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.