Unforgivable Douchebaggery

So, just real quick like so it's out in the world, if yesterday, the ER staff were all legit exposed to Neisseria meningitis and employee health, the most ineffectual group of people in the entire universe, are busting their assess to get us prophylactically treated, and you, the ER doctor on duty, refuse to sign the prescription because it was supposed to go through somebody else or some other bullshit excuse, you sir, are an asshole. Seriously. Especially if you try and play like you don't care about what the hospital tells you to do the rest of the time, but now that it comes to bending the rules to help people you have worked with for years you're all of a sudden a boy scout. Whatever dude. And no, I don't want to hear about what percentage of people who were exposed actually contracted the illness in the last study you read. Fuck you, and fuck your study. From this day forth you are dead to me, procedure whore doc. I will no longer talk to you about alternative country. We are finished, because of your actions. That's really it, more posts to come pending me not dying of sepsis before I wake.

Touche

Combative drunk girl, after charge nurse buddy missed her IV because she was interrupted by said girl attempting to punch one of our police officers- "Bitch, what the fuck? Somebody should have taught you to stick veins better!"

Charge nurse buddy- "Really sweetie? Somebody should have taught you to handle your liquor better, because if they had, none of us would be here right now."

Hissy Fit of the Night

A few of our doctors are prone to hissy fits. Such is nursing that you are forced to listen to grown ass men (and occasionally, women) bitch and complain to you like petulant children about stupid shit isn't that important over which you have absolutely zero control in order to get your job done. Anyway. It's usually just annoying but occasionally it's kind of funny, particularly when the doctor in question doesn't speak English as a first language and they're trying to spit out the proper words to express their frustration.

Such as last night, as burly eastern european doc is hastily trying to intubate when he looks up to see that the heat lights in the resus room are on. "Why? Why do you do this to me? Why are these lights on like this? These lights are for snakes and iguanas only! I am not a snake! Turn them off please!" When everyone in the room responded with riotous laughter as opposed to a fearful silence, he attempted to explain further. "These lights are like the lights for the snakes at the petting zoo! We do not need this!" Yes sir! The lights were turned off three minutes ago while you were still talking about snakes.

Henceforth, the heat lights will forever be known as the snake lights.

Screw You ALL

Ughhhh. I feel like I need a week off and about a gallon of gin after just about every triage shift I work. I get stuck up there without fail, the most awful night of the week, every week, and by the end of it my attitude towards everything is absolutely horrible and I am a horrendous bitch and I hate myself for it. I get so disgusted with humanity and then myself that I just want to become a crazy hermit and never talk to anyone ever again. But even more so today, like the douchebaggery of tonight really took the cake.

It was a team effort. And I have to commend the creativity, because people did some amazing shit that I've never seen before. I mean, yeah, coming in with your parents when you're a grown ass adult is old hat- obviously you're not a productive human being so you probably still live with them anyway- but I think tonight marks the record for the amount of times I've seen a man swear at other women in front of his own mother. Even more notably, it's also the first time I've seen a grown ass man throw himself on the floor, dry heave, push his mothers hand with the emesis bag away so he could vomit on the floor of the triage booth, proceed to roll around in said vomit, and then demand his elderly mother pick his 200 pound ass up and place him back in the wheelchair because he "didn't feel like getting up." WTF. Also, the first time I have said to anyone anything like, "Okay, fine. Well, we're trying to get you back and get you seen, but if you don't feel like getting up you can just lay here on the floor and I'll leave and triage people in the next booth. Neither me or your mother is big enough to pick you up, so that isn't happening. The pain and nausea medicine is back there. Get up when you decide you want it." (floor to wheelchair time- 2 seconds). Also, before you feel bad, may I also point out that the culprit in all this drama was that someone's tum-tum hurt x 3 hours after eating some bad sausage and biscuits. Awww.

Also, people trying to weasel out of the complicated process of writing down their name, birthday, and chief complaint all the time, but doing so because you have a sore throat, then faking a syncopal episode, THEN being well enough to scream at me when I try to get you to finish your check in form in a wheelchair that I need to do it- YUP. Okay, it looks like your throat is feeling better now, so have a seat in the waiting room.

Oh, also, in case you were wondering, taking back a white lady with diaphoresis and chest pain before someone of another race with hemorrhoids means you're a racist. DUH.

So yes, I know we're short staffed and stuff and I should pick up extra, but I don't really think I'll be helpful when my state of mind is one of PUNCH EVERYTHING.

Welcome to Hell

This place is a fucking nightmare right now. People are quitting in droves. Like, we're down about a third to a half of the RNs that we're supposed to have on any given day. Not to mention they cut our medic staffing months ago based on the idea that our RN staffing was going to be better. Okay. As the kids these days would say, LOLZ, management, LOLZ.

Surprisingly, management has actually shown some serious fortitude lately. Like, I didn't know it was in them. They're pulling 16 hour shifts, working as charge or triage or something other than staffing where they know the true ass raping occurs, but still. I don't even expect you to deal with that madness when you're up here for 70 hours a week or whatever.

Except- last night was another day like many we've had this week. Big boss was charge nurse. Now, a little about big boss- he's always been nice and approachable- but kind of clueless and spacey. Like, to the point that it scares me a little bit when he charges because one time he nearly transferred the wrong patient to another hospital until I caught and was all, "dude, that's not it." It's like he's been away from the clinical setting long enough that he's just kind of wandering around lost when a situation arises outside of "Room clean and open. Patient go in clean room. Patient like room. Patient unhappy? Me talk to patient, make patient happy. "

So, obviously why it was inadvisable to arrange the staffing so that the area where the really, really sick patients go is super short on nurses so you can open more rooms in the overflow unit and make more patients happy was a concept that escaped him.

So hey, here's all the resuscitation rooms in one spot. There's three of them, and four nurses, and each nurse is expected to take a full assignment including the resus room. Okay. So what happens when one of those rooms actually has to be used for like, I don't know, a resuscitation? Oh, and I forgot to mention that we have no transport, no medic, and no tech. Oh, and the resuscitation? Successful, which is awesome, except now you have a crumping, no-blood-pressure-having patient with an art line maxed out on vasopressors while you're on the phone begging pharmacy to please, please, send us that epinephrine drip stat no really we mean STAT DOUBLE STAT. So, that's at least two nurses in there. At least. Everyone has a full patient load. Everyone. So you have two nurses taking care the rest of the ER while trying to also help out with crashing train wreck ICU patient. Oh, and B-T-Dubs, ICU train wreck sure does have a pneumo because po-dunk fire medics know that broken ribs=awesome CPR (no, really, they were bragging about this while giving report on the patient). Haay, somebody go get the chest tube tray, y'all.

So, what is big boss up to right about now? You know, like filling out charge nurse reports and shit, and asking me if I've called report on my patients yet. Are they dead or dying? Then no, I haven't done anything for them in 3 hours. Oh! And sending ambulances to the few empty rooms we do have, including one with no blood pressure and no veins who was shitting. everywhere. EVERYWHERE. Constantly. But we're loading up all the rooms in the rest of the ER with vag complaints and baby fevers. Lalala!

A few hours in train wreck guy finally stops trying to go be with Jesus quite as aggressively as he was before, and I manage to get a patient or two discharged or upstairs. About that time, I get an ambulance- I'm getting them checked in as post-CPR guy starts crumping AGAIN as I overhear that I'm also getting the next ambulance. I try to catch up on my other admitted patient who has been criminally neglected at this point as my coworkers run in to help with the drain circling. About then my ambulance rolls in.

FUUCCCKKK.

This guy is totally about to die. I mean, stop breathing and code for real. He's satting 60 percent on BIPAP with wet lung sounds that you can hear from the other side of the ER, and no IV access. Big boss is transporting my patient, surely so he can fill my room back up, my coworkers are busting ass in the resus room, the other resus rooms are full, and I am the only person at the nurse's station. I put this dude in the closest room I have while I grab all my IV shit and stick my head out the door to beg our secretary to find the doctor and our registration rep to bring me the crash cart from one of the other rooms. One of my coworkers emerges as the doctor comes running, we get a line, get our RSI drugs, get the guy intubated.

Naturally he's huge with the strength of the incredible Hulk and will not stay down on sedation for shit without dropping his pressure in the toilet. I'm trying to play the please don't extubate yourself game with him and am somehow still expected to magically get my shit together on my admit. I explain the improbability of this to big boss as I hold my patients hand down with my knee and try to switch him to a Versed drip and hang fluids to pressure bags. He responds by finding a phlebotomist from one of the floors to do my stat labs, who promptly comes into the room as I am holding the patient down while RT adjusts the ET tube to tell me that she doesn't know how to draw labs from an IV and she'll have to watch me do it. Yeah, I don't see that happening any time in the future, so just forget it. Obviously it's practical to replace our medics with this. Fantastic. 2 minutes later, labs calls to tell me all of my blood is hemolyzed and I'll have to recollect it.

I just say a prayer that no one dies or gets terribly pissed off while I'm dealing with this. At about that time one of my real nurse coworkers takes over charge and big boss goes to the triage desk. She comes into the room to ask what I need, I tell her all my shit is hemolyzed and I need labs, and she immediately goes to work getting me an IV. At that point, I seriously just burst into tears because I was frustrated and starving and thirsty and already feeling like utter shit and I was just so relieved to finally have someone who was able to help me who had a fucking clue. I think I actually hugged her after she drew my blood cultures.

And really. It was all better after that. Big boss left, ICU patients got beds, and at 5 am I even got to eat lunch! Anyway. I guess that point of this post is that while I appreciate managements' hard work, it doesn't make up for apparently having no fucking sense. Also, that the liquor store doesn't open early enough in the morning.

DB Time

So, I should have known better, but I took report from the first person today who was like "oh hi, my patients are all admitted and everything is done!" Uh, sure. Bamboozled again. Now, I am by no means one of those whiny little princesses who wants to take report with nothing to do. It's 24 hour care for a reason, and that's just unrealistic- that said, I do feel bad when I leave someone else with something to do and I usually stay a little late to help them catch up if it's more than one thing.

However. I have one rule. The chicanery isn't necessary. I'll still take your damn report regardless of whether everything is done. I'll find out eventually what isn't after your ass is long out the door, but it will be more work for me to investigate the matter. Don't lie straight to my face and tell me stuff is done and then make up some bullshit story when I ask you about it. Just be a grown up, look at me in my face, and tell me that you consider yourself an excellent nurse despite the fact that you decided to leave me shit that was ordered as stat 8 hours prior to me getting here. Really. That's all I ask. I will pat you on the back and tell you to go home, have a glass of wine and a bubble bath and pat yourself on the back for being so awesome. Then I will silently file your name into the douchebag section of my mental rolodex.

Which brings me to the real point of this post-obviously lying and doing it poorly makes you a douchebag in my book, but at what point does unapologetically leaving a bunch of shit for someone else to do also put you in that category?" ER BFF and I were discussing this and had differing opinions, so I wanted to poll the internets and figure out- how old does an order have to be for you to feel like it should have been done already? I feel like three hours- an order written at 4PM in the 7P-7A world- should probably have been taken care of before I get there unless a really good explanation is offered. She felt that 2 hours- an order written at 5PM- should be plenty of time. But we both get stuff done pretty fast, so who knows, maybe we are princess bitches after all. So please give me your feedback, inter webs. I kind of want to use the power of math to average all the responses together so I can feel like I have a concrete number which I will, of course, use for academic research to quantitatively justify thinking someone is a douche.

In Your Own Words

One approach to charting I've really embraced in my short time in nursing is the use of quotes. Especially when someone is acting foolish. I've found it's pretty difficult to truly capture exactly how crazy some of these fools are when they come in, but their own words really help paint the picture.

For example, by all means, come to my hospital and request IV pain medicine. Please. I will put in the chart exactly how you requested pain medicine in your IV today. I will chart how many times you called me while you were waiting to be evaluated and every obscenity you used. I will also chart how much Fanta and Cheetos you were eating at that time, and how many times I encouraged you to stop eating with your 10/10 abdominal pain. Finally, when you call me a "skanky white bitch" and tell me "I'll kick your little ass in the parking lot"because the doctor didn't order you that D medicine you got last time, well. One, that shit is now in your permanent medical record, boo. Have fun reporting the hospital like you keep threatening to do. I hope you do report us, and I hope they pull your chart and see how violent and psychotic you really are. Two, hi, I believe that was a threat to the staff? Yeah, meet the police. They will be escorting your ass off the hospital grounds now, bye. Funny how the folks that get brought back to the room via wheelchair are suddenly able to walk independently with a brisk and steady gait once going to jail is part of the picture.

As an added bonus, quotations are just fun for everyone and are the next best thing to a dramatic reenactment you can get. Use as often as possible for the entertainment of your coworkers. Thus concludes my inservice on charting. Reading this will give you approximately 30 seconds of CE credit.

Report Follies

2030 on a typically cray Monday night, calling report on a 60 something lady who was here for chest pain:

Hood Nurse: Yeah, so I'm giving you Mrs. Smith, she's a 65 year old lady being admitted by Dr. Spazz for chest pain. She had one episode of burning to her epigastric area that was unrelieved by antacids, we gave her some Morphine here and the pain hasn't returned since. She should be a pretty easy admission, she's overall a pretty simple healthy patient, her enzymes are all negative, but the doctor wanted her to stay for a stress test just because of her age and because she's a diabetic.

Floor Nurse: Wait! She's a diabetic! Well, what was her last blood sugar?

Hood Nurse: Um, hold on, let me look at her labs from earlier. Looks like it was 63 on her metabolic panel, but she said she hadn't eaten all day and was complaining of being hungry so we gave her a sandwich right after that.

Floor Nurse: 63! That's too low! You need to recheck it!

Hood Nurse: Um, I mean, like I said she was fasting and then she was fed. It wasn't critically low by any means, and it was addressed.

Floor Nurse: Well, you still need to recheck it.

Hood Nurse: Look, this patient is stable, she has no complaints even slightly resembling those of hypoglycemia, in fact, she's been discussing the next Dancing With the Stars cast very passionately with me for the last hour or so, obviously she's okay.

Floor Nurse: Well, I'm not taking that patient until you check her blood sugar again.

Hood Nurse: Yeaaah. I'm not going to do that. It's not an emergency. I'm gonna go ahead and use some judgement and assessment skills and say she's fine. If a blood sugar of 63 just before eating a sandwich is that much of an issue for you, you can go ahead and check it when she comes upstairs or you can call the house supervisor on me if you feel like this is a legitimate issue worth refusing a patient over.

Floor Nurse: Well, whatever. It's your license.

Hood Nurse: Yup. Any other questions?

Floor Nurse: No. (click)

What, you're not even gonna stay on the phone to get the vital signs and ask me if the patient is alert and oriented or if she has any skin issues? Yeah, sorry, on another day I might have obliged, but when there's 50 sick people in the waiting room and I have three other patients that need shit, you're not going to bamboozle me into doing your HS blood sugar. I guess I'm just a bitch that way.

The Answers You've All Been Waiting For

Sorry guys, I've been neglecting the internet a lot lately. To be fair, I've been working a lot and had obligations with friends and family. And also drinking. But anyway, it's not that important. What is important is the answer.... which is... C! If you chose smelly kid, you are the winner!

Yup, someone really did bring in their child because he was smelly. The dog and the booger are both fictional scenarios made up by ER BFF and I respectively that we are convinced WILL happen one of these days. We're just waiting for it.

The inevitable question I'm getting whenever I tell real world friends this story is "was the kid really that smelly?" I'm afraid I can't even answer that question. He was in a pod next to a patient with a GI bleed, all you could really smell in that whole part of the ER that night was melena and sorrow. So, I guess not smelly enough to overpower the scent of GI bleed poo, then. Thanks for playing.

Chief Complaint of the Night

Today we're putting a new twist on this, as inspired by NPR's "Wait, Wait, Don't Tell Me." I'm gonna give you three ER scenarios, and you have to guess which one is an actual chief complaint from Hood Hospital. Are you ready?

Was it A) A 20 something man who checked in because he had a booger stuck in his nose that was hard and painful?

or was it B) another young gentleman who took his dog in and demanded the staff treat the dog for an injury, arguing that we were bound by law to do it?

or was it C)the couple who brought their toddler in because he smelled bad?

There is no prize, because in any scenario, somebody actually checked in for one of these, which means we all lose. Bragging rights only, you guys.