Let Me Just Say..

...a quick thanks to everyone today and I will try to move on with my life. I am really not eloquent enough to express how much the support I've received from everyone really means, but let me try.

My approach to life and my job at times does not serve me very well. I have high expectations of individuals and humanity. I have even higher expectations for myself. I'm often disappointed on both fronts, but this way of thinking is what makes me want to keep doing what I do and loving it. I try to see the good in everyone and treat them accordingly; some days are more difficult than others.

Even before all this happened, I'd been having one of those periods where I was kind of just being bombarded with foolishness and douchebaggery every time I came to work. I was physically and mentally exhausted and continuing to be tested pretty frequently. I was starting to feel the bitterness set in, and I already kind of just wanted to get away from everything, and then all of this bullshit happened. I really felt powerless to help anyone, and I questioned why I was even trying. I saw a lot of ugliness around me, and a lot of ugliness in myself. It was just an awful cycle of feeling bitter about everything I do and then feeling guilty about feeling the way I did. I felt as if nothing good I really did mattered against the overwhelming amount of apathy and cruelty.

Thankfully, it seems that benevolent and compassionate people have an inexplicable way of recognizing distress. My friends and family have shown themselves to continually be more wonderful than I could ever imagine. But the kindness of those I don't know well has really the most overwhelming part. My gruff, sarcastic coworkers became empathetic confidants; quiet, sweet types who I always liked but never knew well wiped away my tears and offered me their prayers. And people who read this-stuff- stuff, that as far as you really know, may be the elaborate delusions of some crazy person- have been willing to go so far for me. People who don't know me at all who are willing to share stories that no doubt open up old wounds for them to make me feel better. So many of you have offered such heartfelt concerns and comfort to a complete stranger. To those that posed questions as to whether it helped, yes, it absolutely did.

You see, my self blame and doubt about myself is always going to be a facet of who I am. Unchecked, it consumes me- in balance, it just drives me to be better. I'm somewhere in between- in a better place now than I have been. But my doubts about human kindness? Vanquished. Again, I don't know how to say how important this is in me carrying on doing other than to say it's everything. All of your kind words were the answer to my prayers and a huge part of me being able to carry on. Thank you again, and back to the usual crazy soon.

And We Though Heroin IM-ing was Bad

Heroin is really not the drug of choice at Hood Hospital (crack cocaine forever, y'all), but I'd say we still see a moderate amount. When users run out of veins, they often resort to shooting the heroin straight into the muscle- not as quick a high, but it gets the job done. The additives in the drugs combined with the circumstances under which they're taken result in some pretty horrendous looking wounds.

I've seen some pretty horrible shit secondary to drug use. But what happens here is, like many other things, a freaking cake walk compared to what's happening in Russia. My brother sent me an article today about Krokodil. It is to heroin what crack is to cocaine- a cheaper and less pure alternative- except it ROTS YOUR FLESH OFF. It's actually a little more comparable to meth in it's preparation in that it's made from over the counter drugs and a bunch of other shit that's toxic to humans. Apparently in Russia, codeine is available over the counter. The codeine preparations can be turned into desomorphine (similar to heroin) pretty easily in a lab, but the solvents used in this process on the street are pretty much just poison, so when the users inject, they end up with some pretty horrific wounds that often end up being gangrenous. Amputations are not an uncommon side effect. Here is the io9 article if this sort of thing simultaneously fascinates and frightens you as much is it does me. Fair warning- graphic rotten flesh pictures ahoy.

I can't explain why I find this so interesting. I guess the psychology of addiction is just really compelling to me. What is happening inside someone that they really cannot give up a substance that is literally costing them limbs? How does someone willing to inject heroin into their genitals to chase that feeling? Seeing stuff like this makes me feel a lot more sympathy for addicts. The willingness to face this much suffering for a feeling that lasts for a couple of hours is nothing short of insanity. Something inside them is clearly different.

Things That Make Me Stabby

I've had a lot of really difficult, sad cases at work lately. I'm just gonna be honest when I say that I feel like shit and I don't have the energy to write about it at the moment, so I'm just gonna express my sadness as displaced rage like any other healthy American and talk about some stuff that really pisses me off. Well, one thing.

Now that's out of the way- you know what really pisses me off? These idiot assholes who bring their young kids in for asthma and reek of cigarette smoke. It makes me sad to even acknowledge how much it happens. Pretty much without fail I find out while taking care of these kids that it's not their first visit to the ER, either. Oftentimes, they look like shit and need to be IV'd and transferred, and I find out it's not even their first IV start either. Seriously?

If you and your kid both smell like a pool hall, you're obviously still smoking inside your house and probably your car with the toddler in tow. If the kid has been to the hospital for this before, I cannot fathom that you don't understand that this will almost certainly lead to another visit where your child will again be held down by several adults and get another damn IV start. The weather isn't that bad here. Literally the only change you have to make is walking outside for a matter of minutes. Even if you weren't told that this simple lifestyle change could be the difference between your child sitting at home playing or going to the ER and being tortured, which I find very hard to believe, it's a pretty simple cause and effect relationship that anyone who isn't a complete dumbass should be able to observe. The only two options then, are that you're really, really stupid, or you are such a shitty parent that you really don't care about your child's health enough to step outside for three minutes. Judging by the reactions I get from the education I attempt to give on this subject, I'm guessing it's the later. A butthurt "Are you saying this is my fault?" is not generally the response I get from parents that care.

But yes, since you're asking, I am saying that. Because it is your fault. Please, continue smoking. Just not around your small child. It isn't that hard.

Dear Floor Nurses

Hey, I really, really want to be cool. Yes, when I am not getting my ass handed to me, I will make sure that my patient has a brand new, shiny, non field IV started for you at 1201 so that you can keep it a little longer, my paperwork will be impeccable, I will document a skin assessment, draw any pending labs and start the admission fluids and I will give you 5 minutes to call me back so you can talk to the doctor on the other line. I know your job is hard, too. I really do.

Do you think, though, that maybe, just maybe you could try to do me a solid back by not making the 5 minutes actually 30 minutes, or asking me if I filled out the medication form 3 different times? Listen once and you'll save lots of energy in the future. Do you think a sarcastic "really?" is the most appropriate response to the fact that the patient has a 24 gauge IV that flushes very well? Sorry, if I could use voodoo to conjure up veins in dehydrated 98 year old DNR patients whose families rightfully don't want to put them through getting a central line, I totally would, but we didn't have a lesson in ancient magic during my internship. And while we're on that subject, I was also never trained in divination, so I don't know how to answer the question "what is her blood pressure going to be when she gets to me?" Also, riotous laughter about how shocked you are that an ER nurse actually did a skin assessment when I tell you my patient has non-blanching redness on her sacrum is not necessarily the most appropriate response, just so you know. Sorry if on the days I have a combative psych patient, a call light happy drug seeker and I dying ICU patient that I don't immediately think to run into the room of my immobile, non-verbal nursing home patient to explore what's happening under the diaper. I know that makes me an atrocious nurse and I should probably quit right now.

Seriously. It's so good we don't do bedside reporting. There would be so, so much more punching, that that's unprofessional.

ER Party

Family calls police and fire rescue out to their house because they can't get their son to get off the lawn and stop doing ninja moves. Naturally, upon finding him, they bring him to us, with his brother and his friend following close behind. They get there and are obviously toasted as well. I just love it when I get an intoxicated patient and the friends who were with him at the scene show up in sunglasses at 3 am. Yeah, okay.

So, we finally give the guy enough Ativan to get him to stay on the bed and to sit through an entire head CT without trying to grab his junk (it took about 3 attempts). We finally finish up, and wheel him back to his room. I'm talking to his primary nurses as we're hooking him up to the monitor and she mentions that his brother must have gone home. Just as she's saying this, I turn around to see the patient's brother and friend in the empty room right across the hall. The patients brother is dancing to one of the music channels on the TV, doing what appears to be the robot with the call light in his hand. His friend is sitting in a chair right in front of him, staring at the wall without blinking. Family of winners, these guys.

I Think They're Just F-ing With Us Now

Oh, hi local fire medics. So hey, I've resigned myself to the fact that you aren't going to start IVs on diaphoretic patients in respiratory distress with sats in the 40s. I'm over it, I'm not trying to say anything about that.

But can you just do me one favor? Yeah, could you please not stand in the room drinking coffee watching us start the IV and set up the ventilator right where everyone moves in and out? Thanks. And if you're going to stand there, can you at least drink your coffee quietly, as opposed to loudly making fun of our very nice, young enthusiastic RN for explaining paralytics and sedatives to the EMT student because "he's just a basic, he doesn't need to know all that"? Really douchebag? Really?

Do you guys have some kind of bet up there at the station house about who can be the biggest jackass? Because you've got my vote.