Sunday, December 30, 2012

I'm Not Sure That Applies Here

So, a one of the cooler people at the new job was taking care of a level one trololololol the other day, and homeboy was getting shut the eff down.  Hi, if you want to keep getting a bunch of narcs and benzos prescribed, by all means, keep returning to your source, but keep in mind that if you keep returning to the same bird feeder, one day you're going to find it empty. Or something.
Delivering the news that you'll have to find a primary doctor (or you know, another ER) to prescribe loads of  controlled substances is a pretty hard sell for a patient like this, so I played mean nurse to her nice nurse as we tried to get this dude out sans his usual parting gift.
He went through the exhaustive list of excuses about why he was already out of pills, went through the stages of grief, started making threats and heading into agitated crazyville when I was like, "Okay, no. Here's how this is going to work.  No one here with prescribing rights is going to give you what you want, regardless of what you say to either of us.  So you're going to leave now, and you're going to leave without a substance for controlled substances.  That's how it's happening today.  Here's your discharge papers."  Through the entire saga of why I need another prescription for oxys and Xanax, homeboy had been struggling with shaking hand to write his name on the discharge papers. As soon as he heard the definitive, hell no, GTFO, he finished signing, wrote the date, and in all caps, wrote UNDER DURESS below his signature. LULZ.  Yeah, I guess not giving you narcs falls somewhere between the iron maiden and water boarding on the continuum of torture.  The ER is a cruel, cruel place.

Friday, December 21, 2012

The Burden of Proof

Maybe I should just start calling this blog "things that suck about being new".  Ugh, but really, you know another thing that sucks about being new? Doctors.
There's a pretty limited number of docs that work the night shift at the new hospital- most of them are amazing and we already get along really well and they listen to me and recognize that I generally know my shit. I think it helped that a couple of them worked at Hood Hospital as well, so they already knew I was at least competent and stuff, and I guess the word spread among them. Most of them.
But the thing that's a bummer is for some of these people, the burden of proof is completely on you to prove that you're not an idiot, and you're a moron until proven otherwise.  Which, great, fine.  Talk stupid to me.  I'm a girl, and I look twelve, and I don't back down when someone's obviously trying to bulldog me, and duh, I work in the ER, I'm kind of used to being treated like shit.  This particular doctor strikes me as someone who I am probably not ever going to mesh with anyway- I'm pretty sure he's Hood Hospital's Dr. Stick-in-the-Ass' long lost twin- people who take themselves that seriously generally don't like my style and vice-versa. So, anyway, treat me like crap.  I can handle it.  But maybe  set aside the douchiness and your personal shitty biases against nurses for a minute when a patient's safety is concerned.
Elderly dude came in the other night that had some pretty vague, questionable complaints about dizziness- some random aches and pains-nothing too major.  Family provided most of the history and weren't really great at it- the patient seemed confused at first, but would provide information if he was prompted repeatedly and was oriented and lucid, but was just hard of hearing and didn't seem to want to be bothered. The elderly weakness workup proceeded, labs and scans were normal, Dr. Stick-in-the-Ass 2 gets ready for disposition, and something changes.  This guy is just not resounding the same way any more.   He looks like he's in pain but won't talk, he gets really diaphoretic and starts having weird runs of PVCs, is still awake but just won't follow commands or talk.  I drag him in to see the patient, he glances at him, rolls his eyes, and orders pain medicine.  Two minutes later as I get ready to give it, the patient is now drooling with snoring respirations.  I tell the doctor he needs to come in there, yeah, now.  His response?
"I can't even deal with you anymore with this patient. You're killing me. Seriously." (with a disgusted shake of the head)
He takes a look and begrudgingly orders a repeat scan.  I run the patient over, and oh, guess who now has a massive fucking head bleed?
Yeah.  I wish I could say this is the first time something like this has happened to me, but it isn't.  At all. I hate how in situations like this when the doctor knows he was wrong and fucked up, there's never any acknowledgment that a mistake was made or that he was being a massive douche canoe, but there is an abrupt 180 shift in the way I'm being spoken to.  Like now all of a sudden we're using our octave higher soft and gentle voice that we use with the patients, and I'm being thanked and fussed over every nursing intervention no matter how mundane.  Not like I need a pat on the back or acknowledgment every time I catch something, but I'd really almost just deal with these guys continuing to be asshats than suffer through this mister nice and respectful routine that we both know is fake.
Whatever.  Hopefully this situation has placed me in this guy's not an idiot column and he'll actually listen to me the next time something like this happens, but I kind of doubt it.  People like this seem to have a pretty short memory when it comes to their own fallibility.

Tuesday, December 11, 2012

Why It's Worth It

ER goes in cycles for me.  Some days I swear the troll douche parade made a pit stop in my ER,  or that someone in triage or charge is pissed at me, because everyone I deal with has some kind of hidden agenda or just a totally rude, shitty attitude.  Other days I take care of mostly really nice people and I genuinely feel a sense of well being about my decision to become a nurse-I think I've mentioned before that this seems to happen whenever I'm burned out or just at my wit's end with assholery.
Unfortunately, we nurses, like most other humans, seem to focus on our  negative experiences, so one remarkably awful person can pretty much ruin your day.  But every now and then, you get a patient who is so incredibly nice and wonderful that the rest of humanity gets a free pass for the day as you bask in the afterglow of their awesomeness.  
I had a super independent, sassy, adorable elderly lady the other day that has to have been one of the most remarkably awesome patients of my career.  She had sustained a moderate, but not life threatening, injury doing some kind of yard work that she definitely could have gotten away with delegating at her age, but being badass and all she was having none of it.  She had the cutest smile and she would just grin and laugh when anyone came into her room. She was in her 80s but still hilarious and witty as hell,  and was the type of patient who was so grateful for just a warm blanket or a gauze dressing and made a huge fuss over the slightest effort on my part. 
After she was discharged, I got her bundled up and I wheeled her out to her son's car.  We got her up in the seat and I waved goodbye and told them to have a good night.  Without even thinking about it, she smiled and said "Thanks to you, honey, we will." Best thing anyone's said to me in a long time.  She totally made my day. Obviously I wish more patients were like this, but even one is enough to break you out of the worst of funks.

Sunday, December 9, 2012

The Price of Being New

So, I guess I've established myself at the new place.  Like, I done rode up in there on my magical ER nursing stallion and did all the hard IV starts on my first attempt and took care of 30 ICU patients by myself, and was all, yeah, fear and respect my skillz everyone.  LOL.  J/K guys.  But IRL, everybody knew I came from Hood Hospital, I figured out the charting quick and stuff, so I got like, a day and a half of orientation before they were like, okay, you're done, go take care of patients on your own now.  Except I am still learning some stuff here but I haven't gotten called to the office over anything yet so whatever.
BUT.  I'm in a very awkward and shit position at the moment.  Because all these people are now aware that I can handle a crazy patient load without killing anyone, that I'll usually work my ass off without complaining, and that I'll pick up the slack if my pod partner is lagging.  BUT.  I'm also not BFFZ with anyone here yet, because I am totally freaking weird and socially inept and it takes me forever to make friends. Like, not like, adorably quirky manic pixie dream girl weird, but like, makes a bunch of  obscure mid 90's SNL references that no one gets and says stuff way louder than I probably should most of the time weird.  
So, anyway, the significance of all this is that I am close with no one, therefore, nobody has my back and I am getting the shaft all day every day when I come to work at this place.  It's like, oh, well, Hood Nurse is competent, let's give her the shittiest assignment with the laziest person here! Okay, awesome. And few of the charge nurse or float nurses are stepping in to help, because if their buds need anything at all, it's getting taken care of prior to anything I need. 
Luckily, the medics here mostly already like me because I don't delegate and then sit on my ass and I can show most of them up when it comes to IV starts, so if they see that I'm really drowning, they have my back. And most of the doctors like me already because I work hard and make them laugh. Still.  It's just frustrating.  I can handle my shit, but it sucks to be drowning and see everyone congregating and grab assing by the charge desk having fun. 
I don't know.  I feel like (and I hope my perception was the actual reality) that I was pretty fair as charge at Hood Hospital.  I mean, I would honor a friend's request for a certain area if they were having a crappy day but overall I would try to move people around and be pretty objective about who ended up with what.  Don't get me wrong, some of the charge nurses here a pretty rad and objective, but overall I kind of feel like I'm a little isolated and that if someone is gonna have to get crapped on, it's gonna be me.  Oh well.  Such is being new I guess.

Thursday, December 6, 2012


I'm discharging a gal in the hall bed for gastroenteritis with her husband/boyfriend/babby's daddy/s.o. present.  It's one of those dynamics where the patient really doesn't ask you any questions, but just kind of looks wide-eyed at you while companion does all the talking. To be fair,  as someone who is super shy, this doesn't bother me as long as it's not an obvious domineering douche relationship, which this wasn't.  No, it was one of those I'm asking the questions cause I know you won't type of dynamics, except it was. not. working. The message I was trying to convey was just totally not getting across.
I have a basic spiel for most common illnesses.  My gastro spiel goes something like, "yeah, these symptoms are really a bummer, and unfortunately there's no treatment for the virus itself, but we can treat your symptoms and try to make you comfortable.  Fortunately this usually runs it's course within about 48 hours on average, in the meantime try to rest, take your nausea medicine, and make sure you're drinking lots of liquids in small quantities..etc" Except dude was really hung up on the "there's no treatment for the virus" part.
"Wait, so what is this medicine?"
"It's two of the same medication.  It's called Phenergan, and we're giving you pills and also suppositories if you can't keep down the pills. You can take it every 4-6 hours or so for nausea and vomiting.  "
"Okay.  So the medicine is just for the nausea.  You aren't going to give her anything for the virus?"
"Well, no, there's no medicine for that, it just has to run it's course.  But this medicine should make it a lot more bearable."
"What about the diarrhea?"
"We just recommend Immodium over the counter after the first 24 hours if it's still happening."
"Okay, but you're not giving her anything for the virus?"
"No, there's not any treatment for the virus, unfortunately."
"But, wait, why aren't you guys giving her anything for the virus?"
"Because it's not a thing.  Scientists haven't invented it yet. "
"OH. "
One of my coworkers was walking during the last part of that conversation- as soon as the patient left and I rounded the corner, he immediately started laughing at me.  Did you seriously just answer that question with "scientists haven't invented it yet?"Well, yeah.  Look, I hope I don't sound mean because I genuinely don't mean to be.  But sometimes, things aren't getting through and you have to just go off script and hope for the best.  Luckily the message seemed to get across in this case.

Wednesday, December 5, 2012

The True Mark of Experience

Some people might think that competency in a critical care situation, or knowing how to titrate drip, or some shit, is the true marker of being experienced.  I'm coming to terms with being experienced, I guess.  I mean, it's been nearly four years, and I'm more experienced than most of the people I work with, so whatever, sure.   But let me tell you.  At least for me, I knew how to titrate Nicardipine and Levophed, like, year one, because my patients were sick as hell all day everyday.
Naw, real experience has to do with dealing with shit like this:
So, dude presents with a butt abscess or some equally unrelated shit, it really makes zero difference, but upon discharge, dude is all, "Um, let me ax you a medical question"
and I'm all "Sure, shoot"
and he's all "It's personal"(translation it's about teh secks)
and I'm all "aw fuck"
and he's like "So my girlfriend (who BT-Dubs eds note is sitting right there) thinks I can't get a boner b/c I don't like her but it's not like that, I totally dig her but it's not happening for some reason."
So year one nurse me would have blushed and been all "I'm sorry, I can't answer that" but experienced me was like "Look, I don't know for sure because I don't even know you like that, but what you need to do is find you a doctor, and make sure everything is all good with your health and your penis and all that.  And if everything is OK on that front, you guys should probably see a counselor or something, but imma start with this referral to a doctor, any questions? Okay, great, bye."
Yeah, for real.  I hate to break the hearts of you new nurses, but this is mostly the type of clinical skill you'll gain after 2 and a half years of this foolishness.

Edited to add: apparently "butt access" is not a real thing, at least in the context I meant it. For future reference, one drink before blogging is totally okay but 3 is too many.  The more you know....

Saturday, November 24, 2012

The Annual Influx of Holiday Cheer in the ER

OH SHIT.  I totally forgot how much I freaking hate working around the holidays.  Really, it has very little to do with the fact that I miss the holidays themselves.  My family is pretty flexible and we don't generally do a lot of stuff on the day of anyway.  Naw dude, it is the stuff that happens at work.  
I always think I'm exaggerating it in my head, and I go a whole year without dealing with it and kind of forget it happens, but the holiday season brings the crazy assholes out of the woodwork.  
I wish I could fully do justice to how ridiculous the holiday brand of crazy is without violating the shit our of HIPAA, but holy crap.   I guess crazy really is a misleading word if you're using it in the traditional sense of a less-than-kosher term for people who are genuinely mentally ill.  I guess I should really be using the word cray, which is generally the word that I reserve for people that just act totally foolish and childish who may at some point try to throw in some kind of mental health angle, but only as a means to an end.  These are the patients that think being completely hysterical pains in everyone's ass is going to get them what they want, usually, drugs, attention, or both.  These are the trolliest trolls of the troll genome, and they have never faced a problem they couldn't solve by escalating the DRAMZ.   These are the patients that suck the compassion and life out of you, who make me ask myself if maybe I would have been better suited as a park ranger or a stripper or a barista at Starbucks. And the other night, I seriously had like, 10 of them in one shift.
I can't even count the number of IV resites I wasted my time with when somebody decided they were leaving because they weren't immediately showered with Dilaudid as soon as they stepped out of their car in the parking lot.   The one that really took the cake was seriously just a living, breathing, red flag for drug seeking.  Came in with some sketchy story that kept changing about a traumatic injury, with nary a mark on his body, multiple non-narcotic allergies, controlled substances stolen, from out of town, admitted to going to hospital x for this same problem and was treated so horribly OMGZ, you are totes suing them because BTW you're a lawyer (I know tons of lawyers with sweet homemade tattoos), lots of crying with zero actual tears. Oh, and great job dumbass, it also seems that you went to hospital y for this problem yesterday with the same story not realizing it's in our hospital system and we can see the notes from that visit.   Unfortunately for you, the Dilaudid fairy isn't working today, and all the doctors here actually read your history.  It seems this incident has led to them looking you up on both the state bar website and that state narcotic database, and those two findings combined with your IV pulling shenanigans have you at strike 3, dear. You're going to the house empty handed, unless you can pull out a really impressive performance late in the game.  And sure enough, our lack of compassion and/or generosity with IV narcotics has lead to some pretty dark times and some suicidal thoughts.  MMkay now, if you wanna blow up the call light for drugs you won't get while waiting on the psych consult, go on with your bad self, but now we gotta take all your stuff for your safety, sorry buddy. Enter dramatic family member for act 3, with all his mean-mugging and enabling skillz. And look, he's attempting to wheel you out dramatically with IV still in place because THIS HOSPITAL IS THE WORST.   But sorry, no take backs for suicidal ideation, so we're gonna get the po-po cause we're concerned for your safety and stuff.  I think you can probably guess how the psych consult worked out for the goals he had in mind.  Nope, the psych consult people won't prescribe you Xanax, but thanks for playing.
Yup, imagine this in varying degrees all night and you have what is probably going to be my life for the next month and a half.  My theory has always been that crap like this increases because they're putting on a show for family and friends that aren't paying them enough attention, but now I'm starting to wonder if they aren't trying to take care of their stocking stuffers early.

Monday, November 19, 2012

Reason Number 501

The last few weeks we were working at Hood Hospital I together, ER BFF and I had a little game we would play when shitty stuff would happen (like, multiple times a day) where we would exchange a knowing look and just say "reason number __" with any random number between one and five hundred, as if we had a real numerical list of the reasons we were getting the hell out of there.
Anyway, fast forward to this weekend, I'm hanging out with a friend that still works there.  She started telling me a story about one of our authentic cray-cray drug seeker frequent flyers coming in the other day. This lady comes in so much and is so nuts that she has a hierarchy of doctors and nurses that she prefers to take care of her, all of whom she knows by name.  I've seen her do it too- she'll run down the list, asking if so-and-so is here tonight and what they're up to, pretending to make conversation, but yeahhh, no one's buying that angle, lady.
So as my friend is taking care of her, she's going through her usual routine, and none of her favorites are on that night.   After she's run down the list, she's all, "Well, how 'bout that one girl? Where is she?  You know, the little one? The young one, with dark hair." Coworker shrugs and mentions this describes several people.  "You know! She's small, and she's a white girl, but she's got a black girl's booty?" So my former coworker is all... "Uh.. Hood Nurse?", and crayzee frequent flyer lady is like "I think so, hold on" and then she digs in her suitcase and pulls out her journal.
Her journal which I guess contains detailed accounts of her numerous ER visits.  Which apparently included me.  AND MY BUTT. Dude.  That shit is scary, and I'm so glad I'm out of there.  Don't get me wrong, it's not like all the patients at my new job are all sunshine and kittens, but at least I'm not aware of any of them describing my ass in their diary.

Monday, November 12, 2012

Rise of the Man-Baby

Real talk right now you guys- there is an epidemic sweeping the nation as we speak.  Or, um, maybe it already swept the nation and I just wasn't around when it started, but I'm talking about the emergence of the man-baby.  I am referring the the concerning growing numbers, at least in my life, of men over 35 in the ER accompanied by their very aggressive concerned late middle aged or older parents.  Most of these man-babies I refer to are white upper-middle class, but not always- this is a phenomenon that seems to transcend race or socioeconomic status.
New hospital is still basically in the hood, but it's not surrounded by hood for miles like the original Hood Hospital, so a lot of the folks from the nicer areas seem to trickle in pretty frequently.   I think this dynamic tends to play out in these families a lot of the time because they tend to be smaller. See, most man-babies are almost always only children, although some are occasionally the youngest sibling, usually by several years.  Virtually all are unmarried and childless. Many, but not all, also live at home- all are unusually dependent on mom and dad in various ways without any contributing physical or cognitive limitations.
Man-babies present to the ER for things that could almost always be addressed at urgent care.  You would not know this by their behavior or the behavior of their parents.   Mom is ALWAYS present with man-baby, but sometimes dad makes an appearance, too.  The parent's behavior goes beyond healthy, caring parental concern and into a brand of helicopter parenting that would put modern parents of toddlers to shame.  This is their business, I guess, except that parents to man-baby are never happy being the only one to render care to their special guy.  No, man-baby's parents will find you in a CPR and bring you in to fluff son's pillow. Their concern for your lack of concern usually manifests itself in various ways ranging anywhere from passive aggressive suggestions about how your job should be done to straight up indignant yelling that things aren't just right.  I actually had parents of a man-baby being treated for a scalp laceration last week get upset with me because I didn't wash their son's hair to get the dried blood out.  For reals.  
Man-baby, for his part, varies in his response to this behavior from his parents. Some man-babies will be obviously embarrassed, but still too afraid of their overbearing parents to shut the dysfunctional behavior down.  Most play in to the drama like they've surely been trained to do their entire lives.  Applying an air splint to a sprained ankle is comparable in their world to amputating a limb without anesthesia. Parents stand by wringing their hands and critiquing your technique, holding man-baby's hand and talking him through the crisis.  Occasionally, I've gotten the super weird parents as man-baby's wing man/woman type of situation, where man-baby will try to be flirtatious and the parents will catch on, flip the switch and start trying to be my new best friend all of a sudden, as if all prior behaviors and their son being old enough to be my dad aren't all huge red flags.
I swear I've seen more and more of this since I first became a nurse, but it may also be that I'm just becoming more cynical and less patient and noticing it more.  So grown up nurses, help me out here- are man babies a modern phenomenon, or do you think our girl Florence Nightingale had a couple of man-babies in the tents out there in Crimea?

Friday, November 9, 2012

Pain Control

Dude with multiple non-Dilaudid allergies and many visits this year (who also, BTW, looks awfully familiar from Hood Hospital but you can never be sure) presents with abdominal pain complete with moaning, kicking, screaming and dry heaving.  Chronic pancreatitis.  Allegedly.  
Reasonably suspicious doctor is activated and labs are initiated based on nurse assessment, along with fluids and nausea meds because we are totes compassionate, after all. But sorry bro, the doctor is super busy right now and he's just not comfortable with giving Dilau-da to a patient he hasn't laid eyes on.   All samples are obtained, with exception of urine, of course.  In the mean time, the patient apparently gets sick of screaming "NURSE" constantly despite having the call light close by and drifts off into a peaceful slumber with his hands down his pants.  Also, to throw an M. Night Shyamalan twist on top of it all, his pancreatic enzymes are all normal.
So he's just sitting there sleeping with his totally normal labs, his fluids are done, time to get some pee and GTFO. So, I wake the dude up in this is seriously what transpires:
Hood Nurse:"Hey, so it's been a while since we tried before and it looks like your fluids are done, do you think you could try again to get me a urine sample?"
Pt (adjusting himself):"Naw, y'all already tried to make me go, I don't gotta go right now."
Hood Nurse:"Okay, well, it's been over an hour since you've tried, and everything else is back and other patients are waiting on this room, so the doctor may want me to put a tube in your bladder to collect the urine if you're unable to obtain a specimen on your own."
Pt:"Man, what the FUCK, this is STUPID, I don't know why I should be in a hurry to get y'all no urine sample when you guys obviously aren't in any hurry to get me no GODDAMN PAIN MEDICINE, man, this hospital is shiiitt."
Hood Nurse:"Sir, we don't routinely give pain medicine to patients who are sleeping soundly. It's a safety issue because it makes you more likely to stop breathing."

I returned 5 minutes later to a urine sample.  And the patient, asleep with his hands down his pants.  AGAIN.  That's a pretty amazing trick; I'll have to suggest it to next person who needs a shoulder reduction.  "Okay, I know this hurts really bad, here's your options.  We can either give you pain meds or you can grab your penis and make yourself fall asleep." We've been wasting time with narcotics for YEARS.

Tuesday, October 30, 2012

New Job, New Blog Title, Same Patients Allergic to Everything but Dilaudid

Yup.  New home is the balls, I am crazy excited to be starting a new chapter in my life as evidenced by my new blog name,  which now includes reference to my favorite sequel subtitle EVER.  I feel like this is the sequel in a way- it's still basically the same shit here.  But also it's way WAY better.
Like, omegerd guys.  The patients here, they actually get rooms.  Like, upstairs, on a floor.   And the nurses take report and stuff, and most of them look at the chart and don't ask insane questions.  So then, right, all the patients in the waiting room come back to rooms, and sometimes, the waiting room is empty.  IT IS AWESOME.
And dude, they have IV pumps, and all of the monitors actually work. And I get to eat and go pee here, too.
I have more patients here but they aren't nearly as sick as the ones at Hood Hospital were.  And you get your stuff back faster and the doctors actually don't sit on the patients for eternity so if you have someone really sick or just a pain in the ass you're usually only stuck with them for a little while. 
Hearing people complain here is hilarious.  Day one I worked with ER BFF, and while we're sitting there in report everyone is all "Oh noes, today is terrible, there's a FOUR hour wait."  Both of us had to stifle our laughter. It's not like it isn't hard, or that I don't get stressed, but it's not I "I have a 14 hour wait and I just filled my last bed with a cardiac chest pain and now I have a CPR coming" level stress.  And I don't see it getting to that point, because they have a system set up here that actually seems to work. 
But yeah, the patients are almost exactly the same.  Well, some of them are  literally exactly the same- apparently some of our frequent flyers at Hood Hospital have been cheating on us with the new ER.  (One saw ER BFF here the other day- "hey, I see you're working over here now! Her reply "Yup, looks like you are too!") I have no doubt I'll still have plenty of stories to tell.  To give you an idea, the first patient I discharged day one was here for dizziness secondary to smoking marijuana.   His family asked me if he was getting any prescriptions.  "Uh... no.  See, the doctors thinks he's dizzy because of the drugs... so prescriptions aren't really necessary... he should probably just, yeah.  Not do drugs anymore."
So yes, the same foolishness that I love/hate about working in the ER without the coming home everyday feeling like I'd been out drinking all night and had the crap beat out of me when in reality I'd just been at work.  A little break every now and then from the constant onslaught of crazy sick people with no mercy.  It still feels so foreign- every time I sit down, I'm still in disbelief that I'm actually caught up with my work and I have nothing else to do.  I just always assume I'm forgetting something.  I kind of have that weird disoriented feeling, like when you step down from running on a treadmill and you're trying to get used to the fact that the ground isn't moving under your feet anymore.
I hoped, but I really wasn't sure, that nursing in the ER or in a hospital setting didn't have to be as awful as it was.  It's such a relief to know it doesn't have to be that way.  To know that I can step away and enjoy my days off without looking over my shoulder and feeling like something was going to come back to bite me.  It's so much better, but a little part of me aches and feels guilty knowing that so many of my friends are stuck where I was.  We'll see how it goes in the next couple of months but right now I am loving it.  I feel like I've gotten my life back. 

Wednesday, October 24, 2012

The Last Time

Woo.  Worked my last shift at Hood Hospital EVAR this week, y'all. And I say that definitively because I was thinking about picking up some shifts over there, but yeah, F that noise.  I honestly thought I would feel more upset about leaving.  I felt upset about leaving some of the doctors and PAs, because I really will probably never see them again.  Turns out a few of them also work at my new hospital- unfortunately not the ones I would necessarily want to see again, but oh well.  One of the most poignant moments for me was saying goodbye to big eastern european doc, who has worked there since I was a baby nurse and has yelled at me many a time.  He was always someone whose respect I sought, although I was pretty much convinced he hated me and thought I was a complete moron up until about a year ago, when he seemed to start tolerating me.  When I went to say goodbye to the docs that morning he actually got up out of his chair and hugged me and said he would miss me.  I really had no idea how some of the people here felt until I was saying goodbye and I saw that they actually looked really sad.
Saying goodbye to my fellow nurses was tough too- especially since the two people that I would really say were both my mentors throughout my nursing career thus far were there,  but I know we'll stay in touch.
Fortunately, they put me at triage, which was probably the most solid affirmation possible that I was making the right choice.  Nope, I sure won't miss making sick people wait for 12 hours to get seen, or getting cussed out every time I open the door to call someone to triage.  I won't miss taking care of people in chairs because there are no rooms in the back while triaging 15 people an hour at the same time. I won't miss compromising my license and questioning why I became a nurse in the first place.  I'm sad to leave everybody, but it was past time to move on.  I feel a little stupid for staying this long.  I know nowhere is going to be perfect, but I'm excited to start the next part of my life.

Thursday, October 18, 2012

Go Ahead and Shock Him Into Asystole, Then

So, it sounds funny to say, but codes rarely work out for anyone.  I mean, obviously it isn't a great starting point, but I didn't know til I became a real grown up nurse how seldom CPR actually does anything at all- and that when it does actually "work", we bring people back to the life of a week long, million dollar ICU stay after which they either a)die anyway or b)spend the rest of their life in some kind of long term care center with a trach and a hypoxic brain injury.  Maybe like, a couple times a year you will get someone who is a legit witnessed cardiac arrest where CPR is immediately initiated and the underlying problem is correctable and they get up and walk out a couple weeks later like nothing happened.  And boy, is it weird when those people check back in to the ER.
Unfortunately, this was not one of those cases.  Guy was older and had already been down around 30-40 minutes when we got ahold of him.  But okay, he's not that old and we've got some gung-ho paramedic students here who wanna do some compressions.  Let's give it a shot.  So we do a couple of rounds of CPR- asystole, asystole, what do you know-V Tach-clear!, asystole, that way too long of a pause in compressions for central line insertion that ACLS guidelines don't want you to do anymore,  PEA... asystole, okay, let's resume compressions, and okay, does anyone object to calling this now, because... yeah.  We've already been doing this probably longer than we should have given the circumstances.  Yeah, alright.  Let's call it.  Time of death is agreed upon, and we go to print the strips off the monitor, and WTF? The patient is in V tach again.  Recording nurse is distressed and tells the doctor we can't print off a strip that looks like this.  "That's a shockable rhythm. I mean, I know you called it, but I can't put this in the chart."
Doctor: "Okay, well, whatever, he's been pronounced, but I guess you can shock him into asystole if that makes you feel better." Walks out of the room.
Okay.  Clear!
Except, uhh.. now it looks like some kind of accelerated junctional funkiness on there.  And, holy shit, the patient has a pulse now.  And, could you hit that button please? A blood pressure! Um, can someone go stop the doctor and tell him before he delivers the bad news to the family please?
So yup, this guy is totally alive again.  Well, technically.  His pupils are non-reactive and he's down with no sedation.  His blood pressure responds pretty well to pressors when the epi finally wears off, but, uh, yeah. Here we are now.  The recorder was apologizing to everyone for the rest of the night, but I would have probably done the same thing.
It felt awful, to be honest.  He had a huge, super sweet family who were eternally grateful that we had saved their patriarch's life, and now we've got to find a way to break the news to them that he's still not really there.  They were on the fence about a DNR status.  They said they wanted everything done but they didn't want him to suffer.   I tried to gently explain that it's impossible to tell if he's suffering because there doesn't seem to be much there. The hospitalist pretty much laid it out how it was, but you could tell they were still grappling with all of it.  I'm sure it probably seemed like he had died twice.
That's the thing that kind of sucks about what we do.  Yeah, it's incredible when our interventions save and improve people's lives.  But so often I just feel like we're making it worse.

Tuesday, October 16, 2012


Gal a little younger than me presents with her baby and her baby's daddy for some kind of Level 1 abdominal pain DRAMZ.  Of course, it's crazy busy and it totally sucks and it's way understaffed because Hood Hospital.  Homegirl's vitals are stable and she goes back to the waiting room.
Baby daddy then proceeds to bum rush the triage desk every 5 minutes to berate us about why she isn't getting a room.  It's been around an hour at this point.  We re-triage her, at his request. Yup, you're still okay, I'm sorry it's so busy, as soon as we get a room we'll bring you back, sorry, okay thanks.
Baby daddy escalates even more, finally reaching a crescendo as he goes up to the window and screams at triage partner "HOW LONG ARE YOU GUYS JUST GOING TO LET HER FUCKING SIT THERE IN PAIN?!!" Oh, I'm sorry, did you want a room?  Well now that you said that, let me just see if I can remember my f-ing room conjuring spell that I learned when I spent my semester at Hogwarts and just make one for you.
So after all the to-do we skip some people to accommodate abdominal pain princess and her knight in shining armor here,  and I walk her back.  The nurse is busy and I'm not at this point in the night, so I decide to help out and start her IV.  Not being in the waiting room seems to already be improving the symptoms drastically, so I'm talking with them about their baby and stuff when she starts making some hilarious baby faces and patient mentions that she thinks the baby might be pooping and baby daddy will have to change her diaper.  At that point, dude gets totally butt hurt and is all like, "Um, NO.  I changed the last one, it's your turn."
OH.  Oh really? Ten minutes ago, you were totally for sure that your baby's mom was legit DYING in the waiting room, but now all of a sudden you're not concerned enough to change your kid's diaper because it's HER TURN? Really? Yeah, all staff be advised, there's now an active douche alert in this room.

Monday, October 15, 2012

Chief Complaints of the Nights

Ugh, sorry I never post anything anymore.  I guess there was some memo sent around that I didn't get about how I've been banned from actually taking care of patients or something, because I am ALWAYS triage or charge.  Unfortunately for you, dear readers, me walking around like an idiot for 12 hours yelling at my phone for ringing so much and trying to sort through my own notes about transfers and dealing with complaints from people about how we haven't fed them when they've been in the ER for three whole hours doesn't make for interesting blogging.  However, the parade of foolishness that is triage is still amusing if you don't think too hard about the reality that these people are out there, driving cars and reproducing.  Sooo here's the highlights this week:

-The guy who checked in for a prescription refill for Naproxen.  Which you can buy over the counter.
-Geriatric patient who came in DRUNK OFF HIS ASS at 4 AM for an insect bite that was most definitely not there, and then proceeded to hit on me in front of his much younger female companion.
-The lady who checked in because she was at "the age when you're supposed to get a colonoscopy".
-The lady that came in with her toddler to get the kid checked after she caught him chewing on the toilet brush.
-Guy who burned his face while smoking over the open gas tank of a running lawn mower who also hit on me, because winners.
-Concerned parent who brought in her two kids that got higher than they were used to after smoking some weed that was more potent than their usual.  I can usually keep a straight face through anything, but when questions about medical history were answered with "man, I really want some meatloaf" I completely lost my shit laughing. Relax, I then reassured mom in a very professional and therapeutic manner that no one has ever OD'd on marijuana and it was going to be okay.
-Oh, I almost forgot the guy that told us there were multi-colored bugs coming out of his butthole that jumped around and layed eggs all over the house.  YUP.
So basically this the entire shift for the last three shifts.  I can't deal with this much longer, so I'm thinking about trying to phase out my own position entirely and maybe replace it with something like this:
with all the staffing cuts, it's only a matter of time.

Tuesday, October 9, 2012

2 weeks

Yup.  It's happening.  I gave Hood Hospital my notice this week, and I'll be starting a new job soon.  I'll still be an ER nurse, and it's pretty close by, so the stuff I see will be somewhat similar, but just less crazy.  New hospital sees a little less people, but it's also run waaay more efficiently. The most amazing part of all- ER BFF is going with me. Apparently when you work in the most ghetto, batshit crazy ER in the city, it's pretty easy to get hired on wherever because they know you can hang.
I'm beyond excited.  I'm sleeping a lot better, and even when shifts at Hood Hospital are shitty, I can at least tell myself that I'll be out of here soon.  It's gonna suck to leave my friends, but I'm so afraid that if I stay here any longer that it could potentially ruin nursing for me forever.  I'm watching people that have stepped up into the roles that I've stepped up to before me- people that I know are amazing nurses, but who have lost a lot of the love for what they do.  This place has taken everything they have.  Before I could see my way out, back when I was still trying to figure out what to do, I would seriously just sit up and cry for absolutely no reason I could identify.  I was a complete and total basket case a month ago, and I pretty much made life impossible for my poor husband.  I know things where I'm going aren't going to be perfect, but I really don't think that I have to settle for a job that's so toxic.
We'll see how it goes.  I'm just relieved I have someone here with me who is going to be going through the same adjustments and growing pains that I am.  I think part of the reason I stayed so long was oddly how horrible it was for me there as a new nurse.  I know the situation was different, but it was really tough being new and isolated and being shy and weird to boot.  I've honestly been a little scared of having to go somewhere new and start fresh with all new people that don't know my quirks and such. Even if this place is staffed with 100 percent total princess Bs, I at least know I have one friend.
The funny thing about all of it is that we're among several people who have jumped ship in the last couple of months.  They've lost nearly a quarter of the staff here recently, and it's finally, finally, caught the attention of the bigwigs.   Despite being told this for multiple YEARS, these idiots are all of a sudden all "OMGZ, you mean you guys don't like running this place with half the staff you're supposed to have and never eating or peeing, and that comparable places with more staff get more shit done and have happier patients? Well OKEY DOKEY then, let's get you a bunch of new staff!"  Except...yeah... the amount they're hiring will only serve to replace the experienced staff that left, so..yeah.
But you know what?  It doesn't matter anymore.  They can make all the promises they want, because I know they're full of crap, and I don't have to take it anymore.   It's a pretty great feeling.

Saturday, September 29, 2012

....But They're A Nice Person

Alright, so there's a subject I'm very opinionated on.  I know you're shocked, but I'm curious what other people think about this.  So like anywhere else, there are some shitty, lazy ass nurses where I work.  Like, not as in forget to hang a med every now and then shitty, but as in basically totally ignoring their patients for hours at a time while updating Facebook and skipping really important shit like CIPs on a patient with chest pain and a mile long cardiac history type of shitty.
These people also may be really good dancers or fun to go to the bar with or maybe they have a boat or an okay personality or whatever.  People still like them for these qualities and want to be their friend while still objectively being able to say, "yeah, they're a shitty nurse, but they're an alright person", to which I would say-naw.  Nope.  They're not.
Here's my thinking.  It's one thing to be inexperienced or tightly wound to the point of being ineffective- these people I can still love and try to help.  But as far as I'm concerned, if you're the shitty secondary to laziness type of nurse, you are probably not a good human being.  You can put on a nice face to your coworkers and buy people Starbucks and smile all the time, but if you have no desire to help patients that are actually sick that depend on you to take care of them, that speaks more to your true colors.  I take this job so seriously and it means so much to me to do a good job that I really cannot fathom how someone can take it lightly and just not care.
 I feel very strongly about this, to the point that I make a concerted effort to never have to interact with these people. When I do, I do very little to hide my disdain.  A lot of my good work friends do not understand this.  They're confused when they want to invite these types out somewhere and I don't want to come along.  It's just that I've seen all I need to see.  I'm not interested in knowing them any better.
I wonder sometimes if I'm maybe too harsh on this, but I really can't reconcile being an okay person with being a lazy nurse.  Am I wrong?

Tuesday, September 25, 2012

Code Blue, ER Waiting Room

Dude, I'm waiting for the day. Hopefully I'll be gone by the time we have to start CPR in the waiting room.  But we've had a couple false alarms in the mean time.
How about the drunk girl whose mom decided she was dead? Yeah, as opposed to calling 911, mom sure did scoop her early 20 something daughter up and throw her in the car when she became unresponsive.  She, um, monitored (?) her on the way to the ER, during which time her pulse became "weak" multiple times.  Mom then initiated compressions, until daughter woke up.  When she would drift off, mom would initiate compressions again.  Repeat the steps above until they reached the ER, when mom ran frantically into the waiting room screaming that they were doing CPR in the car. Poor newer nurse at the desk that night believed her, paged it overhead, stretchers were rolled out to the car until everyone got out there and... yeah.  Dr. Muscles, who is already high strung anyway, had a total shit fit when the girl got back to the room and the staff cancelled the code blue and activated code drunk.  Okay, great, how about a couple saline boluses.. hello.. ah, nope, you're already walking away.  Luckily I was charge, Dr. Muscles likes me, and the situation was diffused.  Well, up until ER BFF accidentally let on her feelings about the situation while giving report to the oncoming nurse.  It went something like... "Yeah, so they were having trouble waking her up at home, and then momm initiated comppressions? And...yeah" (add WTF shrug and wide eyes into the mix) when mom chimed in "I SURE DID!"  Yup, I guess she still probably thinks she saved her daughter's life, as opposed to doing a modified sternal rub.  MMKay, thanks for choosing Hood Hospital.
Then the other day, some girl fakes a syncopal episode at the triage desk. Yeah, it happens about once a week anyway, but this time some random patient runs up to catch her whilst yelling "CODE BLUE! CODE BLUE!", eliciting blank stares from the staff.  Another patient chimes in. "C'mon you guys, code blue!"  Everyone quieted down considerably when the ammonia caps were deployed.  Guys.  You have GOT to stop watching Grey's Anatomy. 
I think the foolishness people pull in the ER is so foreign to the average person that they assume anyone who falls down has actually passed out.  Very rarely does this ever actually happen.  Someone decided to play this game the other day.  She did a terrible job, but since she was twice my size, I just had to wait for the charge nurse to run out with the ammonia caps to expose the truth.  In the mean time, some sweet, unsuspecting big dude came over to render aid.  Poor guy, he was so concerned.  "Oh man, she must have finally passed out from the pain", he said.  "Yeah.  She's fine. People are coming, but thank you", I told him.  Yes, she looked like quite the fool whenever she immediately sat up while trying to bat the ammonia cap away.  I saw the same gentleman on the way out and thanked him again for helping.  He asked me if she was alright.  My triage partner chimed right in.  "Yup", he said.  "That happens sometimes when we have long waits."  The nice man was shocked.  "Seriously? WOW."  He walked away shaking his head.
Yeah. With the way it's going here, it'll happen one day.  But we'll be terribly skeptical when it does. 

Monday, September 17, 2012

Acute Lawsuit Opportunity

Blergh.  People are soooo incredibly not subtle in regards to their ulterior motives when visiting the ER. Every now and then, sure, we get the creative drug seeker who fool us all, but usually people are just not subtle enough and blow their cover in triage by making requests that are way specific. 
The worst are the ones that are clearly trying to establish grounds for a lawsuit.  In adults, this usually manifests itself in the form of symptoms far out of proportion with the actual mechanism of injury, lots of talk about said mechanism of injury, and me having to explain what a contusion is upon discharge. (You've got a bruise, bro, go to the house).  Bonus points for asking for documentation of injuries and putting it on blast that your insurance won't be paying for this visit when the unsuspecting registration clerk comes to collect your information.   Nkay, whatever you say, dude!
It's a thousand times worse when people bring their kids in for this crap.  I'm talking Toddler and Tiaras style coaching.  "OH, honey, weren't you saying your back was hurting on the way over here?" "But sweetie, your pain is only that smiley face with the 2 underneath it? Are you sure it isn't the one that's crying? You were crying earlier!" At this point the parent usually goes totally rogue talking about all the injuries the child sustained and was complaining about at the time.  I always chart these exactly as they say, including the part where the parent said them and what the child is doing at the time.  For example, "Pt's mother states pt was crying and c/o lower back and neck pain at the scene.  Pt denies pain at this time, playing game boy at time of triage.  No pain or guarding noted upon palpation of pt's low back or neck."
We had one like this a couple of days ago that might have taken the cake.  Bonus points for this one when half the triage is spent talking about how something was spilled on the floor at the Wal-Mart and no one had mopped it up and they should have mopped it up.  Allegedly, the kid slipped in whatever slippery substance was spilled on the floor and fell to his knees for a minute. Mom was totally spazzing talking about how she was worried and wanted to get her baby checked out, etc. after the bad people at the Wal-Mart were so negligent as to let this happen, except, yeah.  The kid had not a mark on him.  I'm talking not a skinned knee, no bruising, no swelling, no redness.  He had at least three varieties of chips in his hand at the time of triage, and he rated his pain a 1 when prompted.  I sent them out to the waiting room, as absolutely nothing was wrong with him AT ALL and thirty minutes later mom's bum rushing the desk saying that her son's knees hurt and he needs pain medicine.  The kid is still chilling eating chips in the waiting room. 
WTF? Do these settlements really pay that well? Maybe I should slip on some shit at Wal-Mart so I don't have to keep dealing with this foolishness.

Friday, September 14, 2012

Big Happenings and Stuff Maybe

Welp.  The time has come, sort of.  I've finally reached my breaking point with this place.   Charge did it.  It's not that people are giving me shit, or that I can't handle the pressure (well, maybe partially), so much as it's really brought to light how insanely fucking dangerous a place this is to work as a nurse and I don't feel okay doing it anymore. It's almost okay sometimes as a staff nurse.  Yeah, your patient acuity is crazy and most of us probably have more on our plate than we can handle at any given time.  But at least there's a limit to how many they can make us take.  Charge and triage? Forget about it. 
We do not have the resources we need to take care of all these people. And we haven't since I started here.  Every year it gets worse. They keep telling us to hold on, that we'll do this or that, and it will get fixed.  And okay, great, we don't have to hang Levophed on a fucking dial-a-flow anymore, am I supposed to be impressed at this progress? There are still good nights. But the bad nights are becoming the norm.  And it's not alright anymore.  It's seriously just not okay that I look at the tracker and consider it a "good night" if the waits are in the single digits and I don't have to scroll down to see how many people are in the waiting room.  The conditions here are setting us up for failure. With as sick as our population is, someone is going to either die in the waiting room or go home after waiting to be seen forever and die and it's going to be all of our asses.  Not the people in suits who keep making excuses about why we have so many holds all the time and why we never have any staff.  Not even my manager who's been begging them to do something.  Us.  The nurses.  We're the ones that are going down when this happens.  And maybe when it does they will finally do something about how this place runs.  But our lives are gonna get ruined in the process.
I've felt so loyal for so long, because I really love it here.  I really care about our patient population.  Among the ridiculous hood foolish behavior, there are some really sick, sweet, hardworking people that really need good nursing care and are really grateful when they get it.  I actually genuinely like my manager.   And damn it, my coworkers.  That is the hardest part.  They have kept me here for so long.  Worrying about leaving them here with a bunch of people who don't give a shit.  About who is gonna teach the baby nurses how to work on a team and how to deal with the crazy shit and how to deal with all the messed up stuff they feel in the first year or so.  I absolutely adore these people. About who my charge nurse buds are gonna put at triage on the nights they have a quarter of the rooms they should and they need someone who's only gonna call about the really sick people.  They have reached out to me and held me up when I was at my wit's end with the crap this place dishes out.  It's like having a second family.
But ultimately, I can't do it like this.  I can't continue looking these patients in the eye and telling them it's acceptable to wait to be seen for 10 hours with chest pain and a cardiac history.  And can't keep sending these people I care about more ambulances when I know they're already overwhelmed.  I can't continue to be part of an environment where I don't have the tools I need to be successful and practice safely.  I worked so hard to get my license.  I'm not gonna lose it for the dignity of staying on this sinking ship.  I feel like I can't do anything good for these people anymore, and it's breaking my heart. I'm constantly anxious days after I'm in charge or triage, because I it's gonna come back that something bad happened on my watch.  I feel like crap for days on end thinking about how sub-par the care I'm able to give these patients is when I want to be doing so much more.  I'm generally having nightmares about being at work after I get off a shift.  It's gone past being a tough job at this point- it's crept into my entire life. 
So I'm looking for jobs.  I'm gonna stay in the ER.  Preferably one that's still busy, but one that isn't a total shit show in the way it operates.  I'm sure I'll still be here for a bit, and even then that I'll still have stories.  I just can't take the way things are here anymore.

Saturday, September 8, 2012

New Item on My Last Day To-Do List, Courtesey of Emesis Bag Nurse

World Famous Emesis Bag Nurse: Yeah, I've been looking into going into the trophy store and buying a whole box of those acting statues with the little gold man on them so I can just hand them out to people in triage after they roll all over the floor and shit.  It's getting ridiculous up there. 
Gawwwdd that would be amazing.  I've been daydreaming what the reaction might actually be for days now. I'm thinking in order of likelihood, it would be angry yelling, total confusion, or slinking back into the waiting room in a defeated manner.  Either way it would be the most hilarious shit ever, and when I finally become a dusty old nurse who is about to retire, I'm doing it.  It's happening. I wonder how much they cost.  

Oh, and in other slightly related trophy news, I'm seriously considering hot-gluing a troll doll to a piece of plywood and spray painting it gold, thus creating the golden troll award (trademark pending).  This honor would obviously be granted at the end of the shift to the nurse who took care of the most abusive/terrible patient. I think it would boost morale, but probably also land me in the office. But still. Worth it?

Wednesday, September 5, 2012

Worst Admission EVER

Ugggh. You can always tell when Dr.Septic Workups and Dilaudid for everyone has been on for a few days, because there will always be shit-tons of holds in the ER.  Because he single-handedly fills up the entire hospital by admitting everyone.  His behavior is so notoriously ridiculous that I've seen it lead to multiple hospitalists having public meltdowns, including one of my favorites, an awesome Vietnamese doctor, who once famously exclaimed to him at the nurses station, "I cannot take this many patients! You fuck me over!"
If a patient still requests more pain medicine after the insane amounts of Dilaudid he usually prescribes, he will admit them for "intractable _____ pain" and order some ridiculous regimen like 3 of Dilaudid Q 2 hours until the hospitalist sees it and changes it to something reasonable because, I don't know, maybe they like their patients breathing.  Which often leads to huge confrontations and AMA signing, own IV pulling dramz when the abrupt Dila-da cutoff is discovered by the patient, but hey, at least that's one more hold that can get a bed?
Anyways, this is all standard procedure at this point, deliver us lest we receive a complaint from a drug seeker.  I guess I get it.  Why bother fighting when you can admit people for whatever they want and make them happy?  However, that still leaves me without an explanation for his most recent insane admitting diagnosis: "acute alcohol intoxication",  The BAC in question? 0.12.  In a 23 year old.  With no other medical history.  Who, with homeboy's crazy long dispo times, was most likely under the legal limit by the time his bed request was put in.  Awesome.  Way to reduce they unnecessary medical costs you're always bitching about, guy. A good friend of mine was taking care of this one, so we had a field day with it.
"0.12, huh? Dude, I guarantee that my BAC was higher than that last weekend.  And I'm pretty sure you bought me one of those drinks.  Obviously, I needed to get admitted to the hospital and I just went home and ate macaroni and cheese.  Why did you not call me an ambulance? You're a shitty friend."
"Right? We should always come up here after we drink.  We've been playing with fire all this time when we were out eating pancakes and stuff."
Seriously, though.  If we're going to start doing this we need to have a whole new wing that's open only for this purpose on weekends and holidays.  Bring on the life saving banana bags!

Saturday, September 1, 2012

ER Fashion Trends

Back in my shiny, noob nurse days, when I was all excited to go out and buy my uniform for my exciting new job in the ER, I wandered into a scrub shop while out running errands with my husband, found some relatively cute shit, and bought it with my fancy new nurse intern money.  As I was checking out, the lady at the counter asked me if I was a medical professional.  I replied that yes, I was an RN, with the typical shit-eating grin of someone who hadn't yet had to start drinking to cope with my chosen  profession. Okay, she told me, you get a discount then.  Just write your name down here.
I remember thinking at the time that it was so odd that they did that, because who the hell buys scrubs that isn't a medical professional? Who exactly is buying this scratchy, expensive crap to wear in their downtime?
Um, yeah.  My patients, that's who.  Most of the time they present to triage in their scrubs, I guess in the attempt to trick us into thinking they're some kind of medical professional or nurse or whatevs, except when you open your mouth and start talking about your vaginal discharge that you've had for two weeks and how your baby's daddy had that gonorrhea last month, it kind of ruins the illusion, but thanks for playing. One girl even showed up a while back in a scrub top with a little cutesy print with "RN" as part of the pattern, and then proceeded to blow her cover in record time with a chief complaint that not even the dumbest of RNs would present to the ER for.
Even better is when they show up wearing this shit as we're taking care of their family member like they're at work here (bonus points for showing up in the uniform of whatever fly-by-night 6 week medical assisting/phlebotomy program they're currently enrolled in) and then stand at the bedside trying mean mugging anyone involved in their family member's care.  Even more bonus points for googling the shit out of everything we say and then trying to argue about what we're doing.
Come to mention it, a general rule of thumb ER BFF and I have come up with is that if you are wearing scrubs and advertising the fact that you're a "nurse", chances are, you're NOT. This comes from several years of empirical evidence during which we've looked up face sheets and verified people's licenses online. Most of these people are actually lab techs, in the best case scenarios, they are nursing aides, but a good portion of them are also just total liars/cray-crays. Most actual nurses, myself included, wear street clothes and say nothing about being a nurse.  People are more likely to show the real time of care they intend on giving when they aren't trying to impress you, and you can more accurately judge whether or not they're a douche.
Anyway, complete tangent, but are my patients the only ones who try and pull these kinds of shenanigans? It's really a terrible waste of money.

Friday, August 31, 2012


Right, so I'm triaging this lady the other day for some vague pregnancy-related complaint and I'm asking her the standard OB type prenatal care GPblahblahblah type of questions.  I mean, I know these are easy things for me to answer, because the answer is currently and may always just be "naw dude, never", but I'm a little taken aback when the answer to "how many times have you been pregnant?" is answered with an indifferent shrug.
Huh? You don't know how many times you've been pregnant? I mean... can you give me, like, a general number?
Uh, maybe like 15 or 16?
Mmmkay then.  How many children?
So the other pregnancies were stillbirths, miscarriages, terminations?
Some miscarriages and some terminations.
How many of each?
Yeah, I don't remember.

Okay, look. I'm overall pretty pro-choice and women's health and freedom and Planned Parenthood and make it rain birth control at a reasonable cost for everyone everywhere BUT COME ON. SERIOUSLY DUDE. Hi, if you can't remember how many times you've been pregnant and your answer for how many abortions you've had is pretty much how I would answer if someone asked me how many sandwiches I ate last week, maybe it's time to look into condoms or maybe just not having sex for a while.  You're probably having the problems you're having right now because your uterus is tired and cranky and it just wants a vacation.  STOP IT.  Give it a break for like, a year. PLEASE.

P.S. Everyone.  Please don't make me regret sharing this anecdote by turning the comments section into a shit-throwing contest about Roe V. Wade.  You're never going to change each other's minds about anything ever. K thanks.

Wednesday, August 29, 2012

Depressing Developments and Therapeutic Crack Rocks

Nursing home sends the standard "altered but more altered than usual" via EMS at 3 AM.  Yeah, okay.  I do a quick head to toe and find that yes, the patient is still altered.  I'm trying to decipher the paperwork these fools sent over when I realize the name is someone I recognize- she was a former street person who would occasionally find her way to our ER, usually agitated due to some combination of crack and mental illness.  Both had clearly taken their toll-she looked about 20 years older than her actual age and was basically obtunded. Pretty depressing stuff, really.  
I'm going about my business when the patient's sister calls to check up on her. I talk to her for a while about what she was normally like and she gave me a brief history of what had happened over the last few years and how she had declined after an inpatient psych stay.  At some point it came up that I remembered her from her previous visits, which somehow seemed to comfort her.  She was obviously a pretty nice lady.  "I'm glad you remember her.  Yeah, she was on drugs there for a while."  "I remember", I tell her. "She was doing crack then, wasn't she?"  "Uh huh.  That was her." She paused for a while after that and then chuckled a little bit.  "You know, the funny thing is, she was good and strong when she was smoking that crack rock! She just started going bad when she quit!" I laughed a little bit without thinking, but by this point she was laughing hysterically.  "I'm sorry", I told her, after I'd regained my composure.  "No, that's okay", she said, still stifling laughter or tears, I couldn't tell over the phone.  "That's just how things worked out.  Will you call me when you guys know something though?  I know I'll be up all night worried about her."
Sure enough, she was wide awake when I called her back a few hours later to tell her all the tests we'd run were negative.  It makes me feel a little bit better that we aren't the only ones who do this kind of thing.

Monday, August 20, 2012

Basic Problem Solving Skills

Sometimes I feel like they're doing this to me on purpose now to listen to my rants and tirades, but anyway, charge brings a lady with cc: rectal pain to my room.  Of course. How long? Over a year.  Of course.
I'm sure I've mentioned it before, but I rarely ask why anymore.  I certainly never attempt to explore any situations like this myself, but I walked the young lady through what she could expect as far as the rectal exam and then threw the deuces up.  I had a couple of other patients with a more acute complaints.
I'm going about my business when sassy lady ER doc grabs me to chaperone the rectal exam.  Fun times.  Yup, little lady, there sure are some fissures there, she tells her.  Okay, so I'll go head and prescribe you some cream and  OH ALSO YOU SHOULD PROBABLY STOP HAVING TEH BUTTSECKS  FOR A WHILE NOW K?

Yup.  I don't know what the first thought that crossed YOUR mind was, but I was immediately shocked that after a year or more of relentless butthole pain that this chick was never like "hm, maybe a should lay off the anal intercourse for a little while." You'd think before coming to the ER and waiting to be seen for 8 hours you might try this, but yeeaah.  Her reaction to these discharge instructions was one of complete shock, like she had never made the connection before.  I tried to tell her about sitz baths, but I don't know if it really helped. .

Wednesday, August 15, 2012

Compassion Tap Out

Well, I sort of alluded to this a few posts back but some fuckery Nurse K has been showered in lately got me thinking about it a little more in depth.  You can get the full recap here, but the highlights would be 1)Nurse K posts about an shutting down some verbally abusive chick who is obviously drug seeking in a hilarious manner 2)Hijinks ensue when some spiritual healing jackwagon tries to lecture her for not having compassion for the poor drug seekers omegerd.
Fill a number of things into the drug seeking blank and you have the life of anyone who has blog about being involved in any type of medicine ever. One lovely reader a couple of months ago felt the need to go back into my archives and comment on any posts where I talked about making mistakes to call me a "dumb whore", including one in which I was  distraught about an abused child who I had cared for later dying, because I dared admit that I did not always think about the implications of laughing at the poor spelling and grammar on our check in forms. MMkay. Declined to publish all those, but you stay classy now anyway anonymous lady/dude/troll.
Anyway, as I've also talked about before, we may seem to the outside world like we don't care about a lot of shit.  I just want to clarify that it's not so much that as it is that it is absolutely imperative to our sanity and survival in this field that we are selective about what we care about.  I can't for sure speak for anyone else, but I can at least say for myself that I started blogging to work out a lot of tough feelings I was having about what I do.  But no one wants to read all that shit, because it's depressing, so occasionally I throw in things that happened that I found funny at the time. Sometimes the funny and the frustrating and the sad shit overlap, because you know what? When I really think about what I actually do every day, I see a ton of really, really sad shit.
I think the perception of the sad nature of the ER for a lot of people is basically "people die and that's a bummer".  Dude.  That's just the tip of the iceberg.  We see much, much worse.  We see victims of rape and violence, sometimes children, who are completely vulnerable and suffering for absolutely no tangible reason.  We see broken, frail, neglected elderly people covered in sores and wasting away forced to live in pain every day because their families who have forgotten them for years won't let them escape it until their heart fails after weeks on a ventilator. We see people unable to clean themselves or talk after a stroke who are perfectly aware of the world around them, trapped inside their own bodies, watching their families  carry on without them. People wasting away from cancer in horrific pain. Formerly happy, healthy individuals who now live in a completely different world than the rest of us because of mental illness.
Beyond the surface, there are so many more sad stories.  I talked to the sweetest elderly man recently who was telling me about how he lost his house after a prolonged illness- his only option was living in a nursing home which didn't allow pets, so he lost his dog, which was the only thing he cared about.  Seriously.  ALL he wanted was just to see his dog, and he was incredibly depressed because of how much he missed her. We bonded as I was talking to him about my dogs, and I was full on snotty-nosed bawling by the end of the conversation.  So many things will break your heart if you let them.
Nursing is awesome but at the same time, it's also one giant parade of getting bitch slapped with sadness. Depending on your personality, I think we live in a world where it's pretty easy to completely drown in the sorrows of others if you let yourself. There are nights where I sit up alone and think about how much suffering there is and how little I can actually do about it and weep at the pointlessness of what I'm doing in the world.
Point is, if we looked deeper at a lot of the situations we poke fun at, we would find, yes, even more sadness.  Is drug addiction awful and tragic? Absolutely.  Is the general level of education among the people I see in fact a huge downer and a symptom of a bigger problem that is overwhelming to even think about? Hell yes. Are the zany things our homeless patients do probably a sign of a much greater problem which without a doubt, is worthy of tears on it's own? Certainly.  It's not that we don't know these terrible things lie under the surface.  It's that we aren't digging under the surface because one person can only feel so much sadness in one day without going absolutely bat shit crazy.
Some people say that people like us, who laugh at some of the things we laugh at, are a disgrace to the field and we should do something else.  People that think compassion is not a limited commodity and that you don't have to save it up.  I'm telling you that's bullshit.  If you only want people with bottomless compassion to take care of you, stay at home and pray for healing instead of going to the hospital, because I'm pretty sure the only person with limitless compassion who walked the earth was Jesus. Right or wrong, I'm saving mine up for the people who seem to need it the most. I'm perfectly willing to admit I'm not always right on who fits that criteria.  But I'm also pretty confident it's not the girl calling me a bitch while asking for Percocet either.

Sunday, August 12, 2012

Chief Complaint of the Century

It's always a special night when a patient like this is the first one you triage.

Hi, first patient I've seen today at Hood Hospital, what's up?
Oh, you know, low back pain.
For how long?
Some time.
Well, how long is some time for you, ma'am?
Well... let's see.  It's been on an off.  It always kind of hurts. I think it first started in 1993, though.

It's never a good start when your reason for visit is older than some of our volunteers, but it gets even better.

Yeah. Alright then.  Any allergies?
Yes! I'm allergic to ALL medicines. All of them. Prescription and over the counter.  All medicine.

Wow. That's too bad, seeing as how that also means we can basically do nothing to help you here. But if you'll excuse me, I need to take my daily dose of face palm now.

Tuesday, July 31, 2012

Adventures of Charge Nursing, Part 1

Welll. I worked my first shift on my own as big girl charge, y'all. The ER did not collapse into a pile of rubble or burn to the ground and no one made me cry.  Yet.
 I have a new respect for the position.  As in, I stand in admiration and awe of any of our charge nurses that are able to pull their shit together long enough to have time to help out frequently with patient care.  I had spaghetti brains in the worst way, like I haven't experienced since I was a brand new nurse. I was inundated with so many different requests that I would get distracted just walking across the nurses' station.  You've usually got the phone on one ear with multiple people talking in your other ear, so all the auditory input was just scrambling in my brain and all my responses were getting mixed together word salad style. I felt like a HUGE spazz. But I know I'm at least making progress. A few things I've learned already:
-Despite being less physically demanding, I feel about one thousand times more exhausted after charging than I do after working in staffing.  Probably because of the constant muscle tension associated with the underlying fear or doing something incredibly stupid, like transferring the wrong patient or something.
-People seem to respond to a work ethic at least. I mean, maybe I shouldn't have been, but I was very surprised by my teammates.  They seemed to take note of how much I was running around and either felt sorry for me or responded to my working hard and being nice, because every time I looked up, people were cleaning their own rooms and filling them up. So much that one of the doctors got mad about it.  Oh well.  Which brings me to...
-Shrugging with a whatevs look seems to be the best policy for dealing with most petty arguments/hissy fits/backhanded comments. Somebody hurt your feelings during report? Either ignore it, be a bitch back like I would, or file a complaint to HR. I have no real authority, I really don't care,  and I have real shit to do.
-When your manager calls to check to see how things are going, I guess responding with, "yeah, I have no idea how many people left without being seen, probably a lot, a million people just checked in, we've been getting killed with ambulances and also someone wanted to come in extra and I said yes I hope that's cool because they're already here" probably isn't the best thing to say.
-Unspecified department problems are by default, your problems.  The doctor's printer is out of paper? HELP ME CHARGE NURSE! The coffee machine is broken? Hello, did you not learn coffee machine CPR in nursing school? Cray cray people want to call and ask for medical advice about cray cray shit? Forward to charge phone. Random foot-fetishist who is neither a patient nor a visitor is scurrying around the unit sniffing patient's shoes? Get the charge net, gotta catch 'em all!

Anyway, the verdict is, this sucks, but I know I'm learning new things and that's good for me.  But if I was doing it for the money, it wouldn't be worth it. Such is nursing in general, I guess.

Thursday, July 26, 2012

Why I'm in the Right Place, I Guess

It's an amazing, unexplainable, but universal rule.  The people that have everything want even more. The people that have nothing are thankful for any scrap of kindness that's thrown their way.
 I encounter someone just about once a shift that is absolutely livid about something that is totally insane.  I am the type of person that cannot simply tell these people to just get lost.  I've tried.  I say to my co-workers all the time that it's what I want them to do.  But secretly, even more, because of some totally insane defect in my personality or malformation in some part of my brain, I really just want to make them happy.  But people like this never are. They expect the world, and I can't give it to them.  They feel it's owed to them.  I really can't wrap my head around it, because I don't really feel as if I'm owed anything.  So when the inevitable happens, and my efforts are still not enough, I get discouraged.  I feel bad.  I know it's not my fault, but my crazy, pathological people pleasing perfectionism still overpowers me with feelings that if I could only be better, or express myself more effectively, or if I worked harder, that I could make these people happy.  I've come to terms with the fact that this is nuts and I'm aware enough of it to see it in perspective.  I can help them, but they won't let themselves be helped. 
Then there are the other types of people.  The people that I actually, really, truly, can't help.  I took care of a lady the other night whose circumstances were so horrible that I actually felt physical pain watching her.  I was fighting back tears every time she looked me in the eye.  I was looking right into her, and I saw a desperate battle of pain and suffering beyond the worst nightmares any of us could ever dream up.  She was dying.  She knew she was dying, and she was watching herself in horror as her body deteriorated and turned against her for absolutely no reason.  I wanted to give her everything.  I tried so hard.  There was nothing I could do for her.  I begged doctors for medicine and I doted on her as much as I could but it was all for nothing.  Nothing on earth could treat that kind of pain.  I couldn't help her.
Finally, as she apologized for the hundredth time for me having to take care of her in this state she had absolutely no say in, I could hold my tears back no longer.  I did my best to hide them as I grabbed her hand. "Please don't apologize to me", I begged her.  "Please.  You can't help any of this.  You didn't do this.  You are why I'm here.  I want to help you.  That's why I do what I do.  Please don't say sorry for asking.  It's okay, I promise." She nodded and thanked me.  I sat down and cried discretely while I charted. It was a full load that day, and I was already feeling bad that I hadn't done enough for her when her father came out before she went upstairs to thank me for all I'd done.   At this point I couldn't even try to keep the tears hidden.  He was taken aback and apologized.  "I'm sorry. I didn't mean to make you cry, but we've been in so my hospitals over the past few years and you have just been so attentive, and not everyone is kind like you and we're thankful." I hugged both of them and told them goodbye and I went back to work. 
I know I'll think about  them constantly for weeks and this will probably be one of the moments in my nursing career that I will remember forever.  I've been in a funk for a while, thinking about people like this and the ungrateful types, and how unfair it is that some people have everything and they don't even know, while people like this have to suffer so terribly.  I think sometimes that maybe if I devoted my career to people like this that things would be better for me.  But the more I'm exposed to this, the more I realize I emotionally cannot handle it.  I can shake the douches off, but things like this really do creep inside of me and cause me an incredible amount of sadness to the degree that it's probably really unhealthy.  I talked about hospice for a while, but I really think I'm in the right place.  I'm here, fighting through the bullshit with a smile on my face, trying desperately to hold on to my compassion when I'm occasionally faced with the reason why I do.  Perfect, no, but perhaps a little bit better for me than putting myself in the line of completely merciless emotional devastation and exhaustion every day.  I really want to help people like this.  But I fear after a while there would be no more pieces of myself to give. 

Sunday, July 22, 2012


While discharging a young man for his 4th visit for STD symptoms:
Hood Nurse: "Okay, so it looks like you've been here for the same thing a couple of times in the last couple of months.  It's important to make sure your partner is getting treated so you don't keep re-infecting one another, and you probably need to make an appointment with a regular doctor to get actual STD testing done to make sure that you're not dealing with a drug resistant strain, got it?"
Hood Nurse: "Alright then, well, here's the prescription for your antibiotics.  I just need you to sign right here and then you're through, but do you have any questions before I let you go?"
Patient: "Yeah, are you single?"

Um. No.

Monday, July 16, 2012

Lord Save Us

After all the protesting, list of things I would rather do (eat broken glass, get new boobs and find a job at hooters, be up at triage every day for the rest of my career) I have agreed to be charge nurse at this place like an idiot. So. That's happening.
I'm ambivalent. On one hand, I've exhausted all my options as a regular staff nurse as far as doing new things, unless I want to go somewhere else, which I'm also considering, oddly enough.  I know  make me stronger, and maybe more confident, and it'll look good on resumes and stuff if I do decide to leave. I'm sure it will help me with decision making skills and with being assertive, which I absolutely need to improve on.
On the other, I am scared shitless.  I feel like I am way too dumb to be doing this already, and that I know absolutely nothing, but sad as it is, being a nurse in this ER for three years and a couple of months is what some people call "experienced". The thing I'm most concerned about it is not having the emotional fortitude required to do this job.  People can be serious dicks to the charge nurses.  Like they think that being bitchy and bratty and whining about who has what (obviously you aren't too busy to take an inventory of everyone else's patients) is going to make the ER less full and make them less slammed.  I don't know.  I just don't really complain to other people and I don't have a ton of patience with people who do.  I honestly worry that I will end up getting stabbed in the back by someone I'm cool with or more likely, that I will have to listen to someone bitch about trivial bullshit on what is already a crappy day and that I will completely lose it on them.
Either way, it's happening and I guess I'm on my way to being a grown up nurse.  Any tips from the adults out there? Can I have a couple more years at the kid's table, please?

Saturday, July 7, 2012

Least Favorite Complaint?

ER BFF and I were having a deep philosophical discussion the other day about which complaint is the absolute worst.  For me, it's a toss up between vaginal bleeding vs. elderly constipation.  Not always, but vaginal bleeding usually has at least somewhat of a dramatic spin that requires hostage negotiator  level de-escalating skills.  Plus it's a guaranteed pelvic set up, which is a pain in the ass, and at my facility you're guaranteed to wait at least 10 years for a transvaginal ultrasound to get done, so, yeah, you better hope the patient is nice. Elderly constipation really doesn't require an explanation I hope.  Once you've done a fleets enema on one old person with unsteady gait and then had to watch them on the bedside commode for half an hour so they don't take a monster dump all over the floor and then fall in it while the room fills with the smell of 5 days worth of angry hardened turds, you understand.
I figured at least the last one was universal, but her answer surprised me: toothaches.  Her explanation was that the situation pretty much always turns into drama.  The patients that come to our ER with dental pain generally tend to think it is a life threatening emergency.  Most have Lortab at their disposal at home, so when they aren't offered anything more than that once they've waited 6 hours to be seen, they are PISSED. I get her point, but I would still rather talk down 10 angry toothache patients than administer one fleets enema to just about anyone, so I guess it's just a personal preference.
So. What say you, internets? What chief complaint gives you the most nightmares?

Saturday, June 23, 2012

"I Hate This Hospital"

I can't tell you how many freaking times I triage someone or take care of someone that decides to tell me how awful the hospital I work at is and how crappy their care is every time they come and so on and so forth until they tell me the whole saga or I find a way to leave the room.  Most of the people complaining are here for complaints they could have seen their own doctor about an average of three weeks ago, but I digress.
Now, a little about Hood Hospital- it's not like we stand alone for miles or anything.  Granted, we are the closest ER for most of the population we serve, but if our care really sucks that bad or if we're really the hospital that "kills people", you would have go all of 5 minutes to be seen somewhere else.  But alas, despite the fact that we have allegedly nearly threatened the life and limb of these patients on multiple occasions and universally treated them like shit, they continue to return. This puzzles the hell out of me.  Virtually all of these people have cars and the bus system here is rad, so it's not even like being in walking distance is an issue.
One of our housekeepers who lives near the hospital put it best the other day when she was complaining about her neighbors.  "All these people complain to me about this place like I'm taking care of patients, and they all act like y'all are out in the street with motherfuckin' guns or something rounding folks up and making 'em come to the ER! Shit, if you don't like it, there's ten other hospitals right around here that y'all can go to! Nobody's making you go there! Just go down the street, damn!"
But WTF.  Are people just really slow learners, or do they just want something to complain about?

Tuesday, June 19, 2012


It's still just bad and worse most of the time up at Hood Hospital, but Monday being a Monday, it fell into the worse category.  Maybe even a worst.  Probably for this month, at least.  Hello, 8 hour waits.  It doesn't all completely suck.  ER BFF and I are team triage.  That means one of us is given up as a sacrifice to the anger of the waiting room at the desk, while the other hides in the booth and makes the life-threatening-or-not decisions.  Most of the time I make a run for the booth (mostly due to the fact that I am the least authoritative sounding at looking person here), but I couldn't do that to a good friend. Desk it is.
Days like this are a little frightening.  Triage is all caught up, but you're dealing with a waiting room full of people you haven't seen before, and you're responsible for all of them.  You're responsible for trying to decipher the computer notes of whoever the hell was triaging before you, which is extra fun if they don't include a lot of information and/or you don't trust their judgement. My nursing spidey-sense (which I rely on greatly in triage) really can't come into play here.  It's nerve wracking.
I'm getting my stuff together and scanning the waiting room to see if there's anyone I can place with the list of names on my computer screen and if there's anyone who just doesn't look right, even from across the room.  No red flags here, just a lot of dirty looks. In my scan of the crowd, an average chronically sick looking guy in no apparent distress meets my eyes and smiles.  I smile back, somewhat surprised and a little suspicious that anyone out here is directing any sort of good energy my way.  I go about my business, checking people in, explaining waits, fielding questions from the charge nurse about dozens of patients I know nothing about.
About an hour in, smiley man wheels himself up the the window to say he's been waiting a while and he thinks he's going to go ahead and check himself out and go somewhere else or see his doctor tomorrow.  I'm looking for his name on my list just as my charge nurse comes out to fill the handful of empty rooms and see that it's close to his time. "Hold on just a second for me.  I think they're coming to get you in a room right now. Can you wait for just a few minutes more?" He reluctantly nods, smiles and wheels himself back a few feet so another group of people can check in.  They come to collect him a few minutes later.  I think nothing of it and take some verbal abuse disguised as questions.
A couple of hours later I'm running back for my first bathroom break of the night when one of the friendlier doctors grabs me for some quick education. "Hey Hood Nurse, have you ever seen a dissecting triple A on a CT before? No? Come here for a second." He's showing me the space on the CT and talking about how this is one of the really bad kinds when my eyes wander up to the name at the top of the screen. It's familiar.  Did he come from the waiting room? Yeah.
I go back up to my post and look his chart up.  Oh. Shit.  It's the friendly little guy that was just about to leave. It makes me a little anxious that nothing about his appearance set off any alarms for me.  I look through his triage notes and vitals- nothing terribly notable there, either. I start to wonder if I would have suspected anything even if I had been the one to check him in.
This could have been pretty catastrophic for everyone involved. But he was fine.  It kind of makes you wonder how many close calls like this we see everyday without realizing it, or how many of the people that come in as CPRs might have been fine if they'd been seen a few hours earlier. Sometimes among all the toes pains and toothaches we forget the gravity of what we do.  It's actually some pretty scary stuff.

Wednesday, June 6, 2012


Ugh.  Sorry for my non-updating ways.  It's all a giant combination of not a lot of interesting stuff, feeling like I have nothing new to say, fear of getting busted by the man, ambivalence, insomnia, and gin.
Anyway.  Life goes on.  Census at Hood Hospital has finally reached that point in the year where we move from "totally fucking batshit and dangerous" to "still above average for most ERs but isn't it cool that we get to pee when we want now?" I love summer.  Now just because of swimming and drinking outside, but because we occasionally get the night at work where we can just screw around and talk like normal coworkers and have a little fun.
Except, to the point of this post, it feels a lot darker to me this year.  This is my third summer at this place. Summers seem to get more violent here every year.  Or maybe now I'm just thinking about the implications of everything I see.  I don't work at a trauma center, but being the lone hospital in the ghetto, I sort of do in a way.  The culture out here blows my mind sometimes.  The same people that would call an ambulance for tooth pain will not call 911 after being the victim of some really screwed up violent crime. There's probably a few walk in gunshot wounds each week now, and even more stabbings.  The new thing seems to be drop-offs from some pretty legit MVCs involving alcohol.  Okay, bye c-spine precautions!
When I first started out I was really intrigued by this stuff.  I was all about the treatment, the mechanism of injury, all the excitement.  Learning new things.  Virtually all of the stuff I saw as a new nurse were by no means threatening to life or limb.  Critical traumas still get my blood pumping like nothing else, but at this point I'm kind of... over it? I don't know.
I just internalize way too much shit with these cases.  I hate to say I've become numb to the nursing home CPRs, but it's really just the truth.  It's sad, but it's not anything next to these cases.   There's something so inherently wrong with having to tell a mother about the age of my parents that their child is dead.  There's something so much more raw and tragic in the reactions of people who have really never prepared themselves for the death of this young a person with exception of maybe their worst nightmares.   Of watching someone's world turn upside down right in front of you.  I feel a certain satisfaction of being able to call the medical examiner and take out all the invasive stuff, to be able to gently close granny's eyes and wipe her face and lower the lights and make her look almost like she's asleep when the family says goodbye.  There is no peacefulness in cleaning the dried blood off a young person's face.  To try and wipe up all the blood that just sprayed out of the ET tube across the room before someone's mom and dad come in to see them.  It forces you to imagine your own face, and the faces of those you love the most, and how absolutely easily it could happen to anyone at any time.  I've been asking myself questions I don't know the answer to.  How I would carry on if something like this happened to my husband, or to my little brother.  I can't even think about without crying.  I think that I would die.  I know people go somewhere better.  But having them torn away so violently is more devastating than I can fathom.

Almost as bad is the people that come so close to this who still have no fucking clue.  People who have been to your facility multiple times because they want to live the thug life and deal drugs and be in gangs and shit.  People who have had so many chances to clean their lives up and spare their families this kind of pain, but they don't. You hear them talk about how many of their friends have been shot and killed, but they continue doing the same bullshit. It's so sad and frustrating when you think about all the people you've seen that didn't get a second chance.
I really wonder if and how this gets easier if you see it all the time.  I see this just infrequently enough that it causes me to dwell on it a lot.  I wonder, as I gain experience, if this will just become another part of the job.