Tuesday, May 31, 2011

Slow Your Roll

Oh hey, welcome to Hood Hospital triage! Let me just stop you right there. A few things:

-Hi! Nice to see you again! Oh yeah, I do remember you from last time, seeing as how you're here on a weekly basis. You presented about the same way last time too- tearful, dramatic, allergic to numerous non narcotic pain medicines and with crappy looking vitals because you just don't take your medications we continue to refill. You seemed to do fine that time, so you can just wait to get triaged like everyone else. Sending your boyfriend up to swear at me is a new approach, and I applaud you for your creativity, but the Dilaudid fountain still hasn't been installed up here and the triage desk so I still can't really pour you a refreshing Dilaudid-rita just yet. I'm real sorry.
-Hey, wait a sec. That's the hospital pen. You know, the one all these patients with coochie rashes and sepsis and yellow fever or whatever have been touching? Yeaaahh. I wouldn't put THAT in my mouth if I were you. I usually have a pretty good poker face up here, but I'm not even gonna attempt to hide my disgust that you just did that. Also, after doing that, you're going to put your baby's pacifier in your same mouth that JUST held the MDRO pen and then give it to your baby! No ma'am. Fail. The complaint you brought him in for is foolish but it's about to be legit. Too legit to quit.
-Yuop. I know Flubber is on in the waiting room right now so it's probably hard to concentrate, but if you look up there right above the desk there is a giant sign that says in big black letters that patients in the emergency room are seen based on acuity and not on a first come first serve basis. So needless to say that when we try to call to triage you for very emergent toe pain while you are in the bathroom, and during that time someone comes in for chest pain with low O2 sats, you sure did get skipped and your toe pain is gonna have to wait 5 minutes longer. What's cussing at me and making threats gonna do to change that? Well, not much, other than let you head back on out there to the waiting area to finish watching Flubber instead of going back to a room. Yes sir. Be nice to your nurse.
-FYI- Nurses cannot order tests, meds or admissions, but especially not urinary tract x-rays (very sensitive test) and admit orders for UTI pain for a grown woman who has not taken any of the prescribed medication from when your were treated at the hospital for the same problem literally 3 hours ago. Bringing your mother in to demand these things at the top of her lungs on your behalf despite the fact that you are perfectly capable of speaking for yourself and providing your own medical history will not change this fact.

I swear. I hate triage. I feel like I'm in the movie clerks. This scene, to be specific.

Saturday, May 28, 2011

Chief Complaint of the Night x 2

Let me just preface this story by saying 1.Both of the young ladies in the stories I am about to relate to you seemed relatively articulate and well dressed, like normal people you would see anywhere. 2. The wait last night was average, about 3 and a half hours.

Okay, so the first chick checks in at the height of all the craziness and looks completely fine, so I ask what she's here for and she points to this red zit on her cheek. She tells me it hurt before it popped up last night and it hadn't come to a head yet so she thought it might need to get lanced. Mmkay. Is there a triage code below a 5? Next, please.

So about an hour or two later another girl comes in for a cold sore she's had on her lip for a week. Really.
WHY? You are young women, with lives and friends I'm sure. Even if you aren't paying for your ER visit, isn't the 5-6 hours total you will surely spend here from check in to discharge worth the price of some abreva? People perplex the shit out of me.

Thursday, May 26, 2011

Efficient Fuckery

Hood Hospital. EMS patient with 10/10 chest pain s/p smoking too much crack. ER doc fed up at foolishness capacity for the evening. Deliriously tired ER nurses. These are their stories.
Hood nurse: M'am, do you have any medical problems?
Pt: Quit asking me fucking questions. I just came here cuz my chest pain and my headache and I been pissin all over the place and I'm outta hydros. Don't none of that shit matter. Look it up in my records.
Hood nurse: Ma'am. I can't start treating your condition until I have some basic information about you.
ER doctor: Ma'am, you know I'm not going to give you any narcotics this visit.
Pt: Fine, fuck you then doctor, I'll just go to another doctor to get some more hydro. I'll buy it on the street with some more crack. I'll go to another hospital, I got that Medicaid. Fuck all of you, I hate hood hospital, I just came up here for my blood pressure and that ambulance fix it.
Hood nurse: So do are you saying you wanna leave then?
ER doctor: Yeah, you just have to sign this form.
Pt: Yeah. You motherfuckers can't make me stay here (DC'ing own EMS line, the single one this crew has started in the last 2 years).
And this took all of about 8 minutes. The one thing you can say about crackheads, at least they don't waste any time.

Wednesday, May 25, 2011

Effin' Gasto

Dudddee. It's gastroenteritis season apparently, and I am already FINISHED with this shit. Every third patient I triaged this week seemed to have nausea, vomiting and diarrhea. And for some reason it's also causing paralysis, because they all need freaking wheelchairs. Seriously.
Now I completely understand this phenomenon among the elderly or chronically ill, whose fluid balance already kind of blows anyway, especially if their symptoms have been going on a couple of days. But if you're younger than me- No ma'am. I expect you to walk, that is ridiculous.
We actually had a chick come in last night- and by came in, I mean she was dragged in by a dude on either side followed by three other concerned gentlemen. As to minimize the scene in the waiting room and to see what was going on, I went and got a chair and wheeled her back to the triage booth. Yeah. Homegirl had no medical history and had been vomiting x 3 hours. She wouldn't answer any questions directly- I would ask, she would whisper the answer to her entourage, and they would tell me in a grown up voice. None of these guys were her relatives, so she had to sign her own consents before we brought her back. So she whispers to her posse that she was too weak to sign. Girl, please. I couldn't even handle it anymore. I straight up told her, "Ma'am, seriously. You've been vomiting for three hours. There is absolutely no medical reason you cannot pick up a pen and sign your name, and you have to do it before we can treat you legally, so just figure it out please." She sure did make one of the dudes hold her hand and trace write her name. Hoolly balls.
This is not at all atypical of the gastroenteritis presentation. I know it sucks. I never thought I would consider linoleum floor with bathmats a comfy bed, but it's happened. So just compared to my own experience, I seriously have to ask:
1. Why can't anyone walk across the room? No one's asking you to do a 5K in this state.
2. Does moaning and screaming really help? Really?
3. Do IV narcotics really help? I thought they were supposed to make you more nauseated.
4. Do people really ever think eating solid food when they're like this is a good idea? And after you've puked the solid food 6 or so times, why wouldn't you stop trying?
5. The really important one- how do you hold your poo long enough to even drive to the ER? I'm serious. Diapers? Butt plugs? Please advise.

Sunday, May 22, 2011

Hell Yeah

I continue to reign supreme at the blood ETOH game! I need to take this shit on the road. It'd be like the fair where they do guess my weight, only it would be guess how drunk I am, and I'd be making the big bucks.
My internship full of drunken foolishness (patients, not my own, at least on the clock) taught me one thing- guess low for the young folks.
Usually. At least guess low for people who pull total noob moves like passing out in public places and puking all over themselves. Bonus lightweight points when their poor parents get dragged into the madness. No cash prize for me today, just the sweet glory of victory.

Saturday, May 21, 2011

Chief Complaint of the Night

Young lady presents with cute, chubby baby playing with her stuffed toy in no distress.
Hood Nurse: Hi! What an adorable baby! What's going on tonight, guys?
Baby's Mama: Uh, hey. Yeah, so I brought my baby in here basically cause I just don't know what's wrong with her. She just keeps whining. I don't know why. Maybe she's just bratty. I don't know what her problem is.
Hood Nurse: Okay. Well. I mean, how long has this been going on? Has she been running fever? Pulling at her ears? Eating less?
Baby Mama:No. None of that. She's just whiny. She's been whiny for two weeks now. I'm getting really tired of it. Do you think you guys can figure out why she's whiny?
Hood Nurse: Uh. Maybe. I really don't know.
Baby Mama: Do you guys see a lot of stuff like this?
Hood Nurse: No. Not really.
Baby Mama: Oh. Well, I guess I just pay more attention than most parents.

Thursday, May 19, 2011

Birds of a Feather

Hood Hospital triage, 3 AM- two young ladies check in together. Both young ladies, I would say would probably wear about a size 14, but insist on wearing what I can only assume is about a size 8. Muffin top abound. I proceed to triage girl 1.

Hood nurse: Hi there ma'am! What's going on today? What brought you to the ER?
Girl 1: Hi, hi ma'am. Um, well, you see, I came in today because I, I have pain in my kidney, I have kidney problems, and like, I'm here because I was like, just at County Hospital, like just there, and my ovaries hurt, and you see they did the tests and they put the thing in me and they started this IV, see, right here, and they were gonna do a CAT scan but then they didn't and no one told me what was wrong and my kidneys are like really really hurting and they gave me some Morphine but I think it's starting to wear off and it's starting to hurt again and I don't know what's wrong and I'm really reallly scared, ma'am-
Hood nurse: Wait. Hold up. You were seen for this same thing at County Hospital and they did a full work up but you don't know what any of the results are? Did they not give you any discharge paperwork?
Girl 1:Well, no, because, see, I had to sign do the AMA and I told them I didn't want to do the AMA but my friend, she had her gallbladder taken out there, and I had mine taken out too, but they like, just did hers but she had to go but they still gave me this Morphine but I think it's wearing off, but my grandma gave me some of here Hydrocodone the other day and it helped and I could clean my house, and also, I don't know if this matters but I had Gonorrhea and Chlamydia but I took that medicine but I never went to see if it was better but I took all of it so it should be fine right? But now miss it really really hurts right here (grabbing suprapubic area)
Hood nurse: Okay ma'am, well, we'll get that checked out for you. Can you tell me if you have any medical problems?
Girl 1: Well I go to the mental health clinic and they say I have bipolar and ADHD and I take that Trazadone and Xanax but I'm out of Xanax and basically I'm just crazy I guess.

So, out to the waiting room she goes, and her friend comes into the triage booth:
Girl 2: Please be nice, not like at County Hospital, they suck.
Hood Nurse: Um, sure. What's going on today?
Girl 2: Well my legs hurt and all down here and it just really really hurts and I went to County Hospital and they were like really mean and I like just had my gallbladder taken out there last month, but it still really hurts, yo. And so I was in there and I kept asking them for pain medicine and they kept getting mad because I kept coming up and asking them and they weren't giving me any and then they were finally gonna give me some and then this man came and asked me if I needed help and I told him no I didn't need help and then the lady said that was rude and she called security and they made me leave and didn't even give me any pain medicine. Hood nurse: I see. Well. Are you mostly here for leg pain or abdominal pain then?
Girl 2: Well my legs hurt but also this still really hurts (pointing to incision site) and also it's hard and I think somethings in there or it's infected inside.
Hood nurse: Okay, yeah. What kind of medical problems do you have?
Girl 2- I got that Bipolar and ADHD.
Hood nurse: Realllyyy. Cool. Well go ahead and have a seat out there for me and they'll call you back there when they get a room open.

Surprisingly, it wasn't the girl who had just been kicked out of the other hospital that gave us hell. About an hour later, I took a couple of people back to rooms that had been waiting longer than Girl 1 back to rooms, so naturally, she thought it would be a good time to tell me a was a stupid bitch for not calling her name. So, after calling everyone before AND after her (to be fair, she was asleep when I called everyone after her, but still be nice to your triage nurse) she went back to a room and got her exams done. She was revealed to have numerous STDs, and nothing else, so she was sent home with multiple antibiotics. When she figured out she wasn't getting Vicodin, she tore up the prescription for the Flagyl and the Doxycyline while screaming, "Fuck all of you bitches! You just like sticking things in people's pussies and not giving them any pain medicine! Tell that motherfucking doctor lady to come back in here and I'll put that thing in HER and see how SHE likes it!" By then, her friend had been discharged without incident and they both strolled out of the ER to wherever the hell they came from.

Classy broads, these two. Whenever I deal with people like this in pairs, I always just wonder where they hooked up. Do you think it was another ER waiting room? I'd say it's about a 50% chance.

Tuesday, May 17, 2011

Chief Complaint of the Night

Well, sort of.
23 year old male presents to Hood Hospital via EMS for dental pain x 1 week. As is the standard of care, he is seen at the front desk briefly by the doctor and is sent promptly to the waiting room to check in and be triaged like everyone else and their mama who decided to check in last night.
I hand him the check in form, to which he responds by pushing it back towards me and saying, "Man, fuck y'all, fuck this, I'm about to go to the house", and then promptly leaves to walk back to his apartment, which is blocks away.
Yup. Your tax dollars at work, ladies and gentlemen.

Thursday, May 12, 2011

Just something to think about

Gentlemen. Let me just go ahead and tell you that no matter how attractive or charming you are or think you are, there is effectively no chance that hitting on your ER nurse will ever turn into anything but a look of disgust. Look, it's not you- well, chances are it's probably you as well- but also the fact that your nurse probably hasn't eaten or peed yet and has been spending the last 5 hours cleaning the long neglected genitals of the combative elderly and assisting the doctor with collecting GI bleed turd specimens. Doesn't exactly get me feeling frisky, anyway.
I'm pretty sure that at the end of my shift, even if someone like, Charlie Hunnam caliber hot came in as a patient after an unfortunate kitten rescuing accident and asked for my number, I'd still probably be weirded out. Just not the place. Anyway.
Point is, if you are not this caliber hot and your complaint is related to the fact that you can't maintain an erection, welll. Your nurse definitely isn't gonna want any of that, so you should probably just put it away. But seriously, patients. Stop being gross.

Wednesday, May 11, 2011

Just an overall poor effort

Chick checks in last night for nausea x 5 days, with positive pregnancy test at home. Let me pop that in the hood hospital translator for you right quick:
I want a sonogram, and maybe another pregnancy test. Starts going into an in depth discussion with the triage nurse about when she started having sex with this dude that is with her currently. Listen sister, this isn't Maury, we just asked your LMP, next please.
So it was utter pandemonium and fuckery up until about 4 am last night, people were forming human pyramids in the waiting room because there were no more chairs, the line to check in wrapped around the building and everyone had chest pain. I had two dudes who fell off of roofs, like, really actually fell off of them, check in within 5 minutes of one another. One had a broken C2. So, uh, obviously this young woman's complaint was not of immediate concern. So she and baby daddy leave and do some shit at Walmart or whatever and then come back. So, as far as I'm concerned you have now forfeited your spot in line since we already tried to call you back to a room and you weren't there, we gave it to someone else, but I guess some generosity had grown in my heart because I opened her chart back up and put her second.
So how does this turd thank me? By faking a syncopal episode in the waiting room, not even a good one, and kicking over her Mountain Dew in the process just to be hateful. So I responded in turn by taking vitals and checking a blood sugar, just in case, and made sure to see if she was arousable to painful stimuli. She was!
So. She goes back to a room, and they go to do a pregnancy test. She refuses to pee. Not before faking another syncopal episode in the bathroom just for a good showing. Allows blood draws, so they just run a blood HCG. In the meantime, alleged baby daddy has a heart to heart with her nurse about how he thinks she probably isn't actually pregnant, but she's just faking it because he tried to break up with her the week before. Once she finds out the blood HCG is running, she wants to go AMA. She eventually agrees to stay upon hearing that we cannot release the results without her consent. Sure enough, NOT EVEN F-ING PREGNANT.
Really? How massive a douche do you have to be to go through what is surely going to be a workup in the thousands of dollars, act a complete fool, and worst of all, divert tons of time and resources that could otherwise be allocated for people who are actually sick? This makes me so full of rage I cannot adequately describe it. And the worst part was that this was a grown ass woman. Like, older than me. Fail! Next time just threaten suicide like a normal psychotic girlfriend. You don't have to mean it. Just don't drag us into your drama, we have actual emergencies to deal with here.

Sunday, May 8, 2011

I don't know, can you?

So I was messing around on blogger today when I started looking at my traffic stats and what search results brought people here. The accidental finds are mostly searches for medical stuff, naturally; there's also some pretty freaky shit that I'd rather not even look into, but the funniest by far was the search keywords "Can you drink IV Dilaudid?"
Well, I don't know. That's an excellent question. Can anyone help my accidental readers out here? If so, what is the best mixer, or should you just drink it straight? I'll ask the pharmacist at my job and I'll print me up a nice recipe book. 101 classic Dilaudid cocktails, featuring Dilaudid Margaritas with a Phenergan floater and a Benadryl rim. I can see my guest appearance on Martha now. Imma be rich, bitches.

Saturday, May 7, 2011

Fun in Radiology

Am I the only one who absolutely loves reading radiology reports? Not like I just read all the reports for kicks or anything, but I'm always interested to know whats going on with my people, and I find the way radiologists try to word things in a professional manner absolutely hilarious.

One of the more frequent ones I see is the report followed by "limited exam due to large body habitus" which is a nice way of saying, "look, I can't see shit in here because this patient is really fat."

The foreign body reports are always awesome, too, because no one ever wants to say "there's a huge dildo in there" they go into the exact specifications of the size of the dildo down to millimeters without actually saying what we're looking at. In contrast, when we got a visit from iron man a couple months back the report's like, "Yup, he swallowed a pencil this time. There's a pencil in there. " I think there was also a note about all the parts of the pencil being accounted for, which is comforting I guess.

I think my very favorite are the reports from the sassy radiologists who are obviously really pissed off about the people that keep coming in with unspecified abdominal pain who keep get negative CT scans. They'll actually say things like "note: this is the 8th CT abdomen since January of this year" or my favorite "Negative exam of abdomen/pelvis. Unchanged since LAST 23 CTs THIS YEAR." Oh yes, this will bust out the caps lock. They don't play in that reading room.

Thursday, May 5, 2011

Well, I guess I'm gonna have to be that person.

Lately some of the night charge nurses have kind of unofficially tasked me with helping a newly graduated nurse intern- nothing major, he's been released from his preceptorship and such, but just to be a resource. Make sure stuff doesn't get too crazy.
So we're starting an ambulance last night and this fool I recognize has come in for abdominal pain AGAIN and is allergic to everything but Dilaudid and Phenergan and my eyes are about to roll out of their sockets and I realize he has no idea. I mean, you know it's bad when the patient tells you that they have chronic abdominal pain but no one's ever found anything. I even try to throw a line out there like, "what happens to you when you take ALL THOSE MEDICINES? Oh, hives and throat swelling. Oh, wow." or "Man, you've had how many CTs this year? That is crazy, I wonder what's wrong?"
Nothin' dude. So, I pull out my best resource ever, the previous medical records. The discharge summaries are always hilarious for patients like this, because they have to justify discharging the patient despite the fact that they continue to rate their pain 10/10 while drinking Mountain Dew and talking on the phone, so they do all but come out and call the patient a douche in their notes. This dude was actually admitted for the same problem previously, and the doctor in not so many words is like "yeah, I thought this admission was bullshit in the first place" and then diagnoses him with drug seeking behavior. So I just print it off and hand it to him like, yeah bro, check it out. So we have to go through the allergic to Zofran red flag and all the other signs someone is full of shit.
And I'm thinking about how the last important fake preceptor lesson I taught this poor guy that was sometimes if someone's on crack and acting a fool, you just have to yell at them to stop acting a fool because that's the only way they'll listen, and probably they won't complain. Because of the crack.
We have this enlightening conversation so I then see him hand the notes to the ER doctor, and then tell the day shift first thing in report, "Yeah, this dude is a drug seeker." I just process all of this and I feel kind of terrible that I have to be the one to shatter this new idealistic nurse's perception of emergency medicine and nursing in general. I dunno. Is it wrong? Am I doing him any favors? This is all very confusing for me. Again, I'm obviously not ready to precept.

Monday, May 2, 2011

Doctor stereotypes

So I was catching up on my blog roll today when I came across this post by Dr. Grumpy about the hilarious fuckery that ensues with a room full of doctors and it got me thinking about the physicians at my hospital.
Well, first of all, from my experience so far, 98 percent of surgeons and OBGYNs have serious personality disorders. I can think an exception in each case and it almost seems like both of these guys know what dick heads their cohorts are and are trying to make up for it or break the stereotype, because they are both incredibly nice all the time. Our Neurologists and Cardiologists are odd but nice enough. Anyone I've ever dealt with in geriatrics I'm pretty sure are not real doctors. Internal medicine doctors are fine when you can understand what the hell they're saying and they aren't fussy and in need of a nap.
Now to ER doctors. I count myself pretty lucky where I work. With the exception of one who I rarely see, who I'm pretty sure has a steel rod in his ass at all times, everyone is at least tolerable. Most of them I genuinely like. Most are blunt as hell to the point of sometimes being rude, but so am I as are most ER nurses so I'm completely cool with that. My only complaint? I'm pretty sure that if you studied the average ER physicians conversations that "actually" would be the most commonly used word in almost all cases. This especially applies now that we've started using this who SBAR format where we're supposed to be making suggestions. Any suggestion, no matter how reasonable, is often followed by "Well, acttuuuallly" and then a ten minute explanation about how the latest research indicates that most nurses are similar in intelligence to chimpanzees and suggesting Aspirin for chest pain is the leading cause of death among ER patients or some shit. When I renewed my ACLS the other day they actually go into how to communicate effectively in a code, except most of the information the instructor talked about in that unit was pretty much how to suggest the physician follow ACLS algorithms in a way that makes the physician think it's their own idea. It mostly just makes me laugh now, but we have a few people that are such frequent offenders that I just want to beat them over the head with the patient's chart.
So, fellow nurses, is this a common phenomenon, or is it just where I work? What kind of foolishness do the doctors in your field pull? Doctors, do you find yourself saying "actually" a lot, or am I judging you too harshly?

Sunday, May 1, 2011

Unrelated to Nursing: Two of My Favorite Things EVER

As everyone probably knows by now I love hockey more than most things. My team is out of the playoffs but I am still invested. Instead of rooting for the underdog and getting depressed as always, this year I'm rooting for American players and playoff beards. I have a lot of good prospects. Unfortunately, my best bet is out now:

Paul Mara. I will miss your beautiful, beautiful beard, sir.
Luckily, the Sharks are holding strong, and will hopefully knock out the hated Red Wings, meaning Joe Thorton can carry on with this awesomeness:
And if not, Shea Weber's is still beautiful:
Or Tim Thomas:
Well, listen, I know it's a playoff moustache, but first, it's an awesome one, and second, I seriously love Tim Thomas. Like, a whole lot.
So, anyway, you should be watching the playoffs right now if nothing else but for the sweet beard action. If you can't acknowledge the beauty here you're obviously just jealous of Shea Weber.