Choices

So, last night world famous emesis bag nurse turned charge presents to me this scenario: crayzee frequent flyer or broken penis?

And I replied, "Busted penis it is! Bring it on!"

And so it went. The penis? Super broken. Bleeding more than I would have thought. IVs were started, pain meds were delivered, preoperative things were prepared, paperwork was filled out in a frenzy, reports were called. I ran back and forth for about an hour straight. I sat down at the end of the insanity to see that crayzee frequent flyer was pretty much given a stat discharge by my favorite doctor EVAR sans ridiculous workup or that one D medicine that is the only thing that can cure the body aches associated with the common flu (yes really).

I regret nothing. Yup, I had to do way more work, but in the end I got to make a very nice gentlemen with a very legitimate emergency feel better, versus listening to some crazy douche whine about how no one takes her pain seriously while pretending to nod sympathetically or whatever.

And really, pee breaks are for pansies anyway.

Drugs Are Bad

There has been an odd increase lately in jackasses who are high on whatever coming in for essentially, side effects of being high, but they're so high they insist it's something else. These are the worse people to deal with, because they're already agitated and anxious and they don't respond very well to the medical advice "go home and sleep it off".

This crackhead chick checks in the other day for the crack scratchies, is prescribed Benadryl and steroids for said scratchies, and then proceeds leave without treatment because she's pissed that we "aren't taking her complaint seriously". Homegirl then goes across the street, smokes more crack, and calls the ambulance from there. She's so effin' high when she gets to me that she can't even tell me what's wrong- after 10 minutes I get out of her "I feel bad" and "my skin hurts", but they main point she's trying to drive home is that the problems are NOT related to her drug use. They're just not, I know they're not, because I know my body ("I know my body" is a whole other damn post). MMkay. So, basically she is prescribed anxiety meds, which she of course refuses, throws her rehab referrals on the floor and storms out of the ER again. Okay. Thanks for choosing Hood Hospital?

So then last night, I get some dude who's buddy brings him in for heart palpitations or some shit, who is beyond drunk and high on who knows what else. Admits that he's had about 8 beers and around 5 shots since he woke up that afternoon, won't sit down, won't stop talking about every other thing in the world other than his emergent complaint. Then he decides he wants me to get him a drink immediately and just asks repeatedly using a multitude of obscenities. Lovely. I used to try to deal with this crap myself, but I'm seriously over it at this point. You wanna act drunk and stupid? Okay, fine, the police will finish this triage with us. The one advantage to working with idiots like this is that most of them have warrants, so once they see a police officer they are suddenly on their best behavior. These two didn't even stay to get seen once the police came around- you're welcome, treatment area nurses.

Uggh. Can we add a "drunk, stupid asshole" column to our MSE form please? Thanks.

Things I Will and Will Not Do

Patients, for future reference:

I will gladly clean any number of wounds or messes regardless of how long it takes to do so and regardless of how disgusting it smells. It is my job to do so, and it needs to be done. I will not beg you to let me do it. If you are a grown ass adult of sound mind who chooses to not only do nothing for yourself, but wants to scream and complain when I attempt to remedy the situation of you sitting in your own filth because I'm bothering you? Let me stop bothering you. As an adult, you surely understand why dirty ass wounds are problematic. I have other people to take care of that actually want my help, and therefore I don't have time to argue with you about it. Let me just chart that you refused the care I offered you and you can call me when you decide to stop being disgusting and I'll help you. Okay, great.

I will work you up for your intermittent mysterious vaginal bleeding that you've had for two weeks. Sorry you decided during the busiest day of the year that this was now an emergency, but your labs are all back right now, your blood counts are fine, and you're officially not dying, so it's time to take your Flagyl and follow up with a GYN. I cannot magically stop your vaginal bleeding with a pill of some kind or space age laser technology, and I will not tolerate you standing in the staff area yelling obscenities at everyone because you want your f-ing period to stop and we didn't do f-ing shit for you and we just wasted your f-ing time. You're totally discharged. Hi, security?

I will take care of your drunk ass in a kind and gentle manner despite the fact that you have no problems we can help you with here in the ER. You play nice and take your fluid bolus and your warm blankets, I'll turn the light off and you can have a nap and you and me are going to be good friends. We will not be friends if you start cutting up and trying to pull your IV out and threatening suicide and screaming at everyone because now mommy's here and she's mad at you for being a drunk idiot instead of giving you the sympathy you think you deserve. No, I do not have time for you to pull me into your mommy drama, and I will not sit outside the room and therapeutically try to convince you to calm down and stay. If you want to try to manipulate your mom in my earshot by threatening suicide, fine, but you will find your ass in a safe room with a the po-po standing by and mommy out in the waiting room away from your drama before you can say "Haldol". There are literally dying people here today. Act out your Dr. Phil "mommy loved me too much or not enough" bullshit on your own time.

And ultimately these are the people that are going to be determining whether my service was good enough for the hospital to get paid? Why did I stop waiting tables again?

When You Gotta Go, You Gotta Go

I'm taking care of a gentleman last night who was having some seizure activity- nice, normal seeming (by hood hospital standards, anyway) dude. We get him back to a therapeutic level on his meds and I'm just watching him for a while to make sure he's not having any problems before the doctor will discharge him.

It's a decently paced night, so I'm hanging outside his room charting and talking- his door is open so I can see and hear if he starts seizing again. Dude is sleeping peacefully for hours. I hear nothing but the TV and his snoring, until all of a sudden I hear a lot of rustling and moving around on the stretcher. I immediately jump up and run into the room to turn him over, thinking he's having another seizure, but when I get in the room, I find him wide awake and lucid, urinating into his belonging bag with his clothing still in it. I grab a urinal and try to give it to him real quick, but he just kind of shrugs and finishes peeing in the belonging bag.

I feel terrible because I immediately assume he couldn't see his call light where I put it in the bed- I apologize and tell him not to be afraid to yell out if he needs something. Except he's just like, "Nah, it's cool. I knew where it was, I just had to go, yah know? When you gotta go, it's just like, time. " Well, okay! Whatever works for you, I won't make you wear that shirt home. Have a free gown on us, man. Merry Christmas!

Chief Complaint of the Night

Are you ready? Here we go.

Trouble sleeping for 5 years.

Yeop. And was seriously a douche to ER BFF in triage when she asked if she'd seen a doctor or tried any meds before. I guess maybe she was crabby from not sleeping, but still. It's not necessary to be nasty to the triage nurse for just doing her job and trying to collect your information. Anyway. 1,000 cool points were awarded to our new ER doctor, for this conversation:

New Dr: So, what's wrong today ma'am?

Miss Insomniac: I haven't been able to sleep well for 5 years.

New Dr: Yeeeah. So, this is the ER, so I don't prescribe sleeping pills here.

Miss Insomniac, scoffing and rolling eyes: Well, and I haven't had my period in two months either.

New Dr: Okay. Well, now you can go buy a pregnancy test, because you're discharged.

I tried to start a slow clap at the nurses' station, but no one was paying attention.

Things That Are Not Emergent

People sure do get upset when I seem to mention that most of our patients are not having legitimate emergencies. I get these random comments like, "Bitch, how can you say that a UTI is not an emergent complaint? My sister's friend's cousin's baby mama got UTI one time that was so bad that she ended with pyelo and then got intubated and ended up in the ICU!"

Look, they're just not most of the time. And that's fine. I enjoy the non emergent stuff too, plus, if we saw exclusively life threatening emergencies at all time, one, my job would most certainly be in danger, and two, it would be reallllly stressful.

But, in the spirit of Christmas unity and peace on earth, let me just throw one out there that I think we can all agree on. Checking into the ER to get documentation from a doctor that you have the sickle cell trait so you can try to use it to get on disability? Really? Not an emergency. Any questions? Okay, great.

Guess the Complaint

As written:

hirna bother hurt him ril bad

Answer tomorrow, pending day shift coming to take report on time. Winner will receive a lightly used pair of hospital socks and a half eaten bag of flamin' hot cheetos I found in the waiting room.

UPDATE: Well, I seem to have underestimated my readerships' talent for deciphering the writing of the borderline illiterate. There are too many of you that got the answer correct (yup, hernia pain) for me to declare a single winner, but you have all shown that you are qualified to work at the Hood Hospital triage desk, where 99% of your duties consist of explaining to registration what the hell these people are trying to check in for. Hit me up if you're looking for a job where you are verbally abused on a continual basis.