Friday, May 10, 2013

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.




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