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.