OMFG, she came back.

Holy crap, dude. Remember Buckwheat lady? She came back the other day. This time, her chief complaint was that she had a hog in her stomach, and that she came to get it out. She then preceded to hit up all the other patients in the waiting room for money. Classic.
You know those above the influence my anti drug commercials? Yeah... well, patients on crack with hogs in their stomach? That's my anti drug, for real.

Okay, I'm ready for a change now please.

Alright. This may be the winter months getting to me, but this job is starting to wear down on me a little bit. I got into ER because I like to be busy- I want a steady stream of work all the time. I still partly love this job for that, not to mention the fact that I'm learning and becoming confident with critical patients pretty fast- but this seems to have gone to an extreme in the last few months. I need a break. Not even from work necessarily, but in my day. The last time I worked was on Sunday- 12 hour shift. I got to go pee once. I never got to eat- I drank coke at the nurses station and one of my teammates was nice enough to bring me a piece of cheese. Part of this is certainly my own fault- I run myself into the ground getting little things for patients instead of taking care of myself because I want them to be happy; I spend my free moments helping my teammates when I know they need it because I would want the same, and most of them would help me, too. I take responsibility for this part. But that's not all of it.
We need reinforcements, bad. We have a 45 bed ER- only 23 of those are really set up for true ER patients, the other areas or for non-emergency clinic patients, and half of those beds are usually closed because of staffing. We're lucky if we have enough for a skeleton crew- lately with call-ins we've had to close rooms in the critical areas. Essentially, upper management is killing us. We can't keep new staff because of the work conditions, and they won't spend the money on agency nurses. They replaced our fast doctors who got complaints but actually moved people with baby docs fresh out of med school. This results in patients spending around 9 hours in the waiting room on average lately- sometimes more- yet the justification for not giving us the resources we need is that we're not meeting our patient satisfaction goals. You don't say? Well, I wouldn't be satisfied if I waited 9 damn hours either. It wouldn't matter if I rubbed these patient's feet and cooked them a 5 course meal- if they spent half their day in the waiting room, they're gonna be pissed.
I know part of this is due to it being winter, and it should get better soon. But these conditions are insane. I don't know whether this is just the nature of ER, or whether it's just my ER, but I'm getting pretty sick of walking into a disaster area every day. My contract is up soon and I'm gonna start probably looking for a new job in the next year if things don't get better. I'll miss lots of things about this job- but not as much as I'd miss my mental and physical health or my nursing license if things continue they way they're going.

To make a long story short...

I knew last night was going to be bad. Terrible. What I couldn't expect, though, were:

• Patients in the waiting room for 16 hours.
  
• Stroke patient in the waiting room.
  
• 9 ICU holds. 3 per nurse on my team.
  
• CPRs going to regular rooms.
• Chest tubes being inserted in regular rooms.
  
• Running out of IV pumps and putting Dopamine on a dial-a-flow.
• Housekeeping staff getting in screaming matches with family members.

It's by nothing but the grace of God that no one died last night that wasn't a CPR in progress. I'm off for 2 days- I'm just going to say a little prayer that they won't be doing CPR in the hallway when I come back, because that's about the only way it could get much worse.

Finally, an explaination?

In the last year I've been working, I've made the discovery that there is an entire other world out there. A world full of people who do shit I wouldn't even think of doing. One of the things that still totally weirds me out is the complete lack of modesty on the part of some of our patients. Now, I'm not talking about psych patients or the bra-less women who lift up their shirts for EKGs or other stuff that's actually related to medical treatment- that I understand.
I'm talking about people who just chill with their junk hanging out watching TV who make no attempt to cover it up when the nurses or doctors come in the room. I know we're med professionals and we've seen it all, etc, but c'mon buddy. Why does your boob have to be hanging out while I'm talking to you? I have boobs (well sort of) and that's still distracting to me. This actually happens frequently enough that I really didn't think to mention it, until the other day I'm charting at the nurses station and a patient another nurse had been taking care of pokes her head out of the door and asked me for a belonging bag. I hop up and walk into the room to get her one, and when I get in the room I notice she's wearing a hospital gown backwards with all of her junk hanging out. Trying to engage me in conversation with her vagoo, like, right there! Dude. She even had a blanket on and all her shit was still showing.
I got the bag and gracefully backed out of the room. I'm standing with a sort of bewildered look on my face in the hall when the doctor walks by and asks me what's wrong. I asked him if that patient had kept her vagina out the entire night. He just shrugged and said, " Yeah. I don't know why women do that. Maybe they think it'll get them their medicine faster." Well, that's a thought. Maybe I'll ask next time.

What I've Learned in a Year

Or something close to that. Yeah dudes. It's been about a year since I started writing about people checking into the E.R. for ringworm or herpes or other such things. And over a year since I became a practicing nurse person. If I wasn't super lazy, I would probably post a graph detailing my comfort with being a nurse increasing slowly but steadily, and my compassion level plummeting. Well, sort of. I'm still compassionate, in the sense that families after CPRs still make me cry, but less in that my ability to detect bullshit is a skill I have developed quickly. Along that idea, I'd like to share a few important things that I have learned in my first year of nursing that will hopefully but probably not save some other folks some trouble:

• If you're checking into the ER for suicidal ideation or an attempt made with meds, you are more than likely full of it. Now I won't completely generalize here. Because it makes me sound pretty awful and heartless. But literally every case I've had of someone checking in for "suicidal thoughts" is someone with no real plan or access, and a lot of manipulative requests for pain meds, anxiety meds, food, drink, cab vouchers, etc. and in my most recent case, female nurses. That's right. This dude had a chronic case of F.O.S. He actually came in after leaving a psych facility for the same thing because he said a gay guy there attacked him by trying to kiss him. He couldn't have a male nurse because he was still "traumatized". Bitch, please. This dude reeked of garbage and had the nastiest grill I had ever seen. And he spent his entire stay staring blatantly at my butt and making creepy remarks. As for the pill folks- I've seen one exception- a sweet little lady who look a bunch of benadryl to try and escape her abusive husband. I've never cried so much ever. But a lot of them are narcissistic pieces of garbage who intentionally take non-lethal meds and dosages to manipulate someone, like the jerk I had recently who tried to "overdose" on Ambien (suicide? You're doing it WRONG) because his cancer stricken wife had thrown him our for taking all her pain medicine recreationally.
  
• Status dramaticus is easily curable if you treat it like you would if it were the real thing. Oh, I'm sorry, you can't walk? My goodness, I bet you need a catheter. Oh my. This "asthma attack" you're suddenly having now that your husband is in the room without any wheezes while you're satting 100% is pretty serious. I better hold this Dilaudid, it's only going to make your breathing worse. You've been vomiting blood, you say? Well I better bring you straight back and pop an NG tube in real quick. We don't want this to get any worse. Oh, your vomit might be bright red from the flaming Cheetos you're eating right now? In that case, why don't you go back out to the waiting room and leave those Cheetos in the trash here. They probably aren't helping your abdominal pain. Man, you just keep having these "seizures". The next time you have one, I think I'm gonna put a nasal trumpet in to protect your airway. You can't be too careful when it comes to seizures.
  
• Sometimes the best nursing care is a little f%*!ing perspective. I can't tell you how many times I get the eye roll combined with the biggest sigh ever with the statement, "I seriously waited 8 hours for you to tell me my kid has a virus and to send me home and tell me to give my kid Tylenol and Motrin?" Instead of what I want to say, which is something along the lines of, "I'm sorry, is it my fault that you use the E.R. as a doctors office and thought your kid who is currently trying to jump over this stretcher was critically ill because he has a damn fever?", I find that it's more effective to say, "Look at it this way. I just had to transfer a kid out of here with (insert life threatening medical condition). Aren't you glad your child just has a virus?" Now go home, make your kid some Nyquil pops, and GTFO of my ER please, thank you.
• If you're well enough to walk up to the nurses station and complain every 5 minutes, you're well enough to walk out. But seriously, attitude aside, watch the patients that don't complain or ask for anything, because they're probably the sickest.
• The chance of someone, including yourself, getting "crunk" increases exponentially with the number of people in the room. Do yourself a favor and stand up for the 2 visitors at a time rule.
  

• If you're triaging a girl in the 16-30 year range with abdominal pain, make sure to ask specifically about funky discharge or other STD symptoms, because it's a lot easier to come in and complain of lower abdominal pain without even mentioning your broken cat, and you may save your patient and coworkers from an unnecessary IV.

Just a little bit of the wisdom that I have acquired in my first year as an E.R. nurse. Tune in next time for more, when I might have more than 4 hours of sleep and no alcohol in my system.

Providing accurate medical information...

I know it's hard sometimes. Just so you know for next time, though, if you can move all your extremities and walk- you are not paralyzed.
Oh, and if you're going to pretend to pass out in the cab on the way to the hospital so you don't have to pay your bill, you probably shouldn't give him your real name. Because he may give it to us, and then when you try to check in with your fake name and social so that we can't tell that you've been in the hospital a bunch of times before looking for pain meds with nothing wrong with you...yeah. We have to have that whole conversation about fraud. And that's really kind of awkward.

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!