Saving lives, for real?

Usually when I talk about saving lives at work, I'm making some sort of joke about the people who come in for STDs and sore throats. I personally think the whole image of nurses saving tons of lives a day is a little silly. The truth is most of the people we see aren't that critical, and I don't feel that I do anything particularly special for the ones that are- I follow orders and make sure they aren't circling the drain. I think the instances in which we do save lives are when we have to look a little further into something and see something others might not.
I finally had one of those moments on Saturday. I was in triage and it was insane. I had a long line of people waiting to get triaged and this young guy checks in for rapid heart rate. We get this complaint a lot in young people and about 99.9% of the time it's total bullshit- rapid heart rates of 83. I'm thinking the same thing with this guy automatically- I put the oximeter on his finger and the heart rate pops up as 60. Something just told me to check a radial pulse- when it did it, it felt... wrong. So I get my stethescope and listen to him. It sounds weird. I hook him up to the EKG machine- holy crap. He's in atrial fibrillation with a heart rate of 180. We got him back to a trauma room and he never converted to a normal rhythm, but they at least got his heart rate down a little bit and got him admitted. I don't think I saved his life necessarily, but I'm glad I didn't settle for the vitals that popped up and send him back to the waiting room!

Attempting to sound smart- LOLZ

I believe I've expressed myself pretty clearly in the past about my opinion on medically ignorant asshats who try and tell me my business, but the family member I dealt with the other day really took the cake. The patient this lady was with had somehow managed to get into a car accident where there was a two-seater with 4 people and some alcohol involved. Apparently at some point she had been hit by some part of the car and cut her knee open, so I came in to give her a tetanus and antibiotic shot. I told them what each was for while the patient talked on her cell phone with one of her 800 family members that was at the hospital that night, and as soon as I finished talking, her sister asks "Is one of them shots for pain?". Nope. I literally just told you what those shots were for. Listen. So I explain myself again. "NO. NAW. She need somethin' for pain." I tell her that I will ask the doctor as soon as I finish giving the shots I've drawn up and proceed to try and go ahead and give the shots. "No! NAW! She need somethin' for pain NOW. Where's the head doctor at? I don't care. I'll talk to the head doctor if I have to. She need something for pain. You don't understand. Her PHYSICAL BODY was STRUCK BY THE CAR. Her physical body. She was physically hit by a car."
A few things. I don't even know how to start really, so I think I'll present my points high school essay style:

Introduction: Oh hell no.

1. Body paragraph-Keep your panties on.
a. I literally just said I would ask the doctor.
b. There is no head doctor. There's the ER doctor, who I just said I would ask.
c. There's especially no head doctor at 2 AM on Christmas morning.

2. Body paragraph-Your sister is totally not dying.
a. If she was well enough to ask someone for a pair of socks when she came in, she'll be okay for a second.
b. If she's well enough to be talking on her phone, she'll be okay for a second.
c. Where the hell are her socks, anyway? It's 20 degrees outside.
d. If her grown ass is well enough to be attempting to grab the damn needle out of my hand, she's probably okay.

3. Body paragraph- You're an idiot
a.Her physical body? As opposed to her metaphysical body?
b. Was her spirit also struck by the car?
c. Don't try to sound smart when your grasp of simple grammar is not beyond that of most of the 5 year olds I see.

Conclusion: WTF.
There. I feel so much more clear headed and organized now. I unfortunately couldn't say any of those things, so I just went out and asked the doctor with syringes in hand. They were seemingly satisfied after that- the patient actually thanked me when I gave the shots and told me I was good at it, that she could hardly feel it. When our registration representative went to collect their co-pay, her sister mentioned that she wanted to talk to someone in administration because I had been pulling the skin too hard and she knew I was intentionally trying to hurt her sister when I gave the shots. Nevermind that's how IM injections are supposed to be given, or that her sister was about 100 pounds overweight and I had to push her rolls out of the way to hit the muscle. Wow. I'd like to suggest a minimum IQ requirement for sending our Press-Ganey cards, please.

What am I supposed to do with this?

That's all I can ask at this place sometimes. Last night I get this ambulance. Dude in his early 60s. Hasn't been to a doctor in, no joke, over 45 years. Admits to drinking a GALLON of whiskey a day, and has the most yellow skin I've ever seen. And.. he's been puking and pooping blood a lot for the past few days but this has been going on for the last 2-3 years off and on.
So I see he's pretty sick- I start a couple of big IVs and get blood work started. His platelet count ends up being a very small fraction of what it should be, his other blood counts looks like crap, he's on the fast track to liver failure. The doctor comes in and takes one look at him and admits him to ICU even before any tests came back.
This guy does not care. He does however, care about the fact that he can't have anything do drink when he's puking blood. He cares about having to leave this stupid pulse oximeter on his finger. He cares that we keep taking his blood for all these damn tests. I tell him we're going to transfuse two units of blood and his response is to scoff and say, " A blood transfusion? I hope they test it for AIDs!"
Really? AIDs? Wow. I don't know why, but that really blows my mind. I guess the whole idea that someone would think about the very remote risk of getting AIDs from a blood transfusion but not consider the very real and immediate risk of drinking a freaking gallon of whiskey daily! But hey, priorities, right?
But seriously. What am I supposed to do with someone who has absolutely zero involvment in his own care other than to complain about the things I need to do to save his life? I swear. Sometimes these patients make ME want to drink a gallon of whiskey a day.

You thought you needed an ambulance for that, huh?

I haven't been working in healthcare for long, so I'd legitimately like to know- when did the ambulance become an effin' taxi service? Seriously. This is one of the things that makes me the angriest about my job. We're now getting to the part of the winter where the waits are long enough that these morons actually check in to be seen, get tired of waiting, walk across the street, and call an ambulance to bring them through the back. Fool, please. Your abdominal pain for a week is no more important to us now that you've rolled in on the big white taxi with lights. Now your ass is just at the end of the line again, well played.
We've had some good ones in the last week or so. I, for one, was pretty impressed with the 19 year old girl who called the ambulance from her job a half block away for a toothache. Yeah...she went to triage. I can at least give her some credit for being courteous and finding herself a ride home- I wish I could say the same for this next moron.
Last night was pretty slow- it was about 4:30, and I had one patient when EMS rolls in with this guy in his late thirties who they got a call on- his complaint? Sore throat for 2 MONTHS. He was a truck driver, and had been on the road for a while, and I guess it was the right time for him, so instead of taking his damn truck up to the hospital he called EMS from his vehicle, where he lives, and came to the hospital. If his being a system abusing jackhole wasn't bad enough, he was also a massive whiner and a complete idiot. He was thoroughly convinced that his throat hurt because he had a tooth removed in October, and according to him, a piece chipped off and flew into the back of his throat and was lodged there. Um, no dummy. You have tonsilitis. I told him that was what it sounded like after he complained to me that it always felt like there was drainage in the back of his mouth and that it smelled bad. He rolled his eyes at me and said that wasn't it- guess what the doctor diagnosed him with? Yeah.
Of course, he was also the type of patient who thought he should be the priority and immediately receive narcotic pain meds for his 9.5/10 tonsil pain. While I'm dealing with him, a patient on the other team actually coded in a room, which was really rare for us and really upsetting for the staff. He didn't make it, and I went over to help clean up the body before the family got there. I'm helping RT get blood out of the ETT tube when Mr. throat pain calls to ask when the doctor is coming in. It's a good thing I didn't answer the call, because I probably would have grabbed him and dragged him into the room and said, "When you start turning purple like this guy! This is who the ER is for. Sit your ass down!" After all that, this joker had the nerve to ask for a cab voucher! We ended up giving him one, too, since all his friends lived out in BFE in the midwest somewhere, so he had no one to pick him up. I wish we could have just kicked him out and let him figure it out. He could have walked in the cold. It's not like he was sick.

A + for creativity.

So I'm spending my first (very enlightening) night in triage last night in first look (where we first ask the patient about their complaint and see if they can wait to be seen or triaged) when this woman walks up to the door and asks if I can bring out a stretcher. A stretcher? Nope. I tell the lady I can bring out a wheelchair. She tells me that her mom is in such terrible sickle cell pain that she can't even sit up in the chair. Once she figures out that's all we have, her mom manages to make it from the sitting position in her daugher's SUV to a sitting position in our wheelchair, and we wheel her to the check-in desk where she refuses to write her own information, because it was too painful, although she was able to answer her cell phone on the way in. In the middle of collecting their information, when they start to realize that they won't immediately be swept straight into a room and may even be forced to sit in the waiting room without getting Dilaudid on arrival, the lady pulls out this gem-
"I can't wait in this waiting room. I'm in the witness protection program, and someone might recognize me."
WOW. Lucky for them we had our third triage room open, so they got to wait their turn in there with their identity uncompromised, sitting in the wheelchair. But hey, you can't blame them for trying.*

*Not in any way to sound calloused toward sickle cell pain, I'm actually calloused against patients who don't get that we're not just blowing off their pain, but that people who are bleeding and trying to stop breathing go first! "Witness protection" or not.

Even I blushed.

I'm sure it would come as no surprise to anyone that I have a little problem with language. I try to tone it down on here, but when I vent at work, I swear so much that it has earned me not one, but two different nicknames- "Lil' pot" by one nurse, and the one that's caught on a little more- "Sailor". Nice. But man. I can honestly say that lately, the little old people around here have been giving me a run for my money.
There was the one the other day that I had to start an IV on- she was pretty demented and very combative. She cussed up a storm, repeatedly asking all of us what the F we were doing, and constantly telling us to quit our f-ing "rat piddlin'". What that actually means, I have no idea, but it's definitely caught on here. If giving us the word rat piddlin' was the high point of the evening, I'll definitely say that the low point of the evening was when about three of us had to pretty much wrestle this lady so we could catheterize her. As my coworker was holding her arm, she looked straight into her eyes and said, "You little bitch. I bet you're enjoying this, aren't you?" Ouch. That's even worse than the time I got called a bitch ass hoe by a drunk lady.
The funniest of these experiences so far, though, came last week when me and one of the medics had to cath this little old lady with a urinary tract infection. The shift had just started when I grabbed him to come help me, and he immediatly looked into the room before I even told him where it was when he said, "It's not that lady, is it? She's already cussed me out once today." So we go in to do this, and naturally she's soiled her diaper and we have to go ahead and clean that up. As we're cleaning her, she runs off into a string of cusswords that made even me blush a little, but with in a tone and cadence like she was trying to remember what was on her grocery list. "He-hey, what the F are you doing with this shit? Get the F outta there. Leave that shit."
"We're just trying to clean you ma'am. We're trying to keep this out of your urethra so we can keep from making the UTI worse."
"F it. That shit is all up there anyway. What the F are you doing, stupid ass bastards?"
It pretty much went on like that the entire time- once it was over with, we got her settled and I went to give her some Tylenol for her fever. She's very cooperative and she takes it just fine, I give her a few sips of water, and as soon as she finishes, she says very calmly, "Dumbass bitch. I don't want anymore f-ing water." I could not stop laughing.
Her son came by a little later, and I was telling him with much amusement about her cussing us all out. He started laughing hysterically too, and then he tole us that she used to be a nurse, too. Well. That explains it.

Cheif complaint FAIL

Wow. When I worked in yellow zone last night, we had a lady check in with the chief complaint of "insect bite" and leave with discharge instructions for genital herpes. Um. Those must have been some bugs, lady.