Friday, August 27, 2010

Totally badass

So, I think one of my weaknesses at this job is going along with the fuss a lot of people make about their medical conditions. A good deal of the people I see are being treated for problems I've had before- sprains, breaks, gastroenteritis and nasty upper respiratory infections- mostly at home with zero drama. When I have to deliver morphine for something that turns out to be a stomach bug or send someone home with Hydrocodone, but apparently not enough, for a sprained ankle, I kind of want to punch something. Bitch, please. Suck it up.
But lately. Wow. I've taken care of a couple of people so tough and badass that all I could do is sit back in admiration.
We had the adorable young stabbing victim. He was on the way to the bar when a guy flagged him down in the road. He said he normally wouldn't have stopped but that the guy had his kids with him and he wanted to help. He picked the man up to bring him somewhere for help, and the man stabbed him in the stomach and ran off. This guy drove himself home about 10 or 15 miles, where his sister then brought him up to the hospital. He probably had a good 4 inches of intestine sticking out of his abdominal wall. He didn't scream or cry. He strolled in casually where we brought him back to a trauma room- the only fuss he made at all was when I had to start his two 16 gauge IVs- and by made a fuss, I let him squeeze one hand while I started the IV with the other and he looked away. He never once asked for narcotics, but he did want to know what kind of antibiotics he was getting. He was a little nervous about getting transferred for surgery. He looked at me and said "Can't you just push it back in there?". I laughed and told him that he probably wouldn't want it done that way. He smiled and said,"No, it's cool. Just dump some of that hand sanitizer you guys use on there. It'll be fine." Hilarious. I was sad to see him go.
I took care of an older man recently who had fallen off his roof at about 6 that night. Not doing anything stupid like lots of our patients, just trying to clean the gutters. He fell about 10 feet but he stuck it out at home and tried to take some Aleve. He came it at 1 AM cause the pain got worse. I was pretty freaked out that he had broken something important or had a traumatic injury to an organ, yet he was incredibly patient about waiting to see a doctor and very sweet and funny. I got him some Fentanyl and we x-ray and CT'd just about everything- nothing life threatening going on, but homeboy had broken off a chunk of his scapula. Yeah. It was just floating around in there while he was chilling at the house with his OTC pain meds.
Then last week. I took care of a lady with a Hemoglobin at about half of what it should be. I asked her if she'd be feeling dizzy or weak. Yeah. For a while now. But she was trying to get in a clinic. She didn't want to come to the ER and bother anyone. Was a little freaked out about getting transfused. No, it's fine. I'm really okay as long as I'm lying down. It's been like this three weeks and the only time I wanted to pass out was going up some stairs. I talked her into the transfusion and finally got her upstairs to a bed. She'd been a hold in the ER most of the night with zero complaints.
I realize it's a little extreme. But I love patients like this. There's something very refreshing about taking care of people that actually belong in the ER, but it's even more refreshing when you can tell that they don't even think of treating the ER like a Starbucks. I wish there was some kind of medal of honor I could give them so that they could go out in the community and be like, "Yeah guys, look at this. I had a legit painful illness but I handled it like it was nothing. I'm a badass, fear me." At least I get to give them IV pain meds. I guess that's the next best thing.

Sunday, August 15, 2010

Oh, summer.

If I ever get crazy enough to go back and get my masters, I think I may do some kind of study on the kinds of patients the ER sees in the summer time versus the winter.
We're hardly seeing any respiratory distress right now compared to the winter time- in February, we actually ran out of ventilators. Someone had to hop in their car to drive to our sister hospital and pick one up. The ICU was full non stop- no doubt the result of winter illnesses gone horribly wrong.
Summer is a whole other set of fuckery. I would say slightly less challenging and slightly more entertaining, although sometimes I'm just done with this shit. I mean, really. What is it about high temperatures that make people stab one another ALL THE TIME. And if you have to stab one another, okay, but please don't come to the hospital to see your boyfriend when you were the one who put him here in the first place by stabbing him, and then try to talk crazy to the ER staff when they ask you to leave because you were the stabber, then try to sneak back in after you are asked to leave only to get more crazy with the ER physician, who then has no other choice than to put you in a headlock because you can't act right.
Also- I like to drink and I know plenty of people who enjoy drugs. Please enjoy these activities safely in your own house and refrain from coming to the hospital like a normal person so I don't have to try and start an IV on your stupid ass. I have more important things to do, like taking care of all of these stabbing victims.
Another note about alcohol- drinking is fine, but if you're going to do so, please refrain from doing it on or around your roof. Just stay away from the roof altogether. Roofs and booze are mortal enemies and you should keep them apart at all times. If you really need to go on the roof, when you inevitably fall off, this is a time when it is appropriate to call an ambulance. Because when you come to the hospital in the back of your friend's SUV, and we have to go get a stretcher and climb in the car and try to cram one of the backboards EMS left here under you while we hold C spine and you scream at us, that's a whole thing and it would be a lot easier if you let the medics do that in the first place when you're on the ground and not in the back of a car.
At least I'll get away from it all today. Yes, dear blog readers, I am finally taking a vacation. I am going to rent a house with friends, drink for a week and float down a river. I think I'll manage to stay off the roof, refrain from stabbing anyone, and stay out of the hospital. If not, I may be gone for a little over a week.

Saturday, August 14, 2010

Yeah, I know we're not supposed to judge.

But I'm just gonna come out and say it. If you're my age (24), on kid number 5, and you can't refrain from coming to my ER with sobbing with a blood alcohol three times the legal limit- yeah. You've pretty much failed at life so far. Especially when you do this often enough that your mother in law has to take care of your 5 kids full time, yet you can't hold your booze enough to not try and jump out of the bed non stop to try to hit me in my face.
I will humbly clean up your piss and gently tell you stop whenever you try to crush my fingers because I'm trying to make sure your circulation still looks good after the soft wrist restraints I had to put on you. But in my mind, I am totally thinking you're an asshat. Yeah. Sorry about that.

Thursday, August 12, 2010

Follow up: WTF/ face punching day

So yeah. I promised a follow up to the last post and I'm approaching some nice time off, so I figure I should stop being lazy. As I'm describing probably my second worst post intership shift ever, second only to ICU hold hell fest 2009, I'll at least make this fun by breaking it down hour by hour and pretending this is an episode of 24.
1900- Get stuck in the break room before shift listening to the same shit on repeat from management about how much we collectively suck and how our blood cultures are contaminated. And how there would be lunchmeat and bread sitting out for hours the next night to celebrate the fact that we've enacted an inefficient and expensive system in order to improve an arbitrary statistic that our VP is concerned with for some reason- Hooray!
1910- Walk out to get report from dayshift to death glares, even though we are late due to management's tomfoolery. Figure out that I am now responsible for transporting a patient upstairs who has had a bed for an hour and a half. Cool, whatever. Finish report and get my affairs in order.
0730-Transport said patient upstairs. While pushing patient into room, I drop the chart at the closest nurse's station where, from what I can tell, two able bodied women are sitting working on computers. Neither of them comes into the room to help me, but one does ask me to transport the chart to a different nurses station after I get done transporting a patient. I reply that I'll get on that in a second and continue helping the patient to the room. I get her fixed up and come out to find that one of the ladies has managed to stand up and pick up the chart themselves-amazing- I take the cue and book it down to the ER. One of these turkeys follows me and starts to chide me about how she doesn't appreciate me rolling my eyes at her. Really? If you have time to be worrying about something like that, you clearly have too little to do up here. I shake my head and continue walking, to which she responds, "I'm not done talking to you". I reply, "Really, because you need to stop." She asks me my name. My head turns around like the exorcist at this point, and respond with my name and offer my charge nurse's number. She then tears into me about how unprofessional my behavior was, how rude it was to walk away from her, how she has a witness to my eye-rolling, how she is my customer, and how I should stop using closed body language. What a freak. I managed to hold back the urge to curb check her crazy ass, and asked what she wanted from me. An apology. Okay. I'm sorry that my face upsets you and that I have patients down in the ER and I don't have time to stand up here and chat with you about body language. That's all I have to say to you. This is the closest I can get to a semi amicable resolution and I get the hell out of there before this drama queen can suck me into any more of her bullshit.
1950-Standard work stuff- I help my sweet hyperkalemic patient on and off the bedpan approximately 1,000 times while dodging the 13 family members in the room- I don't mind because they're cool and I fundamentally disagree with catheters for convenience, but it took up quite a bit of time. I run in and out of there to help my teammates, and my charge nurse brings me a schitzophrenic patient with chest pain. I deal with the standard business with him, but it all takes about 3 times longer as he can't follow simple commands because he refuses to take off his headphones. Awesome.
2030-I come out of chest pain room to find two hall beds- a little boy with a painful rash and a lady with pink eye, which she apparently obtained when someone threw urine in her face.
2035-Medicate cute little hall bed boy with Tyelenol with codeine. He proceeds to dance about in the hallway.
2045-Take a million telephone orders on my hyperkalemic lady, then proceed to do all of said million orders while chest pain man drifts in and out of conciousness asking me for pain meds.
2120- Get out of room after drawing labs and administering tons of meds to find my hall people's discharge instructions ready and urine lady standing at the nurses station yelling at us to hurry our asses up because her ride was here.
2125-Take vital signs and give the most thorough discharge instructions I have ever given for scabies for the little boy in the bed next to hers. No, I don't reward bad behavior.
2135-Discharge rude ass hall bed lady with pink eye, who then swears at me and tells me it's impossible for her to have pink eye. Explain to her about 4 times in a row what Norco consists of. Mmkay. I don't even need to see your ride sweetheart, just get out of here, now. Seriously.
2145-Admitting doc comes down to see hyperkalemic lady, several more bathrooms trips ensue, a couple more hallbeds filter in and out.
2230-Admitting doc finally gets me my chart back and I work on getting my lady upstairs. I call report and go in to do her now labs before I ship her up. All the lady has is a field IV- I've actually attempted to start another IV to help out the floor nurses with zero sucess. No problem, I tell the floor nurse, it draws great and maybe she can get a PICC line in the morning or something. I'll draw everything she needs now so you don't have to fool with it. I go to draw the labs and get nothing. I fanangle a little. Nothing. I go to flush it. Infiltrated. Fuck. I get super awesome charge nurse on the case along with one of our medics, but she has nothing. I mean, not even tiny hand veins. It's a complete nightmare, because the woman is an absolute saint about it, and her poor husband is hovering over us watching and commenting on our every move, talking non stop. She is actually in tears by the time we can start another line- a neonate size in her thumb. I'm about to be in tears with her.
2320- Poor sweet hyperkalemic lady finally goes upstairs. I call and update the floor nurse.
2330- I discharge headphones and prepare for the A -raping I know I'm about to endure. No patients in the waiting room to fill up with, a couple more hallbeds cooking, I help my teammates, I wait for my ambulance....
0010...and it comes. With my super sick but still awful frequent flyer with a blood pressure that would have made me faint earlier in my career. She screams and flails about on the bed while I attempt to collect her medical information. She doesn't have a primary doctor. Excellent.
0030-One of our awesome medics manages to get a tiny IV in her hand after much screaming. Being super sick apparently did not make her accustomed to this sort of thing. I feel bad for her, until...
0040- I go in to give her medications and she is now in no apparent distress and unwilling to get off her cellphone to verify her name. I shouldn't even say that I don't feel bad for her at this point, because I do. I'm just annoyed. Reconnect her to the monitor she has taken herself off of.
0110- Realize I'm getting cranky and try to drag myself back to eat some food.
0115- Get a call for critical labs for my patient. Run to report them, run back to finish my "break".
0130-Finish my break, run up to draw blood for a type and screen for my patient who now needs a blood transfusion, with her 24 gauge IV. Good luck with that shit. She refuses to let me draw it until she finishes braiding her hair. Fabulous. Attempt to adress her blood pressure with minimal success. Reconnect her to the monitor she has taken herself off of AGAIN.
0150- Get another ambulance carrying a man with approximately 15 complaints, missed dialysis twice in a row now, with high blood pressure, diabetes, no meds, no doctor. Starts by complaining about what a douchebag the dialysis doctor is for not prescribing him medicine. Screams at everyone for pain medicine whenever we ask for any sort of information/cooperation. Falls asleep with an open mouth snore during the doctors evaluation. Gets Asprin and Nitro paste for his chest pain.
0215-Get about one thousand calls from my other patient about how much she's itching. Explain to her that she's already maxed out on Benadryl and there's absolutely nothing else I can do for her. Offer her non pharmacological relief for her itching. Get stared at like I just said the dumbest thing in the history of humanity and watch patient scratch herself violently. Reconnect her to the monitor for the hundreth time. Explain the importance of keeping the oximeter on her finger for the hundredth time. Attempt again, unsucessfully, to try and fix her blood pressure. Argue with ER doc about how yeah, dude, she really really does need to get admitted. Yeah, I know she's here alot. She's sick.
0230-Run into the room of my screaming chest pain patient, who has now woken up from the loud snoring to-duh- excruciating pain unrelieved by Nitroglycerin. Tell the doctor. Reconnect my other patient to the monitor.
0240-Go in to medicate my excruciating chest pain patient to find him snoring and unarousable except to violent shaking-again. Leave room to write down the multiple critical labs I've recieved on him (apparently it isn't a good thing to miss your dialysis twice).
0250-Go back into the room to deliver pain medicine now that patient is awake and screaming.
0300-Reconnect patient to the monitor. Find her in room with admitting doctor, who talks to me like I'm an idiot because she's doing the violent itching act for her as well. Explain that she got the max dose of Benadryl to her approximately two hours ago and that I already notified the ER doctor. Am met with a blank stare.
0320- Leave the room to get more critical labs on my other patient. Get order for about 15 meds to correct said critical labs. Am running to get them when admitting doc runs into me to ask for some labs and meds on my other patient. I go to do that first because I want her out of here, STAT.
0330- Reconnect patient to monitor. Go in to draw labs out of this lady's IV with zero sucess. Attempt to flush IV. No dice. Contemplate suicide. I mean, this chick has nada for veins, and she's scratched out her tiny IV. I get a grown up nurse just to make sure. Yup. Grown up nurse attempts IV start is lady's foot and nearly gets kicked in the face. Much screaming ensues.
0345-IV badasses are assembled and attempt to fix this freaking nightmare. More screaming ensues. Patients blood pressure gets even worse.
0400-IV search continues and I walk out of room to keep from screaming. Take a few minutes of me time to avoid screaming and yanking out all of my hair.
0405-Go to give million meds to my other patient to correct his ridiculous labs. He refuses to wake up. I give his IV meds and his kayexalate, which he drinks okay with encouragement- then promptly spits it in my face.
0430-Finally finish with giving meds and wipe most of the kayexalate out of my hair. Walk in to more screaming and no IV. Hug and thank my teammates and go to have a pow wow with the admitting doctor about what the hell we are going to do with this woman. Baby ER doctor jumps to my rescue and offers to try and start an IV in her neck.
0445-Set doctor up for neck IV, stand at the bedside and hold the patients hand while saying a little prayer that this works so I don't have to run screaming from the ER. By the grace of God, he gets a wonderful line and all is dandy.
0500-Read through admitting doctors orders for something I can give to fix this lady's blood pressure. Attempt to chart all the fuckery that has ensued.
0515-Go in with blood pressure meds and Benadryl in hand to find patient disconnected from monitor, tugging at the monitoring cables and yanking the tubing connected to the precious, golden IV. Wait for patient to finish braiding her hair. Change the linens at her request. Reconnect her to the monitor. Tell her the good news- the admitting is giving you another dose of Benadryl- Hooray! Am met with more blank stares. Give boatload of meds.
0545-Get out of room to find my other patient has a bed. I didn't know he had orders yet. I whip through all the now orders and call report.
0610-Go in to recheck my lady's blood pressure with zero results. Give pain meds. Reconnect patient to monitor.
0620-Give more blood pressure meds. Reconnect patient to monitor.
0630-Chart, weep silently, attempt to wash kayexalate off my scrubs.
0645-Recheck blood pressure and reconnect patient to monitor. She has a bed now, too, but there isn't much I can do about it as her blood pressure is atrocious and they won't take her like that anyway, nor should they have to. Make sure her stuff is charted beautifully.
0700-Get paperwork in order and give report to dayshift. Get attitude for not fixing blood pressure with my magical nurse wand. Too tired to care.
0715-0900-Sit through mind numbing meeting adressing same topics discussed before this horrid shift. Eat an unadvisable amount of donuts.

Man. Even though I was taking mostly two patients with hall beds through all this crap, sometimes just two real rooms are enough to kill me. In retrospect I feel a little better- I'm thankful that I didn't get stuck with 4 people like this at once. But everyone has their limit. Apparently sick folks and tons of attitude was enought to push me to the line.

Thursday, August 5, 2010

Strong post to follow.

Listen, I need to drink and go to bed, so I can't really go into detail, but lets just say due the perfect storm of some personal fuckery, some super sick and borderline abusive patients, and PMS, I want to punch faces.
When you start your shift with getting into a verbal altercation with some douchebag floor charge nurse who is on some customer service board because she didn't like the way you looked at her when she asks you to bring a chart to another nurses station while you transport a patient and she sits on her ass, the night is not going to go well. Especially if what follows involves not one, but two patients with NO veins pulling out their 24 gauge thumb IVs literally right before you're about to send them upstairs due to foolishness. Especially if what follows that is some idiot spitting Kayexalate all over your face, hair and clothing right before you have to sit through a "meeting" where you're supposed to bring up your "issues", which actually means management is going to jerk off for an hour and a half while you make fun of them to yourself and snicker. And when you do try to bring up sincere questions, some day shift charge nurse turd tries to use it as an opportunity to be as condescending as possible towards you and to climb just a little bit further up management's ass.
Seriously. Sometimes I hate everyone and I just pitch my spectralink across the ER, scream back at the patients who scream at me, kick the piece of crap printers that never work with all my might, cuss out specific nurses on the floor and the ICU, and wield blunt fill needles in a threatening fashion.
It's a good thing I have self control. And champagne and orange juice in my fridge.

Sunday, August 1, 2010


It's been a rough couple of days and I may or may not be on the internets in the coming weeks depending on how I'm doing.  
However, my nifty visitor log did offer my one nugget of joy- this little device tracks where blog visitors are from and how they got there- apparently, somebody got to my blog the other day by googling "big busted nurses".  Nice.  
Move along, nothing to see here.