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.
Friday, May 10, 2013
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?
Thursday, April 25, 2013
...and a Half Dozen of Another
Me: "On a scale of zero to ten, what number would you rate the pain you're having today?"
Elderly Male Patient: "Which one is the worst?"
Me: "Ten is the worst."
Elderly Male Patient: "Then it's a five."
Is it my imagination or wouldn't it still have been a five if........oh, fuck it.
Elderly Male Patient: "Which one is the worst?"
Me: "Ten is the worst."
Elderly Male Patient: "Then it's a five."
Is it my imagination or wouldn't it still have been a five if........oh, fuck it.
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