Monday, May 31, 2010

Is it bad

When you're going over your Facebook status updates to see if it's okay to approve your priest as a friend, and you notice that about 80% of them are about drinking because your job is terrible?
Yeah, I kind of thought so.

Thursday, May 27, 2010

You know...

I really, really do feel sorry for the one person in the world who is actually allergic to Demerol, Morphine, Fentanyl, Stadol, Toradol, Motrin, Tylenol, Ultram, and Darvocet. Because the thousand people that are "allergic" to all of those drugs are the hugest douchebags in the entire universe.

Saturday, May 22, 2010

Lazy Douche County EMS

OH MY GOD. I swear, you guys. I generally feel for EMTs. They have to wake up from their sleep to saving lives immediately. I could not do that without pulling through Starbucks first. They have to carry ginormous fatties down flights of stairs. I most definitely cannot do that. They deal with foolishness just like we do. But damn. I'm sorry. There's a difference between doing everything you can, even if it isn't enough and being a lazy douchebag. And I can tell the difference.
The hospital I work at services a pretty big area- we service the southern part of a big city and all the po dunk counties in the 20-30 mile radius below it, as all the hospitals that used to be out there got closed down because they sucked. I have no complaints about the po dunk EMTs. They generally work hard and actually know stuff about the patients. My only complaint might actually be that they do a little too much- some of them are a little IV and med happy- but I would never actually complain about that.
Big city EMTs are another story, however. Half of them are pretty good, but just seem beaten down by life in general. The other half are lazy, self important ass clowns, who do nothing for the patients. I have nearly lost my shit on at least 3 crews in the last 2 weeks. The first was a crew that brought in an older lady in respiratory distress. They miraculously started an IV (+1 point) and hung a fluid bolus (-2 points, as the lady was a CHF patient who couldn't breathe), but that's really fine. Whatever. I had no beef with them at that point. My problem came when me and one of our externs were starting a catheter on this lady and one of their dumb asses tried to start walking through the door and the curtain. Take a hint, bro. You don't belong back here at this particular moment. We don't know who it is, so I just yell, "Hey, give me 5 minutes or so, I'm starting a catheter." This idgit just stands there halfway behind the curtain. I call out again. "Can I HELP YOU?" Continues standing there like a moron, then asks me what I'm doing. Putting in a catheter. I just f-ing told you. Holy balls. He asks me how long it's going to take. Really? Really? Finally I ask who it is. "Unit such and such. I just wanted to see if she was responding to the BIPAP." We JUST told you to wait, about 500 times. Are you slow? Get the hell out of here. NOW.
So a few days later, I'm sitting in triage, and a crew rolls in with an ambulance to triage. I am in the midst of triaging a patient when one of them walks in and sticks a toughbook in my face trying to get me to sign that I received report. Bitch, please. First of all, get that shit out of my face. I am in the middle of something and interrupting is rude, yo. Second of all, did you give me report? I don't care if the patient called you and asked to be transferred to the ER for a stubbed toe, I am not signing that I assumed care until you tell me at least some information. For all I know, I could be signing that I assumed care of an effing CPR in the waiting room. I wouldn't put it past you. They then gave me a half assed report and acted as if I was an uber bitch for even wanting one. Whatever bro. It's my license. Suck it.
I think it might have actually been the same two dudes that I nearly punched tonight. Douchebags. Seriously. These turds roll in with this young guy. They start blurting off report at the nurses' station to no one in particular about how the dude had just gotten surgery at the county hospital 3 days ago, and now he has severe abdominal pain and distention. Might I also mention that the county hospital is at most 15 minutes from us, and that it was about 4 in the morning, and this crew ran no other calls to us the rest of the night. The ER doctor straight up asks them, because she is sassy and awesome and doesn't care, "Why didn't you take him back where he came from?" Donger EMT immediately gets indignant and starts talking to her like she's stupid. "Um, because his house is like, right there." SO? "Well, he didn't ask to go there." Really? Maybe because he was writhing in pain on your stretcher? And if you had him any longer, you might have had to do something? It's not like they were worried about his medical stability, or they might have started an IV. They did manage to put him on a backboard for some reason I could not ascertain. When I asked, their response was "Well, I mean, he doesn't need it, but it like, made it easier to move him." Fabulous. They don't help me clear him from it, though- they do get coffee while I the patient cries and hangs onto the IV hanger from the ceiling and I pull the backboard that's twice my size out from under him. After I do that, hook him up to a monitor and am starting an IV, the less douchey of the two comes in and sheepishly asks if I need anything else. Um. No. Not now, but thanks. Shoot. At least he asked I guess. So. Naturally the guy's belly is full chock full of blood and he can't answer any questions about his surgery or who did it. And shocker- we transfer him to the county hospital in a matter of hours. And a private ambulance company has to come pick him up and take him 15 minutes down the road. Awesome. Great use of resources, guys. Strong work. The best part is, I'm reading the run sheet, and after the whole showdown with a doctor they added some bullshit note that the patient insisted on being transferred to the nearest hospital. Lying bastards.

Wednesday, May 19, 2010


The last 2 shifts I worked I've managed to end up in fast track and triage- good lord. People are absolutely batshit crazy. I know I sound like a broken record, but I don't understand these people's reasoning. Like at all.
Night before last, 2 early 20 something girls check in together, both with their various vagoo problems- girl 1 thinks she has a yeast infection, but "wants to get a good exam" because she had a baby 11 months ago and it's been a while since anyone looked at her cat, so 2 AM on a Monday in the ER is a good time to do that, I guess. Her friend, girl 2, wants some bullshit low abdominal pain checked out and oh, by the way, she also hasn't had a period in a few months and might be pregnant. Shocker- she is- also she is my age and is on pregnancy number 4, ladies and gentleman. So they both get in line for their respective hoo-hoo exams- at this point girl 1 is only complaining of "slight vaginal itching"- I go in to bring her to the exam room and she's snoring. I try to wake her up. Nothing doing- not a surprise, as she wouldn't stay awake through the nurse or the NP assessment to provide her own damn medical info, either. So, we skip her ass and go to girl 2. She gets her business done, as well as some blood work, and chills in the room. I go back in and give girl 1 a second chance- after shaking her a couple times, she finally asks if she can "pass" on the pelvic exam. Um. Sure. I tell the NP, who tells me she can't just write her a prescription without the test, that she needs to sign out AMA.
I go in and tell the patient this and she totally loses her shit. I am legitamately confused at this point. I ask her what she wants, and whether she understands that she can buy Monostat over the counter- she becomes indignant and informs me that shit doesn't work and she has to be at school tomorrow and her friend is probably already discharged because she just came to see how long she had been pregnant-girl 2 apparently knew she was, but lied about it because she wanted a sonogram. Girl 1 takes an angry lap around the ER and comes back to her friends room, where the NP is talking to her about her bloodwork. I go in to discharge girl 2 five minutes later and the two of them are screaming at the top of their lungs at one another- they are arguing about what STDs the ER will test for, and what you have to tell them so that they will run the tests you want them to run. I wrote the number for planned parenthood and the hospital clinic down for both of them and got the hell out of there before someone's weave got torn out. Holy shit.

So after that lovely patient encounter, I go up to triage for the last 4 hours of my shift, where a patient who was treated earlier checks in AGAIN for the same thing. She's got a legit history- gastroparesis with diabetes, which can make for some sick ass patients, but MAN. She is acting a fool. She starts out with her earlier straight-back-to-a-room worthy performance by rolling around on the floor of my triage booth, literally. I, like the compassionate nurse I am, continue writing and tell her to please get up and sit in the chair so I can take her vital signs. Bitch, please. You drove here and walked in here, don't try to act like you can't sit in a chair. She finally sits down- before I can even ask her any questions, she asks if she has to go back to the waiting room. Yup, but I'll get you some Zofran first. I don't have any rooms with nurses to cover them in back at the moment. At that point she tells me she has chest pain. It just keeps getting better! Any time I ask her questions she doesn't want to answer, she starts to gag and wretch and then forces herself to vomit. She then pants and looks to me for a reaction. At this point I go back to get her a Zofran but also to ask around about her earlier visit. I talk to the nurse who took care of her- apparently, she did the same performance earlier, for which the doctor planned on giving her a full cardiac and abdominal workup, and probably an admission. However- as soon as she got the Dilaudid, she asked the doctor to cancel the tests, and he obliged. Now she's back for round 2! No ma'am. I gave her the medicine and tried to throw her ass out in the waiting room- except by the time I got a blood sugar (400 oh no!) and tried to load her up in a wheelchair since now she became "lightheaded", the day shift triage nurse came in and bought the act, upped her acuity level and then brought her back to a room immediately (because what does the dumbass night shift nurse know? Nothing!). I made sure to tell her about the visit history when she returned from saving this girl from her critical vomiting- congrats, you just filled your last room with that crap. I'm gonna go home and drink a beer now, later.
Fast forward to last night, where I was apparently smoking the wrong stuff and agreed to pick up and extra shift. I naturally ended back up in fast track, where I immediately as given the gift of the husband who thinks his grown ass wife with a fever and a headache was extremely critical. The NP does a CT scan and gives her a pill. She calls a little later saying she's still in pain- no problem- I let them know that I have to get vitals first so we know what kind of pain meds I can give. I'm putting the blood pressure cuff on the lady's arm literally 10 seconds later and he tells me "She's hurting really bad. She needs something for pain. NOW." I let him know I'm taking her vital signs NOW and then we can give something for pain, like I said, 10 seconds ago, damn it. He then proceeds to tell me she needs a shot (the lady has an IV already) and then turns around and scolds his wife about how she needs to demand I give her a shot. She points at the IV and stares at him. I walk out in disgust. He continues this foolishness through the whole night, while his wife, who's actually very sweet, hangs out quietly. Then I get her discharge instructions- as expected, she has a virus, but her urine test also tell us she has Trichamonas- an STD. Ruh roh. If that isn't bad enough, his mom is in the room when we have to explain that one of them went and picked up an STD. By her reaction, I'm guessing it was him. Yikes. I would have liked to have seen that car ride home. Akward.

Wow. I'm really hope I get back to the critical area this weekend. Something about people who are actually at risk of being sick or dying makes for a lot less drama, surprisingly. I guess they don't have time for it.

Friday, May 14, 2010


Just a thought. If your patient has bad enough diarrhea that I can collect 500 mls of poo with the wall suction, maybe, just maybe, you should not give Lactulose daily. I don't know. I'm just throwing that out there.

Monday, May 10, 2010


Ugh. This weekend is just one more reason to add to the list of my pedi-patient phobia.
Saturday an ambulance rolls into my room with a little 5 year old boy in a c-collar and on a backboard. He's been out on the BMX track (at 5! what a little badass!) with his dad when he ran into a wall on his bike taking a hill too fast. He's whimpering a little and I ask if he's in pain. He says no. I ask why he's crying, to which he responds he's afraid we're going to laugh at him. I tell him that no one's going to laugh at him because he's the coolest person here. The doctor clears him and sends him for a head and c-spine CT.
I talk to him for a while as he hangs out and watches TV. He's pretty much the most adorable little boy I've ever seen- he's super tough but really shy and sweet, too. I start thinking about how I hope my kids act like him whenever I have them. He sits through his CT like the brave kid he is. Then we get the results back.
No bleeds. No breaks. But there's something there. A tumor. A pretty big one. Instead of giving him a popsickle and sending him home like I knew we would, now we're sending him to a pediatric oncology unit. I was completely crushed. I wanted to puke. I managed to keep it together for him and his parents. On his way out, I told him what a good job he did and how I wish he could show all our grown up patients how to act. He just smiled and blushed.
I know we're not supposed to take stuff like this home. But I can't leave it. I can't. I can't stop thinking about him. About whether he's gonna be okay. About how he's gonna do with the hell that he's about to be sent into. About why it's happening to him. It's so shitty. It's so unfair. How can all these horrible assholes who come in looking for drugs, who contribute nothing to anyone, who make everyone around them miserable and seemingly live forever, with no consequences, no pain, when this awesome, sweet little kid has brain cancer and is about to get thrown into at best, months of suffering, and at worst, death? Why?
I'm sitting here bawling wondering about how the two people who deserve it the least get diagnosed with brain tumors in the same week. I wonder how parents do it. I'm so sick over this and I don't even know this kid. How could you even get up every day when that was your flesh and blood, who you've known every day of his life, who is suffering or dying? It makes me absolutely terrified at the idea of having children.
All I can do is say a prayer for him. Hope that this accident is some serendipitous event that allowed us to catch it before it was too late. Because I can't see much sense in it right now.

For the last time.

Pardon my french, but I don't give two shits if you have insurance. Seriously. I don't care. I probably don't even know. The same thing is true for every other nurse in the ER, ever. At our hospital most of it comes in the form of," you don't care about me because I don't have insurance/ I'm a Medicaid patient" when the real problem is the patient is here for stupid bullshit and they don't need to get seen before all the little nursing home patients, also on medicaid, who are actively dying.
What pisses me off even more, though, are the ones that do have insurance and think they're entitled to some special treatment for it. They actually mention it when I triage them, like I'll send them straight back to the platinum club for people who have healthcare. Hospitals do not work that way. Or they think that they deserve a higher level of care because they're insured, like the lady who I discharged at shift change today. She was completely beside herself because she said that she'd been "just left in the room!" mind you, on a monitor, with a call light in hand. She claimed no one had come in and talked with her about her test results, which is a legit complaint- even though I had just gotten on, I apologized profusely and explained her results to her- the she was short of breath because she had COPD and was a smoker, and that we had gotten negative test results for cardiac problems of pulmonary emboli. Still not satisfied. I apologized again, and told her that the nurse may have had other very sick patients that needed her constantly, etc. She continued to be rude as hell to me, and then went into a tirade about how she deserved better treatment because her father and sister had a whole lot of money in medical bills paid to this hospital.
REALLY? First of all- if you have a history of blood clots (which she did) and are so anxious about it that you're furious at the staff for not immediately telling you you didn't have one when your test results came back, maybe you should QUIT EFFING SMOKING. Also- do you really think we have a way of knowing that your family were also patients here? And more importantly, do you really think we care? In case there was any confusion, my number one concern is taking care of the patients who are sick and actually need me. I owe them that, because that is my job. My job is not to fluff pillows and give extra accommodations for people with insurance. Consequentially, I don't owe you shit.
I really think entitlement is the biggest issue ever for me. Like, it makes me enraged. I have insurance. I work at the ER. When I broke my hand last year, I did not come in through the back. I walked into the waiting room and signed in. I waited my turn to be triaged. When the nurse recognized me, he brought me to a room, but if he hadn't, I would not have cared. If someone is sicker or has been waiting longer, they deserve to go first. Insurance or no insurance.

Wednesday, May 5, 2010

I must have missed it

But apparently it's now acceptable to urinate all over a stretcher if you're being discharged for your 3rd "Seroquel overdose" this week alone, and the nurse woke you from your sleep and "scared you", even if doing so means that you, a grown man, has to commit to pissing your pants and then sitting in the waiting room without a ride in your same pee pants. Sweet. Happy nurses week, everybody!
On a related note, if you happen to be in the market for a bus pass, pissing your pants out of spite is probably not the best way to achieve that goal.

Sunday, May 2, 2010

Beautiful, terrible

Last weekend, as things were finally starting to get together, a middle aged lady checks in. She's been having some neck pain for some time now, and just can't seem to shake it. She's been going to her primary care doctor, but nothing has seemed to help. The doctor orders a couple of tests and some pain meds. Pretty routine ER stuff.

Then the call comes from the radiologist. They found a tumor- a massive one- on the lady's brain stem. Pretty grim diagnosis. Everyone kind of freaks, the charge nurse and the doctor are calling around to try to get the lady into a hospital that has a neuro ICU. The doctor goes in and delivers the news. We expect disbelief. Tears. Hysteria.

Everyone is a little dumbfounded when this isn't her reaction. She smiles, and says "It's alright! I'm just glad I know what the problem is. I've got the Lord in my life. I know I'm gonna be okay." We get the transfer in order, and she leaves peacefully, waving and thanking the staff.

Wow. That's real faith. A lot of us say we believe in God, but to believe in him enough to face a death sentence out of nowhere and still be completely unshaken? To leave for the neuro ICU via ambulance with a smile on your face? I'm certainly not there.
I've talked about this a little before- being here really shows you what people are capable of. And not usually in a good way. Usually I see the selfishness and cruelty people are capable of. The stupidity and ignorance and the most disgusting kinds of manipulation. I wish I could adequately describe what it feels like when through all that, you see the best of what people are capable of. It's almost like a punch in the stomach. It absolutely takes your breath away. I'm still crying thinking about this woman. I usually feel pretty good about myself compared to all the awful people. But putting myself next to someone with a heart this pure, it's pretty humbling. It's a pretty good reminder that I'm not so great, and I have a lot of growing to do before I can be anywhere near as awesome as some of the patients I take care of.