cigarettes only by prescription...oh yeah

It is no secret that I loathe cigarette smokers. I think they should all be put on an island somewhere together. They are now the subject of more and more legislation around the world.

In the US cigarette packages will be adorned with graphic photos of the results of this filthy habit. In Australia this is already in place. There is a proposal there to have the packs be olive green and the company logo will be so small it will be hard to figure out which is which. They cost $16.75 a pack . there. There are a couple of companies in this country who won't hire smokers. Recently in Iceland, there is a proposed legislation to make cigarettes only available by prescription. I love it. Nicotine is a drug and should be treated as such.

You know what pisses me off royally? Smokers saying they have rights. You do not have the right to be in the vicinity of any other person who does not want to smell, inhale your smoke. People who smoke around children should be charged with a crime. You have an ADDICTION. I don't want to watch you partake in your addiction, just like I don't want to watch a heroin addict shoot up. Smokers have ruined the air outside of buildings and at entrances. They have ruined outdoor seating at restaurants.

Smokers are losers. Period. End of conversation.

saturday funny page

OK, I admit it, I have the sense of humor of a 9 year old boy. You know toilet humor, farts, etc.

Don't ask me how I got to looking for toilets from around the world. Just know that there really was a logic for what led to the subject. Ha. Also, I have no life, so looking up stupid stuff is what I do most of the time. Really, I can't walk on my infected foot right now and I have a lot of time on my hands to surf the net. Wait a minute, why do I feel the need to explain myself to you?? Maybe it is because I am a grown woman, I don't know....

So I found this site which talks about toilets around the world. The funniest one is the Japanese high tech toilet:

"In Japan, you might be hovering over a hole in the ground (see China Squatter above) or you have arm rests with remote controls that make your stay on the seat very enjoyable and luxurious. The high tech extreme is quite difficult to master. Like flying a space shuttle, this toilet has buttons for just about any bathroom predicament you may find yourself in, specifically: a noise button to mask the sound of whatever you need to do while in the john (yodeling for instance), one that activates a blow dryer, a clock to time your visit (handy for when you’re competing with your Japanese friends), amongst many intricate others. It seems like you need at least an associate’s degree in computer technology to operate this type of machinery."

Here is the site: How to Use Toilets Around the World (I LMAO)

Am I going to die?

What do you do when your patient asks you: "Am I going to die?" And they keep asking it over and over again. You tell them no, you aren't going to die. What else are you going to say? Good chance you will die sorry....A guy I had a couple of months ago was so anxious that he even asked me on a scale of 1 to 10 he wanted to know where he was in relation to dying. I said I couldn't do that, put a number on his probable mortality. So I went on reassuring him that he wouldn't die, that we were going to make sure he didn't, we were going to take good care of him.

Well, its time for me to go home, and guess what? The critical anxious guy started circling the drain. He is in his 40's. His blood pressure plummeted. He got pale and sweaty, lethargic. Not good. I had been worried about him anyway and I don't worry about a lot of people, but he worried me. I just had this feeling that he could go down the toilet at any minute and sure enough he did. So he went into trendelenburg, fluids wide open, blood already infusing. Doctor sets up to put in a central line. We get the rapid infuser ready to plug into that line. This guy, who had been so anxious that he was literally shaking, was now staring, still conscious but very quiet. When I gave report to the ICU nurse, the first thing I said was this guy worries me. I don't say that much. Will he make it? I don't know. He will need some rapid intervention in ICU or he won't.

As I left he was still in trendelenburg, looking a little better but not much. When I got home I cried. I never cry. I have been doing this so long that I have seen just about everything, done just about everything. I saw his face, pale and sweaty, as I rode home staring off into space. His worse nightmare was coming true. He was only one of several younger critical patients I've had in the last couple of months. I guess it just got to me today. After all, I'm human.

bitchin' ambulance

Hey I want to work for this ambulance service:

Link via
The Doctor Stole my Stethoscope

ERland where everyone is happy all the time

Welcome to ERland where the sun is always shining and the staff is always grinnin'. I am Bertha and I am your triage nurse. Your spouse may park the family sedan in our ER parking lot at the bottom of the driveway. It is of course, free of charge. We do have valet parking for your convenience. We will be happy to guide your family to the nearest restroom, pop machine, cash machine, mcdonalds, smoking area. When I am done performing triage I will be putting you into our comfortable waiting room. Feel free to let your children run circles around the waiting room. If you want our attention you may take one of 3 routes: 1) Lay on the floor of the ER waiting room. 2) Lay on the bench in the ER waiting room. 3) Hang pathetically over the side of your wheelchair. Feel free to come up to the triage window every 3-5 minutes and ask how much longer it will be.

You will find two televisions for your convenience with cable in our waiting room. I assure you your wait will be minimal because you are important to us. If you get cold, we would be happy to give you a warm blanket to take care of any chill you may experience. Your family is welcome to bring any type of food into the ER waiting room and partake of one of our hospital eating establishments fine cuisine. There is even a table for your family to gather around to make it a more festive occasion.

If you feel at all that you can no longer sit in an upright position, feel free to approach the triage window and we will be happy to allow you to lie on a cart in back of triage.

Your turn has come. I will now be taking you to your room. When you arrive in your room please remove your clothing and don one of our lovely gowns. A phone is on the wall for your convenience. Chairs are available for your family. This is the call light. Feel free to use it as often as you like - our staff loves serving you. If at any time you are chilly, we have many warm blankets available for your use. Feeling hungry - feel free to request juice, crackers, a box lunch, a hot entree. We also have foot socks available in many colors to keep your tootsies warm.

Ah, your visit has concluded. Allow me to call valet parking to bring your car around. Oh you didn't bring a car. Would you like a bus token? You may fill your meds in our lobby at the insty med machine. Of course, I will be happy to give your the dollar for your co-pay. Don't have any insurance? We will be glad to fill your medication free of charge. Yes that's right, its on us! Don't feel up to taking a bus - we also have cab service available free of charge to any destination in the metro area. We hope you enjoyed your visit to our fine establishment and look forward to seeing you again. You are now exiting ERland.

.445, awake and eating a sandwich

What alcohol level is incompatible with life? I guess it depends on your age, your tolerance, your liver function. In ERs we see the worst of the worst chronic drunks. Like the people who are conscious and can eat a sandwich at .445. Unbelieveable. These are the kind of people who never probably go below .20 if they can help it. Every day their goal is .44, however they can get there. These are the people you see at the freeway exits and entrances with the signs about being homeless. I have often wondered, how much can they really be making standing there? Not that much. I mean most people are irritated by them more than anything. But then they probably don't need that much. A cheap bottle of booze probably costs a few dollars. If they're desperate there is always rubbing alcohol. It is just unimagineable to be so addicted to alcohol that you will pour just about anything down your throat that contains alcohol. Its pathetic.

Sometimes I wonder, who could they have been if they hadn't fallen into addiction? I'm sure most of them die at a young age. I would guess a lot die due to violence. Its a rough life out there trying to get that daily bottle. In my state there is no law against public drunkenness. We have 2-3 detox centers. When those are full the drunks come to the local emergency rooms. The county hospital has a specific area for them. All the other ERs just find a room. Thousands and thousands of dollars are spent every year on these people. They aren't the kind of people you are going to help. All you can do is let them sleep it off and stagger out the door to start a new day of searching for that bottle. For the average person, a high level of alcohol in their blood is incompatible with life. Recently a college student in a town about an hour from here found that out the hard way. She died after doing 21 shots on her 21st birthday. The ironic thing is she was a nursing student.

highway robbery

This blog entry is all about me personally, 'cause after all, in the end, its all about me..

May I say that I am beginning to feel the pain about medical insurance. I carry the insurance for my family. I know for a fact that it will go up to at least $470 a month next year. I think thats a lot of money. Right now its about $400.

It really is infuriating that it is so expensive. I know there are people that pay a lot more than I do. They pay for the whole premium, they have no insurance at all. I just think that when people like me with a decent income, start feeling the pain about insurance costs, its a sign. A sign that medical costs truly are out of control in this country.

It can cost less, it does in other countries. Here's a graphic of health care costs in different countries.

me.

florence nightingale had fibromyalgia

So I'm sitting on the couch, perusing etsy (handmade jewelry site), and I come across a "fibromyalgia awareness bracelet". Okay then. The person who made this apparently got fibromyalgia after a car accident and hasn't been able to work since.

Well this all peaked my interest and I looked up fibromyalgia awareness jewelry. Turns out quite a few people sell it. There is an organization called cure4fibromyalgia that sells all kinds of fibromyalgia merchandise. They call themselves fibro fighters. Apparently the color purple has been adopted as the color for fibromyalgia awareness. There are hats, tshirts, jewelry, mouse pads, stickers for your car, etc. They have purple ribbons for you to wear.

This is an interesting site. Among the things listed are "celebrities with fibromyalgia". According to them Florence Nightengale suffered from "fibromyalgia-like symptoms". Shit we are all doomed.

I might have to become a fibromyalgeur with all the fun shirts, hats, jewelry I like the color purple. I hear there are plans for a fibromyalgia telethon. Who could be the host? Maybe the Whiners from saturday night live....see below

its all about the benjamins

It used to be that the docs in my ER worked for the hospital. Several years ago they decided to form their own private group and contract with the hospital. I know for a fact that they had a big jump in salary. They have incentives that pay more, the more patients they see. The higher the level of care, the more the doctor charge.

There has been a big change in patient care, in many ways for the better. The doctors want the patients to be happy, they don't want them to wait. They want them to come back for their care. We have had a big reduction in wait times. They don't want any patient complaints. Patient complaints = no renewal of contract for docs.

The cons: Because they don't want complaints and want people to come back, they do whatever they have to do to make people happy. They do what the patient expects, not necessary what the patient needs. There is a tendency to order more tests and things like MRIs and CT angios. A lot of people could live without them or do them outpatient. The more money that is spent, higher level of care, more money for doc.

Narcs are given freely for stuff that don't need narcs. Unnecessary scripts for narcs are written. Don't want the patient to be unhappy and complain. Doc complaints = no renewal of contract.

Why do I bring this up? To show the conflict that will arise with health care reform and budget constraints. In an effort to decrease costs, emergency room care will become a focus. Millions and millions of dollars are spent on unnecessary ER visits that could be handled in a doctors office. As part of a new budget in my state, hospitals will be offered incentives to decrease ER visits. I envision a time when unnecessary ER visits will have financial penalties for patients. The question is how will these coming changes fit with ER docs wanting all these patients to come back? The more patients the more money for the docs.

grandpa dump

You know what I hate? Well lemme tell y'all. I hate families who bring grandma in from her nursing home because they are not happy with her "treatment" there. The staff is not as attentive to grandma as you think they should be. So you decided todays the day you need to hall grandma outtathere and where else you gonna go (cause you're an idiot) but the local ER? Bring her on down to ERville.

This is in the same category of "grandpa just can't take care of himself anymore" and we have to do something, right now, this minute, so who ya gona call? Sure ain't ghostbusters. Bring him on down to ERville.

Of course the prize winning category is the its Christmas day and I haven't seen
old aunt jenny for 6 months (I know how busy you are) and she don't look so good and surely cannot stay in her apartment any longer. Bring her on down to ERville.

Advice: Please do not bring grandma, grandma, aunt jenny to the ER. Take them to your house. Call thier doctor. Arrange for nursing home placement. Use some damn common sense.

migraineur madness

We have "care plans" in our ER. These are basically "feel free to go into the ER this many times per month and get shot up with narcotics" care plans. They are written agreements between a patient and their doctor for treatment for things like migraines. So and so can come in twice a month and get dilaudid or some other fun drug. And you can be sure that every month, like clockwork these people are there. The first week of the month, they line up at triage.

Most of them are migraineurs. I shit you not when I say that we start IVs and give a combination of drugs to these people. Then they go on their merry way.

My son has migraines. Since he was a kid. All of his life he has refused to take medication mostly because he doesn't like to swallow pills, but also because he just doesn't want to take medication at all. So he just waits them out, sleeps and they go away. He doesn't make a big deal of them. He lives with them. Perhaps, he has a less severe type of migraine than most, I don't know. The thing is he reminds me that there are thousands of people with migraines and they manage them at home or with their own doctor. They don't need "care plans". They aren't addicted to narcs.

ER nursing is all about timing

I was telling one of our techs the other day that ER nursing is all about timing.

I be bein' an ER nurse a long time and I know the tricks of the trade. Its all about self preservation at this point in my "career". I no longer have the need to take more patients than everybody else. I like criticals but I'm not going to knock another nurse down to get to one. That shit is for the newbies and the less than about 5 yearbies.

Means of self preservation: Take my load right away and deal with it, whats coming next may be a lot worse. If I see frequent flyer mary is coming by ambulance and I have had her 100 times, hmmmmm...bed 3 needs to be revitaled about now. I am not above using friendship with the current triage nurse to not put a bad frequent flier in my area. Hey...relax...I'll return the favor when I'm in triage. When I have my limit, sorry inept fellow ER nurse, not taking another one. I'll be in the med room. Deal with it.

You might think this isn't a good thing. Oh well. I am for the equal distrubution of wealth in the ER. I'm a commie in the ER.

you are bipolar with PTSD and borderline personality and depression....

Psychiatry is a weird profession. It seems to have fads. I remember a few years ago multiple personality disorder was a fad. Every other person had been diagnosed with it. The current fad is PTSD and bipolar.

Most people associate PTSD with combat soldiers. Espescially the Vietnam war era, when I think the term was coined. Soldiers experience horrible things and some relive it when they get home in flashbacks and other symptoms.

Now if you had a rough childhood you can be diagnosed with PTSD. I am not discounting bad childhoods okay? The other day I saw someone had an alcoholic father and from that was diagnosed with PTSD. Now, lots of people come from families with alcoholism (Probably a good 75% of nurses for example), but seriously do the majority have PTSD? No. My point being, sometimes I think that people who are neurotic and anxious and can't seem to cope with life are given these labels too easily.

Another popular new label: bipolar disorder. Its the new de rigeur label. I mean Catherine Zeta Jones has it. Again, not saying there aren't a lot of people who truly have it. Lord knows I've seen my share of manic patients, but sometimes I think it is just too easy to diagnose someone with a serious mental illness.

What bugs me the most is when kids are given these labels, teenagers. Its a big deal to be labelled at any age, let alone adolescence. It becomes a part of your medical record. Then the medication merry go round begins in which they try ten meds to see which one works, which messes people up further and if you weren't nuts to begin with, you will be by the end.

Its a sometimes a stressful, harsh world we live in. Perhaps its easier for psychiatry to label people and throw a pill at them, then it is to talk to them and teach them how to cope. Mental illness still has a lot of stigma, how will it ever be taken seriously if this labelling fad doesn't stop?

where ya goin'?

I love this picture. I just did a post a couple of days ago about people who carry all their worldly possessions with them...

nurse abandons post

jus' when you think you seen it all...

Yup. Seen it all..nope. Patient presents accompanied by their own home literally. I shit you not. My patient presents because everybody is against them and cruel to them and life ain't fair, etc etc etc. And my living situation has not worked out and nowyouhavetohelpme and saveme and givemeabedandmeals because everybodyisouttogetme.

Did I mention the patient came by ambulance? Did I mention that they came with all their worldly possessions? We are talking suitcases and boxes and animal paraphanalia and other assorted junk that is so much it has to be put out in the triage area along a wall and is probably 10 feet wide and five feet high worth of stuff. It could have fit in a small moving van.

Now I have seen people bring in some shit - espescially those of the mental health persuasion - they pack a couple of suitcases, a 24 pack of diet pepsi..but this was one for the records books.

My question is: How did they fit it all in the ambulance? Never got a chance to ask. Was patient admitted? I dunno. I left before that happened.

this made me cry

yes it did...The story of Sgt Leroy Petry, a 31 year old army soldier who was today awarded the Medal of Honor at a White House ceremony.

Sgt Petry has been deployed 8 times to Iraq and Afghanistan. That isn't a misprint, 8 times. The 7th time he and his unit were under fire and he was shot in both legs. After he was shot, he grabbed an enemy grenade in order to save a couple of soldiers nearby. As he threw it back it went off, blowing off one of his hands.

After this happened, he still chose to re-up with the army. He has since returned to Afghanistan for the 8th time. He has a prosthetic hand and on the hand there is a metal plate with all of the names of those in his unit who have been killed.....and that's what made me cry. Don't forget them.

when your mortality is chasing you

Of the patients I care for, those with cancer are the ones I most admire and sympathize with. They come in, often minus thier hair, most often suffering the side effects of chemo. Usually they are the kindest and most patient. Perhaps their long experience with medical settings has taught them patience.

I see people who have been living with cancer for YEARS, off and on. Sometimes they had one kind that had been "cured" and then another spot somewhere else comes back. I see those newly diagnosed, faciing a long haul. Sometimes those who are at the end of their haul.

I'm sure they are human and have their bad days and aren't always nice, just like everybody else. But facing death changes you. It humbles you. In humility there is dignity.

taking a dirt nap

Something K wrote, got me thinking about something I often think about: care of the very elderly. That is, resuscitating, providing expensive care, etc. When I see some 80 or 90 year old coming in really sick I think: Grandpa wants to die but we aren't going to let him.

More and more we are seeing peole over 90 in the ER, sometimes over 100, and of course there is an explosion of people in their 80's. Because we want to live forever in this country, nobody talks about resuscitation, what you would want done if you are really ill, etc. So millions and millions of dollars are spent on futile care. Eventually we will have to deal with this but of course we will wait until medicare is completely bankrupt. Thats what we do. We aren't exactly a proactive country.

The debate over this will get very, very ugly as it already has over something as simple as whether your doctor can get paid to talk to you about end of life care. Here's the deal though: either we deal with it or the country goes into a depression ten times worse than the current one, hospitals close left and right.

This is already going on in other countries and somehow the world has not come to an end. It will happen here. Sooner rather than later. Everybody dies. Even your mom and dad.

the unspoken thoughts of an ER nurse

I don't say what I'm thinking when you roll through the door, walk in the room. The minute I hear what is wrong with you, I am already thinking about what is coming next, because I can predict it, its not that difficult. I know what the doctor will order.

I dread the old woman with weakness, dizziness because I know you will get the $10,000 work up. One of my first thoughts is whether I'm an going to have to cath you for a urine or can you go on your own?

Got vaginal bleeding? My first thought is are you pregnant? Are you having a miscarriage and will I have to assist with a vaccuum curretage (D and C)? Not a procedure that is fun for anyone. Sad for all around. Why does the machine have to sound so horrible during the procedure? Makes it so much worse for the patient.

Decided that today is the day you don't want to live any longer? Took an overdose of pills? My immediate thought is how long ago did you take it? If it was within the last 1-2 hours I might have to lavage you (pump your stomach). A messy, unpleasant experience for you and me. If we avoid avoid getting the liquid charcoal (a gooey black substance) into you without a major mess, I consider it a good day.

Been drinking and 1) been in a fight 2) worried about going through withdrawal 3) decided today is the day you need help with your problem? I know you won't be staying. My first thought? Do you have a ride home? Can someone come and get you? You aren't going home on your own if you are drunk. If you don't have a ride, I have to see if there is a detox bed, which there probably isn't. No detox bed, you are with me until you sober up. Oh joy.

Been doing crack and now you have chest pain? I am gritting my teeth when I go in and put you on the monitor, get an EKG, etc etc etc. You see, you will be treated like any other chest pain patient with all the bells and whistles, even though you created this situation by your stupid behavior. Chances are you are scared shitless because people like you usually are in this situation. Thousands will be spent on you at taxpayers expense to determine if you have damaged your heart. You take up a bed in the ER for hours with your foolishness and there's nothing we can do about it.

These are the unspoken thoughts of an ER nurse.

weird mamas boy

Now I know some of you guys out there are really close to your mothers. You have a special relationship, but let me give some advice to men with STD symptoms: don't bring your mother with you. If you bring your mother with you, don't bring her into the room with you. The ER staff will think you are a STRANGE person if you are over the age of lets say 16 and bring mommy in when things are going drip, drip, drip....If you are old enough to do the dirty then you are old enough to handle your idiocy on your own. And oh by the way, at the end of the visit when I am giving you instructions tell your mother to shut the F--- up when she asks how long do YOU have to wait to have intercourse?!! I will tell her and YOU that this is an inappropriate question for HER to ask...how about you wait forever....you and mom have BOUNDARY problems my boy and I don't want you to bring anybody else into the world til you resolve them...

triage: before and after

This is me in triage:

before triage:

during triage:

After triage:

mr. crackheads lucky day

This is the kind of completely ridiculous shit that goes on in an ER:

Crackhead/alcoholic man presents saying that he was assaulted. Moaning and groaning and writhing and carrying on as crackheads/alcoholics are want to do. Out partying with the cocaine and jack daniels and, lo and behold, one of his companions became "peeved" and threw said crackheadee to the ground, prompting a visit to the ER.

ER doc orders ativan and toradol PRONTO! You betcha, ifitdle shut this upstanding citizen up, I'm down. Course it doesn't. Urine tox comes back positive for guess what: COCAINENA Morphine and benadryl (crackhead be itchin') PRONTO! exclaims ER doc...Okay let me get this straight - we got us some crack, alcohol, toradol, ativan and now benadryl and morphine...Oh did I mention that Mr. Crackhead went home with a Vicodin script? Why the hell not? Lets add another 15 Vicodin to the mix!

Well at least mr. crackheads humiliated family who took him home won't have to deal with him for the next few hours as he sleeps off all of this shit.

Exit stage right: Rocket scientist ER doc

pissed

Whats better than to start the day with a moaning crackhead and end it with someone who is morbidly obese. It seriously doesn't get any better than that does it?

I was in a piss poor mood today. Maybe it was that this weekend was the first real nice, non-rainy, non-stifling humidity weekend we've had and I had to be at work.

This is unuusal: My co workers irritated the shit out of me. The words "shut the f--- up!" come to mind. The words: "why don't you get off your lardass!" come to mind. Shit is anyone else working this frickin' triage area?! Damn it.

Went out of the placed pissed. Maybe its hormonal...

eating the puppies

ER nurses tend to be type A's okay? Driven, competitive, ambitious, aggressive types. We are the kind of people who when you go to a class, think we know more than the teacher. Thats why I hate going to classes. Its embarassing to see us in action sometimes. Of course some of us think we are so superior that we act like some kind of ER Goddess whose job it is to inform lesser mortals of the way things SHOULD be done.

Sometimes the people who choose to be preceptors are ER Goddesses. They are the ones who tend to volunteer for a job like that. Mix this with a new ER nurse orientee...

The ER Goddess expects humility and fear and worship from the new orientee. If you don't sit at their feet humbly as they drop pearls of wisdom, they can make your life a living hell. They will talk about you. They will sew doubt about you. It irritates the shit out of me.

Me? I've never been a preceptor. I'm not anal retentive enough. Here's what I tell new people: If you have questions, I'll try and answer them, feel free to ask me. I've been here a long time and I don't know everything. I rely on my co workers to help me if I need it. Critical patients are scary. You are not alone. We will help you. We won't let you go down in flames. Welcome.