Friday, April 10, 2009

oh hai, stupid

It would make sense that the day I see this

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up our doctor's station, that I would also get the patient which I am about to describe, which, by the way, managed to totally screw my day by being a total dumbass.
So, this week, the ER was bananas. We have had holds a million because all our ICU and telemetry beds have been full. Yesterday a guy waited 30 hours for an ICU bed. On this particular day, we had tons of people get sent straight back from the waiting room without being triaged- this usually happens when people are either really critical, like chest pain, strokes, or asthma attacks, or sometimes if people are just puking uncontrollably and they don't want to clean that shit up in the waiting room, or other times if the triage nurses are being lazy. That day was the latter, for the most part. So I'm working on an ambulance with a shortness of breath/possible aspiration pneumonia patient, who I'm 95% sure was drunk, trying to get a breathing treatment from respiratory and trying to collect medical information from this inebriated man, when the guest relations guy comes and and tells me they've taken a patient straight back next door, a 19 year old female with nausea and vomiting for three days. So, my thoughts are whatevs- probably some dummy who was puking in the waiting room and doesn't know how to use a clinic- I take my time with my ambulance patient , put his chart up for the doctor and stroll in to this girl's room pretty leisurely.
She's sitting there in bed, talking to her brother and laughing, and I ask her, like I do everyone- "So, what's going on today?"
She looks up at me and says "Oh. Um.... I think I'm in that.. uh, Diabetic Ketoacidosis again?"
Um. WHAT? For the non medical folks, DKA is when people's blood sugars get super high and through a series of events I don't care to explain, it makes their blood extremely acidic and they get super dehyrated and can die without treatment pretty easily. I honestly didn't believe her at first, since most people in DKA are lethargic or breathing rapidly- until I looked at her triage paperwork and saw that our meter only read her blood sugar as "HIGH" which means it's over 650- it should be under 100.
At that point I freaked out and started looking for a line- naturally she had no veins and was terrified of needles, and all the IV badasses were in on a code so I was pretty much screwed for a while. I started putting the girl on the monitor and was asking her questions like when did she take her insulin last, how had her diet been, etc. Yeah. Um... Insulin.. let's see.. about 5 days ago? Diet... yeah... that's something she's "working on". It's pretty much cool except for the sodas. The whole time she and her brother are giggling about the kind of sweets she has eaten to get herself in this state. I finally get a medic in the room, who still can't find a vein, and we finally have to get a doctor to start an IV in her neck. Naturally, she's pretty upset about that- the whole time her brother is practically leaning over the doctor's shoulder because he "loves stuff like this". As all this is happening, I look down at her allergy band and see that it says "insulin". Dude. What. The. Fuck. Insulin? Seriously?
Yeah. So, apparently, she's allergic to it, but she takes it anyway, but it makes her "swell up, and feel worse that when she doesn't take it"? I specifically ask if it has ever caused any respiratory issues. No. So, the doctor orders fluids and regular insulin, another nurse goes to get it and asks about allergies first, to which she now replies she is allergic to insulin, but only regular insulin, and when she takes it she can't breathe. So we have to get a glargine drip from pharmacy, which naturally takes forever- in the meantime, we get her blood sugar back from lab- yeah. 930. I nearly peed myself.
When I go back in the room to get another tube to the lab for blood sugar, I tell her mom that she's gonna probably go to the ICU, to which the patient replies, "yeah, that's what they did last time." Really? Are you retarded? Apparently the first ICU trip wasn't enough to scare her straight. Her mom, rightfully so, was totally pissed. She's begging me as I draw blood out of her daughter's neck, to explain to her how serious this is, that she could lose her kidneys and vision. All I could manage to say was yeah, and you can die from THIS. NOW. All she could do was blink at me.
The last trip to the room, there were literally about six of her friends standing around asking me how old I was, could I get her some water, when was she going to get a room- all the time while I'm trying to collect blood, get vitals, and give meds. The whole time, her brother was standing in the doorway taking pictures of her for Myspace. It was all I could do not to smack them both. I just wanted to drag her out of the room and take her on a tour of all the diabetic patients we had in the ER that day- the missing toes, swollen legs, dialysis patients- HIPAA kept me from teaching a valuable lesson, damn it.


  1. You express yourself so well in your writing. I understand the frustration - your pt and her family sounded like idiots....typical frequent flyer who causes their own problem type idiots. Get used to it...there is an abundance of them out there.

  2. I had a pt the other day BG = 1029..."Um I'm hungry is it cool if my man brings me some pizza?...seriously?