weekend, dummies

Wow. Nights this weekend have brought in some winners. Winners with lying problems, apparently. My favorite was probably the guy who came to the ER on a stretcher covered in road rash and reeking of beer. First he lied to us about how many beers he had (seriously, I do NOT GIVE A SHIT how drunk you are, nor does anyone else but we NEED TO KNOW these things, man) I think the number started at three and went up to 6 or so as the assessment continued- whatever- but then came the inevitable question of how did this happen to you- oh, um, hit by a car. Huh? Yeah. He was crossing the street and got hit by a car and somehow that lead to tons of road rash but zero broken bones. We x rayed just about everything, irrigated his wounds and sent him home- the whole time we were trying to clean him up he kept trying to walk around the room and talk on the phone to his girlfriend, who couldn't find the ER, so he was sticking his head out of the room and yelling at people for directions- I was practically chasing him with the bottle of saline. I thought he was weird, but he wasn't my patient so I wasn't too worried about it- I found out later from the ER cops that he had been drunk and riding his motorcycle and had wrapped it around a pole but didn't want anyone to know because he had gotten a DWI a month prior. I guess he thought being honest with the nurses was going to get him another one. Everyone kept asking him if he'd been in a motorcycle wreck just based on his injuries, and he kept insisting that he had been hit by a car. Again, we don't care. Unless you injured yourself hurting someone else I could give a damn about your illegal activities.
Same story for the dumb dumb that came in the next night. I don't know if he was on anything, but came in claiming that he'd been shot by someone but he didn't know who it was. The only problem was, he had a big bullet hole in his hand with a powder burn around it, meaning it had to be at close range. The kid changed his story about 4 times, zero versions of which actually made any sense. The police and the doctor were both pretty sure that he had gone and bought a gun off the street trying to be thug and suceeded only in shooting himself in the hand with it. Well played.
As far as illegal activities, that's pretty much all we got other than the guy I ended up with from jail on warrants who came in for his "Crohn's flare up" and immediately left without being seen at the first opportunity. It's not really a valuable use of the police's time to babysit people who are in jail for traffic tickets during their whole ER stay, so if they have an emergency in jail they just let them go with EMS to the hospital and allow them to turn themselves in later. The only problem with that is that a lot of people just use it to get out of jail and bounce when no one's looking. Unfortunately for me, the only other patient I had dealt with in this situation was actually sick, so I spent a ton of time doing a full work up on this douchebag and even tryed to stick him twice, all the time while he screwed around and wiggled and did nothing conductive to a sucessful IV start. It's actually fortunate for him I couldn't do it, because otherwise the police actually would have had to go after him for leaving with IV access. I was pretty pissed that I spent the time on him, but I did learn a valuable lesson with jail patients- next time I will give them the opportunity to "get a urine sample" before I do anything else.

WTF.

Okay, seriously. Between me and my teammates on the last two days there have been an uncomfortable amount of people coming in for generalized complaints that turned out to me nothing other than, oh, surprise, metastatic cancer- probably. Mine was 23, had already had a kidney removed, came in for vomiting, and while they were CT-ing his belly, found out it was probably now in the bone. Awful, awful. This crap needs to stop, I have two more days to go before I get a break and no more energy for this business.

night and day difference, literally.

So, a while back I talked about a day I had where I had way the hell too many sick people at once and I was super scared one of them was gonna die on me? Well, I had another one last night, but amazingly- it was totally fine. Not to say that it didn't still suck- I had a guy with a blood pressure of 270/160, a 6 year old with a possible concussion, a patient who the doctor needed urine on who couldn't get up and a guy with a uncontrollable vomiting, a possible seizure before he got there, and a heart rate of 140 for some reason. The guy with the high blood pressure ended up being an ICU hold all freaking night and I had to titrate multiple drips that I had never given for him. The nurses last night, even the ones that weren't on my team, helped me to look up the limits on the drips and how much I should titrate up by, etc. Just as soon as I would start to get swamped and overwhelmed with the tasks I had to do, I would walk out of a room to get them started and half of them would be done.
The guy who works charge half the time when I'm here totally rules, too- he'll come start IVs and ambulances for all the nurses when he knows we're behind. It's just so comforting to have backup- it was never like that on days and it makes a huge difference. Not only did people rarely help on days but half of them were watching and waiting for me to screw up; on nights everyone genuinely wants to help and will drop what they're doing to if you're in bad shape. I really was getting miserable and thinking about getting out of here as soon as my contract went up, but I'm super happy now. It's amazing what a difference there is when you're on a good team.

The exact moment I realized my attempts at discharge education were pointless:

I worked in out fast track unit on Tuesday, which turned out to be STD party '09 that particular night. I go to send home a 20 year old girl who had come in with funky vag discharge, and as I'm standing there giving her instructions about her antibiotics, she looks at me with this blank stare, turns to the friend who's with her, and says, "Girl, can you believe I got chlamydia again?"
I was totally speechless. What can you say to that? Yeah, okay. Make sure you finish these antibiotics, and wrap it up next time, even though I know you won't. Sweet. See you later! Bye!

night shift= babysitting drunks?

Oh. my. god. I never had any idea how much manpower hospitals ended up devoting to people who can't handle their booze. Last week we got the girl with an "asthma attack", who came in via ambulance in nothing but a bikini satting 100. She was a melancholy drunk, though, so it took at least one nurse at all times to stay in the room with her to convince her that she could, in fact breathe, and no, she wasn't dying.
Last night was oddly slow- each nurse had about one patient. Unfortunately, the one that I ended up with was an overdose, apparently a suicide attempt, which consisted of her taking a few OTC sleeping pills and drinking a whole shit ton of alcohol. She was medically stable, but an incredibly belligerent drunk. The charge nurse took her straight back because no one knew how many pills she had actually taken, and by the time she got back to my room she had already started screaming and swearing at him. It took me and another nurse about 15 minutes just to get her to sit still for a blood pressure reading, she spent the whole time screaming and hitting herself in the face and the like. I gave her two doses of valium, which did absolutely nothing but make her yell at me more about how I was just giving her water and I better give her something to calm her down or she was going to cut her wrists. I would have felt bad for her if she hadn't been so damn manipulative- any time she didn't get her way she just screamed at me about how she wanted to die and didn't I understand that. At one point I walked in to hear her talking to her family members about how when her husband called that they just shouldn't answer the phone and they should just let him wonder what happened, since apparently something he had done had precipitated her "suicide attempt". Ugh. Whatever dude.
I was in her good graces-well, at least about half the time- she alternated between telling me how wonderful I was and that I was taking such good care of her and that God was gonna bless me for that, etc. The other half, she would scream and swear at me about why did she have to use the damn bedside commode like an fucking 65-year-old child (I didn't type that wrong, she actually said that), why the hell couldn't she go outside and smoke an fucking cigarette, don't we have any food in this damn place other than crackers, don't we have any mother fucking cheeseburgers? It took all my power at that point not to say, "No M'am, this is an emergency room, not a Mc Donald's. I'm sorry, but we don't have any motherfucking cheeseburgers. Is there anything else I can get you?"
Finally the doctor took mercy on my soul and prescribed some Haldol. I had never given that drug before, but it worked like a charm. She went right to sleep, but unfortunately, her blood pressure completely went to hell, even though she was hypertensive when she came in. So by the time I finally got her behavior under control, I was getting calls from our Tele tech every 5 minutes about my patient's 80/40 blood pressure. She was fine and her sats were still great, but it still made me super nervous and I had to keep giving fluid boluses. Luckily by the time the psych consult came she had woken up a little and her pressure had made it's way slightly out of the toilet.
We finally got her out of there right at shift change. She ended up going to a facility where I had actually started applying right before I got the job I have now. I'm glad things worked out the way they did, because I'm pretty positive I am not equipped to deal with that every day.