Tuesday, December 29, 2009

Attempting to sound smart- LOLZ

I believe I've expressed myself pretty clearly in the past about my opinion on medically ignorant asshats who try and tell me my business, but the family member I dealt with the other day really took the cake. The patient this lady was with had somehow managed to get into a car accident where there was a two-seater with 4 people and some alcohol involved. Apparently at some point she had been hit by some part of the car and cut her knee open, so I came in to give her a tetanus and antibiotic shot. I told them what each was for while the patient talked on her cell phone with one of her 800 family members that was at the hospital that night, and as soon as I finished talking, her sister asks "Is one of them shots for pain?". Nope. I literally just told you what those shots were for. Listen. So I explain myself again. "NO. NAW. She need somethin' for pain." I tell her that I will ask the doctor as soon as I finish giving the shots I've drawn up and proceed to try and go ahead and give the shots. "No! NAW! She need somethin' for pain NOW. Where's the head doctor at? I don't care. I'll talk to the head doctor if I have to. She need something for pain. You don't understand. Her PHYSICAL BODY was STRUCK BY THE CAR. Her physical body. She was physically hit by a car."
A few things. I don't even know how to start really, so I think I'll present my points high school essay style:

Introduction: Oh hell no.

1. Body paragraph-Keep your panties on.
a. I literally just said I would ask the doctor.
b. There is no head doctor. There's the ER doctor, who I just said I would ask.
c. There's especially no head doctor at 2 AM on Christmas morning.

2. Body paragraph-Your sister is totally not dying.
a. If she was well enough to ask someone for a pair of socks when she came in, she'll be okay for a second.
b. If she's well enough to be talking on her phone, she'll be okay for a second.
c. Where the hell are her socks, anyway? It's 20 degrees outside.
d. If her grown ass is well enough to be attempting to grab the damn needle out of my hand, she's probably okay.

3. Body paragraph- You're an idiot
a.Her physical body? As opposed to her metaphysical body?
b. Was her spirit also struck by the car?
c. Don't try to sound smart when your grasp of simple grammar is not beyond that of most of the 5 year olds I see.

Conclusion: WTF.
There. I feel so much more clear headed and organized now. I unfortunately couldn't say any of those things, so I just went out and asked the doctor with syringes in hand. They were seemingly satisfied after that- the patient actually thanked me when I gave the shots and told me I was good at it, that she could hardly feel it. When our registration representative went to collect their co-pay, her sister mentioned that she wanted to talk to someone in administration because I had been pulling the skin too hard and she knew I was intentionally trying to hurt her sister when I gave the shots. Nevermind that's how IM injections are supposed to be given, or that her sister was about 100 pounds overweight and I had to push her rolls out of the way to hit the muscle. Wow. I'd like to suggest a minimum IQ requirement for sending our Press-Ganey cards, please.

Wednesday, December 16, 2009

What am I supposed to do with this?

That's all I can ask at this place sometimes. Last night I get this ambulance. Dude in his early 60s. Hasn't been to a doctor in, no joke, over 45 years. Admits to drinking a GALLON of whiskey a day, and has the most yellow skin I've ever seen. And.. he's been puking and pooping blood a lot for the past few days but this has been going on for the last 2-3 years off and on.
So I see he's pretty sick- I start a couple of big IVs and get blood work started. His platelet count ends up being a very small fraction of what it should be, his other blood counts looks like crap, he's on the fast track to liver failure. The doctor comes in and takes one look at him and admits him to ICU even before any tests came back.
This guy does not care. He does however, care about the fact that he can't have anything do drink when he's puking blood. He cares about having to leave this stupid pulse oximeter on his finger. He cares that we keep taking his blood for all these damn tests. I tell him we're going to transfuse two units of blood and his response is to scoff and say, " A blood transfusion? I hope they test it for AIDs!"
Really? AIDs? Wow. I don't know why, but that really blows my mind. I guess the whole idea that someone would think about the very remote risk of getting AIDs from a blood transfusion but not consider the very real and immediate risk of drinking a freaking gallon of whiskey daily! But hey, priorities, right?
But seriously. What am I supposed to do with someone who has absolutely zero involvment in his own care other than to complain about the things I need to do to save his life? I swear. Sometimes these patients make ME want to drink a gallon of whiskey a day.

Saturday, December 12, 2009

You thought you needed an ambulance for that, huh?

I haven't been working in healthcare for long, so I'd legitimately like to know- when did the ambulance become an effin' taxi service? Seriously. This is one of the things that makes me the angriest about my job. We're now getting to the part of the winter where the waits are long enough that these morons actually check in to be seen, get tired of waiting, walk across the street, and call an ambulance to bring them through the back. Fool, please. Your abdominal pain for a week is no more important to us now that you've rolled in on the big white taxi with lights. Now your ass is just at the end of the line again, well played.
We've had some good ones in the last week or so. I, for one, was pretty impressed with the 19 year old girl who called the ambulance from her job a half block away for a toothache. Yeah...she went to triage. I can at least give her some credit for being courteous and finding herself a ride home- I wish I could say the same for this next moron.
Last night was pretty slow- it was about 4:30, and I had one patient when EMS rolls in with this guy in his late thirties who they got a call on- his complaint? Sore throat for 2 MONTHS. He was a truck driver, and had been on the road for a while, and I guess it was the right time for him, so instead of taking his damn truck up to the hospital he called EMS from his vehicle, where he lives, and came to the hospital. If his being a system abusing jackhole wasn't bad enough, he was also a massive whiner and a complete idiot. He was thoroughly convinced that his throat hurt because he had a tooth removed in October, and according to him, a piece chipped off and flew into the back of his throat and was lodged there. Um, no dummy. You have tonsilitis. I told him that was what it sounded like after he complained to me that it always felt like there was drainage in the back of his mouth and that it smelled bad. He rolled his eyes at me and said that wasn't it- guess what the doctor diagnosed him with? Yeah.
Of course, he was also the type of patient who thought he should be the priority and immediately receive narcotic pain meds for his 9.5/10 tonsil pain. While I'm dealing with him, a patient on the other team actually coded in a room, which was really rare for us and really upsetting for the staff. He didn't make it, and I went over to help clean up the body before the family got there. I'm helping RT get blood out of the ETT tube when Mr. throat pain calls to ask when the doctor is coming in. It's a good thing I didn't answer the call, because I probably would have grabbed him and dragged him into the room and said, "When you start turning purple like this guy! This is who the ER is for. Sit your ass down!" After all that, this joker had the nerve to ask for a cab voucher! We ended up giving him one, too, since all his friends lived out in BFE in the midwest somewhere, so he had no one to pick him up. I wish we could have just kicked him out and let him figure it out. He could have walked in the cold. It's not like he was sick.

Monday, November 23, 2009

A + for creativity.

So I'm spending my first (very enlightening) night in triage last night in first look (where we first ask the patient about their complaint and see if they can wait to be seen or triaged) when this woman walks up to the door and asks if I can bring out a stretcher. A stretcher? Nope. I tell the lady I can bring out a wheelchair. She tells me that her mom is in such terrible sickle cell pain that she can't even sit up in the chair. Once she figures out that's all we have, her mom manages to make it from the sitting position in her daugher's SUV to a sitting position in our wheelchair, and we wheel her to the check-in desk where she refuses to write her own information, because it was too painful, although she was able to answer her cell phone on the way in. In the middle of collecting their information, when they start to realize that they won't immediately be swept straight into a room and may even be forced to sit in the waiting room without getting Dilaudid on arrival, the lady pulls out this gem-
"I can't wait in this waiting room. I'm in the witness protection program, and someone might recognize me."
WOW. Lucky for them we had our third triage room open, so they got to wait their turn in there with their identity uncompromised, sitting in the wheelchair. But hey, you can't blame them for trying.*

*Not in any way to sound calloused toward sickle cell pain, I'm actually calloused against patients who don't get that we're not just blowing off their pain, but that people who are bleeding and trying to stop breathing go first! "Witness protection" or not.

Monday, November 16, 2009

Even I blushed.

I'm sure it would come as no surprise to anyone that I have a little problem with language. I try to tone it down on here, but when I vent at work, I swear so much that it has earned me not one, but two different nicknames- "Lil' pot" by one nurse, and the one that's caught on a little more- "Sailor". Nice. But man. I can honestly say that lately, the little old people around here have been giving me a run for my money.
There was the one the other day that I had to start an IV on- she was pretty demented and very combative. She cussed up a storm, repeatedly asking all of us what the F we were doing, and constantly telling us to quit our f-ing "rat piddlin'". What that actually means, I have no idea, but it's definitely caught on here. If giving us the word rat piddlin' was the high point of the evening, I'll definitely say that the low point of the evening was when about three of us had to pretty much wrestle this lady so we could catheterize her. As my coworker was holding her arm, she looked straight into her eyes and said, "You little bitch. I bet you're enjoying this, aren't you?" Ouch. That's even worse than the time I got called a bitch ass hoe by a drunk lady.
The funniest of these experiences so far, though, came last week when me and one of the medics had to cath this little old lady with a urinary tract infection. The shift had just started when I grabbed him to come help me, and he immediatly looked into the room before I even told him where it was when he said, "It's not that lady, is it? She's already cussed me out once today." So we go in to do this, and naturally she's soiled her diaper and we have to go ahead and clean that up. As we're cleaning her, she runs off into a string of cusswords that made even me blush a little, but with in a tone and cadence like she was trying to remember what was on her grocery list. "He-hey, what the F are you doing with this shit? Get the F outta there. Leave that shit."
"We're just trying to clean you ma'am. We're trying to keep this out of your urethra so we can keep from making the UTI worse."
"F it. That shit is all up there anyway. What the F are you doing, stupid ass bastards?"
It pretty much went on like that the entire time- once it was over with, we got her settled and I went to give her some Tylenol for her fever. She's very cooperative and she takes it just fine, I give her a few sips of water, and as soon as she finishes, she says very calmly, "Dumbass bitch. I don't want anymore f-ing water." I could not stop laughing.
Her son came by a little later, and I was telling him with much amusement about her cussing us all out. He started laughing hysterically too, and then he tole us that she used to be a nurse, too. Well. That explains it.

Wednesday, November 4, 2009

Cheif complaint FAIL

Wow. When I worked in yellow zone last night, we had a lady check in with the chief complaint of "insect bite" and leave with discharge instructions for genital herpes. Um. Those must have been some bugs, lady.

Monday, October 26, 2009

What? A touching and beautiful moment in the ER?

Aw. Right after my week of the most annoying ass family members in the entire world, I probably had the sweetest one I have ever seen. I had a little lady in her eighties come in with her grandson, who was probably in his late 20's- they lived together and had been watching the football game together when she had a seizure- he called EMS and followed them to the hospital in the rain. He never left her bedside unless she was asleep. He was genuinely attentive to her every need- he helped her go to the bathroom without thinking twice about it, he helped me steer the bed and lift her on and off the CT table- some people you can tell are doing stuff like this because they're trying to be nice to the nurse or because they don't know what else to do- with him, you could tell it was really because she was his entire world. I took care of her for a good part of the night, and when I finally discharged her and took her out to his truck, I sat and watched him gently lift her up into the passenger's seat and arrange all the blankets around her so she stayed warm, and it was genuinely one of the most touching things I've seen in my entire career. It brought tears to my eyes. I told him what a great job he was doing taking care of her, and how I wished everyone I took care of had a family member like him. I think he thought I was referring to how much he was able to help me with everyday nursing stuff- but it really wasn't that at all. It just felt so wonderful to finally see- after all the abused and neglected nursing home patients, after the full code, advanced Alzheimer's patients with families that never visit, after all the ugly and selfish parts of humanity I see from day to day- a patient with real needs going home to someone who not only would take care of them but who someone genuinely loved them with everything they had. They say in nursing that you see the absolute best and the absolute worst side of mankind. This was one of the few times that I can genuinely say that I saw the best.

Saturday, October 24, 2009

Why don't you try it, then?

Dude. I have a week so far. I'm paying because all of my patients and family members earlier this week were super nice and complementary- telling me how sweet I was, how much I helped them, explained things and that I was an awesome nurse. Naturally, life couldn't stay that way, and the last 2 days I have had the most awful family members EVER. All the patients related to these people have been fine- really sweet, actually. But their family members have seemed to feel the need to tell me how to do my job, even though they medically knew slim to none.
It started with a poor little lady who came in with abdominal pain and turned out to have pneumonia. She also ended up being pretty anemic when we did our blood work, so the doctor went ahead and order a unit of packed red cells to be transfused on the floor. I went in to draw the type and cross before I sent her upstairs, and I explained to the patient in the family what I was drawing and why I was drawing it. Her daughter freaked.
"A blood transfusion? Why are you doing that? She could get AIDs!"
"Well, Ma'am, with the precautions they take with blood donors and the tests they run on blood now, the risk of catching HIV from a blood transfusion is just about none."
"Well that's not what I HEARD! Can't you just give her some iron tablets or something?"
I went on to explain that the doctor wanted to treat her aggressively since she already was not oxygenating well with pneumonia, but that the choice was up to them and that I would go ahead and draw the blood to give them the option, and they could talk with the doctor later. They agreed and were actually very sweet and reasonable. If only I was so lucky with the next patient.

This woman brings in her mom, who was 90. She had fallen the week before on her knee and shoulder. They x rayed the knee, nothing was broken. They apparently didn't x ray the shoulder but referred her to an orthopedist- apparently sometime in that week, the daughter decided since her mom hadn't recovered immediately, that she needed to be admitted to our hospital for rehab. The orthopedist, I'm guessing to shut her up, told her to come to our emergency room and we would admit her, that he called the ER doctor and gave him orders. This is totally not how that works, or what happened, so this old lady had been sitting in a hall bed for an hour and a half waiting to be seen by the time I got to work. I tried explaining that since the ortho didn't admit her directly, that the descision would ultimately be up to the ER doc whether to admit, and that he had to do x-rays first. I probably told her this 4 times, and every time she just stared and said, " But doctor so and so said he was going to admit her!" The whole time, the mom was just sitting in the hall bed chilling, while her daughter demanded blankets for her, because she gets cold, and when is she going to get a bed, Dr. so and so said he would admit her, why doesn't she have a bed yet? I explained the same. things. over. and over. and over. until I thought I was going to strangle this woman. Finally, our ER doc caved and admitted her, because he didn't want to deal with this woman's crap. I had to start an IV on her, so I went ahead and gave all her stuff to the secretary to get her admitted while I knocked the IV out. Miscalculation on my part- the daughter spent about 15 minutes asking my question I'd already answered, so by the time I got to looking for a vein, the patient already had a room. I then spent another 5 explaining that the floor wouldn't take her without and IV, and no, they couldn't start it upstairs.
So I go to start an IV on this woman. It is about as difficult as most IV starts on 90 year olds- not easy- but the whole time the daughter is hovering over me, literally and figuratively. "That needle is so big!" ( I used the baby size) "That tourniquet is so tight!" "She needs more blankets!" And as soon I stuck her mom " OUCH OUCH OUCH you're hurting her!!!" (The patient said nothing). As soon as I draw blood from the IV she screams. I have to explain to her that blood return is the sign of a working IV. You don't know that, but you want to tell me how to insert the IV. Awesome. I then spend another 20 minutes taking the patient to the bathroom, because the daughter insists she can bear no weight at all on either foot, and that I need to pick her up and place her in the wheelchair. Oh hell no. I do this with the assistance of another nurse, but as soon as I get the patient in the bathroom and away from her daughter, I'm able to lift her arms while she stands in front of the toilet. I put her back in the wheelchair and the nurse floating on our side takes her upstairs, with the daughter following her the whole way-" Watch her foot! Watch her foot! Her foot really hurts!" (The patient put her pain at a zero 10 minutes before and refused meds).
And last night, I worked in yellow zone and I had my first note pad lady. Now, I don't necessarily mind that people that want to write stuff down- I tend to overexplain things, so they tend to like me anyway. But there's writing things down because you actually want to know, and writing things down because you are looking for me to screw up. We don't really take patients in this area necessarily- we kind of work in one big team. So the other nurse I'm working with goes to start the IV on this girl there with adominal pain, who's in her 30's- her mom is there with her writing everything down. The first IV blew, so she starts another that won't draw, but that flushes-not unusual for people who are hard sticks- the entire time this woman is hovering over her asking if she can start the IV herself. Uh, no. So, I go in later to give meds, and she's asking me questions about the dosages and indication in a very demanding manner, even though I told them that, as I do with every patient, first thing when I walked into the room. Writing furiously. Then demands to know the name and title of the nurse who started the IV, the PA's name, my name, even though we've already told her, and it's on the board in the room. I explain after giving her daughter morphine that we'll monitor her oxygen sat and may give her a little if it drops. She responds by very haughtily saying, "Well. I don't see any oxygen." I very sweetly explain to her that it's right there, on the wall, and we'll get a cannula, if we need it. We had her drink contrast for a CT, which requires at least 2 hours between the time the contrast as finished and the time the CT is done- she comes out exactly two hours after her daughter finished the contrast, demanding to know where the CT tech is. At some point during this whole exchange, I ask her if she's an RN, too. Her response, " Oh, no, I'm a lab technician. But I have nursing skills. So, yeah, I basically am." Fool, NO. You basically aren't. If you have to ask me what Zofran is for, you totally aren't. That makes me freaking crazy. I understand what labs mean- that doesn't mean I can do your job, so just because you understand nursing doesn't mean you can do my job. Which was obviously what she thought- that she had to watch all of us like hawks so we didn't screw up a job that she could totally do herself.
Out of all of these people, she had the most medical knowledge, and she didn't have much. I have absolutely no problem with questions. I love questions. I have no problems with the patients and family looking at the charts, or giving me tips on where to draw blood. Involvement in care is awesome- it makes for better patient outcomes. But. As soon as people come around with absolutely no medical background whatsover, or just enought medical background to be dangerous, and try to tell me how to do my job- Eff no. I busted my butt in nursing school. I was at the top of my class, and I still have questions everyday. My job is still a challenge. I would just once, love to be able to make the offer to all the people that seem to think my job is easy, for them to try it. Just for about an hour. Try starting an foley on a 450 pound lady. Why don't you start an IV on a screaming three year old whose family is yelling at you? Why don't you run in the room with the demented patient who is throwing his own feces and try adminster a medication? It's a breeze, right? Go for it. If you can knock that out without a problem, come back and tell me how to do my job. But until then, back the hell off.

Tuesday, October 20, 2009

Various insane stories (warning: mature and disgusting situations ahead)

My work schedule has been crazy- lots of days on with nothing to write about but things that would make me sound horribly, horribly bitter, and no time to write about it anyway, and recently 5 days in a row off! Lots of playing/watching hockey, drinking beer, cooking experiments and realizing I'm super out of shape- not much nursing related to mention. So, this seems like a perfect opportunity to pull out some firsthand and secondhand stories that did not merit their own entries- enjoy!

Most recently- a possibly drunk/very hostile man in his mid 40s, who I only saw briefly after leaving fast track to check on red zone friends during shift change. All I knew was that he was there for back pain and was acting a complete fool- screaming at the nurses, swearing, demanding to know when the doctor was going to see him after being there for 15 minutes. He became so threatening to the day nurse that the hospital police had to escort him out without treatment, not before having a big confrontation with the nurse and charge nurse in the hall, during which I was almost sure he was going to get tazed. The awesome part of the story is what I found out the next day- not only did the guy get tazed after leaving the ER, get readmitted, only to have the doctor refuse to treat him because of his behavior, but the initial reason he came to the ER in the first place, the reason he had back pain: he got body slammed by his MOM. His mom. Who, if your math matches mine had to be at the least, 60, but probably more. Yeah.

From the other weekend shift- an elderly man who presented to the ER with a pencil inserted in his urethra. With x-rays to prove it. When asked WHY, the guy apparently kind of shrugged and said he didn't get much action anymore. Okay?

`From one of our ER docs- a psych patient at our sister hospital, who casually walked up to the nurse's station, pulled out his junk, stuck it on one of the charts one of the RNs was working on, and said, "can one of you ladies tube this up to the third floor for me?"

A few weeks ago, patient who ended up on my team after having been on a month long alcohol bender. He was extremely disheveled and mentally jacked- in fact, he was so drunk, he pooped himself, which isn't too unusual. What was unusual was the fact that when we took his pants off to clean him, a lizard ran out! Poor little guy. This my teammate telling me the funniest thing I have ever heard at work: "Girl, he was so drunk he shit a lizard!"

Finally- the confirmed legend. If you are at all squeamish, you should probably skip this one. The best way to tell it is probably the way I first heard about it. About a month after I started my internship, I met up with a friend from nursing school who had also started working in a different ER in the city- the only ER that sees more traffic than mine, as well as TONS of crazy stuff. When I asked her what the weirdest thing she had seen yet was, she thought a minute and replied, "Well. We have this guy who uses his ostomy* as his money maker."
"Wait, what?" I thought I understood this, but I couldn't believe it was true.
"He pimps his colostomy."
"Holy crap."
Apparently, this guy sought treatment on about a weekly basis for STDs in his ostomy at her hospital. As our ERs aren't too far away from each other, and most patients prefer one to the other, I figured she was the only one who would get the joy of treating such classy, and obviously compliant, patient. That was, until I switched to nights, and one of the nurses asked if I had taken care of Mr. Stinky yet. It soon became clear that this Mr. Stinky was the same prostitute (or ostitute?) that my friend's ER saw. I recently found out from one of my friends that this guy took up the time and stunk up the waiting rooms of so many different ERs in the city that the various doctors all got together and told him that if he didn't stop showing up with his nastiness and wasting everyone's time that they were going to call the police and report his source of income (I imagine a citizen like this might have had some warrants as well). Sure enough, he called their bluff and now he's in jail for at least the rest of the year. Looks like I'll have to wait a while before witnessing the horror firsthand.

*in case anyone isn't familiar with the term ostomy, it's when part of the lower bowel has to be removed for one reason or another, and the colon actually has to be re-routed through a hole created surgically in the abdomen, and the patient's stool is collected in a pouch on the outside of the body. Why someone would want to engage in intercourse with this particular hole, however, is a question I cannot answer.

Wednesday, October 14, 2009

Why patient care shoudn't be treated like a business (Or why I hate Press Ganey)

Well, it was bound to happen that there would be a disruption in my perfect work world- other than the swine flu panic that is sending our census through the roof and as a result, making a lot of our patients kind of act like assholes- that I can kind of deal with- but recent management changes- do not want. Our hospital has had not such a great reputation in the past- whether this was deserved or not I can't say, but both our reputation and our patient satisfaction scores- in our case, based on something called a Press Ganey survey, are going up steadily since I've started.
I'll be frank- I think Press-Ganey is pretty much a bunch of bullshit. Scores are calculated based on a card that is mailed out after the patient is discharged, and added together based on the ones that people send back. I learned even in elementary stats that this is a really unreliable indicator of anything- generally the only people that take the time to fill out a survey like this are the people that are pissed off and want to complain. The people that are satisfied are much more likely to tuck it away and deal with it later (never)- I can say this in my own experience- I still haven't filled out my survey for our outpatient radiology department, even though they were super cool and I had a good experience. I put it away to fill it out later, and I lost it. Now, if in my mind I had been disrespected somehow, you know I would have sent that in immediately. We get very few surveys back in relation to how many patients we actually see. And among the few we do get back, some of them are from crazy ass mofos- we actually got a really horrible score from one patient whose only complaint was that the sandwich tray she got in the ER didn't have mustard on it. Seriously.
Some of our administration- at least our awesome night manager- acknowledges that this isn't accurate. He's actually started calling people at home randomly to follow up, or going to visit patients who have been admitted, and find that most of them loved how they were taken care of in our ER and have little or no complaints about their care. So do we change our indicators? NO. What do we do? We hire a consultant to be our interim manager who's whole career is based on improving Press-Ganey scores. To a certain extent by actually making improvements in patient care, but also in a large part coming up with canned lines to feed patients that correspond with Press-Ganey questions. For example, if the survey has a question about whether the staff was respectful of your privacy, we're supposed to say things like "I'm going to pull this curtain for your privacy" every time we leave the room, so they'll remember and check the "excellent!" box.
This makes me ill. I am not selling Avon. I am not promoting a brand. I am taking care of a human being to the best of my ability. The idea that I should be trying to manipulate them into giving me better feedback is disturbing. I may alientate some people with this, but that's fine- this is why I have a big objection to running healthcare like a business as opposed to a social institution. There are many other reasons that I won't get into because it isn't relevant, but patients, especially ER patients, cannot and should not be dealt with in the same manor as hotel patrons. Function and need outweigh satisfaction for me. As much fun as it would be to listen attentively and contact my charge nurse and manager for a patient with a suspected GI bleed who isn't allowed to eat, I can't, because I, frankly, have more important shit to do. I often need to check on the person in the next room to make sure they aren't dying. I may need to help a teammate with a procedure. As nice as it is to build rooms with fancy matresses and new floors, it would probably be a better move in the grand scheme of helping humanity to have plainer rooms and take on more cases for charity care.
Sometimes we have to accept that some people are perpetually unsatisfied. That we could call in the freaking CEO of the hospital to personally thank them for choosing us, and they would still be pissed off about the temperature of their coffee. Sometimes we have to take a kind of paternalistic approach and acknowledge that sometimes, what may satisfy the patient is not in their best interest. Our Press Ganey scores among drug seekers would probably be through the roof if we passed out Dilaudid like candy! Would that actually help anyone? No. I realize that's an extreme example, but treating our hospital like a competitive retail chain is not a comparable model.
The best example I can think of to illustrate this is a patient who came in for tooth pain from a dental abcess who, during my assessment, revealed to me he had taken an entire bottle of Motrin in the last 24 hours because his tooth hurt. He immediately got admitted for observation to make sure he hadn't just made himself a transplant patient, and then promptly spent 20 minutes arguing with me about whether he would allow me to draw blood or start and IV if he wasn't immediately going to get pain meds for his tooth pain. I tried being gentle. I tried being rational. Finally, I had to close the door and tear him a new one- in short- go ahead and leave AMA if you want to, but that would be another pretty damn stupid move- and it got through to him. I then went back to caring nurse mode, and stayed late to adminster his pain medicine while smiling and joking with him. He ended having some damage to his liver, so cussing at the guy was probably the biggest favor I could have done him.
I try to, but don't always live by, the idea that you should treat every patient like it's a member of your family. And I like that approach much better than treating them like a customer. When I worked retail, I would smile through lots of ridiculous bullshit to keep my job. I could have cared less about my customers. By treating my patients like family, I'll put up with a reasonable amount of bullshit, but I refuse to be walked all over. I refuse to kiss ass, I refuse to smile and get my manager when someone acts like a bully. I will give that person the business in the most caring manner possible- just like I would for someone I know and love- and if they still want to talk to my manager, I'll get them. But it usually isn't necessary.
Reasonable people can generally recognize when someone is being real out of genuiene care and concern versus being fake to improve a number on a piece of paper. And I'd like to quit my damn job before I do the latter.

Friday, October 9, 2009

I'm not taking that patient!

Ugh. I think there is always somewhat of a conflict between the ER nurses and the floor nurses. Some of the floors I get on with great, but there is one in particular that seems to freak out if all the patient's vital signs are not within normal limits. I get where they're coming from part of the time- I have had a few patients that I tried to send them that later had to be admitted to ICU- but other times I swear this one particular floor is either a) medically stupid, or b) just plain lazy. I will admit ER nurses tend to be flippant about vitals where I work. a 180/90 blood pressure is perfectly fine for me- our patients are generally hurting and stressed and their vitals are going to be out of whack, whatever.
Before I get into some of these stories, let me first point out that I'm talking about a telemetry floor- meaning they specifically see patients with cardiac issues- so you'd think they would understand basic cardiac pathophysiology. Maybe not.
My hospital is close to a nursing home, so most of our patients have CHF, or congestive heart failure- meaning, in summary, they've had some damage to the heart, so it doesn't work as efficiently and has to pump faster, and the patient is more prone to getting overloaded on fluids, so we're really careful about giving them too much.
The first patient they freaked about was being admitted for fever due to a urinary tract infection- so her heart was already elevated from that- plus she was in late CHF, so her heart rate was 130. It had been that way they whole time- she was completely stable- that was just where she lived. I told the nurse this when I called report. It wasn't sinking in-
"The heart rate's 130!"
"Yes. But there's a medical reason for it."
"But it's 130! Aren't you going to call the doctor?"
"The doctor knows. He was down here lookig at her when he wrote the orders for her to go to your floor. The heart rate isn't going to change."
"You need to call the doctor!"
"You need to call the doctor. I'm not calling him about information he already knows."
That turkey called the house supervisor on me! I explained the situation to her and she immediately sent the patient to the floor. One explainable, out of normal limit vital sign does not an ICU patient make!

I swear they've gotten even worse since. Yesterday we had a similar issue- an elderly man with CHF who had fainted due to dehydration. We gave him a liter of saline fast to get him rehydrated, but we started him on a slower rate of fluids as not to overload him. The blood pressure was 95/52 when we called report- technically normal and completely explainable by his condition. The nurse upstairs did. not. get it.
"That is a low blood pressure!"
"Uh, yeah. But there's a reason why, and it should continue to improve."
"But it's low!"
"Yes. But we don't want to fill him up with fluids too aggressively because of the CHF. "
"But it's really low. What if it drops?"
"Why would it drop? If it drops call the doctor! Do you understand how this works?"
I was literally hitting myself in the head with the phone by the end of the conversation.

Forget completely about the med floors- I swear they aren't allowed to have any sick people up there. Some of it makes sense- they can't give cardiac drugs IV push since their patients aren't on continous monitoring- but the stuff they refuse to accept is freaking ridiculous. I sent them a patient with a 180/90 blood pressure who I had been holding in the ER all night for his blood sugar so they wouldn't have to fill an ICU bed. The admitting doc would have let me send him up a lot earlier but I wanted to get his sugar down the where the meters could actually read it so the floor nurses wouldn't have to send blood to lab. I even started a second IV for them- if EMS starts the first they have to remove it and start a second of their own, unless we do it in the ER.
So the whole night I dealt with time consuming hourly blood sugar crap, I was ready for him to be OUT. His pressure had been high earlier in the night and I knew they wouldn't take him, so I called the doctor and got a ton of orders- including two oral blood pressure meds and and IV meds for the gaps in between. He ordered them all at once, but I wasn't comfortable dumping all three in him at once so I held one and gave it right before he went up- I'd also stopped the insulin drip, started the sliding scale orders, and checked a blood sugar. She did not seem to get that they medicine was going to bring the pressure down soon, so I mentioned that she had order for IV meds, too.
"I can't give that. Can't you call the doctor and get the order changed?"
"You can call the doctor and get the order changed."
"Aren't you going to check another blood sugar?"
"We check an hour after we give insulin. I just gave it."
"But it's been 15 minutes, hasn't it?"
"Do you seriously want me to check it 15 minutes later? That makes absolutely no sense. No."

Ugh. the thing that makes me the craziest about that shit is that they have techs to do that! We have ourselves, and other sick patients! I understand stabalizing people, but please! Not everything is going to be fixed by the time the patient gets admitted. That's why they get admitted.

Tuesday, October 6, 2009


Menstrual cramps?
Not an emergency, in case anyone was wondering.
Also- constipation? And by constipation, I mean, bowel movements were harder today than usual. Did not try Metamucil or drinking more water. Oh, and since we're here- clear vaginal discharge x 1 year. ONE YEAR. No odor, itching, dysuria.
WTF. I mean. Emergency room. Holy shit, emergency room.
I have no words. I am still trying to figure out how it is humanly possible to be nice about this.

Tuesday, September 29, 2009

excitement, a little too much!

Yikes. This whole weekend has been pretty uneventful- lots of flu, actually, dare I say it, slow? Until... Sunday night. We got our payback, cause shit hit the fan.
I had a lot going on the whole night- a septic nursing home patient, full abdominal pain workup, and a chest pain who I was trying to get upstairs at the same time, but stuff I knew how to do- just a lot of it until later that night. I'm finally hitting a lull and getting rid of some people when they wheel back a lady with her foot up in the air and her sister walking next to her, carrying a bag.
She's been bit by a snake, they don't know what kind. Her vitals are stable, so I hook her up to the monitor and start and IV. My manager and I open the bag and pick up this snake trying to figure out what it is. The doctor comes in and looks with us- we don't recognize the markings, but it has a diamond shaped head. Uh oh, this is bad news. Poisonous. Our charge nurse wanders by and takes one look at it- Copperhead. Balls.
I call poison control and the doctor orders Crofab- an antivenom, apparently- they send it up in powdered vials with mixing instructions. My manager and I try to mix it and it's seriously insane- mix each vial with sterile water and then mix that in 250 ml of saline? Each vial? All of them? We don't know. I call the pharmacist, who tells me to send it back, so they can mix it. Thank you.
I end up waiting about an hour for the Crofab- while I'm waiting, they try to bring an wheelchair back to another room, that isn't clean- mine is, so I end up with a patient with chest pain and ST elevation on his EKG, which means acute heart attack, fly them the hell out to a cath lab emergency. Yikes. We repeat EKGs, start IVs- I explain to the family it may not be what it looks like and the doctor needs to interpret the EKG himself. We get meds at about the same time I get the Crofab- I give both and we repeat the EKG after I give the nitroglycerin, we show it to the doctor, and he confirms it- yup, ST elevation MI. We rush around working on transfers, starting a second IV- meanwhile I'm watching the snakebite lady like a hawk to make sure she doesn't have an anaphylactic reaction to the Crobfab. we get the transfer in order and fly the patient out, and with the Crofab going and my patient's vitals stable, I'm finally feeling at ease. I ended up having her the whole night, since we had no ICU beds, and she did great- we had cold compresses on her foot, so the swelling actually went down remarkably and she was looking great.
Luckily we had lots of EMS students there- not only were they able to help out with vitals and EKGs, but they also got to see some real stuff. It's always stressful at the time, but I love it now- I'm now the resident ER expert on snakebites, as I'm the first person to have dealt with one and given Crofab! Plus, I had lots of fun chasing the other girls on my team around with that dead snake.

Wednesday, September 23, 2009

Appropriate transfers, you're doing it so wrong.

Ugh. The state of nursing in other facilities that we get patients from is nothing short of frightening, frankly. I won't even go into the stupid crap like the PEG tube replacements that the geriatrics docs should do at the nursing homes but are too lazy to, or the DNRs with low 02 sats (what are we going to do, intubate them?) but stuff that can only fall under the category of why-the-f would-you-ever-call-an-ambulance-for-this?
My favorites lately, from the nursing homes- a lady who banged her knee on a cabinet, denying pain, with a little bruise, who they sent via EMS to rule out a fracture; a hypoglycemic patient with a blood sugar of 95 when EMS arrived- supposedly, the patient had a sugar of 20 that they gave glucagon for. BS. When they arrived, they asked if they still wanted to send the patient-oh, absolutely. He was acting "altered". Oh, by the way, he had Alzheimer's. A 35 year old down's syndrome patient with a twitching knee. Really? One of our sassier ER docs has actually called and gotten in yelling matches with the nursing home doc on multiple occassions over the inappropriate crap they send over.
Probably even better is the psych facility down the street. I'm really starting to wonder if any RNs are actually employed at this place. Transfers we've gotten include: a ten year old with a fever. No tylenol or motrin given for 8 hours. A patient who was detoxing from cocaine that they woke up at 4:30 AM. He was confused, so they decided he was having a stroke. He was probably about 38, and had no facial droop, no weakness, no suggestive symptoms other than confusion that could easily be explained by the fact that it was four in the freaking morning! I always love the countless "altered mental status" patients they send us that need to the "medically cleared" who are either on drugs or withdrawing from drugs. Uh, yeah. They're sluggish and feel like crap and are mentally a little slow because they are withdrawing from an addictive substance. HOLY CRAP.
The absolute best, however, is the crap we've been getting this last week- I can't believe I'm saying this- but CPRs in progress from other hospitals. Seriously. Well, one hospital, specifically- a long term care facility that basically see ICU style patients day in an day out. Their patients code. They are sick. Do they run the CPR as they are trained to do? Nope. They call the ambulance and send it across the street so that when the patient dies, someone else has to do all the paperwork. We've gotten two of these in the last couple of days. Usually, by the time the EMS has been dispatched, arrives, does their work, and gets them to our ER, the patient has been down at least half an hour, but usually longer. They are always older patients with tons of comorbidities, so the docs usually call it after 1-5 minutes, as they should.
Man. I know I enjoy work more than most people- I work in the ER because I have to bust my butt there and it makes the time fly- but how lazy can you possibly be? I can't tell if these people are really so medically stupid that they're actually concerned about the conditions these patients are dealing with, or if they are so lazy that they are looking for any excuse to call EMS so that they don't have to do their work and take care of their own patients. Either way, it makes me want to drive across the street and smack them in their faces.

Saturday, September 12, 2009

My Hallmark nursing moment, with help from the hospital police.

Sometimes, with the drug seekers, the drama queens, and the legal requirement of pulling elderly people trying to mercifully go in peace from the sweet arms of death, I get in a completely shitty mood and forget why I do this job. I had actually just dealt with the latter in my trauma room- a 78 year old Alzheimer's patient in respiratory distress that the family (over the phone, of course) insisted be intubated- when I got orders back for a little boy who was being seen for knee pain.
I should probably mention that pediatric patients scare the hell out of me- especially when they need IVs. In this case, our tech had already stuck him- but whoops, didn't draw all of the labs the doctor ordered, nor did she start a line. Balls. So, we have to go back in there and put an IV in this little three year old who's already hurting. As we're prepping him, I chat with him about his spider man shirt and ask him if he wants to be a superhero when he grows up. He says no, that he wants to be a policeman. He gets really excited and tells me that he saw one at the store earlier that day. We stick him, and I bring him a popsickle, and he's pretty happy, but I get the idea that I can do more.
It was pretty slow, so I ran up to triage and grabbed the cops posted up there. I explain to them that I have a little boy who idolizes the police and ask if they would go talk to him for a little while. Both of them gathered some stuff up and came back to talk to the little boy- they brought him a little police badge and a bear, and told him that they had heard he was a brave kid, and that they needed his help to be a deputy. They gave him two stuffed animals as a reward for being their helper. He was so excited. I have never seen a kid's eyes light up like that before- I know that they completely made his day. I had tears in my eyes watching how great they were with him, and how happy he was- and I had this moment like, oh, yeah. This is the reason that I do this job. I remember now.
We actually ended up transferring him to the children's hospital- the doctor started to suspect he had septic arthritis- but I felt so good that he would actually have one happy memory from a pretty traumatic day.

Thursday, September 10, 2009

baby update

So, I just got the news recently about the details of everything with my little newborn a few weeks ago. One of the ER nurses here is friends with one of the girls in the nursery, who told her that apparently, the cause of death was sepsis. Pretty soon after he got admitted, the little guy spiked a fever, and since he wasn't really old enough to have developed an immune response, his organs eventually shut down.
The sad part is that he might have lived if he was cared for by the mother- if the mom had cleaned her feces off of him at birth, if he had gotten care earlier, or if he could have gotten some maternal antibodies from breast milk.
The good thing was it was nothing intentional, and the nurses caring for him loved him a lot. Apparently they all adored the little baby and had even given him a name. So in the short time that he was alive, there were lots of people who cared for him- which is really all any of us can hope for.

Wednesday, September 9, 2009

oh, drug seekers.

Arrggh. So I get a patient the night before last, 18 year old, comes in on the ambulance, in his words, in a sickle cell crisis. Chest and joint pain, 10/10. Huge kid. Like, 350, 6'3. Immediately starts asking me for pain medicine, but in a very desperate, sweet sort of way- "Oh please, miss, I'm hurting so bad." I tell the doctor the story and get him some Tylenol, since we can give some per protocol. I tell him very sweetly and sympathetically that I can't do anything until the doctor sees him but that his chart is second in line and he should be in soon. I go to take care of my other patients. I'm in a room for 15 minutes- when I come out, he's called me three times asking for pain meds. Same story- sorry dude, I don't have MD behind my name, I can't give you Dilaudid yet.
I reach a lull and tell him that I can at least start an IV so that when I do get orders, he'll be ready to go. Kid has absolute garbage for veins, naturally- I call one of our medics but he's tied up doing other things, so he can't help for a little while. In the meantime, the patient falls asleep- the doc gives me orders- as soon as the kid wakes up, he is all over me again asking for pain meds, water, blankets, crackers, juice. My medic finally gets a line and I go to medicate him- first red flag- he asks me how many milligrams he's getting. I can see this in some cases, but it always makes me a little suspicious. Two. He's already pissed about that. Twenty minutes later, he calls me in asking for more pain meds. I tell the doctor, who rightfully says no- he demands to talk to the doctor. He calls me about 8 times about it, starting to yell at this point. The doctor tells him no in person- he calls me every hour on the hour after that, arguing with me about the number of minutes that have passed.
At this point, I talk to the lab, who helpfully point out that no sickled cells were present on his CBC. Hmm. I very delicately inform the doctor, who orders two more of Dilaudid anyway(!)
Naturally, he immediately wants more, along with more juice, and lets us know by yelling at us out the door all night long. Finally, it becomes time for his third dose- I'm stuck in a room dealing with a demented patient who is trying to fight the breathing treatment she needs. He is calling the secretary constantly at this point, since apparently the doctor had told him he would get another dose, probably since the patient starting pulling shit saying that he couldn't go home and needed to be admitted, but he hadn't written an order yet. I try to explain this to him- that I can't give narcotics based on his word alone- and he starts screaming at me about how I'm not listening to him, that he wants the doctor and the charge nurse, that I don't care, etc. I finally get the order his last dose- he tells the charge nurse that he has a ride home.
We wait a while and I discharge him- he's clearly drugged out of his mind at this point, so we keep him in the room for a while to let him sleep it off while he waits for his ride. It's right about shift change at this point, and his hulking ass keeps trying to get out of bed and run out of the room. We tell him repeatedly that he has to have a ride at the bedside before he can leave- he responds to this by pointing at random nurses while everyone is taking report and screaming that his ride is here. When that doesn't work, he screams at me that he wants food, that we've kept him her all night without feeding him. I tell him no repeatedly, that he's discharged and his ride can pull through McDonalds. We finally have to call the police- I decide this is probably a good time to go home.
When I got back to work last night, the nurse who took report tells me he was here until noon that day- apparently he lied about having a ride and spent the whole morning yelling at the nurses for breakfast tray. During that time, one of the family practice doctors walked by and recognized him (he's been here 20 times this year for the same thing) and let us know that apparently, he's not even sickle cell- he just has the sickle call trait. Awesome. I can't wait for the night that he comes in next. Someone's going to have some explaining to do.

Sunday, September 6, 2009

surprises, not the good kind.

Yipes. I think God may be trying to teach me a lesson when I get into my "you're not actually sick" mode- see my disaster a couple of months ago, when my prescription refill turned out to be a heart attack. I get it the worst when I work yellow zone- you would think people with STDs and flu like symptoms wouldn't wait for 8 hours to be seen in the ER, but you would be wrong. They wait, but are super pissed off at everyone by the time they get back there. I respond by being incredibly annoyed, since when I see gunshot wounds and heart attacks every other day of the week, your 10/10 finger pain and tonsilitis are not as urgent in my mind. That doesn't stop those patients, of course, from being on the call light every ten minutes and making me want to run in and slap them senseless.
I had one of these, or so I thought, the other night. The patient spoke little to no English- he had a family member in there translating for him who was incredibly demanding. His cheif complaint was fever- when they took it in triage, it was 97.9. She started telling me all of this totally off the wall stuff- there must have been some kind of language barrier- He has "fever from the inside". He drinks 5-6 gallons of water a day, and he says it all tastes like salt. He got an over the counter Penicillin shot(?) because some healer told him he had an infection? What the hell? I told them I would wait for the Nurse Practitioner to come in, and the family member got pissed off because a Doctor wasn't going to see him. Five minutes later, he hits the call light to let us know he's feeling bad. Uh, yeah. I start a line at this point just so they feel like I'm doing something. The NP sees them, and they finally calm down for a while.
Right as I'm telling people how they're driving me insane, the lab calls to ask about the patient's history. None, why? They're getting "weird" results. So far the blood sugar is reading 1,000. And then it hits me- drinking tons of water? Nausea? Ugh. New onset Diabetes. I look at his urine results- high ketones. Great. Now I have a DKA patient. I do a recollect on the blood just to make sure and call my charge to get this dude the hell out of yellow zone. After the transfer, the lab calls me back- the final blood sugar reading was 1208. The guy ended up going to ICU. Turns out, I can't always tell who's "not sick".

Sunday, August 30, 2009

sad stuff.

Big bummer, guys. I just found out last night that my little newborn baby boy from last week died a couple of days ago at the Children's Hospital. I have no idea what from- they transferred him out last week, and apparently a few days ago one of the cops was walking around on day shift trying to figure out who the nurse was in order to obtain more info about the guy who dropped him off. I never actually saw him, but I hope the police will be able to tell me more about what happened. I just pray that in no way was this a result of something the parents did. There should be video of their car, so if it was they can hopefully find them. I'll update if I get anymore details. I've been shying away from this lately since most of the stuff that's happened in the last week has been really sad. I'll catch up soon- hopefully with some more lighthearted stuff tonight.

Saturday, August 22, 2009

I know, I know

it's wrong to laugh at psych patients. It is. And I generally feel a lot of compassion towards people who have legitimate psych illness, which this lady certainly had. But tell me if you could keep a straight face through this conversation:
Me: What brought you to the hospital today?
Patient: Well, my heart is beating fast. I had a double heart attack. And my face burns.
Me: Okay. What kind of medical problems to you have, ma'am?
Pt: Well, I have maggots in my eyes and on my face. I have the pneumonia in my stomach. I also have tires, cement, and plates in my stomach.
Me: When did you have your period last?
Pt: I have it all the time, in different places. I have it in my arms.
Me: Well, when did all this start?
Pt: Well, I guess it all started.. with Buckwheat. You remember Buckwheat?
Me: From the Little Rascals? Yeah, I remember him.
Pt: Well, I was giving Buckwheat oral pleasure, and he ejaculated on my face. Now my face burns.
Me: Alright. Well, I'm gonna go give the doctor your chart now. Do you need anything?
Pt: Yeah. Some alcohol wipes to get this off my face.
Me: Okay, I'll let your nurse know.

I don't know if I can really capture why it was funny other than how lucid she was about other things- she could tell us her doctors name and address- and how nonchalant she was about everything she was telling me, like, yeah, you know, Buckwheat, oral pleasure. Whatever. Everyday stuff. The fact that was her reality was sad, but discussing things like that in that manner was oddly funny. I went ahead and skipped the questions about her flu shot, though.

Friday, August 21, 2009

Holy shit, a baby!

I think last night was the first night I have seen literally everyone I work with lose their cool at the same time. The beginning of the shift was crazy, but we were managing- I was managing hall beds and two intubated patients, one of my coworkers had 7 rooms, another had 5 including an ICU hold- but we all kept our cool. The shift died down, we started drinking coffee and seeing Level 4s and 5s. Then it freaking happened.
Unbeknowst to me, a man walks up to the triage nurse and simply says, " I have a baby to drop off." She and the medic up front walk outside to his van to find an newborn bundled in a sheet, covered in afterbirth, blood, and crap, and still attached to the MFing placenta.
I'm chilling at the nurses station when I hear someone screaming for the doctor. That doesn't even happen when someone codes here. I look up to see my charge nurse running with a baby in a bloody blanket back to my room. He sets him down as the doc looks at him and we rush around like crazy trying to find the OB tray and try to learn how to use the dusty old warmer in the corner. Doc clamps and cuts the cords and warms the baby, we wrap him up and toss him in the warmer. He's pink, breathing, and crying, but everyone is still visibly shaken. We try desperately to get vitals on the little guy- his O2 sat kind of blows but the baby warming gear we have in the ER isn't exactly state of the art.
Newborn nursery comes down and checks him out- he's a little underweight and jittery and hungry but otherwise fine. Cute as can be. I think we all just wanted to pick him up and hold him as soon as we realized he wasn't broken, but he really needed to stay in the warmer. Nursery took him upstairs to correct his low blood sugar, and we stood around and tried to sort out the mess.
Do we need to report this to someone? Who? What the hell are you supposed to do with the placenta? Does it go in the biohazard waste? The sharps? Huh? We actually had to call L&D, who called the doc who wanted it sent to lab for tissue samples, so they had to bring me a plastic bucket to put it in. Meanwhile housekeeping is super pissed at me because I've left a tray full of placenta in the room, but I have no idea where else it should go at this point. On a related note- how does anyone eat that? It looks like a jellyfish covered in blood. Then I had to call the lab and ask if there was a special window to drop off womb squid, or if I'm just supposed to leave it on the counter like I do blood. I don't think they much appriciated my questions, but i do not do this everyday.
After the initital shock, I just got kind of sad. I hope he finds a good home- he was a perfect little baby boy that so many people would love to have. It just bums me out to think of him in the nursery, surrounded by other little babies with families all alone. Not that he'll really know since he's a newborn, but I hope the staff gives him extra love. Oddly, it made me kind of excited for the day that I have kids in how immediately I felt connected to the baby. I can only imagine it must be a hundred fold when you have your own kids, and it makes you wonder what kind of person could give something like that up like they were dropping off an old sofa. In a sad way, that's probably the best thing that mother ever did for her baby.

Monday, August 17, 2009

Why I love my team and why day shift can suck it.

Arg. Last night was kind of crappy. We had zero tele beds open, which meant anyone with chest pain of any kind over the age of 40 got to stay overnight, all night, in the ER. Not a big deal- it actually ended up being okay, but the end of the shift was frantic because all of the admitting docs order repeat cardiac enzymes and EKGs right at shift change, plus all the AM blood sugars and other floor nursing crap that I don't normally handle and such are due. It always happens that beds open up at shift change, too- naturally two of my patients got beds at the same time. So in the last 30 minutes of my shift, I managed to get orders in, cardiac enzymes sent, vital signs updated, report called, and blood sugars done on all the patients going upstairs, since tons of the rooms up there had opened up and they were about to get slammed. All the med orders had already been sent to pharmacy and all the charts were broken down. I spent most of the time before that working on a guy who came in with a pressure of 190/120 and chest pain. It wasn't a big deal, it was just lots of steady, frantic work.
So, I get my stuff together and I'm giving report to day shift on all of my rooms. The only thing she has to do other than find someone to transport the patients with beds is to get a repeat EKG on a patient going upstairs and a blood sugar on a lady if she didn't get a bed in the next hour or so. I'll take this time to say that we have no transport at night, at all, unless we have a medic, which we haven't for the past two days. That means we have to transport our own patients by ourselves. Day shift has patient transporters, as well as a medic for each team and nurse externs, who they use as their transport bitches, so this isn't even really a task. She immediately delegates everything, then looks at me, and in the snippiest tone ever, says, "you need to get the urine out of the rooms, now.". She's referring to the sample cups on the sinks that I always leave there as long as the patient is still in the room, in case the doc orders more tests. The same cups that day shift leaves for us all the damn time, even when the patient is no longer in the room and hasn't been for hours. I just stare at her and nod, as she interupted me mid-sentence to tell me this. My totally awesome charge overhears it and goes to the rooms to pick up the cups- he then promptly walks back to the nurse, sticks the urine cups about 6 inches away from her face, and says, "They're out of the room now! Is the rest of this acceptable for you? Do you need anything else?" as he steps between her and I. Then he turns to me and says, "Hood nurse, I told you about day shift. If you stay out here, they'll just bitch at you and suck you into their vortex. Let's go home. " We stand up and stroll back to the break room. I wanted to hug him.
I never cease to be struck by how huge the difference is between these shifts. Day people were always so cliquely. You ocassionally get a charge nurse or a teammate who will ask if you need anything to get home, if they like you. I've seen this woman in action enough to know that she does as little work herself as possible and delegates the rest to everyone. Our charge won't leave the floor until everyone is back in the breakroom thanks to crap like today. If we get tied up, he'll triage an ambulance and draw blood for us. Everyone else is the same- most of the people I work with now never stop working until their teammates are caught up- we'll even go help on the other team if we're needed. It's exactly how things should be. I've gone from hating my job during my internship to almost feeling like it's too good to be true. Even if patient situations get bad, I always know someone has my back. And it certainly doesn't hurt when the person who is looking out for you is willing to wave urine in someone's face to get you home faster. .

Friday, August 14, 2009

suck. it. up.

It may be awful, but I have absolutely no patience at all for people my age who are massive babies. Especially if they're in the ER for illness I've experienced and managed, albeit unpleasantly, at home.
I cut people some slack knowing that I have a higher pain tolerance than most, but some of these people are freaking ridiculous. I got a girl in an ambulance today who had eaten some bad taco bell and gotten food poisoning. Sucks. Been there, puking 12 hours straight and sleeping on the bathroom floor. Never again will eat sushi from target. DID NOT call an MFing ambulance. Because I'm an adult. The worst part is, she got sick earlier in the day and could have gone to a clinic. Nope. Somehow she managed this at home all evening, but I guess got sick of it- she was also three months pregnant, but she was 18, so I'm not cutting her a ton of slack. By the time she got there, she apparently couldn't walk across the hall to get a urine sample- how did you walk to the bathroom at home to use it? Oh and her headache- pain 10/10. Okay. Her sister in law was there, too, by the way, with the same symptoms, but she came in through the waiting room.
I almost could have tolerated the drama had she not also been completely resistant to anything I was doing to try to help her. IV? No. As soon as she saw the needle, she flipped out and started crying. Like, sobbing. I've had 7 year olds that handled it better. I hung saline on her, then went to give her medicine for her vomiting and 10/10 headache. I pushed the med in little spurts through the saline tubing, and immediately after I started pushing, she sat up and started hyperventilating and screaming about how she couldn't see. Really? You were stricken blind my normal saline? Because I can guarantee that's the only thing that hit your veins in that time period. I disconnected the syringe and told her to breathe slowly. Then I told her, "Well, you're satting 100, but if this demerol is making you feel like you can't breathe, I can just give you the phenergan? Do you think it's the pain medicine? I can hold it if you want, some people react badly to narcotics."
Her vision was magically restored after that. And she went to sleep. I woke her up when her saline was done, and I had to give discharge papers to baby daddy, who was actually really nice- she ignored most everything I said, then of course needed to exit in a wheelchair. Naturally, she wanted our asses to pick her up put her in the chair without her having to stand. I helped her up, but made it very clear that if she was still too weak to transfer from bed to chair, I would have to restart her IV and go get the doctor. Naturally, I sounded very concerned and she made a miraculous recovery and was able to move.
Maybe I'm being too harsh, but I have been sick enough before to know the difference between not wanting to move and not being able to to move. And sorry, if you're 18 and otherwise healthy, it's the former. Get it together, lady.

Tuesday, August 4, 2009

Things that go wrong, even when you do everything right.

Really, just with odds in life, something like this was bound to happen at some point. The last night I worked, we got this patient on an ambulance. Adorable little old lady- she was about 81, with the complaint that she had run out of blood pressure medicine and that she had started to get a headache and feel bad. She ended up going in one of my team members rooms and we all went in and helped get her triaged and set up. Her pressure was pretty high, but she only rated her pain at about a 3. She wasn't stressed out, and was laughing and joking with us- the only reason she had really come to the ER because one of her in-laws had come over to take her blood pressure and had seen how high it was. We didn't even start a line on her- we put on a heart monitor and the doc ordered a head CT and was probably just going to give her a pill for the pressure and send her home with a prescription.
My teammate got another patient who was pretty sick while this lady was in CT, so I was walking over to help her when I looked over and saw the patient shaking and vomiting on her stretcher. The CT tech said that it looked like she had just had a seizure. We wheeled her back into the room and my charge nurse and I put her on a heart monitor- some really weird junctional rhythm popped up, and she was snoring and unresponsive to pain at this point. I ran to get the doctor, and by the time I got back in the room she was having agonal respirations, like people get when they're trying to die. We moved her into one of the trauma rooms and felt for a pulse- there wasn't one. At this point it became a full on code- we started compressions and the doctor came in an intubated her- we pushed all kinds of drugs until she converted to V-Fib (as my ACLs instructor so eloquently told us, one of the "oh shit" rhythms), which we finally shocked her out of after about 5 cycles of CPR. Unfortunately, she converted to asystole (flatlined), and after 17 minutes, we called it at request of the family.
I understand and deal pretty well with death most of the time, since it's pretty much a given part of where I work. But it's unusual and really eerie to have someone talking to you and feeling fine for one minute and then 15 minutes later, you're doing CPR on them. Almost all of our CPRs come in as CPRs in progress, and the rest generally happen after a patient is already very sick and on their way down. Situations like that don't really lend themselves to you getting to know that patient as a person. You don't get to see them interact with their loved ones or to see what their personality is really like. It was different with this lady- just with a short interaction, you could tell that she was really neat and funny. Apparently, when the medical examiner called the doctor that had been taking care of her, he cried upon hearing that she was gone. Our trauma nurse had a good way of looking at it in that she didn't suffer, and she was living independently until the end of her life. It's just weird to feel like there's something you should have or could have done, some sign you should have caught, that might have allowed the patient to live. I tend to be hard on myself anyway, so naturally I felt like her death was somehow a result of my negiligence since I had collected all her information. I again figured out how blessed I was to be part of such a great team- my charge nurse and the more experienced nurse on my team were both so supportive and reassuring that there was nothing I could have done and that they both would have done all of the same things.

Monday, August 3, 2009

Drunks, and some more drunks.

Ooh man. This weekend was a weekend for partying, apparently. I ended up with the rooms close to the nurses station again this weekend- I've actually starting to prefer them since it's less stressful for me to deal with a combative crazy ass than a nursing home patient desperately trying to die on me, which is always what I seem to end up with when I take any of the other rooms on this particular side of the ER. Plus, it's kind of funny. The room closest to the nurses' station is actually what we refer to as the alcohol room, and it certainly lived up to its name. The night before last, I got a guy in there who had ended up severely outmatched in some drunken brawl- he walked in to the waiting room with the crap kicked out of him. He had a massive laceration to the forehead and was bleeding all over the place as well as a blood alcohol of 325. He spent most of the evening fighting the c-collar we put him in and yelling to anyone who would listen about how he was going to kill the punk bitches who beat him up and how he didn't know who they were, but that he was going to kill their mamas and grandmamas, too. He also wanted to make sure we knew that he was a "for real pimp". Sweet. We sent him to get his neck CT'd, and sure enough, he had a break on his C7. We kept trying to tell him that his neck was broken, which half the time he responded to by telling us that, no, it was actually fine, and proceeding to try and show us that it was fine by moving it. Luckily it was a stable fracture, but we had to get him to sit still so he didn't displace it while trying to staple up the laceration on his forehead. Unfortunately, we couldn't give him any meds since he was too drunk, so we ended up pretty much having to tie him down to a backboard until careflite got there while the doctor stapled his scalp. The whole time, he had his hands in his pants manipulating himself, which he swore was the only thing that would keep the pain from being unbearable. It seemed to at least sink in a little bit when we told him that part wouldn't work anymore if he displaced his fracture, and we were able to transfer him out safely.
Last night was less legit- I pretty much just ended up babysitting a girl whose only complaint was being drunk and vomiting. Sweet. Definitely something that should be managed in the ER and not at home in front of the toilet. Apparently she was drinking with her family at 8 Pm on a Sunday, cause why not ( by the way, she was only 20 and had an 8 month old) when she had too much Crown Royal and started puking everywhere- they responded by dumping cold water all over her, for some reason, and then calling an ambulance because she was "foaming at the mouth". Uh. Yeah. That's called vomiting, and it happens when you drink a bottle of Crown by yourself when you weigh 110 pounds. She was actually pretty cooperative with the IV- less so when I had to catheterize her, but considering she was a drunk puking mess, all was okay. That was, until she remembered that she had a baby and decided she wanted to see him, immediatly, at 1130. When I informed her that she was far too drunk and that I had no idea where her spawn was anyway, she responded by yelling that I was a bitch ass hoe, and that she wasn't drunk. Oh. Okay. We literally had her sleeping in the booze room from 9 to 3 am; during all that time, none of her family showed up or called. Finally, we woke her up and told her we needed to call someone to get her drunk ass. She spent the next half hour after that on the phone telling her cousin how we stuck her, like, everywhere (we stuck her twice, and the first was by an EMS student who would have gotten the line had she not jumped halfway off the bed) and how we thought she was gonna die (nope). She then berated them about how she couldn't find her baby or her weave. When they got there to pick her up, the only thing she was embarrased about was that she'd been seen by the staff without her hair (or hurra). On her way out, she told us she was going to go get pregnant. Awesome, you should definitely have another kid if you leave the one you've got wherever you leave your weave.

Thursday, June 25, 2009

weekend, dummies

Wow. Nights this weekend have brought in some winners. Winners with lying problems, apparently. My favorite was probably the guy who came to the ER on a stretcher covered in road rash and reeking of beer. First he lied to us about how many beers he had (seriously, I do NOT GIVE A SHIT how drunk you are, nor does anyone else but we NEED TO KNOW these things, man) I think the number started at three and went up to 6 or so as the assessment continued- whatever- but then came the inevitable question of how did this happen to you- oh, um, hit by a car. Huh? Yeah. He was crossing the street and got hit by a car and somehow that lead to tons of road rash but zero broken bones. We x rayed just about everything, irrigated his wounds and sent him home- the whole time we were trying to clean him up he kept trying to walk around the room and talk on the phone to his girlfriend, who couldn't find the ER, so he was sticking his head out of the room and yelling at people for directions- I was practically chasing him with the bottle of saline. I thought he was weird, but he wasn't my patient so I wasn't too worried about it- I found out later from the ER cops that he had been drunk and riding his motorcycle and had wrapped it around a pole but didn't want anyone to know because he had gotten a DWI a month prior. I guess he thought being honest with the nurses was going to get him another one. Everyone kept asking him if he'd been in a motorcycle wreck just based on his injuries, and he kept insisting that he had been hit by a car. Again, we don't care. Unless you injured yourself hurting someone else I could give a damn about your illegal activities.
Same story for the dumb dumb that came in the next night. I don't know if he was on anything, but came in claiming that he'd been shot by someone but he didn't know who it was. The only problem was, he had a big bullet hole in his hand with a powder burn around it, meaning it had to be at close range. The kid changed his story about 4 times, zero versions of which actually made any sense. The police and the doctor were both pretty sure that he had gone and bought a gun off the street trying to be thug and suceeded only in shooting himself in the hand with it. Well played.
As far as illegal activities, that's pretty much all we got other than the guy I ended up with from jail on warrants who came in for his "Crohn's flare up" and immediately left without being seen at the first opportunity. It's not really a valuable use of the police's time to babysit people who are in jail for traffic tickets during their whole ER stay, so if they have an emergency in jail they just let them go with EMS to the hospital and allow them to turn themselves in later. The only problem with that is that a lot of people just use it to get out of jail and bounce when no one's looking. Unfortunately for me, the only other patient I had dealt with in this situation was actually sick, so I spent a ton of time doing a full work up on this douchebag and even tryed to stick him twice, all the time while he screwed around and wiggled and did nothing conductive to a sucessful IV start. It's actually fortunate for him I couldn't do it, because otherwise the police actually would have had to go after him for leaving with IV access. I was pretty pissed that I spent the time on him, but I did learn a valuable lesson with jail patients- next time I will give them the opportunity to "get a urine sample" before I do anything else.

Monday, June 22, 2009


Okay, seriously. Between me and my teammates on the last two days there have been an uncomfortable amount of people coming in for generalized complaints that turned out to me nothing other than, oh, surprise, metastatic cancer- probably. Mine was 23, had already had a kidney removed, came in for vomiting, and while they were CT-ing his belly, found out it was probably now in the bone. Awful, awful. This crap needs to stop, I have two more days to go before I get a break and no more energy for this business.

Thursday, June 18, 2009

night and day difference, literally.

So, a while back I talked about a day I had where I had way the hell too many sick people at once and I was super scared one of them was gonna die on me? Well, I had another one last night, but amazingly- it was totally fine. Not to say that it didn't still suck- I had a guy with a blood pressure of 270/160, a 6 year old with a possible concussion, a patient who the doctor needed urine on who couldn't get up and a guy with a uncontrollable vomiting, a possible seizure before he got there, and a heart rate of 140 for some reason. The guy with the high blood pressure ended up being an ICU hold all freaking night and I had to titrate multiple drips that I had never given for him. The nurses last night, even the ones that weren't on my team, helped me to look up the limits on the drips and how much I should titrate up by, etc. Just as soon as I would start to get swamped and overwhelmed with the tasks I had to do, I would walk out of a room to get them started and half of them would be done.
The guy who works charge half the time when I'm here totally rules, too- he'll come start IVs and ambulances for all the nurses when he knows we're behind. It's just so comforting to have backup- it was never like that on days and it makes a huge difference. Not only did people rarely help on days but half of them were watching and waiting for me to screw up; on nights everyone genuinely wants to help and will drop what they're doing to if you're in bad shape. I really was getting miserable and thinking about getting out of here as soon as my contract went up, but I'm super happy now. It's amazing what a difference there is when you're on a good team.

Friday, June 12, 2009

The exact moment I realized my attempts at discharge education were pointless:

I worked in out fast track unit on Tuesday, which turned out to be STD party '09 that particular night. I go to send home a 20 year old girl who had come in with funky vag discharge, and as I'm standing there giving her instructions about her antibiotics, she looks at me with this blank stare, turns to the friend who's with her, and says, "Girl, can you believe I got chlamydia again?"
I was totally speechless. What can you say to that? Yeah, okay. Make sure you finish these antibiotics, and wrap it up next time, even though I know you won't. Sweet. See you later! Bye!

Monday, June 8, 2009

night shift= babysitting drunks?

Oh. my. god. I never had any idea how much manpower hospitals ended up devoting to people who can't handle their booze. Last week we got the girl with an "asthma attack", who came in via ambulance in nothing but a bikini satting 100. She was a melancholy drunk, though, so it took at least one nurse at all times to stay in the room with her to convince her that she could, in fact breathe, and no, she wasn't dying.
Last night was oddly slow- each nurse had about one patient. Unfortunately, the one that I ended up with was an overdose, apparently a suicide attempt, which consisted of her taking a few OTC sleeping pills and drinking a whole shit ton of alcohol. She was medically stable, but an incredibly belligerent drunk. The charge nurse took her straight back because no one knew how many pills she had actually taken, and by the time she got back to my room she had already started screaming and swearing at him. It took me and another nurse about 15 minutes just to get her to sit still for a blood pressure reading, she spent the whole time screaming and hitting herself in the face and the like. I gave her two doses of valium, which did absolutely nothing but make her yell at me more about how I was just giving her water and I better give her something to calm her down or she was going to cut her wrists. I would have felt bad for her if she hadn't been so damn manipulative- any time she didn't get her way she just screamed at me about how she wanted to die and didn't I understand that. At one point I walked in to hear her talking to her family members about how when her husband called that they just shouldn't answer the phone and they should just let him wonder what happened, since apparently something he had done had precipitated her "suicide attempt". Ugh. Whatever dude.
I was in her good graces-well, at least about half the time- she alternated between telling me how wonderful I was and that I was taking such good care of her and that God was gonna bless me for that, etc. The other half, she would scream and swear at me about why did she have to use the damn bedside commode like an fucking 65-year-old child (I didn't type that wrong, she actually said that), why the hell couldn't she go outside and smoke an fucking cigarette, don't we have any food in this damn place other than crackers, don't we have any mother fucking cheeseburgers? It took all my power at that point not to say, "No M'am, this is an emergency room, not a Mc Donald's. I'm sorry, but we don't have any motherfucking cheeseburgers. Is there anything else I can get you?"
Finally the doctor took mercy on my soul and prescribed some Haldol. I had never given that drug before, but it worked like a charm. She went right to sleep, but unfortunately, her blood pressure completely went to hell, even though she was hypertensive when she came in. So by the time I finally got her behavior under control, I was getting calls from our Tele tech every 5 minutes about my patient's 80/40 blood pressure. She was fine and her sats were still great, but it still made me super nervous and I had to keep giving fluid boluses. Luckily by the time the psych consult came she had woken up a little and her pressure had made it's way slightly out of the toilet.
We finally got her out of there right at shift change. She ended up going to a facility where I had actually started applying right before I got the job I have now. I'm glad things worked out the way they did, because I'm pretty positive I am not equipped to deal with that every day.

Saturday, May 30, 2009

biggest oh shit moment ever

Holy crap. I have no idea even what to say, here, other than- I will never, ever, ever, ever again, get upset with a doctor for doing a full workup.
I had a patient last night who came in with epigastric pain- she had been in a week before and been diagnosed with GERD, gotten some nexium, which helped, and gotten a referral for a GI doctor. She told the people in triage and me that she only hurt after she ate, that she had no other symptoms, and that she wouldn't have even come back except for the fact that she was out of nexium and no GI doctor would take her insurance. I updated her vitals and put her chart in the doctor's rack and let her hang out, thinking she would probably get a prescription and get sent home.
I finally got orders back an hour or two later and the doctor had order an EKG and bloodwork. I was kind of annoyed by it all, as she was only in for a prescription refill and was putting her pain at a 4- I went back into the room and did her EKG while another nurse got blood.
If you hadn't guessed it by now- ST elevation. I re-ran the EKG. Same result. I nearly urinated on myself, and I got the doctor. We compared it to her old one, and there were definitely changes. We transferred her out within an hour. The odd thing was that her CIPs were negative- so it's still hard to say for sure what was happening, but she was a diabetic, so her chances of presenting with atypical symptoms was even higher.
It freaking figures that this would happen on my first night alone with critical patients. I felt awful, but the doctor and one of the other nurses on my team said they both thought the same thing. Lesson learned- I will never again bitch about performing and EKG or doing bloodwork.

Tuesday, May 26, 2009

responsible parenting, ur doin' in rong.

Oh man. I'm sure saying this will come back to bite me whenever I have kids, but damn- why can no one seem to take care of their children? Seriously. Common sense seems to be rare lately. I got a kid earlier that somehow managed to drink an entire bottle of cough syrup without his mom finding out until he brought her the empty bottle, I guess- luckily the kid turned out fine and didn't really need anything, but we just kept him in the room on a monitor for a little while- except mom didn't seem to understand he actually needed to stay on it- which I somewhat sympathize with in that kids are squirmy, but you have to make some sacrifices when you let your child out of your sight long enough to drink an entire bottle of medication that shouldn't have ever been out in the first place. On top of that crap, the med student that went to see him decided that an appropriate form of entertainment would be an inflated glove, which is subsequently had to take from the kid, explaining to his mom that it was an aspiration hazard, all the while with her staring at me like I'm stupid.
Later I ended up with a patient who was being treated for cancer who was coughing up blood and short of breath. At first we suspected pneumonia- naturally her daughter thought that this was an appropriate time for her three month old daughter to get some quality visiting time in. She was not the only family member there either, so it's not as if she would have been leaving her mom alone had she left with the damn baby. One of our more ballsy doctors was seeing her and pretty much told this woman that it was probably not a good idea to have her baby up there, to which she naturally dealt with by complaining to me about the doctor having a problem and explaining how germaphobic she was- clearly not that much- although she did get onto the registration lady for touching her kid's leg. Apparently contact with the intact skin of a woman who effectively never touches patients is an infection risk, but being around someone that may have TB or pneumonia isn't, as long as it's someone you're related to?
I would be more forgiving, I think, if it weren't always these types of parents that are constantly demanding explanations in a hostile manner for totally reasonable shit. Like the mom I got this morning who brought her daughter in herself after a seizure, apparently for the sole purpose of getting a prescription. It wasn't enough that the doctor wrote to increase her dosage, but she also wanted some valium to take home to give her daughter just in case she had another one. Nope. That's a risky drug and you're an idiot, so the doctor doesn't trust you to administer it safely. And the daughter was pissed that I wouldn't give her valium for her headache. Yeah. That's not how it works. Of course instead of listening to the reasons why they shouldn't have this at home (you don't understand the purpose?) both of them felt the need to berate me about the hospital (there are much nicer ones where they come from, this one is gross) and my care (the urine is still there on the sink, because, you know, I was just doing that so you could look at it and not because I thought the doctor might order something that might require us to have it). Just getting a last set of vitals taken was apparently a giant chore for them, and they had to bitch the entire time about how they should have just called her neurologist. Well, if you were just here for a prescription, you probably should have. If you were actually here to get your kid checked out after her seizure, that might have been difficult over the phone.
It's days like this that I thank God I don't work pedi.

Saturday, May 16, 2009

blog neglecting and young eating

...they continue. But, there is an end in sight. I got released from my internship this week- woot- which means at the next schedule I can finally move to nights and stop defying my body's urge to stay awake until four in the morning. Naturally, this didn't happen before another installment of events to show me that I can't really trust any of these assholes- well at least not most of them, especially on days. Dramz you guys- this lesson has come to me in the form of my first preceptor! The one that has been telling me this whole time, despite my very candid doubt as to whether I could do this, that she knows I can do this, that it's just hard because I wasn't an extern before, that I shouldn't give up- well, apparently that isn't actually what she thinks. Apparently the whole time she has been telling my manager and our administration that I'm unsafe, that I can't do this, and that I need to move up to the floor. She's also been recruiting other nurses to watch me for unsafe behavior. The hell? I mean, if this is actually what she thought, I can't really fault her for it- it's her job to see if I'm cut out for it- but why in the hell would you not tell me if you think honestly that if I continue working here I'm going to screw up and kill someone?
The funny part is that I've done really well with my new preceptor, who totally rules, because she actually teaches me things. I found out about all this fuckery through her, pretty much because she thought I already knew because she actually had the expectation that there would be honesty in the preceptor-intern relationship. It's the best thing that could have happened, though, because my confidence really has been restored by the whole thing. The more I've learned, the more I've figured out it really was her and not me. She's that back stabbing with everyone, and I think at some point she realized she was going to be held responsible for not being great at teaching and decided to throw me under the bus to make herself look better. So, whatevs, that was pretty douchey, but stuff has been okay. I haven't seen a lot of funny stuff, but a lot of crazy business has gone down.
We had a shit ton of people on swine flu week. Like, more than the hospital has had ever. One day we literally had ambulances waiting in the hall to go to rooms for about 45 minutes each, and the people in triage went through 4 boxes of surgical masks in one day.
The next week we had crazy ass overdose day, where everyone came in full of something- the peak was the patient I got in the trauma room, naturally, at the end of my day at shift change. It was the most insane shit ever. According to EMS, this man had just strolled into a hardware store, picked up a jug of acid, and started drinking it. A bunch of customers followed him outside where he collapsed, and when they brought him to us they couldn't even figure out what his name was because his driver's license didn't match his passport. He was from Haiti and couldn't speak English, so no one could figure out who next of kin was or even where he lived or worked. When I put the foley in him his urine just came out green. I talked to the nurse who had taken the room the next day, who said that he had made it up to ICU but that he probably wasn't going to live. Very sad and strange.
This week I ended up with a patient in some kind of psyc related catatonic state- she didn't respond at all to being catheterized, her drug screen was negative for everything, nothing on her head CT, and when the doctor did a lumbar puncture and poked her repeatedly because he couldn't get through the vertabrea, her biggest response was to flinch a little bit. It was very strange.
The rest of the notable people have pretty much been noncompliant to the point of being enormous pains in the ass- always massive trainwrecks pretty much due to their own actions. Last week I ended up with a guy who came in on bipap who eventually had to be intubated who constantly asked me if he could smoke a cigarette while he was on bipap. No. Absolutely not. You could easily die, the cigarette is not a priority right now.
My patient yesterday was even worse. He was thirty five and already had kidney disease, congestive heart failure and COPD, along with tons of other shit- of course, he was morbidly obese and refused to take any of his medication. He was in a nursing home with all this crap and came in to our ER because his heart rate was in the 150s and he was full of fluid that wouldn't respond to Lasix (pretty much the most effective diuretic there is)- by the time he'd been there two hours it was already up to 170 and his blood pressure was slowly but surely spiraling down the toilet. All he did the entire time was bitch. Not about anything important, but about how it was too hot, that he wanted a fan in his room, that he wanted more pillows, and that we came in and "bothered him" by taking his blood pressure, even though we were only doing that hourly. His mom was there and continually demanded to know what was holding up "getting that fluid off him". Um, his kidneys? I took some time and explained the reasons as to why he might not be responding to Lasix and how there really wasn't anything else we could do until we figured out what was going on. After going through this about three times she was finally alright.
As soon as I let them know he was getting admitted they both started asking non-stop about why he wasn't getting moved up to a room yet. Um. Because there isn't one. Just like there wasn't one five minutes ago when you asked me the last time. He asked me multiple times for pain medicine for a stomach ache- when I finally talked the doctor into giving him some, he refused it. He finally took it when I let him know the codeine would help his cough go away (on top of everything, he also may or may not have had pneumonia, what the hell), but he acted like he was doing me a big favor by taking it. His reason for refusing it- it would make him go to sleep- even though an hour before that he had asked me for a sleeping pill. In the ER. At 2 in the afternoon. No. Just no. I really think he was just looking for a reason to bitch and moan. Any time I was in the room taking vitals or giving meds, he complained about me messing with him, but as soon as I left, he sent his mom out to ask where I was and when I went back he asked me why I was neglecting him. When I finally got a bed, I let him know I would be right back in about 8 minutes to move him to the floor but that I needed to check on my other patients and give meds to one. At this point I had two other rooms and a patient in a hall bed that I hadn't even seen yet. He responded by asking why I was ignoring him and why he had to wait. I took him up with a relatively small medic, and it was pretty much the two of us trying to move him into his ICU bed- I can lift about 60 pounds max and this guy is about 350 plus and has no real condition that would prohibit him from helping us a little bit- the whole time he is doing nothing other than yelling at us "Hurry up! My ass hurts! This bed is uncomfortable! I want in the big bed!"
Luckily I had some very sweet patients that day, including one who kept telling me what a great job I was doing and how I had wonderful potential and he was going to let everyone know, so I didn't immediately want to quit my job, but man. If I'm developing any skill, it's definitely patience.