Compassion Deficit

I think everyone has their type of patient that they just can't get over the feeling of wanting to kick. I've been a little surprised at myself lately at who it's been. I've always known that I can't deal with the entitled patients. I know why, and I've learned how to deal with them. But lately another sort of pet peeve- I hate to even call it that, because it's a little stronger than that- has crept over me for our addicts.

This may seem like a given to a lot of nurses, especially those that work in ER. But it sort of bothers me. I've always sort of felt deep inside that the reason I always end up with so many high drama psych patients is that God knows I know how to deal with them. I always thought that I would feel sort of a kinship or at least a deep empathy for addicts because of my own past. I was never a substance abuser, but I've dealt my whole life with a lot of unhealthy tendencies. When I was about 13 or 14, I started cutting myself. A couple years later, I also started dieting to a ridiculous degree even though I was already underweight. When I slipped up, I would make myself throw up. I didn't tell anyone. For a long time. When my family found out, and I realized how much it hurt them to see me this way, I worked very hard to stop. I had my setbacks, and I still have the tendency to do these things. I always will. The thoughts still run through my head, but I have it in me to stop myself because I think about how it hurts the people around me.

I think this is where I struggle. I hurt for our depressed patients. I hurt for the type of people who rely on some self destructive behavior to escape all the bad things they feel. But I hurt even more for their families.

I took care of a lady with liver failure and esophogeal varicies their other day. I remembered her face. I knew why she was here. Drank herself sick again. This time, though, her son was with her. I knew I would have remembered him. He was a big cherubic looking kid. Really quiet. Really young, about 21. He never asked us for a thing. He sat there and stroked his mom's hair and held her hand while we tried to start an IV on her scarred-up shit veins. I don't think she even really acknowledged his presence. She did demand Dilaudid from us while he sat outside the room and cried. He asked one of the nurses how much it would cost to get his mother a liver transplant. That was enough to make me cry, too.

And my patient last night. Came in via EMS for approximately the 50th time this year. Took 9 Vicodin at once for whatever bullshit pain complaint she made up at that particular moment. Her tooth...nope. Maybe her back. And/or neuropathy. Wherever the pain was, she wasn't trying to kill herself or get high. She was just trying to make the pain better. In fact, the pain was still there, could she get some more pain medicine? Yeah. No. So her husband came back. Apparently this was a pretty regular little routine for them. By the way, she'd also been popping Xanax all day like they were sweet tarts. She does the and passes out, he says, so he just calls the ambulance as soon as she does it. Take her meds away, we tell him. Nope. Can't do it. Supposedly if he takes her meds she throws boiling water on him. Why he stayed with her I have no clue. But he did. The whole night he hugged and kissed her while she drooled. He cleaned and changed her when she peed on herself. This is my wife, he said. I married her because I love her. The EMTs who ran on her knew her by name. They said he would run down the block and use the pay phone to call 911 because she got so irate and abusive when he did it, so he would call from outside the house and pretend it wasn't him. I felt so awful for him. He clearly loved his wife so much, and there was absolutely nothing he could do for her.

I looked into both of these people's faces trying to find what it was that made these people love them. I could not figure it out for the life of me. Who had they been? And what happened? I can understand trying and failing. But I cannot understand looking into the eyes of your loved one and seeing the desperation I saw in both of these men and not wanting to change at all. The selfishness in them made me sick. It didn't change the way I cared for them but it just felt... bad. Like there was an anger in me for them that I really felt uncomfortable with. Chances are that these women will both kill themselves with their behavior one of these days. An awful part of me felt like it would be better for their loved ones if they went ahead and did it.

Is this normal? Am I putting too much on them? And is it even fair for me to compare my problems with theirs? This job sneaks up on me so bad some days.

Reach for the Stars!

Ugh. Sorry guys. I have sucked at updating this lately. I really have trouble motivating myself to write about work when it seems like I have nothing to do but complain, but hot damn. The douchebag stretch has continued with very few exceptions.
I have some things to be thankful for- we're actually adequately staffed, which is amazing.
And I took care of the most wonderful old lady the night before last. I mean, she was the cutest ever. And so sweet. She actually said to me at one point, "I'm so thankful you came into my life. I could just be around you forever. It's so wonderful to be around happy people." Had she not had to stay and repair her broken leg, I probably would have picked her up and taken her home with me.
Now for last night. Not so much luck. For every sweet normal patient, there were 3 psycho douches on the loose in all my other rooms. It wasn't all bad, however, because I've kind of figured something out. I'm almost okay with douchebaggery if you make it an art form. I'm talking, really, truly, dedicating your whole visit to being absolutely crazy and unreasonable. It's the in betweens that kill me.
Whining and requesting Dilaudid for your UTI is just annoying. Coming in and being "allergic" to everything except Dilaudid and Phenergan and then trying to convince me that it's fine for me to discharge you with the Huber needle still in your Mediport because they do it at your cancer center all the time just makes me want to hit you.
No. If you want to act like a jackass, you need to just aim high and go for the gold so at least you're entertaining. For example, try coming the ER on an ambulance a day after you've signed out AMA from another hospital for a uterine prolapse you've had for 10 years but refuse to have fixed, and sign out AMA repeatedly from said ER as soon as you get your narcotic pain meds. Do it frequently enough that the staff is on a first name basis with you. But make sure to walk the halls with your prolapse hanging out and dripping God-knows-what secretions all over the floor for all the patients and their family members to see. Take your prolapse along with you into the trauma room where your nurse is trying to start an IV so that your can tell her to call the EMS service to tell them to hurry up because it's been 20 minutes and they're taking too long. Make sure you insist on being discharged with Hydrocodone because "it's the only thing that works." If you really want to shine at hood hospital, you need to aim for the stars.
How about refusing to be triaged because it's too cold in the waiting room, and sleeping in the play area whilst scaring the shit out of everyone's children? Make sure when you finally do get back to be triaged, your only complaint is the HIV you've had for 15 years that you've stopped taking meds for for 8 years, despite the fact that you get government assistance. Make sure to refuse to be weighed, especially if one of your complaints was weight loss. When you do get back to a room and the nurse tries to draw your blood, don't give it away for free. You should try to charge the nurse at least twenty dollars a tube and insist on being admitted without having any tests run first. When you do inevitably get discharged, don't leave unless escorted out by the police. Make sure you use every racial slur possible when interacting with the staff about your discharge instructions. Continue to demand money for your blood, and refuse to walk out of the room that you walked back to because your feet hurt. When the police do haul you away, it's a good idea to exit the ER screaming that your nurse is a bitch hoe who stole your 5 ccs of HIV positive blood and sold it for money, and that she is the reason you don't fuck with white bitches. Bonus if you ask the officer who is escorting you off the premises,"Why do you defend these whores?" Yeah. It's lots of fun for everyone. At least when you do this, we can stand outside your room and laugh hysterically while you're taken away in cuffs insisting on another popsickle because your other one melted, and we have stories to tell our friends over beers. Anything worth doing is worth doing right, damn it.

Come one, come all

One of my work friends is the most hilarious angry person ever- I'll always remember the night that her whole side was full of combative and hateful patients and she went on a huge rant after work in the morning about it. "It was a special for douchebags" she said. "Somebody put a sign up. 2 for 1. Bring all your douchebags. Come one, come all."

That's all I could think of tonight. Holy shit. All night long from the second we got there. Douchebags on parade. The day nurse talking crazy to me in report over me mentioning a page was missing out of a chart. The crazy lady who kept demanding pain medicine with a negative CT who insisted we give her a soft c-collar to wear home. Oh, yeah. And the police had to escort her out to get her to leave. Sweet.

Record AWOLs. Oh, you're not going to give me the prescriptions/treatments/tests I think I need NOW? No, that's okay. I'll just take out my own IV and leave. Great. Awesome.

It's also hot right now to lie about having a ride home. No, it's okay. Go ahead and give me that Morphine.

The lady with the "migraine headaches" who was allergic to everything that you usually prescribe for migraine headaches? Shocker. The one who of course gets no relief from non narcotics, but the last time she was here we gave her that D medicine and that seemed to help her a lot. Well, she got some Demerol. Apparently that wasn't the right D medicine but the person who gave it to her forgot to ask if she had a ride home so we were stuck with that foolishness for a minute. By the time she did produce a ride home for herself (also, for her 9 year old son who she had brought along for the party, because why not?) her blood pressure was too low for that other D medicine so she opted to stay for another liter of saline so she could experience the healing touch of Dilaudid. Her ride didn't get it and actually asked me how long it would take for her blood pressure to be high enough. Really!? Also, she tried to tell us she was homeless but she had a blackberry and had just gotten a new tattoo that day. Bitch, please. I can't afford a new tattoo. Amazingly, once we delivered the correct D medicine, her migraine was cured and kittens and rainbows actually flew out of the IV site when she "accidentally" took it out herself. Fabulous!

Once we finally got rid of her, she passed the douche torch to the husband of another patient who presented to the hospital because she didn't follow her diet orders after being discharged for gastroenteritis the day before. After walking up to the desk 4 times in an hour to insist his wife be seen above the patients waiting in front of her, he finally demanded that we call an ambulance for his wife because "we clearly weren't going to do anything for her". Yeah, no. Not how ERs work. I told him such and he nearly ran the practitioner over with the wheelchair he grabbed to try to roll her out in as she was walking in to see the patient. The patient was fine. She was discharged within the hour with exactly what we thought she had.

Luckily, the educator didn't let the ball drop by walking in and talking crazy to me about some foolish paperwork he never sent me about getting "checked off" to work in triage (never mind the fact that had already been working up there for several months before they decided I needed to be trained and checked off) and then being an ultra mega douche when I had no idea what he was talking about.

Oh! And I almost forgot! The guy whose mom died four times last year- I guess she died for the 5th time last night! Yup! I may have remembered his name and made a couple of phone calls to EVERYONE about that as soon as I saw his name on the tracker.

In my head, I imagine it was probably him that led the march of douchebags to the ER last night, and that there might have been a bullhorn involved. "Come one, come all, to hood hospital! Follow me to all your work excuses for STDs, your favorite D medicines, sandwich trays, and free yellow fall risk footies! 2 for 1! Huzzah!"

Isolation? What?

Dude. Seriously. ER nurses are a special breed. I took care of an MRSA patient today and I was thinking back about how we had to deal with that on the floor when I was in nursing school. Gown and gloves if you're going to step over the red line. Don't you dare cross that red line to hand that MRSA patient the phone or give them a glass of water if you 're not decked out in that sexy plastic gown.

ER is the polar opposite. Pretty much projectile blood and shit are the only reasons I will put on an isolation gown these days. Oh. Flesh eating bacteria. That's about it. So many of our patients come in without any kind of information that when we realize we should be wearing PPE, it's already way the hell too late anyway. We took this little MRSA lady up to the ICU today and they were teasing us about our lack of gowns. "ER nurses have special immunity", they said. I agreed with her. "Yup. It's called we've probably been exposed to everything ever."

I just feel sorry for the nurses that will have to take care of me when I'm old. Those poor bastards are going to need hazmat suits.

Floor nurses, I salute you.

I'll be the first to admit that at times, I've been hard on floor nurses. I get mad when despite my extra efforts to get a patient settled before going to the floor, they still talk crazy to me in report. I want to pull my hair out when I have to repeat everything 4 times in report because they just aren't listening. I get irritated when they yell at me because they're getting slammed, or when they sit at the nurses station talking and stare at me while I transport a 300 pound patient on my own and then act like I'm a lazy bitch when I ask for help.

But when I think about it, I respect them a whole lot and I could never do the job they do. I was thinking about it today, when it 0530 this girl rolled in. Again. Whiny, screaming, ungrateful, non-compliant to the point that it almost seems out of spite and disdain- a giant middle finger to the entire medical profession. I walked out of another patient's room to find her flailing of the stretcher screaming. I swore out loud without even thinking about it. The foolishness of her last visit was naturally multiplied for this visit. She turned up the drama to a whole new level. Even though I had ended up with pretty wonderful patients for most of the night, 15 minutes in I was like," I am totally done with this shit and I need a drink. I kind of hate this job sometimes." As I was pushing her second dose of Dilaudid in an hour while she asked me for ice chips for the 20 thousandth time between screams of pain, I started thinking about the nurses on the floor.

This douchebag always gets admitted. Always. Those poor nurses show up at the beginning of their shift and have to take care of this idiot asshole through the whole thing. All of it. There's no end in sight. No one to call report to. No nice long breaks for ultrasounds or CTs. No. They have to put up with this crap for 12 hours straight. And then a lot of the times they have to come back to the same bullshit the next day. I really, really don't think I could ever do that. I would take the bed down the elevator and push it out into the parking lot if I had to deal with that crap for my whole shift. I'm serious. At the best, I would call in every time I knew I was coming back to that crap the next day. And I can't even imagine the dreaded moment when you get report and recognize a name and realize, oh shit. This night is going to be the worst. If I was a floor nurse, I would probably not have a license and/or be in jail for punching someone's face.

So floor nurses, I salute you. For all you do, but especially for not punching people like I would. Sincerely, Hood Nurse

Totally badass

So, I think one of my weaknesses at this job is going along with the fuss a lot of people make about their medical conditions. A good deal of the people I see are being treated for problems I've had before- sprains, breaks, gastroenteritis and nasty upper respiratory infections- mostly at home with zero drama. When I have to deliver morphine for something that turns out to be a stomach bug or send someone home with Hydrocodone, but apparently not enough, for a sprained ankle, I kind of want to punch something. Bitch, please. Suck it up.
But lately. Wow. I've taken care of a couple of people so tough and badass that all I could do is sit back in admiration.
We had the adorable young stabbing victim. He was on the way to the bar when a guy flagged him down in the road. He said he normally wouldn't have stopped but that the guy had his kids with him and he wanted to help. He picked the man up to bring him somewhere for help, and the man stabbed him in the stomach and ran off. This guy drove himself home about 10 or 15 miles, where his sister then brought him up to the hospital. He probably had a good 4 inches of intestine sticking out of his abdominal wall. He didn't scream or cry. He strolled in casually where we brought him back to a trauma room- the only fuss he made at all was when I had to start his two 16 gauge IVs- and by made a fuss, I let him squeeze one hand while I started the IV with the other and he looked away. He never once asked for narcotics, but he did want to know what kind of antibiotics he was getting. He was a little nervous about getting transferred for surgery. He looked at me and said "Can't you just push it back in there?". I laughed and told him that he probably wouldn't want it done that way. He smiled and said,"No, it's cool. Just dump some of that hand sanitizer you guys use on there. It'll be fine." Hilarious. I was sad to see him go.
I took care of an older man recently who had fallen off his roof at about 6 that night. Not doing anything stupid like lots of our patients, just trying to clean the gutters. He fell about 10 feet but he stuck it out at home and tried to take some Aleve. He came it at 1 AM cause the pain got worse. I was pretty freaked out that he had broken something important or had a traumatic injury to an organ, yet he was incredibly patient about waiting to see a doctor and very sweet and funny. I got him some Fentanyl and we x-ray and CT'd just about everything- nothing life threatening going on, but homeboy had broken off a chunk of his scapula. Yeah. It was just floating around in there while he was chilling at the house with his OTC pain meds.
Then last week. I took care of a lady with a Hemoglobin at about half of what it should be. I asked her if she'd be feeling dizzy or weak. Yeah. For a while now. But she was trying to get in a clinic. She didn't want to come to the ER and bother anyone. Was a little freaked out about getting transfused. No, it's fine. I'm really okay as long as I'm lying down. It's been like this three weeks and the only time I wanted to pass out was going up some stairs. I talked her into the transfusion and finally got her upstairs to a bed. She'd been a hold in the ER most of the night with zero complaints.

I realize it's a little extreme. But I love patients like this. There's something very refreshing about taking care of people that actually belong in the ER, but it's even more refreshing when you can tell that they don't even think of treating the ER like a Starbucks. I wish there was some kind of medal of honor I could give them so that they could go out in the community and be like, "Yeah guys, look at this. I had a legit painful illness but I handled it like it was nothing. I'm a badass, fear me." At least I get to give them IV pain meds. I guess that's the next best thing.

Oh, summer.

If I ever get crazy enough to go back and get my masters, I think I may do some kind of study on the kinds of patients the ER sees in the summer time versus the winter.
We're hardly seeing any respiratory distress right now compared to the winter time- in February, we actually ran out of ventilators. Someone had to hop in their car to drive to our sister hospital and pick one up. The ICU was full non stop- no doubt the result of winter illnesses gone horribly wrong.
Summer is a whole other set of fuckery. I would say slightly less challenging and slightly more entertaining, although sometimes I'm just done with this shit. I mean, really. What is it about high temperatures that make people stab one another ALL THE TIME. And if you have to stab one another, okay, but please don't come to the hospital to see your boyfriend when you were the one who put him here in the first place by stabbing him, and then try to talk crazy to the ER staff when they ask you to leave because you were the stabber, then try to sneak back in after you are asked to leave only to get more crazy with the ER physician, who then has no other choice than to put you in a headlock because you can't act right.
Also- I like to drink and I know plenty of people who enjoy drugs. Please enjoy these activities safely in your own house and refrain from coming to the hospital like a normal person so I don't have to try and start an IV on your stupid ass. I have more important things to do, like taking care of all of these stabbing victims.
Another note about alcohol- drinking is fine, but if you're going to do so, please refrain from doing it on or around your roof. Just stay away from the roof altogether. Roofs and booze are mortal enemies and you should keep them apart at all times. If you really need to go on the roof, when you inevitably fall off, this is a time when it is appropriate to call an ambulance. Because when you come to the hospital in the back of your friend's SUV, and we have to go get a stretcher and climb in the car and try to cram one of the backboards EMS left here under you while we hold C spine and you scream at us, that's a whole thing and it would be a lot easier if you let the medics do that in the first place when you're on the ground and not in the back of a car.
At least I'll get away from it all today. Yes, dear blog readers, I am finally taking a vacation. I am going to rent a house with friends, drink for a week and float down a river. I think I'll manage to stay off the roof, refrain from stabbing anyone, and stay out of the hospital. If not, I may be gone for a little over a week.