Saturday, September 29, 2012


The bain of our existence: charting.  More and more required charting, to the point where it will drive us all insane.  In the interest of collegeiality here are some abbreviations that might help you:  
AQR - Ain't Quite Right
Call Button Jockey - patient that uses call button, every few minutes  for no good reason
SALT Same as last time
CTS - Crazier than shit
DQ - Drama Queen
ETOH - Extremely Trashed or Hammered
FMPS - Fluff My Pillow Syndrome (attention/sympathy seeker), like Call Button Jockey
FOS - Full Of Shit
GOK God only knows
Gomergram - Ordering all available tests because the person is unable to explain what is wrong with them
JPS - Just Plain Stupid
PRATFO - Patient Reassured And Told to Fuck Off
LGFD - looks good from door (but not closely examined, possibly an obnoxious patient)
OBS - Obvious bullshit
Urban Outdoorsman - Homeless person
MFC measure for coffin
SWAG scientific wild ass guess
Additions anyone?

Friday, September 28, 2012

I been robbed, I say, I been robbed

Here are the top ten things stolen from our emergency room:

1) syringes - before drawers were locked

2) linen - sheets, towels and wash cloths

3) phones off the wall

4) fetal doppler

5) lap top

6) bandaids, bandages

7) box lunches

8) gowns

9) oximeter

10) staff purse

Extra added bonus points:


ornaments off Christmas tree in lobby

Thursday, September 27, 2012

send in the clowns


Attention all citizens:

The following are not emergencies:

1) bug bites - unless it have swollen to the size of a baseball

2) the fact that you cannot control your teenage daughter or son

3) you are fatigued or can't sleep

4) you want your son, daughter, brother, sister, etc. to get chemical dependency treatment

5) the condom broke

6) you are hungover

7) G tube not working

8) the cut is less than 1"

9) any kind of medication refill

10) menstrual cramps

Thank you,

your neighborhood ER

Wednesday, September 26, 2012

fraud is fruad is fraud

If you come into the ER with a stubbed toe, you could go out with ten diagnosis' on your visit record.  If you are admitted there will probably be twenty.  Everything that has ever been wrong with you will be noted as part of your discharge or admission diagnosis. Depending on which doctor you get, it will be more or less.

Knowing this, when I saw an article in the New York Times a couple of days ago (September 24: "Medicare Warning to Hospitals on Medicare Abuse"),  I was fascinated.  It talks about how the government isn't going to tolerate hospitals that try to "game the system".  In a statement, government officials were quoted in the following:

 “There are also reports that some hospitals may be using electronic health records to facilitate ‘upcoding’ of the intensity of care or severity of patients’ condition as a means to profit with no commensurate improvement in the quality of care".

The article also states:  

"Much of the higher billing is taking place in hospital emergency rooms, where hospitals are classifying many more patients as sicker and needing more care". 

Oh my goodness, ya think?????!!!  ER nurses have been talking about this for YEARS.  The fact that people are being way overtreated. There are very few people who come into the ER who don't have an IV started, aren't given IV medications, lab tests, xrays, etc.  It has gotten to the point of ridiculousness.  If you have a virus or a tummy ache you get all of this shit.

Doing all of this allows doctors to up the level of care and CHARGE MORE MONEY, and therefore MAKE MORE MONEY.  It is nothing less than fraud.  Now doctors try to justify all of this by whining about "liability", "patient satisfaction",  etc.  Bullshit. This is called greed folks.

It is done for all patients, not only medicare patients - espescially patients with insurance. Your chance of getting an MRI or a CT ANGIO increase in direct proportion to what kind of insurance you have.

Lets hope the government truly cracks down on this shameful practice of medicine.




Tuesday, September 25, 2012

Dear Mr. Romney:

TO: Mitt Romney

FROM: Madness the nurse

RE:  care of  uninsured in the emergency room

Dear Mr. Romney:

Regarding your comments on a recent 60 minutes program in which you stated that the 50 million uninsured can get care in the emergency room. You referenced somebody having a heart attack and their ability to call 911 and then be taken to the ER for care.

Mr. Romney, I wonder if you realize that the reason why that uninsured person ends up in the emergency room is because they have untreated heart disease, high blood pressure, diabetes, etc.
All of these things are UNTREATED because this person does not have a regular doctor that  can monitor those problems.  Mr. Romney, why do you think these people don't have a regular doctor? BECAUSE THEY DON'T HAVE HEALTH INSURANCE.

This kind of uncompensated care runs up millions and millions of dollars every year in hospitals throughout the country.  Hospital eat the cost.  Meanwhile, reimbursement for medicare/private insurance/medicaid keeps decreasing.  The health care system is headed for collapse.

Surely, someone like you, knows these facts, right?  RIGHT?! Maybe not. No doubt you have what is commonly referred to as "concierge medicine".  This is care for wealthy people like yourself in which you pay lets say 20,000 a year to have a doctor at your beck and call.

I can only conclude you are a CLUELESS BASTARD. 

Affectionately yours,

Madness the nurse

Monday, September 24, 2012

its too much to take in

Bad week in ER #3

You are finally getting used to this parenting thing. The shock has worn off. The baby is smiling and cooing and life is great.

You start having some trouble though. No big deal, off to the doctor you go. The doctor sends you to the hospital for an expensive test just to make sure there is nothing going on. Turns out there is something going on.  And the results aren't good. In an instant your prospects for a future are dimmer.

Your life has now completely changed. It will never be the same. Your childs life will never be the same. How will you get through this? What if you don't get through this? Who will take care of the baby?

Its too much to take in. You are in a daze. Your spouse is in a daze. As you go up to your hospital room, all we can do is say a little prayer for you.

Sunday, September 23, 2012

tell Dad to wake up

Bad week in the ER #2

You and your family are living your life. Going along, as families do, working, going to school, having dinner together, la de dah. You all love each other, mom, dad, 2.2 kids, living an ordinary all American life.

Family member develops a symptom, goes to local ER. Family member doesn't do well at local ER, almost dies. Local ER decides to transfer family member to big time fancy smancy ER.

Family member arrives to big time fancy smancy ER, not in good shape. Family member is unstable. They are never stable again. They die. A couple of times, and are brought back, then die again permanently.

Family member is parent. Parent has children, old enough to know whats what. Children arrive and are in a state of shock. This isn't supposed to happen to parent. Son says: "Tell Dad to wake up". We hear you crying. It brings tears to our eyes.

Everyone's life is changed forever. Yesterday everything was OK.

Saturday, September 22, 2012

things aren't always what they seem

Sometimes trauma sneaks up on you. Somebody arrives by ambulance. It seems fairly straightforward. Blah blah blah. No big deal. Then it becomes more complicated. What seemed simple is now much more involved than originally thought. Tests are ordered. More fractures are found that didn't seem obvious at first. Suddenly its a whole new ball game. This person is severely injured. Most people would be yelling in this situation, but not this one. They refuse pain meds, stating that if they don't move they are fine. I don't usually encourage pain meds, but I tell them its OK to take them. They still refuse. Wow. I know that this person, with the extent of their injuries will have months of recovery. They may never be the same. Their life has changed. What started out as a beautiful sunny day for them, enjoying themselves, has morphed into tragedy.

Thursday, September 20, 2012

triage before and after

This is me in triage:

before triage:

during triage:

After triage:

Wednesday, September 19, 2012

I just got out of the penitentiary

You know it's a bad day when a drunk guy and a mental health patient are bonding around their unhappiness with the ER. They are out in the hall egging each other on.

The drunk is not one of those people who happily sleeps it off. This person is wide awake and unhappy. They just can't understand why they can't just leave. IT MUST BE THAT pint of vodka you chose to partake in earlier today and then proceeded to pass out on the grass around the corner from the hospital. Then some good Samaritan called 911 and the medics were obligated to bring you in. When they gave me report they said you were, "a nice guy". The niceness didn't last very long.

First sign of trouble: you peed in your pants. Then you came out of your room demanding to use the phone, where you proceeded to rant about us, the unfairness of life (with a few MFers thrown in). You plead with the "girlfriend" to come and get you. Of course she won't. She's fed up.
I had you change into a gown to get you out of the wet clothes, but you couldn't seem to get the concept of CHANGE YOUR CLOTHES...When you did get them changed, you had the wet ones back on in a couple of minutes. I gave you food to try to speed up the sober up process - ended up on the floor, a milk puddle on the chair, which you proceeded to sit in. Okay now we got pee and milk going on the clothes.

Of course detox, had no beds. Does detox ever have any beds?!!! So you were ours until you got a ride or sobered up enough to go.

You got louder and louder, wanting to use the phone over and over, getting mad at security for watching you. At one point you shouted at security: "I just got out of the penitentiary. I don't need nobody watchin' me".

A couple of visitors response to your antics: "I'm just enjoying the show". "You need to call the police".

Meanwhile while you waste everyones time, a guy down the hall is not doing well with a GI bleed, a man a couple doors down is gasping for breath, someone is having a heart attack, a woman has metastatic cancer.

There is nothing we can do about people like you. In our city public drunkenness is not a crime. If it was the jails would be filled So your local ER acts as a detox center to the tune of tens of thousands of dollars a year. Ever wonder why your insurance is so high? This is part of it.

Monday, September 17, 2012

if the med room walls could talk

If the walls of the med room and supply room could talk they would have some interesting things to say. This is where the nurses go to say out loud what a fucking idiot someone is. It is where we say out loud that we hate this place and this job. It is a place to blow off steam.

If we didn't blow off steam in these places sometimes, somebody would go postal during the shift. Nobody wants that right? It would be really messy, involve a lot of paperwork, etc.

So we go in there and talk and yell at the walls and walk out able to deal with all of the shit once again.

Thursday, September 13, 2012

triage pet peeves

I got a lot of pet peeves in triage. The biggest one is that people keep showing up at the window. Bada bing. Here are my top ten pet peeves in triage:

1) I am finding out what is wrong with someone at the window. You are waving your arms to get my attention. YOU ARE A RUDE PIECE OF CRAP.

2) I wish I had a dime for every time a relative/friend asks if they go out the triage door, will we let them back in? I seriously doubt it. ONCE YOU LEAVE, YOU ARE NEVER COMING BACK IN...

3) You come and ask to see Franco. No last name. Just Franco. Or the other scenario, you can't spell their last name. I am supposed to find them in the hospital for you. NOT.

4) You come up to the window and ask for so and so. They are not in the ER. They are not in the hospital. You argue with me to the point of getting pissed off that I can't find them. Here's the thing: WE ARE HIDING THEM. YOU CAN'T EVER SEE THEM.

5) I am in the triage bay. You can see me triaging somebody. You yell: "HELLO HELLO!! or know on the window. GRRRRRRRR..

6) You are here to be seen, you have brought your six kids under six with you at 9 pm. There is no one else with you. JUST KILL ME NOW.

7) You are:
- a doctor
- a doctors nurse
- a doctors receptionist
- a home health nurse
- a nursing home
- etc etc etc

You call to give a courtesy "heads up" about a patient coming in. DON'T CARE. WASTING MY TIME.

8) You want me to make a decision about whether you should be seen. I WILL ALWAYS ADVISE NOOOOOOO.

9) You:
-kneel dramatically at the window
-hang your head through the window
-talk so softly I can't hear you



Tuesday, September 11, 2012

step right up, sit right down, hope you brought a book

We are consistently more busy then we have been. The "budgeted" census has been blown to hell. At least a couple of times a week there are 15-20 people in the lobby.

Our local EMS system does not like ERs going on divert. It used to be you could go on divert for 4 hours. It is now down to 2 hours and, ideally, the plan is to eliminate the ability to close. What are we supposed to do if the place is completely out of control and we have 3 or 4 criticals at once? Your guess is as good as mine. Run out the door perhaps?

Anyway, we rarely close anyway these days. The frequent 15-20 people in the lobby are usually people who use the ER as a clinic. Toothache, sore throat, female abdominal pain, UTIs, lacerations, etc etc etc. I am always amazed at how long people will wait for this shit.

My point? More and more people seem to be using our ER as a clinic. Those populations have exploded this summer. Why? I don't know. Can't get an appointment? The county hospital down the street wait is too long? Aliens are speaking telepathically and telling people to come to the ER?

I just can't wait until EVERYBODY has insurance, can't get doctors appointments and come to the ER BECAUSE THEY CAN.. I'm totally in favor of Obamacare, as far as I'm concerned the government should take over the whole damn thing, blow it up and start over again.

Sunday, September 09, 2012

Which ER supplies the softest, most cuddliest and toasty warm blankie?

I'm thinking about starting a new local ER website. As a service to humanity.

On this site would be listings of every ER in the city and the waiting times on their websites. Listed in order of least waiting time to most. Length of typical visit.

In the interest of serving the community, there would be a list of whether the ER has:

1) box or bag lunches and their contents and rotation
2) types of (cold, icy) juice and selection of crackers
3) whether they supply warm, cuddly, toasty blankets.
4) footie availability and color selection
5) whether they have TV (with HDTV cable or DVD availibility)
6) probability of getting a cab voucher or bus token
7) probability of you scoring a script for percocet
8) probability of you taking an ambulance in for a sore throat and getting back to a room versus being put in the lobby
9) comfort of chairs in lobby and presence of TV, fish tank, vending machines (quality of snacks, selection of sodas), play area
10) whether your car can be valet parked on arrival

There would be a comment section in which you could name names about which docs at which ERs were Dr Feelgoods.

Oh the fun that could be had! The comments section could be entertaining in and of itself.

Hey...its a competitive world out there and patient satisfaction is the goal of every single solitary person in the ER, including of course, yours truly, thus the web site...

Thursday, September 06, 2012

the doctor won't see you in our ER

I'm out of my ER next spring one way or the other. Can't take it any more.

To say that the morale in my department is in the toilet is to vastly understate it. The negativity is out of control and makes it a miserable place to work.

It is rundown, way too small. The hospital doesn't give a shit. All the other hospital in our "corporate system" have been redone. Ours, that sits in the middle the ghetto ER has not (no accident there - poor folks don't need a nice ER). I don't see it happening anytime soon.

My ER is an embarassment. Walls with paint scraped off. Ceiling tiles with big round wet brown spots on them. Looks dirty. Is dirty. Equipment that is an embarassment. Whatever. Been like that for many years.

Now the straw that broke the camels back. There has been a decision made that our ER will be staffed by physician assistants. They will see the vast majority of our patients, except the criticals apparently. I admire NPs. I admire PAs. I think they are great. I work with NPs. They see our urgent care patients. They don't belong in the main ER. Sorry.

I don't think ER patients, other than urgent care patients, should be seen by anyone other than an ER doc. Apparently the PAs will "present" these patients to the docs. Not good enough. No doubt will greatly slow the process.

Here's my thought about the whole process personally: When I, or my relative, come to an ER, we EXPECT to be seen by a DOCTOR. We pay insurance to be seen by a DOCTOR. I won't bring myself or my relative, needs to be seen for an EMERGENCY, to an ER where chances are they will not be seen by a doctor. I will choose to go to another ER where they will be seen by a DOCTOR. I will also choose to work at an ER that employs DOCTORs to see patients.

Saturday, September 01, 2012

ya got dem sticky fingers

I work for this big healthcare system that has a few hospitals. So with the "standardization" of all the hospitals, decisions come from on high that are implemented at all the hospitals. They don't always implement it at the same time. Like we are going to bedside barcoding, meaning scanning the wristband and the medication before giving meds. La la la. Patient safety blah blah blah.

We were the last ER and last department in all the hospitals to get the training. They installed the nifty barcode readers a month ago. They kind of look like a laser gun. When you push a button on it a red light comes on, there is a red cross that appears that you are supposed to put in the middle of the scan dealybob on the wristband and medication.

Well it seems that the local ghetto geniuses who frequent our ER, decided to see what the hell this new fangled thing is. Oh cool its like a laser gun. I can put a red cross in the middle of your forehead!! So what did they do? They took four of them before we even started the whole barcoding thing. $500 a pop.

The genuises who come up with these fancy new doodads don't get that we are in a ghetto where a lot of people have sticky fingers. They take things that are worthless to them, but take them nonetheless.

Another day in paradise.