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.


  1. omg! I just stumbled upon your blog and you are downright fucking is the obligation of any seasoned preceptor to be the buzz-killer of newbee wide-eyed and bushy-tailed idealism

  2. Heh, love it when students have no fucking idea that people abuse the healthcare system. Gotta tell them this stuff because it's part of working in the ER.

  3. Well, someone had to break his spirit sooner or later. You're just doing your civic duty.