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.