Quotables

Ellen: "I can't believe somebody ate all my "I Can't Believe It's Not Butter!"
Me: "Unbelievable"
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Pirate: "She is sufferering from Half-a-deck-a-cardia"
(as in not playing with a full deck)
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Patient's Significant Other: "This is an emergency!  Why isn't anybody getting all excited??"
(as in life-threatening finger boo-boo)

Let me just add a personal  note to this last one:  the more excited you get, the less excited I become.  And I think I can speak for most ER nurses and add a  sidebar to the general public:  If I AM excited, you had better be afraid.....very afraid.
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Partner in Crime: "Why do people call the ER when they have been sick for three days and ask if they should come in?"
Me: "Because when you are a douchebag, the world is your oyster"
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Me: "So how many sutures was that in total" (for charging purposes of course, like we don't have better things to do
Parvati" "Well, three on the outside of this one, no, four.  Um, 16"
Me: "So....I guess I should figure the value of X?"
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T-shirt of a wonderfully vibrant, health and active 80 year old woman: "In Dog Years, I Would Dead Now"

You're Killing Me Smalls

It has been about a year since my facility rolled our JCAHO mandated  Electronic Medical Record, AKA the Shittiest Computer Program Ever Devised (SCPED).

Every so often there will be an update to SCPED that entails shutting down the system for 12 or more hours, during which the entire electronic charting and ordering system is unavailable.  Which means:

1.  All charts will be paper charts
2.  All orders will be written by hand, a copy made and delivered to the lab/xray/pharmacy, which will then
3.  Enter all the orders on each of their separate systems which apparently don't get updated

Of course paper generated charts just means more work for everyone. Each patient gets a pre-determined ID number.  Those ID numbers are HAND LETTERED (does that make them artisanal, Dr. Grumpy?) on labels to be used for a variety of things.  Like X-ray and lab draws.  The secretary does this, adding to the already cumbersome registration process.

A couple of weeks prior to SCPED updates there will  bulletins, notices, reminders and memos announcing DOWNTIME procedures.  Basically, to brush up on DOWNTIME protocol and stock up on paper and prepare for Electronic Armageddon.

During the most recent SCPED update there were specific instructions for removing current patients from the tracking board so that they would not be irretrievably committed to THE VOID, which had occurred during the previous update.  In order to prevent this, all patient charts were to be printed off 30 minutes prior to DOWNTIME.  I personally received calls from 6 different people each giving me a different deadline for the paper festivities before I told the secretary to just take a message.  It is no wonder there is such chaos.

"OK, downtime starts at 10:00 PM....print off the records about 20 minutes prior to that"
"OK, do this.  Any patients who come in after 9:30 PM, just do a paper record.  Don't start them in the computer.  Start printing any patients in the department at that time"
"Did you get that last message?"
(Different tech weasel) "You should print off starting at about 9:15 PM.
(Still another tech weasel)  "Probably should start going paper about 9:00 PM"

Me, to Ellen: "Next time someone calls, just tell them we're already on downtime".  It was 5:00 PM.

Following updates computers slow down to crawl or outright freeze.  None of the updates goes well with our elderly operating systems.

Pirate: "Jeez, it's like we have the first version of Windows, like  Windows 1.2.
Me: " Our versions of Windows are so old that it is more Porthole".

For added fun updates are always done on a weekend when only the people who actually take care of patients work.  This gets extremely frustrating; patients don't like the little signs posted by the tech weasels any more than we do.

"Thank You For Your Patience While Our Computers Are Updating!".  The clever little hopping frog graphic was immediately replaced by me.  With a picture of a snail.

That about covers the Shittiest Computer Program Ever Devised tutorial.  Although there is some hope.  We are updating all the computers with a newer (but not the newest) version of Windows within 2 years.  And an entirely new Electronic Medical Record System will be up and running....in 3 years.

Psyched.  Now if the computers  could be updated maybe we wouldn't have to trip over all these wires.

Can't we have a nice little Mac? 

Does this look safe?

I'm Free and It's So Easy to Get By Cause I Don't Try

As we must co-sign every ml. of narcotics from an unused vial that is not ordered for a patient, we have a tendency to sort of stack them up until 1.  the patient goes home, or 2. we have a minute to reconcile with each other.  This is so the hospital can rest assured that we nurses aren't taking all that perfectly good morphine or dila-la and selling it on the street.  Trust me: I could fill a fountain with the stuff I've wasted over the years.  Sadly, there are health care workers who use the stuff themselves but that is not today's subject.

Policy demands we must always have a paper trail to follow, mustn't we?  So when we are busy and we have a moment to sort track and co-sign each others wasted sh#t we refer to it as "cocktail hour".

And so, another name for waste narcotics is born.

"Dilaud-a-tini":  5 separate vials of Dilaudid to be wasted.

And because there were too many to put in a med cup, all the extra was stacked up in a paper cup.  Paper trail, paper cup.  Not a Red Solo Cup.  Please enjoy this musical interlude by "The Fifth Dimension".

 The lyrics are messed up but oddly go well when you think about a bunch of Dilaudid in a paper cup ready to be thrown away.

Here inside my paper cupEverything is lookin' upNo one comes in, no one goes outNothin' to get hung up about
I'm free and it's so easy to get by'Cause I don't try
In my paper cup, I have installedA shower stall across the hallRunning water and a denIt's looking just like home again
I'm free and I've installed refrigerated airYou'd have to look insideBefore you know that I was there
And everybody says I'm quite insaneAnd someday I'll be going down the drainI know they're right but I don't careI feel no pain
Here inside my paper cupEverything is lookin' upNo one goes out, no one comes inIt's lookin' just like home again
I'm free and it's so easy to getThe things I've always wanted'Cause I don't really want 'em anymore
An' living ain't so bad without a rudderAn' life is kinda groovy in the gutterIf you know how, and I doYeah, and I do, we do too
So if you'd like to come alongWe'll sing a little paper songAbout a lonely paper plateWho couldn't find a paper mate
I'm free, yes I'm free
And my life is lookin' upFrom inside my paper cupAnd I'm always lookin' upFrom inside my paper cup
And my life is lookin' upFrom inside my paper cupAnd I'm always lookin' upFrom inside my paper cup

Is This the Same Thing?

Hello, anybody there?

**crickets**

Lots of stuff going on, none of it of any real significance but enough to keep me from composing any new fascinating posts.  I have lots of stories.  Oh, so many stories.

Part of my posting absence has been physical.  On Easter Sunday I sliced off the tip of my right index finger with the Mandolin blade.  Yes, I know, stupid.  Stupid.  Stupid.  The Mandolin has been sitting on the top shelf of the cabinet for over 2 months.  I was scared of it before; now I am outright terrified.

My wound healed just fine, the fingernail grew back in, but typing.....now that's a little bit of a problem.  I type so much at work that it just isn't fun when I try to get my own thoughts down.  It still hurts, but less every week.  In the grand scheme of things, it is pretty insignificant but it is annoying that only 5 mm of tender flesh can have such an impact.  Ah well.

I leave you with this:

After suturing a finger laceration, Parvati told the young guy to have sutures removed in about 10 days. Clueless friend:  "Or I could just cut them off, haha!"
Parvati:  "Or he could come here, and we could do it"
Clueless friend: "His mom could do it, she's a doctor"
Parvati: "Really?"
Clueless friend: "Well, she's a vet tech.  Same thing"

Wow.

So, using this logic

Being a nurse is the same as being a waitress
Being a pharmacist is the same as being a bar tender
A respiratory therapist is the same as an HVAC technician
A lab tech is the same as a chemist.  Although in Wednesday's case being a lab tech is the same as being Alice in Wonderland.

Lady Games

The Lady on Elm St. is still alive.  I won't say she is well.  But as cockroaches will survive a nuclear holocaust, so Lady will survive all maladies real and imagined until....well...her ticket gets punched.

Lady's nonsense urgent attention-seeking issues have logged hundreds of annual calls to 911.   Dispatch has been heard to simply say "head on over to Elm St for complaint", which means Lady's apartment, for things she sees out the window like moths, meteor sightings, or a well-being check request on a neighbor who has simply gone out for lunch.  One would think Lady has a pretty full schedule with all that silliness yet she manages untold amounts of time bitching out patient services and carping about EMS to whoever will listen.  Of course her numerous outpatient visits for various maladies are certainly time consuming, and I failed to mention that she is on 25 DIFFERENT MEDICATIONS which surely takes up a good portion of her day.

But no, she still has lots of free time to call the ER pretty much daily, usually on the evening shift.

It is a pattern of ramping up the calls, either for escalation of some chronic complaint or for a new boo-boo that the average person would handle easily.  It culminates with 911 drama and the inevitable ride to the ER in the Big White Taxi with the Flashy Lights

It is our policy not to give out the names and schedules of the doctors.  It's pretty obvious when individuals are "shopping" for a doc who gives out narcotics or are looking to avoid the doc who piss tests first.  This is not the case with Lady.  She has her favorites, and those she can't stand, usually because they have had the temerity to bring up the subject of her weight, the elephant in the room; no pun intended.

When she doesn't call, or we don't identify any police response to "Elm Street, apartment X" on the scanner for a deer sighting or some such,  then we know we are probably in for an evening visit.  High drama.  No reason to be there. And we are always busy.

She is not fond of me.  I have honestly tried with her, but when your best effort gets rewarded with some bullshit complaint, well, sorry.  You get the bare minimum from me especially if I have an Actual Sick Patient to deal with.  I don't want to chat or talk about your day.  Or mine.  Partner in Crime talks to her a lot and nearly always tells her to call her doctor in the morning.  Still, Lady likes Partner in Crime.

I drew the short straw when Lady was brought in by EMS.  She rolled by on the super-duper heavy weight cart like she was the Queen of the May on her parade float, waving and smiling, surrounded by her contingent of EMS personnel as reluctant honor guards.   She was making the usual sarcastic remarks meant to be funny (they weren't) and behaving as if we were all bosom friends.

"Where is Partner in Crime?", Lady bellowed as she was wheeled in, proving that she wasn't in fact having any of the life-threatening shortness of breath which precipitated her 911 call.  "I want Partner in Crime for my nurse, she understands me".

"Sorry, she's busy with an Actual Sick Patient and you don't get to pick your nurse.  Here is a nebulizer treatment since you are speaking in full sentences, have normal skin color, have a normal oxygen saturation and your lungs are clear.  Dr. Parvati will be along shortly"

Parvati might be abrupt, lack communication skills, be blind to the fact that she is a generally a piss-poor team player but she is never unkind on purpose.  However much we might want to kill her I have to give her that.

Parvati dealt with Lady's BS complaint empathetically with the therapeutic equivalent of patting her on the shoulder and telling her she was just perfect in every way.   Which is not what Lady wants to hear generally because it would mean she would have to take up a new hobby to fill her days.  But I guess she appreciated Parvati's delivery because she was eventually happily kicked to the curb like she is 99.99% of the time.

As usual it took Lady about 15 minutes to vacate the room, and then there was the requisite lurking at the desk to engage Partner in Crime and grill her about some activity that occurred 12 visits ago.   Partner in Crime was too busy to play though, so Lady turned her attention to Parvati on her excruciatingly slow egress from the department.

She paused dramatically before heading out,  planted herself in the middle of the hallway, raised her arms like the Mayor of Munchkinland (and equally proportioned) and her dramatic announcement, "This is the best doctor of all time".  The speech was punctuated by bestowing upon  Parvati a big smelly hug before she left waddled to the waiting room.

I wish I could feel bad for Parvati but I just...don't.