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Friday, January 23, 2015

a new era in the emergency room

Have we entered a new era in hospital/ER medicine?  It is so much more busy than it used to be over the last few months. Every day we are full with a full lobby. At first, I thought it was the flu, seasonal illness, but it has kept going.

The hospital has been full too. So people wait in the ER. Mental health beds?  Forget about it.

Is it obamacare and people having insurance? It feels like we now see two types of patients in the ER: those with serious problems and those with urgent care problems. We are seeing more and more urgent care patients.  Patient who are willing to sit in the lobby for 3 or 4 hours for a sore throat.

We are also seeing a lot more mental health patients, especially adolescent mental health patients.

We used to get an occasional day when things were reasonable and we could breathe a little bit. Seems like those days are over.

Wednesday, January 21, 2015

mental health patients are treated like caged animals

In the modern ER if you are a mental health patient we kind of treat you like an animal. (I know, I know, I'm always harping on this, but it bothers me.)

We take you and put you in a room with a cart. There is nothing else in the room out of our fear your will use it to hurt yourself or us All of your stuff, including your clothes will be taken from you. You will be watched on a camera. There is nothing to distract you in the room.  You have walls to stare at, thats about it. We will throw food your way three times a day. To be honest, most of the time we will be too busy to spend much time with you.

You will stay in the room for hours, sometimes days. These days most of the time there are no psych beds. Anywhere, sometimes in the whole state.

You will have plenty of time to sit and think about what brought you there, your problems. You will also have plenty of time to get pissed off because you are sitting there for hours or days. You may lash out, run down the hall, thrown something, get out of control.  Then we will restrain you and sedate you.  Its like we are tranquilizing you in order to have control of you.

This is the modern day emergency room mental health experience. It isn't going to change anytime soon.  It is dangerous for the patients, dangerous for the staff.  The thing is, nobody cares.

Tuesday, January 20, 2015

madness: beacon of virtue


Every once in a while (okay its rare), I say to myself: Madness, you have to change. You have got to stop the profanity on the blog. You have to stop being an evil bitch (oops). Stop being so damn (!) cynical and hateful and acting like all the patients are dumb losers. Be the professional you were trained to be. You know - caring and skilled, soothin' fevered brows, sheddin' an occasional tear, lots of nodding in sympathy, etc. That usually lasts about one blog post and I'm back to my normal self...it's a hopeful endeavor...

May I just say that I get a perverse delight pissing people off on the blog. When all the dysfunctionistas and dysfunctionistos come forward calling for my head, it is fun. They call me an unsympathetic, uncaring nurse who should leave the profession, get a new job, etc.  They are right. BADA BOOM.

I don't fit in with what a nurse is supposed to be: kind, gentle, caring, self sacrificing, understanding, etc. I am kind of at the opposite end of that spectrum. If you are nice to me, I'll be nice to you. If you treat me like shit, I'm not going out of my way for you. Sorry. Just because I am a nurse doesn't mean I have to put up with abuse, rudeness, yelling, cussing, threatening, etc. Sorry not gonna happen.

I especially enjoy the fibromyalgiers, migraineurs, chronic back painers when they comment. They often go back to their friends on forums or sites that they frequent and tell everybody to go to the blog and comment. May I just say: I welcome you. Come one. Come all.

I fancy myself kind of like lady liberty, a beacon of virtue in the emergency room...

This is the motto I try to live by:

"Give me your tired, your dysfunctional,
your huddled back painers, yearning for one more script for percocet,
The wretched sunglass wearing migraineurs wanting benadryl with their dilaudid,
Send these, the fibromyalgiacs, with their fauning families to me,
I sneer inside the emergency golden door."

Of course this is based on the inscription on the statue of liberty:
Give me your tired, your poor, 
Your huddled masses, yearning to breath free, 
The wretched refuse of your teeming shore, 
Send these, the homeless, tempest tost to me,
I lift my lamp beside the golden door.

Monday, January 19, 2015

I don't care if you can't chunk a deuce/flo nightengale is rolling over in her grave tonight


Sometimes the ER smells like a pig pen. Literally. Shit is running off of carts and on to the floor.

Speaking of poop, why does anyone ever come into the ER with constipation? ATTENTION ALL CITIZENS OF THE US:

*****CONSTIPATION IS NOT AN EMERGENCY. I REPEAT. CONSTIPATION IS NOT AN EMERGENCY. THAT IS ALL. GO ABOUT YOUR BUSINESS.*****

If you come into the ER with constipation, you will be viewed as the frickin' idiot that you are. I don't care if you are 102, the fact that you haven't had a bowel movement in 3 days is not an emergency. While we're at it, why is it that old people are obsessed with having bowel movements? Its like if they don't have a daily poop, its a crisis...

By the way, I don't believe you when you say you haven't crapped in 2 weeks. Don't believe you. Sorry. You wouldn't be able to eat, drink. Go home.

Attention all ER docs: IF YOU ORDER AN ENEMA, ESPESCIALLY A TAP WATER ENEMA, YOU WILL BECOME A HATED FIGURE. THAT IS ALL. GO ABOUT YOUR BUSINESS.

When I see a constipation coming my way, I run for the med room, staff lounge, bathroom, pop machine, develop a sudden interest in my patients personal life.

Don't come to the ER for constipation. The ER staff will hate you. And while I am at it, don't bring in granny or grandpa either. Have you ever tried to give an enema to an 85 year old? Its a recipe for diaster for all concerned. Now we hate you and your whole family.

Now come forth, o readers, tell me in the  comments how your case of constipation WAS DIFFERENT, how I am a terrible, unfeeling nurse who should just quit because Flo Nightengale is probably rolling over in her grave right now.  I'm feeling kind of evil tonight.

Sunday, January 18, 2015

good or bad day?

ER nurses guide to whether it was a good day or a bad day:

1) Do you feel like you have been hit by a truck?  BAD DAY

2) Do you just have the usual backache, feet hurt, mild headache?  GOOD DAY