Friday, May 17, 2013

We Have a Winner!

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

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?


(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.

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.

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!".

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.

It Was a Very Good Year

Sir, can you tell me the date?


What is it?


Sir, what is the date?

Oh.  It's...uh....'94.

Okay.  And can you tell me what state we're in?


What state?


What state are we in?

Oh.  94.