Ruined

Nursing has enriched my life outside of my career in so, so many ways. Especially being an ER nurse. Very little truly frightens me anymore. I'm able to help my loved ones if they need me. It's actually helped me overcome my shyness. I generally have a good story to tell my friends.

But. That said, nursing has ruined me for a lot of things. Meat? Yeah, now that I've seen human muscle fibers in all the states I have, I can't eat it. That's been good for me, so whatever. Anything grape flavored is over forever. Once you've done a couple of Kayexalate enemas, that's pretty much done. The biggest change in my life is TV, though.

Like, if a show has terrible medical consulting I CANNOT watch it. I was the biggest Law and Order junkie that ever was, up until they tried to make fetch happen with all their stupid spinoff series, but Law and Order original flavor ruled. I still get pretty excited when a re-run I haven't seen comes on, which is rare. So the other day a re-run of an 80s episode comes on where some kid codes in the beginning. I definitely hadn't seen it, but I could not even get past the code, because it was done TERRIBLY. Like, they call some code blue in the ER overhead, which, whatever, I suppose maybe they do that somewhere, and then they're bagging this kid and not doing compressions, and then they try to shock her out of asystole, and then they call it, like, 2 minutes in. It was awful. I mean, I could not have watched the rest of the episode for anything.

I wish it was only stuff that blatant, but I nitpick so many shows and I know my husband is totally over it by now. We're watching The Walking Dead right now, which is amazing. The medical consulting isn't awful, but it certainly isn't excellent. Like, they threw out this stuff in the last season where they're trying to scientifically explain the zombie virus and this dude in the CDC is all like "it spreads through the brain tissue, like in meningitis." Um, no. And then this week *SPOILER ALERT* Rick's son gets shot and needs surgery and then OMG his best friend who also is kind of a creep and banged his wife after telling her Rick was dead has to go to the local FEMA center which is overrun by zombies with the dude who accidentally shot Rick's son who happens to be a volunteer EMT to get a ventilator and other shit so this veterinarian guy the met can do surgery on his kid. Anyway. You should really watch that show if you're not watching it already. So, they're in there gathering supplies or whatever, and volunteer EMT/kid shooter dude picks up a laryngoscope blade and handle and he's like, " I got me an endotracheal intubator". At which point, I immediately rolled my eyes and said "no one calls it that", shaking my head just in time to look over at my husband, who at that moment had obviously just lost the last bit of enjoyment he had in watching the TV show based on his favorite comic book due to my inability to shut the eff up about any slight medical discrepancy.

Sigh. Sorry, husband. I wish I could get past it, too, but probably not near as much as you do.

What 4 AM lull?

Nothing like a 20-something chick running frantically into the ER screaming that she grew a penis and needs to go to the operating room NOW to get it removed to get your blood pumping in the slow part of the morning.

Family Fun

I get some little old lady last night who came in for weakness- cute, tiny lady who was kind of mildly confused, but pleasant. We're doing the regular weakness/dizziness work up bit with labs and such, and I'm talking to the family about what was happening before the symptoms started as I'm hooking up her EKG leads.

"Well," her daughter tells me, "we were sitting there about to leave for the strip club, but then she started feeling bad, so we called the ambulance." I asked if she was serious. "Yeah!" She told me, "I mean, her husband's been sick for a while and he just died last week, we thought it would cheer her up." Shoot, maybe it would have. Who says ladies in their mid 80s aren't into that kind of thing? Can't fault them for trying!

Although, this is coming from someone who went to a bar with my parents and grandma last week, so maybe I'm not the best person to ask.

Hood Hospital Epidemiology

While speaking to ER BFF during lunch about a patient I'd triaged earlier in the night:

Me: Dude. This chick just checked in for vaginal discharge for a MONTH. And then she left because the wait was too long. Can you imagine that? Like, just letting your cooch rot for an entire month? You just know here normal bacterial flora are now duking it out and mating with whatever kind of STDs are up there, and they're probably gonna meld together and become some kind of gnarly super gonorrhea, and the CDC is gonna come down here and be all up in our business.

ER BFF: Yup, and then it's gonna mutate and become airborne and then we'll be really screwed. They'll have to declare a disaster state down here, and they'll put us in one of those bubbles and stuff-

Me: And then try to set us on fire like that movie Outbreak?

ER BFF: Exactly like that.

So, there it is- if you hear about the government wiping the most ghetto part of a major city on the news (you probably won't, because it'll be a super-secret-covert-black-ops/CDC conspiracy), have a moment of silence for the brave men and women of Hood Hospital, and remember to get your STDs treated promptly. Goodnight and good luck.

Ambulance To Triage

Sassy zero b.s. coworker of emesis bag fame has started acting as charge nurse, which, let me just say, is AWESOME. The one downside, I would have to say, at least as a triage nurse, is about 3 times the amount of ambulances in triage. Pretty much the criteria tonight was breathing and walking. Justifiably so, too, as there were several sick people out there for about 6 to 7 hours thanks to the clusterfuck we walked into.

Yup, the part of me that has a relatively low capacity for drama and conflict would really rather these people just go back to rooms so I don't have to deal with them. The other part of me that's a spiteful b kind of loves it.

Let me explain myself a little further lest I sound insanely hateful. I like it when entitlement and douchebaggery are punished. I'm not so much spiteful as I am the type of person who gets really pissed off when someone thinks they're above the rules. Like, I'm the one who always has to say something to the person who cuts in line or the able bodied princess with no tag that parks in the handicapped space. I'm the one telling the people in the movie theater who are talking to shut the eff up or pay me for my ticket. I know. World police, it's a character flaw. But as this type of person, I absolutely love the moment when the asshole who thought using the ambulance as a taxi realizes, "oh, wow, I'm gonna have to follow the rules and wait like everyone else." LOVE IT.

Anyway. We had one last night who thought he'd come in on an ambulance and get seen sooner for his back pain x 2 days. Nope! To triage you go, sir. Now before anybody with a back pain history decides we're douchebags, not only were there much sicker folks in the waiting room, but homeboy also got Fentanyl IV thanks to the extra generous EMS crew, so he should have pretty much been good to go. But no. He screamed and carried on and acted dramatic- when that didn't work, he told me he felt like he was going to pass out from the pain (I have yet to see that happen in the waiting room. You aren't getting your leg amputated, bro), so I told him to sit down and I would come recheck his vitals. Which were of course fine. But he took that time with me to express how the pain medicine didn't do anything and it was already wearing off. I explained that Fentanyl usually stayed in the body longer that 40 minutes, to which he responded by yelling at me, " This is RIDICULOUS! I shouldn't. Even. Be. Out here. I came in an AMBULANCE!"

I decided at that point to explain to him, loudly, that your mode of transit does not factor into your acuity level. If you're dying, you get seen quickly. If you don't, you wait. I wish more people understood this. It would save tax payers so much money.

The Stupid Flows.

Hood Hospital, for a long time, has had several paramedics in our employ. Over the last several years, however, it's been pretty obvious that they're trying to phase them out. We've hired one new medic in the past 2 years- meanwhile 3 or 4 have left or gotten fired. Word is that before I got there, the medics could do just about anything the nurses could do- give several meds, apply splints, even triage. The triage function was gone before I started, but over the last couple of years they've pretty much reduced their functions to IV starts (which they can't even flush, because oh noes, normal saline is a med, y'all), EKGs and transports. They can't even apply oxygen any more because it's a "medicine". Last week they decided they were going to slash their hours like crazy, and only have one medic working part of the shift on the floor. The others would be helping the charge nurse move patients to rooms and doing EKGS and shit in triage. Really? In case there's been any doubt up to this point, our management obviously has their heads pretty far up their asses.

I know there's controversy, for sure, about paramedics in the hospital setting. For the setting I work in, though, it's pretty much a no-brainer. We need them. Straight up. They save our asses on a regular basis. I'm actually a pretty good example of the average nurse in our ER. Young and inexperienced in any other area that isn't ER. A lot of the times, I'm the "grown up" nurse on my team- it's me with two other nurses that have been at it for less than a year. All the really experienced folks have moved on to either charge or management. Now, don't get me wrong- I can handle just about any ER situation. But when it comes to some of the really obscure stuff, or when I have to be an ICU nurse- I need my medics. Most of these guys can manage a critical patient on their own- they've worked flight before, so they know how to pace, they know how to set up an art line in their sleep- stuff I review once a year at skills day and maybe deal with twice a year other than that. I can't imagine having to do that stuff without them. It'll get done, but it'll be a clusterfuck. And IV starts? Yeah. As good as I've gotten over the last few years, I can't hold a candle to someone who was doing flight transport while I was still taking my SATs.

And now their talking about relegating their duties to moving patients back to a room. Seriously? You idiots think you need to pay a licensed professional to do that? Because that sounds like a job a tech, or shit, a volunteer could do. Here's the thing- when you start treating licensed staff that are an important part of the healthcare time like idiots, you are the ones that end up looking like idiots, because you're paying someone who certainly makes more money to do a job you could pay someone less money to do. Meanwhile, you rob your young staff of someone who has a lot to teach them. We might be able to get away with this crap if we were a hospital full of sage and learned nurses with lots of experience. But we're not. So we're basically just screwing ourselves. Sigh.

I'm gonna throw a fit and argue my case at the next staff meeting, but if they haven't seen these guys' obvious value by this point, I don't know what will change their mind. It's certainly a huge bummer, though.

Chief Complaint of the Night

This little nugget of joy comes to you from a coworker's triage notes from last night:

HPI: Pt c/o right hand pain x 7 minutes after reaching into vending machine in waiting room and briefly getting her hand stuck. No bleeding or swelling noted.

Yeah, I know. What was she doing in the waiting room in the first place? Dude. That's like a philosophical chicken or egg type of question.

Quote of the Night

Sassy lady ER doctor, after seeing me after the visit from my patient's wife- What's going on right now? Hood nurse, are you crying? There's no crying in the ER! No crying!

If you don't know what she was referring to, shame on you.

Let's Play a Game

Are you ready? Here's a game we play at work when captain dumbass from the major city fire rescue squad brings us a patient. It's called "find all the stupid shit on this run sheet". Whoever counts them all is the winner. Go!

On a CPR in progress-
UNIT 123 ARRIVES ON SCENE TO FIND FEMALE PT WITH MULTIPLE LOWER EXTREMITY AMPUTATIONS LYING ON FLOOR OF APT UNRESPONSIVE. PT HAS BLOOD PRESSURE OF 150/90 BUT NO PULSE WITH RESPIRATIONS OF 7. KING TUBE INSERTED AND PT TRANSPORTED TO HOOD HOSPITAL FOR FURTHER EVALUATION.
VS- BP-150/90 HR-- RR 7 ECG-Normal Sinus
GCS-Motor-Obeys commands-6, Speech- Converses normally-5, Eyes- Opens spontaneously-4
Circulation-BL upper extremities-normal, BL lower extremity-normal
Hospital-Patient's choice

Your time starts now. Make sure to show your work.


Disclaimer to the inevitable butt hurt commenters- I promise, there really are not extenuating circumstances- this particular guy is seriously that lazy and that stupid. He stayed at the hospital for 30 minutes putting this together. Just think about that for a minute.

How I Do It

ER nursing is so, so much bullshit. Really. I mean, it's obvious from this blog, but I'd say about the vast majority of the people we see don't need to be there, for various reasons- either they're here for a problem that could be handled by a clinic, or they're looking for drugs, or they have a problem that could have been prevented if they bothered to fill their prescriptions and actually freaking take some responsibility for themselves or their health, or they're just overall not bright and/or educated enough to know that the problem they feel is an emergency is not an emergency at all. I go whole shifts sometimes without seeing anyone in need of help that I can actually provide. A lot of the times I'll go a whole day where everyone I see treats me like total shit.

I have no regrets about my career path, but it's certainly not what I envisioned when I became an ER nurse. I was not prepared for the kind of douchebaggery people dish out in this place. I know I probably sound jaded and hateful sometimes. People ask me pretty regularly why and how I do what I do.

This is how. Night before last, I can truly say I had a role in saving a man's life. A man who wasn't ready to die, who actually had a chance, but who was very much on his way when he came to us. My teammates and I busted our asses for about two hours to save him. I left work an hour late with blood and vomit residue on my scrubs. Exciting, exhausting, stuff, a nice change of pace from the CYA chest pain admissions and nursing home dumps.

Tonight I was back in the midst of my regular routine, when I noticed a familiar face coming around the nurses' station- the wife of my patient from the night before. She walked up and gave me a big hug, and with tears in her eyes, and thanked me and my charge nurse and our doctor for saving her husband's life. She told us he was up in the ICU, doing much better, and that he would probably be released in the next few days. She had so many kind things to say about the care he had received, even in just the short couple of hours he had been with us. She told me she could tell how much I cared, and that she would always remember my face- I couldn't possibly hold back the tears. Even our cocky cowboy doctor was clearly touched.

It's hard to describe the feelings surrounding this, the exhilaration, how important it is. It's not an issue of hearing someone praise you and say nice things about you. It's knowing that you actually changed someone's life, that you were able to help them for the better, and be there for someone who needed for you. It's really not something we get to do a lot here. But when it happens. Wow. It's like being on top of the world. It's something I'll remember forever. Something so wonderful that one million abusive drug seeking trolls can diminish it's joy. It's why I became an ER nurse, and it's how I do what I do.

Real Life Floor Nurse Complaint

In regards to a medic who had just transported a patient upstairs to a room, where he alone moved the patient to the bed, got the patient comfortable in bed and raised both side rails:

"He just took the patient up there and LEFT THEM! He always does that, too!"

Shortness of Breath

Yup, patients, you may have heard of this little thing we use in ER called the ABCs. Meaning, we prioritize based on airway first, followed by breathing, then circulation. So, I suppose you have now inferred that an airway issue would, logically, take priority. Good job! Great intuition on your part. Now, we're glad you chose to be seen at Hood Hospital, and we are here to listen and take your "shortness of breath" seriously. Let me, though, clarify a few things about shortness of breath.

-People who are short of breath are incapable of yelling " I can't motherfucking breathe"repeatedly at a volume that patients at the opposite ends of the ER with their doors closed can hear you in triage.

-People who are short of breath don't generally have the energy to punch the glass at the triage window.

-People who are short of breath do not generally attempt to spit in the face of the nurse trying to evaluate them.

-People who are short of breath do not throw themselves on the ground and fake a seizure when they are told by the nurse that they are indeed satting 100% on room air with clear lung sounds.

So, for future reference, you're on the right track, but you definitely need to modify a few things before you go back to a room immediately. True, you did get seen quickly by a doctor today, but only long enough for him to say that you were, in fact, breathing fine, before the police hauled you off to jail, which I doubt was your goal.

On a related note, a quick hypothetical- If a 90 pound crackhead can break the "protective glass" in your triage area with a single punch, is it still fair to call it protective glass? Just something to think about.

I Probably Should Have Seen That Coming

Nurse Buddy, to me- "Girl. You have got to go take a look at my baby in room 6. It's one of the cutest babies I've ever seen in my life. Seriously."

I walk in there to find indeed one of the most adorable babies I've ever seen, with a tiny adorable baby afro and huge dimples, all chubby and giggly and squee-inspiring. It was especially impressive given the fact that his dad, who was there with him, was a dead ringer for Lil' Wayne, minus the dreads.

I stayed in there for a bit and made a fuss over the baby and then excused myself, making some joke about how the baby was making me want a kid but mine couldn't possibly turn out that cute, so I had better go. Of course, hood hospital Lil' Wayne didn't miss a beat and responded with, "It would if you had the right daddy!", smiling to reveal one of the most ridiculous grills I have ever seen and pointing enthusiastically to himself.

Damn! I walked right into that one. I mean, I'm married and don't want kids any time soon, but I still don't even think that would be a viable back-up plan just based on how many prophylactic antibiotics would be necessary alone.