Chief Complaint of the Night Returns

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

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

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

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

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:

Carbonated water.

No, I don't know either.

Reason For Visit

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.