what kind of car they drive, know their address when the ambulance tones out for their 143rd ER transport for abdominal pain this year, and can accurately predict their visits based on the day and date. I don't know how they survive because they are not, for the most part, working. They come late at night when they know they will be given a supply of meds to "tide them over" because the pharmacy is closed. They want every test possible and they want it now. They have no intention of paying their bills. They are usually heavy smokers.
Group two may have a job and no insurance. Or may not have a job at all. They are trying to make ends meet, cannot legitimately afford their care or their meds. They are undemanding and try hard to keep their costs as low as possible. They are the ones who will struggle for years to pay their medical bills. The hospital will hound them for $25 and send it to a collection agency.
It is especially tough on people who work for themselves. And hurt themselves while working. The double whammy is that not only are they not able to afford an ER visit, now they are out of work.
The system works so very well for some people and not at all for others. Why can't we fix this?
Saturday, July 30, 2011
More Stupidly Spelled Names
This is a bunch of idiotically spelled names. This is a week's worth. I have included the traditional spelling as well for reference.
Mickaylia (Michaela).
Falysha (Felicia)
Kameryn (Cameron)
Josslin (Jocelyn)
Linsay (Lindsay)
Skyla, and Skyler both in the same day (Schuyler)
Jaymz (James). Yikes.
Xander (?)
Alysha (Alicia)
Jarrid (Jarrod)
Allden (Alden)
Justen (Justin)
Kaleb (Caleb). This kids last name also began with "K". You know how I loathe alliteration.
Apriel (April). Not sure about this one, although the kid will be spelling her name forever.
Sybrynna (Sabrina, and pronounced as such)
Haileigh (Hayley) Not as bad as Sybrynna
Aeden (Aidan). This one is not necessarily wrong as there are about a dozen ways to spell this, but again, this kid will be spelling it for everyone.
It is crazy how many people never bother to look up the correct spelling of a name they like, or spell it any whay they want so their kid's name will be unique. Some are so obviously spelled phonetically. Then, there is the unique vs. over the top stupid.
Psandeigh = Sandy
Ps2ughe= Sue
Ahndreighah = Andrea
Chandis= Candace
I left my list of names at the desk so others could add to it. Brian had this to add.
"When I was in Texas I had two patients with unusual names. One woman pronounced her name "Sha-THEED". It was spelled "Shithead". Then there was the kid named PAJ-a-mus, that was how it was pronounced although it was spelled "Pajamas". I asked the parents what the inspiration was for the name and they told me they saw it in a J.C. Penney catalogue. One of the kids was named Pajamas. Guess what he was modeling?"
Mickaylia (Michaela).
Falysha (Felicia)
Kameryn (Cameron)
Josslin (Jocelyn)
Linsay (Lindsay)
Skyla, and Skyler both in the same day (Schuyler)
Jaymz (James). Yikes.
Xander (?)
Alysha (Alicia)
Jarrid (Jarrod)
Allden (Alden)
Justen (Justin)
Kaleb (Caleb). This kids last name also began with "K". You know how I loathe alliteration.
Apriel (April). Not sure about this one, although the kid will be spelling her name forever.
Sybrynna (Sabrina, and pronounced as such)
Haileigh (Hayley) Not as bad as Sybrynna
Aeden (Aidan). This one is not necessarily wrong as there are about a dozen ways to spell this, but again, this kid will be spelling it for everyone.
It is crazy how many people never bother to look up the correct spelling of a name they like, or spell it any whay they want so their kid's name will be unique. Some are so obviously spelled phonetically. Then, there is the unique vs. over the top stupid.
Psandeigh = Sandy
Ps2ughe= Sue
Ahndreighah = Andrea
Chandis= Candace
I left my list of names at the desk so others could add to it. Brian had this to add.
"When I was in Texas I had two patients with unusual names. One woman pronounced her name "Sha-THEED". It was spelled "Shithead". Then there was the kid named PAJ-a-mus, that was how it was pronounced although it was spelled "Pajamas". I asked the parents what the inspiration was for the name and they told me they saw it in a J.C. Penney catalogue. One of the kids was named Pajamas. Guess what he was modeling?"
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