So, a one of the cooler people at the new job was taking care of a level one trololololol the other day, and homeboy was getting shut the eff down. Hi, if you want to keep getting a bunch of narcs and benzos prescribed, by all means, keep returning to your source, but keep in mind that if you keep returning to the same bird feeder, one day you're going to find it empty. Or something.
Delivering the news that you'll have to find a primary doctor (or you know, another ER) to prescribe loads of controlled substances is a pretty hard sell for a patient like this, so I played mean nurse to her nice nurse as we tried to get this dude out sans his usual parting gift.
He went through the exhaustive list of excuses about why he was already out of pills, went through the stages of grief, started making threats and heading into agitated crazyville when I was like, "Okay, no. Here's how this is going to work. No one here with prescribing rights is going to give you what you want, regardless of what you say to either of us. So you're going to leave now, and you're going to leave without a substance for controlled substances. That's how it's happening today. Here's your discharge papers." Through the entire saga of why I need another prescription for oxys and Xanax, homeboy had been struggling with shaking hand to write his name on the discharge papers. As soon as he heard the definitive, hell no, GTFO, he finished signing, wrote the date, and in all caps, wrote UNDER DURESS below his signature. LULZ. Yeah, I guess not giving you narcs falls somewhere between the iron maiden and water boarding on the continuum of torture. The ER is a cruel, cruel place.
Sunday, December 30, 2012
Friday, December 21, 2012
The Burden of Proof
Maybe I should just start calling this blog "things that suck about being new". Ugh, but really, you know another thing that sucks about being new? Doctors.
There's a pretty limited number of docs that work the night shift at the new hospital- most of them are amazing and we already get along really well and they listen to me and recognize that I generally know my shit. I think it helped that a couple of them worked at Hood Hospital as well, so they already knew I was at least competent and stuff, and I guess the word spread among them. Most of them.
But the thing that's a bummer is for some of these people, the burden of proof is completely on you to prove that you're not an idiot, and you're a moron until proven otherwise. Which, great, fine. Talk stupid to me. I'm a girl, and I look twelve, and I don't back down when someone's obviously trying to bulldog me, and duh, I work in the ER, I'm kind of used to being treated like shit. This particular doctor strikes me as someone who I am probably not ever going to mesh with anyway- I'm pretty sure he's Hood Hospital's Dr. Stick-in-the-Ass' long lost twin- people who take themselves that seriously generally don't like my style and vice-versa. So, anyway, treat me like crap. I can handle it. But maybe set aside the douchiness and your personal shitty biases against nurses for a minute when a patient's safety is concerned.
Elderly dude came in the other night that had some pretty vague, questionable complaints about dizziness- some random aches and pains-nothing too major. Family provided most of the history and weren't really great at it- the patient seemed confused at first, but would provide information if he was prompted repeatedly and was oriented and lucid, but was just hard of hearing and didn't seem to want to be bothered. The elderly weakness workup proceeded, labs and scans were normal, Dr. Stick-in-the-Ass 2 gets ready for disposition, and something changes. This guy is just not resounding the same way any more. He looks like he's in pain but won't talk, he gets really diaphoretic and starts having weird runs of PVCs, is still awake but just won't follow commands or talk. I drag him in to see the patient, he glances at him, rolls his eyes, and orders pain medicine. Two minutes later as I get ready to give it, the patient is now drooling with snoring respirations. I tell the doctor he needs to come in there, yeah, now. His response?
"I can't even deal with you anymore with this patient. You're killing me. Seriously." (with a disgusted shake of the head)
He takes a look and begrudgingly orders a repeat scan. I run the patient over, and oh, guess who now has a massive fucking head bleed?
Yeah. I wish I could say this is the first time something like this has happened to me, but it isn't. At all. I hate how in situations like this when the doctor knows he was wrong and fucked up, there's never any acknowledgment that a mistake was made or that he was being a massive douche canoe, but there is an abrupt 180 shift in the way I'm being spoken to. Like now all of a sudden we're using our octave higher soft and gentle voice that we use with the patients, and I'm being thanked and fussed over every nursing intervention no matter how mundane. Not like I need a pat on the back or acknowledgment every time I catch something, but I'd really almost just deal with these guys continuing to be asshats than suffer through this mister nice and respectful routine that we both know is fake.
Whatever. Hopefully this situation has placed me in this guy's not an idiot column and he'll actually listen to me the next time something like this happens, but I kind of doubt it. People like this seem to have a pretty short memory when it comes to their own fallibility.
There's a pretty limited number of docs that work the night shift at the new hospital- most of them are amazing and we already get along really well and they listen to me and recognize that I generally know my shit. I think it helped that a couple of them worked at Hood Hospital as well, so they already knew I was at least competent and stuff, and I guess the word spread among them. Most of them.
But the thing that's a bummer is for some of these people, the burden of proof is completely on you to prove that you're not an idiot, and you're a moron until proven otherwise. Which, great, fine. Talk stupid to me. I'm a girl, and I look twelve, and I don't back down when someone's obviously trying to bulldog me, and duh, I work in the ER, I'm kind of used to being treated like shit. This particular doctor strikes me as someone who I am probably not ever going to mesh with anyway- I'm pretty sure he's Hood Hospital's Dr. Stick-in-the-Ass' long lost twin- people who take themselves that seriously generally don't like my style and vice-versa. So, anyway, treat me like crap. I can handle it. But maybe set aside the douchiness and your personal shitty biases against nurses for a minute when a patient's safety is concerned.
Elderly dude came in the other night that had some pretty vague, questionable complaints about dizziness- some random aches and pains-nothing too major. Family provided most of the history and weren't really great at it- the patient seemed confused at first, but would provide information if he was prompted repeatedly and was oriented and lucid, but was just hard of hearing and didn't seem to want to be bothered. The elderly weakness workup proceeded, labs and scans were normal, Dr. Stick-in-the-Ass 2 gets ready for disposition, and something changes. This guy is just not resounding the same way any more. He looks like he's in pain but won't talk, he gets really diaphoretic and starts having weird runs of PVCs, is still awake but just won't follow commands or talk. I drag him in to see the patient, he glances at him, rolls his eyes, and orders pain medicine. Two minutes later as I get ready to give it, the patient is now drooling with snoring respirations. I tell the doctor he needs to come in there, yeah, now. His response?
"I can't even deal with you anymore with this patient. You're killing me. Seriously." (with a disgusted shake of the head)
He takes a look and begrudgingly orders a repeat scan. I run the patient over, and oh, guess who now has a massive fucking head bleed?
Yeah. I wish I could say this is the first time something like this has happened to me, but it isn't. At all. I hate how in situations like this when the doctor knows he was wrong and fucked up, there's never any acknowledgment that a mistake was made or that he was being a massive douche canoe, but there is an abrupt 180 shift in the way I'm being spoken to. Like now all of a sudden we're using our octave higher soft and gentle voice that we use with the patients, and I'm being thanked and fussed over every nursing intervention no matter how mundane. Not like I need a pat on the back or acknowledgment every time I catch something, but I'd really almost just deal with these guys continuing to be asshats than suffer through this mister nice and respectful routine that we both know is fake.
Whatever. Hopefully this situation has placed me in this guy's not an idiot column and he'll actually listen to me the next time something like this happens, but I kind of doubt it. People like this seem to have a pretty short memory when it comes to their own fallibility.
Tuesday, December 11, 2012
Why It's Worth It
ER goes in cycles for me. Some days I swear the troll douche parade made a pit stop in my ER, or that someone in triage or charge is pissed at me, because everyone I deal with has some kind of hidden agenda or just a totally rude, shitty attitude. Other days I take care of mostly really nice people and I genuinely feel a sense of well being about my decision to become a nurse-I think I've mentioned before that this seems to happen whenever I'm burned out or just at my wit's end with assholery.
Unfortunately, we nurses, like most other humans, seem to focus on our negative experiences, so one remarkably awful person can pretty much ruin your day. But every now and then, you get a patient who is so incredibly nice and wonderful that the rest of humanity gets a free pass for the day as you bask in the afterglow of their awesomeness.
I had a super independent, sassy, adorable elderly lady the other day that has to have been one of the most remarkably awesome patients of my career. She had sustained a moderate, but not life threatening, injury doing some kind of yard work that she definitely could have gotten away with delegating at her age, but being badass and all she was having none of it. She had the cutest smile and she would just grin and laugh when anyone came into her room. She was in her 80s but still hilarious and witty as hell, and was the type of patient who was so grateful for just a warm blanket or a gauze dressing and made a huge fuss over the slightest effort on my part.
After she was discharged, I got her bundled up and I wheeled her out to her son's car. We got her up in the seat and I waved goodbye and told them to have a good night. Without even thinking about it, she smiled and said "Thanks to you, honey, we will." Best thing anyone's said to me in a long time. She totally made my day. Obviously I wish more patients were like this, but even one is enough to break you out of the worst of funks.
Unfortunately, we nurses, like most other humans, seem to focus on our negative experiences, so one remarkably awful person can pretty much ruin your day. But every now and then, you get a patient who is so incredibly nice and wonderful that the rest of humanity gets a free pass for the day as you bask in the afterglow of their awesomeness.
I had a super independent, sassy, adorable elderly lady the other day that has to have been one of the most remarkably awesome patients of my career. She had sustained a moderate, but not life threatening, injury doing some kind of yard work that she definitely could have gotten away with delegating at her age, but being badass and all she was having none of it. She had the cutest smile and she would just grin and laugh when anyone came into her room. She was in her 80s but still hilarious and witty as hell, and was the type of patient who was so grateful for just a warm blanket or a gauze dressing and made a huge fuss over the slightest effort on my part.
After she was discharged, I got her bundled up and I wheeled her out to her son's car. We got her up in the seat and I waved goodbye and told them to have a good night. Without even thinking about it, she smiled and said "Thanks to you, honey, we will." Best thing anyone's said to me in a long time. She totally made my day. Obviously I wish more patients were like this, but even one is enough to break you out of the worst of funks.
Sunday, December 9, 2012
The Price of Being New
So, I guess I've established myself at the new place. Like, I done rode up in there on my magical ER nursing stallion and did all the hard IV starts on my first attempt and took care of 30 ICU patients by myself, and was all, yeah, fear and respect my skillz everyone. LOL. J/K guys. But IRL, everybody knew I came from Hood Hospital, I figured out the charting quick and stuff, so I got like, a day and a half of orientation before they were like, okay, you're done, go take care of patients on your own now. Except I am still learning some stuff here but I haven't gotten called to the office over anything yet so whatever.
BUT. I'm in a very awkward and shit position at the moment. Because all these people are now aware that I can handle a crazy patient load without killing anyone, that I'll usually work my ass off without complaining, and that I'll pick up the slack if my pod partner is lagging. BUT. I'm also not BFFZ with anyone here yet, because I am totally freaking weird and socially inept and it takes me forever to make friends. Like, not like, adorably quirky manic pixie dream girl weird, but like, makes a bunch of obscure mid 90's SNL references that no one gets and says stuff way louder than I probably should most of the time weird.
So, anyway, the significance of all this is that I am close with no one, therefore, nobody has my back and I am getting the shaft all day every day when I come to work at this place. It's like, oh, well, Hood Nurse is competent, let's give her the shittiest assignment with the laziest person here! Okay, awesome. And few of the charge nurse or float nurses are stepping in to help, because if their buds need anything at all, it's getting taken care of prior to anything I need.
Luckily, the medics here mostly already like me because I don't delegate and then sit on my ass and I can show most of them up when it comes to IV starts, so if they see that I'm really drowning, they have my back. And most of the doctors like me already because I work hard and make them laugh. Still. It's just frustrating. I can handle my shit, but it sucks to be drowning and see everyone congregating and grab assing by the charge desk having fun.
I don't know. I feel like (and I hope my perception was the actual reality) that I was pretty fair as charge at Hood Hospital. I mean, I would honor a friend's request for a certain area if they were having a crappy day but overall I would try to move people around and be pretty objective about who ended up with what. Don't get me wrong, some of the charge nurses here a pretty rad and objective, but overall I kind of feel like I'm a little isolated and that if someone is gonna have to get crapped on, it's gonna be me. Oh well. Such is being new I guess.
BUT. I'm in a very awkward and shit position at the moment. Because all these people are now aware that I can handle a crazy patient load without killing anyone, that I'll usually work my ass off without complaining, and that I'll pick up the slack if my pod partner is lagging. BUT. I'm also not BFFZ with anyone here yet, because I am totally freaking weird and socially inept and it takes me forever to make friends. Like, not like, adorably quirky manic pixie dream girl weird, but like, makes a bunch of obscure mid 90's SNL references that no one gets and says stuff way louder than I probably should most of the time weird.
So, anyway, the significance of all this is that I am close with no one, therefore, nobody has my back and I am getting the shaft all day every day when I come to work at this place. It's like, oh, well, Hood Nurse is competent, let's give her the shittiest assignment with the laziest person here! Okay, awesome. And few of the charge nurse or float nurses are stepping in to help, because if their buds need anything at all, it's getting taken care of prior to anything I need.
Luckily, the medics here mostly already like me because I don't delegate and then sit on my ass and I can show most of them up when it comes to IV starts, so if they see that I'm really drowning, they have my back. And most of the doctors like me already because I work hard and make them laugh. Still. It's just frustrating. I can handle my shit, but it sucks to be drowning and see everyone congregating and grab assing by the charge desk having fun.
I don't know. I feel like (and I hope my perception was the actual reality) that I was pretty fair as charge at Hood Hospital. I mean, I would honor a friend's request for a certain area if they were having a crappy day but overall I would try to move people around and be pretty objective about who ended up with what. Don't get me wrong, some of the charge nurses here a pretty rad and objective, but overall I kind of feel like I'm a little isolated and that if someone is gonna have to get crapped on, it's gonna be me. Oh well. Such is being new I guess.
Thursday, December 6, 2012
Clarification
I'm discharging a gal in the hall bed for gastroenteritis with her husband/boyfriend/babby's daddy/s.o. present. It's one of those dynamics where the patient really doesn't ask you any questions, but just kind of looks wide-eyed at you while companion does all the talking. To be fair, as someone who is super shy, this doesn't bother me as long as it's not an obvious domineering douche relationship, which this wasn't. No, it was one of those I'm asking the questions cause I know you won't type of dynamics, except it was. not. working. The message I was trying to convey was just totally not getting across.
I have a basic spiel for most common illnesses. My gastro spiel goes something like, "yeah, these symptoms are really a bummer, and unfortunately there's no treatment for the virus itself, but we can treat your symptoms and try to make you comfortable. Fortunately this usually runs it's course within about 48 hours on average, in the meantime try to rest, take your nausea medicine, and make sure you're drinking lots of liquids in small quantities..etc" Except dude was really hung up on the "there's no treatment for the virus" part.
"Wait, so what is this medicine?"
"It's two of the same medication. It's called Phenergan, and we're giving you pills and also suppositories if you can't keep down the pills. You can take it every 4-6 hours or so for nausea and vomiting. "
"Okay. So the medicine is just for the nausea. You aren't going to give her anything for the virus?"
"Well, no, there's no medicine for that, it just has to run it's course. But this medicine should make it a lot more bearable."
"What about the diarrhea?"
"We just recommend Immodium over the counter after the first 24 hours if it's still happening."
"Okay, but you're not giving her anything for the virus?"
"No, there's not any treatment for the virus, unfortunately."
"But, wait, why aren't you guys giving her anything for the virus?"
"Because it's not a thing. Scientists haven't invented it yet. "
"OH. "
One of my coworkers was walking during the last part of that conversation- as soon as the patient left and I rounded the corner, he immediately started laughing at me. Did you seriously just answer that question with "scientists haven't invented it yet?"Well, yeah. Look, I hope I don't sound mean because I genuinely don't mean to be. But sometimes, things aren't getting through and you have to just go off script and hope for the best. Luckily the message seemed to get across in this case.
I have a basic spiel for most common illnesses. My gastro spiel goes something like, "yeah, these symptoms are really a bummer, and unfortunately there's no treatment for the virus itself, but we can treat your symptoms and try to make you comfortable. Fortunately this usually runs it's course within about 48 hours on average, in the meantime try to rest, take your nausea medicine, and make sure you're drinking lots of liquids in small quantities..etc" Except dude was really hung up on the "there's no treatment for the virus" part.
"Wait, so what is this medicine?"
"It's two of the same medication. It's called Phenergan, and we're giving you pills and also suppositories if you can't keep down the pills. You can take it every 4-6 hours or so for nausea and vomiting. "
"Okay. So the medicine is just for the nausea. You aren't going to give her anything for the virus?"
"Well, no, there's no medicine for that, it just has to run it's course. But this medicine should make it a lot more bearable."
"What about the diarrhea?"
"We just recommend Immodium over the counter after the first 24 hours if it's still happening."
"Okay, but you're not giving her anything for the virus?"
"No, there's not any treatment for the virus, unfortunately."
"But, wait, why aren't you guys giving her anything for the virus?"
"Because it's not a thing. Scientists haven't invented it yet. "
"OH. "
One of my coworkers was walking during the last part of that conversation- as soon as the patient left and I rounded the corner, he immediately started laughing at me. Did you seriously just answer that question with "scientists haven't invented it yet?"Well, yeah. Look, I hope I don't sound mean because I genuinely don't mean to be. But sometimes, things aren't getting through and you have to just go off script and hope for the best. Luckily the message seemed to get across in this case.
Wednesday, December 5, 2012
The True Mark of Experience
Some people might think that competency in a critical care situation, or knowing how to titrate drip, or some shit, is the true marker of being experienced. I'm coming to terms with being experienced, I guess. I mean, it's been nearly four years, and I'm more experienced than most of the people I work with, so whatever, sure. But let me tell you. At least for me, I knew how to titrate Nicardipine and Levophed, like, year one, because my patients were sick as hell all day everyday.
Naw, real experience has to do with dealing with shit like this:
So, dude presents with a butt abscess or some equally unrelated shit, it really makes zero difference, but upon discharge, dude is all, "Um, let me ax you a medical question"
and I'm all "Sure, shoot"
and he's all "It's personal"(translation it's about teh secks)
and I'm all "aw fuck"
and he's like "So my girlfriend (who BT-Dubs eds note is sitting right there) thinks I can't get a boner b/c I don't like her but it's not like that, I totally dig her but it's not happening for some reason."
So year one nurse me would have blushed and been all "I'm sorry, I can't answer that" but experienced me was like "Look, I don't know for sure because I don't even know you like that, but what you need to do is find you a doctor, and make sure everything is all good with your health and your penis and all that. And if everything is OK on that front, you guys should probably see a counselor or something, but imma start with this referral to a doctor, any questions? Okay, great, bye."
Yeah, for real. I hate to break the hearts of you new nurses, but this is mostly the type of clinical skill you'll gain after 2 and a half years of this foolishness.
Edited to add: apparently "butt access" is not a real thing, at least in the context I meant it. For future reference, one drink before blogging is totally okay but 3 is too many. The more you know....
Naw, real experience has to do with dealing with shit like this:
So, dude presents with a butt abscess or some equally unrelated shit, it really makes zero difference, but upon discharge, dude is all, "Um, let me ax you a medical question"
and I'm all "Sure, shoot"
and he's all "It's personal"(translation it's about teh secks)
and I'm all "aw fuck"
and he's like "So my girlfriend (who BT-Dubs eds note is sitting right there) thinks I can't get a boner b/c I don't like her but it's not like that, I totally dig her but it's not happening for some reason."
So year one nurse me would have blushed and been all "I'm sorry, I can't answer that" but experienced me was like "Look, I don't know for sure because I don't even know you like that, but what you need to do is find you a doctor, and make sure everything is all good with your health and your penis and all that. And if everything is OK on that front, you guys should probably see a counselor or something, but imma start with this referral to a doctor, any questions? Okay, great, bye."
Yeah, for real. I hate to break the hearts of you new nurses, but this is mostly the type of clinical skill you'll gain after 2 and a half years of this foolishness.
Edited to add: apparently "butt access" is not a real thing, at least in the context I meant it. For future reference, one drink before blogging is totally okay but 3 is too many. The more you know....
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