There's something that happens when a woman turns 50 that makes it impossible for her to allow anyone she cares about to go to the hospital without her orchestrating the entire episode.
She pushes her way into the triage room, then answers all of the triage questions for the patient, including his or her pain level. I do draw the line at that, explaining that the patient is the only one who can answer subjective questions.
Along with the 3-way triage interview, her phone is constantly going off while she simultaneously attempts to control all the rest of her family and friends, while also summoning her clergy person.
Occasionally, she has to step out into the waiting area to exert her control in another direction and she always asks, "If I go out here for a minute, how do I get back in?"
"You don't." That's what I want to say and that's the truth, if I have any control over it, and I do, most of the time. But instead, I say, only so she'll leave, "Just hit the buzzer and we'll let you right back in." (fingers crossed behind my back)
Once in a while she is unable to accompany the patient to the hospital which makes for some creative control efforts via telephone or written instructions sent along with the patient on the ambulance, as in this next case, one of my favorites.
(Again, this is posted exactly as it appeared on the note book paper it was received upon. And, although I would have omitted it if it had, it did not contain any kind of identification or phone number, etc. with which to contact her, had we been so inclined which I can promise you, we were not.)
Since leaving emergcyroom last week or so, he has gotten very ill.
2nd trouble breathing
1st throwing up not stop for days on end
3rd dehundreaded (even thow he's drink liquids)
4th Weakness is getting worse
5th pain in stomack (not contenpaded)!!!!
Do something! even if you have to keep him which I Recomend until this is under control. I'm
disabled myself.
He HAS insurance, So there's no reason not to help him.
Please Call me to let me know what going on.
ThankYou,
GOD BLESS
no matter what, you keep him until you find out what's going on, or he's going to die. Do you
understand.
She got kinda nasty there at the end, didn't she?
Sunday, October 28, 2012
Friday, October 26, 2012
Brown Town
Lab tech goes into a treatment room to draw blood on an elderly gentleman.
Lab: Sir, can you tell me your full name?
Patient: John Brown.
Lab: Where are you from? (making small talk while setting out his venipunture
supplies).
Patient: I'm from over at Tarkinton.
Lab: Oh. There's a bunch of John Browns down there, isn't there?.
Patient: Yessir.
Lab: How many of them are there down there?
Patient: Well, my mother and father had 13 children.
Lab (smiling): How many of them were named John Brown?
Patient: Not too many of 'em.
Lab: Sir, can you tell me your full name?
Patient: John Brown.
Lab: Where are you from? (making small talk while setting out his venipunture
supplies).
Patient: I'm from over at Tarkinton.
Lab: Oh. There's a bunch of John Browns down there, isn't there?.
Patient: Yessir.
Lab: How many of them are there down there?
Patient: Well, my mother and father had 13 children.
Lab (smiling): How many of them were named John Brown?
Patient: Not too many of 'em.
Calculus
Male with displaced femur fracture.
Triage Nurse: "Sir, what number would you rate your pain on a scale of zero to ten?"
Patient: "One"
Patient's Wife: "One? Is that all?"
Patient: "That's the worst one, isn't it?"
Patient's Wife: "No! Ten's the worst one."
Triage Nurse: "A zero to ten scale."
Patient: "Oh! Ten!"
Triage Nurse: "Sir, what number would you rate your pain on a scale of zero to ten?"
Patient: "One"
Patient's Wife: "One? Is that all?"
Patient: "That's the worst one, isn't it?"
Patient's Wife: "No! Ten's the worst one."
Triage Nurse: "A zero to ten scale."
Patient: "Oh! Ten!"
Just the Facts
An actual nurse's note narrative:
Patient ambulated to room 4. Removed dressing to right upper extremity. Patient reports arm is "rotting off" because he found green drainage when he took the dressing off. Patient unsure but believes he had surgery 1 week ago to repair his humerus which was broken by his brother hitting him with a hoe while the patient was drunk. Surgical site intact, small amount of dark green drainage noted. MD to room. Site cleansed with Hibiclens and normal saline. Redressed with triple antibiotic ointment, telfa, cling, coban, splint and ace wraps. Patient requested dressing be tight at top and bottom of dressing because he has roaches at his home and he is concerned regarding prospect of roaches crawling under bandage. MD notified.
Patient ambulated to room 4. Removed dressing to right upper extremity. Patient reports arm is "rotting off" because he found green drainage when he took the dressing off. Patient unsure but believes he had surgery 1 week ago to repair his humerus which was broken by his brother hitting him with a hoe while the patient was drunk. Surgical site intact, small amount of dark green drainage noted. MD to room. Site cleansed with Hibiclens and normal saline. Redressed with triple antibiotic ointment, telfa, cling, coban, splint and ace wraps. Patient requested dressing be tight at top and bottom of dressing because he has roaches at his home and he is concerned regarding prospect of roaches crawling under bandage. MD notified.
Thursday, October 18, 2012
It Was the Best of Times, It Was the Worst of Times
So today, I felt like I was working in a big city ER. We were so busy, I got no breakfast or lunch. Saints be praised, I brought a protein shake to work with me so I got that life-saving 26 grams of soy isolates at least, and that's the only reason I didn't lose my shit several times.
Which brings me to one interesting patient. I connected with this gal. She was a GI bleed. About my age. The paramedic hadn't started an IV because she had no veins and before I could even get her vital signs, she'd crapped Blood Lake. I was in her room alone as the ER was blowing wide open and everybody was busy somewhere else. I was trying to clean her up a little bit but feeling that pressure to get an IV started and, for God's sake, some vital signs to get an idea of her life expectancy and she starts to hassle me about a drink of water. No, I said, no drink of water right now. Oh, but she'd be so much more comfortable if she had a drink of water as if she didn't know she was exsanguinating through her anus. I told her that we had several things to do before we worried about making her comfortable and that we weren't even close to being done making her more UN-comfortable. She was totally cool and went back at me a few times and neither of us held a grudge and I really appreciate that kind of human interaction. It feels real to me. And there's nothing more real than a big pool of shitty blood in a bed, right?
Toward the last, as the surgeon was stitching in her central line, she said something about something hurting and I was swabbing her spoiled rotten lips for her and said, "Bitch, bitch, bitch!" and she smiled. I hope she does okay.
We jumped through our asses all day long and once I was just acutely aware of how every single minute, there's somebody wanting something from us and it's almost made worse by the fact that it's usually a relatively small thing to ask and so appropriate. It's just that there are billions of bells and orders and people and phones and doctors and other nurses and hunger and having to go to the bathroom grabbing out for us at the same time until you think you're going to roll up in a little ball and roll under the desk. And they keep coming.
Yet, there was something oddly satisfying about today. Feeling like you fit somewhere, like you were used as a tool to turn a special nut on a bolt. Like you made one, small difference to at least one second of someone else's life.
Saturday, October 13, 2012
More Fun in Store
Elderly Male Patient: "I can vomick some more in a minute when I get sick enough."
Conversations With God
A construction worker comes in day before yesterday while I'm at lunch. They're all in Trauma II when I get back. Blood all over the floor, the stretcher, the clothes. Everybody's gowned up. Turns out the guy was cutting a board with a circular saw and somehow ended up severing his brachial artery. He was drifting off, every once in a while. The chopper was called to transport him to another facility and his wife was getting ready to head out on the 75 mile trip to the other hospital. I overheard another nurse giving her directions.
Me: "Don't hurry, now. Take your time. You don't want another accident today."
Spouse: "I won't. I'm fine."
Me: "You are taking someone with you, right?"
Spouse: "No, I'm okay to drive."
Me: "You need to at least take someone with you."
Spouse: "I'm really okay, I'll be okay."
Me: "I know you think you're okay and you probably feel okay but you need to take someone with you."
Spouse: (looking at the other nurse, now) "I'll be okay. The Lord will take care of me."
Pause
Me: "The Lord told me to tell you to take someone with you."
Me: "Don't hurry, now. Take your time. You don't want another accident today."
Spouse: "I won't. I'm fine."
Me: "You are taking someone with you, right?"
Spouse: "No, I'm okay to drive."
Me: "You need to at least take someone with you."
Spouse: "I'm really okay, I'll be okay."
Me: "I know you think you're okay and you probably feel okay but you need to take someone with you."
Spouse: (looking at the other nurse, now) "I'll be okay. The Lord will take care of me."
Pause
Me: "The Lord told me to tell you to take someone with you."
Friday, October 12, 2012
We Are The Champions
It seems no matter what the problem is in the hospital, the solution is to have the ER nurses take on one more responsibility.
Electronic charting, for instance. The patient's vital signs, height and weight doesn't transfer from the triage note to the flow sheet (where everything after triage is charted). Solution? Have IT or a representative from the software provider tweak the issue? No. Better to require the ER nurse before triaging the bleeding, moaning, puking, smothering, screaming and/or dying patient, to first click on the flow sheet option, open a flow sheet, apply it, save it, close it and then open the triage sheet by clicking on the electronic forms tab, triage sheet tab and then the go to sheet tab.
A patient in a hospital in Chicago killed himself by drinking a cleaning substance which was left in a treatment room. The solution? Make sure noxious solutions are clearly marked as such? Acknowledge the fact that, unless a patient exhibits suicidal tendencies, common sense dictates that we're simply not responsible for every single irrational thing anyone, anywhere might decide to do at any given time in any given place? Realize some people are just too stupid to live? No. Better to declare cleaning agents can no longer be kept in the treatment rooms, thereby creating a need for the ER nurses to go all the way to the clean utility area to get a spray bottle of solution to clean the rooms after patients leave, then go all the way back to the clean utility room to replace the bottle. Hibiclens, alcohol, betadine, hydrogen peroxide? Same thing. Can't be kept in the rooms. How did we ever keep from killing patients back in the day when we kept glass thermometers soaking in alcohol-based antiseptic in stainless steel trays with lift off lids in each treatment room? How do we keep them from hanging themselves with the sheets on the beds, for instance? Where does the responsibility of ER nurses stop?
ER doctors (whose salaries exceed ER nurses in our facility by in the neighborhood of nearly 10 times and rightly so considering the level of education and licensure required of them) can't seem to manage to a) sign the patient discharge instruction sheet or b) sign and document a diagnosis on their T-sheets. The solution? Discuss with the physicians the reimbursement issues involved with incomplete physician documentation? Create a system whereby physicians are motivated to complete proper documentation such as not allowing them to work until said documentation is complete, as would be the case if a nurse were to do the same thing? No. Better to devise a new form for the ER nurses to be responsible to fill out at the discharge of every patient requiring her to go down a list, checking boxes indicating each form is accounted for and that the MD has signed his documents and written down a diagnosis. If anything is missing, it will be the nurse's evaluation that suffers and she may miss out on her 2% annual raise, if the hospital happens to even give raises that year, which they often do not.
Somebody in the hospital is getting paid minimum wage to scan all the ER documents into the computer but can't quite manage to scan them in the correct order or even right side up in all cases. The solution? Counsel the persons responsible for scanning, impressing upon them the importance of legible scanned documents? Explain to the entire hospital staff in an in-service if necessary that the upside down, scanned electronic documents can easily be turned right side up by clicking the rotate button on the pdf file viewer? No. Better to add to the ER nurses' responsibility that of ensuring each discharged patient's chart is placed in the correct scanning order and paper clipped, once before giving it to the ER doctor to sign and add his diagnosis to, and then a second time when received back from the doctor in a messy pile, paper clip missing.
Patients come to the hospital without a clue what medications they take, nor the dosages or frequencies. The solution? Public teaching regarding the necessity of the above data in order to provide safe care of the patient? Requiring a family member to go home to retrieve the patient's medication bottles? Refusing to render care in non-critical situations until somebody magically remembers or retrieves said data? No. Better to require the ER nurses to find out what pharmacy the patient uses and call them and waste their time looking up the medication lists of patients who don't care enough about their own health to notice what chemicals they put in their bodies. Or call the patient's primary care provider's office and waste time they could be using to tend to the needs of responsible patients who actually make appointments and seek medical care in an appropriate setting. Or, in the event the pharmacy and PCP's office are both closed or the patient orders medications from an insurance mail-order system, require the nurses to pull the information out of their asses. Incomplete medication forms are unacceptable.
Some of the ER physicians are having difficulty mastering the task of ordering ER medications electronically. The solution? More and extensive teaching regarding the electronic ordering of meds to be done by IT with ER physicians? Reworking the current system for the physician ordered medications? No. Better to require the ER nurses to learn to enter medication orders electronically (despite an aggressive taboo in the past regarding taking verbal med orders from physicians) which is to only be done in an emergency. We all know how that's going to play out, now don't we? After all, we do work in the emergency room. They're all emergencies, aren't they? I mean, in somebody's eyes.
Besides, the ER physicians are busy. They have every patient in the ER to see and there are several nurses to share the (growing list of) responsibilities assigned to them. However, with the exception of a code situation, the doctor spends approximately 7 minutes with each patient and has an average of 2-3 orders per patient to put in electronically. Otherwise, the medications need only be clicked "Continue" or "Discontinue" in the electronic medication list which was entered by the nurse while the patient was bleeding, moaning, puking, smothering, screaming or dying, incidentally (see the paragraph on electronic charting). Otherwise, he has one T-sheet to fill out. With a pen. On real paper and not on a goddamned computer. Like in the good, old days. Is it really that difficult?
Meanwhile, the ER nurse has an extensive triage form full of medical history that hasn't carried over from the previous admissions due to yet another IT glitch, a medication form (including meds, dosages, frequencies, routes, last dose and time, doctor who prescribed and pharmacy filling the medication), a flow sheet including everything anybody in the ER or elsewhere has done for or to the patient during his/her stay in the ER, a list of vital signs, a treatment sheet where things like blood cultures, etc are documented, transfer forms (okay, the MDs do 33% of this form, too), discharge education, a charge form and the new form where all the other forms are accounted for.
In the interest of time I'll stop here but know that this is an incomplete list.
Electronic charting, for instance. The patient's vital signs, height and weight doesn't transfer from the triage note to the flow sheet (where everything after triage is charted). Solution? Have IT or a representative from the software provider tweak the issue? No. Better to require the ER nurse before triaging the bleeding, moaning, puking, smothering, screaming and/or dying patient, to first click on the flow sheet option, open a flow sheet, apply it, save it, close it and then open the triage sheet by clicking on the electronic forms tab, triage sheet tab and then the go to sheet tab.
A patient in a hospital in Chicago killed himself by drinking a cleaning substance which was left in a treatment room. The solution? Make sure noxious solutions are clearly marked as such? Acknowledge the fact that, unless a patient exhibits suicidal tendencies, common sense dictates that we're simply not responsible for every single irrational thing anyone, anywhere might decide to do at any given time in any given place? Realize some people are just too stupid to live? No. Better to declare cleaning agents can no longer be kept in the treatment rooms, thereby creating a need for the ER nurses to go all the way to the clean utility area to get a spray bottle of solution to clean the rooms after patients leave, then go all the way back to the clean utility room to replace the bottle. Hibiclens, alcohol, betadine, hydrogen peroxide? Same thing. Can't be kept in the rooms. How did we ever keep from killing patients back in the day when we kept glass thermometers soaking in alcohol-based antiseptic in stainless steel trays with lift off lids in each treatment room? How do we keep them from hanging themselves with the sheets on the beds, for instance? Where does the responsibility of ER nurses stop?
ER doctors (whose salaries exceed ER nurses in our facility by in the neighborhood of nearly 10 times and rightly so considering the level of education and licensure required of them) can't seem to manage to a) sign the patient discharge instruction sheet or b) sign and document a diagnosis on their T-sheets. The solution? Discuss with the physicians the reimbursement issues involved with incomplete physician documentation? Create a system whereby physicians are motivated to complete proper documentation such as not allowing them to work until said documentation is complete, as would be the case if a nurse were to do the same thing? No. Better to devise a new form for the ER nurses to be responsible to fill out at the discharge of every patient requiring her to go down a list, checking boxes indicating each form is accounted for and that the MD has signed his documents and written down a diagnosis. If anything is missing, it will be the nurse's evaluation that suffers and she may miss out on her 2% annual raise, if the hospital happens to even give raises that year, which they often do not.
Somebody in the hospital is getting paid minimum wage to scan all the ER documents into the computer but can't quite manage to scan them in the correct order or even right side up in all cases. The solution? Counsel the persons responsible for scanning, impressing upon them the importance of legible scanned documents? Explain to the entire hospital staff in an in-service if necessary that the upside down, scanned electronic documents can easily be turned right side up by clicking the rotate button on the pdf file viewer? No. Better to add to the ER nurses' responsibility that of ensuring each discharged patient's chart is placed in the correct scanning order and paper clipped, once before giving it to the ER doctor to sign and add his diagnosis to, and then a second time when received back from the doctor in a messy pile, paper clip missing.
Patients come to the hospital without a clue what medications they take, nor the dosages or frequencies. The solution? Public teaching regarding the necessity of the above data in order to provide safe care of the patient? Requiring a family member to go home to retrieve the patient's medication bottles? Refusing to render care in non-critical situations until somebody magically remembers or retrieves said data? No. Better to require the ER nurses to find out what pharmacy the patient uses and call them and waste their time looking up the medication lists of patients who don't care enough about their own health to notice what chemicals they put in their bodies. Or call the patient's primary care provider's office and waste time they could be using to tend to the needs of responsible patients who actually make appointments and seek medical care in an appropriate setting. Or, in the event the pharmacy and PCP's office are both closed or the patient orders medications from an insurance mail-order system, require the nurses to pull the information out of their asses. Incomplete medication forms are unacceptable.
Some of the ER physicians are having difficulty mastering the task of ordering ER medications electronically. The solution? More and extensive teaching regarding the electronic ordering of meds to be done by IT with ER physicians? Reworking the current system for the physician ordered medications? No. Better to require the ER nurses to learn to enter medication orders electronically (despite an aggressive taboo in the past regarding taking verbal med orders from physicians) which is to only be done in an emergency. We all know how that's going to play out, now don't we? After all, we do work in the emergency room. They're all emergencies, aren't they? I mean, in somebody's eyes.
Besides, the ER physicians are busy. They have every patient in the ER to see and there are several nurses to share the (growing list of) responsibilities assigned to them. However, with the exception of a code situation, the doctor spends approximately 7 minutes with each patient and has an average of 2-3 orders per patient to put in electronically. Otherwise, the medications need only be clicked "Continue" or "Discontinue" in the electronic medication list which was entered by the nurse while the patient was bleeding, moaning, puking, smothering, screaming or dying, incidentally (see the paragraph on electronic charting). Otherwise, he has one T-sheet to fill out. With a pen. On real paper and not on a goddamned computer. Like in the good, old days. Is it really that difficult?
Meanwhile, the ER nurse has an extensive triage form full of medical history that hasn't carried over from the previous admissions due to yet another IT glitch, a medication form (including meds, dosages, frequencies, routes, last dose and time, doctor who prescribed and pharmacy filling the medication), a flow sheet including everything anybody in the ER or elsewhere has done for or to the patient during his/her stay in the ER, a list of vital signs, a treatment sheet where things like blood cultures, etc are documented, transfer forms (okay, the MDs do 33% of this form, too), discharge education, a charge form and the new form where all the other forms are accounted for.
In the interest of time I'll stop here but know that this is an incomplete list.
Friday, October 5, 2012
Overheard in ER
Nurse to Elderly Male Patient: "Do you still have your gallbladder and appendix?"
Elderly Male Patient: "No, I never had them. I never had no appendix or nothin' that'a way."
Elderly Male Patient: "No, I never had them. I never had no appendix or nothin' that'a way."
Thursday, October 4, 2012
This Bud's For You, Bud
I used to get automatic emails of the local obituaries but somehow when I got this new laptop in June, I quit receiving them and haven't yet gotten around to re-subscribing. In September I was out of town roughly 3 weeks, altogether, and because I long ago stopped buying a local paper on a regular basis, I've been out of the loop. Tonight while writing another post which I've since saved in draft form for another day, I did an online search to check a fact and ended up on the obituary page of the local funeral home. There I tarried for 30 minutes, or so, catching up on people I hadn't realized had passed. There were a few surprises but I was aware of about half of them before tonight.
I'm sort of a connoisseur of obituaries. I love them. I love everything about them, even when I'm sorry to see some of the names, like tonight. And I don't think I'm alone. Back in the 90's, my daughter took a sociology class at the local community college along with the daughter of one of my co-workers in the ER. The instructor, a male in his 30's, shared with the class one day that he used to date a nurse who always listened intently to the obituary segment of the local morning news on the radio which he considered a bit strange. Upon hearing the story, my daughter and my co-worker's child turned, open-mouthed toward each other whispering, simultaneously, "My Mom does that!"
In a small town, there are certain people you see all the time, people you don't even know but who, because you're around them for sometimes your entire life, as in the case of the natives, or at least for 33 years, in the case of me, you feel a closeness to without even realizing it. Then one day, something reminds you of them and you say, "Hey, whatever happened to that great big, fat guy who used to sit on the bench in the city park and wave at the cars going by?" or, "Remember that gal who used to walk up and down the highway picking up cans? Whatever became of her, I don't see her anymore?". It's complicated because you don't even know their names.
Lately though, the obituaries have begun to include pictures and that helps a great deal. Although, oftentimes, for some reason the family picks a picture from 28 years ago that nobody would recognize and that certainly complicates matters. It's easy to miss one and never realize it. The internet helps but I managed to miss a bunch in September, I found out tonight.
So tonight I was browsing, reading in depth each obituary, one at a time. I read the obituary for the boss I had at my favorite nursing job in my entire life. She died while I was out of town and unable to attend the funeral. That one hurt. And it was unexpected. But I'd already seen it in the free paper somebody had lying around at work one day. On the second page of the funeral home website, after a few of our ER regulars who came as a shock when I heard about them last week, I saw a familiar face.
He was a jovial guy. Used to come in with his wife. And daughter. They were all three sort of regulars but only periodically. The daughter had her own set of psychoses and, okay, I suppose his wife was probably crazy, too. But he was just a pleasure to see coming and never had anything seriously wrong with him, just wanted to be checked out to make sure a twinge in the chest or a little swelling in his feet or a cough weren't anything serious. No big deal. I didn't even remember his name, until I saw it and his face on the same page together. But when I realized he'd died it made me feel really, really sad. It sort of surprised me, the way it made me feel, and I even cried real tears for a while. And I still feel sad.
We get our balls busted so much of the time by people who just make our lives at work a living hell, that when someone is polite and acts like an adult and even makes us smile once in a while, we appreciate it. And I know I'm greatly callused, maybe even pathologically but I still love people, even though I'd probably be better off if I didn't, and in a quirky, philosophical way, I loved that guy. And now he's gone and never coming back.
You don't realize how many people you touch. I think Bud would be surprised to have seen me cry when I saw his picture online tonight.
I'm sort of a connoisseur of obituaries. I love them. I love everything about them, even when I'm sorry to see some of the names, like tonight. And I don't think I'm alone. Back in the 90's, my daughter took a sociology class at the local community college along with the daughter of one of my co-workers in the ER. The instructor, a male in his 30's, shared with the class one day that he used to date a nurse who always listened intently to the obituary segment of the local morning news on the radio which he considered a bit strange. Upon hearing the story, my daughter and my co-worker's child turned, open-mouthed toward each other whispering, simultaneously, "My Mom does that!"
In a small town, there are certain people you see all the time, people you don't even know but who, because you're around them for sometimes your entire life, as in the case of the natives, or at least for 33 years, in the case of me, you feel a closeness to without even realizing it. Then one day, something reminds you of them and you say, "Hey, whatever happened to that great big, fat guy who used to sit on the bench in the city park and wave at the cars going by?" or, "Remember that gal who used to walk up and down the highway picking up cans? Whatever became of her, I don't see her anymore?". It's complicated because you don't even know their names.
Lately though, the obituaries have begun to include pictures and that helps a great deal. Although, oftentimes, for some reason the family picks a picture from 28 years ago that nobody would recognize and that certainly complicates matters. It's easy to miss one and never realize it. The internet helps but I managed to miss a bunch in September, I found out tonight.
So tonight I was browsing, reading in depth each obituary, one at a time. I read the obituary for the boss I had at my favorite nursing job in my entire life. She died while I was out of town and unable to attend the funeral. That one hurt. And it was unexpected. But I'd already seen it in the free paper somebody had lying around at work one day. On the second page of the funeral home website, after a few of our ER regulars who came as a shock when I heard about them last week, I saw a familiar face.
He was a jovial guy. Used to come in with his wife. And daughter. They were all three sort of regulars but only periodically. The daughter had her own set of psychoses and, okay, I suppose his wife was probably crazy, too. But he was just a pleasure to see coming and never had anything seriously wrong with him, just wanted to be checked out to make sure a twinge in the chest or a little swelling in his feet or a cough weren't anything serious. No big deal. I didn't even remember his name, until I saw it and his face on the same page together. But when I realized he'd died it made me feel really, really sad. It sort of surprised me, the way it made me feel, and I even cried real tears for a while. And I still feel sad.
We get our balls busted so much of the time by people who just make our lives at work a living hell, that when someone is polite and acts like an adult and even makes us smile once in a while, we appreciate it. And I know I'm greatly callused, maybe even pathologically but I still love people, even though I'd probably be better off if I didn't, and in a quirky, philosophical way, I loved that guy. And now he's gone and never coming back.
You don't realize how many people you touch. I think Bud would be surprised to have seen me cry when I saw his picture online tonight.
Wednesday, July 4, 2012
Window to the Soul
Me: "Sir, on a scale of zero to ten, with zero being no pain and ten being the worse pain imaginable, where is your pain today?"
Elderly Black Gentleman: "It be in my eyes."
Elderly Black Gentleman: "It be in my eyes."
Monday, July 2, 2012
You Is Kind, You Is Smart, You Is Important
I just finished watching The Help for the second time. I saw it last year in Iowa and again tonight. I taped it on the DVR to watch with a friend who came to eat chili rellenos and homemade pico de gallo and relax in front of the television.
As we watched the beer-swigging Hilly swerving down the gravel road toward Skeeter's house after reading the book and revealing her secret, I jokingly told my friend, "That's how it's gonna be when my book comes out about the hospital". And we laughed.
Just now, after my friend went home I got out my notebook to journal a while and began to think about what I had said. I wondered what is it I really want to say. Here and in a book. And I decided this.
I want to tell our side. My side. What I and we are expected to smile through and not let common sense contaminate. Electronic charting and demanding patients in an ego-centered society and the crabs in a barrel syndrome with other nurses. All of it. I need to tell what kind of insanity exists in this profession, what I've seen that the rest of the world doesn't know, nor may believe exists. It's hard to believe. I know. I have trouble believing it, too. That's what I want to say. Because saying it makes me feel a little less insane.
But it's not just that, not just the hospital and the pressures and stressors of that. You and I know it's also about menopause and about having had enough water pass under the bridge to no longer be able to smile and nod and to even care a lot of the time. It's all of that, too.
I found an old pay stub the other day from 2009 that I'd stuck in a book to mark my place. I was working where I do now, in the very same department and as full-time status. I'm making exactly $0.16 more today than I was then. Three years ago.
My boss came out to the nurse's desk the other day and we were slow and we all started talking about something. There were three of us. And I said to him, and we weren't on the subject of salary, "Let me ask you something. I'm making sixteen cents an hour more than I was here 3 years ago. (He wasn't the supervisor then). Do you think there's something wrong with that?"
The answer is that there is something wrong with me, that's the answer. The answer is why am I not enrolled in truck driving school like I dream about all day long? And before the comments come telling me what a horrible life I'd have driving a truck, let me say that I know all of that. (Isn't it cute how I pretend there will be comments?) I've already been told. By everybody. But there is something about the prospect of turning in my notice and jumping in a truck and driving for 70 hours a week for a year that is somewhat of a siren song for me and others like me. I think of it as only a year because I really like to be home too much to do it for the rest of my life. But God knows I need a break from the ER.
Like Hilly, I'm tired. It's hard work eating shit pie for twelve hours a day, three days a week.
Monday, June 4, 2012
...and I quote
Possibly the best part of my job (if there is a best part) is the pre-triage form. When patients come to the ER, they fill out a form indicating their chief complaint which is then submitted to admissions and, subsequently, given to the triage nurse. These are some which have caught my eye (the quotation marks are mine, otherwise these are completely unedited regarding spelling, grammar, punctuation, sentence structure and capitalization):
"He has had a high Fever of 102.6 for the past 24hours coughin an cumplanin of his tummy heartin."
"High Fever, votmonting, sorl thoroght runy nosie"
"Colon burn Stomach hurts qallbladder"
"Right Lover Pain"
"Been Bound up in Gut For About A week"
"Fell on cement + with fist at heart area needs to find out if anything is badwrong"
"Face is Busted it woozy Need stitchly"
"Sour throught. Ears hurts runny noses."
"I have a shoulder that is on my right arm + down my arm + I have tingling in my Finger + it feels num"
"Herniated dick" (submitted by a female patient)
"I was diajnosed a year ago.In leavenworth KS My lungs hurt thats it I'm weezing!"
"Sunday yall said Go Sleep it off it Just a head ach made appomint to day she Been having headach nosia weak all this time No Legs are weak she has a concusion Dr SAID!!"
"My left foot is strained?"
"IM diying Bealse my arem is roting off."
"Cant really talk because half of mouth is swallowen abcest tooth, throat swalloen andchest pain"
I particularly like the ones with the exclamation points!!!
"He has had a high Fever of 102.6 for the past 24hours coughin an cumplanin of his tummy heartin."
"High Fever, votmonting, sorl thoroght runy nosie"
"Colon burn Stomach hurts qallbladder"
"Right Lover Pain"
"Been Bound up in Gut For About A week"
"Fell on cement + with fist at heart area needs to find out if anything is badwrong"
"Face is Busted it woozy Need stitchly"
"Sour throught. Ears hurts runny noses."
"I have a shoulder that is on my right arm + down my arm + I have tingling in my Finger + it feels num"
"Herniated dick" (submitted by a female patient)
"I was diajnosed a year ago.In leavenworth KS My lungs hurt thats it I'm weezing!"
"Sunday yall said Go Sleep it off it Just a head ach made appomint to day she Been having headach nosia weak all this time No Legs are weak she has a concusion Dr SAID!!"
"My left foot is strained?"
"IM diying Bealse my arem is roting off."
"Cant really talk because half of mouth is swallowen abcest tooth, throat swalloen andchest pain"
I particularly like the ones with the exclamation points!!!
Monday, May 28, 2012
Connect the Dots
Tremulous Girl in Treatment Room #3: "Nurse, can I have a warm blanket? I'm freezing."
Me: "Sure, I'll be right back"
(There are only a few warm blankets in the warmer and many patients before we get more cold ones to replace them with once those are gone.)
Tremulous Girl in Treatment Room #3: "And nurse? Can I have a glass of ice water?"
Me: "Ice?" (moment of silence, shaking head slowly) "No. No ice."
Tremulous Girl in Treatment Room #3: "But my mouth is dry."
Doting and Hovering Family Member: "She's so thirsty."
Me: "I'll bring you a glass of water."
Tremulous Girl in Treatment Room #3: "I can't have ice?"
Me: "No ice."
Tremulous Girl in Treatment Room #3: (Staring, incredulously as I slowly close the treatment room door and walk away)
Am I the only one who has linked the drinking of ice water with the sensation of feeling cold? Just wondering.
Me: "Sure, I'll be right back"
(There are only a few warm blankets in the warmer and many patients before we get more cold ones to replace them with once those are gone.)
Tremulous Girl in Treatment Room #3: "And nurse? Can I have a glass of ice water?"
Me: "Ice?" (moment of silence, shaking head slowly) "No. No ice."
Tremulous Girl in Treatment Room #3: "But my mouth is dry."
Doting and Hovering Family Member: "She's so thirsty."
Me: "I'll bring you a glass of water."
Tremulous Girl in Treatment Room #3: "I can't have ice?"
Me: "No ice."
Tremulous Girl in Treatment Room #3: (Staring, incredulously as I slowly close the treatment room door and walk away)
Am I the only one who has linked the drinking of ice water with the sensation of feeling cold? Just wondering.
Tuesday, May 22, 2012
A Minor Setback
I took a nap yesterday afternoon and had this dream.
The unit secretary and I were trying to load an elderly patient into a wheelchair for transport to her daughter's vehicle for discharge home. Her daughter was one of those entitled-seeming, late 50's aged women in khaki capris who never smile, unless engaged in some sort of manipulation, and then only with their mouths and never with their eyes and you sense you're expected to be giving special treatment to due to their prominence in the community. I didn't recognize her, nor do I generally respond in the desired fashion when I do. I make a habit of pretending I've never heard of them which seems to bother them more than anything. These are the very people I abhor even more than most.
She was going ahead of us out the doors to the waiting area to fetch her vehicle, a Lincoln Continental SUV I'm sure, with a heated steering wheel, or some such. She'd barely passed through the door when the patient became invisible. I was grateful her daughter didn't appear to have noticed, hoping we'd have time to locate the old woman and, hopefully, reverse this new symptom or at least get her in the vehicle before her daughter noticed. I thought to myself, 'she's not going to want to take her mother home in this condition'.
I was attempting to strap her into the wheelchair (?) but was uneasy because, not only was she invisible, we were also unable to feel her. I was going through the motions to secure her but wasn't entirely certain she wasn't lying dead on the floor somewhere between the chair and the stretcher we'd just transferred her from. I was sure hoping she'd reappear as she was five minutes from a successful discharge and I wasn't certain her daughter wouldn't notice should she not reappear before we loaded her into the vehicle. And then I woke up.
The fact that this is loaded with revealing symbolism is not wasted on me.
The unit secretary and I were trying to load an elderly patient into a wheelchair for transport to her daughter's vehicle for discharge home. Her daughter was one of those entitled-seeming, late 50's aged women in khaki capris who never smile, unless engaged in some sort of manipulation, and then only with their mouths and never with their eyes and you sense you're expected to be giving special treatment to due to their prominence in the community. I didn't recognize her, nor do I generally respond in the desired fashion when I do. I make a habit of pretending I've never heard of them which seems to bother them more than anything. These are the very people I abhor even more than most.
She was going ahead of us out the doors to the waiting area to fetch her vehicle, a Lincoln Continental SUV I'm sure, with a heated steering wheel, or some such. She'd barely passed through the door when the patient became invisible. I was grateful her daughter didn't appear to have noticed, hoping we'd have time to locate the old woman and, hopefully, reverse this new symptom or at least get her in the vehicle before her daughter noticed. I thought to myself, 'she's not going to want to take her mother home in this condition'.
I was attempting to strap her into the wheelchair (?) but was uneasy because, not only was she invisible, we were also unable to feel her. I was going through the motions to secure her but wasn't entirely certain she wasn't lying dead on the floor somewhere between the chair and the stretcher we'd just transferred her from. I was sure hoping she'd reappear as she was five minutes from a successful discharge and I wasn't certain her daughter wouldn't notice should she not reappear before we loaded her into the vehicle. And then I woke up.
The fact that this is loaded with revealing symbolism is not wasted on me.
Tuesday, May 15, 2012
Another Tricky Triage Question
Me: "Sir, on a scale of zero to ten, how would you rate the pain you're having today?"
Triage Patient (turning his head quizzically): "With zero being.....?"
Me (pausing to glance around the triage room for Alan Funt): "Um...zero."
Triage Patient (turning his head quizzically): "With zero being.....?"
Me (pausing to glance around the triage room for Alan Funt): "Um...zero."
Monday, May 14, 2012
Cancer Awareness
Transcript from a texting session with my community-minded neighbor/friend from two weeks ago:
Her: You know what's weird? Me and Dee (her daughter, Delynn) are both on the hospital relay team and you're not.
Me: Relay?
Friend: Relay for life. Me and Dee are on the hospital Relay for Life team and you're not and you work at the hospital and we don't.
Me: Well, it's not really that weird considering I'm not a team player. And I abhor the hospital. And I don't really want to be aware of cancer nor do I see how doing so would prevent anyone from getting it.
Her: Having a bad day? Too many doughnuts, maybe? (We'd gone to the store together the night before and I bought doughnuts. They were cherry and I'd been trying to quit eating sugar until then.)
Me: No, this is me in a good mood on a good day. And I only ate two doughnuts, one with each bowl of ice cream.
Her: You know what's weird? Me and Dee (her daughter, Delynn) are both on the hospital relay team and you're not.
Me: Relay?
Friend: Relay for life. Me and Dee are on the hospital Relay for Life team and you're not and you work at the hospital and we don't.
Me: Well, it's not really that weird considering I'm not a team player. And I abhor the hospital. And I don't really want to be aware of cancer nor do I see how doing so would prevent anyone from getting it.
Her: Having a bad day? Too many doughnuts, maybe? (We'd gone to the store together the night before and I bought doughnuts. They were cherry and I'd been trying to quit eating sugar until then.)
Me: No, this is me in a good mood on a good day. And I only ate two doughnuts, one with each bowl of ice cream.
Decompensation, The Downhill Slide of Burnout
We
were having a day like I read about over at Madness. I was standing over an
evolving CVA patient pushing something or other and the moans and bells and call
lights and ambulance reports on the radio were going off. The patient's son,
late 50's, his mom lying there, probably dying, asks me, "Do you ever get
used to this?"
"Yeah, you do but then you begin to decompensate," says I, the ravages of burnout mirrored in my eyes. "I'm on the downhill side of that, now".
He never said another thing to me. The next day I thought about what I said. Might've instilled a little unease in the guy, reckon? His mother's caregiver? Shouldn't have asked me.
"Yeah, you do but then you begin to decompensate," says I, the ravages of burnout mirrored in my eyes. "I'm on the downhill side of that, now".
He never said another thing to me. The next day I thought about what I said. Might've instilled a little unease in the guy, reckon? His mother's caregiver? Shouldn't have asked me.
No Words
The other day was like amateur night in the ER. Bogus “hurt my arm 2 weeks ago, need pain
meds” guy from a town 40 miles away, one with a hospital and ER of it’s own,
incidentally. Carried a 44oz Styrofoam
cup full of soda into the triage room with that horribly injured arm but when I
began questioning him about his symptoms, he began to writhe in pain and
whimpering. Piss poor actor.
In a few minutes after getting this rather odiferous
individual out of my triage room, comes yet another pre-triage sheet through
the slot with the same last name on it.
This is something people do. At
least in our area. They all come to the
ER together like a sporting event.
Friends all sitting around the living room watching TV and Jerry
Springer gets over and nothing good on so they load up and head to the ER to
kill some time before Walker, Texas Ranger comes on at 4, or something.
The other triage was hurt arm man’s tweaker mother. The family that smokes rocks together, stays
together. They were both so fucked up
they could barely put any sentences together.
Drug-seeking, I suspected but they weren’t at themselves enough to even
get any appropriate symptoms or stories straight in their heads. Her chief complaint was lice for which she’d
treated herself with olive oil and dog flea shampoo and then, as a last resort,
lice shampoo. Okay. And?
Let me guess. You’re here for
admission to our adult psych unit?
Soon after, we got a 22-year-old girl in who’d fallen off
a horse. Abraised her great toe and
broke her radial head right off. In the
words of Walter Mattheau, fortunately for her, she’d had a few glasses of
whiskey just prior to the accident so it wasn’t as painful as it might have
been. She kept us in stitches with her
nonsense. Her blood alcohol was
165. Funny gal. And not a faker. And too drunk to act.
What’s not to like?
Then
the thorn in my side. A 70-year-old man
who came in for a 2-week history of constipation and weakness. No obvious distress. I had to bite my tongue hard during that triage. The whole time. He really got under my skin and I had to fight hard to not ask
him what the fuck he thought he was doing in there wasting our time. I was busy in triage for the rest of the
shift but I could see him come out to the desk every once in a while wanting to
know how much longer it was going to be.
I couldn’t believe this guy, coming into the ER for something he could have fixed by going to
Walmart and buying some colace. Hadn’t
called his doctor. Couldn’t even
remember his doctor’s name. He was still there when
I left at the end of my shift and I forgot about him except a mental note to
use him in my writing as an example of ER abuse. (Something about his case
really irritated me).
The
next day I was at work and I heard the unit secretary talking about a CT
report. In the ER, the xrays and CTs
are all read by the radiologist in person, if it’s during daytime hours, or
remotely if it’s after hours. The
results get called to the ER doctors as soon as they’re read but the actual
transcription isn’t usually done until the next day and then prints out on our
copier. So I’m hearing the unit
secretary talking about a patient with cancer and on and on until I realize
she’s talking about that guy from the day before, the 70-year-old. She’s got the CT report in her hand so I
took it from her and read it.
Masses
in his liver, bladder, around his aorta and, probably the origin, his
prostate. Clearly terminal. Clearly very soon.
Sunday, May 6, 2012
Maybe Baby?
"That girl in 1...I hope she's not pregnant." My coworker was talking to the nurse beside her, a doctor's wife who prides herself on what she perceives to be her superiority over the other nurses.
I'd put a 19-year-old, female accompanied by her "fiance" in room 1. She weighed 300lbs and wore a huge, dirty t-shirt, flannel pajama pants and a pair of work boots. Her medications included a statin drug, an antidepressant and a blood pressure medication, all of which she receives once a month at the free clinic. She was here today for a large, painful, draining abscess, probably MRSA, on her, uh, right love handle. Her last menstrual period? Six weeks ago. I figured it was she they were referring to.
"I know," this from the doctor's wife, "some people just shouldn't be allowed to procrastinate."
I'd put a 19-year-old, female accompanied by her "fiance" in room 1. She weighed 300lbs and wore a huge, dirty t-shirt, flannel pajama pants and a pair of work boots. Her medications included a statin drug, an antidepressant and a blood pressure medication, all of which she receives once a month at the free clinic. She was here today for a large, painful, draining abscess, probably MRSA, on her, uh, right love handle. Her last menstrual period? Six weeks ago. I figured it was she they were referring to.
"I know," this from the doctor's wife, "some people just shouldn't be allowed to procrastinate."
Do You Walk to Work or Take Your Lunch?
Dr. Lindly: "Did your chest pain come on suddenly or all at once?"
Long pause while patient thinks.
Patient: "All at once."
Long pause while patient thinks.
Patient: "All at once."
Time for Classifieds
Kimberly comes in about once a week.
Early 20's, about 5’2”, weighs 85 pounds and cries the whole time she’s in
the ED. Typical of anorexics, she sits
with both legs folded up in front of her on the chair. Obviously plagued by
deep-seated mental issues, she pretends she can’t get to the bathroom without
help, crumpling into a heap on the floor and crying until someone helps her up and to her room.
I must confess that I do, on occasion and for experimental purposes only, merely offer the slightest touch on the forearm or lightly hold a hand at moments like these. The patient will almost always miraculously get right up and walk now that they're being "helped".
Same thing with wheelchairs. People load their family members into a vehicle, rush to the emergency room, run inside to the admissions desk and demand someone to help them get the patient out of the car. Our first response is often, "How did you get them IN to the car?" Nine times out of ten, I go out with a wheelchair, roll it up to the car and stand there holding it in place, a concerned expression on my face, and the patient gets right up and sits down in the chair and nobody realizes they didn't need to drag a nurse away from another patient to roll a wheelchair to the curb, unnecessarily. I'm tellin' ya, I shoulda been a faith healer.
I must confess that I do, on occasion and for experimental purposes only, merely offer the slightest touch on the forearm or lightly hold a hand at moments like these. The patient will almost always miraculously get right up and walk now that they're being "helped".
Same thing with wheelchairs. People load their family members into a vehicle, rush to the emergency room, run inside to the admissions desk and demand someone to help them get the patient out of the car. Our first response is often, "How did you get them IN to the car?" Nine times out of ten, I go out with a wheelchair, roll it up to the car and stand there holding it in place, a concerned expression on my face, and the patient gets right up and sits down in the chair and nobody realizes they didn't need to drag a nurse away from another patient to roll a wheelchair to the curb, unnecessarily. I'm tellin' ya, I shoulda been a faith healer.
I was ready to go home when Kimberly came in at five after six (less than one hour before my shift was over).
Her chief complaint form reads, I can’t stop throwing up. A truer statement was never made.
She was, of course, crying when I called her into triage. Her
Dad, the spitting image of the father in the movie Juno, waited outside but somehow the knowledge of
his presence just outside the door concerned me as our interview turned rapidly
ugly.
"What's going on today?
Sobbing, "What?"
"Why are you in the ER today, Kimberly?"
“I’m
sick,” she drones, eyes closed. Then more sobbing.
Another observation: When a patient keeps their eyes closed throughout the triage interview, there's always a mental component.
Another observation: When a patient keeps their eyes closed throughout the triage interview, there's always a mental component.
“In
what way are you sick?” I ask her, the back of my neck beginning to tighten.
But of course, she only sobs, burying her face in one hand.
Answering
pertinent questions is always too much of a demand for people like Kimberly. They are disgusted by our need to interview
them, expecting instead, that we should intuitively know by some unknown mechanism, not only the nature and duration of their symptoms, but all their
medications and the dates of their immunizations. Or possibly expecting we should rush them to a stretcher, turn the lights down dimly, and stand silently sentinel as her family and friends file solemnly past them, wishing they'd treated them better, until the patient's condition improves enough to remember the information requireded to provide their safe care.
Turning back to my computer, I girded myself for what I knew was going to be the dental extraction of information from her.
Turning back to my computer, I girded myself for what I knew was going to be the dental extraction of information from her.
Meanwhile, I needed to discharge a patient who'd been waiting for 5 hours for CT results which had never been submitted to the distance radiologist by the radiology tech. Once discovered, it took only minutes to recieve an "all clear" and her chart was ready to go, waiting on the other side of the wall for me to finish with Kimberly's nonsense.
“I’m
going to need your arm so I can do your blood pressure,” I said, my eyes on the computer screen. When I turned to start her vital signs, I
saw she hadn’t removed the heavy sweater she wore despite the 85 degree outdoor
temperature, but had, instead, merely stretched her arm toward me still holding
her face with her opposite hand, crying without tears. “I need your arm out of your sweater so I
can do your vital signs.”
A new crop of sobs poured forth. “I didn’t know what
you meant, you don’t have to be cranky!”
She had no idea how wrong she was about that. Being cranky is the
last thing I have any control over.
Once
I sent her back to the waiting area, chart in hand, I was relieved to see
another triage slip in the door. If I
stretched this next triage out until I heard the admissions clerk bring Kimberly’s
chart back and put it in the rack on the wall, somebody else would have her in
a room and take over her care and my role in her ED stay would be officially over.
As I brought the second triage patient's chart back to place in the waiting rack, I heard Kimberly's familiar bellowing emitting from a treatment room down the hall alerting me that my plan had unfolded seamlessly and
once completing the next triage, I was back to my original patient in room 2A,
finally discharging her home with a prescription and instructions on
constipation.
Cha ching! I love it when plans come together!
Cha ching! I love it when plans come together!
Monday, March 12, 2012
Ready or Not, Here I Come
"You'll be okay, " God said to my patient. "But be ready for Friday, March 9th."
Like Tommy Lee Jones in No Country For Old Men, I don't know what to make of that.
Sunday, March 11, 2012
Look Around
I went to a funeral last week. The son of one of my old hospice patient's died. He was young. The funeral was in a little, country church in the woods. The preacher wore a blue plaid button-up shirt, not tucked in. He was pretty country and when he spoke, I fell in love with him. That's unusual for me, by the way. I don't, as a rule even like preachers. But there were two of them there that day and I liked them both quite a bit. I liked the way they talked to the...sort of... "rough" crowd packed inside the tiny church that day. Not like others I've seen, not
condescending. Anyway.
At one point, one of the young man's friends got up and spoke about the deceased. He kept saying, "Look around the room. You never know who may not be here next week." He said it more than once.
Skip to today. It was my day off. About 4:30 this evening the hospital called and said they had a big wreck with pediatric injuries flooding in and could I come and help out for a while.
It's been a long time since I got called in on a trauma. Used to happen all the time. In fact, I remember back before I was burned out, I'd be in a restaurant and hear a bunch of ambulances and just go on in to the ER when I got through eating to get in on it. Now, not so much.
So I got dressed and went in. Long story short, the guy who was speaking at his friend's funeral last week? He was the driver of one of the vehicles. He had his 3 kids with him. They all had broken bones. The middle one herniated his brainstem and died in the ER. He was 14.
condescending. Anyway.
At one point, one of the young man's friends got up and spoke about the deceased. He kept saying, "Look around the room. You never know who may not be here next week." He said it more than once.
Skip to today. It was my day off. About 4:30 this evening the hospital called and said they had a big wreck with pediatric injuries flooding in and could I come and help out for a while.
It's been a long time since I got called in on a trauma. Used to happen all the time. In fact, I remember back before I was burned out, I'd be in a restaurant and hear a bunch of ambulances and just go on in to the ER when I got through eating to get in on it. Now, not so much.
So I got dressed and went in. Long story short, the guy who was speaking at his friend's funeral last week? He was the driver of one of the vehicles. He had his 3 kids with him. They all had broken bones. The middle one herniated his brainstem and died in the ER. He was 14.
Sunday, February 12, 2012
Sorta Suicidal
I'd just come in on day shift. The ambulance brought in a portly, 60-something female, an alleged overdose of an unknown quantity of Xanax and Vicodin. Oh, and alcohol.
She radiated hostility, glaring at each of us, struggling to focus her glassy eyes. She immediately demanded to be allowed up to use the bathroom, cussing us at the top of her lungs when we told her she had to stay in bed to avoid falling. She declined a bedpan, then deliberately voided all over the bed and her clothes.
Nurse-retirement-age and I spent 20 minutes fighting her out of her sodden clothes and into a clean gown, threading the IV tubing and bag out of the sleeve of the wet gown, then back through the sleeve of the dry one.
Later I heard her say to a visitor, "I wonder how that nurse and doctor would like it if I hit them right in the side of the head." When I related this to Nurse Retirement Age, she wondered how Miss Drunk Suicide Attempt would like jail.
Eventually the admissions clerk called to say the daughter was here to see her. Visibly embarrassed, she'd just gotten off work at the sheriff's department in a nearby county where she worked the night shift as a dispatcher. I felt sorry for her, seeing her interact with her drunk mother, undoubtedly a lifelong no-win situation.
Before long, the Miss Drunk Suicide Attempt starts bellowing for her CPAP machine.
"I need my Goddamn CPap machine! None of these dumbass doctors here know shit about CPap." And then, my favorite part. "What're you gonna do? Just let me lie here and die?"
And here I'd have thought she might appreciate us killing her so she wouldn't have to worry about going to hell for doing it herself.
She radiated hostility, glaring at each of us, struggling to focus her glassy eyes. She immediately demanded to be allowed up to use the bathroom, cussing us at the top of her lungs when we told her she had to stay in bed to avoid falling. She declined a bedpan, then deliberately voided all over the bed and her clothes.
Nurse-retirement-age and I spent 20 minutes fighting her out of her sodden clothes and into a clean gown, threading the IV tubing and bag out of the sleeve of the wet gown, then back through the sleeve of the dry one.
Later I heard her say to a visitor, "I wonder how that nurse and doctor would like it if I hit them right in the side of the head." When I related this to Nurse Retirement Age, she wondered how Miss Drunk Suicide Attempt would like jail.
Eventually the admissions clerk called to say the daughter was here to see her. Visibly embarrassed, she'd just gotten off work at the sheriff's department in a nearby county where she worked the night shift as a dispatcher. I felt sorry for her, seeing her interact with her drunk mother, undoubtedly a lifelong no-win situation.
Before long, the Miss Drunk Suicide Attempt starts bellowing for her CPAP machine.
"I need my Goddamn CPap machine! None of these dumbass doctors here know shit about CPap." And then, my favorite part. "What're you gonna do? Just let me lie here and die?"
And here I'd have thought she might appreciate us killing her so she wouldn't have to worry about going to hell for doing it herself.
Saturday, February 4, 2012
ER For Dummies
If I have learned anything in my 23 years in nursing, it is that the general public is in desperate need of education. Much of what I see as lacking in the public's knowledge base is information I assumed (before becoming an ER nurse) was common knowledge. Therefore, I am compiling a long overdue, common sense manual for the prospective ER patient.
For instance, there will be a section titled, "When To, and When Not to Call 911". Under the Not column will be a paragraph explaining that when you have a bowel movement which...let's say..."stalls"...you have a few options, none of which involve activating the emergency medical alert system. One option is to end the attempt by employment of the anal sphincter thereby ridding yourself of the sluggish substance. Another option involves straining to expedite things. There is always the sit-and-wait option to see if anything changes.
Under the same scatagorical heading, I will explain that if you are in your 50's, in sufficient condition to ride a motorcycle through the mountains to a state park and camp with your friends, there is no reason for you to call an ambulance because you haven't had a bowel movement for 3 days. Moreover, if you insist on calling an ambulance and you have a bowel movement immediately prior to the arrival of the ambulance, you certainly don't need to continue into the ER, anyway, because you "don't want to get in that shape, again!". Consider Raisen Bran, coffee and/or prune juice and assume some responsibility for your own GI tract.
The chapter on "Proper Medical Terminology for Novices" will address topics such as the following: You have blood clots. There is no such thing as blood "clods" or "clogs." And, you have fibroids in your uterus, not "fire balls in your euchrist". And the proper pharmacological names are Motrin and Phenobarbital, not Mo-teen and peanut butter balls.
Under skin conditions: Just because you have a boil doesn't mean you were bitten by a poisonous spider. You probably have an abscess and might want to think about bathing once in a while. In the rare event that you were, indeed, bitten by a spider, it probably was a brown recluse, not a "brown glucose" spider.
When you came to the emergency room once in the past because you couldn't pass urine, you were catheterized, not castrated (at least, I don't think so. However, I'm updating my resume in case your ER really did that. That job has my name written all over it).
Under miscellaneous, I'll explain that when you "feel hot one minute and freezing the next" and you're not menopausal, it's no big mystery. You have a fever. They actually sell devices that enable you to make your own fever diagnosis at home. They're sold at Walmart and they're called "thermometers". What's more, you can actually take Tylenol or Motrin for a fever and determine the correct dosage yourself by reading the label. Again, having a fever for one hour is no reason to rush to the emergency room.
Same thing with throwing up. If you threw up an hour ago, that doesn't constitute an emergency and you can stay at home. If you just can't help yourself and come to the hospital anyway, throwing up isn't going to kill you and you don't need to send a family member darting into the hall to summon a nurse to the room. A nurse is not going to keep you from throwing up, (which is, by the way, pronounced "vomit", not "vomick"). Just throw up and wipe your mouth and lie back down on your stretcher. What's more, when the nurse or doctor do come into the room, turn your head when you breathe or cough. Your breath smells like vomit. Nobody wants to smell it, not even public servants. And while on the subject, if you come to the ER vomiting, don't get mad when the nurse won't give you a big glass of ice water to drink and a bag of Funyuns from the vending machine. I promise you, if you drink a glass of water and eat greasy junk food, you're going to throw up again. It happens. Every. Time.
Another point: It doesn't matter what you saw in your vomit. Just because you saw, say, carrots doesn't mean you got food poisoning from your mother-in-law's glazed carrots last Sunday. You threw up what was in your stomach. Your stomach does not have the capacity to isolate the one offending substance and throw up only that. It doesn't work that way. Furthermore, you needn't describe it to us as in, my personal favorite, "It was green and slimy". Of course it was. It came out of your stomach. It was vomit. There's bile in it. Bile is green. It's no mystery. And there are no scientists in the lab waiting to analyze your vomit so don't bring it to the hospital with you in a peanut butter jar.
Now for the chapter on Medical History. You may be allergic to sulfa, not "sulpher". It is called emphysema, not "the zee-mee". And it's a hiatal hernia, not a "high up hernie". You have high blood pressure, not "high blut" and your reddened, swollen joints are a result of gout, not "the gouch". Additionally, "sugar" is not a diagnosis, it is a condiment. Diabetes is a diagnosis. The numbness in your first three fingers is a result of carpal tunnel, not "corporal tunnel". And your shoulder pain stems from an issue with your rotator cuff not rotator "cup". Chances are "hot potatoes" are not what your doctor determined your abdominal pain to be from but rather, hepatitis.
Surprisingly, leukemia is actually considered to be a health problem so if you have leukemia and the triage nurse asks you if you have any health problems, you should probably mention it. If you are missing a kidney, we need to know if it was surgically removed or you were born without it, or what. It's not helpful to tell the nurse, "Honey, I don't have any idea what happened to it". We expect you to research this before you come to the hospital.
If you cut your hand opening a package of bologna with your pocket knife, don't expect general anesthesia during your suturing. You're going to get a local anesthetic and stay awake. Nobody in the ER has time to recover you for an hour after an unnecessary general anesthesia. If they did, they would instead, squander those minutes in some trivial manner such as taking a lunch break or going to the bathroom. In the meantime, you might want to explore why it is you want so badly to be put to sleep.
When you come to the ER, bring a list of your medications with you. Despite what you think, the nurses don't have copies of your med list folded up in lockets around their necks. If you can't even keep up with your own medications while taking them every day, how do you expect us to? Telling us at midnight on a Friday that "Dr. Smith has a list of my meds" isn't helpful. Dr. Smith is home in bed right now watching Girls Gone Wild infomercials and despite the fact that you’re the only thing he has to think about, he has no intention of getting up and traveling across town to unlock the office and look up your med list. While on the subject of medications, "Equate" is not a recognized medication. It is a bargain brand produced for Walmart which includes everything from toothpaste to personal lubrication jelly. Telling us that you took "2 Equate" for your fever is like saying you ate two General Mills and a Proctor & Gamble for lunch.
FYI, if a nurse or a lab tech comes to your bedside to start an IV or draw blood, the chances of them being successful are much better if you don't first say to them, "You have one chance! If you blow that, I want somebody who knows what they're doing." Oddly enough, the nurses, doctors, lab and xray techs at the hospital actually have licenses. They went to school. Chances are, they may really know more about medicine than you do. That's why you're there. If you don't believe that, perhaps you should ask yourself why you didn't just stay home. Next time, you might want to think about doing that. Just stay home and use your Waffle House waitress or log truck driver experience to figure out the appropriate treatment for your heart attack and I promise you, nobody from the hospital will come to your house and force you to come to the hospital and poke needles in you. They'll leave that to the funeral director and simply read about you in the obituaries section of the newspaper.
To be continued.
For instance, there will be a section titled, "When To, and When Not to Call 911". Under the Not column will be a paragraph explaining that when you have a bowel movement which...let's say..."stalls"...you have a few options, none of which involve activating the emergency medical alert system. One option is to end the attempt by employment of the anal sphincter thereby ridding yourself of the sluggish substance. Another option involves straining to expedite things. There is always the sit-and-wait option to see if anything changes.
Under the same scatagorical heading, I will explain that if you are in your 50's, in sufficient condition to ride a motorcycle through the mountains to a state park and camp with your friends, there is no reason for you to call an ambulance because you haven't had a bowel movement for 3 days. Moreover, if you insist on calling an ambulance and you have a bowel movement immediately prior to the arrival of the ambulance, you certainly don't need to continue into the ER, anyway, because you "don't want to get in that shape, again!". Consider Raisen Bran, coffee and/or prune juice and assume some responsibility for your own GI tract.
The chapter on "Proper Medical Terminology for Novices" will address topics such as the following: You have blood clots. There is no such thing as blood "clods" or "clogs." And, you have fibroids in your uterus, not "fire balls in your euchrist". And the proper pharmacological names are Motrin and Phenobarbital, not Mo-teen and peanut butter balls.
Under skin conditions: Just because you have a boil doesn't mean you were bitten by a poisonous spider. You probably have an abscess and might want to think about bathing once in a while. In the rare event that you were, indeed, bitten by a spider, it probably was a brown recluse, not a "brown glucose" spider.
When you came to the emergency room once in the past because you couldn't pass urine, you were catheterized, not castrated (at least, I don't think so. However, I'm updating my resume in case your ER really did that. That job has my name written all over it).
Under miscellaneous, I'll explain that when you "feel hot one minute and freezing the next" and you're not menopausal, it's no big mystery. You have a fever. They actually sell devices that enable you to make your own fever diagnosis at home. They're sold at Walmart and they're called "thermometers". What's more, you can actually take Tylenol or Motrin for a fever and determine the correct dosage yourself by reading the label. Again, having a fever for one hour is no reason to rush to the emergency room.
Same thing with throwing up. If you threw up an hour ago, that doesn't constitute an emergency and you can stay at home. If you just can't help yourself and come to the hospital anyway, throwing up isn't going to kill you and you don't need to send a family member darting into the hall to summon a nurse to the room. A nurse is not going to keep you from throwing up, (which is, by the way, pronounced "vomit", not "vomick"). Just throw up and wipe your mouth and lie back down on your stretcher. What's more, when the nurse or doctor do come into the room, turn your head when you breathe or cough. Your breath smells like vomit. Nobody wants to smell it, not even public servants. And while on the subject, if you come to the ER vomiting, don't get mad when the nurse won't give you a big glass of ice water to drink and a bag of Funyuns from the vending machine. I promise you, if you drink a glass of water and eat greasy junk food, you're going to throw up again. It happens. Every. Time.
Another point: It doesn't matter what you saw in your vomit. Just because you saw, say, carrots doesn't mean you got food poisoning from your mother-in-law's glazed carrots last Sunday. You threw up what was in your stomach. Your stomach does not have the capacity to isolate the one offending substance and throw up only that. It doesn't work that way. Furthermore, you needn't describe it to us as in, my personal favorite, "It was green and slimy". Of course it was. It came out of your stomach. It was vomit. There's bile in it. Bile is green. It's no mystery. And there are no scientists in the lab waiting to analyze your vomit so don't bring it to the hospital with you in a peanut butter jar.
Now for the chapter on Medical History. You may be allergic to sulfa, not "sulpher". It is called emphysema, not "the zee-mee". And it's a hiatal hernia, not a "high up hernie". You have high blood pressure, not "high blut" and your reddened, swollen joints are a result of gout, not "the gouch". Additionally, "sugar" is not a diagnosis, it is a condiment. Diabetes is a diagnosis. The numbness in your first three fingers is a result of carpal tunnel, not "corporal tunnel". And your shoulder pain stems from an issue with your rotator cuff not rotator "cup". Chances are "hot potatoes" are not what your doctor determined your abdominal pain to be from but rather, hepatitis.
Surprisingly, leukemia is actually considered to be a health problem so if you have leukemia and the triage nurse asks you if you have any health problems, you should probably mention it. If you are missing a kidney, we need to know if it was surgically removed or you were born without it, or what. It's not helpful to tell the nurse, "Honey, I don't have any idea what happened to it". We expect you to research this before you come to the hospital.
If you cut your hand opening a package of bologna with your pocket knife, don't expect general anesthesia during your suturing. You're going to get a local anesthetic and stay awake. Nobody in the ER has time to recover you for an hour after an unnecessary general anesthesia. If they did, they would instead, squander those minutes in some trivial manner such as taking a lunch break or going to the bathroom. In the meantime, you might want to explore why it is you want so badly to be put to sleep.
When you come to the ER, bring a list of your medications with you. Despite what you think, the nurses don't have copies of your med list folded up in lockets around their necks. If you can't even keep up with your own medications while taking them every day, how do you expect us to? Telling us at midnight on a Friday that "Dr. Smith has a list of my meds" isn't helpful. Dr. Smith is home in bed right now watching Girls Gone Wild infomercials and despite the fact that you’re the only thing he has to think about, he has no intention of getting up and traveling across town to unlock the office and look up your med list. While on the subject of medications, "Equate" is not a recognized medication. It is a bargain brand produced for Walmart which includes everything from toothpaste to personal lubrication jelly. Telling us that you took "2 Equate" for your fever is like saying you ate two General Mills and a Proctor & Gamble for lunch.
FYI, if a nurse or a lab tech comes to your bedside to start an IV or draw blood, the chances of them being successful are much better if you don't first say to them, "You have one chance! If you blow that, I want somebody who knows what they're doing." Oddly enough, the nurses, doctors, lab and xray techs at the hospital actually have licenses. They went to school. Chances are, they may really know more about medicine than you do. That's why you're there. If you don't believe that, perhaps you should ask yourself why you didn't just stay home. Next time, you might want to think about doing that. Just stay home and use your Waffle House waitress or log truck driver experience to figure out the appropriate treatment for your heart attack and I promise you, nobody from the hospital will come to your house and force you to come to the hospital and poke needles in you. They'll leave that to the funeral director and simply read about you in the obituaries section of the newspaper.
To be continued.
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