Wednesday, February 27, 2013

the batshit crazy club

After many years in the ER, I have developed certain talents. I would say one that I have perfected is the ability to keep a straight face. You could tell me that you have are growing a second head or have a tuba up your behind, and I would tell you "okay, have a seat in the waiting room, we'll be with you shortly". There is little that you could tell me that would stun me. Heard it all, seen it all.

With that in mind, may I say that there are many bat shit crazy, freak-deaky people in this world,and eventually, they make their way down to the emergency room. I had one a couple of months ago. This dude seemed to be making a game out of how far he could go with all these bizarre facts about himself and his life. I'm not even going to get into it here because it is just too weird.

I thought what is this guy getting out of this? Telling me all this weird shit. Is he doing it for attention? For effect? Is he trying to freak me out? All I thought about him was that he was a fucking nut. I avoided him as much as I could.

I didn't discharge him, the charge nurse did. She said to me she hadn't know he couldn't hear. I said, couldn't hear? The man had been talking to me and hearing me just fine. It turns out when she went in to do the discharge, he starting using sign language like he couldn't hear. Bat shit crazy, just like I said. This world is a crazy place. There are more lunatics than you realize

Tuesday, February 19, 2013

second class citizens

Don't even get me started on the gun debate.  Grrrrr... The thing that irritates me the most is talking about the mentally ill.  Doing a background check, one aspect would be to check about whether you have any mental health problems.  Intervening with people who are mentally ill before they can get to the point of shooting people.  It is obvious that the people who talk about this have no clue about psychiatric care in this country.

1) Clue #1: There are not enough psychiatrists.  Especially those who are willing to work in hospitals.

2) Clue #2: There are privacy laws called HIPPA which prohibit sharing any kind of information about patients. Think about this: It is hard enough to go and get help, do you think people will go if they know their name will be shared with others?  Who will determine who is on the list?  The whole thing is a preposterous idea.

3) Clue #3: The mental health care system in this country is abysmal.  Those who seek care for their mental health are second class citizens.  Their care, for example counselling, has to be pre-approved by insurance companies and is limited.

There are a very limited amount of mental health beds.  Apparently caring for the mentally ill is not profitable.  Here is a fairly frequent scenario when you come into an ER, using my ER as an example.

It is typically at least a 4 hour visit.  It takes that long to decide what to do with you. I see you.  The doctor sees you. Then a mental health person comes to see you and talk at length about your problem and they are the ones who decide whether you need to be admitted. The majority of people do because they are usually suicidal. There are typically two of these people for a 35 bed emergency room.  There can be 5-6 patients in the ER for mental health at one time.  Their evaluations take time.  You may wait to see them for a while.

Once they see you, they have to call the psychiatrist and discuss you with them to decide whether you should be admitted. Once they decide to admit you, they have to call your insurance company to get approval. This gives you a clue how we view mental health right here.  Does the doctor have to call your insurance company  to get approval to treat your for a heart attack?

So you are approved for admission.  Let the bed shennanigans begin.  Maybe it will be your lucky day and there will be a bed.  You may have to wait a few hours for someone to be discharged. There may not be any beds at all,  Then they will look for a bed in the rest of the city at another hospital.  You will be transferred there.  No beds in the city? They will look statewide.  You could be transferred 50-400 miles away.  I have seen people transferred to a bordering state. There may be no beds anywhere.

In that case, you will spend your time waiting in the ER.  I have people have to wait 24 hours to get a bed. They lay on an ER cart, with nothing to do.  Many of them escalate during this time.  I have people need to be restrained, sedated because they get out of control in this situation.  Who can blame them?

This is how the mentally ill are treated in this country. Perhaps the politicians who tout all the shit about mental health treatment would like to come and go through this process?

Wednesday, February 13, 2013

endangered species: nursing

Whitecoat, one of my favorite bloggers has an entry about how the state of California is realizing that it won't have enough doctors to take care of the people who will have insurance with Obamacare.  He seems to indicate that their solution will be to let people like PAs, NPs, optometrists (?) and such care for people because they are cheaper.

Of course docs are against all of this. Less money for them. Here's the thing: You are  looking at the future of medicine.  NPs and PAs as primary care providers, doctors as specialists.  Its inevitable.  Like I said, they are cheaper.  Docs don't want to do primary care. There aren't enough docs.

Healthcare is undergoing a radical transformation right now and this is just the beginning. The group that will be most affected by all this: docs.  The days of them being at the top of the health care system are done.  They are another cog in the wheel.  They can be pissed, but its reality.  Unfortunately, even they can be replaced.

Speaking of being replaced, I often think about the nurses coming into nursing now. I feel sorry for them.  The job is becoming more and more stressful.  Another thing that concerns me is worrying about nurses being replaced.  I think employers will move to replace nurses with paramedics, medical assistants or others, with nurses as supervisors.  They are cheaper. Its already happening.  I worry that young nurses, like most young people, don't realize what it took to get nurses to this point. I worry that nursing as a profession is so weak in having a national strength to stand up for us. I worry that we are too exhausted to fight for our profession.  I worry that we are an endangered species.

Tuesday, February 12, 2013

hell week and combat pay

Subject #1: Hell week.  Thats what we call it when you work 60 hours in a week in the ER.  Five 12 hour shifts. Usually its the week of your weekend.  You are scheduled five out of seven days.  By day 3 I am ready to commit homicide.

Nursing is so ridiculous.  In any other job you would be paid overtime for this. But here's the thing: The first three days are in one pay period.  The next two are in a different pay period.  Thats how they get away with not paying overtime.  It is such a crock.  Nursing are like slaves.

Subject #2:  I was once in the military, in a war zone.  I got what was called "hazardous duty pay".  It is extra money because you are in an area of danger.  You know what?  Nurses in the ER deserve hazardous duty pay.  Everyday we deal with the bottom rung of society: junkies, criminals, drunks, assholes.  Some of them are verbally abusive, even physically abusive.  They threaten us.  They sometimes get out of control.  We never know whats coming through the door and what they are going to do next. They can be shot, stabbed. Their gang buddies could show up.

ER nurses are on the front line of medicine.  They deserve more money because of that fact.  

Sunday, February 10, 2013

you are a winner!!

I had 1,000,000 hits about 4 people ago on the counter.  I feel like I should have confetti and balloons drop and a big sign that says: "YOU ARE THE 1,000,000th VISITOR TO THE MADNESS BLOG".  You win a weeks supply of percocet or something.

Unfortunately I don't have prescribing ability. So thats out. Maybe we could share a glass of champagne. Yeah...that sounds good.  Especially after I just finished my fifth 12 hour shift in the last 7 days. I could use a drink.

Wonder how I have keep this blog going for this long? I don't know.  Its become a habit I guess. Just something I do every one to two days. II don't write long dissertations on the ER or nursing (at least not that much).  Most stuff is pretty short.

Over the years, I have seen many nurse blogs come and go, even ones with lots of readers like Emergiblog. Crass Pollination seems to be gone. There are 3 blogs I read every day:

Adventures of Hood Nurse

White Coat

What should we call nursing

Anyway, thanks for reading.

Saturday, February 09, 2013

old folks are fun

Old people can be really funny.  They are often times some of the nicest patients we have.  I had a woman recently who was 90 and her boyfriend was 60.  Showed me his picture. This woman told me that she came of age in the world war II era and the average person from that time lived to 92, so she had two years left.  She was sharp as a tack.  I  knew her life story by the time she was gone.

I've noticed something about people who live into their 90's:

1) They are almost all women.

2) They are thin.

3) They don't take many medications.

It has always struck me as ludicrous that doctors give cholesterol meds, blood thinners and all the other shit they throw at people these days.  I mean, seriously?  Who cares what your cholesterol is at 92?  And do the risks outweight the benefits of coumadin at 90?  Don't give me any of that shit. I'll take my chances...

Thursday, February 07, 2013

watching torture

Its hard to believe that somebody can dislocate something like a hip.  But they do.  More often than you think.  Usually its some little old lady who had a hip replacement or something.

The thing is, it is like watching torture when they try to put it back in. The patient is out.  It is usually difficult to do. They yank and they yank, like they are going to tear the leg off.  Then one of the docs will decide to stand on the cart to do it.  That usually works.

It makes me wince, the whole thing.  I want to shout: "JUST GET THE DAMN THING BACK IN, WILL YA?!!"  There is a collective sigh of relief when it is done.

The thing is once its back in, the patient can walk and its all good.

Wednesday, February 06, 2013

the big green woman

I sort of had the assignment from hell today:  triage/urgent care.  Now you would think that when you are getting away from the regular ER patients, it would be a nice break. WRONG.

I go from a mild mannered nurse to the INCREDIBLE HULK when I cross into triage.  Its not anything I can control.  It just happens.  You start to dread people coming up to the window with  their tales of woe. Oh don't want to hear it.

Then urgent care just sucks the life out of you.  The people who come to this part of our ER are the neighborhood riff raff with their abominal pain, back pain, sore throat, blah blah blah.  I find myself doing a lot of eye rolling. Then when you have to start an IV on a 20 year who has been vomitting for 4 hours, you just want to go ballistic.  GRRRR.....

Sunday, February 03, 2013

when it hits close to home

Over the years I have seen a lot of bad things happen to people in the ER.  Sometimes they have been my coworkers. What brings this up? Right now, somebody that has worked in the hospital for years is very ill, and although they are doing well now, they will eventually die of their disease.  I don't know them very well, but it bothers me anyway.

I have had two co-workers who I worked with for years die when they were only in their 50's.  One died suddenly.  The other died over the course of year.  I had worked with them for many years. It was very hard.  I watched thier children grow up through pictures and stories. They were a big part of my life seeing them at work every day.  Then suddenly they were gone.

When you work in a place for a long time, you see a lot of things.  I have seen my co-workers - doctors, nurses, techs get fired for drug use.  One staff member committed suicide. People have had cancer and survived it.  People have lost children in tragic ways. I seen pretty much seen it all.  Your job becomes a microcosm of life in general and all its triumphs and tragedies.

Good things have happened to, don't get me wrong.  People have had great success - become nurses, doctors, lawyers. Many peoples children have grown up and gone to college.  But somehow, the bad things that happen to such good people seem to stand out more sometimes...