Monday, February 28, 2011

Well, that must be nice

So, last night one of the brilliant and exceptionally run nursing homes in our area sends over one of their employees for some kind of arm pain or whatever, clearly some kind of muscle strain that somehow required EMS transport.
Anyway, so I'm talking to this lady as I go to medicate her and she's telling me how stumped she is that this has happened to her and she has no idea what could have caused it. I tell her that in our line of work with moving patients and such that it's pretty easy to strain a muscle and not realize it until later. So she looks at me kind of funny, scoffs and says, "I'm an RN. I don't move patients." Oh, well shit, that's right. No one the techs move the patients. Excellent. Strong work as always.

Saturday, February 26, 2011

Puppies and rainbows

Well, what can I say? I feel like I'm living in the twilight zone right now. After weeks and weeks of a-raping, we have now been clearing out our waiting room and lately even I, the queen of crazy douchebags, have been caring for nice patients. For real! Plus, my husband and I went to the shelter and adopted us an adorable dog that looks like a tiny lamb, so overall I am in a freakishly good mood.
I took care of a super sweet lady last night with a broken hip who actually thanked me for putting in a foley! Yeah. It was actually kind of sad since the fools on dayshift apparently hadn't been asking about the 3 P's or 5P's or whatever they are for the 4 hours they were taking care of her, so by the time I asked her what she wanted to do about the whole peeing with a broken hip issue, she was about to go on herself, but she was too polite to say anything. Poor lady. So I put in a catheter and actually talked to her about what the hell was going on and all of a sudden I was Florence Nightingale to these people. Before I took her upstairs, her son actually said to me, "You're a wonderful nurse. Thank you so much for taking such good care of my mom." Seriously. Just for doing my job. If all my patients were that way, I would do this job for free.

That's just how it's been lately. Both of my ICU patients last night gave me hugs as I dropped them off at their beds. One was actually my first experience with TPA, and it is pretty awesome. We got her within 2 hours of onset 0f symptoms and you could see the changes! She came in with slurred speech and right side weakness- by the time she went up to the ICU, her speech was clear and her right arm was at full strength. I was so excited I was actually jumping around her room at one point. I'm sure her family was all, "get this one some Ativan please", but I was crazy excited. I've never seen anything so cool. Just overall, very cool people for a couple of days. Even the floor and ICU nurses have been nice! I don't even think I'd be shocked if a little pack of cartoon birds and chipmunks and shit started following me into my rooms and helping me insert NG tubes and clean poop like I was Cinderella or something.

Yeah, I know that because of all this, when I go back to work triage tonight probably all of our frequent fliers will come in via vanpool and fake syncopal episodes or seizures in the waiting room. I'll probably get cussed out by 10 different girls for not taking them back to a room immediately for their pregnancy tests and coochie rashes, and their two-fer babies with 98.9 degree fevers and runny noses will probably vomit on me. I'll probably triage 8 to 9 combative drunk men with complaints that have been going on a year or longer, and I probably won't get to go pee until 3 AM and I'll go home to find my new dog has pissed all over my belongings without remorse, but you know what? It's worth it. If I get one day of awesome patients and 364 days or the other stupid bullshit, it's still worth it to me. I'm happy, damn it.

Thursday, February 17, 2011

Work absence FAIL

So, last night some fool checks in for elevated blood pressure- I guess 2 AM on a weeknight after you've been out all night drinking is as good a time as any to check in for the fact that you stopped taking your blood pressure meds months ago and you want a prescription refill. Yeah, okay.
His blood pressure was actually fine but the doctor was much more concerned about his drunkness so we kept him in the room for a while after he was discharged. At one point I was walking by his room to go do real work when he called me in to ask me a question.
Hood Nurse: What can I do for you sir?
Pt: Yeah. I need a work excuse from the doctor, for like, three or four days off or somethin'.
Hood Nurse: For elevated blood pressure that you've had for several months? Why? We're sending you home on meds, sir.
Pt: Well, um, like, my job is like, really stressful and I just don't think I need to be there while my pressure is high.
Hood nurse: Yeaaahh. I'm gonna have to talk to the doctor about this one.

At this point I have to know what he does that is so stressful and I look up his demographic info in the computer to see that he works for a carpet steaming company. Oh really. Yeah, that's gonna be a big negative on the three days off work, but thanks for playing.

Wednesday, February 16, 2011

"You're my valentine"

So, February has been as usual, a brutal beating in terms patient acuity and staffing ratios. This year, we seemed to have added to the mix a whole mess of cray crays, so not only is 3/4 of the ER full of hold patients that have been down there for two days, but hold patients that bite and scream and pull out their own foleys with their toes while in 4 point restraints (yes really).

It all came to a head Valentine's day when I was given the hold nurse assignment by a charge nurse who clearly hates me and wants me to die. So, they throw me back there and immediately give me report on 4 patients with out of control blood pressures and various other issues, then bring me two psych patients that are angry and have been admitted in the waiting room for 6 hours without having anything done. They force some poor floor nurse who has never been oriented to our unit to come down to help me- she's totally overwhelmed and has no clue how to use our computer system or our paper charting, so my manager is there trying to orient her while simultaneously interrupting my IV starts to ask me shit like whether she can put my name on the patient assignment boards. Seriously, woman, I don't care. You could put my name as Tits McGee on the patient assignment board and I probably wouldn't notice. Go home.
So, I explain to the first angry psych patient that no, we aren't going to give you Dilaudid, Phenergan and IV Benadryl for your pain you have in your abscesses that you got from shooting heroin, since you're at the hospital for opiate withdrawals and it seems counterproductive to give you a whole mess of opiates. Yeah, I know you're allergic to Zofran and that's what the doctor usually gives you, but he sure won't give it to you this time. Yup, I talked to him about this when I had the 2o minute conversation with him about how you needed to go for PICC line placement in the morning because you done killed all your veins, and the ER doctor who never saw you and did not admit you was not going to start a central line on you no matter how much he insisted. He didn't seem to get it but at least we got a 24 gauge in your earlobe in case we need to push code drugs. Yeah, here's a Vicodin, though.
My second angry psych patient can't move his arms due to a nasty episode of gout, so I hang upside down from the IV pole like Batman to start a line on him, get him medicated, happy, and upstairs- I sit down to chart and help the floor nurse with putting in orders and meds. I'm rethinking my choice of careers and feeling pretty much spent at this point. I 'm sick of working this hard and dealing with nothing but hateful people.

As soon as gouty man's room gets cleaned, they bring me a little old lady with Alzheimer's- it seems her son dropped her off for some little complaint and left, I kind of suspect to get a break from her. All her stuff was done, but she was quite the handful. If she wasn't screaming for me to come in the room for something, she was trying to wander the halls with a very unsteady gait. She eventually got discharged and her son came to get her- I got her dressed and helped her to the bathroom before she went home. She was a little bigger than me but I was able to scoot her toward the toilet and she put her arms around my neck while I lowered her down. As I was lowering her, she kissed me on the top of the head and told me, "Thank you sweetheart. You've been so kind. You're my valentine."
Yeah, I started crying. That little gesture after all the foolishness was all I needed to remind me why I do what I do. I still could use a vacation, though.

Sunday, February 13, 2011

Since I guess there was some confusion

Yeah, hi. Well I guess there are some things in the world that need to be addressed that I didn't think ever would be an issue due to the human ability to reason and function on a basic level, but that's my bad for assuming. Okay, where should I start?
Um... let's start with you, dumbest, laziest dickbag fire rescue team of all time. So, you know when you get called to the scene of a rollover MVC at high speed on the highway with lots and lots of damage to the vehicle where alcohol is involved and the patients are lethargic and don't remember what happened, and you are between a hospital that is a trauma center and a hospital that isn't a trauma center? Yeah, those patients should probably be taken to the one that's a trauma center. Yeah, that's okay, just try to remember next time. Oh, you also might try taking vital signs on your patient en route next time instead of sneaking in the room behind me and writing down the vital signs I'm taking on a paper towel, typing them into your report like you did them at the scene and then handing them to me thinking I won't notice. I know it's a total bummer to have to drive out of your way and like, do stuff instead of getting back in bed, but you do get paid for this I think.
Well, I think that's about it- shall we go to you, crazy lady? Yeah, epsom salt? Doesn't work as a laxative. In fact, don't ingest it. At all. It's not that kind of salt. And when you aspirate said epsom salt and get all hypoxic on me and stuff, I can't give you all the Dilaudid in the Pyxis. Yeaah. Sorry.
Great. And you, girl with disturbing number of children at your age. The provider may be concerned with your satting at 100 "I can't breathe but give me the phone so I can call my baby daddy and bring me some juice too" routine, but I can't say I am. That's neither here nor there, but just know that when you insist on juice 15 times and then proceed to puke all over the floor while you are within arms length of the trash can, and then stare at me like "bitch, clean that up" while you watch the disney channel in your room, I WILL NOT BRING YOU MORE JUICE.

Well, I believe that's it for us today. If you have any questions you will find me on the psych floor where I plan on being admitted for my suicidal ideation that I now have thanks to all of you.

Monday, February 7, 2011

Apparently, we're whack

So, I'm stuck in triage the other day in my little booth of shame when I hear this conversation go down at the check in desk.
Dude with oozy but manageable head lac -"Yeah, I need to see the doctor."
Medic-"What's going on today sir?"
Head lac dude-"Well, I was at the club, and I got into a fight with some dudes and I need to have the doctor to come up here and look at me and tell me if I need stitches."
Medic-"Well, take this form here and sign in and the nurse will get you triaged."
Head lac dude who reeks of booze- "Naw, I don't wanna do all that shit. Just go get the doctor right quick so he can tell me if I need stitches."
Medic-"Sir, the doctors are with critical patients. I can't just pull them out of a CPR to come tell you whether or not you need stitches. If you would like to be seen, you have to wait like everyone else."
Head lac dude-"Man, that's some BULLSHIT. I just want him to tell me whether or not I need stitches. That's whack, man. Can you tell me if I need stitches?"
Medic-"Sir, I am not a doctor, and I cannot diagnose you. You'll have to check in. Also, if you would please stop yelling obscenities. You're scaring our other patients."
Idiot head lac dude- (gesturing to his friend) "Man, gimmie that form. Here, I'll be back, I gotta go drop off my homeboy but you go ahead and get me in line."
Medic-"You can't do that here. I can't check you in if you're about to leave. Either stay or go, but I can't put you in line if you're leaving. This is not a doc in the box."
HLD- (Surveying medic in attempt to be gangster, but with vacant drunk eyes). Man. Man. That's not cool man. You got all these tattoos and stuff all out everywhere. That's whack. You whack. (leaves without checking in).

Approximately 5 hours later, I grab a chart from the triage rack and call the patient's name. To my surprise, as I'm not behind in triage, I get no answer. I start looking around and I see the other patients gesturing to a young man leaning back in his chair snoring. I shrug and skip to the next person. Sorry, if you're asleep and obviously still breathing, I'm not gonna wake you up to triage you. Obviously it's not that big of an emergency. So, I triage a little baby with a fever which takes all of about 4 minutes, and when I go to let them back out in the waiting room I see the dude awake and irate, standing at the front desk yelling at the new medic on shift. I walk up and tell him very calmly, "Sir, I already tried calling you but you didn't answer. Are you awake and ready to be triaged now?" At that point I realize it's the same fool from earlier. So began the triage process.
Me- Sooo. What brings you in today?
Head Lac Patient- Yeah, well, earlier, I fought some dudes and I cut my head and now I'm here. I need to lay down, man.
Me-Yeah, you can't do that in here. Have you been drinking tonight sir?
Head Lac Patient- Yuh. I need to lay down, you whack.
Me-How much have you had to drink tonight?
HLP- Too much.
Me- How much is too much? Too much for me and too much for you are probably different.
HLP- Um, like 12 or 20.
Me- Really? Wow. Let's just move on. You say this happened earlier? When is earlier?
HLP- Like, midnight. Yeah. (continually touching his clotted head wound) It keeps bleedin'.
Me- Well, yeah, it does when you keep touching it. What have you been doing the last 5 hours?
HLP- You know, drivin around. I had to drop off my homeboy.
Me- Did you drink some more?
HLP- I dunno. That's how I do. It helps me get through the day.
Me- I see. Excellent. Well, I think that will be all. Have a seat out in the waiting room for me there.
HLP- Miss, I wanna lay down. Do I need stitches? Am I gonna have to wait much longer?
Me- I really don't know sir. Just have a seat out there and relax for me.
HLP- Man, for real miss? You whack. Ya'll are all whack.

And to think they sent out a Press Ganey card for that visit. I wonder what whack translates to on a zero to five score.