Saturday, November 27, 2010

I mean, really

Sometimes I just wonder about the fate of humanity and whether at some point we aren't just going to devolve to the point that we're so stupid that we just run off a cliff in mass like effin lemmings.
Nights when people do things like come in on an ambulance drunk for knee pain they've had 5 years. When this man was automatically discharged by the ER doctor for being foolish, he then refused to leave the room because he claimed he couldn't walk on his knee, despite the fact that EMS made him walk in from the ambulance bay, where he was walked to triage and back from triage to the room in which he was currently sitting. Yeah, stuff like that.
Or when people call the hospital operator threatening suicide from the telephone in their family member's rooms on the med floor who then proceed to assault the staff responding to the call attempting to help them. This fool acted so crazy that medics responding to the call couldn't even get him on a stretcher to get him down to the ER, so the police had to cuff him to the recliner in the room and push him into the elevator. When he finally got downstairs, about 5 people had to sit on him in addition to the cuffs and ankle restraints to keep him from punching, headbutting, and biting those of us trying to get vital signs.
Don't let me forget the people with absolutely no clue as to their family members med history. I'm not asking for everyone's family member to be a doctor or nurse, but basic comprehension of how any human body might work would be nice. EMS brought an unresponsive lady last night- apparently when they asked family if they knew anything about medical history, this is seriously what they came up with and put in writing:
"She had some fluid on her leg due to depression.
One time B4, she fainted once about 6 yr ago."
Um, no. I don't think that's it at all.
Or how about taking out your own IV, running from the ER, and attempting to stop the bleeding with the surface wipes that say "NOT FOR HUMAN SKIN" on them in giant red letters. No, that can't be good on open flesh.

Oh, and I nearly forgot possibly the winner for dumbest person of them night. This is a real conversation that someone had on the phone with one of our clinical secretaries:
Secretary: Hello, this is hood hospital, how can I help you?
Patient:Yes, is Mary (another secretary) there?
Secretary: Um, no sir.
Patient: Well, is big bulgarian doctor there?
Secretary: Sir, we can't disclose that information for security reasons.
Patient:But I'm a regular patient there.
Secretary: Sir, this is an ER, not a doctor's office, there are no regular patients here.
Patient: Well, see, I'm in (city on the other side of the US) and I'm pretty sure I'm passing a kidney stone.
Secretary: Well, sir, we can't really do anything for you when you're on the other side of the country. You'll have to go to another ER in the city you're currently in.
Patient: Oh. Well, I'm low on gas. But I'm in a lot of pain. Do you think I should go in?
Secretary: Sir, I can't make that decision for you.
Patient: Well, I'm just really low on gas.
Secretary: I'm sorry to hear that. Good luck. Go somewhere in the city you're in.

Yeah, wow. Lord help us.

Monday, November 22, 2010

The Reverse Midas Touch

So I ended up with what I call the Gomer rooms last night- the rooms where all the super sick thousand year old nursing home patients and the super sick non compliant frequent flyers always end up- add to that a full moon and the fact that I am a compete and utter shit magnet and wowzer. Literally everyone I took care of today seemed to be on the express train to FUBAR.
My first patient as the clock struck midnight was the sickest DKA I've ever seen- and I've seen a lot of DKA. She was breathing about 40 times a minute when she came to my room, and her eyes kept rolling to the back of her head like she was about to stop breathing... yeah. As soon as I hooked her up to cardiac monitoring I could actually see on her strip her potassium was going to be stupid high- the final count was 7. Yikes. It took eternity to get an IV on her- I was finally able to stick a neonate needle in vein right above her wrist joint. About half a bag of saline and some IV insulin she started looking like one of the living again, but damn.
A little before I shipped her up to ICU with her insulin drip and a myriad of other shit, another lady, this one in her early 70s rolled in with difficulty breathing and chest pain- not an uncommon sight where I work- didn't think a whole lot one way or the other. Her vitals were probably better than mine but she appeared pretty distressed. I gave her oxygen, which helped her, and did an EKG, which looked fine as well. We sent her for a CT of the lungs to rule out a blood clot- and ohhh wow. She had a GIANT saddle pulmonary embolus. Enormous, like, miraculous you're still alive embolus. We had to give her blood thinners, but she was already anemic from chemotherapy so I also had to give her a blood transfusion. Yeah. She made it to the next shift alright but I'm curious how she'll do later on.
So the last guy I get has poor circulation from diabetes and a yeast infection to his junk. Yeah. He sure did get his foreskin stuck over his glans so tight that he couldn't even go pee. We had to give him moderate sedation to even attempt to put a catheter in the poor guy, and even that didn't work. He was super nice, and a very good sport about the whole thing- they left the whole mess in the hands of urology as I was leaving.
Well, I'm pretty sure I'm just cursed.

Sunday, November 21, 2010

Quoth the patient part 2

"Are you gonna start that Tramadol drip on me now?"
Ma'am, that's not a thing.

Thursday, November 18, 2010

Thank You, FDA

Just saw on the news today that the FDA is banning Four Loko. I would just like to say to them on behalf of all emergency medical personnel, police, anyone who has ever driven after 11PM, and people with annoying-ass friends who can't handle their booze, thank you. Thank you for saving me countless hours of chasing some idiot asshole around the ER because he is drunk and strung out on caffeine and thinks he needs to fight everyone. I mean, really, a tall boy sized can with the alcohol content of wine and more caffeine than a Red Bull in fruity flavors sold for 2.50? Whose idea was this, the creator of bum fights? I'd like a personal apology from this person issued to all night staff at hood hospital, stat double stat. Thanks.

Tuesday, November 16, 2010

Quoth the patient

"I want some more of that pain juice in my IV."
Yeah, I bet you do.

Saturday, November 13, 2010

New Most Favorite Blog EVER

I know this relates to customers in a comic book store, but I'm kind of jealous I didn't think to illustrate my ridiculous patients and the things they say first. Nonetheless, the parallels are amazing. Funniest thing you'll read all year- Our Valued Customers.

Monday, November 8, 2010


Well, I must admit I've been super lazy as of late. I haven't been to work since my last post- been doing some traveling and then just chilling at home this past week, as I seem to have taken a ton of time off in the summer while I was sort of hating what I do. As always, I've been utilizing my time very wisely by watching lots of TV shows with my husband, one of which is The Walking Dead. If you haven't seen it, I very much suggest you watch it- it comes on AMC and I believe the pilot is up for viewing on their website. That being said, I don't know if I can keep watching it.
My husband loves zombies- he's actually been reading the comics the show is based on for years. Me, yeah, not so much. The whole idea of a post-apocalyptic world really, really upsets me. Not just zombies- natural disasters, terrorism, disease...yeah. I want to throw up thinking about it. I can't even really verbalize what it is. I think a big part of it is the inhumanity that comes with living in a lawless world and how much it challenges the things I want to believe about the human race- I think it's mostly the idea that I would have to become that in order to stay alive.
We did this stupid computer module when I took community health to help us learn about bio-terror and nuclear warfare. It's probably the most vivid memory I have of nursing school, because it bothered me greatly. It upsets me to think about it even more now that I work in ER. In the scenario they gave us, you have to triage patients that are victims of a nuclear blast using the disaster triage system. In the everyday world, we use a system where the sickest patients are seen first, and the healthier patients have to wait. Where I work, we assign them a number based on acuity- those who are actively dying or who are very at risk get a level 1- it goes down in acuity to level 5. Disaster triage works by color- red, yellow, and green from worst acuity down. But in disaster triage, the patients who would be a 1 or sometimes even a 2 at hood hospital would get a black tag. You even physically place a tag or write on the patients in these scenarios. In most situations, this would pretty much mean you just won't do CPR, but in this particular module you had patients with obvious radiation poisoning who you could do nothing for, but they were still talking to you. Cute little old people, in fact, who were crying and asking what was wrong, but as the module points out, you don't have time to explain or hold their hand or give them a hug, because you have a waiting room full of hundreds of other people you might be able to save- you just put a black tag on them and walk away. I was in tears. Like, lots of tears.
All these situations also face you with the inherent question- would you stick around your job or come in to help, or would you get the hell out of there? Most of these scenarios put you at a great risk as a nurse, be it exposure to radiation or disease or violence from the inevitable chaos. It would almost certainly mean not knowing what has happened to your loved ones. This is a question I pose a lot to people over beers, and almost everyone I've asked say they'd try and get out alive. I can't say what I'd do for sure, but I would like to think I'd stay. Partially because I feel it's the right thing to do, but I'd be lying if a big part of it wasn't the fact that I would probably rather die than try to fight to stay alive in a world like that. I think I might be at peace with the possibility of risking or giving my life to do the right thing. Even in doing the right thing and getting out alive, I know I would have to go against every principle that's natural for me as a nurse. The experience would probably scar me for life, but I hope I would have the courage to stay.

Unless it's zombies. Then I'm getting the hell out of there, cause I'm not trying to get eaten by undead. But I'm curious, internets- what do you think you'd do?