tornado hits ER and they keep working

Think your ER is ready for a disaster? Read this story of an ER in Joplin, Missouri which was not only hit by the tornado but continued to do their work afterwards even though the ER had been pretty much destroyed. It is writtent by one of the ER docs who worked there.

Joplin doctor details tornado aftermath

The hospital is now working out of a huge tent (similar to what the military would use) with trailers housing MRI and CT equipment. They have a 60 patient capacity. I guess the hospital was a total loss.

By the way I saw this story on a link from White Coats blog.

I love..not

Things I love....I love a patient who stops at White Castle for a few burgers after drinking heavily, then calls 911 from there for a chronic problem. Not only do they have alcohol breath, but now they have white castle breath too...I also love junkies who are brought in by a friend and the friend takes you aside and whispers to you about them and their problems. I love putting 300 lb people on the bedpan about every 15 minutes. Why is it people that big can never get up to a commode or the bathroom? What do they do at home?I love mothers who come in with their grown daughters and have to sit right next to them in the triage bay and try to talk for them. I love people who get mad on the phone because I can't solve their problem over the phone. I love it when its one of those days and its time to go home and I don't have to come back tomorrow.

gang warfare

Last week we had a morbidity and mortality (M & M) lecture about the gunshot wounds we have had in the last year. Mind you, I don't work in a Level I trauma center. We transfer bad trauma to the county hospital. However because I work in the hood, we get more GSWs than you would think. The drop off kind.

We have had a few already this year, so as a part of the lecture we had someone from the police gang unit come and talk about gangs in the area. We had done this before years back when violence was on the rise in the city. I'm not really sure if this benefits us all that much but it certainly is interesting. There are at least seven gangs in the area around where I work. It seems gangs don't wear colors much anymore, too obvious the police I guess.

Here is an interesting tidbit: Gang members like to be dropped off at the hospital, rather than have an ambulance called. Apparently that makes them look more tough - they didn't have to be a wuss and have the ambulance called. Apparently that gives them more street cred...

So one of the things the cop told us was that there are a couple of gangs who come downtown on Sunday nights. On those nights some of the clubs have 18+ nights (legal age in our state is 21). There are fights every Sunday usually at closing time. There have been a couple of shootings this spring. The thing is last night there were four shootings. I don't know if any of them went to our ER, I wasn't working.

It feels like its going to be a bad summer....

drug seeker wins award

Welcome to this years Drug Seeker awards. I am your host girlvet. Sit back ladies and gentlement as we honor those emergency patients who gave the most convicing performance over the last year to obtain that almighty bottle of Percocet. Yes, people,these performers put some premeditated thought into those requests and now they will get the recognition they deserve....

In our first category, the nominees for best performance by a chronic back pain sufferer, the nominees are: 1) car bound junkie - this billiant performer is in the back seat of the car lying flat on their back unable to move without assistance. They send a concerned relative to the triage window who requests a cart, not a wheelchair, because they cannot possibly make it into triage by themselves. The ER must come to a grinding halt as 3-4 staff go out to lift their carcass onto a cart, no small feat. Bravo, car bound junkie.2) MRI toting junkie - this performer, in a well thought out strategy,walks in with with an earnest, yet tense, look on their face and does a lot of heavy sighing. Requiring no direction, they bring their own props in the form of an MRI or at the very least a typewritten report of an MRI, thus proving their legitimacy for all concerned. What can I say, they dominate the screen with their presence...3) victim of circumstances beyond my control junkie - this person, is a credit to their profession, a method actor really,who has obviously spent time in ER waiting rooms across the country observing other drug seekers in order to get a real picture of the lifestyle. It brings a tear to the eye, as they explain that their medication a) tragically fell into the toilet b) was stolen by some rapscallan or in a surpise turn the script was lost BEFORE IT WAS EVEN FILLED..It makes the average ER staff want to shout "NO!! NO! IT CAN"T BE! SURELY LIFE CANNOT BE THAT CRUEL!!" But alas, dear viewers it can indeed be that cruel and victim of circumstances beyond my control lets us in on that emotion brilliantly...4) I have an appointment junkie - this performer, comes right out of lest field during the triage interview with a left hook. Things are moving along nicely in the story when all of a sudden POW!! they hit you with an emotionally wrenching: "I can't get into my doctor for 2 weeks and I am out of my Vicodin!" Of course, this dramatic twist was unexpected and leaves one breathless...5) I just moved here junkie - in a subtle yet convincing performance, this actor's actor, will casually let drop the fact that they just moved here from out of town and, cue the dramatic music, DO NOT YET HAVE A DOCTOR...it leaves you reeling.. and before you can recover from that startling news, in a moment of sincerity they request that maybe you could refer them to a local doctor. Shades of Sir Lawrence Olivier, you sit there stunned, speechless, jaw open applauding your heart out...And the winner is...ome up here you talented fool and receive your beautiful gold plated Vikey, along with a years supply of Vicodin....VICTIM OF CIRCUMSTANCES BEYOND MY CONTROL JUNKIE...that's right...I think you will agree that victim is the most versatile and creative performer this year. You literally never know what excuse they will come up with next and it keeps you on the edge of your seat.We'll be right back after a word from our sponsor, why Percocet of course you silly...

the year I got a vibrator for nurse week

I kid you not.  One year the hospital got us all vibrators for nurse
week. No doubt the thought was we could massage our old tired muscles but really: A VIBRATOR???!! What were they thinking?
I have to say the jokes out of that gift went on for a long time...

Every year Advanced Healthcare Shop gives a gift certificate for the worst nurse week gift. Here are some selections from entries this year:

From ANN, RN, Florida: Having been an RN for 38 years and working in five different states, I have received varied "gifts" over the years. The usual pens, pins, mugs, tote bags, lunch bags and sweets have all been received. Having thought I had seen it all by now, I was stunned when our clinic administration gave us a bar of soap for Nurses' Week! We opened our "gift bags", our jaws dropped and we looked at each other wide-eyed and said simultaneously, "A bar of soap?!?!" Laughter erupted when one of the nurses said "Look! It's cellulite soap!" Sure enough, peering closely at the label it was a bar of soap touting its ability to treat cellulite. We all laughed and said "Well, that does it, we get chocolate next year!" Periodically, months later someone would say, "You know I used that soap and look, it didn't do a thing!" We were hoping the message wasn't what it seemed, but in true Nursing fashion, we saw the humor in it and moved on, doing our jobs and doing them well!

From GINGER RN, PHN, New Jersey: Nurses at a small Philly hospital were given a special gift from one of the TOP surgeons. He told everyone this was his tribute to the BEST nurses he'd ever worked with... It was a 3 X 5 color photo of his great dane dog, "Lilly White", with a nurses cap on her head. Really!

From CAROLINE, RN, North Carolina: The worst nurses week gift I got was when I was on the GI unit at a hospital. I received an enema bottle filled with brown M&M's. It was very distasteful to say the least. We kept trying to figure out where the bottles came from. Yuck!!

From ALESSANDRA, RN, Texas: Now I don't want to sound unappreciative, but sometimes a Thank You is best. Nurses week is usually a big deal in our hospital system. In the past we have gotten nice T-shirts, insulated lunch boxes, insulated coffee cups, etc. Last year, they must have been hurting financially. We received these very thin, very ugly beach towels. They didn't have any hospital logo on them, no nursing phrase, no healthcare ditty, nothing. As a matter of fact, it had a winter scene on the front. We are in South Texas, in May it’s very hot - clearly summer. Although appreciated, I graciously gave mine to another employee and as I did so, the fibers of the towel began to pull. Some of the threads came loose and started coming undone! A very poor attempt at being cheap.

From PATRICIA, RN, New York: The absolute worst gift I ever received was an old fashioned, white, chipped porcelain bedpan that was filled with dirt and was planted with numerous flowering live cacti.

What was your worse nurse week gift?

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.

the lighted rock thingy in the lobby

Welcome to hood hospital. Allow our valet to park your car. Here is a member of the administration to direct you to your destination as you enter the door to our feng shui appointed lobby. Notice our lobby resembles a hotel with its muted tones, player piano, large wall fountain, some kind of large lighted rock thingy. Up the stairs to your right you will find a coffee shop with lattes, mochas or a light snack for your convenience and enjoyment. A little more hungry than that? Let me show you to the 24 hour McDonalds on premises. There you can mix with the colorful locals.
Need toiletries? Our gift shop will provide what you need along with books, magazines, flowers and assorted doodads. Don't forget to step outside to our "healing garden". There you will find benches, tables, a waterfall and beatuiful trees and flowers to soothe your stresses away.
Here for a heart problem? Step into>our state of the art heart hospital with individually appointed rooms with tv with cable (of course), wood flooring and pull out couch for family members to spend the night. Each floor has a well appointed lobby with fireplace, some with balconies. Hungry? Order directly from our "room service menu? between the hours of 6am and 6 pm.
Feeling particularly stressed? The nurse can put you in touch with the "rich person who wanted their name on something integrated holistic healing and medical center", all part of our services here at hood hospital. Employees will be happy to give you a massage, provide aromatherapy and music therapy. We also have "energy healing including Reiki and healing touch".
There is a convenient hotel down the street for your guests and family and there is a shuttle to take you there.
Please avoid walking in the area surrounding the hospital. Your safety may be compromised as you note the neighborhood is home to the street gangs and various hoodlums. Never fear, we have crack security staff that patrols in cars, on bikes, in golf cars, on foot, equipped with tasers and batons to protect you and your loved ones. We have a "they ain't gettin' in here" philosophy when it comes to our neighbors.
Yes we can meet all your needs here at hood hospitals, and by the way we also provide medical care...

unwritten rules of ER

1) If you come in on a backboard you will have to go to the bathroom within minutes of arrival.
2) If you come in with a probable broken hip you will have to to the bathroom immediately on arrival.
3) If you order food you will be too busy to eat it.
4) Xrays that were done in a nursing home of that broken hip will never come with the patient to the hospital. They will have to be done again.
5) If your patient overdosed on pills and you have to do a gastric lavage, they will always have eaten a disgusting meal before they took the pills.
6) If you get a loud, obnoxious drunk, detox will be full.
7) If one person comes up to the triage window to ask how much longer it will be, it will have a domino effect and everybody in the waiting room will come up there too.
8) If your pro football team is any good at all, you will slow down during the games.
9) If you wear any kind of new uniform or shoes someone will bleed, vomit or pee on them.
10) If you are the charge nurse and go to the bathroom, your phone will ring.
11) If you are having a horrible, busy day, at least one of your frequent flyers will show up. (Its like they have radar or something)
12) If you have a patient who is crashing, ICU tell you they have to transfer a patient to take yours.
13) Its true that when the moon is full, or there is a change in barometric pressure, the weirdos come out of the woodwork.
14) At some point in your time in ER, an embarrassing relative, old boyfriend, hated friend will come in while you're working.
15) When you are really, really busy, one of the following things will happen: the computer will go down, the tube system will go down, a lab machine will go down,
the hospital down the street will go on divert.

a long ride to help

Is it just me or are young adolescents coming out of the woodwork with mental illnesses? I swear we see at least 3-4 thirteen or fourteen year olds a shift depressed and suicidal. Are their more of them or are the parents taking them for help now a days?

Mental health care is a farce in this country. Especially inpatient mental health. There is a shortage of psychiatrists and it seems like we are always short of beds. I guess mental health is not profitable. So our patients at times sit in the ER for up to 24 hours waiting for a bed.

Sometimes they are transferred to other hospitals in the city and sometimes even to another city in the state or neighboring state. A couple of weeks ago I transferred an adolescent 250 miles away to a hospital. For some reason the parents couldn't go with, so I sent this 14 year old 250 miles away by himself with medics.

Its really sad how we treat the mentally ill in this country.

another fun day in the hood

The caliber of folk we get in the ER gets lower and lower. Witness: Women with 3 kids under 5, now pregnant with 4th kid comes in to be seen. It is late evening and kids are tired and what do kids do when they are tired? They rev up and start running around. Of course rocket scientist mom does nothing to stop them.

Family #2 also in to be seen. They have a couple of kids under 5 in same situation: tired, ramped up. The kids are whooping it up. Rocket scientist mom calls Family #2's kids motherf----ers.

Security is called before a fight breaks out. All is once again calm in the lobby. Another fun day in the hood..

a sticky wicket

stupid survey shite

Oh how I love modern corporate medicine. They want so much to make you feel that they care how you feel, that your opinion matters. hahahahahaha. Right.

The latest stupidity? A survey of course. Hospitals love this shit. Well, of course, yours truly had to take the survey...I love surveys. What was interesting about this was the following question: Describe the hospital in 3 words...I read those words with glee, rubbing my hands together. Let me see:

CEO bonus bonanza

mediocre management paradise

feng shui nightmare

corporate hack refuge

hood rat haven

Then: Describe what your vision of the hospital in the future in 3 words:

registered nurse dreamworld

wealthy nurse stronghold

pampered nurse spa

great staffing fantasy

JCAHO/CMS free zone

I filled out the survey a hundred times...har

la familia

There are days when I go to work (like today) and I just don't want to be there. Especially Mondays. They are guaranteed to be shitty most of the time. So when you go in dreading the day already and you have the moaning crackhead or neurotic Nellie the fibromyalgeur, it makes things so much worse. By the end of the shift, knowing you have to come back tomorrow, you drag your butt out to the car feeling worse than you did when you came in.

Then I get home. Here people treat you nice. They care about you. They do nice things for you after a bad day. I sit on the couch and watch a little TV with my son and I feel so much better. I can relax. Its not so bad after all.

Having the kind of job that I do, I appreciate my family. Without them, I don't think I could face the ER on a regular basis.

airing dirty laundry

Here's something I have never seen before: I was perusing the local Sunday paper and under a section entitled Whistleblower there was an article about nurses who have had their licenses suspended or revoked. Periodically I have seen this for doctors, but not for nurses.

Four of the nurses who apparently were the worst of the worst had little paragraphs telling about what they did mostly involving drug use. The others just had their names and towns listed.

Of course, like you would, I looked to see if I knew anybody. Didn't thank goodness. I don't know this seems kind of cruel to me. I suppose it is all public record. Is it necessary to drag it into the public? If one profession is going to have their dirty laundry aired, then what about dentists, vets, etc.? Shouldn't they all be in the paper.

Maybe this is as a result of a couple of highly publicized cases involving nurses and drugs. Who knows. Your thoughts?

nurse week: EPIC FAIL

Next week is nurses week. Whoopee. Every year the "medical staff" gives us a t shirt with so and so hospital nurses, blah, blah, blah(I bet all the docs think its really neat that they give us a shirt)..No thanks I'll pass. I don't want it. You showed us how much you value us when you gave us no raise last year, 1% this year and treated us like shit during negotiations. Madness don't forget..I'm like an elephant when it comes to that shit.

So you may take your so and so hospital nurses bullshit shirt and you know where you can put it. I have a great idea. A design for next years t shirt, in big bold letters: IT'S NURSES WEEK AND ALL I GOT WAS THIS LOUSY TSHIRT

somebodys watching you

You are being watched. On so many different fronts. You are being watched to see if you snoop in patients charts that have nothing to do with you. If you are, sooner or later you will be fired. Espescially if it is a case that is somebody well known or in the news.

You are being watched around narcotics. Audits are done. One time I didn't sign in the right place for something and was called at work a couple of days later about it.

You are being watched to see if you are charting specifically the way JCAHO wants you to chart, espescially around things like conscious sedation (which has become a charting nightmare), blood transfusions, restraint use, etc. etc. etc. One of the things that bothers me the most is knowing that I haven't done all the charting crap they want me to do.

Do you fill out the screening questions around violence? Have you done the medicine reconcilliation? Did you chart the start and stop times of that IV, antibiotic? Did you take vitals at least 1/2 hour prior to discharge, transfer, admission? Did you do and chart teaching about conscious sedation? Did you waste that narc within a half an hour of taking it out? Did you? Did you? Did you? You didn't? Perhaps we will need to WATCH you a little more closely.

this is an ER nurse

Top ten characteristics of an ER nurse:

1) toughness - be able take being called a racist bitch, a fat cow, be swung at, etc

2) Strong stomach: I have seen every color of everything that can come out of a person and everything that can be done to the human body and had to smell it too

3) Sales ability: you have to be able to sell ice to an eskimo in order to talk people into you doing painful or uncomfortable things to them

4) Acting ability 1: you have to be able to act like you care even if the patient is a complete jerk

5) Acting ability 2: you have to be able to keep a straight face no matter what someone tells you: yeah they did put that there...

6) Nerves of steel: you have to remain calm when a couple of hood rats run into triage with their friend who is shot in the head

7) morbid sense of humor - you have to find gross, cruel things funny

8) physical fitness - you have to have the ability to not eat for up to 12 hours, hold you bladder for up to 12 hours, help lift those upwards of 500 lbs, contort your body to do things in a room the size of a closet

9) good instincts - you have to be able to spot a drug seeker a mile away, know when someone is about to go down the toilet

10) be humble - ask for help when you need it, know you don't know everything

Anything to add?