New nurse, in the hood.

Chief Complaint of the Night

2012-02-14T06:48:00.000-08:00

Typical balls to the wall Monday night triage at hood hospital with an average wait time of 7 hours:

Crayzee* Pt: Yeah, I'm really tired of coming up here for this same thing. I have all these parasites coming out of my mouth, and my nose, and my ears, and y'all keep giving me all these antibiotics and stuff and it's not helping. I need something that will kill it, not just slow it down!

Hood Nurse: Um, yeah, okay ma'am. So, how long has this been bothering you? Are you hurting anywhere?

Crayzee Pt: Yes it hurts! They're falling out of my nose right now! This is been going on for three years and you guys won't help me! Last time they sent me to an ear nose and throat doctor, and he told me it was boogers! That's bullshit! Fucking quack!

She then proceeds to pull out some weird looking petri dish like container full of boogers suspended in water.

Hood Nurse:Uh, okay ma'am. Go ahead and have a seat in the waiting room for me, they'll call whenever they're ready for you.

*TM Nurse K

ER Forensics

2012-02-12T06:27:00.000-08:00

This morning I get our usual 4 AM nursing home dump, the ever so uncreative altered mental status in a late stage Alzheimer's patient. Yeah, okay. We've started theorizing that they're just transferring the patients for diaper changes now. So of course as we're doing the old person AMS workup that always includes a Foley catheter, we open the diaper up to find a diabolical situation including a turd that is probably older than some of our nurses. Enter famous emesis bag nurse and I attempting to carbon date fossilized stool.

Hood Nurse:"Dude. This has definitely been in there a while. There seem to be rings forming around it. And there's like, a film on it, see that? What would you say, that has to have been there for like, at least 4 hours, right?"

Emesis Bag Nurse:"Four hours? No way. That's way under. It's pretty obvious she must have dropped that when she heard Whitney Houston died last night and it's been there ever since."

When in doubt, guess high.

Communication

2012-02-07T07:23:00.000-08:00

Hood Nurse: Okay, ma'am, I'm gonna give you some medicine right now. The first thing I'm going to do is give you some IV fluids. It's very important to stay hydrated when you have a fever and an infection, so this will help with that. The other medicine I'm giving is called Rocephin. It's an antibiotic to help fight the infection.

Patient, to her husband: Ask her to tell me what these medicines are for.

Help

2012-02-03T19:53:00.000-08:00

Okay. I'm really, really trying to figure out if I'm crazy or not. I've been polling my coworkers and I'm getting split results. Occasionally, when staffing is really sufficient and rad (one thing I will say for my management, we're no longer trying to run a 45 bed ER with 6 staff nurses, which is always nice) we get a float nurse. Like, someone whose only job is to help everyone else and make sure their shit is in order. I never actually get assigned this task (they give the rooms to the ones they know can take some punishment) but I occasionally fill this role when they assign me to the resus rooms and I don't have any dying patients.

Anyway. It's not fucking rocket science. We page ambulances overhead when they go to rooms, the trackers clearly show who needs treatments and meds now that we do computer charting, and the lab label machine prints out big red stickers for the patient that need LABS drawn. So when I have nothing to do, I look for this stuff, and I go do it, because it's my job, and that's what I'm being paid to do, as opposed to sitting at the computer paying my phone bill. I'm the float nurse. You know, float around and do shit. Find stuff to do.

So the other day I'm getting the standard ER ass kicking- ambulances waiting outside my room as the patient I just discharged walks out and housekeeping wipes the stretcher off type of day. I've been doing this long enough that I can do it all myself. It's just a lot of work. We have two, count 'em, two nurses floating. What are they doing? Shopping online for a friend's baby shower. Obviously.

Whatever. Again, I've got my head above water. I'd just really like to chart and pee and eat a snack, but oh well. That's the way the ER goes. Finally, at one point, I have to flatten myself out a like a roach to get past one of them who is obliviously standing in front of the med area talking about cruise ship food with my charge nurse who is also sitting on her ass when she notices the pile of shit I'm balancing on top of the EKG machine. Ten minutes later when I sit down to chart, the mentalist over here uses her astute powers of observation and makes a comment that I looked busy and if I needed something I could have asked for her help. Really?

Nope. I just gotta sit down and chart all the shit I've been doing for the past 2 hours, it's whatevs. Then she wants to know why I didn't ask her for help. I tell her what I genuinely believe. Really. If an ambulance is coming into my room, I honestly don't have time to figure out where you are and ask you to come help me. Because I have an ambulance. By the time I find you and wait for you to finish your conversation about which airline is your favorite to ask for your assistance, I might as well have just done all the shit myself. So that's what I do. You have ears. If you hear "ambulance to room 2" being announced overhead and you don't have the sense to go in there to help when your entire job tonight is to help, then you probably aren't much good to me anyway. But thanks. I said it in a much less harsh manner than this, yet she and the charge were both looking at me like I'd sprouted a second head.

So what is your stance on this, internets? Am I being butthurt and expecting my coworkers to be all powerful mind readers? Or is a little initiative too much to ask? I really don't know anymore.

Pile Up

2012-01-31T21:25:00.000-08:00

We sure did have a twelve patient MVC last night.

Yeah, twelve. Van full of kids with their parents breaks down on the service road. They call their friends, who also happen to be carrying a station wagon full of kids, to come jump them. Cars are facing head on to jump the battery of the van when some drunken asshole swerves off the road, hits the van, which in turn runs into the station wagon. Naturally, this all goes down in BFE surrounding county, who has a total of three ambulances. What do they do? They go full ambulance clown car, pack like, three patients per truck, and book it on down to Hood Hospital. We knew they were all coming- my patients were all waiting on disposition, so me and my medic buddy just went out in the bay with stretchers and unloaded the patients from the back of the ambulance. We look up to see that a little shelf on the ceiling where they store extra backboards actually has one of the kids on it, back boarded and c-collared. Holy crap, good thing he was stable.

Most of the injuries were pretty minor, if not non-existent, so we parked all of them along the hall, took vitals, and did about a two minute triage- okay, were you in the car or the van? Do you remember everything that happened? Do you hurt anywhere? Do you have any medical problems? Are you allergic to anything? Okay, next. The worst of all the injuries ended up being a little school age boy with a fib fracture, who was the biggest badass of all. He was all polite and yes ma'am to everything we said, and rated his pain at like 4, was more worried about whether his siblings were all doing okay.

It ended up being kind of a funny story and almost like a little mock disaster drill, but it could have been so much worse. Don't drink and drive, kids.

More Fun With Coordinating Transportation

2012-01-30T06:50:00.000-08:00

It started like so many other cases at Hood Hospital. Elderly gentleman who normally makes it around the house on an assistive device and gets his everyday stuff done with the help of his wife has a rough day and takes a spill. He's then transported to us via EMS without said assitive device, wife stays at home. Thankfully, pappy is just fine, his c spine is cleared, and he's ready to be discharged. Enter drama.
Awesome baby nurse coworker calls his son, who is listed as his emergency contact, to see if he can come down the road and pick dear old dad up from the ER. His response? "Um, I just lit a fire in the fire place, so, I can't."
You can't put some water on it or something?
"Nah."
Coworker then tries the approach of playing it tough and saying he really needs to come up here and get his dad. Yeah.
"I can be there in like, two to three days. You guys need to keep him, and like, check his blood, and his sugars, and his organs. Yeah. Yeah, you guys need to check up on his organs."
All I'm hearing at this point is my friend's end of the conversation. "Check his organs? What? What are you talking about? I'm hanging up now. Bye."
So I guess at this point he's trying to figure out with the wife whether the poor guy can go home via cab or if he needs ambulance transport. He's kind enough to put this one on speakerphone, where this 70 something year old lady totally loses her shit on him for asking if it's safe for the patient to go home via cab. At the crescendo of it all, she ends up on some crazy ass rant about how awful our hospital is and that's why they always talk bad about us on "the black folk radio station" and that's how come no one goes to Hood Hospital.
Finally we just say screw it and arrange for private ambulance transport. It's ridiculous, but at times it's really the only viable option. I know he was beyond frustrated about he amount of verbal abuse he took for just trying to do the right thing. I couldn't stop thinking about how long he'd been dealing with the whole situation and how many combined man hours our nursing staff must put towards non-medical fuckery like this. It kind of makes my head spin.

How to NOT Get a Cab Voucher

2012-01-28T06:26:00.000-08:00

-Take the ambulance here for a complaint 100% secondary to you being an idiot

-Your idea of asking nicely is "go get me a voucher"

-You think you're being very cunning when you tell me and other staff members "The doctor said she'd get us a cab voucher" (world-famous emesis bag nurse's response: "the doctors tell everyone that so they can get out of the room and not have to deal with you anymore.")

-Five of your family members magically showed up here after you came in on an ambulance and you want us to get all of you turds a ride home. One, it's good for one person only. Two, how the hell did the rest of you get here in the first place? Wait, I don't care.

-The last time you were here and we said no to a cab voucher, your spouse suddenly started having a chronic back pain flare up and decided to check in.

-You mention you live within walking distance.

-And always, number one, forever: Say something about how you always get a cab voucher. Say it. Please. I will make sure that you DO NOT get a cab voucher. I will eat the cab voucher. I will make you fish the cab voucher out of the sharps container or the bio waste bin. I swear. Ever wonder why your hospital visits cost so much? It's because of shit like this. It's because there are actually assholes out there that come to the ER routinely for stupid bullshit, are sent home for stupid bullshit, and act foolish enough that we ALWAYS pay their way home. Then when some poor little old granny who would never think to ask for a cab voucher and actually needs one to get home because she can't drive and has no family in the area, we don't have any more cab vouchers because we gave them all to the same douchebag who keeps calling an ambulance for non emergent foolishness. Whatever. I'm over it. Point is, I will say no. Nope. No cab voucher for you. You can think about your life choices and what is owed to you while you walk your ass home. Bye.

Yet Another Enlightening Triage Experience

2012-01-24T06:46:00.000-08:00

Woman presents with her toddler. You know the rest.

Pt's mother: Yeah, so I'm bring him in 'cause he has a fever, he woke up and was just shivering and stuff.

Me: Okay, yeah. So what was his temperature?

Pt's mother: Scoff. Well, I didn't take his temperature, I mean, that's why I brought him here.

He didn't have a fever. But he did have Cheetos!

Logic

2012-01-22T20:29:00.000-08:00

Me, to patient being seen for abdominal pain as she was about to chomp into a double cheeseburger: "Ma'am, you really shouldn't eat until we have the results of your CAT scan back. That's the reason I wouldn't bring you coffee when you asked me for it earlier. I'll let you know as soon as we know something, though."

Patient:"Well, if I can't eat my cheeseburger then I need more pain medicine. I haven't eaten all day. This shit is ridiculous!"

It was a ten. Obviously.

Step Away From the Laptop

2012-01-21T03:05:00.000-08:00

Late middle-aged lady comes into triage last night with chief complaint of bilateral leg numbness and inability to walk with spontaneous resolution about an hour prior to arrival. Concerned, I started asking more questions. FAST screen? Negative. Any other symptoms when this happened? No? Any medical problems? No. What were you doing when this started?

"...Well, I had been lying on the couch with the laptop on my legs for an hour or two, and when I got up, my legs felt all numb and tingly and it was hard for me to walk. So I looked up leg numbness on my laptop and it said on the internet I might be having a stroke."

Uh. I think there was a message in all this somewhere, but it is definitely not getting across.

The Big Picture

2012-01-19T06:47:00.000-08:00

Parts of ER nursing are still really difficult for me to deal with. Twice today, I had to clean up the pieces after patients were given some very bleak diagnoses. Sweet people. People who thought they were coming to the hospital for minor emergencies who found out otherwise. Turns out, this cough looks like pneumonia that's probably secondary to AIDS. Yeah, this headache is a brain tumor. Trying to hide the fact that I'm crying when saying goodbye after someone looks me in the eye and tells me I'm a great nurse just because I wiped their tears away and brought them a sandwich.

But in combination with other things, it's almost intolerable. The enraged patients who are upset because they waited so long to be told nothing is wrong. The one that swore and screamed and threatened to sue because the million dollar work up was all negative (side note, she knew her body). The ones using their immaculate, cancer free brains to think of what to say to get more Dilaudid, yelling obscenities at us at the top of their healthy, well oxygenated lungs on the way out the door to go home to their families that they will spend several more pain free decades with.

The juxtaposition kills me, but the truth is that most all of us, myself included, are walking around on and breathing with tons of precious gifts that we never acknowledge. I've been bummed out about my ten year old car breaking lately. This morning I'm just thanking God for my pain free body and my kick ass cardiopulmonary system. Not everyone got one today.

Conversations in Triage

2012-01-17T06:37:00.000-08:00

After triaging a 14 year old patient with a 102 fever:

Hood Nurse: Okay, well everything looks good but that cough and fever you're having, so I'll go ahead and give you some Ibuprofen while you're waiting to see the doctor. It should help with those chills and make your throat feel better, too.

Patient's mom, rolling her eyes: Really? All you're gonna do is give him some Ibuprofen? I have that in my medicine cabinet, I could have done that at home.

Hood Nurse: Um. Well...

After I suppressed the urge to tell that between her and her teenage son, one of them probably should have figured out that antipyretics work for fevers, she then got mad because I tried to give him pills instead of a liquid. I'm just saying, this stuff might be why I come across like a cranky B at times.

Hood Hospital Lockdown

2012-01-14T06:09:00.000-08:00

Hey guys! Here comes multiple walk in gunshot wounds! Hooray! Obviously, these fine citizens were just minding their own business when a bunch of dudes came out of nowhere and opened fire (does it ever happen any other way?) Point is, we have a shooter still at large. No one can say what he looks like, because no one knows him, because they were just going on down to the local homeless shelter to do some volunteer work to earn their eagle scout service badges when a gang of hoodlums, probably wearing masks, started shootin'. So what does that mean? It means the MF-in hospital is on lockdown, y'all. That's right, granny who stepped out to call your son. You can't go back and see pappy until this "security situation" gets to a cardiothoracic surgeon, so, just have a seat for a second. Sorry.

Great. So, who enforces the ER lockdown? The hospital police? (cue cricket sounds now).

No, silly! I do! You know, the one who still gets questioned on a weekly basis as to whether I've graduated high school yet? Nothing says "unquestionable authority" like the girl dressed in a jacket from the children's department. Registration knows this, which is why they direct all the verbally abusive folks who can't go back to see their family members right now to me. Also because it takes the letters "RN" behind your name to explain basic security measures, and most grown ass men respond to being sworn at with "if you have a problem, ask the nurse." Seriously? F you, buddy.

And what happens when you call the hospital police and suggest that they might, like, I don't know, like, maybe, one of the five of you might want to post up at this here door that's the only way in and out since you're the only one with that shiny badge and gun? Or something? Naw, it's cool. I feel much better having you tell me "I'm here if you need me", after which you immediately stand outside, away from the waiting room madness and then stand there talking to your buddies for two minutes and then leave because the person who was just screaming obscenities in my face already left before you got here. Cool.

So, for the sake of clarity, we're locking down the ER because we're worried about an armed gunman coming in here and finishing the job, and we're leaving the job to an unarmed nurse. Okay, so if the shooter comes in and pulls his weapon, I'll just disarm him with one hand and stab him in the neck with one of registration's ball point pens using my lighting fast reflexes and extensive nurse combat skillz. Great, but can I get an extra dollar an hour for being triage sheriff please?

"I Know My Body"

2012-01-13T02:45:00.001-08:00

As Promised.

Oh, the statement that strikes fear into the heart of doctors and nurses everywhere.

Look, at face value this seems like a relatively innocuous statement. People with chronic illnesses are in tune with when something bad is on the horizon before it's immediately evident to everyone else. I know when my asthma is getting bad before I start to wheeze. One of my fellow nurses who suffers from lupus can feel when she's about to have a flare. It comes with the territory of having a chronic problem.

That being said, people like this are not the ones who utter "I know my body" to ER staff. But who does? Hold on, let me go get my graph:

Obviously this is now the time that every butthurt person who has been un- or mis-diagnosed since medicine was invented is going to come out of the woodwork and tell me what an asshole I'm being, but listen. There is a whole other world of people that those who don't work in crazy town everyday do not even know about. And I can say this as someone who used to not work in crazy town- I had no idea these people were out there before I started working in the ER.

I'm talking about the people who come into the ER on a semi regular basis with the same vague complaint who receive a negative workup each time. Sometimes they get pain medicine, but every time they get pissed off because we can't find anything. We refer them to specialists, who they sometimes see; other times, they just keep coming back to us and getting angry when the same limited tests we can show the same thing (nothing). You know you're really screwed when these folks visit the specialist we referred them to, only to be told nothing is wrong, and then they come back to us for answers.

You can explain the tests results and the necessity for follow up until you are blue in the face, but there's always the one comeback that you can't address- "I know my body! Somethings going on and you guys are missing it!" Sometimes, people want to be admitted to the hospital for "I know my body", because somehow sleeping on the hospital grounds will somehow lead to answers that the extensive tests run today did not reveal.

It frustrates me not to know what the problem is, too. The fact is, there are several illness for which there is no positive test. There is also not a positive test for attention seeking, narcotic seeking, hypochondria or straight up craziness. Unfortunately, regardless of the true cause, this means a referral and further investigation is in order. Dramatically throwing your discharge papers on the ground and shaking your head while screaming "but I know my body" does not change this fact.

Picky, Picky

2012-01-12T00:57:00.000-08:00

I will admit I am very consciously not a super particular person. It's probably because I've basically worked service my entire life (before nursing, I waited tables and worked retail) and I always found the multifaceted special request people secretly annoying. Yeah, I can get that salad for you with the chicken extra crispy and no tomatoes and with half full calorie and half zero calorie ranch on the side, but I am totally thinking in my head that you're probably kind of a high maintenance douche. I can put half of your twenty five dollar total on a check and the other half on a credit card, but really? Should you be buying clothes if you don't have twenty five dollars in the bank? Just something to think about.

While I found these people mildly annoying in food service, in nursing I often just find them confusing. Mainly, the things they choose to be particular about. It seems to me the people who want a Shasta with a half cup of ice and then an extra cup of ice with no water on the side are always the sorts that come in harboring some kind of sick-ass fungus on their skin that could have been prevented by simple hygiene; the people that want the head of the bed raised a half an inch up, no, now a quarter inch down, are the same ones that have been sitting on some kind of funky discharge for a month and a half. It really blows my mind. Seriously. How can you be so type A about one facet of your life but you seem to be completely unconcerned about the new species being created between your skin folds?

Maybe it's some kind of joy people take in requesting things of others. I'm embarrassed to ask for a class of water with my beer, so maybe I just can't understand it. I can't really judge since this is the sort of stuff I spend my time thinking about.

Also- I can't get the links on here to work yet, but I've created a twitter account-@hood_nurse.

I might post stuff, or might just use it to see what kind of shenanigans Ilya Bryzgalov is up to this week.

I'm Sorry, I Don't Have Anyone Here By That Name

2012-01-08T22:02:00.000-08:00

Triage desk, 3 AM: 50 something male visitor who smells distinctly of marijuana approaches. Foolishness ensues.

Hood Nurse: Hi there sir, can I help you with something?

Visitor: Yeah. Uh, yeah, I'm here to pick up my girl, she's back in the ER!

Hood Nurse: Okay. Do you already know which room she's in?

Visitor: Naw. Naw. She just said that she was about t'get discharged, and they told her she needed a ride, so here I am, I'm her ride.

Hood Nurse: Oookay. Sure. Well, what's her name?

Visitor: I mean, well, you see, I don't really know her last name, but I mean, like she just called me and she said I need to come pick her up, so I'm here to pick her up-

Hood Nurse: Okay. Well. Um. What's her first name? Can you tell me how old she is approximately and what she might be in here for?

Visitor: Aw, no I don't know why she's here, you see, she just said, come here and pick her up.

Hood Nurse: Well, I can't let you back in the treatment area if you can't tell me the patient's name, sir.

Visitor: Well, see, I just call her boo.

Hood Nurse: Well, we don't have "boo" in our system here, hon, so I can't really let you back there.

Visitor (now on cell phone): BOO! HEY! I'M HERE GIRL! What's yo last name, boo? WHAT? I said, I'm here to pick you up! YOU'RE WHAT? You say you at county? Boo, I'm at Hood Hospital! Well I'm here at Hood Hospital to pick you up? What? You're not here? Man, these bitches be wastin' my time out here with this...(wanders out)

Triage Foolishness Edition One Hundred Million

2012-01-06T06:45:00.000-08:00

Because we all just continue to find more creative ways to be crazy douchebags, don't we?

Okay, day shift. Let's not abandon our post at triage for an hour because we had an interesting case come in through the front and we wanted to see how it turned out. Really? Seriously? Do you have any fucking clue how much it sucks to walk in an hour behind in triage with 20 people waiting to be triaged? No? Oh, that's right, because I would not do that to you EVER, nor would I even do that to my worst enemy in my wildest dreams, because it sucks. Oh, and B-T-Dubs, I thought the lady satting in the 80s who had to wait an hour to be triaged was pretty interesting myself. Good job on that.

And really, pseudo seizures again? FML. But really, one, if you're freaking huge, physics alone tells us that you don't just fall on your stomach after leaning back in the wheelchair, it requires force, like you propelling yourself for dramatic effect. Everyone in the waiting room saw it, and they were doing dramatic reenactments and laughing at you after you went back to a room. Let's just stick with unconvincing syncope instead of half assed seizures next time. It's hard for me to do a sternal rub on you subtly in front of all these people anyway, and it's documented in your medical records by a neurologist that you were essentially thrown out of his office for being a lying fool, so the Ativan is not forthcoming.

Everyone- keep your pills away from your toddlers.

Yes sir, you're right. Your daughter's menstrual cramps aren't a priority over the chest pains that have been waiting 3 hours longer. Call the complaint line if you wish. Thanks for choosing Hood Hospital.

When checking in for STDs, it is unadvisable and confusing to run up to the triage window holding your crotch and screaming "I'm burned" repeatedly. Also, the courtesy phone is not there for you to talk to your four different girlfriends during the hours your are waiting to be seen for your drippy penis.

Drunk and escorted by the police? It's not even Friday yet, bro! Sorry to hear about your parole situation. That is a bummer. No, I don't want to be your pen pal in jail, but thanks for the offer. I will spread the word to my fellow nurses just in case someone is looking for a baby daddy in the pen.

Do you think if I just coded all these STDs and dental pains as ESI level ones that they might fire me from triage? I'm willing to give it a shot.

Choices

2012-01-05T07:05:00.001-08:00

So, last night world famous emesis bag nurse turned charge presents to me this scenario: crayzee frequent flyer or broken penis?

And I replied, "Busted penis it is! Bring it on!"

And so it went. The penis? Super broken. Bleeding more than I would have thought. IVs were started, pain meds were delivered, preoperative things were prepared, paperwork was filled out in a frenzy, reports were called. I ran back and forth for about an hour straight. I sat down at the end of the insanity to see that crayzee frequent flyer was pretty much given a stat discharge by my favorite doctor EVAR sans ridiculous workup or that one D medicine that is the only thing that can cure the body aches associated with the common flu (yes really).

I regret nothing. Yup, I had to do way more work, but in the end I got to make a very nice gentlemen with a very legitimate emergency feel better, versus listening to some crazy douche whine about how no one takes her pain seriously while pretending to nod sympathetically or whatever.

And really, pee breaks are for pansies anyway.

Drugs Are Bad

2012-01-03T12:39:00.000-08:00

There has been an odd increase lately in jackasses who are high on whatever coming in for essentially, side effects of being high, but they're so high they insist it's something else. These are the worse people to deal with, because they're already agitated and anxious and they don't respond very well to the medical advice "go home and sleep it off".

This crackhead chick checks in the other day for the crack scratchies, is prescribed Benadryl and steroids for said scratchies, and then proceeds leave without treatment because she's pissed that we "aren't taking her complaint seriously". Homegirl then goes across the street, smokes more crack, and calls the ambulance from there. She's so effin' high when she gets to me that she can't even tell me what's wrong- after 10 minutes I get out of her "I feel bad" and "my skin hurts", but they main point she's trying to drive home is that the problems are NOT related to her drug use. They're just not, I know they're not, because I know my body ("I know my body" is a whole other damn post). MMkay. So, basically she is prescribed anxiety meds, which she of course refuses, throws her rehab referrals on the floor and storms out of the ER again. Okay. Thanks for choosing Hood Hospital?

So then last night, I get some dude who's buddy brings him in for heart palpitations or some shit, who is beyond drunk and high on who knows what else. Admits that he's had about 8 beers and around 5 shots since he woke up that afternoon, won't sit down, won't stop talking about every other thing in the world other than his emergent complaint. Then he decides he wants me to get him a drink immediately and just asks repeatedly using a multitude of obscenities. Lovely. I used to try to deal with this crap myself, but I'm seriously over it at this point. You wanna act drunk and stupid? Okay, fine, the police will finish this triage with us. The one advantage to working with idiots like this is that most of them have warrants, so once they see a police officer they are suddenly on their best behavior. These two didn't even stay to get seen once the police came around- you're welcome, treatment area nurses.

Uggh. Can we add a "drunk, stupid asshole" column to our MSE form please? Thanks.

Damn You, HIPAA

2012-01-02T05:51:00.000-08:00

Some local government big wig jackwagon decides to play "don't you know who I am" on the busiest day of the year thus far. Fabulous. Naturally, upper management is already aware, buy into the bullshit, and this douchebag is ushered back for a not very serious complaint ahead of tons of people that are much sicker who have been waiting much longer. That alone is a dick move. But then, he makes such a fuss about having to wait long enough to be registered and triaged that the fallout over that leads to management insisting the most honored duke of hood land have a one-on-one nurse to attend to all his pillow fluffing and Dilaudid receiving needs, as a result closing several rooms that sick people could have gone to.

So, multiple things- one, our entire upper management is apparently embarrassingly spineless. Seriously. Gross. But more importantly, I wish so bad that this guy's constituency could find out about this. Yup, councilman such and such abuses his power and doesn't care if your granny having an MI in the waiting room, because he wants one on one nursing care for his bullshit complaint. I wonder how that shit would go over with the voters. I wonder how these assholes would act if there was any transparency at all. If HIPAA weren't around I'd have this shit all over the news.

Things I Will and Will Not Do

2011-12-28T07:03:00.000-08:00

Patients, for future reference:

I will gladly clean any number of wounds or messes regardless of how long it takes to do so and regardless of how disgusting it smells. It is my job to do so, and it needs to be done. I will not beg you to let me do it. If you are a grown ass adult of sound mind who chooses to not only do nothing for yourself, but wants to scream and complain when I attempt to remedy the situation of you sitting in your own filth because I'm bothering you? Let me stop bothering you. As an adult, you surely understand why dirty ass wounds are problematic. I have other people to take care of that actually want my help, and therefore I don't have time to argue with you about it. Let me just chart that you refused the care I offered you and you can call me when you decide to stop being disgusting and I'll help you. Okay, great.

I will work you up for your intermittent mysterious vaginal bleeding that you've had for two weeks. Sorry you decided during the busiest day of the year that this was now an emergency, but your labs are all back right now, your blood counts are fine, and you're officially not dying, so it's time to take your Flagyl and follow up with a GYN. I cannot magically stop your vaginal bleeding with a pill of some kind or space age laser technology, and I will not tolerate you standing in the staff area yelling obscenities at everyone because you want your f-ing period to stop and we didn't do f-ing shit for you and we just wasted your f-ing time. You're totally discharged. Hi, security?

I will take care of your drunk ass in a kind and gentle manner despite the fact that you have no problems we can help you with here in the ER. You play nice and take your fluid bolus and your warm blankets, I'll turn the light off and you can have a nap and you and me are going to be good friends. We will not be friends if you start cutting up and trying to pull your IV out and threatening suicide and screaming at everyone because now mommy's here and she's mad at you for being a drunk idiot instead of giving you the sympathy you think you deserve. No, I do not have time for you to pull me into your mommy drama, and I will not sit outside the room and therapeutically try to convince you to calm down and stay. If you want to try to manipulate your mom in my earshot by threatening suicide, fine, but you will find your ass in a safe room with a the po-po standing by and mommy out in the waiting room away from your drama before you can say "Haldol". There are literally dying people here today. Act out your Dr. Phil "mommy loved me too much or not enough" bullshit on your own time.

And ultimately these are the people that are going to be determining whether my service was good enough for the hospital to get paid? Why did I stop waiting tables again?

When You Gotta Go, You Gotta Go

2011-12-23T06:24:00.000-08:00

I'm taking care of a gentleman last night who was having some seizure activity- nice, normal seeming (by hood hospital standards, anyway) dude. We get him back to a therapeutic level on his meds and I'm just watching him for a while to make sure he's not having any problems before the doctor will discharge him.

It's a decently paced night, so I'm hanging outside his room charting and talking- his door is open so I can see and hear if he starts seizing again. Dude is sleeping peacefully for hours. I hear nothing but the TV and his snoring, until all of a sudden I hear a lot of rustling and moving around on the stretcher. I immediately jump up and run into the room to turn him over, thinking he's having another seizure, but when I get in the room, I find him wide awake and lucid, urinating into his belonging bag with his clothing still in it. I grab a urinal and try to give it to him real quick, but he just kind of shrugs and finishes peeing in the belonging bag.

I feel terrible because I immediately assume he couldn't see his call light where I put it in the bed- I apologize and tell him not to be afraid to yell out if he needs something. Except he's just like, "Nah, it's cool. I knew where it was, I just had to go, yah know? When you gotta go, it's just like, time. " Well, okay! Whatever works for you, I won't make you wear that shirt home. Have a free gown on us, man. Merry Christmas!

Chief Complaint of the Night

2011-12-22T06:16:00.000-08:00

Are you ready? Here we go.

Trouble sleeping for 5 years.

Yeop. And was seriously a douche to ER BFF in triage when she asked if she'd seen a doctor or tried any meds before. I guess maybe she was crabby from not sleeping, but still. It's not necessary to be nasty to the triage nurse for just doing her job and trying to collect your information. Anyway. 1,000 cool points were awarded to our new ER doctor, for this conversation:

New Dr: So, what's wrong today ma'am?

Miss Insomniac: I haven't been able to sleep well for 5 years.

New Dr: Yeeeah. So, this is the ER, so I don't prescribe sleeping pills here.

Miss Insomniac, scoffing and rolling eyes: Well, and I haven't had my period in two months either.

New Dr: Okay. Well, now you can go buy a pregnancy test, because you're discharged.

I tried to start a slow clap at the nurses' station, but no one was paying attention.

Things That Are Not Emergent

2011-12-21T02:30:00.001-08:00

People sure do get upset when I seem to mention that most of our patients are not having legitimate emergencies. I get these random comments like, "Bitch, how can you say that a UTI is not an emergent complaint? My sister's friend's cousin's baby mama got UTI one time that was so bad that she ended with pyelo and then got intubated and ended up in the ICU!"

Look, they're just not most of the time. And that's fine. I enjoy the non emergent stuff too, plus, if we saw exclusively life threatening emergencies at all time, one, my job would most certainly be in danger, and two, it would be reallllly stressful.

But, in the spirit of Christmas unity and peace on earth, let me just throw one out there that I think we can all agree on. Checking into the ER to get documentation from a doctor that you have the sickle cell trait so you can try to use it to get on disability? Really? Not an emergency. Any questions? Okay, great.

Guess the Complaint

2011-12-16T03:37:00.000-08:00

As written:

hirna bother hurt him ril bad

Answer tomorrow, pending day shift coming to take report on time. Winner will receive a lightly used pair of hospital socks and a half eaten bag of flamin' hot cheetos I found in the waiting room.

UPDATE: Well, I seem to have underestimated my readerships' talent for deciphering the writing of the borderline illiterate. There are too many of you that got the answer correct (yup, hernia pain) for me to declare a single winner, but you have all shown that you are qualified to work at the Hood Hospital triage desk, where 99% of your duties consist of explaining to registration what the hell these people are trying to check in for. Hit me up if you're looking for a job where you are verbally abused on a continual basis.

In Response to the News That She Was Going to be Receiving Sub Q Heparin

2011-12-14T23:12:00.000-08:00

Patient (who was in the ER for skipping dialysis x 3 weeks to go on a crack bender), with a mouthful of chewing tobacco: Heparin? In my belly? Uh-uh. That don't go in no shot. That only go in the IV for dialysis.

Me: Well, ma'am, I can guarantee you this is a pretty routine order for the prevention of blood clots in the hospital. You can look at the written order here if you like.

Patient: Naw. That don't go in a shot. I ain't takin' that. You nurses here are dangerous.

Me: Alright, well, I can't make you take it. I'm pretty sure skipping dialysis for three weeks didn't kill you, a DVT probably won't either. Also, I'm pretty sure you aren't supposed to chew tobacco in here.

...and end scene.

"We're In a Code"

2011-12-13T17:14:00.000-08:00

Go ahead and turn your caps lock on now, butthurt commenters. Here we go.

So, as I may have mentioned before, last night sucked. Hard. I think we had about 4 intubations and 2 codes in the first 2 and half hours in addition to a bunch of other train wrecks and ICU holds that were already down in the ER at this point. At some point in the midst of all the madness, we hear them call a code blue to one side of our ICU (it's split into 2 big hallways) and think little of it. Even procedure whore doc, who usually is calling upstairs to see if they need intubation before the operator is even done announcing the code, payed little mind, as he's already intubated half the patients in the ER at this point and was over it. About half an hour later, they assign me an ICU bed on the hallway where the code isn't happening. I get my stuff together and call up there, and some chick answers the phone and is like, "Um, did you NOT hear the operator? We're in a code right now. Yeah. I think your report's gonna have to wait for a little while." Generally trying to be understanding, I ignore the fact that this woman is talking to me in the same way one would speak to a child who is interrupting the grown ups talking and say, "Oh, I'm sorry, I thought that was the other hallway." I swear I can hear her roll her eyes over the phone as she responds, "Well, up here we all come help", after which the B hangs up on me. Oh hell naw. Let me break this down for you, girl.

One, is it really necessary to act like that? If you'd just been like, "hey, we're all in this code, can the nurse call you back", this would not be an issue and I wouldn't have to make fun of you anonymously over the internet. But now I do. You brought this upon yourself. But seriously. I'm so sorry, I didn't realize the important ICU nurses were still in a code, which I wouldn't understand, because we don't do anything down here besides sew up boo-boos. Let me just get back to handing out ice packs and Norco until the real nurses can call me back and bestow upon me the honor of taking report. Meehh.

But the real point of the post is, how many of you does it take to code a patient? I'm gonna drop a hot opinion on y'all right now and say if it's more than 5, you're probably doing it wrong. I apply that rule to us, too. Okay, if you're coding a patient you need a nurse to record what's happening (1), a nurse to push meds (2) two to alternate between compressions and code gopher (3 and 4) and I'll throw a 5th in there to do other procedures or whatever or to bag if RT isn't there (which they are). Really four is enough, and we've coded patients many a time with three with no problem. If we're really in a bind, I've had days where it's me, super medic and a doctor where I push drugs and record and super medic and the doctor switched off compressions while the doctor ran the code. It's not ideal, but you know what? I would rather have that any day than 10 people in the room. Why? Because if there are 10 people in there, half of them are just standing around anxiously getting in everyone's way, and that is the most annoying shit in the world. If you are standing around in a code, your presence alone is not helping. You are making it worse because you are limiting flow in and out of the room, and you are sucking up everyone's oxygen and making it hotter in there. Get the F out.

If I am the recording nurse, I will actually tell people to get the hell out. If I am helping and a bunch of people come in, I will switch with someone and go take care of my teammates' patients while they're in the code while announcing loudly on the way out that the room is at capacity and the fire marshall is going to come and write us a ticket. In the ICU, I would think this is probably even more true because you often already have lines and an airway established. So you're doing compressions, pushing drugs, and recording . It shouldn't take that many of you. Plus the house supervisor, the chaplain, and everyone else and their mama is up there in your business once that shit gets called overhead. To quote my ICU buddy nurse XY, "It's an ICU room, not a clown car". Leave.

My second point is, that shit must be nice. It would be rad if we were coding one patient down here and if EMS showed up with another super sick patient we could be like, "Nuh-uh! We're in a code! You keep that out in the ambulance bay until we're done! What's wrong with you?" But it doesn't work that way. Sometimes we just have to bag with one hand and do compressions with the other and push drugs with one foot while hoping we remember all this crap, because every patient down here is crashing at the same time. It happens, and I don't feel sorry for myself about it because this is what I signed up for. But do I feel sorry for you when you are asked to step out of a code 15 people are standing around in to take report from the mean, ugly ER nurse so I can fill my room with the next code coming in down here? Nope! That's the way nursing goes. Dry your tears with your fancy cellulose dressings and pull up your disposable one use big girl panties that we don't stock down here and deal with it.

How You Know Your Night Truly Sucks

2011-12-13T08:02:00.000-08:00

Last night was the worst. Like, very possibly in my top 5 shittiest shifts of my life. The ICU is full, which basically means we're boned. I thought I lucked out with the 2 code rooms, as I would be guaranteed only 2 ICU admits- unfortunately they were both enormous train wrecks with piles of comorbidities and families who were prone to anxiety while at the same time being unable to really grasp how sick their loved ones actually were. At least they were nice. Anyway.

At about hour 9 at one bathroom breaks and zero water or snack breaks, I'm mixing my patient's smashed BP meds in water so I can give them down the NG tube when I look at the monitor to see that his blood pressure has tanked for some unknown reason. As soon as I process the information in my brain, the next thought that pops into my head is "I wonder if I drank this if I would have a syncopal episode and be able to go home?" Mind you, this is never something I would do or even consider doing, but for some reason like, some other part of my brain took over and was all, "screw this! self destruct!!!" Luckily (?) the generally sane rest of my brain was like, "that isn't cool, plus you're not wearing your cute panties, so you can't pass out here," and I finished my shift relatively uneventfully other than the general awfulness.

So, I guess the moral of this story is, when your brain tries to kill you, it's time to stop picking up extra shifts.

Service Training in Action

2011-12-11T22:23:00.000-08:00

Now that our patient satisfaction scores will actually affect reimbursement rates, Hood Hospital is trying to teach all of us ragamuffins down in the ER how to act right so our patients will be happier. Who better to teach us than a bunch of people from finance and upper management who have never taken care of a patient in their entire lives? I can't think of anyone with a better perspective. Anyway. They've been doing mandatory training the last month, and despite the fact I will never get those hours of my life back, at least the things these people think will work to improve our scores are hilarious.

The vast majority of the stuff they are trying to teach is are things that decent nurses already do. Hi, don't start a Foley with the door open, don't talk to the patient about your child support case, explain what the hell you're doing before you do it, maybe talk about the discharge papers a little while instead of just throwing them in the patient's general direction. Yeah, okay. No, the true comedy gold happens when these jackwagons present to us the things they actually think will make our patients happy. It's kind of sad, really, as they've clearly had many a meeting about synergy in healthcare and buzzwords or some other bullshit and come up with some stuff that they probably think is really fantastic and practical, only to be met by icy, dead silence or riotous laughter when they present it to those of us who actually take care of the patients.

So, with that in mind, ER BFF and I thoughtfully considered their suggestions and pondered how they might apply to the situations we encountered that weekend. Here's a couple I'd like to share with you.

"Mr. Homeless McCrackhead, you seem upset. Please allow me to listen without interruption about what the problem is. Yes, I can see you're very upset that we can't bring you a third sandwich and that the staff won't allow you to go into other patients' rooms to ask for their phone numbers. I'm so sorry this is happening to you. Let me see what I can find out for you about a bus ticket to that nudie theater downtown. Thanks for choosing Hood Hospital!"

"Hi Mrs. Abdominal Pain of Mysterious Origin with Multiple Non-Narcotic Allergies! My name is Hood Nurse, and I've been an RN for nearly 3 years and I have a lot of experience starting 24 gauge IVs and pushing Dilaudid through them. I see that Dr. Unnecessary Workup is going to be your doctor today, and let me just say that he comes highly recommended by other patients with problems similar to yours. Today we will use state of the art technology the perform several fruitless tests on you, and when they all come back negative, we will continue to take your pain seriously by giving you criminal amounts of IV Dilaudid. After a couple of hours, Dr. Unnecessay Workup will probably admit you for pain control to Dr. Spazz Hospitalist. I've heard many good sources that he has a pulse, and I've noticed he's been urinating on himself a lot less lately. Please let me know if there is anything I can do to make your stay more like a combination between a spa and a trip to Disneyland. I have the time. And for the 40th time this year, thank you for making Hood Hospital your first choice. We are delighted to take care of you again and hope we have this opportunity to collaborate in your care again soon."

"Mr. Drunken Head Laceration, I'm sorry you're not feeling well today. I realize that hitting and groping the staff might make you feel better. However, we're concerned about some possible issues to your health and safety, so we may have to use some state of the art leather restraints in your care today. We may call in the hospital police to help make your stay more enjoyable. They and their tasers have several years of experience dealing with patients a lot like you, and they are excellent at what they do. Now the doctor is going to use his excellent technique to staple your head closed. We will allow you to voice you concerns in the form of multiple obscenities screamed at the top of your lungs in an uninterrupted fashion, because we respect your point of view. Let me, as an agent of hood hospital, express how sorry I am that the doctor will not prescribe narcotics for your head laceration pain. It seems he is concerned about the possibility of mixing them with alcohol. I recognize that this is unacceptable to you, so I'd love it if you'd stay to talk to our house supervisor, who would be happy to provide you with a gift card to our on campus Starbucks. We'd be happy for you to enjoy a gingerbread latte on us for your trouble. Or, if you really do feel that you would prefer we, as you say, 'shove that up our asses', we would be happy to do that as well, if it would make you more likely to recommend us to your friends and family. As always, thanks for choosing us today!"

I don't see how communication like this couldn't fix all of our problems. I mean, obviously any problems we're having with feedback are certainly solely related to our shortcomings in communicating, as opposed to lack of staff, budget, resources, training, or reasonable expectations.

The Solution to All of Our ER Woes

2011-12-07T04:25:00.000-08:00

So, obviously drug seekers are a big cause of frustration and wasted resources in ERs, but I think the number one thing that I deal with that tests my patience the greatest is the douchebags with no medical training that want to micromanage how you do your work. I had people like this recently who were seriously so ridiculous that they wanted to argue with everything we did down to the dosages and types of medications. Might I add, the suggestions in question- yeah, most likely would have been lethal. For a condition that is pretty black and white on how to treat. Rationale was given and was recieved with many a scoff. Efficient care was met with suspicion and hostility. I seriously have no idea what the hell these people's problem was. But, one of our doctors has suggested a solution that I think will please everyone.
He suggests that we can go ahead and just make all of our medicines and medical supplies available to everyone. You want 15 mgs of Dilaudid at once? Cool, go buy it and make it happen! You think you and your layperson family can manage your care better than all these dumbshits down at the ER? Go to the store and get all the supplies and meds you need, and see how it works at home. If it turns out to be harder than you think, you can always come see us, and maybe you'll appreciate the fact that we went to school for this for a reason and let us do our damn jobs. Hey, you can even pay by the hour to rent one our stretchers. You can pay another fee to have Pyxis access and you can pay us by IV set for every start attempt you make. At any time, you can opt to STFU and let us take over.
Look, I realize this is ridiculous, but I'm really curious how many people would call our bluff if we gave them the chance. I bet the attitude would change after about an hour. We'd just have to stock up on Dilaudid.

The VIP Treatment

2011-12-03T07:25:00.000-08:00

Look, I try to help out other public servants. At least in my ER, if a paramedic or police officer shows up to triage, I try to get the back to a room quickly, if possible. It's kind of an understanding. I know they put up with bullshit similar to the stuff we deal with. They're (usually) pretty cool when they bring in patients, and supposedly the cops around where I work will pretty much not write you a ticket if they see your badge. I'm sure it doesn't hurt that we try to take care of them whenever they come in.

But, um, tell me if this isn't abusing the understanding a bit much. Last night, we're hanging out at the nurses station wrapping stuff up for shift change when this guy runs in thorough the ambulance entrance from one of the local PDs and says, "I need a wheelchair NOW! I have an officer out here who has a HURT ANKLE!" You would have thought the guy had been shot and was bleeding to death in the ambulance bay. One of the medics and and I grab a chair and run out there to find the police car triple parked across the ambulance parking and a young man in uniform in back looking around very sheepishly. We loaded him up in the chair while his superior followed us in, giving a detailed account of how the injury happened and how the insurance billing would work. Finally, he went to move the car. We x-rayed the nice young officer and gave him some pain meds and an ice pack- he was discharged with a sprain by shift change.

Come on now, dude. We would have hooked up your buddy in triage, too. The ambulance bay blocking hysterics would be kind of like me throwing my badge at you and yelling "I WORK IN HOOD HOSPITAL ER!" if you pull me over for speeding and ask for my ID and insurance.

Overheard In The ER

2011-12-02T01:58:00.000-08:00

Mother, angrily to her son who had promptly been discharged with zero tests or meds after checking in for "feeling weird" s/p smoking marijuana- "I TOLD YOU we should have taken the amb-a-lance! They take you more serious and they run more tests when you come in the amb-a-lance! This shit is ridiculous! Let's go home!"

Charting Fail

2011-12-01T02:26:00.000-08:00

We have an agency nurse on day shift right now who is- let's say- a little special. We've had a couple of great agency nurses, but as a general rule, we don't exactly get the cream of the crop. This guys is right up there with the winner who finally got fired for getting in a screaming match with one of our NPs about whether it was kosher to give a gram of Rocephin mixed with 10 mls of sterile water IV push. Yeah.

Anyway, despite the fact that everyone who else who came here while we were still using paper charting a while back was appalled that we were so provincial and dated, this guy, who is allegedly a seasoned nurse, seems to be terrified of our computer charting. Since all but a handful of our portable computers broke within the first 2 weeks of getting them, it's not uncommon for us to use a piece of scratch paper while getting an ambulance started and put all the information in the computer later, key statement being put the information in the computer later.

If a patient has gotten there within an hour before shift change, this guy writes a bunch of shit in random places on a blank piece of printer paper and then hands it to you during report like, yeah, here's my assessment, bye. So, not only are you stuck with all the other crap he inevitably leaves you, but his charting too. It's whatever to me- I just collect all the information myself and put it in when I triaged the damn patient, because I don't really have time to sit down and decipher this Son of Sam looking shit that is supposed to be nursing notes. I got some time to look over some of this charting (?) the other day when I was helping a friend catch up, and it was pretty amusing. Among the vital signs and medical history, there were all these notes- I'm guessing observations or reports from EMS, one of which read "pt is tacky".

Tacky? Please elaborate, sir. Were you referring to her attitude or her manner of dress? I mean, she wasn't super cooperative, but I'm pretty sure the nursing home dressed her, so you should at least give her a pass on wearing a nightgown this early in the day. Certainly not any more People of Wal-Mart worthy than any of our other patients. Oh... did you mean "tachy?" Oh, okay. Yeah, maybe the avoiding putting stuff in the permanent medical record route is your best bet when possible.

Let Me Just Say..

2011-11-25T08:37:00.000-08:00

...a quick thanks to everyone today and I will try to move on with my life. I am really not eloquent enough to express how much the support I've received from everyone really means, but let me try.

My approach to life and my job at times does not serve me very well. I have high expectations of individuals and humanity. I have even higher expectations for myself. I'm often disappointed on both fronts, but this way of thinking is what makes me want to keep doing what I do and loving it. I try to see the good in everyone and treat them accordingly; some days are more difficult than others.

Even before all this happened, I'd been having one of those periods where I was kind of just being bombarded with foolishness and douchebaggery every time I came to work. I was physically and mentally exhausted and continuing to be tested pretty frequently. I was starting to feel the bitterness set in, and I already kind of just wanted to get away from everything, and then all of this bullshit happened. I really felt powerless to help anyone, and I questioned why I was even trying. I saw a lot of ugliness around me, and a lot of ugliness in myself. It was just an awful cycle of feeling bitter about everything I do and then feeling guilty about feeling the way I did. I felt as if nothing good I really did mattered against the overwhelming amount of apathy and cruelty.

Thankfully, it seems that benevolent and compassionate people have an inexplicable way of recognizing distress. My friends and family have shown themselves to continually be more wonderful than I could ever imagine. But the kindness of those I don't know well has really the most overwhelming part. My gruff, sarcastic coworkers became empathetic confidants; quiet, sweet types who I always liked but never knew well wiped away my tears and offered me their prayers. And people who read this-stuff- stuff, that as far as you really know, may be the elaborate delusions of some crazy person- have been willing to go so far for me. People who don't know me at all who are willing to share stories that no doubt open up old wounds for them to make me feel better. So many of you have offered such heartfelt concerns and comfort to a complete stranger. To those that posed questions as to whether it helped, yes, it absolutely did.

You see, my self blame and doubt about myself is always going to be a facet of who I am. Unchecked, it consumes me- in balance, it just drives me to be better. I'm somewhere in between- in a better place now than I have been. But my doubts about human kindness? Vanquished. Again, I don't know how to say how important this is in me carrying on doing other than to say it's everything. All of your kind words were the answer to my prayers and a huge part of me being able to carry on. Thank you again, and back to the usual crazy soon.

Regret

2011-11-22T02:08:00.000-08:00

Sorry. I've been absent. I don't even know how to start. I've been in a huge tailspin. More in a bad way than any other time in my nursing career.

A while back, I took care of a little boy with a broken arm. I recently found out he was beaten to death. In retrospect, absolutely no doubt at the hands of the same monster that hurt him before.

But I didn't see it then. And I've gone over it a thousand times in my head and I can't stop thinking about what I missed. About how I should have seen it. About how maybe if I had, things would have been different. That maybe somebody would have come and saved him.

The day keeps repeating in my head. He was one of four patients, two of whom needed everything done when I took over. I frantically ran in to check on him when I first arrived, I told his mom what we were waiting on, I ran back out and back to my other patients. I caught up a little and I went in with the doctor and a medic friend of mine to splint him before transfer- he was going to need some pins placed. He cried, but he took it well. I went and got him some pain medicine and talked to him mom a little as I was giving it. About his daredevil behavior jumping off the couch. I told her about my godson, who is a little older, and how he had some of the same tendencies. We laughed together and talked to the little boy about which Spiderman toy he wanted when all of this was over. She was mild-mannered and sweet. For a brief moment, his injuries concerned me, but she was so candid- so- normal, so loving, that it removed any thought in my head about foul play. Surely, this woman wouldn't let someone hurt this baby.

I was so stupid.

I remember waving goodbye to him as the transfer medics loaded him on the stretcher, him looking at me with his big, sweet eyes, and managing a little smile. It's so clear in my head, like I could go back there. That I could see through it all, and do something to stop it. But I can't do anything. All I can do is replay the moment in my head where abuse crossed my mind and then went as quickly as it came. All I can do is picture myself, waving like an asshole, to an innocent little person headed into the last month of a short and brutal life. I should have known. I should have seen it. I should have tried to stop it.

I've been completely engulfed in the guilt. I've been told so many times this isn't my fault, but I can't seem to completely believe it. I see him in every kid on the street. I dream that he's still alive. That his mother has brought him in again, beaten and broken. But in the dream he's still awake, she's telling me some lie about how it happened, and he's staring me right in the eyes. He says nothing but looks as me as if to cry for help. And I want to grab him and hold him and I want to take him away but I can't. I can't do anything.

I'm getting a little better. I talked to my medic friend who was with me that day. I try to keep reminding myself what he told me- that I did all I could and that I can only learn from this and become a better nurse. That I can see the signs better the next time something like this happens. That I can't drown myself in all this sorrow about what I might have been able to change. Some days that advice is easier to take than others. Somehow the thought of seeing it in the future just feels as if it isn't enough.

I would give anything to go back and change how it happened. But I can't. I just have to let go. It just feels awful.

And We Though Heroin IM-ing was Bad

2011-11-17T01:20:00.000-08:00

Heroin is really not the drug of choice at Hood Hospital (crack cocaine forever, y'all), but I'd say we still see a moderate amount. When users run out of veins, they often resort to shooting the heroin straight into the muscle- not as quick a high, but it gets the job done. The additives in the drugs combined with the circumstances under which they're taken result in some pretty horrendous looking wounds.

I've seen some pretty horrible shit secondary to drug use. But what happens here is, like many other things, a freaking cake walk compared to what's happening in Russia. My brother sent me an article today about Krokodil. It is to heroin what crack is to cocaine- a cheaper and less pure alternative- except it ROTS YOUR FLESH OFF. It's actually a little more comparable to meth in it's preparation in that it's made from over the counter drugs and a bunch of other shit that's toxic to humans. Apparently in Russia, codeine is available over the counter. The codeine preparations can be turned into desomorphine (similar to heroin) pretty easily in a lab, but the solvents used in this process on the street are pretty much just poison, so when the users inject, they end up with some pretty horrific wounds that often end up being gangrenous. Amputations are not an uncommon side effect. Here is the io9 article if this sort of thing simultaneously fascinates and frightens you as much is it does me. Fair warning- graphic rotten flesh pictures ahoy.

I can't explain why I find this so interesting. I guess the psychology of addiction is just really compelling to me. What is happening inside someone that they really cannot give up a substance that is literally costing them limbs? How does someone willing to inject heroin into their genitals to chase that feeling? Seeing stuff like this makes me feel a lot more sympathy for addicts. The willingness to face this much suffering for a feeling that lasts for a couple of hours is nothing short of insanity. Something inside them is clearly different.

ER Madness

2011-11-16T02:40:00.000-08:00

There's a phenomenon in my hospital that I've always assumed is universal, but I'm curious if that's really the case. Does anyone else work with a chronic freak-outer? Like, a person who could have one simple task at hand, but they routinely make a federal case out of it because they're so damn high strung?

We have a nurse like this who has it so bad that the charge nurses seriously have to arrange staffing around her. She can't be in the main area half the time because multiple doctors have requested specially not to work with her because she drives them insane the whole night updating them with information that does. not. matter. They can't put her in triage, obviously, because all the rooms would be full by the first 5 minutes of the shift due to all the perceived crises occurring in the waiting room. Usually they have to hide her in fast track, but the chaos follows. This is enough when the someone just bitches and stresses a lot, but no one is immune to being delegated into the madness. Homegirl seriously came over to a different part of the ER to find me while I was precepting to try and delegate a task to me. Wanting to help if a true emergency existed, but not wanting to get engulfed in the drama if possible, I asked what she needed. The crisis in question? An admission EKG for a patient with a UTI. Dude, seriously? If these orders were written upstairs, an order would be placed and an EKG tech would show up in a few hours. It'll probably be okay if it's not done right now. She's a sweet person and really, a good nurse, but it stresses me out just seeing her work. I'm amazed she hasn't given herself an MI working in this setting.

We have a medic prone to hysteria, too. I never ask him for help. By the time I ask and listen to the 5 minute rant about why he can't because of everything else he has to do and how he hasn't had a smoke break, I could have just done it myself. Again, patient scenarios that have an iota of potential to become something legit are routinely treated as if Level 1 traumas.

A couple weeks back, ER BFF and I were discussing what might happen in an imaginary scenario where freak out nurse and freak out medic end up in a resus room with inexperienced questionable judgement doc. "Maaan", she said, "I would not want to be any part of that. It would be like the perfect storm."

Well, I sure did end up in the room on the day that perfect storm did occur. And as expected, it was clusterfuck. Granted, unresponsive patient with a blood sugar of 15 and no IV is a reason to hustle, but throwing airway supplies around in a frenzy and screaming at one another? Not helpful, guys. Yes, I believe that marks the first time I have asked my coworkers to calm down and shut the F up. They didn't take it badly, though, either because I wasn't audible over the din of their hysteria, or because I got the IV and removed the need (at least briefly) for all the pandemonium, as I was the only person in the room at the time who was not losing my shit.

Look, everyone is entitled to the occasional freakout or meltdown- I know I probably had more than my fair share in my first year as a nurse. But I figured out pretty early on that when I was constantly in a tailspin about what I had to get done, I usually was accomplishing nothing, so the only choice was to just shut up and get it done. If I hadn't figured this out, I doubt I would still be working here. I would have either died secondary to stress or found another job that I could cope with better. These people are not new. In fact, they're some of the more experienced people who work here. I just don't understand. Why engulf yourself in the madness if you don't have to? That level of stress cannot be good for anyone.

Things That Make Me Stabby

2011-11-13T21:01:00.000-08:00

I've had a lot of really difficult, sad cases at work lately. I'm just gonna be honest when I say that I feel like shit and I don't have the energy to write about it at the moment, so I'm just gonna express my sadness as displaced rage like any other healthy American and talk about some stuff that really pisses me off. Well, one thing.

Now that's out of the way- you know what really pisses me off? These idiot assholes who bring their young kids in for asthma and reek of cigarette smoke. It makes me sad to even acknowledge how much it happens. Pretty much without fail I find out while taking care of these kids that it's not their first visit to the ER, either. Oftentimes, they look like shit and need to be IV'd and transferred, and I find out it's not even their first IV start either. Seriously?

If you and your kid both smell like a pool hall, you're obviously still smoking inside your house and probably your car with the toddler in tow. If the kid has been to the hospital for this before, I cannot fathom that you don't understand that this will almost certainly lead to another visit where your child will again be held down by several adults and get another damn IV start. The weather isn't that bad here. Literally the only change you have to make is walking outside for a matter of minutes. Even if you weren't told that this simple lifestyle change could be the difference between your child sitting at home playing or going to the ER and being tortured, which I find very hard to believe, it's a pretty simple cause and effect relationship that anyone who isn't a complete dumbass should be able to observe. The only two options then, are that you're really, really stupid, or you are such a shitty parent that you really don't care about your child's health enough to step outside for three minutes. Judging by the reactions I get from the education I attempt to give on this subject, I'm guessing it's the later. A butthurt "Are you saying this is my fault?" is not generally the response I get from parents that care.

But yes, since you're asking, I am saying that. Because it is your fault. Please, continue smoking. Just not around your small child. It isn't that hard.

Dear Floor Nurses

2011-11-11T07:39:00.000-08:00

Hey, I really, really want to be cool. Yes, when I am not getting my ass handed to me, I will make sure that my patient has a brand new, shiny, non field IV started for you at 1201 so that you can keep it a little longer, my paperwork will be impeccable, I will document a skin assessment, draw any pending labs and start the admission fluids and I will give you 5 minutes to call me back so you can talk to the doctor on the other line. I know your job is hard, too. I really do.

Do you think, though, that maybe, just maybe you could try to do me a solid back by not making the 5 minutes actually 30 minutes, or asking me if I filled out the medication form 3 different times? Listen once and you'll save lots of energy in the future. Do you think a sarcastic "really?" is the most appropriate response to the fact that the patient has a 24 gauge IV that flushes very well? Sorry, if I could use voodoo to conjure up veins in dehydrated 98 year old DNR patients whose families rightfully don't want to put them through getting a central line, I totally would, but we didn't have a lesson in ancient magic during my internship. And while we're on that subject, I was also never trained in divination, so I don't know how to answer the question "what is her blood pressure going to be when she gets to me?" Also, riotous laughter about how shocked you are that an ER nurse actually did a skin assessment when I tell you my patient has non-blanching redness on her sacrum is not necessarily the most appropriate response, just so you know. Sorry if on the days I have a combative psych patient, a call light happy drug seeker and I dying ICU patient that I don't immediately think to run into the room of my immobile, non-verbal nursing home patient to explore what's happening under the diaper. I know that makes me an atrocious nurse and I should probably quit right now.

Seriously. It's so good we don't do bedside reporting. There would be so, so much more punching, that that's unprofessional.

ER Party

2011-11-09T13:31:00.000-08:00

Family calls police and fire rescue out to their house because they can't get their son to get off the lawn and stop doing ninja moves. Naturally, upon finding him, they bring him to us, with his brother and his friend following close behind. They get there and are obviously toasted as well. I just love it when I get an intoxicated patient and the friends who were with him at the scene show up in sunglasses at 3 am. Yeah, okay.

So, we finally give the guy enough Ativan to get him to stay on the bed and to sit through an entire head CT without trying to grab his junk (it took about 3 attempts). We finally finish up, and wheel him back to his room. I'm talking to his primary nurses as we're hooking him up to the monitor and she mentions that his brother must have gone home. Just as she's saying this, I turn around to see the patient's brother and friend in the empty room right across the hall. The patients brother is dancing to one of the music channels on the TV, doing what appears to be the robot with the call light in his hand. His friend is sitting in a chair right in front of him, staring at the wall without blinking. Family of winners, these guys.

In Which I Ponder the Way We Do Things, Lose a Little Respect for Those Around Me

2011-11-03T17:53:00.000-07:00

We get a little old gentleman from the nursing home the other night. Not an unusual presentation-comes in with some bizarre report about how they double dosed him on his Parkinson's meds, and now he's hallucinating and he only ate oreos for lunch. Naturally, he is completely oriented and with the program, not hallucinating, seemingly has no reason to be here. Sassy lady ER doctor does the standard CYA nursing home confusion workup anyway just to save us an automatic return if we send him back with no labs. We draw blood, send of a little urine sample, the little man smiles at us and tell us a bunch of jokes. Hey nurse! Have you heard this one? This man, he sees a policeman and starts running. The policeman chases him down, and when he catches him, tells the man, "If you can give me a good reason why you're running, I'll let you go. " So then the man, the man says to him, "You see officer, my wife ran off with a policeman yesterday. So, I see you and I figure you must be bringin' her back!" He was fun.

So, he has a UTI. Yup, could be cause for some confusion, we call for the transporters to come take him back. They get there and tell him that they're here to take him back to the nursing home and he FREAKS OUT. Starts telling us that the nursing home is trying to kill him, trying to poison his food, that if he goes back he will certainly die. The transport medic is obviously pretty conflicted, but as far as I'm concerned, it's a pretty simple decision at this point. The guy is with it. He's his own medical power of attorney. He's completely of sound mind other than the fact he's convinced the nursing home is trying to kill him. He isn't going back.

He wants to call his daughter. I give hime the phone and go to talk to the doctor. I mention to one of the many new charge nurses what's happening and what I'm doing to handle it. She seems pretty irritated by the whole thing and wants me to call family- I explain to her that the patient's already working on it and I call the nursing home to shed a little light on the situation.

Miraculously, I am connected to someone who actually speaks english fluently, isn't on the job for the first day, and actually has some idea as to what is going on with the patient. She said the doctor had recently increased his Parkinson's meds, and since then he had been getting increasingly paranoid, thinking his food was poisoned, thinking the staff was trying to kill all the residents, refusing to eat or have anything to do with anyone. I clarify that yes, he has no history of dementia, he isn't sundowning, the only reason he is under the care of the staff at the nursing home is because his Parkinson's was severe enough that he no longer had the motor function to take care of himself. I speak to his son, who basically tells me the same thing. Yup, dad is normally sharp as a tack, but now he's talking to people that aren't there and hearing people in the walls, and he was starting to get really worried.

I thank him and get back to check on my other patients- when I come out of a room, I find the hospital police in the room with my little elderly man, essentially telling him he has to go back to the nursing home at the direction of my charge nurse. At that point the ER doctor had come in to reevaluate him and after hearing about 3 seconds of his pleas with the officer, realized he needed, at the very least, a short admission and a psych consult. The patient was visibly upset at this point, so I pretty much sent everyone out and reassured my patient that no one could force him to go back if he didn't want to. The doctor admitted him for the UTI and set up for a psych consult the next day. Then I fed him some applesauce and we talked about baseball for a while. Occasionally I'd have to reassure him the the people from the nursing home weren't sawing through the ceiling to come get him.

The whole thing just was really gross and upsetting to me. Would we even consider treating a young or middle aged person this way? I understand that we can't really leave these kind of decisions up to our advanced Alzheimer's patients who have not the slightest clue what the hell is going on around them, but this was not the case at all. This guy was with it. His Parkinson's medicine had a pretty well documented side effect of paranoia and hallucinations. He truly felt that staying or going back was a life and death matter for him. Any 20 something that came into our ER thinking that everyone in their family was out to kill them would pretty much get a psych consult immediately. But because someone is old we're okay with shoving them into a transport vehicle and telling them to shut up. Because someone is debilitated it's okay to do the wrong thing if it's more convenient for us. These are the kind of patients I became a nurse to help. I'd like to believe that's true for most nurses. I just don't understand how anyone could be okay with sending a patient back to the nursing home that upset if there's something you can do to help. It just depresses the hell out of me. Some days I really hope I don't make it to old age. Being at the mercy of others is a terrifying thing.

I Think They're Just F-ing With Us Now

2011-11-01T06:43:00.000-07:00

Oh, hi local fire medics. So hey, I've resigned myself to the fact that you aren't going to start IVs on diaphoretic patients in respiratory distress with sats in the 40s. I'm over it, I'm not trying to say anything about that.

But can you just do me one favor? Yeah, could you please not stand in the room drinking coffee watching us start the IV and set up the ventilator right where everyone moves in and out? Thanks. And if you're going to stand there, can you at least drink your coffee quietly, as opposed to loudly making fun of our very nice, young enthusiastic RN for explaining paralytics and sedatives to the EMT student because "he's just a basic, he doesn't need to know all that"? Really douchebag? Really?

Do you guys have some kind of bet up there at the station house about who can be the biggest jackass? Because you've got my vote.

Ruined

2011-10-27T06:40:00.000-07:00

Nursing has enriched my life outside of my career in so, so many ways. Especially being an ER nurse. Very little truly frightens me anymore. I'm able to help my loved ones if they need me. It's actually helped me overcome my shyness. I generally have a good story to tell my friends.

But. That said, nursing has ruined me for a lot of things. Meat? Yeah, now that I've seen human muscle fibers in all the states I have, I can't eat it. That's been good for me, so whatever. Anything grape flavored is over forever. Once you've done a couple of Kayexalate enemas, that's pretty much done. The biggest change in my life is TV, though.

Like, if a show has terrible medical consulting I CANNOT watch it. I was the biggest Law and Order junkie that ever was, up until they tried to make fetch happen with all their stupid spinoff series, but Law and Order original flavor ruled. I still get pretty excited when a re-run I haven't seen comes on, which is rare. So the other day a re-run of an 80s episode comes on where some kid codes in the beginning. I definitely hadn't seen it, but I could not even get past the code, because it was done TERRIBLY. Like, they call some code blue in the ER overhead, which, whatever, I suppose maybe they do that somewhere, and then they're bagging this kid and not doing compressions, and then they try to shock her out of asystole, and then they call it, like, 2 minutes in. It was awful. I mean, I could not have watched the rest of the episode for anything.

I wish it was only stuff that blatant, but I nitpick so many shows and I know my husband is totally over it by now. We're watching The Walking Dead right now, which is amazing. The medical consulting isn't awful, but it certainly isn't excellent. Like, they threw out this stuff in the last season where they're trying to scientifically explain the zombie virus and this dude in the CDC is all like "it spreads through the brain tissue, like in meningitis." Um, no. And then this week *SPOILER ALERT* Rick's son gets shot and needs surgery and then OMG his best friend who also is kind of a creep and banged his wife after telling her Rick was dead has to go to the local FEMA center which is overrun by zombies with the dude who accidentally shot Rick's son who happens to be a volunteer EMT to get a ventilator and other shit so this veterinarian guy the met can do surgery on his kid. Anyway. You should really watch that show if you're not watching it already. So, they're in there gathering supplies or whatever, and volunteer EMT/kid shooter dude picks up a laryngoscope blade and handle and he's like, " I got me an endotracheal intubator". At which point, I immediately rolled my eyes and said "no one calls it that", shaking my head just in time to look over at my husband, who at that moment had obviously just lost the last bit of enjoyment he had in watching the TV show based on his favorite comic book due to my inability to shut the eff up about any slight medical discrepancy.

Sigh. Sorry, husband. I wish I could get past it, too, but probably not near as much as you do.

What 4 AM lull?

2011-10-24T07:44:00.001-07:00

Nothing like a 20-something chick running frantically into the ER screaming that she grew a penis and needs to go to the operating room NOW to get it removed to get your blood pumping in the slow part of the morning.

Family Fun

2011-10-22T01:35:00.000-07:00

I get some little old lady last night who came in for weakness- cute, tiny lady who was kind of mildly confused, but pleasant. We're doing the regular weakness/dizziness work up bit with labs and such, and I'm talking to the family about what was happening before the symptoms started as I'm hooking up her EKG leads.

"Well," her daughter tells me, "we were sitting there about to leave for the strip club, but then she started feeling bad, so we called the ambulance." I asked if she was serious. "Yeah!" She told me, "I mean, her husband's been sick for a while and he just died last week, we thought it would cheer her up." Shoot, maybe it would have. Who says ladies in their mid 80s aren't into that kind of thing? Can't fault them for trying!

Although, this is coming from someone who went to a bar with my parents and grandma last week, so maybe I'm not the best person to ask.

Hood Hospital Epidemiology

2011-10-21T00:34:00.000-07:00

While speaking to ER BFF during lunch about a patient I'd triaged earlier in the night:

Me: Dude. This chick just checked in for vaginal discharge for a MONTH. And then she left because the wait was too long. Can you imagine that? Like, just letting your cooch rot for an entire month? You just know here normal bacterial flora are now duking it out and mating with whatever kind of STDs are up there, and they're probably gonna meld together and become some kind of gnarly super gonorrhea, and the CDC is gonna come down here and be all up in our business.

ER BFF: Yup, and then it's gonna mutate and become airborne and then we'll be really screwed. They'll have to declare a disaster state down here, and they'll put us in one of those bubbles and stuff-

Me: And then try to set us on fire like that movie Outbreak?

ER BFF: Exactly like that.

So, there it is- if you hear about the government wiping the most ghetto part of a major city on the news (you probably won't, because it'll be a super-secret-covert-black-ops/CDC conspiracy), have a moment of silence for the brave men and women of Hood Hospital, and remember to get your STDs treated promptly. Goodnight and good luck.

Ambulance To Triage

2011-10-18T06:19:00.000-07:00

Sassy zero b.s. coworker of emesis bag fame has started acting as charge nurse, which, let me just say, is AWESOME. The one downside, I would have to say, at least as a triage nurse, is about 3 times the amount of ambulances in triage. Pretty much the criteria tonight was breathing and walking. Justifiably so, too, as there were several sick people out there for about 6 to 7 hours thanks to the clusterfuck we walked into.

Yup, the part of me that has a relatively low capacity for drama and conflict would really rather these people just go back to rooms so I don't have to deal with them. The other part of me that's a spiteful b kind of loves it.

Let me explain myself a little further lest I sound insanely hateful. I like it when entitlement and douchebaggery are punished. I'm not so much spiteful as I am the type of person who gets really pissed off when someone thinks they're above the rules. Like, I'm the one who always has to say something to the person who cuts in line or the able bodied princess with no tag that parks in the handicapped space. I'm the one telling the people in the movie theater who are talking to shut the eff up or pay me for my ticket. I know. World police, it's a character flaw. But as this type of person, I absolutely love the moment when the asshole who thought using the ambulance as a taxi realizes, "oh, wow, I'm gonna have to follow the rules and wait like everyone else." LOVE IT.

Anyway. We had one last night who thought he'd come in on an ambulance and get seen sooner for his back pain x 2 days. Nope! To triage you go, sir. Now before anybody with a back pain history decides we're douchebags, not only were there much sicker folks in the waiting room, but homeboy also got Fentanyl IV thanks to the extra generous EMS crew, so he should have pretty much been good to go. But no. He screamed and carried on and acted dramatic- when that didn't work, he told me he felt like he was going to pass out from the pain (I have yet to see that happen in the waiting room. You aren't getting your leg amputated, bro), so I told him to sit down and I would come recheck his vitals. Which were of course fine. But he took that time with me to express how the pain medicine didn't do anything and it was already wearing off. I explained that Fentanyl usually stayed in the body longer that 40 minutes, to which he responded by yelling at me, " This is RIDICULOUS! I shouldn't. Even. Be. Out here. I came in an AMBULANCE!"

I decided at that point to explain to him, loudly, that your mode of transit does not factor into your acuity level. If you're dying, you get seen quickly. If you don't, you wait. I wish more people understood this. It would save tax payers so much money.

The Stupid Flows.

2011-10-15T12:30:00.000-07:00

Hood Hospital, for a long time, has had several paramedics in our employ. Over the last several years, however, it's been pretty obvious that they're trying to phase them out. We've hired one new medic in the past 2 years- meanwhile 3 or 4 have left or gotten fired. Word is that before I got there, the medics could do just about anything the nurses could do- give several meds, apply splints, even triage. The triage function was gone before I started, but over the last couple of years they've pretty much reduced their functions to IV starts (which they can't even flush, because oh noes, normal saline is a med, y'all), EKGs and transports. They can't even apply oxygen any more because it's a "medicine". Last week they decided they were going to slash their hours like crazy, and only have one medic working part of the shift on the floor. The others would be helping the charge nurse move patients to rooms and doing EKGS and shit in triage. Really? In case there's been any doubt up to this point, our management obviously has their heads pretty far up their asses.

I know there's controversy, for sure, about paramedics in the hospital setting. For the setting I work in, though, it's pretty much a no-brainer. We need them. Straight up. They save our asses on a regular basis. I'm actually a pretty good example of the average nurse in our ER. Young and inexperienced in any other area that isn't ER. A lot of the times, I'm the "grown up" nurse on my team- it's me with two other nurses that have been at it for less than a year. All the really experienced folks have moved on to either charge or management. Now, don't get me wrong- I can handle just about any ER situation. But when it comes to some of the really obscure stuff, or when I have to be an ICU nurse- I need my medics. Most of these guys can manage a critical patient on their own- they've worked flight before, so they know how to pace, they know how to set up an art line in their sleep- stuff I review once a year at skills day and maybe deal with twice a year other than that. I can't imagine having to do that stuff without them. It'll get done, but it'll be a clusterfuck. And IV starts? Yeah. As good as I've gotten over the last few years, I can't hold a candle to someone who was doing flight transport while I was still taking my SATs.

And now their talking about relegating their duties to moving patients back to a room. Seriously? You idiots think you need to pay a licensed professional to do that? Because that sounds like a job a tech, or shit, a volunteer could do. Here's the thing- when you start treating licensed staff that are an important part of the healthcare time like idiots, you are the ones that end up looking like idiots, because you're paying someone who certainly makes more money to do a job you could pay someone less money to do. Meanwhile, you rob your young staff of someone who has a lot to teach them. We might be able to get away with this crap if we were a hospital full of sage and learned nurses with lots of experience. But we're not. So we're basically just screwing ourselves. Sigh.

I'm gonna throw a fit and argue my case at the next staff meeting, but if they haven't seen these guys' obvious value by this point, I don't know what will change their mind. It's certainly a huge bummer, though.

Chief Complaint of the Night

2011-10-13T07:01:00.000-07:00

This little nugget of joy comes to you from a coworker's triage notes from last night:

HPI: Pt c/o right hand pain x 7 minutes after reaching into vending machine in waiting room and briefly getting her hand stuck. No bleeding or swelling noted.

Yeah, I know. What was she doing in the waiting room in the first place? Dude. That's like a philosophical chicken or egg type of question.

Quote of the Night

2011-10-11T23:33:00.000-07:00

Sassy lady ER doctor, after seeing me after the visit from my patient's wife- What's going on right now? Hood nurse, are you crying? There's no crying in the ER! No crying!

If you don't know what she was referring to, shame on you.

Let's Play a Game

2011-10-11T00:37:00.001-07:00

Are you ready? Here's a game we play at work when captain dumbass from the major city fire rescue squad brings us a patient. It's called "find all the stupid shit on this run sheet". Whoever counts them all is the winner. Go!

On a CPR in progress-
UNIT 123 ARRIVES ON SCENE TO FIND FEMALE PT WITH MULTIPLE LOWER EXTREMITY AMPUTATIONS LYING ON FLOOR OF APT UNRESPONSIVE. PT HAS BLOOD PRESSURE OF 150/90 BUT NO PULSE WITH RESPIRATIONS OF 7. KING TUBE INSERTED AND PT TRANSPORTED TO HOOD HOSPITAL FOR FURTHER EVALUATION.
VS- BP-150/90 HR-- RR 7 ECG-Normal Sinus
GCS-Motor-Obeys commands-6, Speech- Converses normally-5, Eyes- Opens spontaneously-4
Circulation-BL upper extremities-normal, BL lower extremity-normal
Hospital-Patient's choice

Your time starts now. Make sure to show your work.

Disclaimer to the inevitable butt hurt commenters- I promise, there really are not extenuating circumstances- this particular guy is seriously that lazy and that stupid. He stayed at the hospital for 30 minutes putting this together. Just think about that for a minute.

How I Do It

2011-10-10T06:22:00.000-07:00

ER nursing is so, so much bullshit. Really. I mean, it's obvious from this blog, but I'd say about the vast majority of the people we see don't need to be there, for various reasons- either they're here for a problem that could be handled by a clinic, or they're looking for drugs, or they have a problem that could have been prevented if they bothered to fill their prescriptions and actually freaking take some responsibility for themselves or their health, or they're just overall not bright and/or educated enough to know that the problem they feel is an emergency is not an emergency at all. I go whole shifts sometimes without seeing anyone in need of help that I can actually provide. A lot of the times I'll go a whole day where everyone I see treats me like total shit.

I have no regrets about my career path, but it's certainly not what I envisioned when I became an ER nurse. I was not prepared for the kind of douchebaggery people dish out in this place. I know I probably sound jaded and hateful sometimes. People ask me pretty regularly why and how I do what I do.

This is how. Night before last, I can truly say I had a role in saving a man's life. A man who wasn't ready to die, who actually had a chance, but who was very much on his way when he came to us. My teammates and I busted our asses for about two hours to save him. I left work an hour late with blood and vomit residue on my scrubs. Exciting, exhausting, stuff, a nice change of pace from the CYA chest pain admissions and nursing home dumps.

Tonight I was back in the midst of my regular routine, when I noticed a familiar face coming around the nurses' station- the wife of my patient from the night before. She walked up and gave me a big hug, and with tears in her eyes, and thanked me and my charge nurse and our doctor for saving her husband's life. She told us he was up in the ICU, doing much better, and that he would probably be released in the next few days. She had so many kind things to say about the care he had received, even in just the short couple of hours he had been with us. She told me she could tell how much I cared, and that she would always remember my face- I couldn't possibly hold back the tears. Even our cocky cowboy doctor was clearly touched.

It's hard to describe the feelings surrounding this, the exhilaration, how important it is. It's not an issue of hearing someone praise you and say nice things about you. It's knowing that you actually changed someone's life, that you were able to help them for the better, and be there for someone who needed for you. It's really not something we get to do a lot here. But when it happens. Wow. It's like being on top of the world. It's something I'll remember forever. Something so wonderful that one million abusive drug seeking trolls can diminish it's joy. It's why I became an ER nurse, and it's how I do what I do.

Real Life Floor Nurse Complaint

2011-10-08T06:25:00.000-07:00

In regards to a medic who had just transported a patient upstairs to a room, where he alone moved the patient to the bed, got the patient comfortable in bed and raised both side rails:

"He just took the patient up there and LEFT THEM! He always does that, too!"

Shortness of Breath

2011-10-06T07:01:00.001-07:00

Yup, patients, you may have heard of this little thing we use in ER called the ABCs. Meaning, we prioritize based on airway first, followed by breathing, then circulation. So, I suppose you have now inferred that an airway issue would, logically, take priority. Good job! Great intuition on your part. Now, we're glad you chose to be seen at Hood Hospital, and we are here to listen and take your "shortness of breath" seriously. Let me, though, clarify a few things about shortness of breath.

-People who are short of breath are incapable of yelling " I can't motherfucking breathe"repeatedly at a volume that patients at the opposite ends of the ER with their doors closed can hear you in triage.

-People who are short of breath don't generally have the energy to punch the glass at the triage window.

-People who are short of breath do not generally attempt to spit in the face of the nurse trying to evaluate them.

-People who are short of breath do not throw themselves on the ground and fake a seizure when they are told by the nurse that they are indeed satting 100% on room air with clear lung sounds.

So, for future reference, you're on the right track, but you definitely need to modify a few things before you go back to a room immediately. True, you did get seen quickly by a doctor today, but only long enough for him to say that you were, in fact, breathing fine, before the police hauled you off to jail, which I doubt was your goal.

On a related note, a quick hypothetical- If a 90 pound crackhead can break the "protective glass" in your triage area with a single punch, is it still fair to call it protective glass? Just something to think about.

I Probably Should Have Seen That Coming

2011-10-04T00:17:00.000-07:00

Nurse Buddy, to me- "Girl. You have got to go take a look at my baby in room 6. It's one of the cutest babies I've ever seen in my life. Seriously."

I walk in there to find indeed one of the most adorable babies I've ever seen, with a tiny adorable baby afro and huge dimples, all chubby and giggly and squee-inspiring. It was especially impressive given the fact that his dad, who was there with him, was a dead ringer for Lil' Wayne, minus the dreads.

I stayed in there for a bit and made a fuss over the baby and then excused myself, making some joke about how the baby was making me want a kid but mine couldn't possibly turn out that cute, so I had better go. Of course, hood hospital Lil' Wayne didn't miss a beat and responded with, "It would if you had the right daddy!", smiling to reveal one of the most ridiculous grills I have ever seen and pointing enthusiastically to himself.

Damn! I walked right into that one. I mean, I'm married and don't want kids any time soon, but I still don't even think that would be a viable back-up plan just based on how many prophylactic antibiotics would be necessary alone.

A Few Words About Actually Giving a Shit

2011-09-30T07:54:00.000-07:00

I had a hateful drug seeker last night- the type that gives you a huge sob story and guilt trip, and when it doesn't get them what they want, they resort to swearing and personal attacks- that kind? Yeah? So, as I'm discharging her without a script for Vicodin and actually trying to explain to her calmly that the doctor literally cannot write her one because the other doctor gave her thirty when she was here 2 days ago, she started screaming at me about how I had no compassion for her and I was one of those nurses who "is only in it for the money."

She was obviously a douchebag, but it still bothered me for some reason. I started to think about it when I got home when I realized that is possibly one of the worst things you can say to a nurse who actually does care. It sounds weird, but I would actually rather face a barrage of C-bombs than to have a patient ever say that to me. And I think it's because I see what nurses like that are actually like.

Nursing really is one of those careers where you have to in some fashion, feel a calling to your job and care about what you're doing. You have to care about people and want them to do well. You can do the job, I suppose, by possessing the necessary knowledge and skills to get it done, but if you're not really into what you're doing then you're probably gonna be pretty shitty at it.

We have a nurse on days that's a pretty classic example of this. She's been a nurse for quite a while, she understands what she's doing and why she's doing it, she's not incompetent- but she obviously could care less. She clearly has no interest in her patient's comfort, or even their outcome. It's pretty much expected when I take report from her that I'm going to have to get everyone's pain meds, etc, but this is seriously the douchebag I took report from one day who hadn't started a Heparin drip on a patient with NSTEMI and active chest pain for over an hour because the order hadn't crossed over to our Pyxis yet and it would have generated a report for an unlinked order in her name (i.e. she didn't feel like screwing with the math involved with a weight based drip.) Whenever she sees a call light in front of one of her rooms go off, she actually gets up and walks the other direction. So far she hasn't killed anyone, but if she did I doubt she'd be upset about it.

I guess I really just don't understand this mindset. Why would you get into this profession if you don't care? There are plenty of other jobs out there that pay more and don't require you to clean shit. Especially ER. Why? Why work in on of the busiest and most challenging ERs in the city if you just want to sit on your ass and not deal with people? Even if you don't wanna switch careers, almost any other nursing job is easier than this one.

I'm really feel like if you really have no investment in what happens to your patients then you should GTFO of the profession. Seriously. I don't care if it makes the shortage worse. I would rather double my patient load and get my ass handed to me every night than to work with a someone who would sit at the nurses' station and text while their patient sits in their own waste in pain. There's no worse insult in the world than being lumped in with assholes like this.

Free Parenting Advice

2011-09-29T07:03:00.001-07:00

Hi, yeah, I know at 12 you can leave your kid at home unsupervised or whatever, but that does not also mean that you can drop said kid off at the ER for a sports injury he received a couple of days ago that you don't wanna deal with and then go home and tell him to walk back to the house when he's done.

Obviously you know this since you gave the registration people a fake phone number when you dropped the kid off because you didn't want to deal with getting calls from the staff here. You probably shouldn't have given them the real address, though, because now the sheriff's department is there trying to figure out whether or not they can bring you up on child abandonment charges, and CPS is probably going to a pay you a visit there some time real soon. Aaand in the end, you still had to get up off your ass and pick up your kid. Wouldn't it have been easier to just stay in the room and watch The Parent Trap on the hospital movie channel with a complimentary warm blanket? Seriously.

Chief Complaint of the Night

2011-09-27T22:59:00.001-07:00

Bear with me, I took the GRE earlier today and I can barely make words my brain is so fried. But here's a short one:

50-something guy on an ambulance- "So, I was smoking my weed like I normally do, right, and I had a couple of 40s of Bud Ice, but then I had one of them Four Lokos and I started feeling real bad, so I thought I just needed to burp and pass gas so I did, but then I kept feelin' bad and the gas kinda moved up to the middle of my chest so I decided to call the Ambulance 'cause my friend lil' K died of a heart attack last week so I just wanted to be safe, yah' know?"

Yup. Absolutely.

He then proceeded to try and figure out my astrological sign when I asked him his birthday for the purposes of verifying his bracelet. Rockin'.

How I Stay Sane in Triage

2011-09-26T06:44:00.000-07:00

Seing as how anyone with more than a year and a half of experience seems to be a charge nurse where I work now, I have officially become the go-to triage wench. And as I am neither lazy nor alarmist, I am the top choice to get stuck in the penalty box by myself on the busiest night of every freaking week. Also, I think I've mentioned it numerous times before, but in case you're new to the blog, I HATE triage.

So. How do I keep from grabbing a 10 blade out of the chest tube kit and slashing my wrists? Well, one, I don't have time for suicidal gestures because 15 people just checked in during the last hour and I'm the only nurse in triage, but I also have a game I like to play. It's actually more fun with dramatic patients. What I like to do is think of the most ridiculously painful scenario and present it to them to see if they'll actually say their pain is a ten.

For example, "Okay ma'am, can you rate that pain in your tooth for me on a scale of zero to ten, when zero is no pain at all, and ten is being mauled and disemboweled by a grizzly bear?"

"Sir, you can rate the pain in your throat right now, if zero is no pain and ten is someone cutting of your arms and legs and then dousing you with gasoline and setting you on fire?"

It's awesome. I have yet to meet anyone ballsy enough to rate their pain at a ten, either. If ever do, I look forward to being able to be like, "Really? Your hemorrhoids hurt worse than burning in the pits of hell while having your eyes pecked out by birds of prey? Those must be some hemorrhoids! Okay, here's a pillow to sit on in the waiting room!"

A word of wisdom to those playing at home, it's only fun with people who don't actually need to be in the ER.

More Fun at the Triage Desk with Badass Sassy Coworker

2011-09-22T02:16:00.000-07:00

Gastroenteritis-stricken-drama-queen patient: You need to get me back to a room! I need to lie down!

Sassy coworker: I'm sorry ma'am, but it's a very busy night. There's several other people ahead of you and every room we have is full right now.

Drama queen: This is ridiculous! Is this what you do in the ER here? This place is a shit hole! I just told you I need a room! I want to lie down!

Sassy coworker- Well, as of 2 seconds ago there's still not a room back there, so unless you wanna go back there and lay in the floor, you're gonna have to wait. Do you wanna go lay in the floor? No? Okay then, go sit down.

Trendspotting

2011-09-21T07:37:00.000-07:00

RSD is the new Fibromyalgia, y'all.

You heard it here first.

Douchebags, everywhere

2011-09-20T06:45:00.000-07:00

I'm so over triage. Seriously. So over it. And I'm really over working stupid shift with charge nurses in training and about 3 competent non-lazy people in the entire ER. ER BFF had to go and have a damn birthday at leave me all alone with these effin' cretins.

So hi, B team coworkers, first, if I have a patient with SVT and breathing difficulty and I've had to run back to talk to charge nurse in training because she can't pick up the phone, are you seriously going to stand here in front of me arguing with the charge nurse about what room this patient is going to go to while both of you are sitting on your asses eating snacks? Because, screw you. And while you're at it, are you really going to come up here and fight with me about whether a patient with a cough needs to be seen before some hot mess geri-psych patient who obviously escaped the hospital with her central line in because the grown up charge nurse took over 3 seconds ago and you didn't hear it as a direct order from her lips? I could do without the attitude, thanks.

Quit stealing my damn EKG machine and not bringing it back. There's 8 hour waits, so everyone up in here has chest pain. I need that. And let's everyone not pretend that I'm speaking Tagalog when I tell you for the fifth time that I've dropped up a homicidal psych patient in a room and they need a sitter because she's not in a psych room. They're ALL FULL. If I could just pull ER rooms out of my ass this whole process would be so much easier, but I can't. Now if you'll excuse me, I have to get back to the hundreds of people in the waiting room so they can cuss me out.

Speaking of which, patients? It's an etiquette no-no to run back to a room that another patient was called for when you haven't even checked in yet and just sit back there and act as if nothing's wrong. Really? Other no-nos for trying to get back to a room quicker- trying to lie down across my triage chair whilst sticking you ass in the air is comedy gold, but it doesn't really help convince me that you're too weak to sit in a chair what with all the acrobatic ability required to do what you're doing now.

Also, pseudo seizures are a classic move, but make sure you scan the area for ammonia caps. If caught faking a seizure, maybe you should google "grand mal seizure" again before you tell me that's the kind you have so you don't ever lose consciousness completely.

Expressing your pain in the most dramatic way possible really won't get you anywhere tonight, as we really, literally, no, for real, have nowhere for you to go right now, but if the triage desk nurse just had to try to get you 3 times to be triaged while you finished your cigarette outside, it really won't help, so you might as well just stop. You're bad at acting and you're embarrassing yourself.

Visitors! No, I can't look up a patient by birthday, by what town they're from, which family members are with them, or by what medical problems they have. If you don't know your friend of family member's last name you probably don't know them well enough to be visiting them in the ER. Even if you do, the problem is not that I'm too stupid to work the computer system. The problem is you don't actually know the name of who the hell you're trying to find, and you're coming up here based on secondhand information about that patient maybe being here. Just go home. I guarantee they don't miss you if they didn't call you themselves and tell you they were at the hospital. Shit.

I want to punch everything, and I need a drink.

Chief Complaint of the Night

2011-09-17T02:33:00.000-07:00

Mom brings in a school age kid at about 3 AM- she's practically dragging the kid back to triage when I call them. Finally wakes him up enough so that he could stand on the scale on his own. At first I think he must have had some kind of head trauma and this must be some real shit, but no, he just really wanted to be home in his bed because he had been in school and it was three in the effin' morning.

The life threatening condition for which the mother felt he needed to be in the ER for at this time? A nosebleed that had happened 4 hours prior to arrival and lasted about 20 minutes. The bleeding had stopped and the kid had gone to bed, but she was "concerned" and "wanted to get it checked out". And yes, in case you were wondering, his hands were also caked in Cheeto dust. Of course.

Unrelated: I'm studying for the GRE right now, so posts will be short, sweet, and possibly infrequent. In the meantime, I suggest you read the yahoo! answers questions about reproduction if you're having withdrawals from the tales of foolishness.

Confidentiality

2011-09-16T06:13:00.001-07:00

So, we have these privacy screens on all our computers at work where you can't see the screen unless you're standing directly behind someone. Complete pain in the ass, but I guess Joint Commission wants us to have them so that no one can see the tracker while walking by lest they find out that other people are there being treated in the ER. Whatever.

I'm up in triage last night going through whatever complaint this lady has and typing away when I noticed she is staring at me looking wicked pissed. I ask her if something is wrong and she rolls her eyes and says, " I know you're not really typing anything! That's just a black screen! I'm not stupid." Oh, no. I hadn't even thought about that angle, but I'm sure now that we're out there charting everyone thinks we're just out there dicking around on the sleeping computers and not getting their meds just to be hateful.

That's almost as brilliant as not being able to put the specific medications on the allergy bands because it's medical information. I'd love to get ahold of whatever the hell they're smoking at these meetings where they come up with this stuff.

Questionable Boundaries For Miles

2011-09-14T02:30:00.000-07:00

Early 20 something chick checks in with lower abdominal pain, our bread and butter in the hood. Brings her daddy along for the ride, because I guess he had nothing else to do and because taking your dad with you to the ER to be seen for your female GU complaint is always an awesome call.

We were blessed with the awesome PA who believes in common sense and minimal workup fuckery, so she got a UA and some Tylenol.

Lo and behold, she has a UTI, so I go in to give her an antibiotic shot. I tell dad it might be a good time to step out, as I'm about to expose most of his daughter's butt. Annnd he just shrugs and stands there. So, after her shot time, my friend goes into discharge her and dad gets upset because she didn't get a pelvic and he thinks "she might be back with that Chlamydia again". Wow.

Receptacle Fail

2011-09-11T05:56:00.000-07:00

It's a debated issue whether people should bring their possible products of conception to the hospital with them. Most of our providers find it weird, but I know some OB types encourage this type of thing.

But. I think we can all agree that if you're going to bring your possible products of conception, you should bring them in something besides a Cheeto bag? Right? Or at least rinse it out first? Okay? Okay, good.

That's What I Get For Not Changing the Assignment Boards

2011-09-10T06:31:00.001-07:00

Patient, to tech passing in hall- Hey! Hey you! Go get my nurse!

Tech- Okay, sir, which one is your nurse?

Patient- I don't know her name. Whatever-the little one. That little frail thing! Go get her!

Welll. Yeah, let me go get you that sandwich but if you're looking for me after that, I'll be downstairs at the fitness center lifting weights.

I Think I Liked You Better When Your Blood Sugar Was 30

2011-09-08T23:03:00.001-07:00

A few nights ago, a friend of mine gets an older gentleman from the nursing home- he's cold to the touch and acting kind of like someone who just took a bunch of Benadryl and is trying to stay awake. Medics tell us his blood sugar is in the 30ish range but they couldn't establish IV access, so it's still that way. He gets the doctor in there and we get to work on an IV- dude is a little ball of scar tissue, unfortunately. His EJs are pretty much useless from as many times as they've been stuck, but I managed to get a neonate IV in his wrist, and push an amp of D50 in that bad boy. Woot! Poor guy's rectal temp was about 96, so we also got him hooked up with a little Bair Hugger action and he started to turn around a bit.

He started looking around and was talking in kind of a pleasantly confused way. He knew who he was, but that was about it- he kept referring to my teammate as "my son" and smiling at him. I get him some warmed fluids and go back about my business with my other patients. About a half hour later my friend rechecks his blood sugar and finds it's now only in the high 30's- I run into the room with him to try and find another IV site for a D10 drip as he's giving the second amp of dextrose. Just as he is finishing up with pushing the med, they guy sits right up and asks me what the hell I'm doing. I explain that his blood sugar keeps dropping and that we're going to try to get another IV to give him some dextrose continuously. I then ask if they're giving him Insulin over there at the nursing home.

He scoffs. "Well. OBVIOUSLY, or I wouldn't be here, would I?"

I explain that there are multiple medications for diabetes besides Insulin, to which he responds with, "Oh. Really. And you couldn't figure out that Insulin was what they were giving me? You're a little special, aren't you?"

So, then my friend decides with the mental status change and junk that he should ask his orienation questions again. "What's your name, sir?"

"MR. ANGRY PATIENT MCGEE !!! GOD, YOU PEOPLE!"

"What's wrong sir, you seem upset?"

"I AM upset, because that's a STUPID ASS question!"

I then make a last ditch effort to explain the state he presented in, to which he responds by rolling his eyes and turning away in a manner similar to a 13 year old girl. I take this as my cue to exit.

I hear screaming coming from the room about an hour later and walk in to find him waving the urinal around and yelling about how he got the sample we keep bothering him about. I thank him and take it away. He squints at me and crosses his arms and says, "and where have YOU been?"

"I've been taking care of my patients", I tell him. "I was in here earlier helping your nurse, the guy that's been in and out of here checking on you, but it seemed like I was getting on your nerves so I thought I'd step out for a while." He stares at me for a minute and says, "You know what?" What? "You're a typical woman. That's what you are."

I just busted up laughing at this point. What else could I do? I always thought people were easier to deal with when they were lucid, but I guess not always.

Forgotten

2011-09-06T07:02:00.000-07:00

It was possibly the worse presentation I've ever seen in a living person. EMTs bring us an older man, sliding down the stretcher struggling to breathe, caked in layers of his own waste. He's missing both legs below the knees. The story we got was that the man had been staying in one of the local nursing homes when he left because he felt that he wasn't being well taken care of. Considering the place we're talking about, he was probably right. He took his wheelchair and what little money he had, and called his son to meet him at the super market down the street. He waited a long time for his son to show up. He got some food, which made him sick- when night fell, he wheeled himself back up to the nursing home. At this point he was not only ill, but very short of breath, as he had also been all day without oxygen. At some point he fell out of his wheelchair and into the street in front of the nursing home. The staff eventually went outside in the early hours of the next morning to smoke and found him- they left him in the street and called the ambulance to come pick him up.

He was one of the sweetest patients I've ever taken care of. He was so apologetic about the state he was in. "It must've been that fruit I ate", he said, "I'm so, so sorry. This is so awful." I reassured him that this is what we do, all the time, and if I was afraid of poop I would have been pretty foolish to become a nurse. He was one of those people who is just incredibly grateful for even the smallest of gestures. He gushed about how great his care was. "You don't understand," he told me, "not all nurses are as kind as you. I usually go the the VA hospital, and it's not like that there. But you're very sweet." His voice cracked as he spoke. In talking to him, I gathered that he fought in Vietnam, which was where he lost his legs. He suffered from PTSD and for all practical purposes, had nowhere to really call home. He had been in and out of different hospitals and nursing homes for the last several years.

This has been nearly a month ago, and a day hasn't gone by that I haven't thought of him. Here is this sweet, vulnerable old man who has sacrificed more that I can fathom. And we live in a world where he is literally left in the street covered in his own waste gasping for air while people that call themselves healthcare workers walk by on their smoke break without doing anything to help. It hurts me to think about it.

I think about the last time I saw him before I went home- sitting up in bed, finally clean, wrapped in blankets with rosy red cheeks-a marked difference from the hypoxic pallor he came in with. He was sleeping, but he opened his eyes and smiled at me as I waved goodbye.

Lots of people have asked me how I don't burn out doing what I do. The answer is the occasional person like this. Being able to bring a smile to the face of someone who has so undeservedly been bound to miserable circumstances for so long. Knowing that I can bring some comfort to someone who has seen so much suffering, to make them feel important and cared for again is enough to sustain me through the months of bullshit.

Creepers

2011-09-03T06:39:00.000-07:00

I'm serving my time at the Hood Hospital triage desk last night when I noticed this disheveled lookin' dude walking through the breezeway smoking a cigarette. Luckily, he puts it out before he gets into the actual waiting room so I don't have to do my "this isn't 1960 where you can still smoke in a hospital" speech, but the alternative is way worse.

He walks in, stares at me with Charles Manson caliber crazy eyes, tells me I'm beautiful, and pulls put his pack of cigarettes. He then slides the cigarettes across the desk to me and asks if I can read him the warning on the side. I look askance at him and then go through the standard surgeon general's warning about how smoking can cause lung cancer and death and such and look up to be met with more crazy eyes. Crazy eyes for days. He stares at me for an awkwardly long period of time, and then says, "Well. All that stuff on there. I hope that does happen to me. Cause then I'll die, and I'll see you."

So, he scampers off back to the treatment area, where I assume he belongs since he's obviously crazy, blowing me kisses the whole time. I don't think a lot of it until one of our cops sees him outside later and starts telling me he is actually a family member of an admitted patient. They apparently had to go talk to him the night before that because he was going outside and rounding up a bunch of homeless dudes and letting them get the free coffee and sleep on the floor of his wife's room.

Wowzer. Hanging out with your buddies and hitting on ladies? Free food and coffee? It's like an all-inclusive resort up in here.

The Bright Side

2011-09-02T01:23:00.000-07:00

It's been a pretty steady influx of crazy and stupid, you guys. To the point I feel with all the stories to come I should take a quick break to tell you about the positives.

-Oktoberfest time is upon us. I know that's not a big deal to a lot of people, but I love me some seasonal pumpkin-y beer.

-It's almost hockey season!!! See above disclaimer.

-I found a pretty awesome blog that explains using logic and reason and various other smart things why some of my favorite comics and movies are awesome. He also talks about other stuff. I can't describe it right with my limited vocabulary consisting mostly of F-bombs, so you should just go read it.

-I also found a Teenage Mutant Ninja Turtles book of kazoo songs complete with kazoos while helping my grandma go through stuff in her house. Putting it to good use. Obviously.

-These guys:

Don't judge me and my dirty house. Point is, despite the crazy bus stopping at Hood Hospital every night, life is still pretty rad. Back to questionable life choices and people shitting on the floor tomorrow. Okay, bye!

Really?

2011-08-30T06:57:00.000-07:00

Last night was a revolving door of drug seekers and ICU patients. I had to resite one lady's IV 3 times in about 5 hours. She told me the first time I had to do it that she was going to cuss me out if I didn't get her on the first stick. Seriously? What do I get to do to you for continually removing them now? I wish I could say that was the last time someone threatened violence against me that shift, but I'd be lying.

I thought I'd been granted serious relief once she got upstairs, until about 35 seconds later, when the charge nurse sent an ambulance containing what might be the single craziest Hood Hospital frequent flyer to the still dirty room. Naturally, she got admitted and was a hold all night, so I had the privilege of listening to her spew all kinds of crazy racial slurs about the asian admitting doctor who cut off her Dilaudid.

The guy in my other room decided to follow suit by cutting up and removing his own IV and slamming doors like an angry teen because I wasn't getting him medicine fast enough for his chronic back pain. I must have resited, like, 8 damn IVs last night. Somehow my shrugging and handing him an AMA form made him decide he actually did want to stay, but at least he scaled back the attitude for the two hours remaining in the shift.

Before you decide I'm mean for my indifference, let me just say that during the time in question that he needed his life saving narcotics, I had just gotten a lady with no IV and a heart rate of 25. Uh, sorry dude, I'll get your Morphine right after this lady's Atropine and transcutaneous pacing junk. I'm here to listen to you and take your pain seriously.

Symptomatic bradycardic lady got worse before she got better, so I traded her for the unresponsive drunk guy that was in the room before. He finally woke up and left with his ride right before shift change, at which point the charge nurse notified me that he had taken a shit in the middle of the floor before leaving as a way of saying thank you. Yeah. Awesome.

Benadryl and Cogentin Seekers?

2011-08-28T06:34:00.000-07:00

What the hell. I'm just very curious to see if this happens anywhere else. For the last couple of months, we have had several people- one of them more than once- check in for dystonic reactions. Except, not real dystonic reactions, but really poorly faked dystonic reactions.

I've gathered that IV Benadryl delivers the same "rush" as you might get with narcotics, but other than this, I'm trying to figure out why so many people are doing this now.

Has anyone else ever seen this? Am I crazy for trying to figure out the rationale?

Edumucation

2011-08-27T06:52:00.000-07:00

Real run sheet material: "PT ON KEMO FOR LAST WEEK. "

Kemo? Like for Kancer? Just checkin' y'all!

The Chief Complaint That Wouldn't Die

2011-08-26T00:28:00.000-07:00

You wanna know what I really, really, more than anything, wish I could say I had only seen once? Well, whatever, I'm gonna tell you anyway. Yeah. Virginity checks. In the ER.

We see this way more often than you would think. It always goes down the same way. Parent finds teenage girl in compromising position with boyfriend, parent immediately drags teenage girl to the ER to find out just how far stuff went, usually with a little STD check/pregnancy test thrown into the mix for good measure (because these tests are very accurate within matter of hours, of course). I also wish I could say we don't touch this foolishness when it comes in, but I'd be lying. If it wasn't bad enough that we're now the local STD clinic, we're now expected to be the local STD clinic for underage girls against their will. Awesome.

So, anyway, I get another one the other day- 13 year old girl with her mom, same story. Great. Homegirl is wearing some kind of athletic short/panty hybrid to the ER, which is think is actually probably a greater infection risk in our waiting room than sexual contact with another teen, but I digress. Mom is going through the whole story, daughter never looks up from her phone. Oh, and while we're here, toddler sibling has also had a runny nose for a week. Why the hell not.

Eventually they go back to a room-I walk by it later on the way to the vending machine. Mom is face down in bed, snoring, while the toddler is running around the room screaming, and the teenage girl is sitting in the corner continuing to text.

Sigh. At this point, I don't really have to say it, do I?

On the Various Definitions of a Real Emergency

2011-08-24T01:25:00.000-07:00

Hood Hospital triage, where else-

Hood Nurse-Hi there ma'am! My name is Hood Nurse, and right now I'm just going to check out your vitals signs and collect some medical information. What's going on today?

Patient- Well, you see, I've had this boil for about 5 days now on my butt, and the pain is just really becoming unbearable. I tried to deal with it at home, but it just keeps getting worse, so I decided to come in.

Hood Nurse- I see. How would you rate the pain right now?

Patient- A ten.

Hood Nurse-Okay, well, we'd be happy to get that checked out for you. I'm afraid all the rooms in back are full at the moment, so I'll need you to wait in the waiting room for a bit and another nurse will call you when a room is available.

Patient- So, am I gonna have to wait a long time to be seen for this? I mean, don't you guys have an area for like, sore throats and stuff, and then another area for real emergencies like mine?

We sure do. Next.

Street Justice

2011-08-23T07:58:00.000-07:00

The call comes in that we're getting a drunk guy being escorted by police in custody for suspected sexual abuse of a child. Great. And an extra fun twist to my usual drunk patients.

The story was that the father of the child walked in on my patient try to do something to his toddler daughter. Not really sure what, and I didn't particularly want to know. I was not prepared for what I saw. His face was hardly recognizable as human. One entire side of it was pretty much just a mass of swelling. He looked like the elephant man. The other wasn't much better, but you could at least see the eye a little bit. He spent most of the visit trying to spit the blood and teeth out of the mess that was formerly his mouth. The only way the officer with him was able to verify his ID was to blow up his driver's license photo and compare a scar on his chin. Of course, he had multiple skull fractures and a brain bleed, so he didn't go to jail that night.

I let the extern start his IV before he was transferred- she asked if she could miss. I told her not to bother. It was weird. I wouldn't really use the term sympathy for what I felt for this guy, but I couldn't really bring myself to want inflict any more suffering on someone whose face looked that way. Maybe it was because he couldn't speak English, so I couldn't really hear him complain or try and defend his actions. He pretty much just sat there quietly and spat blood. Certainly he deserved the punishment he got far more than what he would have gotten in court-maybe a short sentence and some probation- but I just couldn't bring myself to be as happy with this story as just about everyone I've told it to. I don't know. It's just that every single element about it was awful that I guess I kind of moved past anger and just kind of felt depressed that any of it had happened at all. I guess it's just a really uncomfortable feeling to be able to understand and rationalize that degree of violence.

Subtlety Fail

2011-08-22T07:13:00.000-07:00

One of my lovely, but not very tactful co-workers, to a patient's family member: "So, in addition to being a crackhead, your mother also has a history of hypertension?"

Oh dear. Why don't you start the IV and someone else can obtain the medical history.

Sisterly Love

2011-08-21T03:16:00.000-07:00

I'm up in triage last night when what appears to be a nicely dressed, normal young woman walks into my booth- I'm getting my ass handed to me, so I'm not even looking at the tracker before I start asking questions to prepare myself for what these people are checking in for.

The first thing this girl says to me is, " This is so embarrassing", which is never a good start. I then look at my computer screen to see the complaint as "foreign body in vagina", so at that point I kind of cut the formalities and ask her what she's got up there. "A tampon", she tells me. Oh. That's not so weird. I reassure her, as she's obviously mortified. Naw, dude, that's not a big deal. I see that on about a monthly basis. That at least belonged up there at some point, stuff happens.

So, then she continues with, "Oh, that makes me feel better. Yeah. I didn't really want to come up here. My sister made me, though, cause she looked in there and felt around and she couldn't find it, so she said I definitely needed to come to the ER." Uh. WHAT.

That just took it back to weird territory. I mean, maybe I just don't understand because I only have a brother and obviously, that would be even weirder, but for those of you who do have sisters, is it normal for siblings to go digging around in one another's vaginas? Because it seems like it wouldn't be. Please enlighten me on this issue.

In Which Much Swearing Will Ensue

2011-08-19T06:55:00.000-07:00

Please allow me to go off on an angry little rant here and then we will continue with our regular programing of people putting various items in inappropriate places or people checking in for cold sores or whatever. So, here at Hood Hospital the fast track area is in a totally separate part of the department from the real shit so the ER doctors don't get distracted by the overwhelming scent of Trichomonas Vaginosis while they're trying to place central lines and stuff. Okay, it works out most of the time.

Except, somehow this has turned a bunch of the physicians into whiny little princesses who all of a sudden think they should not have to see a fast track patient ever again in their entire career. To which I say- bitches, please. One, just because it sound like a fast track patient does not mean it isn't emergency or it doesn't belong in the ER. Guess what? Vaginal bleeding can be a legit emergency. Yeah. I've figured that one out, and I haven't been to medical school, but apparently to some people, being an ER physician means acting like a complete douchebag to the charge nurse and throwing a fit like a three year old about seeing a patient here for vaginal bleeding. Really? Obviously you didn't trust us when we were telling you there were giant blood clots pouring off the side of the bed, but now that you've seen them yourself you wanna start barking off orders to us in front of the patient like we're the ones who have been lagging? Fuck off.

And two, even if they aren't critically ill, is it that hard to see the occasional lady complaint? I can see how you wouldn't want to take the time up when you have a lot of really sick people, but when the midlevel hasn't eaten or peed for 9 hours and you've got your feet up looking at Yahoo sports, would it kill you to help them out instead of staring at the tracker and screaming at the charge nurse about how there's one room that just opened up in fast track? You graduated medical school, you can insert a chest tube, you can read your own x rays, don't tell me you can't figure out how to navigate a vagina. It really isn't hard. See that hole inside that other hole? Yeah, scrape some stuff off of that and send it to lab. There you go.

Okay, maybe that's still too complicated. That's okay. How about a cough? How about a toothache? Yeah, I know People of Walmart is hilarious, I love it too, but I'm pretty sure a mob with torches and pitchforks is actually forming in triage right now. Do you think you could prevent the death of the nurse at the desk up there and maybe just see some of these simple things that have been out there for 5 hours now? No, great.

You know, that must be awesome. I hate inserting NG tubes and doing orthostatic vital signs. The next time you order that maybe I'll just refuse to do it because I don't like to and see how long it takes me to get fired. Excellent. That's just the kind of professionalism and teamwork we need around an ER that's now a total shit storm all the time. Stupid assholes.

Hood Hospital Arachnology

2011-08-18T06:54:00.000-07:00

Some chick comes in on an ambulance last night for butt abscesses (why not), tells the doctor that she was pretty sure spiders were biting her on her buttocks while she was sleeping, even though she hadn't seen them (spiders are always the culprit in the hood), but somehow during the conversation, it came to light that the patient also worked as a stripper.

So ER Doc went around asking everyone about the odds of contracting such an infection from spiders vs. sticking your bare ass on a pole covered in multi drug resistant clamydia or super AIDs or whatever. So, being creative I decided maybe it was both. "Well. Maybe the spiders were on the pole. Maybe it was a downtown pole spider. You don't know about pole spiders? Did you even graduate medical school? Shit."

Don't laugh, ya''ll. Pole spiders are serious business.

While We're Here

2011-08-15T09:30:00.000-07:00

Chick comes in last night in respiratory distress on an ambulance- she's pretty sick. All stridorous and generally shitty looking. We throw all kinds of crap at her trying to avoid intubation, finally get her relatively settled on BIPAP, and I'm running around the room hanging all these different meds when the patient's husband tells me he needs to ask the doctor a question.

I ask him what the question is and tell him I may be able to answer it- a lot of people don't really understand that nurses have medical training and can therefore answer medical questions.

"It's personal", he tells me. Ruh roh. Something about your wife's care we need to know? Nope. A personal medical question, he tells me. I go ahead and explain to him that the doctor is most likely not going to give any kind of medical advice to someone who isn't a patient, but I'll let him know. ER Doc is in the next room in a procedure and I'm trying to do other stuff, so I catch up with him later and mention the patient's husband wants to talk to him.

I could tell by the look on his face I was too late. Yeah. Apparently homeboy calls poor ER Doc into the room and tells him that sometimes his penis gets red and swollen and drains stuff. He then proceeds to try and show the doctor his penis. Doctor tells him he needs to check in if he wants to be seen for that foolishness and then gets the hell out of the room, stat.

The husband wasn't in the room when I got back, but I didn't think much of it as he'd been in and out smoking for a good part of the night. Until about ten minutes later when I look up on the tracker and see his name up there. He sure did check in to get his penis looked at in fast track while we were still trying to figure out whether or not we were going to intubate his wife. Really.

Congratulations, sir, you just won the Hood Hospital prize for worst two-fer ever, beating out the gentleman who checked in with his wife who was having a CHF exacerbation because he's been walking a lot and had some blisters on his feet. Please exit the hospital and keep walking to claim your prize. It's out there somewhere, I swear.

Things You Can't Unsee

2011-08-10T04:19:00.000-07:00

Yeah, I know when the census is finally low and you're out of snacks and you're out of stuff that the monitored internet will let you look up without you ending up in the office, it may seem like a fun idea to use the woods lamp as makeshift CSI light to figure out exactly how much bodily fluid naked to the human eye is still hanging around in the pelvic room, but it's not.

Just trust me on this one.

It's True

2011-08-08T02:31:00.000-07:00

Elderly patient, when she, upon being discharged, was referred to our affiliated family practice clinic: "Family practice? I ain't goin' over there. They practicin'."

Well.

No Ma'am.

2011-08-07T13:26:00.000-07:00

You know, if you really want pain medicine, calling an ambulance twice probably isn't the worst start, but you probably shouldn't do it totally hammered in the early evening on a weekday, and then start your ER visit off with immediately swearing at anyone within earshot about how you hate this hospital. Also, trying to hit the physician with your cane from the stretcher is another no-no.

If you're trying to convince us you're sober enough to leave AMA now, probably continuing to climb over the stretcher rails to get to the pills in your purse is not the best way to do so. And no sober person tries to eat a sandwich that they dropped off of this floor. Seriously. Nobody. And most not intoxicated people don't try to seductively caress the arm of the paramedic applying their blood pressure cuff.

And- a quick tangent here- if you're serious about trying to bag a medic during your stay here, you should probably not wear low rise jeans with granny panties, and you'd probably have better luck with one who isn't young enough to be your son.

But, if you were not trying to get narcs, but instead just wanted to leave an impression on the staff here, then well played. Not only to we have all the awesome memories of you screaming to anyone who tried to touch you that you have syphilis, but we found pieces of your poorly constructed wig all over everything for at least the next week after your visit here.

You stay classy now.

A Few Minor Changes

2011-08-06T03:23:00.000-07:00

Well, despite the explicit instructions otherwise I mixed antihistamines and alcohol and the last thing I remember I was on the blogger template and google image search and now I have a new layout I guess. The underlying theme of my blog is medical waste so I guess it's appropriate.

Anyway. A longer explanation is coming that sounds a lot more eloquent, but basically I'm not really a new nurse anymore and I don't want people mistaking my stupidity for novice, so I'm probably gonna change the blog's name at some point. Maybe. Whatever. I'm open to suggestions is all I'm saying. Go!

Therapeutic Ignore

2011-08-04T07:23:00.000-07:00

My ER BFF was talking to me the other day when someone came over the call light with completely asinine request the patient had made for the 4th time or whatever and she just said, "Uh, yeah. I think I'm just gonna therapeutic ignore that for right now." I remember at the time thinking it was kind of funny but sort of mean just because I am the type of sucker who immediately answers the call light regardless of how stupid the request is if I'm not doing something else really important, even if it's just to say "No, I'm sorry, I can't do that" yet again.

Until last night.

Last night my rooms became the unofficial frequent flyer unit. To the point that I'm pretty sure the charge nurse was afraid I was going to harm her physically. It was just realllly unfortunate timing, but I literally had three patients whose medical history and allergies I could recite to them as they were rolling in on the ambulance. I'm pretty sure the amount of Dilaudid I gave to any one of these people last night could kill the average horse. In my 4th room I had a woman who would scream constantly at the top of her lungs, until I asked her any kind of pertinent question, which she would then answer in a fucking baby voice. She too, wanted Dilaudid, but her blood pressure was too low so she pretty much kept that whole routine up the entire night. Awesome.

I tried telling the charge nurse that I had suicidal ideation with a plan, but she refused to put me in a psych room and give me a warm blanket and a sandwich, so I just had to deal with my lot. So after running back and forth getting everything one patient requested med-wise, only to be met with, "you forgot my Shasta", only to have her 5 minutes later vomit said Shasta (her 4th, btw) all over her sheets and the floor along with her life saving Kayexalate (I'm pretty sure to make a point about not getting Phenergan ordered), it totally switched to homicidal ideation. Only then did I truly understand the therapeutic part of the therapeutic ignore.

You know how they tell new parents that it's better to go outside and ignore a crying baby for a minute when you're about to snap instead of shaking the baby? Yeah, well. I think that same concept applies to nurses. When you start looking around your room for pillows for reasons other than keeping your patient comfortable, go outside a minute. Maybe scream, or break something. Go to the bathroom. Then come back. The conversation about Phenergan can wait just a minute. It'll be better for you, and your patient. Therapeutic ignore for a minute, and you'll be a more patient nurse.

An Open Letter to the Borderline Personality Disordered Internal Medicine Douchebag From Hell

2011-08-01T08:22:00.000-07:00

Ahem. Dear Broke Ass Dr. House,

Hi! Nice talking to you again! It's always so pleasant when I get to catch up with you on the night shift. Me? I'm 6 hours in with no bathroom break or chance to get a drink of water, so you can bet I'm feeling pretty guilty right now about waking you while you get paid way the hell more than I do to be on call in the comfort of your own home. Sorry my friend. But enough about me, I'm calling about the uroseptic nursing home patient we've been holding down here in the ER for a bit now. I know you told my ER doctor to stop the vasopressors we've been giving her to keep her alive immediately and switch to NS at 50 mls an hour, but since that's dumb as hell, we decided to taper of the pressors gradually, and unsurprisingly to either of us, it isn't working, so we'd like your guidance on the next step. Yes, I do realize that not following your orders exactly is an insult to your infallible judgement as a physician and probably practicing medicine without a license on my part. I'm very sorry about that. Next time we'll just stop the lifesaving medications abruptly and gently hydrate your patient's corpse. We'll call you in the morning after your coffee and omelette about the disposition of the body, just let us know when you usually wake up. Please continue to scream at me about it for the next couple of minutes, though, because it's actually making your patient less sick the more you do it, and it's a great use of my time.

Oh! I see! The real problem is that we started the pressors in the first place without consulting you. Sorry. They started this during the day shift, but I'll pass along to them and my doctor that you would like to have nothing at all done on your patients in the ER until you are asked. We'll make sure not to do any interventions until the average 45 minutes it takes you to return a page. At that time, the patient will be pulseless and asystolic, and we will make sure that you want to use the new ACLS guidelines or whether you, lord and savior or all ER personnel, have your own guidelines for us to follow. After all, you know best about everything because you have "been at this a lot longer than I have", and you're so good you can make these kind of judgement calls without having ever laid eyes on the patient. Also, please continue to refer to call me "young lady" because it make me feel very special and not at all like a child who has done something wrong. What's that? Go ahead and admit the patient to the ICU on pressors because I'm going to do whatever the hell I want anyway? Oh, thank you darling. You're a peach, as always. We'll have to do this again soon, because I really love getting in screaming matches with the doctor on call at the nurses station with the other staff and all the patients in the hall beds looking on. Okay! Bye now! Have a great evening!

Hugs and Kisses, Hood Nurse

I Just Had to Know

2011-07-31T07:04:00.000-07:00

So, after a couple of years working in the ER I for the most part have learned to stop asking why. Why? Because what does it really matter, most of the time?

Why did you insert that particular object in that particular place? Does the answer make a difference as to how you remove it? Why did you continue to eat sloppy joes after you had been vomiting? Is there a good answer to this question? Why did you choose to get on the roof to get drunk? It doesn't really change the big ass head laceration at this point, so what the hell do I care?

Yup, now I'm like, "Oh, the old flashlight in the butthole, eh? Cool. Well, let's get that taken out for you. Next please."

Until tonight, when we got the drunk driver found in the car by EMS wearing a shirt, but no pants. We're clearing him from the backboard and without even thinking, I just blurted out, "What happened to your pants, bro?" Everyone in the room started laughing hysterically, because they all know, as I do, that it's pointless to ask- they all thought I was just screwing with the dude. But no, I was just really curious what was going on that he was driving around with no pants on. But alas, there was not a good answer.

Oh well.

Chief Complaint of the Night Returns

2011-07-27T06:46:00.000-07:00

Ugh. I don't know if it's just me, but whenever I look up at our tracker to see someone under ten years old with chief complaint of chest pain I pretty much always want to blow my brains out. So, no different last night- this lady brings her 4 year old in for chest pain, I open the door and the kid skips to the scale and then skips over to the triage booth, so the pain is obviously pretty bad.

So, I start asking the parent what's wrong and she starts telling me that she wanted the kid checked out immediately because at home earlier, the kid walked up to her and told her his heart stopped. The kid then repeats the statement to me and smiles and then starts talking about some other random shit like 4 year olds like to do.

"Did he look like this when he said that?", I asked her. Yup. He didn't have any complaints of pain, he wasn't grimacing, he didn't appear to be struggling to breathe, no crying, didn't seem distressed? No cardiac history or medical problems? Nope. Just walked up to her, said his heart stopped, went back to watching Yo Gabba Gabba or whatever else kids do. She felt it was an emergency because he vomited once two weeks before. Really.

Some days, I really don't know what to say.

Kids These Days

2011-07-25T00:06:00.000-07:00

I've recently been talking to an old friend from nursing school and it got me to thinking about my experiences in school, or lack thereof, and how much I would have loved to have been an extern somewhere. I was super shy but earnest and I remember how excited I was just to give somebody an Insulin injection. The one clinical day I had in ER was in the rich folk ER across the street from the legit ER, so my one day of experience there was pretty much STDs and lacerations and such. If I had seen a day where I work back then, I probably would have never shut up about it to my family and friends EVER. And I certainly would have been less real world dumb when I started working in ER immediately after graduation with no other experience.

So, it really does kind of bum me out to see the absolute lack of enthusiasm among some the students we do see. Like, beyond lack of enthusiasm and straight into attitude, actually. Most of our students at night are basic medic students. Some of them are freaking fantastic, but others might as well walk in and introduce themselves like, "Hi, yeah, I don't give a shit about this but I'm just doing this so I can become a firefighter and talk to girls about it. " We actually had two the other day that went beyond the usual hide out and eat Taco Bell routine- these dudes were completely shameless about hiding out in the break room. A friend of mine walked back there to grab a drink at one point and mentioned to them that something cool had come in to a resus room and they might wanna check it out. After being acknowledged with a grunt, she went about her business and forgot about the situation until one of them came out and started accusing her of telling on them to the charge nurse. She hadn't done it, but that didn't stop them from complaining to her about how they didn't have time to be out here because they had a bunch of clinical paperwork to do. Later on, they were asked to help with an EKG (one of the few things basic students can do), to which one of them responded "that isn't my job". Lovely. After the massive amounts of attitude, my friend did mention the situation to their instructor who happens to be a medic at our hospital the next morning. She sure did stick them both with the nurse I can safely say is the master of all delegators the next night. That was probably the most important lesson they learned for that semester.

I don't wanna seem like I'm just hating on medics up in here because our nurse extern situation is not much better. Well, not all of them, but the newest chick we hired- oh boy. Homegirl spent her whole first day endearing herself to the staff by telling everyone about how it was below her to fold towels and stock carts, and how it was a waste of her time to transport patients because she was supposed to be learning. Umm. No. You're getting paid, sister. Good money for someone without a degree, too, and you set your own hours, so I would just deal with it, personally. So, I hear about all of this second hand and decide to form my own opinion. She seems fine enough until I go in with her and another nurse with a code brown. My teammate practices the unspoken rule of etiquette when it comes to cleaning shit, as most of us do- unless it's like, your best friend in there with you, the people helping you are the ones that hold and turn and you are the one who cleans up the shit, because it's your patient. So basically, all this new extern has to do is help me turn a patient- and yet, she finds a way to not do it. We get down to business while she runs in and out of the room gathering a bunch of supplies we don't really need. She runs back in and asks what else we need her to get. "We really just need you to come over and help me turn this lady," I tell her. At my size I can only do so much. She then continues to stand in the doorway and complains about the smell for a couple of minutes. "I'll go get you some room spray!" she says, running out the door again. She walks back in making a disgusted face and then proceeds to spray, no shit, like, half a bottle of deodorizing spray in the air, slicking up the floor and essentially macing my teammate and I in the process. Then she walks out the door and disappears while we're still elbow deep in feces. Really, dude? You're in the process of becoming a nurse and you think you're above cleaning poop, too. Good luck with that, honey. I guess you could probably go work at the nursing home.

I just don't understand. It just seems so ungrateful to have an approach like you're above something that you're learning how to do. I would have done piles of bitch work to get the opportunities to see the things these guys do. In fact, I did do piles of bitch work, just with no pay off. Aaand I had to walk to clinicals uphill both ways with no shoes on. These darn kids. They don't know how good they have it.

What Not To Do

2011-07-19T13:25:00.000-07:00

Now is the time on this little blog here where I share with you various bits of wisdom that I've learned from the mistakes of others. Such as-

-Hoses. They're great for watering yards, and filling kiddie pools, or washing you car or your dog, but you know what they aren't good as? Sex toys. Nope. Especially not in public pools. Sorry if you knew that already, but some people don't.

-Cleaning product storage. Here's one. Don't store your cleaning products in beverage containers and then leave them lying around your filthy house. It's confusing for everyone, but it's especially a problem when you yourself are not discerning enough to tell Pine Sol apart from Gatorade.

-Say you're drunk and you just have to climb a fence. It happens. More frequently than you would think, actually. You jack up your ankle, of course, and you don't smell great, cause it's hot out. That's fine, but once we've already smelled you it's pretty much over, and the nurses here aren't interested in you that way anyway, so it's pretty pointless for you to try to take a bath in the room with the basin and washcloths you destroyed our cabinets to find. Now you're still stinky, and you're making a mess.

-If you have nasal congestion, it is not necessary to go to the ER, but if you decide to go for that, please refrain from acting a complete fool and yelling at the nurse at the triage desk about the fact that you can't breathe at all when in fact, you can't breathe out of your nose. You see, I see people who actually can't breathe on a daily basis, and they can't stand at the desk screaming at me. Stop screaming for a minute and breathe out your mouth hole, and you'll probably feel a lot better. Thanks.

-If you are the parent of an infant and you can't figure out why it's crying, perhaps you should trying picking the thing up or something before you bring it into the ER because it's been crying too much. The problem probably isn't constipation if it just dropped a load earlier today, it's probably just mad that you aren't mothering it, but instead, are talking on your cellphone.

-If you're here for your 5th visit this week for the same thing, and you actually want to get seen, it probably isn't a good idea when the police officer says hello to you in the waiting room to respond with, "You aren't gonna kick me out this time, motherfucker" followed by a whole other string of fuck words. I know you're still bitter about that time he kicked you out after you'd been discharged for threatening and swearing at the paramedic who asked you to stop popping wheelies in the wheelchair in the part of the parking lots where cars drive up, but he really was just trying to be nice today.

I think that's it for this week. Learn from the mistakes of others, guys, or else all of this was just in vain.

The Hell

2011-07-18T06:46:00.000-07:00

So for the last days now some jackwagon LPN has been sending his patient to the ER via EMS with some vague instructions to the medics to get us to start an IV along with an order sheet handwritten by him with some huge run on sentence on it about how the doctor ordered antibiotics to be given IV after dialysis by the dialysis nurse, but he knew that the antibiotics would require further monitoring so he was sending the patient over to the ER to have it done. WTF. This poor patient was actually oriented and stuff, too, so this shit was even more embarrassing. He was super tired of being shipped back and forth, as you would expect.

So, of course, being the way I am, I just had to talk to this, um, nurse. I mean, I had no other choice. It went about how you would expect it to.

Hood Nurse: Hi, yeah, I'm calling from Hood Hospital to speak with the nurse taking care of Mr. Jones.

Nursing Home "Nurse":Derp derp, yes, that's me.

Hood Nurse: Sooo. I gather from these here papers you sent me that you're sending your patient over here on a daily basis to receive IV antibiotics?

NH "Nurse": Yes, that's right.

Hood Nurse: You're sending him over here on an ambulance so we can give you meds for you, I've got that correct?

NH person: Yes.

Hood Nurse: Yeeahhh. So. About that. We don't do that. The emergency room is here for emergencies. So, giving your antibiotics every day is important, but it isn't an emergency, you know what I mean?

NH person:Um. Yes?

Hood Nurse: And, you know what, if you were sending him over here for line placement, let me just stop you right there. This guy has no places to start IVs left. He has a 22 in the armpit. I will not send him back with that knowing he is coming back to you and you intend on infusing antibiotics through it. If you really need access you need a PICC line and you need to get it scheduled outpatient with a real doctor's order, not whatever this business you sent us today is.

Freaking Idiot:Um. So you guys started a PICC line?

Hood nurse: NOOOO!

Seriously, moron: So, you left the IV in?

Hood Nurse: Absolutely not. He is coming back to you. Get him an order for PICC line placement if you need to give IV antibiotics. Stop sending your patient up here for this foolishness.

Nurse dumbass: Okay, we'll be expecting him.

HOLY BALLS. The worst part? Site in question they were giving antibiotics for? No signs of infection. At all. I was actually shocked to not see him rolling in last night, too.

But It Just Takes 5 Minutes

2011-07-17T07:10:00.000-07:00

Hood Hospital has been running even shittier than usual recently thanks to some genius plan that we needed to remodel and switch to computer charting at the same time. Really dude? Awesome.

So, anyway, stuff is already effed up majorly and we have randomly had crazy high censuses for summer time and a lot of really sick patients, last night being no exception. I lucked out (or so I thought) when I got a little old demented lady from the nursing home who pulled out her PEG tube, probably the easiest thing ever from a nurse perspective- so her daughter shows up and tells me that they don't want to replace it. Sweet. I tell her I'll let the doctor know, that at this point he is currently intubating but he should type them up for discharge when he gets out of the room. After that a whole other trainwreck comes in, the doctor goes to deal with that, and I get a dude on an ambulance who has had an MI before and is currently having chest pains when I get a couple calls that I'm needed in room PEG tube. Well, not right now.

I get out about 10 minutes later to find the daughter of this patient standing in the hall staring-I smile and ask what I can do to help, and apologize for the wait, pushing the EKG machine with blood in hand. She tears into me about why this is taking so long, etc., how ridiculous it is here, the usual stuff. I apologize again and explain to her that the doctor has been tied up with 2 critically ill patients. She becomes even more indignant at that. " I mean, that's really an excuse, is it? How long does it take go write some discharge papers? It takes like 5 minutes! I've got to get home!"

I realize the point is probably moot and go tell the doctor to type up a STAT discharge STAT. I bring the papers in and go through everything with them, and instead of saying all the sarcastic shit I want to say, I take the kindness route. "I'm sorry.", I tell them, "I know it's frustrating to wait when what you need only takes 5 minutes. But the lady who was about to stop breathing and the guy with the gunshot wound who needed to go to surgery didn't have 5 minutes, so the doctor had to take care of them first. Now let's get you guys back home to your comfy beds. Have a great night." Attitude change quite a bit after that. It's incredible what perspective can do.

Allergy of the Day:

2011-07-17T06:58:00.000-07:00

Carbonated water.

No, I don't know either.

Reason For Visit

2011-07-14T03:45:00.000-07:00

Probably one of the most consistently amusing things at my job is the shit people write in the "reason for visit" blank on our check in form. I really wish it was legal for me to copy all of them and make a scrapbook. They bring me great, great joy.

Some require a little bit of background, like the guy who brought in his son who was tripping balls and acting totally cray-cray. Reason for visit? "K2" was all that was written on the form. Well, I guess if you're getting to the root cause, yeah. I had to help the registration rep with that one though.

Others are just literacy issues- like "Somatch" (abdominal pain)- probably things I should not find as amusing, but tell me you could keep from laughing if you saw someone's chief complaint written down as "Golf Stones".

The ones for STDs THE BEST, though. Freakin' comedy gold. A few from this year:

"I got a discharge"

"Slept with a dirty woman"

"My dick be leakin'"

"Pussy swoelen"

or, my personal favorite of all time "Klamidia Gondor dripping from my penis".

Yeah, to be fair, though, if I had a mythical kingdom dripping out of my genitals, I would probably be going to the ER too.

Where We Draw the Line

2011-07-12T07:16:00.001-07:00

Listen up, mofos. We will probably give you IV Dilaudid if you act a fool, fake chest pains, or act a fool, fake abdominal pains, or act a fool, pretend to have sickle cell, or act a fool, pretend to have fallen off of a two story building despite the fact you have not an abrasion on your person, see Hood Hospital doctor on duty for complete list. BUT.

We will not, I repeat, WILL NOT, give you IV Dilaudid when you sign AMA from your long term care hospital across the effin' street because they just stopped your IV Dilaudid and you want some more, and then proceed to immediately call the ambulance from your room because you want to go the ER and see if we'll give you some Dilaudid. Yup. The ER doctor will receive a call from your doctor prior to your arrival, despite the 2 minute trip, and meet you at the ambulance bay to be like, "Nope, bye".

Any questions? Oh, and also, it's poor form to sleep during your entire 40 minute visit (the time it took for the private ambulance to come get you to return to sender) while complaining of 10/10 pain.

Visual Vitals

2011-07-10T00:14:00.001-07:00

Now, I hope no one here loses too much respect for me when I admit that I, on occasion, take visual vitals as opposed to the generally accepted actual vital signs. Calm down. I'm not talking all the time, very rarely, in fact. But, if I'm in fast track, I have 5 more discharges to do, I've been stuck on team lazy and you're a young person here for an STD with no medical problems who just got your vital signs taken in triage an hour and a half ago... yeah. I might just have to take your visual vitals so I can go pee. Sorry. I'm not saying it's right, but dude, sometimes that's the way things go.

However, there are several situations in which this is NOT gonna work our for you. Say, you work at a nursing home and you find your patient in bed cold and pulseless. Note the lividity. Yeah. I'm not saying don't send this corpse over here, because, obviously, you're never gonna stop doing that, but at least don't send this corpse over here with a report sheet with the vitals as follows- BP 110.72 HR68 RR 14 SPo2 98% because this person is wicked dead and dead people don't have vital signs. K thanks.

The Antidote for ER Angst

2011-07-08T17:57:00.000-07:00

So, last couple days up here have been randomly terrible. Like bag of chips for dinner, ER full of holds (in June, WTF), setting up the ER bunk beds, management coming around at 3 am to do what they do (nothing), cray-cray. Last night was the worst.

But tell me if you could possibly be pissed about anything if this happened to you. So, I go back in to check on my hold patients after helping out in the double CPR that had just come in. Everyone's mostly pretty much sleeping, including my last patient I come to see, a sweet little lady with early dementia being admitted for weakness. Just as I step into the room to check on her, she opens her eyes, and as soon as she sees me, she looks up at me with this giant adorable toothless grin and exclaims, "Sweetie! You're here!" As I talked to her I realized she thought that she had been moved upstairs and didn't realize she was still holding in ER, so when she thought I was her nurse on the floor she was super excited.

Seriously. How can you be in a bad mood when someone is that happy to see you?

Return of Compassion

2011-07-05T08:01:00.000-07:00

So, I've been going through sort of a rough patch as of late in that I've just dealt with a lot of foolishness without a lot of payoff in the emotional sense. Not that I'm one of those people who needs to be gratified all the time and told that I'm a modern day Florence Nightingale by every patient I discharge for a UTI or whatever. I've just been dealing with high amounts of drama and abusiveness, and since I'm really pretty introverted and sensitive (despite how I act), it really does take a lot out of me. Like, in ways I don't realize until later when everyone and everything is pissing me off and I don't understand why.

It really bothers me when I get this way. I feel like I was made to be a nurse and comfort the sick, like that it is really my God given purpose in life. I feel like if I'm not doing it well- if I don't feel like working hard and I don't feel sincere when I'm being nice to people, that when I'm just pissy that I'm a total failure at the one thing in life that I genuinely care about and think I'm good at. I've felt pretty lost over the last couple of days. Last night was my last of 4 and I pretty much begged to be in fast track to I could just hide and get a break.

So I'm trucking along back there when I go in to start an IV on this lady. First thing she tells me is that she is HIV positive. With full blown AIDs, in fact. I respect this a lot, since lots of people I see don't tell anyone and I find out later when looking through old medical records on the computer. She's hurting, but still bubbly and talkative. She' sweet anyway, but I get on her good side even more by starting her IV on the first stick despite her bad veins and needle anxiety.

Her labs are not pretty. Her body is aching, and she says she's had fevers coming and going. It's obvious her illness is progressing pretty rapidly, but you wouldn't know it by how cheerfully she interacts with her son, who's sitting next to her reading quietly. She's admitted to the hospital for severe anemia, and I find out a little more about her as I take care of her. The events of her life so far have been horrendous to say the least.

After her son goes home, she reveals to me that doctors have given her less than a year to live. Even as she tells me this, she's smiling. "I have so much to be thankful for", she says. "My son is such a good boy. I have a really good man now. I used to be scared but God has granted me peace. It's like I'm his little baby and he's holding me. I know it's gonna be okay." She tells me how kind I've been and how thankful she is for my care. How much she admires everyone that has helped her today. As I talked to her, I started to cry. Not for any reason in particular- it's just that talking to her has instilled somewhat of a calm in me. I felt as if someone had reached into my chest and pulled the weight of all that angst out of me.

It was hard for me to adequately express it to her, but she really saved me. I feel a renewed sense of purpose in what I do.

Just in time for me, too, since after that it was all drunk people in with fireworks accidents. Thanks to my sweet patient, they all had warm blankets and someone to listen attentively to their tales of woe.