Pile Up

We sure did have a twelve patient MVC last night.

Yeah, twelve. Van full of kids with their parents breaks down on the service road. They call their friends, who also happen to be carrying a station wagon full of kids, to come jump them. Cars are facing head on to jump the battery of the van when some drunken asshole swerves off the road, hits the van, which in turn runs into the station wagon. Naturally, this all goes down in BFE surrounding county, who has a total of three ambulances. What do they do? They go full ambulance clown car, pack like, three patients per truck, and book it on down to Hood Hospital. We knew they were all coming- my patients were all waiting on disposition, so me and my medic buddy just went out in the bay with stretchers and unloaded the patients from the back of the ambulance. We look up to see that a little shelf on the ceiling where they store extra backboards actually has one of the kids on it, back boarded and c-collared. Holy crap, good thing he was stable.

Most of the injuries were pretty minor, if not non-existent, so we parked all of them along the hall, took vitals, and did about a two minute triage- okay, were you in the car or the van? Do you remember everything that happened? Do you hurt anywhere? Do you have any medical problems? Are you allergic to anything? Okay, next. The worst of all the injuries ended up being a little school age boy with a fib fracture, who was the biggest badass of all. He was all polite and yes ma'am to everything we said, and rated his pain at like 4, was more worried about whether his siblings were all doing okay.

It ended up being kind of a funny story and almost like a little mock disaster drill, but it could have been so much worse. Don't drink and drive, kids.

More Fun With Coordinating Transportation

It started like so many other cases at Hood Hospital. Elderly gentleman who normally makes it around the house on an assistive device and gets his everyday stuff done with the help of his wife has a rough day and takes a spill. He's then transported to us via EMS without said assitive device, wife stays at home. Thankfully, pappy is just fine, his c spine is cleared, and he's ready to be discharged. Enter drama.
Awesome baby nurse coworker calls his son, who is listed as his emergency contact, to see if he can come down the road and pick dear old dad up from the ER. His response? "Um, I just lit a fire in the fire place, so, I can't."
You can't put some water on it or something?
"Nah."
Coworker then tries the approach of playing it tough and saying he really needs to come up here and get his dad. Yeah.
"I can be there in like, two to three days. You guys need to keep him, and like, check his blood, and his sugars, and his organs. Yeah. Yeah, you guys need to check up on his organs."
All I'm hearing at this point is my friend's end of the conversation. "Check his organs? What? What are you talking about? I'm hanging up now. Bye."
So I guess at this point he's trying to figure out with the wife whether the poor guy can go home via cab or if he needs ambulance transport. He's kind enough to put this one on speakerphone, where this 70 something year old lady totally loses her shit on him for asking if it's safe for the patient to go home via cab. At the crescendo of it all, she ends up on some crazy ass rant about how awful our hospital is and that's why they always talk bad about us on "the black folk radio station" and that's how come no one goes to Hood Hospital.
Finally we just say screw it and arrange for private ambulance transport. It's ridiculous, but at times it's really the only viable option. I know he was beyond frustrated about he amount of verbal abuse he took for just trying to do the right thing. I couldn't stop thinking about how long he'd been dealing with the whole situation and how many combined man hours our nursing staff must put towards non-medical fuckery like this. It kind of makes my head spin.

How to NOT Get a Cab Voucher

-Take the ambulance here for a complaint 100% secondary to you being an idiot

-Your idea of asking nicely is "go get me a voucher"

-You think you're being very cunning when you tell me and other staff members "The doctor said she'd get us a cab voucher" (world-famous emesis bag nurse's response: "the doctors tell everyone that so they can get out of the room and not have to deal with you anymore.")

-Five of your family members magically showed up here after you came in on an ambulance and you want us to get all of you turds a ride home. One, it's good for one person only. Two, how the hell did the rest of you get here in the first place? Wait, I don't care.

-The last time you were here and we said no to a cab voucher, your spouse suddenly started having a chronic back pain flare up and decided to check in.

-You mention you live within walking distance.

-And always, number one, forever: Say something about how you always get a cab voucher. Say it. Please. I will make sure that you DO NOT get a cab voucher. I will eat the cab voucher. I will make you fish the cab voucher out of the sharps container or the bio waste bin. I swear. Ever wonder why your hospital visits cost so much? It's because of shit like this. It's because there are actually assholes out there that come to the ER routinely for stupid bullshit, are sent home for stupid bullshit, and act foolish enough that we ALWAYS pay their way home. Then when some poor little old granny who would never think to ask for a cab voucher and actually needs one to get home because she can't drive and has no family in the area, we don't have any more cab vouchers because we gave them all to the same douchebag who keeps calling an ambulance for non emergent foolishness. Whatever. I'm over it. Point is, I will say no. Nope. No cab voucher for you. You can think about your life choices and what is owed to you while you walk your ass home. Bye.

Yet Another Enlightening Triage Experience

Woman presents with her toddler. You know the rest.

Pt's mother: Yeah, so I'm bring him in 'cause he has a fever, he woke up and was just shivering and stuff.

Me: Okay, yeah. So what was his temperature?

Pt's mother: Scoff. Well, I didn't take his temperature, I mean, that's why I brought him here.

He didn't have a fever. But he did have Cheetos!

Logic

Me, to patient being seen for abdominal pain as she was about to chomp into a double cheeseburger: "Ma'am, you really shouldn't eat until we have the results of your CAT scan back. That's the reason I wouldn't bring you coffee when you asked me for it earlier. I'll let you know as soon as we know something, though."

Patient:"Well, if I can't eat my cheeseburger then I need more pain medicine. I haven't eaten all day. This shit is ridiculous!"

It was a ten. Obviously.

Step Away From the Laptop

Late middle-aged lady comes into triage last night with chief complaint of bilateral leg numbness and inability to walk with spontaneous resolution about an hour prior to arrival. Concerned, I started asking more questions. FAST screen? Negative. Any other symptoms when this happened? No? Any medical problems? No. What were you doing when this started?

"...Well, I had been lying on the couch with the laptop on my legs for an hour or two, and when I got up, my legs felt all numb and tingly and it was hard for me to walk. So I looked up leg numbness on my laptop and it said on the internet I might be having a stroke."

Uh. I think there was a message in all this somewhere, but it is definitely not getting across.

The Big Picture

Parts of ER nursing are still really difficult for me to deal with. Twice today, I had to clean up the pieces after patients were given some very bleak diagnoses. Sweet people. People who thought they were coming to the hospital for minor emergencies who found out otherwise. Turns out, this cough looks like pneumonia that's probably secondary to AIDS. Yeah, this headache is a brain tumor. Trying to hide the fact that I'm crying when saying goodbye after someone looks me in the eye and tells me I'm a great nurse just because I wiped their tears away and brought them a sandwich.

But in combination with other things, it's almost intolerable. The enraged patients who are upset because they waited so long to be told nothing is wrong. The one that swore and screamed and threatened to sue because the million dollar work up was all negative (side note, she knew her body). The ones using their immaculate, cancer free brains to think of what to say to get more Dilaudid, yelling obscenities at us at the top of their healthy, well oxygenated lungs on the way out the door to go home to their families that they will spend several more pain free decades with.

The juxtaposition kills me, but the truth is that most all of us, myself included, are walking around on and breathing with tons of precious gifts that we never acknowledge. I've been bummed out about my ten year old car breaking lately. This morning I'm just thanking God for my pain free body and my kick ass cardiopulmonary system. Not everyone got one today.

Conversations in Triage

After triaging a 14 year old patient with a 102 fever:

Hood Nurse: Okay, well everything looks good but that cough and fever you're having, so I'll go ahead and give you some Ibuprofen while you're waiting to see the doctor. It should help with those chills and make your throat feel better, too.

Patient's mom, rolling her eyes: Really? All you're gonna do is give him some Ibuprofen? I have that in my medicine cabinet, I could have done that at home.

Hood Nurse: Um. Well...

After I suppressed the urge to tell that between her and her teenage son, one of them probably should have figured out that antipyretics work for fevers, she then got mad because I tried to give him pills instead of a liquid. I'm just saying, this stuff might be why I come across like a cranky B at times.

Hood Hospital Lockdown

Hey guys! Here comes multiple walk in gunshot wounds! Hooray! Obviously, these fine citizens were just minding their own business when a bunch of dudes came out of nowhere and opened fire (does it ever happen any other way?) Point is, we have a shooter still at large. No one can say what he looks like, because no one knows him, because they were just going on down to the local homeless shelter to do some volunteer work to earn their eagle scout service badges when a gang of hoodlums, probably wearing masks, started shootin'. So what does that mean? It means the MF-in hospital is on lockdown, y'all. That's right, granny who stepped out to call your son. You can't go back and see pappy until this "security situation" gets to a cardiothoracic surgeon, so, just have a seat for a second. Sorry.

Great. So, who enforces the ER lockdown? The hospital police? (cue cricket sounds now).

No, silly! I do! You know, the one who still gets questioned on a weekly basis as to whether I've graduated high school yet? Nothing says "unquestionable authority" like the girl dressed in a jacket from the children's department. Registration knows this, which is why they direct all the verbally abusive folks who can't go back to see their family members right now to me. Also because it takes the letters "RN" behind your name to explain basic security measures, and most grown ass men respond to being sworn at with "if you have a problem, ask the nurse." Seriously? F you, buddy.

And what happens when you call the hospital police and suggest that they might, like, I don't know, like, maybe, one of the five of you might want to post up at this here door that's the only way in and out since you're the only one with that shiny badge and gun? Or something? Naw, it's cool. I feel much better having you tell me "I'm here if you need me", after which you immediately stand outside, away from the waiting room madness and then stand there talking to your buddies for two minutes and then leave because the person who was just screaming obscenities in my face already left before you got here. Cool.

So, for the sake of clarity, we're locking down the ER because we're worried about an armed gunman coming in here and finishing the job, and we're leaving the job to an unarmed nurse. Okay, so if the shooter comes in and pulls his weapon, I'll just disarm him with one hand and stab him in the neck with one of registration's ball point pens using my lighting fast reflexes and extensive nurse combat skillz. Great, but can I get an extra dollar an hour for being triage sheriff please?

"I Know My Body"

As Promised.

Oh, the statement that strikes fear into the heart of doctors and nurses everywhere.

Look, at face value this seems like a relatively innocuous statement. People with chronic illnesses are in tune with when something bad is on the horizon before it's immediately evident to everyone else. I know when my asthma is getting bad before I start to wheeze. One of my fellow nurses who suffers from lupus can feel when she's about to have a flare. It comes with the territory of having a chronic problem.

That being said, people like this are not the ones who utter "I know my body" to ER staff. But who does? Hold on, let me go get my graph:

Obviously this is now the time that every butthurt person who has been un- or mis-diagnosed since medicine was invented is going to come out of the woodwork and tell me what an asshole I'm being, but listen. There is a whole other world of people that those who don't work in crazy town everyday do not even know about. And I can say this as someone who used to not work in crazy town- I had no idea these people were out there before I started working in the ER.

I'm talking about the people who come into the ER on a semi regular basis with the same vague complaint who receive a negative workup each time. Sometimes they get pain medicine, but every time they get pissed off because we can't find anything. We refer them to specialists, who they sometimes see; other times, they just keep coming back to us and getting angry when the same limited tests we can show the same thing (nothing). You know you're really screwed when these folks visit the specialist we referred them to, only to be told nothing is wrong, and then they come back to us for answers.

You can explain the tests results and the necessity for follow up until you are blue in the face, but there's always the one comeback that you can't address- "I know my body! Somethings going on and you guys are missing it!" Sometimes, people want to be admitted to the hospital for "I know my body", because somehow sleeping on the hospital grounds will somehow lead to answers that the extensive tests run today did not reveal.

It frustrates me not to know what the problem is, too. The fact is, there are several illness for which there is no positive test. There is also not a positive test for attention seeking, narcotic seeking, hypochondria or straight up craziness. Unfortunately, regardless of the true cause, this means a referral and further investigation is in order. Dramatically throwing your discharge papers on the ground and shaking your head while screaming "but I know my body" does not change this fact.

Picky, Picky

I will admit I am very consciously not a super particular person. It's probably because I've basically worked service my entire life (before nursing, I waited tables and worked retail) and I always found the multifaceted special request people secretly annoying. Yeah, I can get that salad for you with the chicken extra crispy and no tomatoes and with half full calorie and half zero calorie ranch on the side, but I am totally thinking in my head that you're probably kind of a high maintenance douche. I can put half of your twenty five dollar total on a check and the other half on a credit card, but really? Should you be buying clothes if you don't have twenty five dollars in the bank? Just something to think about.

While I found these people mildly annoying in food service, in nursing I often just find them confusing. Mainly, the things they choose to be particular about. It seems to me the people who want a Shasta with a half cup of ice and then an extra cup of ice with no water on the side are always the sorts that come in harboring some kind of sick-ass fungus on their skin that could have been prevented by simple hygiene; the people that want the head of the bed raised a half an inch up, no, now a quarter inch down, are the same ones that have been sitting on some kind of funky discharge for a month and a half. It really blows my mind. Seriously. How can you be so type A about one facet of your life but you seem to be completely unconcerned about the new species being created between your skin folds?

Maybe it's some kind of joy people take in requesting things of others. I'm embarrassed to ask for a class of water with my beer, so maybe I just can't understand it. I can't really judge since this is the sort of stuff I spend my time thinking about.

Also- I can't get the links on here to work yet, but I've created a twitter account-@hood_nurse.

I might post stuff, or might just use it to see what kind of shenanigans Ilya Bryzgalov is up to this week.

I'm Sorry, I Don't Have Anyone Here By That Name

Triage desk, 3 AM: 50 something male visitor who smells distinctly of marijuana approaches. Foolishness ensues.

Hood Nurse: Hi there sir, can I help you with something?

Visitor: Yeah. Uh, yeah, I'm here to pick up my girl, she's back in the ER!

Hood Nurse: Okay. Do you already know which room she's in?

Visitor: Naw. Naw. She just said that she was about t'get discharged, and they told her she needed a ride, so here I am, I'm her ride.

Hood Nurse: Oookay. Sure. Well, what's her name?

Visitor: I mean, well, you see, I don't really know her last name, but I mean, like she just called me and she said I need to come pick her up, so I'm here to pick her up-

Hood Nurse: Okay. Well. Um. What's her first name? Can you tell me how old she is approximately and what she might be in here for?

Visitor: Aw, no I don't know why she's here, you see, she just said, come here and pick her up.

Hood Nurse: Well, I can't let you back in the treatment area if you can't tell me the patient's name, sir.

Visitor: Well, see, I just call her boo.

Hood Nurse: Well, we don't have "boo" in our system here, hon, so I can't really let you back there.

Visitor (now on cell phone): BOO! HEY! I'M HERE GIRL! What's yo last name, boo? WHAT? I said, I'm here to pick you up! YOU'RE WHAT? You say you at county? Boo, I'm at Hood Hospital! Well I'm here at Hood Hospital to pick you up? What? You're not here? Man, these bitches be wastin' my time out here with this...(wanders out)

Triage Foolishness Edition One Hundred Million

Because we all just continue to find more creative ways to be crazy douchebags, don't we?

Okay, day shift. Let's not abandon our post at triage for an hour because we had an interesting case come in through the front and we wanted to see how it turned out. Really? Seriously? Do you have any fucking clue how much it sucks to walk in an hour behind in triage with 20 people waiting to be triaged? No? Oh, that's right, because I would not do that to you EVER, nor would I even do that to my worst enemy in my wildest dreams, because it sucks. Oh, and B-T-Dubs, I thought the lady satting in the 80s who had to wait an hour to be triaged was pretty interesting myself. Good job on that.

And really, pseudo seizures again? FML. But really, one, if you're freaking huge, physics alone tells us that you don't just fall on your stomach after leaning back in the wheelchair, it requires force, like you propelling yourself for dramatic effect. Everyone in the waiting room saw it, and they were doing dramatic reenactments and laughing at you after you went back to a room. Let's just stick with unconvincing syncope instead of half assed seizures next time. It's hard for me to do a sternal rub on you subtly in front of all these people anyway, and it's documented in your medical records by a neurologist that you were essentially thrown out of his office for being a lying fool, so the Ativan is not forthcoming.

Everyone- keep your pills away from your toddlers.

Yes sir, you're right. Your daughter's menstrual cramps aren't a priority over the chest pains that have been waiting 3 hours longer. Call the complaint line if you wish. Thanks for choosing Hood Hospital.

When checking in for STDs, it is unadvisable and confusing to run up to the triage window holding your crotch and screaming "I'm burned" repeatedly. Also, the courtesy phone is not there for you to talk to your four different girlfriends during the hours your are waiting to be seen for your drippy penis.

Drunk and escorted by the police? It's not even Friday yet, bro! Sorry to hear about your parole situation. That is a bummer. No, I don't want to be your pen pal in jail, but thanks for the offer. I will spread the word to my fellow nurses just in case someone is looking for a baby daddy in the pen.

Do you think if I just coded all these STDs and dental pains as ESI level ones that they might fire me from triage? I'm willing to give it a shot.

Choices

So, last night world famous emesis bag nurse turned charge presents to me this scenario: crayzee frequent flyer or broken penis?

And I replied, "Busted penis it is! Bring it on!"

And so it went. The penis? Super broken. Bleeding more than I would have thought. IVs were started, pain meds were delivered, preoperative things were prepared, paperwork was filled out in a frenzy, reports were called. I ran back and forth for about an hour straight. I sat down at the end of the insanity to see that crayzee frequent flyer was pretty much given a stat discharge by my favorite doctor EVAR sans ridiculous workup or that one D medicine that is the only thing that can cure the body aches associated with the common flu (yes really).

I regret nothing. Yup, I had to do way more work, but in the end I got to make a very nice gentlemen with a very legitimate emergency feel better, versus listening to some crazy douche whine about how no one takes her pain seriously while pretending to nod sympathetically or whatever.

And really, pee breaks are for pansies anyway.

Drugs Are Bad

There has been an odd increase lately in jackasses who are high on whatever coming in for essentially, side effects of being high, but they're so high they insist it's something else. These are the worse people to deal with, because they're already agitated and anxious and they don't respond very well to the medical advice "go home and sleep it off".

This crackhead chick checks in the other day for the crack scratchies, is prescribed Benadryl and steroids for said scratchies, and then proceeds leave without treatment because she's pissed that we "aren't taking her complaint seriously". Homegirl then goes across the street, smokes more crack, and calls the ambulance from there. She's so effin' high when she gets to me that she can't even tell me what's wrong- after 10 minutes I get out of her "I feel bad" and "my skin hurts", but they main point she's trying to drive home is that the problems are NOT related to her drug use. They're just not, I know they're not, because I know my body ("I know my body" is a whole other damn post). MMkay. So, basically she is prescribed anxiety meds, which she of course refuses, throws her rehab referrals on the floor and storms out of the ER again. Okay. Thanks for choosing Hood Hospital?

So then last night, I get some dude who's buddy brings him in for heart palpitations or some shit, who is beyond drunk and high on who knows what else. Admits that he's had about 8 beers and around 5 shots since he woke up that afternoon, won't sit down, won't stop talking about every other thing in the world other than his emergent complaint. Then he decides he wants me to get him a drink immediately and just asks repeatedly using a multitude of obscenities. Lovely. I used to try to deal with this crap myself, but I'm seriously over it at this point. You wanna act drunk and stupid? Okay, fine, the police will finish this triage with us. The one advantage to working with idiots like this is that most of them have warrants, so once they see a police officer they are suddenly on their best behavior. These two didn't even stay to get seen once the police came around- you're welcome, treatment area nurses.

Uggh. Can we add a "drunk, stupid asshole" column to our MSE form please? Thanks.