Sympathy

Dramatic attention seeking type patients generally seem to be accompanied by one of two types of family members. Generally, the only people that can stand to be around folks like this are the ones that genuinely buy in to all the drama and crazy, and seem to derive some satisfaction from encouraging and enabling the ridiculous behavior. These are the ones that talk for the dramatic loved one when they are suddenly stricken with the inability to do so for themselves, the ones bum-rushing the doctor cove to demand more pain medicine, the ones interrupting the nurse assessment to tell me "she has a very high pain tolerance, so when she says it's a ten, it must really hurt." Yeah, okay, because your lady friend's 15 ER visits in two months are very indicative of her high pain tolerance. These types, usually men, but not always, are by far the most common. It makes sense-how many normal people would stick around for this kind of crap if they weren't part of the routine?

Occasionally, though, we get the other kind-the ones who see the foolishness for what it is and are completely and totally over it. They usually sit by silently and pretend to not be aware of the foolishness by throwing themselves into a sudoku book or staring intently at a laptop. Every now and then when the drama is really reaching a crescendo, they'll throw in some half assed words of encouragement. Almost inevitably, they reach a point where they can no longer hide their annoyance, and they find a reason to excuse themselves.

I took care of a lady last week who played out this scenario with her boyfriend almost exactly this way. She was most ridiculous people I've dealt with in some time. I mean, this lady was not a whole lot older than me, and she kept trying to get me to put a catheter in her so she didn't have to move onto a bedpan. She seriously starting pissing herself when I said no. I had to have hold help for her IV. I mean, really. She was cray. I had to go to CT with her and the tech and I had to coach her through lying on the table- homegirl insisted we put a washcloth over her eyes while her abdomen was in the machine because it felt cramped and it was too scary.

So imagine everyone's horror when the doctor decided she needed an MRI of the L spine. This is seriously how it went down:

Doc: So, ma'am, I'm concerned about a couple of things we saw on your CT and I want to do an MRI.

Pt: NOOOOOO!!!! I can't DO THAT! It's too scaarrryy!!!!

Pt's boyfriend: Honey, just let the doctors do what they need to do, you'll be fine.

Doc: Yeah, it'll be okay. We can medicate your for the procedure so you'll be nice and relaxed. We do it all the time for people who are claustrophobic.

Pt's boyfriend:Yeah, babe, see, it'll be-

Pt: Will it knock me out? NO? Then it WON'T WORK. If you can't knock me out, I'm gonna get scared, and then I'm gonna vomit and-

Pt's boyfriend:Babe, seriously, calm-

Pt:and then it'll go in my lungs because I can't sit up, and THEN WHERE WILL WE BE?

Doc: Um, I mean, we don't want you to aspirate. How did you do for the CT?

Pt: Horrible! They had to put a cloth over my eyes, and that was only for five minutes!!

Pt's boyfriend (about to go off in one, two..): Then maybe they can just put a bag over your head for the MRI! JESUS! STOP!

Yeah, I got the hell out of that room STAT. Anndd about five minutes later he came up to the nurses station to leave me his number because he had to um, get ready for work. YUP.

Chief Complaint of the Night

"So like, I was sneezin' like, all day today, and I work with the public, so, I can't be at work sneezin'. So I came into the ER 'cause I missed work and 'cause I want the doctor to give me somethin' to stop the sneezin'. How much longer do you think this is gonna take?"

Yup, this is a phenomenon those of us in emergency medicine (okay, just me) like to call "acute work excuse deficiency." To be fair, though, she did also want a pregnancy test.

Kitchen Rescue

Decided to do some cleaning tonight in an attempt to try and like, contribute something to the upkeep of our home and stuff (I would live like a squalorous wino were it not for my husband) when I unearthed a tupperware container containing something that may or may not have been made in 2011. Like, I knew suffering was going to ensue when I opened that shit.

I dreaded it, considered just throwing away perfectly good tupperware, but was ultimately able to psych myself up enough to open it up and wash it. How? I was all, "What's the grossest thing I've seen at work? Maybe oozy stasis ulcers with maggots crawling in and out? Well, this isn't maggot infested stasis ulcers gross, so it'll be okay." And thus, the tupperware was recovered. Thanks, nursing.

Prescription Refill

Of course the ER is the appropriate place to get your prescription refilled! I mean, I can't think of another appropriate place to do it. So, okay, obviously we are here to serve you and you only with your prescription refilling needs, but let me just help make you experience a little more efficient and pleasant and all that with a few tips:

- I know that your doctor's office doesn't open for a whole half an hour from now and they make you do that copay and stuff which is approximately the same cost as a 12 pack of Bud Light, but it really might be worth it on days like this where the ER is super busy and stuff and half of it is holds. Just to clarify.

-Please try not to get too upset when someone who is having a stroke is seen before you. Sometimes life is just unfair that way.

-When asking for a prescription refill, it is very important to know the name of the medicine. Or the dosage. Or at least what it's for. Or, never mind.

-When coming to get a prescription refill for your child, try to know whether the child has actually been diagnosed with any medical problems that would necessitate refilling said medication. The fact that you have been giving the child his siblings medications for a problem you think he may have been diagnosed with a year ago does not mean he actually needs it.

-Your triage code is a 5. Do you know what that means? It's a fancy way of saying, "you never should have come here for this shit, but we will refrain from MSEing your ass out of this ER because we're nice like that." It also means you are not in a position to be screaming at the doctor because you wanted more prescriptions refilled, or more pills, or a higher dosage of pain medicine. I have witnessed doctors who were subjected to this sort of foolishness take the prescriptions back, shred them, and replace them with a prescription for a megadose of GTFO to be filled be security, so I suggest you tread lightly.

Okay. Any more questions? Great. As always, thanks for choosing Hood Hospital.

Anatomy

The seven hour waits of February are always a great source of creativity for Hood Hospital patients. Hmm. How can I get seen faster for my flu like symptoms? Adding additional complaints while you're waiting is a popular one, but the number one most popular tactic by far is to say you have chest pain. I slipped and fell down the stairs and now my tailbone hurts, and also I've been having chest pain all week. Sorry to disappoint, but this alone will not get you seen any faster. You will get an EKG in triage, which of course, will be normal, and you will get labs drawn when you go back to a room. In seven hours. Like everyone else out here.

So, what's the solution? Well, ever you are an ever adapting and clever Hood Hospital ER patient, the answer is to get even more specific. Such as the lady who checked herself and her three kids in for the upper respiratory infections they've all been nursing that week. I start triaging with the oldest of the kids, and this is seriously what she tells me: "yeah, well junior, he been coughing for like, two weeks steady, and when he cough, he cough like this green phlegm, and when he cough his heart hurts." YUP. His heart. Note patients, the bar has just been raised.

Me, to patient: "Point to where it hurts when you cough, sweetie."

Junior: "Here." (points to middle of chest)

"Okay then. Who's next?"

Natch, all four of them had heart pain in the middle of their chests whenever they coughed or took deep breaths. None of them had any medical history. Zero of them got EKGs. Sorry about the wait, folks. The ER beds are all full of people getting 5 hour cardiac workups as opposed to 15 minute flu discharges.

That's Not It

While collecting the history of a non-verbal patient with advanced dementia who came in via EMS:

Pt's son: Yeah, so, she was over there at the nursing home, and her blood pressure was high, so they gave her some insulin, and then that was when we were gonna send her over here and-

Awesome baby nurse coworker: Wait, insulin for her blood pressure? I'm pretty sure that's not what happened, sir. Are you sure?

Pt's son: Yeah! I know it was insulin! I was there!

Awesome baby nurse coworker: Well. It was the nursing home. Maybe they did do that.

Chief Complaint of the Night

Typical balls to the wall Monday night triage at hood hospital with an average wait time of 7 hours:

Crayzee* Pt: Yeah, I'm really tired of coming up here for this same thing. I have all these parasites coming out of my mouth, and my nose, and my ears, and y'all keep giving me all these antibiotics and stuff and it's not helping. I need something that will kill it, not just slow it down!

Hood Nurse: Um, yeah, okay ma'am. So, how long has this been bothering you? Are you hurting anywhere?

Crayzee Pt: Yes it hurts! They're falling out of my nose right now! This is been going on for three years and you guys won't help me! Last time they sent me to an ear nose and throat doctor, and he told me it was boogers! That's bullshit! Fucking quack!

She then proceeds to pull out some weird looking petri dish like container full of boogers suspended in water.

Hood Nurse:Uh, okay ma'am. Go ahead and have a seat in the waiting room for me, they'll call whenever they're ready for you.

*TM Nurse K

ER Forensics

This morning I get our usual 4 AM nursing home dump, the ever so uncreative altered mental status in a late stage Alzheimer's patient. Yeah, okay. We've started theorizing that they're just transferring the patients for diaper changes now. So of course as we're doing the old person AMS workup that always includes a Foley catheter, we open the diaper up to find a diabolical situation including a turd that is probably older than some of our nurses. Enter famous emesis bag nurse and I attempting to carbon date fossilized stool.

Hood Nurse:"Dude. This has definitely been in there a while. There seem to be rings forming around it. And there's like, a film on it, see that? What would you say, that has to have been there for like, at least 4 hours, right?"

Emesis Bag Nurse:"Four hours? No way. That's way under. It's pretty obvious she must have dropped that when she heard Whitney Houston died last night and it's been there ever since."

When in doubt, guess high.

Communication

Hood Nurse: Okay, ma'am, I'm gonna give you some medicine right now. The first thing I'm going to do is give you some IV fluids. It's very important to stay hydrated when you have a fever and an infection, so this will help with that. The other medicine I'm giving is called Rocephin. It's an antibiotic to help fight the infection.

Patient, to her husband: Ask her to tell me what these medicines are for.

Help

Okay. I'm really, really trying to figure out if I'm crazy or not. I've been polling my coworkers and I'm getting split results. Occasionally, when staffing is really sufficient and rad (one thing I will say for my management, we're no longer trying to run a 45 bed ER with 6 staff nurses, which is always nice) we get a float nurse. Like, someone whose only job is to help everyone else and make sure their shit is in order. I never actually get assigned this task (they give the rooms to the ones they know can take some punishment) but I occasionally fill this role when they assign me to the resus rooms and I don't have any dying patients.

Anyway. It's not fucking rocket science. We page ambulances overhead when they go to rooms, the trackers clearly show who needs treatments and meds now that we do computer charting, and the lab label machine prints out big red stickers for the patient that need LABS drawn. So when I have nothing to do, I look for this stuff, and I go do it, because it's my job, and that's what I'm being paid to do, as opposed to sitting at the computer paying my phone bill. I'm the float nurse. You know, float around and do shit. Find stuff to do.

So the other day I'm getting the standard ER ass kicking- ambulances waiting outside my room as the patient I just discharged walks out and housekeeping wipes the stretcher off type of day. I've been doing this long enough that I can do it all myself. It's just a lot of work. We have two, count 'em, two nurses floating. What are they doing? Shopping online for a friend's baby shower. Obviously.

Whatever. Again, I've got my head above water. I'd just really like to chart and pee and eat a snack, but oh well. That's the way the ER goes. Finally, at one point, I have to flatten myself out a like a roach to get past one of them who is obliviously standing in front of the med area talking about cruise ship food with my charge nurse who is also sitting on her ass when she notices the pile of shit I'm balancing on top of the EKG machine. Ten minutes later when I sit down to chart, the mentalist over here uses her astute powers of observation and makes a comment that I looked busy and if I needed something I could have asked for her help. Really?

Nope. I just gotta sit down and chart all the shit I've been doing for the past 2 hours, it's whatevs. Then she wants to know why I didn't ask her for help. I tell her what I genuinely believe. Really. If an ambulance is coming into my room, I honestly don't have time to figure out where you are and ask you to come help me. Because I have an ambulance. By the time I find you and wait for you to finish your conversation about which airline is your favorite to ask for your assistance, I might as well have just done all the shit myself. So that's what I do. You have ears. If you hear "ambulance to room 2" being announced overhead and you don't have the sense to go in there to help when your entire job tonight is to help, then you probably aren't much good to me anyway. But thanks. I said it in a much less harsh manner than this, yet she and the charge were both looking at me like I'd sprouted a second head.

So what is your stance on this, internets? Am I being butthurt and expecting my coworkers to be all powerful mind readers? Or is a little initiative too much to ask? I really don't know anymore.