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.


  1. Awwwww, sending a hug your way. I can definitely remember those days, don't get them too often anymore since I work in a different area, but remember how much they sucked. Hope you can get some time off to recuperate from that night soon!

  2. wtflip! I am supposed to work in 2 hrs and now, thank you, I am EXHAUSTED from reading your blog entry! Thanks! =^@
    Ya, I remember those days. Thankfully, I don't have too many of those nowadays and at least I don't have to deal with the physical presence as you do... :(
    Hope the bottle of wine I am sure you had to have after work helped. :)

  3. These kind of patients do make you want to kill yourself or at the very least pound your, or thier, head against the wall. Not exactly like ER on TV is it?

    I have to say you are really funny, especially, "reconnect patient to monitor for 100th time", "wait til patient finishes braiding her hair".....we have all been there. I love the blog.

  4. ho. lee. cow. man, that was a killer shift. ditto cartoon characters, i got exhausted reading that as well. ER nurses rock man. no icu shift i've ever worked has been that hard.

  5. I admire that you're still willing to go to work after that night. Last time I had a shift that bad I called in sick as I pulled into my driveway that morning just so I wouldn't have to go back to THAT. Upper Management has no idea...
    I love your blog; thanks for sharing.