Tales from the Crib

Babies.  Hate 'em.

Well, not really, just don't like 'em in the ER cause it's generally no place for a healthy child.  There are few reasons to actually bring your young baby to the hospital.  Obvious reasons notwithstanding (AKA life threatening or extremely troublesome symptoms that cannot wait for an appointment), about 90% of the babies we see in the ER have no need to be there.

Mosquito bite.

Low grade fever absent other symptoms.

Diaper rash.

Earache.

Teething.

Vomiting if you have reloaded your child with Hawaiian Punch every time he spits up.

I can't even talk about every kid who ever played a sport and bumped his head on a Nerf ball.

One mother brought her pink as a rose 9 month old by ambulance.  This followed a visit to urgent care, as well as another visit to their pediatrician where she was told the child had an ear infection.  She loudly complained about both of those visits, calling the pediatrician "stupid", and the urgent care "idiots".  No, she didn't give the kid with a temp of 100.2 any tylenol.  No, she didn't fill the prescription for antibiotic.  No, she didn't bring diapers, formula, or clothes.  She refused to let me take a rectal temp.  "He as a diaper rash".  Um, ok.

The kids was bright-eyed, playful, beautiful.  The mother held him and rocked him but was more intent on being on her phone.  In a perfect world, no patient or visitor cell phones would work in the ER when health professionals get within 3 feet of them.  Some sort of jamming device would be nice.  Thank you to all the patients and visitors who actually ask if they can use their electronic devices.

The PA spent a LOT of time with her, going over tylenol dosing, being specific about when she should give the child meds, and in general providing her with the one thing the child would benefit the most from aside from a parent with an actual brain:  education.

I really don't know what she wanted, possibly for the child to be admitted so someone else could take care of him.  Between the two of us, the PA and I, we gave her formula, med syringes clearly labeled, diapers, wipes.  She got fed a meal.  Still, after being discharged the registration clerk came back to let me know that the mother was out at the front desk, talking loudly on the phone, complaining that her child got crappy care and "she needs answers now, and she got nothing".   You just can't fix stupid.  The kid is doomed.

Splatterfest

It happened so fast, yet I recall the details like it was slow motion.

I jumped up from my computer at the request of a family member for food for their entitled loved one.
Feet get snagged by my tote bag, which had become entangled in my chair.  I was going down, down, down.

I instinctively tried to employ tactics learned from years as an adult not-very-good figure skater.  Go with it.  Protect the head.  Try to slide.  Unfortunately not always transferable  to unfrozen surface, but better linoleum than pavement.

I managed to slide into the side of the waste basket, making a racket and commanding far more attention than I wanted.  "I'm OK!"

Unharmed except for my dignity and a dinged little finger.

So yeah,  I have a new nickname at BWOM.

Mary Katherine Gallagher.

Best Of, Worst Of

I bagged a four hour princess shift as a float (in the ER) in which our rooms were at 60% all day.   This followed on the heels of a 10 hour shift in which I could not get anything done because we were so short staffed.  

For 4 hours I leisurely wandered around from nurse pod to nurse pod, chatting, occasionally doing some work when requested, and a lot of transport.  So it was a fairly boring day but no stress.  That's a nice change.  Day shift has it made, too bad I hate to get up in the morning.
Here are the highlights.

Best Transfer of the Day:  an 18 month old bound for peds.  In a stroller, no IV, sound asleep.  Chart in hand, I led the mom off the floor and was back in the ER in 2 minutes.

Second Best Transfer of the Day:  a demented 80 year old to the medical floor.  The floor nurse and an LNA appeared magically (there can be no other explanation) immediately upon my arrival to transfer the patient from the cot to the bed, completely prepared along with the slide board and IV pole with pump attached.  Wow.  This should be number one, actually.

Best IV Start of the Day:  anemic, pale, tachy,  45 year old who asked for "the best sticker in the ER because she was a tough stick".  I was the oldest.  I won.  One stick.  I was compared favorably with the Best Paramedic on the Planet (she said she called to inquire if he was working before coming to the ER) by the grateful patient.

Best Provider Encounter of the Day: the nice PA asked me "hey, when do I get to work with you again?" as I passed her in the hallway.  Tomorrow.  A genuine "Oh, yay, happy dance!".

Best Cup of Dunks of the Day: The one I bought on the way to work.  As I usually do.  This is only on the list because the one I bought yesterday tasted like soap.  Seriously, I had to throw it away, and wasn't I pissed about that.

Best Meal of the Week:  Yummy salad that I actually got to eat.  Because my last shift I got to the cafe 1 minute after they locked the doors and had to resort to a meal of peanut butter in a teeny cup and a couple of saltines.  And a lot of water in the soapy Dunks cup that i rinsed out.

There is no worst.  I lied.  

In closing, I let my happy little dog off the leash, in the woods, for the first time in months to chase a chipmunk or two (she had surgery in April) and ate ice cream for dinner.  I shared it with her.  A good day for me is a good day for my dog.  

Day 5 of my captivity…..I ate the cone of shame.  I 'm not sorry.

Make Mine Fried, Please

An older lady with dementia had been parked in one of my rooms for the entire day when I took over her care.  Because she had a habit of reporting that her care givers beat her, which turned out to be the dementia talking, she had pretty much burned bridges everywhere and now she had no place to go.  Her estranged elderly husband was willing to take her, but there was a small matter of a restraining order to be dealt with first, which was some big misunderstanding according to the many parties involved.  Somehow the restraining order was vacated by a judge in record time.  Gotta love small town America.

The poor wandering lady had been fed, watered, toileted, walked, sung to, chatted with and entertained.   She was kind of entertaining herself as she kept up a steady stream of consciousness.  Every few minutes she asked where her husband was, and that she was tired of waiting.  Mostly she talked nonsense, but once in awhile she seemed to make sense, even if momentarily.

"Have you seen my bird?"
"No, I have not.  Where did you see it last?"
"I had it here, it was in the bag when I came here"
"What kind of bird, can you describe it?"
"It was a green bird, with blue feathers and small red feet,  I fed it some birdseed.  Do you have any chocolate?"
"I have some Lorna Doones.  Your bird sounds pretty, was it a big bird or a small bird?"

She indicated the size with her hands.

"Oh, about the size of a chicken?"

"Yes, like a chicken".  She fiddled with her bracelet, folded a washcloth, and placed the kleenex box on the center of the table.  She sighed loudly.  "I've been waiting hours and hours! Is my husband coming?"

"He said in about a half hour.  It shouldn't be long now"

Another big sigh.  "He should come now!  He is taking too long, if he doesn't come soon……
I will kill him like a chicken"

Me: "I didn't hear that"

The social worker in the next room actually giggled.
But props to her for getting the wheels of justice turning to get the lady a safe place to go.

Dirty Secrets

I had some fun with the infection control nurse, a pompous and self righteous D-bag,  who harangued us with the usual hand washing stuff.  I asked about disinfection of things like stethoscopes, and she rather snidely told me that, of course, they should be routinely disinfected, before launching into a lecture on precautions, MRSA, and disposable stethoscopes.

I was bored.  So I started it.

Me: "Mmm-hmm.  What about ID badges?  Do you have any policy on disinfecting those?  I mean, they are at chest height, in the sneeze and cough zone, dangle onto patient's skin, onto sheets, they go to every patient room and are never washed or disinfected…it seems to me they would be just a germ farm".  I pointedly glanced at her ID badge, on a nylon lanyard, which was covered with 27 pieces of flair.

Blank stare.  She was gob-smacked.  "I've never thought of that".

Yeah. ID badges are filthy things.  Think about it.  Along with watches, rings, bracelets (which I never wear to work) and neckties on the men.

Name badges are mandatory.  It goes everywhere the nurse goes.   It gets touched 150 times per day because they always flip around so that my various passwords are showing instead of my name.   It gets handled and scanned for glucometers and to enter/exit certain areas.  It is used for the time clock.  It goes into the bathroom, the poopy patient's room, and the cafeteria.  Into.  Every.  Patient.  Room.

Yesterday I had a horrifying thought.  BWOM hospital issues clip-on visitor badges, which are never, to my knowledge, washed or disinfected.

Eeew.

Just so you know, I do bleach-wipe my name badge every day.  Always have.  Always will.  
And now you will, too.

You're welcome.