My latest needy patient, the dreaded Man Baby, reminded me of one of Hood Nurse's epic posts from a few years ago. It is both hilarious and sadly true. I miss Hood Nurse's regular posts, she is a badass. You should go and read this, right now.
So, my patient, fat and bald and a self-professed wimp. A man baby of the first order. Clearly he did not do much for himself even on those banner days in which he was fit as a fiddle. This was a middle aged man who had arrived by ambulance after vomiting once with a "high fever" of 99.5. Wow.
"I don't feeeeeeeeel goooooood", he whined
FYI, whining tops my list of "Things I Hate".
Mommy-wife enabler accompanied him, soothing his brow, holding his vomit bag (for him to spit in, for Man Baby never vomited), asking for warm wet washcloths to moisten his lips, and requesting juice, (no), crackers (hell no), extra blankets, and of course "one more thing to ask the doctor". Plus she was a helicoptering monitor-watcher. "Why is that monitor alarm going off!? Is his blood pressure ok?? What is that number?? What's wrong???"
Well. Here is the short list:
Mancold, manflu, man-monia (unlikely).
mancough.
mancongestion
mandiarrhea.
Or a rare fatal disease (also unlikely).
Absent anything being found really wrong, I'm liking the all encompassing manvirus as the culprit.
So.
You will get better, or you will die. Going way out on a limb here, being a stupid nurse and whatnot, but guessing today is not going to be the second date (the one to the right of the dash) on your gravestone.
He was given the panacea for all ills when it is not politically correct to kick patients to the curb within 10 minutes of arrival: IV fluids and Zofran. In a 12 hour shift I will personally execute these lifesaving orders about 10 times. That is just one nurse. There are lots of others who will be saving lives many times over this shift, one bag of normal saline and 4 mg Zofran at a time.
He was there for a couple of hours, moaning, watching TV, texting on his phone, sending the little woman scurrying for ginger ale and ice, and arranging his other chargeable electronics. He was pretty busy. Eventually he was given the good news that he did, in fact, have a virus. Since he had not vomited, his vitals were completely normal and was drinking ginger ale, there was nothing more to be done for him. Also, once a patient who presents with vomiting has asked for a meal tray, his status automatically defaults to "discharge pending".
He was shocked. "I don't think I can go home like this".
Trust me, read your instructions, "you will get better. Drink lots of fluids, rest, take tylenol for headache and fever, here is a script for some Zofran. Now get out and man up "
Mommy-wife will take really good care of you, maybe order out some Chinese.
Tuesday, March 8, 2016
Monday, March 7, 2016
On perfecting the art of hiding
When I am working in the biggest pod in my department, the one shared by three nurses, the nurse/patient ratio is generally less clear-cut. A nurse could have a single trauma or STEMI patient and be bogged down, or five psych hold patients who are being watched by techs….which would mostly be an easy assignment. Or two drunks who are sleeping. Or three stable chest pain rule-outs but with nightmare families. Or one soul-sucker (now in restraints) throwing chairs against the wall and threatening to slice off our heads with a sword. Whatever. The point is that some days you are the dog, some days the hydrant. And when it is your turn to be the hydrant, you hope your teammates will remember what it was like and pitch in accordingly.
As ER staffing is a cyclical thing, we currently have a lot of Freshman ER nurses. I am mostly impressed with how quickly many of them have assimilated on the off-shift hours. They jump in where needed, ask great questions, and in general are a hard working bunch. But of course, there is always that one. Newish ER Nurse has moved up the food chain to sophomore-headed-into-junior-year level in terms of experience and how long she has worked there. Yet, during the times when it is truly crazy, Newish Nurse remains seated. Or in hiding. Not getting the teamwork thing.
She has been renamed "Lazy Nurse"
She can generally be counted on to have the lightest assignment regardless of what is going on in the department. Among her evasive maneuvers for keeping her work load light:
Never taking an ambulance patch and just taking responsibility for it it. She just walks in the other direction.
She absolutely rides the medics and techs like a cheap ponies: IV starts, EKG's, transports, vital signs. She gets them to do it all.
She never, ever volunteers for the next patient when it is her turn. She remains silent when, as a group we are asked, "Who's up?"
There is always a selection of snack items and beverages in her work area which keeps her very busy.
Hiding in the med room. On her cell phone.
Once the night medic was managing a septic patient all by herself until I jumped in to help her. Not that she wasn't doing a great job, but where the fuck was the patient's nurse? Lazy Nurse. Nobody knows. Having a nice chat with someone, or preparing a meal in the break room.
Lazy Nurse's laziness has not gone unnoticed.
Auntie, the clinical leader on shift, has started to keep score and actively seeks her out when she is "missing". She has vowed that it would be "a very long time" before Newish ER Nurse would be having the triage assignment (which, by the way, is my second home) when many of the sophomore-junior nurses with at least a year in the department have progressed to being assigned there if is an experienced nurse to help out. "She is just not motivated enough, not fast enough, and there would be a line out the door and down the block. Disaster. Nope".
Auntie is gunning for Lazy Nurse. Shudder. I wouldn't want to be in her shoes.
As ER staffing is a cyclical thing, we currently have a lot of Freshman ER nurses. I am mostly impressed with how quickly many of them have assimilated on the off-shift hours. They jump in where needed, ask great questions, and in general are a hard working bunch. But of course, there is always that one. Newish ER Nurse has moved up the food chain to sophomore-headed-into-junior-year level in terms of experience and how long she has worked there. Yet, during the times when it is truly crazy, Newish Nurse remains seated. Or in hiding. Not getting the teamwork thing.
She has been renamed "Lazy Nurse"
She can generally be counted on to have the lightest assignment regardless of what is going on in the department. Among her evasive maneuvers for keeping her work load light:
Never taking an ambulance patch and just taking responsibility for it it. She just walks in the other direction.
She absolutely rides the medics and techs like a cheap ponies: IV starts, EKG's, transports, vital signs. She gets them to do it all.
She never, ever volunteers for the next patient when it is her turn. She remains silent when, as a group we are asked, "Who's up?"
There is always a selection of snack items and beverages in her work area which keeps her very busy.
Hiding in the med room. On her cell phone.
Once the night medic was managing a septic patient all by herself until I jumped in to help her. Not that she wasn't doing a great job, but where the fuck was the patient's nurse? Lazy Nurse. Nobody knows. Having a nice chat with someone, or preparing a meal in the break room.
Lazy Nurse's laziness has not gone unnoticed.
Auntie, the clinical leader on shift, has started to keep score and actively seeks her out when she is "missing". She has vowed that it would be "a very long time" before Newish ER Nurse would be having the triage assignment (which, by the way, is my second home) when many of the sophomore-junior nurses with at least a year in the department have progressed to being assigned there if is an experienced nurse to help out. "She is just not motivated enough, not fast enough, and there would be a line out the door and down the block. Disaster. Nope".
Auntie is gunning for Lazy Nurse. Shudder. I wouldn't want to be in her shoes.
Tuesday, February 9, 2016
You know...
…it's bad enough that a female senior management member was wearing a backpack.
I observed her casually cruising the portable desserts in the cafeteria line on her way out after a long day of sitting in meetings, creating forms, and adding to the existing metric fuck ton of workload for clinical staff (although she lacks any ability to actually do any aspect of the job). But it was what was on the backpack that just made me crazy:
I observed her casually cruising the portable desserts in the cafeteria line on her way out after a long day of sitting in meetings, creating forms, and adding to the existing metric fuck ton of workload for clinical staff (although she lacks any ability to actually do any aspect of the job). But it was what was on the backpack that just made me crazy:
All Who Wander Are Not Lost.
Seriously.
Monday, January 25, 2016
Monday, January 11, 2016
Rocket Man
EMS dropped off a LOL with late afternoon "weakness", the universal label for non-specific maladies affecting frail elders who have been left to fend for themselves most of the day. They are found in their La-Z-boy recliners, where they have spent the afternoon sleeping, by family members returning home for the day in a state generally described as "confused", or "unresponsive". Often they are "fatigued". Usually they have numerous co-morbidities, a med list as long your arm, and have "not eaten all day". Cue the turkey sandwich.
This particular day found me floating in the department without an assignment, helping out as necessary as Float Fairy (or Everybody's Bitch). Floaters mostly do EKG's, triage ambulance patients, and transport patients to other departments or inpatient units. Or start a lot of IV's.
The LOL was brought by paramedics I have known for a long time, who are experienced and known to be thorough. As I had taken the radio patch, I owned the patient until I could find the resource person to assign another nurse. Every room in the department was full and we were on overflow hallway beds. This is never good.
"OK to triage her in the hall?" I asked. Sure, no problem she's been stable enroute was the response.
Except she had a heart rate of 30. THIRTY. And hypotensive.
A monitored room was cleared immediately.
I thought the EKG looked tremendously weird. I checked and rechecked my lead placement. The elderly patient roused a bit.
She whispered, "Situs inverses".
Ah. This is a very interesting condition in which the organs of the abdomen are backwards, and in this case a mirror image. Cardio came right away.
I had done (and labeled correctly for posterity) an EKG done the right way, the reverse way, and another weird way that I can't even remember.
As I excitedly whirled to present the latest tracing to the taciturn cardio guy, I found that he had sidled right up next to me. I hate a sidler, I really do. My fist connected with his groin, and he doubled right over, being a small an somewhat frail individual as all brilliant people seem to be.
Ooof. Had he been taller than me it would have been a glancing blow to the upper leg, but no. I muttered an apology, he muttered "no worries", and we both continued on as if nothing happened.
Man, there are a lot of people I would pay to punch in the rockets, but he wasn't one of them. I felt kinda bad.
After I laughed for about a half hour.
This particular day found me floating in the department without an assignment, helping out as necessary as Float Fairy (or Everybody's Bitch). Floaters mostly do EKG's, triage ambulance patients, and transport patients to other departments or inpatient units. Or start a lot of IV's.
The LOL was brought by paramedics I have known for a long time, who are experienced and known to be thorough. As I had taken the radio patch, I owned the patient until I could find the resource person to assign another nurse. Every room in the department was full and we were on overflow hallway beds. This is never good.
"OK to triage her in the hall?" I asked. Sure, no problem she's been stable enroute was the response.
Except she had a heart rate of 30. THIRTY. And hypotensive.
A monitored room was cleared immediately.
I thought the EKG looked tremendously weird. I checked and rechecked my lead placement. The elderly patient roused a bit.
She whispered, "Situs inverses".
Ah. This is a very interesting condition in which the organs of the abdomen are backwards, and in this case a mirror image. Cardio came right away.
I had done (and labeled correctly for posterity) an EKG done the right way, the reverse way, and another weird way that I can't even remember.
As I excitedly whirled to present the latest tracing to the taciturn cardio guy, I found that he had sidled right up next to me. I hate a sidler, I really do. My fist connected with his groin, and he doubled right over, being a small an somewhat frail individual as all brilliant people seem to be.
Ooof. Had he been taller than me it would have been a glancing blow to the upper leg, but no. I muttered an apology, he muttered "no worries", and we both continued on as if nothing happened.
Man, there are a lot of people I would pay to punch in the rockets, but he wasn't one of them. I felt kinda bad.
After I laughed for about a half hour.
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