A Few Words About Actually Giving a Shit

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

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

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

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

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

RSD is the new Fibromyalgia, y'all.

You heard it here first.

Douchebags, everywhere

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

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

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

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

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

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

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

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

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.