Thursday, June 30, 2011

coming back from Mars

Veering off topic a little today. This is about a subject near and dear to my heart: veterans. I read an article today on medical news today about veteran suicide.

We are in 2-3 wars, even more, depending on how you view it. One is "winding down" in Iraq, although if you believe that we will ever be completely out of there, I have some swampland in Florida for sale. A close relative is on his way there now, deployed for one year for the second time. So people are still being deployed to Iraq. Afghanistan: no end in sight. Why we are still there boggles my mind. We are sacrificing US soldiers lives in a place that has not changed and won't change when we leave. We are involved in Libya, air forces being used.

These wars are not "conventional" wars, not the old fashioned world war II type wars. It is difficult to determine who is your enemy or who is your friend. Deployed up to 4 times in the space of several years, you are asked to sacrifice over and over again, along with your family. Here's the thing: you are among a relatively small group of people who volunteered to defend this country. You are "protecting" us from terrorism. There is no draft, no one else is being asked to sacrifice for the cause. Most people don't give you much thought, your death is several pages back in the newspaper.

Coming back from war is like coming back from Mars. You were stripped down to the basics of survival: gun and assorted war paraphenailia, clothes, family pictures, cot if you're lucky, tent. All prentensions of normal life have fallen by the wayside as you depend on your fellow soldiers and develop the kind of bonds with them that you will never develop with anyone again. Then you watch them die. You accept what may be your own inevitable death.

You come back, expected to rejoin your old life, but you have changed, disoriented by a world that has gone on without you. There is really no one to talk to about your experiences even if you wanted because no one really wants to hear it and soldiers don't talk about emotions with each other. Soldiers don't go to counselors, they are supposed to be strong. If you are lucky, you somehow put it in a box, move on. If you don't, it haunts you. You become one of 18 veterans who commit suicide daily in this country, about 6,000 a year.

No one seems to care. We have sanitized these wars. No one sees the dead bodies or missing limbs. We see no bodies coming back. That is carefully hidden. We are okay with you and the others protecting our precious freedom, with little personal sacrifice on our part.

Wednesday, June 29, 2011

family members from hell

In my never ending quest to entertain y'all, I offer the following categories of various FAMILY MEMBERS FROM HELL:

DOORWAY GAWKER- stands in room doorway and stares at the staff, arms folded, from the doorway with an impatient, angry look on their face
THE VENTRILOQUIST - talks for the patient until you tell them to stop it
THE SHADOW- you have to pry this person away from the patients bedside in order to do your job. then they watch every move you make as you start an IV, give meds, etc.
APATHETIC ANN/ANDY - brings a book, laptop - has a sort of been here/done this attitude - seems uninterested in whats going on
THE SUCKER - accompanies a patient with some kind of bogus chronic problem and has bought into it hook, line and sinker
THE KLEPTOMANIAC - you might catch this person rummaging through the cupboards, drawers and perhaps pocketing a thing or twoTHE ERRAND RUNNER - may come up to the desk requesting warm blankets, footies, water, food, more pain meds, etc etc etc
MAMAS BOY MAMA - accompanies their grown son or daughter to the ER and sits with concerned look at bedside
BABY DADDY - accompanies girlfriend to ER and is suspicious of any male that comes into the room. Wants to stay there when pelvic exam is being done.
THE DUMPER- drops off confused mom/dad/annoying sibling/girlfriend/boyfriend and leaves
SPACE INVADERS - crosses that line into the staff area or follows the doctor into their area - definitely a no no
CHRISTMAS GIFTERS - brings mom/dad/grandma who they haven't seen for months to ER because they "aren't doing that well/can't take care of themselves/need to go to a nursing home"
CHICKEN LITTLE - runs to triage desk requesting help for mom/dad/etc in the car who are dying (99% of the time they are fine). Comes up to the desk and tells you heart monitor is dinging - is that OK??!!!
SUSPICIOUS STAN/STELLA- takes notes - wants names of staff, name of medication, name of tests. Has special "medical notebook".
I know, I know I'm evil. Oh well....that's already been established....

Sunday, June 26, 2011

20 uses for duct tape in the ER

I have done a blog post on this before, so may I should call this: 20 USES FOR DUCT TAPE IN ER II

1)IV pole broke: Tape the IV bag to any nearby surface: the monitor, the wall, the patients relative, etc.

2) Demented Donald trying to get out of bed? Duct tape will keep him in bed.

3) Duct tape that irritating drunks mouth shut.

4) No security available to watch your suicidal patient? Duct tape will keeep them in bed and SAFE.

4) Out of arm slings? Fashion one out of a piece of cardboard and tape.

5) Patient hairy and need to put him on the monitor? Duct tape will remove that hair for lead placement.

6) Backboards all in use? Take the sliding board, some rolled towels and tape and fashion your own version of spine stablization.

7) Duct tape your manager to a chair.

8) Low on suture or staples: A quick and easy laceration repair.

9) Tape patients gown together for trip to bathroom.

10) Out of adult diapers: use towel and duct tape substitute.

11) Tape NG, ET tube, foley in place.

12) Tape patients wig or toupee in place.

13) Never lose it again: tape you pen, scissors, roll of tape, stethoscope to yourself.

14) Make letters RN on uniform so patients will know you are their nurse.

15) Afraid your patient might wander off? Put their name on it, room number and attach to gown.

16) Cheap shoulder immobilizer.

17) Confused grandaa will never pull out her IV again.

18) Tape your nostrils together for that smelly clean up

19) Cheap eye patch.

20) Help reset dislocations.

your ideas?

Friday, June 24, 2011

33 addresses for same person

Oh the innovative mind of the average drug seeker. If they put half the effort they put into getting narcotics into actually working or doing something with their life, they would be very successful and rich.

Witness: Drug seeker presents. Doctor looks drug seeker up on state prescription narcotic tracking system. Doctor sees that drug seekee has scored 33 prescriptions in last couple of months using different addresses. The thing is they use their name every time. 10 demerits for that.

I think the person who came up with the idea of doing this tracking deserves a monument on the capital mall. It is truly the best thing that has ever happened to ER medicine.

I kid you not

Yes I kid you not. A man comes up to the triage desk and says:

"I need my stitches out and a clean pair of underwear and socks..."

No problem sir, let me go to the ER underwear drawer..

Wednesday, June 22, 2011

I have become a garbage sorter

Want to become a nurse? Part of your job will be to be a garbage sorter. There is an elaborate system for waste disposal in hospitals involving different colored receptacles. It will be your job as a nurse to know what goes where. You are expected to remember which drugs are hazardous and go in the evil black bin, which drugs and IVs, etc. can go in the blood colored red bin and which can go in the boring white sharps container. There will be a quiz later. If you can't pass it, you're fired.

We are told that if we don't dispose of things in the proper container, it costs the hospital hundreds of dollars a day to pay people to sort it (hey there are worse job than ours). This is supposed to make us feel bad and motivate us to sort it into the proper container. Not. Doesn't happen. Its crazy to expect us to do this.

Today we learned that all used IV bags must be placed in zip lock bags and then disposed of. Why? Who the hell make the ziploc people rich? What gets me about all this, is where all the meds we waste, IVs we waste go: right down into the city sewer system. It is a known fact that drugs have been found at very low levels in water systems. Don't worry about that, just remember to put your empty IV bag into a ziploc...

Is it just me, or does this job get bat shit crazier every day?

Sunday, June 19, 2011

I hate it when...

I hate it when..... - I am almost done triaging you and I ask you when was your last period and you tell me you are not a woman.... - You have a 1/4" laceration on the palm of your hand, but you don't speak english and neither does your 18 year sister accompanying you. Oh by the way your parents phone is disconnected.... - You were seen at another hospital yesterday but had no money to fill your meds, and so now here you are at our ER so you can get your meds filled... - Your elderly mother is in the car, can't walk in and I'll be damned if I can find a wheelchair... - You are suicidal today after drinking, using cocaine and taking "some pills that I didn't know the name of" last night.... - You are making your 3rd appearance to a health provider this week for what was diagnosed as minor the first time you saw someone... - Someone "stole", "you lost", "you didn't have the money to pay for...", your meds we gave you to fill yesterday.... - You call and ask us if we have a "service" that will pick you up and bring you to the ER....

Friday, June 17, 2011

lady godiva visits hospital

Not medicine related but too good to pass up. We have a McDonalds in our hospital (don't get me started). Well of course the neighborhood folks come in to use it. A colorful group, they are. Today more colorful than most. Everybody was chowing down on their big macs, sucking up their cokes and who should walk in but LADY GODIVA. That's right folks this woman was nude, au natural, sans clothing, bouncing down the aisle for all to see. She must have tied up her horse outside... Alas, I wasn't there (thank God), but only heard of the event. We all thought she would inevitably end up with us, but it turns out she was persuaded to leave the premises and gallop on home.....

Thursday, June 16, 2011

bizarre allergies

A man came in today who claimed that he was allergic to "water", then in parentheses in the allergy section it says: "takes quick showers". Just kill me now. Them showers must have to be damn quick. And take an epi pen in there with you...The human body is 50-65% water. By rights, this man should have died years ago. But unfortunately, he is still with us and chooses to present himself to our ER. He has a legitimate problem, but somehow its hard to get past the whole water thing.

There is actually a scientific name for this: aquagenous urticaria. Only 30 people in the whole wide world have this allergy. There is no cure. Their is a 14 year old girl who is allergic to water. Every time she comes in contact with it she develops a rash or blisters. So she applies a barrier foam that has allowed her to function somewhat. My question is what about her body's water content. How come that doesn't cause a reaction? Hmmmmm...

Another allergy someone had recently is an allergy to "cold". "I have just been diagnosed with it" she said. Woman, you are in the wrong part of the country and I suggest you move south my dear. I know someone who is allergic to the sun. Bummer. Here's a good one: "I'm allergic to holy water at church. Whereever it touches me, I break out in hives". Hmmmm.....maybe God is trying to tell you something....

Wednesday, June 15, 2011

death x 4

People die in the ER, everybody knows that. Its never easy. Different deaths affect you differently.

Sometimes someone is a DNR and for some reason are brought into the ER. Maybe the family can't handle them dying at home. The death is expected. You feel bad because the family has lost a loved one, but at least it wasn't unexpected.

Then there is the cardiac arrest that happens outside the hospital. They are usually elderly and may come in with no heartbeat. You make an effect to resuscitate them and then it is called. It is sad to see the family sad because their loved one has passed. Their tears are hard to watch. But you tell yourself that the person was elderly, it was their time to go.

Then there are those that really affect you. The traumatic death, either accidental or intentional. Either fate has put them at the wrong place at the wrong time and they are tragically killed. Or someone intentionally killed someone. Either case it really affects you. Sometimes they are young, barely starting their lives. It is so unfair and it makes you angry. It seems so pointless. In these situations the family is in a state of shock, made worse by the randomness of these deaths or the intention of someone. These are the deaths in which people may wail, act out. It makes it even harder.

Then there is the worst death of all. Someone dies who wasn't supposed to die. They were sick on arrival but stable, but then end up dying. You try hard to bring them back but it doesn't work. The staff is in a state of shock this time, along with the family. What happened? What could we have done differently? Could I have prevented this death somehow? I should have done something differently. In this death you may never know the cause because sometimes there is no autopsy. So you are left to wonder why and how it may have turned out differently. These are the hardest cases of all.

And that's death in the emergency room. Your thoughts?

Tuesday, June 14, 2011

I joined the circus

It was one of those days where the beds were full when you got there and there were always 8 or 9 people in triage and even though it was a beautiful day outside everybody and their brother from near and far decided to grace our doorstep with their sad tales of woe and were breaking hips and having headaches and vomiting and having chest pain and the charge nurse was trolling the halls looking for potential hall bed candidates and bugging the nurses to call report and the nurses upstairs were as usual "at lunch" and would call back in ten minutes and then never called back and meanwhile bed 15 is vomiting and bed 22 is having a bad reaction to a medication that you gave her that is making her anxious and shaky and that woman in 17 is telling you stuff about her life that you really don't want to know because it is weird and scary and another patient is incontinent of stool says their relative and they need help and so and so wants you to start an IV for them and lab is on line 2 and pharmacy is on line 3 and why do you seem so irritable and its 130 pm and you haven't had a break and your blood sugar is low and your bladder is full and if one more person asks you what is taking so long you are going to scream and its finally over and this nurse is tired and needs to rest so that she can have one day off and then start the whole circus over again.

Sunday, June 12, 2011

sex in the ER

Got your attention didn't I? heh heh heh

Sometimes I feel like we should put up a sign at the ER entrance: NO CONJUNGAL VISITS ALLOWED IN ER...I don't know how many times I have gone into a room and the patient and their significant other are in bed together. Or the girl is sitting on the guy's lap. Sorry to interrupt.....but I am your nurse....
I have had to stop people from making out in front of the triage desk. ah.....AHEM! You know how there is a mile high club? Maybe there is an ER club...
I have had patients out in the hall in the doorway of someone elses room having a deep discussion with the person next door. Hey can I get your number...maybe we can have coffee later....
Ladies here's a piece of advice: ER is not a place to find boyfriend material...Some people come to ER dressed like they are stopping on the way to the club. They present to the triage window with a top so low cut it practically goes down to their belly button...
Ladies here's another piece of advice: Don't wear a low cut top to an ER that sits in the middle of the 'hood.
Some people think the nurse is dear abby and tell us things we really, really don't want to hear. Advice folks: I don't want to hear about you significant others kinky porno preferences...Leave your sex life at home....I really don't want to hear about it or see it.

Friday, June 10, 2011


Okay you have been warned...

A few years ago a person presented with a headache and dizziness. Of course, there can be many reasons for said symptoms, so the usual array of tests were ordered including a head CT. Here comes the gross part..CT results: tapeworms in the brain. Yeah worms in the brain. Allow me to explain...WARNING: gets grosser.

These parasite can live in pork. If the meat is undercooked guess what happens? Yeah right into your tummy and attaches itself to your intestine. When it enters your body it is in an immature stage and it matures in your intestine. WARNING: GROSS! GROSS! GROSS! The worms lay eggs. Lots and lots of eggs. They pass out through your stool. You don't wash your hands, your hands go in your mouth at some point and with it go you know what. These eggs can enter your bloodstream and travel to different parts of your body including your brain. They mature into worms there. (okay have you vomitted yet?)

They can cause dizziness, headaches, vomitting, sometimes seizures. The treatment is drugs that get rid of parasites and steroids. Sometimes surgery is required. They can kill you if they affect the brain stem.

I don't think I'll ever eat pork again. I love my job.

Thursday, June 09, 2011

It wasn't me, it was my evil twin

I have an evil twin. The evil twin comes out of the patients room and grumbles to herself, using words like "idiot, moron, fool". My evil twin has to keep herself from dozing off as you drone on about your myriad of problems. My evil twin talks trash about you to her co-workers. My evil twin silently shouts "whadda think of that sucker!" when she gets an IV after you said no one can ever get one. My evil twin thinks you should be able to find your own way don' need no bus token or cab found your way here - now follow the yellow brick road back home Dorothy. My evil twin doesn't want to hear a history of all your medical problems going back to that traumatic experience in Haight-Ashbury in 1968. My evil twin doesn't want to hear that you are sorry that you peed all over the floor. I'm sorry too. My evil twin thinks you are nuts if you have more than three allergies in three different categories. My evil twin feels sorry for the nurse upstairs who has to take care of you for 8 or 12 hours, but is glad it isn't her. My evil twin knows you are on something so don't bullshit her. Remember she's evil. Never forget she's evil. Remember she has the sharp objects.

Tuesday, June 07, 2011

cuckoo cuckoo

After years of experience, hundreds of hours of patient care, I have arrived at a personal philosophy of ER medicine that works for me: YOU ARE NUTS UNTIL PROVEN OTHERWISEYou know, to crystallize this phrase and philosophy in my mind gives me a sense of inner peace. I can relax. There will be no more surprises as I enter a patient's room. I will already know they are nuts, so nothing they do or say will surprise me. I can say to myself - you're doing that because you're nuts! I may even start to develop more empathy for people. Hey they can't help it - they are nuts...What is genius about this is that when they aren't nuts, I will be pleasantly surprised! really are a normal unique. That knowledge will put a spring in my step, a song in my will restore my faith in humanity people I tell you. I'm so relieved...

triage facts and figures

- Highest number of people waiting in the lobby to get in today: 22
- Highest number of people in line at the triage window at one time: 10
- Highest number of people in the ER at one time today: 52
- Longest length of time someone waited: 3 hours
- Most members of one family triaged today: 3
- Longest time someone had a symptom they were being seen for: 2 years
- Shortest time someone had a symptom they were being seen for: 1/2 hour - - Percentage of people who didn't really need to be there: 90%
- Dumbest reason to come to the ER: "I want to be seen for an std, I have no symptoms but something doesn't feel right"
- Smartest reason to come to ER today: severe chest pain for 3 days
- Amount of time left in the shift when I got dinner: 1 hour
- Amount of times I felt like running screaming from the ER while working in triage: 12 - at least twice an hour

Sunday, June 05, 2011

Emergency department no-no's

Emergency department no-no's:

1) Don't fall and come in by ambulance and have a baggie of crack in your sock that the doctor finds when he examines you. At age 65 no less. Then keep coming out of your room yelling that we have no right to take your property.
2) Don't come in with your girlfriend (the patient) and then go out to the ER entrance and try the door on a car that is sitting there and get in and look around for something to steal. Then go back in your girlfriends room like nothing happened.You see my dear moron, we have cameras at the entrance, so smile you are BUSTED!
3) Don't come in with your boyfriend and both of you ask to be seen for the same thing: chronic back pain. Then expect both of you to get a supply of Vicodin. I don't think so.
4) Don't go in the bathroom and down a bottle of jack daniels before you are admitted to mental health.
5) Don't be banned from 3 local hospitals because you were sexually aggressive and threatened to kill the staff, then set your sights on our hospital.
6) Don't adjust your own IV pump to cause yourself another medical problem so you can be admitted.
7) Don't pack some hospital sheets and towels into a patient belongings bag and try to leave with them. EWWWW!
8) Don't come in for something related to your pregnancy and then steal the fetal heart monitor that we used to hear your baby's heartbeat.
9) Don't tie up your dog at the emergency entrance and then come in to be seen.

Saturday, June 04, 2011

questions that deserve answers

Questions asked of the ER staff:

1) By phone: do you do c-sections in the ER? I'm tired of carrying this baby... (I hear ya sista)
2) To triage staff: can you borrow me $20? My car broke down a couple of blocks from here - I promise I'll bring it back...(sure...let me go get my purse)
3) Can you give me a ride to my car that I left in the parking lot about a mile from here? (no problem let me go get the ER van..)
4) On the way out: Have you got any condoms? (oh how I wish we did)
5) by phone: is doctor so and so working tonight? (he was fired yesterday..)
6) How many milligrams of Dilaudid or Morphine did you give me? (98)
7) Can I see: Jane, John, Mary, Sue? No I don't know their last name. I just met them an hour ago. (Isn't it nice how you make friends so easily...)
8) Do I have time to go to McDonalds before you call me? (of course, hey will you get me a blizzard while your there?)
9) Can I have a warm blanket, food, footies, a cab voucher, a bus token, a soda, some coffee? (you can have all that and more...let me get the ER conciere)
10) What's that smell? (ha....haha....hahahahaha...)

Friday, June 03, 2011

there's fungus amongus

When the tide turns in the ER, it can be an ugly thing. You know the patient is kind of a wacko, but you go along with all their aches and pains in an effort to just get the visit over with in the least stressful way possible for everyone concerned. So everything is honky-dorry and you are the patients new best friend, la dee dah. You are the most wonderful nurse who ever lived. And then it happens......something does not go the way the patients way and BOOM!!! New patient....a transformation from sweet, polite, best friends to THE PATIENT FROM HELL!!! The transformation is instantaneous and usually involves shouting, dramatic announcements: I"M LEAVING!!! Okay....hey I thought we were friends...

A patient comes in with some kind of cellulitis/fungus ( there's fungus amongus) thing on their feet. Oh by the way I have carbuncles (abscess like things that drain nasty goop) on my head, and I have an open sore with VRE (organism resistant to some antibiotics) on my derriere. Oh and by the way, I tip the scales at 350. The patients takes their shoes off and the bottom of her feet are black. And I am thinking to myself ICK!!! (You know that feeling you get when you are emptying a commode full of doo-doo). It just sends a shiver up my spine. In the end, said patient was going to be admitted and everything was copacetic. So, being the nice nurse that I am, I offer the patient something to eat (she's gotta keep her strength up after all). She chows down and in comes Miss Resident to do a history and physical. Miss Resident says to pleasant patient "Hey dude, there you are chowing down on a sandwich. I thought you were hurlin' so much, you were blowin' chunks all day!" (Or something to that effect) "I guess you can blow this pop stand and make tracks back to yo' crib after all".

This is when pleasant patient turns a bright shade of red, steam comes out of their ears and shouts: "I knew you weren't going to admit me, you rat faced imbecile" (or something to that effect). "Chill out, fool, let me get with the ER doc" says Miss Resident. "I'm out" says pleasant patient. (Cue dramatic exit music). Moral of the story: When someone seems too polite, too sweet, thinks you are the best nurse who ever lived, calls you ma'am, be afraid be very afraid and look for THE TIDE TO TURN....

Thursday, June 02, 2011

fun with emergency room math

Math. Does anybody really like it but math geeks? You have to have a certain amount of math to get into nursing school and become something like a licensed practical nurse. I wonder if you still learn the apothecary sytem...anyway we don't use much math in nursing anymore because they don't trust us to do the math, literally. Machines do it for us nowadays. In ER there is a special kind of math that we all get to know involving equations. Let me demonstrate:

1)Xanax + ETOH + Lexus +75 mph = airborne driver + multiple fractures
2)Tractors + old men = Death
3)ATVs + young men = Death
4)Bicycles + riders - helmets + cars = Death
5)300 lb old women with UTI + old man with hematuria + anybody with back pain + young woman with abdominal pain = crazy nurse
6)Mean drunk + anybody on meth + overdose needing lavage + anybody constipated = suicidal nurse
7) Unwashed feet + alcohol and cigarettes smell + GI bleed smell = sick nurse
8) Fibromyalgic + migraineur + helicopter relative or friend = nurse running out of ER

Wednesday, June 01, 2011

Whats up yo? Nurse Jackie rips off the nurse blogosphere

What is this shit? Is this sarcasm? Are we being mocked? What the hell is this tomfoolery? It seems that someone around the Nurse Jackie show thought it would be CLEVER to have Zoey the nurse have a nurse blog. This is obviously another ripoff of Nurse K's blog. When are they gonna start payin my sista K?!! Just remember K, imitation is the sincerest form of flattery and all that crap.

Here it is: NURSING IT YO (clever title)