ER Pet Peeve #1 of 890,345

Know who I hate? Indulgent parents, that's who.

I'm not even discussing the people who let their kids run amok about the hospital. If your kid is well enough to be running, I'd be happy for you to please leave and go to the pediatrician tomorrow, please, but otherwise I don't care one way or the other unless I'm about to trip on your child and step on his face.

No. I'm talking about the ass hats that make treatment a choice for their preschool age children. The parents in triage who, when asked if they gave their kid any Tylenol for his fever reply, "Well, no. You see, little Johnny doesn't like taking medicine." It takes all of me not to respond, "Who is the f%#ing parent, you or little Johnny?" No one likes taking medicine. I didn't like taking a bath as a kid, either. My parents made me do it. For one, because it was good for me, and two, because no one likes a smelly child. It's the same for your kid. You punish them if they don't take the medicine. Because they need it. And because it pisses me off when your child attempts to kick me for putting an oximeter on his finger and spits Tylenol in my face.

No, Ma'am. I do not play that. What I play is the "I'm very concerned with this 102 fever"card. "Oh my. This is very serious. We need to get this fever down by any means necessary. Little Johnny, would you like to refrain from spitting this Motrin in my face next time? I'm gonna give you one more try before I put a suppository in your butt. " There. I bet your kid will drink the grape flavored syrup next time. You're welcome.

Parents like this infuriate me in all aspects of life. Children of parents like this as a general rule turn out to be entitled douchebags, because their parents were either too lazy or stupid to say "no" occasionally, even if it's for their best interest. Saying no builds character, keeps your kid's fever down, and keeps them out of jail, okay parents? Now take your demon children, give them a bunch of suppositories, and get them out of my ER and off my lawn. Bah humbug.

No respect.

Let me begin this entry today by saying one thing- I am in no way complaining about looking young. I know, and I always hear- I will be really happy about this when I'm 40. But let me just say, the way a lot of people treat a 23 year old who (apparently) looks 15 is pretty damn rude in my opinion.
The funny thing is, I think it's actually gotten worse since I started trying to look older at work- I dyed my hear from blond to red and started putting on some makeup- not working.
I've recently had an EMT threat to call child labor, which actually kind of made me laugh. I don't even mind when people ask how old I am. However, I do mind when people say stuff to me like:
"Well, what are you, anyway? You don't look old enough to be anything" or "You're so young you couldn't possibly know what I'm dealing with."
The worst so far, though, was this Sunday, when I went to help a nurse from my internship, who is older but graduated the exact same time as me. She needed a blood draw on her patient, so I went in, introduced myself, and explained what I was going to do. Before I could take 2 steps towards him, he looks at me and says, "Where's my nurse?". I smile and say,"Oh, would you rather she draw your blood?", to which he responds, "Yeah. Cause you don't look like you know what you're doing." Oooh. Burn.

I get it to some degree- if you look young, it's impossible that you've been doing this for a long time. But- I wish people understood that age does not necessarily guarantee experience or competence. There are some young nurses out there that are totally awesome, as well as some old ones who are awful. At least let me prove myself awful first! Shoot.

OH REALLY.

That's all I want to say whenever I get put in triage. To everyone. I try so hard not to be a hateful bitch by the end of the night, but it's pretty much inevitable. I always get super excited when I get to go up there because I actually get so sit down and pee occasionally, and then about 3 hours in I'm like, "Oh, that's right. I hate this, and I hate EVERYONE. I need a drink." Last night was pretty much a lost cause from the start, since I came in 2 hours early. Just a few observations:

It should probably go without saying, but ambulances that go to triage always seem to result in giant WTF moments. Like the genius who called the ambulance because he took a Norco on an empty stomach and then got nauseous. I checked him out as he was rolling into the waiting room and asked how many pills he took, his symptoms, etc. One. His stomach hurts. Not impressed, check in over there please. When I got to triaging him 8 minutes later, he had magically developed chest pain, and by the way, pain everywhere also. Um. No. Why did you call the ambulance? Oh, for that stomach pain? Oh, okay, sit down in the waiting room please, and stop attempting to get ahead in line by using tomfoolery. We are smarter than you, thanks. Or my favorite, possibly ever- this 19 year old kid comes in via EMS for a fever he's had for 3 days. Hasn't taken Tylenol or Motrin because he "couldn't get to it" even though he "really tried". Sweet. So he waits about 3 hours, my charge nurse finally walks up and calls him back to a room and he sits there and straight up ignores him. He calls again. Nothing. He's about to mark him as left without being seen when I go out and tap him on the shoulder. "Hey, he's trying to call you back now. Do you wanna get seen for your fever?" To which he responded, "No, I'm about to go to the house. I'll be back tomorrow." Even though he was literally about to be seen. He then precedes to sit there and continue watching TV in the waiting room. WHAT. I think he may actually have taken the ambulance to come to the ER and watch TV. I don't want to believe this is true.

On a continued note- getting your ass kicked is not necessarily an emergency. If you don't really have any marks on you, or you have a few bruises, you can go home. Coming here and getting discharged with a contusion after bringing all your drama up here isn't going to help your case or anything. On a related note, last night was 100% agg assault/ pregnancy test special. "Oh, I missed my period by 2 days. I may have a little sea monkey baby in here that could have been affected when that girl in the club hit me in the face. I need a pregnancy test." Fool, please. Take your ass to Dollar Tree. This is not a one stop shop.

The more you try to do something for someone, worse they behave. Oh, thanks for putting me in a triage room and calling RT to get me breathing treatments while I wait. Why don't I repay you by leaving without being seen or giving you the courtesy of telling you doing so, even though I have a nebulizer at home? Cool, you're gonna let me hang up here while you call someone to remove my sutures in triage so I don't have to wait to go back to a room? Why don't I walk in and out and bug the shit out of you while you're trying to care for actual sick people? I'll make sure to swear really loud and generally act like a drunken fool.

I'm gonna start making people include "incapable of acting right" as one of their medical problems. At least I'll see it coming then.

Feculent vomit: a breakdown

Con- It smells exactly like what it sounds like, except worse.
Pro- After inserting an NG tube only to have the patient pull out the NG tube while crushing your fingers and spraying shit vomit all over himself and everywhere else, your night can only go uphill from there.

BUSTED

Oh man, oh man. A while back I wrote about one of the worst patients I've ever had- a verbally abusive patient in "sickle cell crisis" who it turned out, only had the sickle cell trait.
Well, fate was kind to me, because recently he came back. I was working in a different part of the ER at the time, but I happened to go to lunch at the same time as the nurse and doctor taking care of this little a-hole. They brought up his name, and my heart skipped a beat. I made sure to mention his slight exaggeration about his health condition, and about his nasty little habit of lying about having a ride, and gave them a quick overview of his behavior during his visit with me.
Sure enough, the nurse called his mom about whether she was actually driving him home, to which she apparently responded, "Hell no! He knows I don't have any money to put gas in the car!"
Hmm. Guess who got sent home with a Toradol shot? Dilaudid breakfast combo canceled.
There you go. Be nice to your nurse, ladies and gentlemen, if for no other reason than karma is a bitch.

adjectives aren't gonna save you

First look nurse is officially the job from hell. You sit at the check in desk, ask people about their complaints, and ideally, see who needs to go straight back to a room immediately. Usually, though, its just sitting at a desk while the same three idiots walk up every five minutes to tell you one more reason why they really need to go back to a room STAT for their headache or abdominal pain.
At least I have the comfort of the check in form- the little piece of paper where they put in their demographic information, name and chief complaint. The things people come up with to write in the chief complaint section are hilarious. Not just because of the terrible level of literacy among our patients ("can't breath good" is a pretty common one) but the qualifying adjectives are a riot. You can tell they were well thought out- yesterday we had a lady check her daughter in because her eyes were still a little swollen after half a course of steroids. Her complaint on the form- SEVERE allergies. Severe you guys. This might require a trauma room. It's as if the patients here think that if they come up with a good enough adjective, that they won't have to sit in the waiting room with all these people. It was the same shit all night, too- the people with serious illness kept it pretty simple- but you have no idea how many forms I saw with "serious rash", "severe cough", or "abdominal pain that feels like an explosion". Listen. Just because you check in for "terrible, horrible, no good, very bad STD", doesn't mean you get to skip the 7 hour wait. It sure is entertaining when you try, though.

Hateful

Wow. Well, I've been kind of a slacker at updating, but I have my reasons- I kind of worry that all of this comes across as a giant bitch fest half the time.
So I'd like to take this opportunity to clarify- I'm not a completely hateful person. I don't, in fact, despise all of my patients- actually, I really, really like most of them. It's just a lot funnier to tell about the ones that call me a hoe and expect me to bring them a cheese sampler than it is to tell you about the ones that tell me how I'm kind and beautiful and how I should get a raise.

It's hard to think of those people sometimes. Especially when you start your shift like I did last week. I'm going to create a mental picture here. I've been at work 5 minutes. I go in to see the first patient of the day, who is a woman in her 40's with a mild pneumonia who is about to be discharged. I walk in with her papers to find her sitting in bed with an emesis bag in her lap as she leans over the bed rail and spits mucus on to the floor, all over the monitoring cables. She greets me by silently pointing to the mucus on the floor. When that fails to impress me, she proceeds to complain to me about how she hadn't eaten a thing all day and that she had asked for some iced tea and some bread 2 HOURS AGO. Now 10 minutes into my shift, I had already reached my bullshit capacity, and my response to her was, "Ma'am. If your cough is so terrible that you can't control yourself enough not to spit all over the floor, I don't think it's a good idea for you to eat anything right now. I'm gonna get you one more breathing treatment, and then you can go home and eat your food there. Thanks."

Crap like that can ruin a shift so fast.
That being said, I've had some of the most wonderful people under my care lately. I took care of a woman who kept converting in and out of A fib- she was sick enough to warrant a trauma room yet she complained about absolutely nothing. Instead, she and her husband spent the night telling me about their kids and grand kids. They hugged me goodbye when they went up to the floor. They told me to make sure to tell me parents how proud they should be that I was such a good nurse at such a young age, and asked for my address so they could send me a thank you card.
That same day, I took care of a young guy with a massive throat laceration from a chain breaking loose from his chainsaw. He probably came within centimeters or less of severing his jugular, yet he spent most of the evening joking around with me and the doctor about how he wanted her to put some stitches on the other side so he could get a face lift. I was tempted to leave work and take him and his wife for a beer.
I hope it's clear that I take care of mostly people who aren't incredibly notable but are still remarkably patient, gracious and funny despite our average 6 hour waits. It's just so easy to take them for granted when the argumentative whiners, the "how much longer"s, the drug seekers and the ones working for performance of the year seem to take up 95% of my time.
It sucks, since it's unfair for the patients who act right- especially since most of them are actually sicker. I feel like I'm aware of this, too, and it makes me all the more pissed off at the patients who waste my time by treating my like their personal waitress.

So, I'm trying to work on this. A lot. I think if I spend more time thinking about the sweet patients than the awful ones, then I'll generally be a happier person. And the true challenge- if I learn to set better limits with the a-holes (something I still really suck at doing, because I still want all my patients to love me), I think I'll spend less time banging my head against the wall as soon as I leave the room and more time getting stuff done. I just have difficulting knowing how to stand up for myself when someone is being disrespectful but not outright swearing at me. Someone needs to teach a class on that- "Overcoming condescending tones and general douchebaggery for first year nurses". Now that's a CE I would pay money for.