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.
Sunday, February 12, 2012
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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