Winner of the Written Chief Complaint Award for the week of May 10-17:
She was standin in a wobablely cheier in was told to sit. Keeped up and feel 3 holes in bottom lip
Friday, May 17, 2013
Monday, May 13, 2013
One Fine Morning in the Middle of the Night
I was triaging a 38 year old female with a migraine.
Are you allergic to any medications?
No.
(noticing the previous entry in the allergy box on the electronic triage form) It says here you're allergic to Stadol.
Yeah, I can't take that.
Is there anything else you can't take?
No. Just Penicillin.
Are you allergic to any medications?
No.
(noticing the previous entry in the allergy box on the electronic triage form) It says here you're allergic to Stadol.
Yeah, I can't take that.
Is there anything else you can't take?
No. Just Penicillin.
Nine Lives?
While on the subject of medical history:
What kind of health problems have you had in the past?
I bled to death in Dallas in 1999.
What kind of health problems have you had in the past?
I bled to death in Dallas in 1999.
Sunday, May 12, 2013
Charmed, I'm Sure
I was triaging a 48 year old male who'd come in for a lacerated finger. I asked about previous medical problems and here's what I got.
Nothing much except I can't die.
You can't die? (I said, continuing to type, not looking up)
No mahame.
Why do you say that? (still typing)
Well, once when I tried to commit suicide, I shot myself with a nail gun. I was aiming for here (forefinger held at the back of his head) but I missed and it went through the back of my tongue and through my vocal cords. Before that, I tried to shoot myself with a 25 automatic and it wouldn't go off. Later on, I shot that gun and it went off with no problem. I sold it and it never missed another lick. This other time, I was living in Chicago and the commuter trains come through at the same times all day long. I knew when that train was coming and I got a bottle of whiskey and parked my truck on the tracks. That was the first time in 23 years that train was delayed. Before it got there, I changed my mind. Then another time, I had pneumonia and I took a whole bottle of antibiotics at once. I told my family to make arrangements, and everything, but I woke up later on like normal. Never had no problems. And my pneumonia was gone. They said it was a miracle.
I wasn't typing, anymore. I think my mouth mighta been open a little.
Nothing much except I can't die.
You can't die? (I said, continuing to type, not looking up)
No mahame.
Why do you say that? (still typing)
Well, once when I tried to commit suicide, I shot myself with a nail gun. I was aiming for here (forefinger held at the back of his head) but I missed and it went through the back of my tongue and through my vocal cords. Before that, I tried to shoot myself with a 25 automatic and it wouldn't go off. Later on, I shot that gun and it went off with no problem. I sold it and it never missed another lick. This other time, I was living in Chicago and the commuter trains come through at the same times all day long. I knew when that train was coming and I got a bottle of whiskey and parked my truck on the tracks. That was the first time in 23 years that train was delayed. Before it got there, I changed my mind. Then another time, I had pneumonia and I took a whole bottle of antibiotics at once. I told my family to make arrangements, and everything, but I woke up later on like normal. Never had no problems. And my pneumonia was gone. They said it was a miracle.
I wasn't typing, anymore. I think my mouth mighta been open a little.
Friday, May 10, 2013
One Ringy-Dingy, Two Ringy-Dingy...etc
A while back on a Saturday, we had four admits to Med/Surg in 4 hours. We were generously allowing them 30 minutes to recover after each admission before calling for a bed assignment on the next. But nobody was answering the phone down there when the Lpn I was working with was trying to call report on the 3rd one.
This kind of nonsense never happened before they remodeled the department and got caller ID. Now, it happens on a regular basis. Don't want another admit? No problem. Just don't ever answer the phone.
She'd tried a couple of times with no response before taking a break from the nurse's desk to get a snack. When she came back, she tried the number again. Again, no answer.
"They were all sitting at the desk when I went past there to go to the cafeteria, just now." she told me, holding the receiver up in the air, the persistent ringing emitting through the earpeice. "They're just sitting there letting it ring."
I was charge and the longer that phone rang without an answer, the pisseder I got. So.....I headed down the hall to the nurse's station, sticking strategically close to the wall the furthest from view of the Med/Surg nurse's desk, I could see the hospitalist writing orders at the desk, a frown on his face trying to drown out the incessant ringing of the phone in front of him. Then, the charge nurse, a gal I used to sort of respect, walks over, picks up the receiver and then sets it back down to stop the ringing. Oh, no the fuck you didn't!
She knew she was busted as soon as she saw me.
Are ya'll not answering the phone today, Brenda?
(Smiling), No.
Sonya's been calling down here trying to give report for 25 minutes. (the hospitalist nodded confirmation) You know, all you have to do is be professional and pick up the phone and say you can't take the patient right now and we'd wait. Don't just let the phone ring.
No response. No longer smiling.
Miraculously, when I got back to the ED, the Lpn was talking to a floor nurse, giving report. Later she told me she had to use her cell phone so they wouldn't recognize the number.
I wrote the incident up, included every detail, determined to bust their scam wide open. And then I slipped in into the shred container. Relations are always strained between departments and the way I looked at it, this "one up" might get us further with Med/Surg in the future than getting their asses hung out to dry with administration, as they should've been. Subjecting them to a public flogging might do us more harm than good. If we kept our mouths shut on this one, they'd surely be in our back pockets for a while.
When I went back to work on Tuesday, I was called into the boss's office. The charge nurse on Med/Surg had written up a complaint because we'd admitted four patients in 4 hours.
You. Gotta. Be. Shittin'. Me.
As fate would have it, however, it doesn't take long for what goes around to come around and my story doesn't end here.
The next weekend Sonya and I worked together we got a call from admissions. The family is bringing Brenda, the Med/Surg charge nurse, in by private vehicle. She's having stroke symptoms. Sure enough, in a few minutes, here comes a wheelchair with Brenda looking like somebody'd pulled the plug on her beach ball.
You know, if you're gonna be a dick to the ED staff, you really oughta not do it in a town where there's only one hospital and then go have a breast augmentation and have to be attended to by the same nurses you fucked the weekend before.
Sonya and I converged upon her and it only took a couple of questions to realize she wasn't having a stroke at all but only got a little too stoned from her pain medication. Sonya started her IV and I was her primary nurse. We didn't have to say or do anything. Just knowing we had her by the balls (boobs?) was all it took. And she knew it, too. Sort of broke the ice for all of us after an awkward moment and they answer the phone when we try to call report, now. Most of the time, anyway.
Oh, one more thing, though. When Sonya was starting her IV, Brenda asks us to keep the door shut so nobody can see her and know about her surgery.
"We got your back, sister," Sonya tells her, only what she meant to say was, "We got you back, Beotch!".
This kind of nonsense never happened before they remodeled the department and got caller ID. Now, it happens on a regular basis. Don't want another admit? No problem. Just don't ever answer the phone.
She'd tried a couple of times with no response before taking a break from the nurse's desk to get a snack. When she came back, she tried the number again. Again, no answer.
"They were all sitting at the desk when I went past there to go to the cafeteria, just now." she told me, holding the receiver up in the air, the persistent ringing emitting through the earpeice. "They're just sitting there letting it ring."
I was charge and the longer that phone rang without an answer, the pisseder I got. So.....I headed down the hall to the nurse's station, sticking strategically close to the wall the furthest from view of the Med/Surg nurse's desk, I could see the hospitalist writing orders at the desk, a frown on his face trying to drown out the incessant ringing of the phone in front of him. Then, the charge nurse, a gal I used to sort of respect, walks over, picks up the receiver and then sets it back down to stop the ringing. Oh, no the fuck you didn't!
She knew she was busted as soon as she saw me.
Are ya'll not answering the phone today, Brenda?
(Smiling), No.
Sonya's been calling down here trying to give report for 25 minutes. (the hospitalist nodded confirmation) You know, all you have to do is be professional and pick up the phone and say you can't take the patient right now and we'd wait. Don't just let the phone ring.
No response. No longer smiling.
Miraculously, when I got back to the ED, the Lpn was talking to a floor nurse, giving report. Later she told me she had to use her cell phone so they wouldn't recognize the number.
I wrote the incident up, included every detail, determined to bust their scam wide open. And then I slipped in into the shred container. Relations are always strained between departments and the way I looked at it, this "one up" might get us further with Med/Surg in the future than getting their asses hung out to dry with administration, as they should've been. Subjecting them to a public flogging might do us more harm than good. If we kept our mouths shut on this one, they'd surely be in our back pockets for a while.
When I went back to work on Tuesday, I was called into the boss's office. The charge nurse on Med/Surg had written up a complaint because we'd admitted four patients in 4 hours.
You. Gotta. Be. Shittin'. Me.
As fate would have it, however, it doesn't take long for what goes around to come around and my story doesn't end here.
The next weekend Sonya and I worked together we got a call from admissions. The family is bringing Brenda, the Med/Surg charge nurse, in by private vehicle. She's having stroke symptoms. Sure enough, in a few minutes, here comes a wheelchair with Brenda looking like somebody'd pulled the plug on her beach ball.
You know, if you're gonna be a dick to the ED staff, you really oughta not do it in a town where there's only one hospital and then go have a breast augmentation and have to be attended to by the same nurses you fucked the weekend before.
Sonya and I converged upon her and it only took a couple of questions to realize she wasn't having a stroke at all but only got a little too stoned from her pain medication. Sonya started her IV and I was her primary nurse. We didn't have to say or do anything. Just knowing we had her by the balls (boobs?) was all it took. And she knew it, too. Sort of broke the ice for all of us after an awkward moment and they answer the phone when we try to call report, now. Most of the time, anyway.
Oh, one more thing, though. When Sonya was starting her IV, Brenda asks us to keep the door shut so nobody can see her and know about her surgery.
"We got your back, sister," Sonya tells her, only what she meant to say was, "We got you back, Beotch!".
Hell's Bells
Yesterday's ER blue light special was psych issues. I mean it. All day long, one after another, the walking undead filed through the Emergency Department. The first one was already restrained by two nurses on the stretcher when we walked in at 7am and it didn't stop all day long.
You know, you get a patient and you think, "I got the worst patient of the day". And then another one comes in and you're like, "I'm so glad I've got the one I've got instead of that one,". Then the one who comes in when you're up next makes the other two look like easy peasy. And it goes on like that for 12 hours. Or longer. Just getting worse and worse.
I worked with nurse Avoid the Triage Desk at All Costs. She is a master at the art of surveillance and avoidance. This nurse has a 6th sense about when a patient is due to show up and hauls ass to the other end of the hospital in the nick of time leaving me or another nurse, if there is another one, to triage and assume their care.
She also likes to play the game you triage them and document all their medications including dosages and last times taken, etc. and get them in a room, into a gown, collect their urine specimen and put up with all of their bullshit and that of their family members during triage and then if they don't look too complicated or if I, in the meantime find out there's a worse patient coming, I'll go ahead and take them off your hands for you.
Unfortunately for her, I'm getting pretty good at playing defense and I successfully thwarted several of her attempts to dump on me, yesterday. Only, sometimes it backfires.
I already had a psych patient who was winding up for the big escalation when we got two calls. One alerting us to a patient coming with chest pain and one from a clinic sending a child with a fever. I knew I had immunity because I already had mine and the other two nurses had just discharged the ones they had. So I was caught off guard when, while the chest pain patient was already under the care of the other nurse and the sick child was due to come in, Nurse Avoidance announces she has to use the bathroom, disappearing down the hall seconds before the triage bell goes off. I considered doing the triage myself, then turning him over to her later, but considering the non-urgent nature of the complaint, I elected to wait her out.
Nurse Avoidance also has a secret weapon in the form of a Pentacostal unit secretary with big, Jesus hair. She wears the same black dress skirt every day with a scrub top and running shoes. She has some kind of curious, codependent relationship with Nurse A that I can't quite categorize. Total opposites, the two seem to thrive on each other. I understand Nurse A's attraction as Pentacostal unit secretary, we'll call her Puss for short, acts as Nurse A's personal assistant all day long, helping her in ways completely out of her scope of practice while ignoring the legitimate needs of the rest of the nurses. What's more, while earning probably about 25% of Nurse A's wages, Puss has somehow become solely responsible for providing all of Nurse A's meals. On the rare occasions Puss drops the ball, Nurse A actually pouts until Puss's 70-year-old husband drives into town and brings her a sandwich. Can't even begin to imagine what that's about.
Soooooo, Puss, as one of her many duties, works as sentry for Nurse A, protecting her from any unnecessary unpleasantry she might be in danger of experiencing. So when the triage bell went off, announcing the sick kid, Puss tells me, "Nurse A went to the bathroom" meaning that I should go triage the patient instead of her.
I ignored it and eventually, Nurse A came back and, after about 5 more minutes of avoidance tactics, she went toward the triage desk. I should've known something was up because Puss and she were talking in hushed tones before Nurse A finaly closed the triage door and called back the sick kid. About 2 minutes later, without a phone ringing or anyone coming back from admissions, Puss asks me to go out and check on a patient with stroke symptoms in admissions. I'd been had, once more. Resigned, I headed for admissions, instructing Puss to keep an eye on my psych patient who had been relatively quiet but showing signs of things to come.
In the waiting area I found a 39 year old female with 3 family members simultaneously trying to hold her filth-encrusted, gyrating body into the wheelchair while she uttered the same two nonsensical words over and over, "My tee! My tee! My tee!"
"We think she overdosed on her Lithium", they tell me as the smoke starts to roll out of my ears. As soon as I got her to the room, she stands up and does a Linda Blair inpersonation hurling, in this scene, lentil soup all over the floor beside the stretcher. Then she turns and plasters the visitor's chair and everything else in the path out of the room, ensuring that I won't be escaping the stench of vomit any time soon. I lift her into the bed and fight to get her vomit-soaked stretch pants off when Puss appears at the door.
"How did you hear about this patient, again?" I yell across a sea of puke.
"Kristen (the admissions clerk) told me she was out there."
"Call housekeeping," I growled through clenched teeth.
What I should've asked, but didn't, was how the fuck exactly did she tell you when the phone never rang after that last triage? I'm telling you, the two of them have powers.
My only solace was in the fact that immediately after I got my second psych patient into her room, my first psych patient began to escalate like a mofo and Puss, the only one left to play interception, had to deal with her for the rest of the night, and even until midnight while I went home around 7:30.
The triage bell went off like Sunday morning in Atlanta for the rest of my shift and because Nurse A had assigned herself to nothing but a feverish child while the rest of us scrambled over acute, critical patients, she caught the brunt of it. I, on the other hand, was never assigned another task appearing to have my hands full with "My tee!" from then on. And, once the puke was mopped up, My tee's daughter stayed in the room with her most of the time so all I really had to do was document and call poison control other than placing a catheter in her which she tolerated rather well for a demon-possessed, bipolar drug addict.
Oh, and that brings me to the best part.
Puss, being Pentacostal, not too secretly really believes that mental illness is a form of demon possession and had shared with Nurse A that she heard a low, grumbling, purely evil voice emitting from My tee's room. She furthermore, in keeping with her role of protector, instructed Nurse A to stay out of that room no matter what. What is funny is that My tee was actually wearing a pentacle necklace, which doesn't much bother me but I knew would set Puss into orbit. What's more, when I took her temperature, the digital readout registered 99.9 which isn't impressive in and of itself, but when read upside down is, well, you know. I made a point of it to Puss before leaving for the night.
Payback's a mother fucker.
You know, you get a patient and you think, "I got the worst patient of the day". And then another one comes in and you're like, "I'm so glad I've got the one I've got instead of that one,". Then the one who comes in when you're up next makes the other two look like easy peasy. And it goes on like that for 12 hours. Or longer. Just getting worse and worse.
I worked with nurse Avoid the Triage Desk at All Costs. She is a master at the art of surveillance and avoidance. This nurse has a 6th sense about when a patient is due to show up and hauls ass to the other end of the hospital in the nick of time leaving me or another nurse, if there is another one, to triage and assume their care.
She also likes to play the game you triage them and document all their medications including dosages and last times taken, etc. and get them in a room, into a gown, collect their urine specimen and put up with all of their bullshit and that of their family members during triage and then if they don't look too complicated or if I, in the meantime find out there's a worse patient coming, I'll go ahead and take them off your hands for you.
Unfortunately for her, I'm getting pretty good at playing defense and I successfully thwarted several of her attempts to dump on me, yesterday. Only, sometimes it backfires.
I already had a psych patient who was winding up for the big escalation when we got two calls. One alerting us to a patient coming with chest pain and one from a clinic sending a child with a fever. I knew I had immunity because I already had mine and the other two nurses had just discharged the ones they had. So I was caught off guard when, while the chest pain patient was already under the care of the other nurse and the sick child was due to come in, Nurse Avoidance announces she has to use the bathroom, disappearing down the hall seconds before the triage bell goes off. I considered doing the triage myself, then turning him over to her later, but considering the non-urgent nature of the complaint, I elected to wait her out.
Nurse Avoidance also has a secret weapon in the form of a Pentacostal unit secretary with big, Jesus hair. She wears the same black dress skirt every day with a scrub top and running shoes. She has some kind of curious, codependent relationship with Nurse A that I can't quite categorize. Total opposites, the two seem to thrive on each other. I understand Nurse A's attraction as Pentacostal unit secretary, we'll call her Puss for short, acts as Nurse A's personal assistant all day long, helping her in ways completely out of her scope of practice while ignoring the legitimate needs of the rest of the nurses. What's more, while earning probably about 25% of Nurse A's wages, Puss has somehow become solely responsible for providing all of Nurse A's meals. On the rare occasions Puss drops the ball, Nurse A actually pouts until Puss's 70-year-old husband drives into town and brings her a sandwich. Can't even begin to imagine what that's about.
Soooooo, Puss, as one of her many duties, works as sentry for Nurse A, protecting her from any unnecessary unpleasantry she might be in danger of experiencing. So when the triage bell went off, announcing the sick kid, Puss tells me, "Nurse A went to the bathroom" meaning that I should go triage the patient instead of her.
I ignored it and eventually, Nurse A came back and, after about 5 more minutes of avoidance tactics, she went toward the triage desk. I should've known something was up because Puss and she were talking in hushed tones before Nurse A finaly closed the triage door and called back the sick kid. About 2 minutes later, without a phone ringing or anyone coming back from admissions, Puss asks me to go out and check on a patient with stroke symptoms in admissions. I'd been had, once more. Resigned, I headed for admissions, instructing Puss to keep an eye on my psych patient who had been relatively quiet but showing signs of things to come.
In the waiting area I found a 39 year old female with 3 family members simultaneously trying to hold her filth-encrusted, gyrating body into the wheelchair while she uttered the same two nonsensical words over and over, "My tee! My tee! My tee!"
"We think she overdosed on her Lithium", they tell me as the smoke starts to roll out of my ears. As soon as I got her to the room, she stands up and does a Linda Blair inpersonation hurling, in this scene, lentil soup all over the floor beside the stretcher. Then she turns and plasters the visitor's chair and everything else in the path out of the room, ensuring that I won't be escaping the stench of vomit any time soon. I lift her into the bed and fight to get her vomit-soaked stretch pants off when Puss appears at the door.
"How did you hear about this patient, again?" I yell across a sea of puke.
"Kristen (the admissions clerk) told me she was out there."
"Call housekeeping," I growled through clenched teeth.
What I should've asked, but didn't, was how the fuck exactly did she tell you when the phone never rang after that last triage? I'm telling you, the two of them have powers.
My only solace was in the fact that immediately after I got my second psych patient into her room, my first psych patient began to escalate like a mofo and Puss, the only one left to play interception, had to deal with her for the rest of the night, and even until midnight while I went home around 7:30.
The triage bell went off like Sunday morning in Atlanta for the rest of my shift and because Nurse A had assigned herself to nothing but a feverish child while the rest of us scrambled over acute, critical patients, she caught the brunt of it. I, on the other hand, was never assigned another task appearing to have my hands full with "My tee!" from then on. And, once the puke was mopped up, My tee's daughter stayed in the room with her most of the time so all I really had to do was document and call poison control other than placing a catheter in her which she tolerated rather well for a demon-possessed, bipolar drug addict.
Oh, and that brings me to the best part.
Puss, being Pentacostal, not too secretly really believes that mental illness is a form of demon possession and had shared with Nurse A that she heard a low, grumbling, purely evil voice emitting from My tee's room. She furthermore, in keeping with her role of protector, instructed Nurse A to stay out of that room no matter what. What is funny is that My tee was actually wearing a pentacle necklace, which doesn't much bother me but I knew would set Puss into orbit. What's more, when I took her temperature, the digital readout registered 99.9 which isn't impressive in and of itself, but when read upside down is, well, you know. I made a point of it to Puss before leaving for the night.
Payback's a mother fucker.
It Was a Very Good Year
Sir, can you tell me the date?
Yeah.
What is it?
(silence)
Sir, what is the date?
Oh. It's...uh....'94.
Okay. And can you tell me what state we're in?
Yeah.
What state?
What?
What state are we in?
Oh. 94.
Yeah.
What is it?
(silence)
Sir, what is the date?
Oh. It's...uh....'94.
Okay. And can you tell me what state we're in?
Yeah.
What state?
What?
What state are we in?
Oh. 94.
Oh Brother
We do medical screenings for the geriatric psychiatric unit of our hospital. They come to the ED and we do some labs, a chest Xray and an EKG to make sure they're healthy enough to be admitted and loaded up on psychotropics.
A while back I got a lady I'd seen for the same thing about 3 months ago. In her 70's, she reminded me of Eve Arden. Tall and slender with brown doe eyes and those big, rubbery lips and a voice like Southern accented honey-puddles. There's something regal about her and you can tell she's always had good sense and plenty of money. But not too much. She's what they refer to here as good people, and I liked her immediately.
This day she was here to be medically cleared for admission to the geriatric psych unit, same as last time. As we began to talk in the triage area, her story jarred my memory and I recalled the previous fiasco.
Her much younger brother and even younger sister-in-law were behind the previous admission, as were they this day. When I saw her in June, she had just been diagnosed with colon cancer and was scheduled to begin chemotherapy in 3 days. But her brother brought her to the Emergency Room and requested she be admitted to the geriatric psych unit due to an episode of "thinking people are after her" and oddly, for a specified period of two weeks.
We are guilty of being led down the garden path on these cases, more often than we probably want to admit and this patient was medically cleared and sentenced to a psych admission. When she realized what was going on, she became hysterical.
"I'll miss my first chemo appointment," Big tears filled in her eyes. "How can he do this to me? What did I do to him? I've tried to help him and (Mrs. Brother) and all they want to do is put me away." She then went on to tell me she knew they were trying to get money from her but this new twist had taken on a serious tone. "Are they trying to kill me for my money? I'll be dead in a year, can't they wait that long?"
You know, sometimes these people aren't really crazy and the longer I sat in her room listening to her talk, the more I became convinced she was as sane as the rest of us.
Long story short, she got to go home in time for her first chemo treatment. But now she was back. The brother and his wife hadn't given up since the last time and the plot had become considerably thicker to the point of the patient having lost control of most of her money and now, it would seem, the brother/wife team had their eye on her home and property. She had been forced to sell a peice of artwork the brother was unaware of, in order for her to buy gas to travel, on the days she didn't take chemo, driving herself to a town 60 miles away where she underwent voluntary psychological testing and paid a lawyer to document the findings in her defense for when this particular day arrived.
The day was here and the family had called the police to bring the frail, sweet old woman to the emergency room and drop her off for admission to the psych unit, again at which point, they planned to swoop in for the kill and finish up the leftovers. And this time she was wasn't taking it lying down. She was ready for a fight.
Without going into the details, she finally agreed to admission once convinced that it was in her best interest as a defense and that from that vantage point, the brother and his wife might be, for once, exposed for what they were. And that's exactly what happened. I took her case under my wing as did about a dozen others. That night there happened to be a board meeting and the attorney representing the hospital was even summoned in for an opinion. I personally called her own attorney, having previous positive interaction with him over some office space rental, and was assured she would be looked out for. The staff in the psych unit, social workers, nurses, admitting psychiatrist, were all rallying for her and a snare was placed. When the evil brother and wife showed up at the psych unit the next day, Saturday, to get the patient's purse, they were shut off at the pass by an innocent-appearing but fiery charge nurse who wasn't about to turn over the woman's handbag to those two scoundrels. The purse remained safely locked in the supervisor's office.
In the end, the brother and wife were cracked open and the patient returned safely to her own home to live out the last few remaining days of her precious life. I saw her once after that. In the ER for a physical complaint secondary to her chemo treatment. Considerably thinner, a little pallor to her skin and now, wearing a turban to cover her baldness, some of the life was gone from her eyes. I was happy to see that she had a young, strong family member with her who was acting as protector, now.
There have been a few, count them on the fingers of one hand, incidences so satisfying that I've honestly felt that if I died at that exact moment, I would have absolutely no regrets. One was the day the hospital employees rallied for this patient. Weirdly enough, another was the night I got excepted to RN school.
A while back I got a lady I'd seen for the same thing about 3 months ago. In her 70's, she reminded me of Eve Arden. Tall and slender with brown doe eyes and those big, rubbery lips and a voice like Southern accented honey-puddles. There's something regal about her and you can tell she's always had good sense and plenty of money. But not too much. She's what they refer to here as good people, and I liked her immediately.
This day she was here to be medically cleared for admission to the geriatric psych unit, same as last time. As we began to talk in the triage area, her story jarred my memory and I recalled the previous fiasco.
Her much younger brother and even younger sister-in-law were behind the previous admission, as were they this day. When I saw her in June, she had just been diagnosed with colon cancer and was scheduled to begin chemotherapy in 3 days. But her brother brought her to the Emergency Room and requested she be admitted to the geriatric psych unit due to an episode of "thinking people are after her" and oddly, for a specified period of two weeks.
We are guilty of being led down the garden path on these cases, more often than we probably want to admit and this patient was medically cleared and sentenced to a psych admission. When she realized what was going on, she became hysterical.
"I'll miss my first chemo appointment," Big tears filled in her eyes. "How can he do this to me? What did I do to him? I've tried to help him and (Mrs. Brother) and all they want to do is put me away." She then went on to tell me she knew they were trying to get money from her but this new twist had taken on a serious tone. "Are they trying to kill me for my money? I'll be dead in a year, can't they wait that long?"
You know, sometimes these people aren't really crazy and the longer I sat in her room listening to her talk, the more I became convinced she was as sane as the rest of us.
Long story short, she got to go home in time for her first chemo treatment. But now she was back. The brother and his wife hadn't given up since the last time and the plot had become considerably thicker to the point of the patient having lost control of most of her money and now, it would seem, the brother/wife team had their eye on her home and property. She had been forced to sell a peice of artwork the brother was unaware of, in order for her to buy gas to travel, on the days she didn't take chemo, driving herself to a town 60 miles away where she underwent voluntary psychological testing and paid a lawyer to document the findings in her defense for when this particular day arrived.
The day was here and the family had called the police to bring the frail, sweet old woman to the emergency room and drop her off for admission to the psych unit, again at which point, they planned to swoop in for the kill and finish up the leftovers. And this time she was wasn't taking it lying down. She was ready for a fight.
Without going into the details, she finally agreed to admission once convinced that it was in her best interest as a defense and that from that vantage point, the brother and his wife might be, for once, exposed for what they were. And that's exactly what happened. I took her case under my wing as did about a dozen others. That night there happened to be a board meeting and the attorney representing the hospital was even summoned in for an opinion. I personally called her own attorney, having previous positive interaction with him over some office space rental, and was assured she would be looked out for. The staff in the psych unit, social workers, nurses, admitting psychiatrist, were all rallying for her and a snare was placed. When the evil brother and wife showed up at the psych unit the next day, Saturday, to get the patient's purse, they were shut off at the pass by an innocent-appearing but fiery charge nurse who wasn't about to turn over the woman's handbag to those two scoundrels. The purse remained safely locked in the supervisor's office.
In the end, the brother and wife were cracked open and the patient returned safely to her own home to live out the last few remaining days of her precious life. I saw her once after that. In the ER for a physical complaint secondary to her chemo treatment. Considerably thinner, a little pallor to her skin and now, wearing a turban to cover her baldness, some of the life was gone from her eyes. I was happy to see that she had a young, strong family member with her who was acting as protector, now.
There have been a few, count them on the fingers of one hand, incidences so satisfying that I've honestly felt that if I died at that exact moment, I would have absolutely no regrets. One was the day the hospital employees rallied for this patient. Weirdly enough, another was the night I got excepted to RN school.
Thursday, May 9, 2013
There Oughta Be a Law
Patient (to nurse): Is it legal to put a catheter in a penis no bigger than this?
Gone Fishin'
On a scale of zero to ten, with zero being no pain and ten being the worst pain possible, what number would you give your pain, today?
The only way it could hurt worse is if I had fishhooks in my eyes and little kids hanging off them.
The only way it could hurt worse is if I had fishhooks in my eyes and little kids hanging off them.
Tuesday, May 7, 2013
Wet Dreams May Come
Years ago, we had a bad flood in the Fall.
The county cops were having to rescue people in their cars nearly
getting washed away in creeks and stuff.
A miserable night. And I was working
7p-7a.
We were all sitting around; xray and lab techs, labor and delivery nurse, admissions clerk and ER nurses, talking, listening to the scanner, laughing and eating. One of the nurses in labor and delivery who was married to a cop who also worked the night shift called and instructed him to risk his life to drive to their house and get a leftover tray of Subway sandwiches from a party they'd had over the weekend, and bring them to the ER for us to eat. And even with the weather like it was, I promise you, the morons would have still been flocking to the ER with their non-emergent bullshit if they could have done so but it just so happened that the hospital was safely positioned on high ground, just above a big dip in the road which was full of water. So a good time was had by all.
Around 8:30pm we get a call that an ambulance has been dispatched to an extremely remote area of the county on a man down. On a summer day with the sun shining, it takes a good 35 minutes to travel the 12 miles of snaky, gravel road with sharp drop-offs and no shoulders. On a night like this? Forget about it. He was dead as fried chicken (stole that line from a paramedic I used to work with). They had to park in the long driveway and nearly float the gurney to the house, wading through knee-deep water. Did CPR despite a brief attempt to reality orient the hysterical family. By the time the ambulance got to the ER, the guy had been down way over 2 hours. He was pronounced about 30 seconds after he hit the door.
The thing about a code is that it's all fun and games when it's going on but as soon as it's called, everybody splits and the ER nurse is left to clean up the room and the body by herself. In this particular ER, there were double doors without windows, separating the trauma room from the rest of the department which increased the sensation of isolation. If there were family members waiting, they would then be allowed into the room to see the patient, provided with chairs, Kleenex and pats on the back before the coroner was called and the body released to the funeral home. This night, of course, there was no waiting room packed with grieving family members, friends and clergy people like only a waiting room in the south can be. Instead, it was just us and the dead guy. And that was back in the good ole days when we didn't have to call the organ recovery team on every death which greatly simplified things. So I cleaned up the mess while the rest of the crew continued the "hurricane" party in the next room without me. About 11:15 I called the coroner and left a message to call the ER regarding a death.
Here's the problem: At least in our county, the coroner is usually the owner or an employee of one of the two funeral homes in town. He has to come out on every death and release (or not release) the body before it can be removed by whichever funeral home the family chooses, hoping it will be his own own. But this particular coroner, owned the least popular establishment of the two and was repeatedly called out on deaths, only to release the body to his competitor, which visibly pissed him off. On the night in question, the local elections had just taken place a couple of weeks before and the incumbent coroner, and owner of the least sought-after funeral home, had been voted out which only added to his pisstivity. Still, he officially held the office and was expected to do his job, albeit reluctantly or, as in the case of this wet night, not at all. I called and I called and I called and I left messages and he didn't come and he didn't come and I left more messages that didn't get replied to.
By this time, it was up into the night and the doc had long since gone to the doctor's sleep room to take advantage of the lull. The noon to midnight nurse had gone home and the labor and delivery nurse had wandered off to visit in another department and the lab and xray techs had gone back to take a nap, or watch a movie or something, leaving me alone with the admissions clerk who was reading a novel in the room to my right, and the dead guy in the room to my left.
What I haven't told you about me is that I'm a pretty good sport when it comes to vomit and blood and feces and urine and gaping wounds and draining abscesses. But dead people? They freak me slap out. One of the few things that kills my appetite dead in its tracks is a dead person. Can't even watch Funeral Boss and drink milk at the same time, it's that bad. So I start getting this real, sick sort of feeling of wrongness the longer I'm basically alone in this close of proximity with this dead person, and I've been stuck with him so long by now that I'm beginning to wonder if maybe I should start claiming him on my taxes as a dependent, when I get a call from the little, newly elected, female coroner who happens to work at the more popular funeral home. Turns out, the current coroner had decided that at 2 am on this wet night with two-thirds of the county currently under water, that this would be a good time for her to orient to her new position and she cheerfully announces that she'll be along just as soon as she can get there.
About 3am, here she comes, all apologetic and sweet and little in this big, dark night that I offer to help her, which is really a stretch for me, considering my aversion to the newly deceased, but pity got the best of me and I screw my courage to the sticking place. I help her get him in the purple velvet body bag and zip it up and move it to her stretcher and then I make the fatal error (pardon the pun) of asking if she needs help getting him into the hearse.
So, down the long, empty hall we go, soberly rolling the gurney with what was beginning to feel like my conjoined twin on it, turn and go out the oversized back door to the extra dark, very wet, slick and chilly night. The whole scene had a oddly Boris Karloff-like feel to it what with the dead body at 3am in a storm, and all. We roll the stretcher to the hearse and my companion pulls open its back door. Did I mention that it was raining and there was lightening flashing over our heads?
These stretchers have two sets of legs with wheels on them and they fold back as the stretcher is pushed into the hearse or ambulance or whatever the case may be. So the little, sweet, new, female almost-coroner aligns the stretcher with the back of the hearse and we begin to reverently push it in through the open door. The front set of legs folds back as designed and the stretcher continues to roll back. But when the back set of legs reach the vehicle, they don't break down. We roll it out a little and try it again. Still won't fold up. Maybe if we hit it going a little faster. Still nothing. Maybe a little harder. They don't budge. What does happen, however, is that with each, subsequent push, the front part of the stretcher advances a little more into the back of the hearse but, because the back legs won't fold down, they just sort of slide up, pushing the foot of the stretcher higher and higher in the hearse until the stretcher is at a near 45 degree angle with the bed of the vehicle and the patient's feet are sticking out the top of the door. I mention in passing the possibility of bungee cords to hold the door closed and it was about then that we lost our shit.
Fear, panic, stress, emotional release, call it what you want, we fell victim to that kind of orgasmic laughter that turns taut muscles suddenly flaccid and saps every drop of control right out of two, grown women. We were holding our stomachs, tears running down our faces. We repeatedly tried to regain our composure and reattempt the introduction of the stretcher into the hearse only to crumple, once more, like ragdolls, weakened with hysteria, fresh waves of laughter piercing the inky night.
I'm not sure how long it continued but when it stopped, we somehow manage to get the back legs of the stretcher to behave and shut the door, the corpse's feet safely INSIDE the hearse. Once our task was completed, we stood sniffing back snot, wiping the tears from our faces and straightening our clothing. And then the now serious coroner turns her face toward mine.
"You can't ever tell anyone about this," All signs of merriment absent from her face.
"I won't," I lie. "I'll never tell a living soul."
We were all sitting around; xray and lab techs, labor and delivery nurse, admissions clerk and ER nurses, talking, listening to the scanner, laughing and eating. One of the nurses in labor and delivery who was married to a cop who also worked the night shift called and instructed him to risk his life to drive to their house and get a leftover tray of Subway sandwiches from a party they'd had over the weekend, and bring them to the ER for us to eat. And even with the weather like it was, I promise you, the morons would have still been flocking to the ER with their non-emergent bullshit if they could have done so but it just so happened that the hospital was safely positioned on high ground, just above a big dip in the road which was full of water. So a good time was had by all.
Around 8:30pm we get a call that an ambulance has been dispatched to an extremely remote area of the county on a man down. On a summer day with the sun shining, it takes a good 35 minutes to travel the 12 miles of snaky, gravel road with sharp drop-offs and no shoulders. On a night like this? Forget about it. He was dead as fried chicken (stole that line from a paramedic I used to work with). They had to park in the long driveway and nearly float the gurney to the house, wading through knee-deep water. Did CPR despite a brief attempt to reality orient the hysterical family. By the time the ambulance got to the ER, the guy had been down way over 2 hours. He was pronounced about 30 seconds after he hit the door.
The thing about a code is that it's all fun and games when it's going on but as soon as it's called, everybody splits and the ER nurse is left to clean up the room and the body by herself. In this particular ER, there were double doors without windows, separating the trauma room from the rest of the department which increased the sensation of isolation. If there were family members waiting, they would then be allowed into the room to see the patient, provided with chairs, Kleenex and pats on the back before the coroner was called and the body released to the funeral home. This night, of course, there was no waiting room packed with grieving family members, friends and clergy people like only a waiting room in the south can be. Instead, it was just us and the dead guy. And that was back in the good ole days when we didn't have to call the organ recovery team on every death which greatly simplified things. So I cleaned up the mess while the rest of the crew continued the "hurricane" party in the next room without me. About 11:15 I called the coroner and left a message to call the ER regarding a death.
Here's the problem: At least in our county, the coroner is usually the owner or an employee of one of the two funeral homes in town. He has to come out on every death and release (or not release) the body before it can be removed by whichever funeral home the family chooses, hoping it will be his own own. But this particular coroner, owned the least popular establishment of the two and was repeatedly called out on deaths, only to release the body to his competitor, which visibly pissed him off. On the night in question, the local elections had just taken place a couple of weeks before and the incumbent coroner, and owner of the least sought-after funeral home, had been voted out which only added to his pisstivity. Still, he officially held the office and was expected to do his job, albeit reluctantly or, as in the case of this wet night, not at all. I called and I called and I called and I left messages and he didn't come and he didn't come and I left more messages that didn't get replied to.
By this time, it was up into the night and the doc had long since gone to the doctor's sleep room to take advantage of the lull. The noon to midnight nurse had gone home and the labor and delivery nurse had wandered off to visit in another department and the lab and xray techs had gone back to take a nap, or watch a movie or something, leaving me alone with the admissions clerk who was reading a novel in the room to my right, and the dead guy in the room to my left.
What I haven't told you about me is that I'm a pretty good sport when it comes to vomit and blood and feces and urine and gaping wounds and draining abscesses. But dead people? They freak me slap out. One of the few things that kills my appetite dead in its tracks is a dead person. Can't even watch Funeral Boss and drink milk at the same time, it's that bad. So I start getting this real, sick sort of feeling of wrongness the longer I'm basically alone in this close of proximity with this dead person, and I've been stuck with him so long by now that I'm beginning to wonder if maybe I should start claiming him on my taxes as a dependent, when I get a call from the little, newly elected, female coroner who happens to work at the more popular funeral home. Turns out, the current coroner had decided that at 2 am on this wet night with two-thirds of the county currently under water, that this would be a good time for her to orient to her new position and she cheerfully announces that she'll be along just as soon as she can get there.
About 3am, here she comes, all apologetic and sweet and little in this big, dark night that I offer to help her, which is really a stretch for me, considering my aversion to the newly deceased, but pity got the best of me and I screw my courage to the sticking place. I help her get him in the purple velvet body bag and zip it up and move it to her stretcher and then I make the fatal error (pardon the pun) of asking if she needs help getting him into the hearse.
So, down the long, empty hall we go, soberly rolling the gurney with what was beginning to feel like my conjoined twin on it, turn and go out the oversized back door to the extra dark, very wet, slick and chilly night. The whole scene had a oddly Boris Karloff-like feel to it what with the dead body at 3am in a storm, and all. We roll the stretcher to the hearse and my companion pulls open its back door. Did I mention that it was raining and there was lightening flashing over our heads?
These stretchers have two sets of legs with wheels on them and they fold back as the stretcher is pushed into the hearse or ambulance or whatever the case may be. So the little, sweet, new, female almost-coroner aligns the stretcher with the back of the hearse and we begin to reverently push it in through the open door. The front set of legs folds back as designed and the stretcher continues to roll back. But when the back set of legs reach the vehicle, they don't break down. We roll it out a little and try it again. Still won't fold up. Maybe if we hit it going a little faster. Still nothing. Maybe a little harder. They don't budge. What does happen, however, is that with each, subsequent push, the front part of the stretcher advances a little more into the back of the hearse but, because the back legs won't fold down, they just sort of slide up, pushing the foot of the stretcher higher and higher in the hearse until the stretcher is at a near 45 degree angle with the bed of the vehicle and the patient's feet are sticking out the top of the door. I mention in passing the possibility of bungee cords to hold the door closed and it was about then that we lost our shit.
Fear, panic, stress, emotional release, call it what you want, we fell victim to that kind of orgasmic laughter that turns taut muscles suddenly flaccid and saps every drop of control right out of two, grown women. We were holding our stomachs, tears running down our faces. We repeatedly tried to regain our composure and reattempt the introduction of the stretcher into the hearse only to crumple, once more, like ragdolls, weakened with hysteria, fresh waves of laughter piercing the inky night.
I'm not sure how long it continued but when it stopped, we somehow manage to get the back legs of the stretcher to behave and shut the door, the corpse's feet safely INSIDE the hearse. Once our task was completed, we stood sniffing back snot, wiping the tears from our faces and straightening our clothing. And then the now serious coroner turns her face toward mine.
"You can't ever tell anyone about this," All signs of merriment absent from her face.
"I won't," I lie. "I'll never tell a living soul."
Monday, May 6, 2013
Permission Granted
Son (to 93 yr old female): "You should've come to the hospital when your pain first started, Mom."
93 yr old female: "Oh bull!" Then turning to look at nurse. "Can I say 'bullshit'?"
93 yr old female: "Oh bull!" Then turning to look at nurse. "Can I say 'bullshit'?"
Going Green
The triage bell goes off the other day and I go into the triage room (we all take turns since budget cuts have eliminated a dedicated triage nurse) and this is waiting for me, and I quote.
my dick and my butthole been draning green, and hurt, and stink - my wife says. Puking, to.
So...would that be your wife who's been puking?
I'm never gonna get used to this, am I?
my dick and my butthole been draning green, and hurt, and stink - my wife says. Puking, to.
So...would that be your wife who's been puking?
I'm never gonna get used to this, am I?
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