Really?

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?

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

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

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

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.

Subtlety Fail

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

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

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

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

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

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

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.

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

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

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

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