Tuesday, May 29, 2012

Wrong Sample, Dude

Lady calls 911 because her middle-aged son is on meth.  Obviously emergency services are required.  Anyway.  So PD and EMS show up for good measure, guy is found to be hypertensive and tachycardic, what with all the meth smoking, and is transferred to Hood Hospital. YAY.
So, he of course arrives with a HR of 150, denies meth usage or ever trying meth, because he didn't have all the symptoms of meth use, and his vitals signs weren't totally consistent with someone hopped up on meth, and he wasn't jumping all over the bed and spazzing and generally acting like a fucking crack pot like every other meth user I've ever seen, or-no, wait, cancel all of those things, he WAS.  Oh, and EMS found also found the crystal meth sitting right next to him when they picked him up.  But yeah, okay, great, of course you've never used before.  So can you go ahead and grab us a urine sample? Okay, great, the doctor will see you in a minute, bye.
I go in with the doctor for his exam and find him yanking at his penis furiously.  Like, going to town.  Gross.
"Hey man, what are you doing? Leave that thing alone!"
"Oh, this.  Uhh, I'm trying to get a urine sample."
"Dude, that's not how that works.  Put the mouse back in the house."
I wasn't buying the excuse, but he clearly thought he had come up with a winner, because he spent the entire rest of the night "trying to get a urine sample" regardless of whether staff members were present or not.  Shit, even after we straight cathed him for a urine sample, he continued to try to get one for us. He was anything if not persistent. Luckily, thanks to the meth, he never reached the correct, um, condition to obtain any sort of sample.  Thanks, meth.
My coworker and I had a conversation about it at one point in the night.  "Ew", she said, "I would rather get like, a gallon of pee on me than get semen on me.  That's disgusting."  I agreed."Yup.  If someone's going to do that, I at least want to make the same kind of money that those girls on the internet get.  I KNOW they're making better than nurse cash."

Friday, May 25, 2012

You're Doing it WRONG

If you call me on the call light to tell me you're having a seizure, nope, I'm gonna go ahead and say that is not what's happening.
Also, I'm gonna have to take off ten points for you changing your complaint to chest pain after I walk into the room and tell you, "If you can call to say it's happening, obviously it's not a seizure."
Also, assaulting the staff and then pretending to be altered will not get you narcotics. What will it get you?
-a psych consult, who will confirm what we all know, that you are F.O.S.  (yeah, telling the psych dude that you're totally happy and well adjusted but you attacked the nurse because she pissed you off is poor strategy, BTW)
-600 of Motrin
-A full toxicology and cardiac workup
-A saline bolus
-a straight cath
- a trip to jail after you continue to try to assault the staff after you've admitted there is no medical or psychiatric reason for you doing so other than you just being a dick.
You've got a lot of work to do, buddy. At least now you have a quiet-ish place with minimal distractions to think about the most effective way to obtain Dilau-da in the future.

Tuesday, May 22, 2012

Life Saving Interventions

In case you were wondering, staffing still blows.   Also, there seems to be an extra bus route running to Hood Hospital now, cause, yeah. So obviously, when my inevitable one-to-one septic shock respiratory distress with no IV site patient with the crazy family member comes rolling through with door, it's just me and ER BFF for ten minutes until she has to go back to her own sick ass patients. Rad charge can't help, because she is also triage because that's how shit is now.  Staffing you with enough people do your job safely is not gonna happen. Anyway.  Not really the point.
Point is, I got this.  Well, I mean, not all of it, since I have charted zero of my interventions, but the initial labs are sent, all the necessary tubes are in all the necessary parts to the patient, all 3 of my pressors are on board and maxed out, and the antibiotics are going now that I've call the pharmacist to make sure I can give them in the same tubing as the vasopressors as I am now also out of places to put this stuff. Okay? Yeah, I will be here for three hours after my shift charting all of this, but all the necessary interventions to keep the patient alive are being taken care of. Key words being NECESSARY INTERVENTIONS TO KEEP THE PATIENT ALIVE.
The criteria for these sort of things seem to be pretty universal among most of our ER doctors, but in this scenario, Dr. Stick-up-the-ass seemed to be rather confused, so lets just do a quick rundown of things that WILL NOT save a patient's life, and thus are not cause for eye rolling and sniveling, snotty bitching about how everything wasn't already done an hour before the patient got here because you would have had it done already.  Off the top of my head:
-urine pneumococcal antigen level- hey, sorry, people maxed out on 3 vasopressors sometimes don't make urine, but obviously that's my fault.
-lactic acid level- imma go out on a limb here and say it's going to be HIGH.
-home med list- hold on, let me zero this art line again real quick now that the patient is back from CT, then I'll look through the visit history and maybe a doctor has been nice enough to write down what is surely 800 different meds in the history and physical which you have access to so I can copy them for you right now. If that doesn't work, I'll just turn off the patient's versed drip and ask her to write them down for me real quick.
-finding out who the patient's PCP is-see above
-post Tylenol suppository administration rectal temp-it's a two person job getting in there dude, but feel free to glove up and give me a hand at any time.
Ugh.  It's all whatever, but let me just say I'm really over the assumption that because you're an ER doctor that you can somehow do my job in your sleep.  That isn't how it works at all.  And of course, all of this dickishness occurred exactly one day after one of the cool doctors was hanging out and talking to us about how all of our jobs were equally hard an no one was better, but that we were part of a team that had to work together to be successful.  I wish some of these turds understood this, but I guess I should just be grateful that I work with a lot of doctors who do.

Tuesday, May 15, 2012

The Image of Nursing and Unrealistic Expectations For All

Writing a nursing blog has been an enlightening experience to say the least.  One of the things that was the biggest shift in thinking for me, sort of in tandem with my nursing career, was the realization that not only am I going to never live up to my own expectations, but I am especially never going to be able to live up to the expectations that the average person in the public has of me.
Let me explain.  I distinctly remember the first time I actually got so mad at a patient that the thought entered my head that I wanted to hurt them.  I feel ashamed to admit that I've thought that way even now. I found it extremely distressing at the time.  Here I was, supposed to be helping this girl, regardless of the fact that she was beyond rude, regardless of the fact that she was non-compliant to the point of being spiteful, beyond the fact that she was obviously drug seeking, I was supposed to be helping her and ZOMG I am thinking about kicking her ass and I have failed as a nurse and a person FOREVER. The only reason I didn't quit at the end of the shift was my charge nurse that night.  She is an incredibly hard working, sweet, and fabulous nurse who I look up to immensely.  The type of person anyone would love to have taking care of their family member.  And when I broke down into tears and told her all the shit that had gone down with this patient, her response? "Whatever.  What a dumb whore."
I could have hugged her.  Not for agreeing with me in my assessment that this patient was awful but in unknowingly confirming that just about everyone, even the most kind hearted and badass of all nurses, sometimes feel this way about patients.
And when you think about it logically, and objectively, it makes sense.  Yes, nursing is a calling, but shit, yes, it's also a JOB.  Who at their job has not dealt with someone completely insufferable and thought to themselves for a second, "Dude, if it were you and me in a dark alley outside of this, I would totally kick you in the teeth." Well, yeah.  It happens to us too.  Actually, probably a lot more than in the general population, because the level of bullshit that people have figured out they can get away with in healthcare is beyond just about anywhere else.  I certainly never had anyone pretend to have a seizure to get their meal comped when I was waiting tables.
Yeah, we care about people, and we want to help, but also like anywhere else, we sometimes we deal with people that are genuinely awful human beings and we recognize this quality in them and dislike them for it.  Sometimes there are days where we see nothing but this.  Other days it clouds our vision to make it the only thing we can see.  Sometimes we get in the mindset that just about everyone is full of shit and any effort we put forth is pointless because it will just go unappreciated anyway, because some days it really isn't far from the truth.  It's really soul crushing and defeating when you get into a field because you want to make a human connection and reach out and help someone and so many of the people you reach out to lie and shit all over you.  It's kind of like when you make bad relationship choices and you keep falling in love with manipulative assholes- eventually you put up a wall and you distrust almost everyone because you're so tired of being lied to.  It probably sounds really weird and co-dependent to talk about it that way, but we're supposed to be giving our all to these patients.  Some of us really do, or at least did at some point.  When you realize you gave a piece of your soul to someone who was playing you, it really does wound you.
So we compensate and build defense mechanisms.  We say mean things about the people who have hurt us.  We make fun of the approaches they use to try and play us.  We learn to disbelieve people, not only to protect ourselves, put to learn to prioritize and do our jobs safely.  We pride ourselves on seeing through it all, even if maybe we shouldn't feel that way.  We do this publicly, on our anonymous blogs and forums.  And people find it disturbing and gross.
Why wouldn't they? Yeah, some people outside of this profession can put themselves in our shoes or are close enough to someone in the profession to understand.  But the vast majority of people who see it from the outside think we are just bad apples in a profession full of mini Florence Nightingales.  Again, why wouldn't they? In a lot of ways, we in the nursing profession have done this to ourselves.  I remember them talking about this in nursing school.  How proudly they taught us about how we were the most trusted profession in the U.S., year after year.  They even sort of alluded to the massive PR machine that is the nursing profession as it is represented by various nursing organizations when they talked about nurses seeing the show Nightingales and being like, "this makes us look like whores, shut it down, y'all".  And they made it happen.  It's not an accident that the public expects us to be blameless, holy creatures.  We, as a profession, perpetuate this stereotype ourselves.  We not only sell it to the public, we sell it to ourselves and our young.
They don't teach you to expect the type of awful feelings we sometimes have in nursing school.  They tell you about the hurt and loss of having a patient die, but they never tell you about the hurt and loss you feel within yourself when you commit yourself to helping someone that you later realize was manipulating you.  They never tell you that somedays you'll be so tired of doing what you're doing that the thought of going to work makes you feel like crying or makes you nauseous.  They never tell you about being lied to, or how much that sucks, and they never tell you about the guilt you'll feel when you think someone was lying and it turns out you were wrong. They talk about burnout in passing, like it's something you can stop and change.  Like it's a completely internal force.  Like it's a storm you can pass through unchanged, when in reality you come out of it a little tougher, for better and for worse.
I hope this doesn't come across as a pity party or that I'm making excuses for myself or my profession.  I'm still absolutely freaking in love with what I do and it makes me physically ill to think about what I will do the day that I can't go to work and make sick people smile and make anxious people calm.  Despite the parts that I hate, I love the parts that I love so dearly that I would brave just about any amount of bullshit to still be able to do it.  When I question whether it's worth doing what I do, the answer is always a resounding "yes"- I just wish that someone had told me I was going to be asking myself that question.
We already have such a difficult job.  Why do we torture ourselves with setting our expectations and standards beyond anything any of us can obtain? Why do we teach those we'll be taking care of to expect the same from us? Why do we set ourselves up to be disappointed in ourselves, and others to be disappointed in us?
We are not angels or saints.  We are women and men who do a really tough ass job to the best of our ability.  It's about time to start matching our expectations up with reality.

Saturday, May 12, 2012

Flippin' the Script

Ghetto mama presents to various nurses' stations in different zones of the ER to yell and swear about how long it's taking to get her kids x-rays back for an injury he sustained nearly a week ago.  After the third person she berates about how she's in and out in 2 hours for the same sort of thing at hospital X all the time (feel free to leave and go there any time, baby doll, we all know you aren't gonna pay this bill anyway), she is politely asked to please go back to the room where her kid is and she adamantly refuses to do so until someone explains to her why no one has applied a dressing to her child's contusion with no break in the skin.
Douche SWAT team is activated and emesis bag nurses is deployed from his zone to herd mom into a room and bring the situation down a notch.  Conversation that brought the situation from 10 to 0 in approximately 30 seconds?
Mom-"I can't believe it took us 2 hours to get seen and now it's takin' an hour for this x-ray? What the fuck are y'all doin', this hospital is stupid, and y'all are stupid! Imma report y'all! How come this is takin' SO LONG?"
Emesis bag nurse-"I don't know, why did it take YOU so long to bring your kid in? He fell off his bike 5 days ago and you're just now getting around to take him to see someone? What have you been doing? 5 days kind of sounds like neglect, maybe I should be reporting YOU, ma'am!"
After this, the level of satisfaction with the care provided changed significantly.

I Need To Buy a Vowel, Please

Check-in form for the ubiquitous baby fever (after explaining to mom twice that she didn't write her own name down on the blank that says PATIENT'S NAME)-

Reason for visit:  Haigh fever and cryn.

Okay, well I guess your baby has a high fever and won't stop crying but you ran out of vowels when you used that extra one to tell us about his "haigh" fever, but did you not hear that Medicaid will now provide you with extra vowels at no additional cost?

Wednesday, May 9, 2012

No Savesies

Yeah, our ER is already waayy beyond capacity.  The whole hospital, in fact, but especially the ER.  We need about 50% more beds and twice as much staff on any given day to actually treat all of the patients we're getting these days.  Doctors who have privledges here at some point come to the ER to admit patients, so I assume they know this, unless they're just really dumb or think that we set up all these hall beds because we don't feel like cleaning rooms or some shit. So why do they routinely send their patients up here with the big fat lie "they'll have a room waiting for you" when anyone with half a brain knows that we don't have the luxury of saving a room for anything save a STEMI, acute stroke, or CPR? Really?
It's a sad state of affairs, but the fact is that if you are well enough to call your doctor's office and ask what to do and then drive yourself or have someone else drive you by private vehicle to the ER, you're going to spend some time in the waiting room.  We're not doing it to disappoint you, or to be dicks, but when other people are coming in dying or have been waiting for 5 hours to be seen for the exact same complaint you have, we can't just give you their bed because your doctor said we would.  We don't work for your doctor and he/she hasn't been up here triaging all these other patients and as a result, has no frame of reference. 
It sucks, because these people are really just being good patients and doing what their doctors tell them to do, yet we seriously cannot accommodate them and it reflects poorly on us. I used to kind of try to cover these guys assess, but at some point I just started being real with people.  Not like "your doctor was bullshitting you and he's a dick", but I just say something like "Unfortunately, unless the doctor goes through the process of getting you admitted directly,  a bed can't be guaranteed.  With how unpredictable it is down here it's impossible to save a bed in the ER, I'm sorry."
The waits have gotten progressively worse over the last 3 years, and recently people have started calling the doctor's offices back like "WTF dude", which then leads to the doctors calling up the charge nurses and bitching them out over the phone.  Now the other stuff could definitely be lost in translation between doctor and patient (although it'd be shocking if it went down that way every time with as often as it happens), but that shit is just ridiculous.
Look here, D-bags.  If you really are concerned about your patients, get your shit together and take the necessary steps to direct admit them.  If that isn't possible, meet them here and write their damn orders in the lobby if you have to, if it's such a fucking emergency.  If it's not, then send them down to the ER with some reasonable expectations like yeah, I think you should be at the hospital for this and your only option right now is to go to the ER, it may take a little bit but I'll let the staff there know why I'm concerned.  Really, that's all we ask. But if you can't tear yourself away from you dinner/golf game/re-runs of the Big Bang Theory long enough to come demand a bed and deal with your emergent patient that came in via private vehicle in person, that don't call and scream at us when we can't stop and rearrange the whole ER for them.  Freaking primadonas.

Monday, May 7, 2012


ER Doctor: So, yeah, sir, you've been here for this same this same thing about 15 times this year already. I'm not going to run any labs on you this time, and I'll tell you that if you want to stop feeling bad you just need to quit it with the cocaine.  You're discharged, and you're not getting Percocet.
Freq. Flyer Crackhead pt: Whatever, doctor, this is BULLSHIT. I know you do cocaine, too, I CAN TELL, just by lookin' at you!