year......new.....happy

snoop dogg visits ER

My husband picks me up from work.  He enjoys getting there a little early to watch the moron parade coming into the emergency room.

The other day he watched someone walk up and finish smoking a joint, then go in directly to the triage desk.  Jus' chillin' before an ER visit... dumbass.  No doubt they were there for something like chronic back pain...

go sit your ass down before I come out there...

.

Yes we have a McDonalds in our hospital, believe it or not. So oftent the hood rats stop at McDonalds to get a big mac and fries before they come to ER. They appear at the window with a large bag of stuff asking to be seen for things like abdominal pain or nausea. They expect to be able to bring in their quarter pounder and chow down on it while we are triaging them.  Guess what? No. That won't be happening.  I mean, what is this a restaurant? This is an ER, it isn't a place for you and your family to have lunch.

People get really pissed when they can't bring their Mickey Dees back. Sometimes they are enraged, shouting that it is a stupid policy.  I am always amazed at people who come in with food to be seen.b I mean seriously...could you be a bigger idiot? Then there are the family and friends who go to McDonalds or the cafeteria and appear with all this shit and want to take it back to their brother and Dad. This is gross ER environment with all these germs flying around, yucky stuff gets all over the floor and everything else.  You want to have a picnic in the middle of this?

So take your chicken mcnuggets and fries totin', ronald mcdonald lovin',  idiot self and sit your ass down before I come out there..

I think I got Fucking Tired Disorder

Now I have heard everything...apparently there is a new diagnosis that has been coined: Shift Work Disorder. And of course when some rocket scientist coins a new disorder, you know that there will be a pill to take for it. There is.  I won't help these shysters
push their dope by naming it here.

Hey, every single nurse, doctor, tech, etc. has at one point or another worked nights if you work in a hospital. It is almost required to become a nurse. Unfortunately patients have to be taken care of 24/7. Most nurses try like hell to get off of nights as soon as possible. A chosen few choose to work nights because they hate a authority (hahahaha) and make more money.

The thing is most hospitals seem to try to make shifts as difficult as possible by scheduling people day/night or even day/evening/night. In my ER, no one works rotating shifts. 98% of us work 12 hour shifts. There are people who work straight 7p-7a.  We do self scheduling by clusters meaning  those working for example, 9a- 9p choose a person to do the schedule.  Everyone turns in their requests. If works out great. I don't know why more units don't do this.

As far as shift work disorder, why don't you call it Fucking Tired Disorder. The people who work nights, rotate D/N don't need a pill, they need to be compensated for what they go through. They should be paid $10 more an hour.  They should have block schedules. They should get other benefits. Working these shifts affect peoples health and well being. They deserved to be compensated with cash. End of story.

I gotta boo boo Mr. Doctor

Today sucked, like we knew it would. Days after holidays typically suck. Its like people saved up thier stupid shit for today. Toothaches, a few hours of vomitting, little owies, leftover elderly mom/dad didn't look good on Christmas, but we didn't want to stop the merriment so waited til today type situation.

A good 70% of stuff that comes into the ER is stupid shit that:
a) you could have seen your doctor for
b) you shouldn't have gone to anyone about

I mean seriously if you took away all the fools who come in daily for their little boo boos and perceived neurotic shit, we would be out of business.

If we ever tried to reform how people use the medical system, it would be a gigantic undertaking. People in this country can tolerate no discomfort. They want immediate gratification. The days of letting your body just heal itself for small stuff
are gone. As Americans we think we DESERVE to be able to go to the Dr or the ER for the sniffles. We demand that someone make it better RIGHT NOW.

It really is ridiculous.

you know

don't forget them

Not everybody is home this Christmas season. Don't forget them.

cool

oh yeah

What is it about nurses that inspire all of these weird nurse themed toys and shit? Anyway, looking for a last minute gift for that nurse with everything? I present the following:

Can you ever really have enough troll dolls?

Everyone loves a sock monkey

...rubber duck I'm awfully fond of you...dodo dodedo...

yummy

She/he will love this stylish dog costume for their dog. Bonus: Their dog will attract a cool boyfriend dog.

uh oh

an ER night before Christmas

Gather around kiddies and let Madness read you an ER version of Twas the Night Before Christmas:

'Twas the night before Christmas,the ER is jumpin'.
The chaos at triage is really quite somethin'.
The charts are all stacked in the new patient bin,
I think to myself: we NEVER can win.
The patients are nestled all snug in their beds,
while visions of Dilaudid dance in their heads.
The doc has his gloves on, and I have the tray, its off to that abscess, as I lead the way..
When out in the lobby there arose such a clatter, I sprinted for triage to see what was the matter.
The lobby was chaos, a sight to behold, every other person seemed to have a bad cold.
When what to my disbelievin' eyes did appear,
a frequent flier named Herman we do not hold dear.
With a shuffle, a groan and blood curdling scream, (oh no this can't be happenin' its all a bad dream!)
He appeared with a backpack, along with a sack, and shouted quite loudly: there's somethin' wrong with my back!
He was cursin' and cryin' and carryin' on, he looked around widely and asked for nurse Don,
Or Susan or Wendy or Alan or Fred,
Do something somebody and get me a bed!
By the way I am hungry, haven't eaten in a week, I need a warm blanket and footies for my feet,
I need a glass of water with a whole lotta ice, Now go please hurry, I don't wanna ask twice!
He went on a cart, told you gotta wait your turn, you been here enough, when are you gonna learn?
I turned back to triage and looked straight ahead, trying to stave off that feeling of dread
As I stifled a yawn and was turning around, Up to the window this jolly man came with a bound,
He was dressed in scrubs except with a red and white cap, His face appeared tired, like he jus' woke from a nap,
He was pushing a cart that was laden with sweets,
Some kind soul had come through with the sweet treats.
He asked to be let in, and rolled the cart through, stopped at the reg desk to give a cookie or two,
He walked back to the HUC desk, gave a wink to the crew,
Asked everybody: What can I get for all of you?
He resembled Santa in a very odd way,
He smiled and laughed and had this to say:
Tomorrow is Christmas, oh what can I bring?
What can I bring to make your heart sing?
Oh Santa, dear Santa, somebody spoke up and said: we just want some peace, all this racket to cease,
Santa nodded and said he'd see what he could do, to make a nice christmas for this emergency crew.
"Goodbye!" Santa said as he rolled the cart out, "Merry Chirstmas to all!" he said with a shout,
I went back to triage to see what difference I could make,
I looked around slowly, did a quick double take
Herman was gone, his bed up with a bow,
I asked another nurse: where the heck did that silly Herman go?
He was here just a minute ago, I swear it, I do, yelling and cursing and crying boo hoo.
We searched back and forth and to and fro too,
Then sat in our chairs and gave one collective: Whew!
Oh Santa had been there we all knew it clearly, the man with the scrubs had blessed us quite dearly.
Herman was gone, it was all just so good,
We had a good Christmas Eve that night in the 'hood.

HIPAA gone wild

ER nurse calls report. Patient goes to room.

Fifteen minutes later, ER nurse calls patients station to give family phone number to patients nurse.

Asks how patient is doing.

Patients nurse tells ER nurse that she cannot give out that information because it would be a HIPAA violation.,,,

Just kill me now.

the tide, oh yeah, it gonna turn on yo' butt

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 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 leg. Oh by the way I have carbuncles (abscess like things that drain nasty goop) on my head, and I have an open sore with MRSA (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....

the ER waiting room is a jungle....

An ER waiting room is a cesspool of pain, anguish, resignation. Many people populate such a place. Here are few of the standouts:

1) The Martyr - this person will drag themselves back to the waiting room and lay down on an available bench usually with a hospital blanket and look forlorn. Lots of heavy sighing here.

2) The Enforcer - this is usually the indignant relative or friend of a mildly ill person who stalks up to the desk, hands on hips, and states in a loud voice that the person they are with is
a) in a lotta pain
b) can't sit there much longer
c) that they cannot believe they are being treated this way.

3)Nervous Nelly/Ned - They sit in the far corner away from the other patients and visitors looking like a deer in the headlights, glancing around nervously hoping none of the homies in the waiting room pull a gun before they get in to be seen.

4) The Instigator - this person comes in with a chip on their shoulder and when they don't get in right away, they go back and start talking loudly about, "what crap this hospital is", getting others to join in, creating a mob like atmosphere.

5) Disappearing Dan/Diane - these are the people who either come up to the desk (or not) to tell you they are going to a) McDonald's b) the pop machine c) outside d) to have a cigarette e)to use their cellphone. Sometimes they disappear all together.

6) Mom of the year - these are the women who come in trailed by 3-4 kids who of course are out of control. She and the brood go back to the waiting room to eat their big mac and fries that they purchased on the way to the ER. Then the kids run wild through the waiting room while mom sits and watches TV. Then she gets annoyed and yells, "Peter get your mo'f---ing butt over here boy, I told you 'bout that shit!".

7) The unknown patient - these are the people who are still there after everyone else has left. You don't know who they are. Often they are sitting in a chair sleeping. They don't want to be seen. They just wandered in looking for a place to catch a few winks and use the facilities.

8) The skipping record - this is the person, who like a bad CD that keeps skipping, keeps coming up to the window and saying the same thing over and over, "how much longer will it be? Where am I in the line? Why did those people go in before me?" This type of patient can replicate itself at will, and does, throughout the waiting room.

9) The drama king/queen this person loudly vomits (the whole ER will know they are losing their lunch), seems like they are coughing up a lung, moans loudly, often presenting back at the window requesting to lay down in the hall in back of triage where there is more traffic to witness their performance.

10) Emotional exiter - this person presents to the window after usually waiting an excruciatingly long half an hour or less, proclaiming their unhappiness at their plight for all to hear. They accuse you of being
a) prejudiced
b) a bad hospital
c) lazy
d) uncaring.
They demand the supervisors name, the patient representatives number, anyone with more authority than your lowly self. They state they are, "going to another hospital". Oh please don't....

beam me up scotty

It has been raining and dreary the past 3 days up here in the northland. Usually the weather doesnt get to me this early in the winter, the holiday and fa la la shit usually makes life here tolerable until January.I swear it gets dark at 3 pm these days. I can't take it!!

So therefore, being uninspired, its a video kind of week, here at the madness blog. So without further ado, I present another ZDoggMD (who by the way is wasting his time as a hospitalist - he was destined to be a rapper/video producer) production that I know you'll enjoy:

a funny take on the pain scale

Because I out of clever repartee tonight, here's something to entertain you about the pain scale:

sometimes you just get weary

.

You know its going to be a bad day when your first patient calls you a "motherf----r" and says "get out of my room, I'm not lettin' any of you do anything to me", as her alcohol tinged breath wafts across the room. Okay.....it's 9:15 and I have 11 hours and 45 minutes to go.

Among the other patients was someone in for mental health because their grown son had just been sent to prison for life.

Then there is the 55 year woman who has been fighting cancer for 10 years (and looks it) and this will be her last day of life. She will not go out quietly. Death isn't pretty a lot of the time. It involves noisy breathing that tortures family members. It can go on for a while.

There is the young man found staggering around a local mall and when the doctor asks what's going on with him, he gives her the finger. OK then....

There is the crack/pot abuser in her early 30's with seven children whose family brought her in because they don't know what to do with her anymore.

There is the man from another country with both cancer and tuberculosis who is dying. Sometimes I just feel weary of the suffering and troubles. I'm human.

a Charlie Brown christmas in ER

So I have mentioned before the politically correct, generic christmas decorations that the hospitals puts up every year. NEWS FLASH!! There is a change in christmas decorations for the ER this year. Apparently the Politically Correct, We Love Everybody Committee decided that the ER needed something new.

In our lobby there is this large square thing that normally holds fake foilage. Every year they remove the fake foilage and put in a fake Christmas tree. Well this year we didn't get one tree, but three! The thing is they are small pathetic looking scraggly trees. They have the usual gold decorations. One tree has a ribbon just on the bottom of it.

I was thinking that maybe there weren't enough decorations from last years tree, since about half are probably stolen each year...So they divided the remaining decorations into three small trees. The thing is, the trees resemble the Charlie Brown Christmas tree x 3.

I mean I know reimbursement is down, but geez. I long for the old days when one of the ER staff brought in a revolving Christmas tree and it was in the back of triage. It was great.

uh oh

"I'm gonna gut you like a trout".


From the angry nurse

the results are in

blog poll results:

worst smell: GI BLEED

Will you be a nurse in ten years?

yes - 53%
hell no - 30%
I'll be an NP -13%
I'll be a CRNA - 3%

Best looking Dr on TV

George Clooney - 40%
Patrick Dempsey 29%

smells, good looking doctors, your future

Its cold outside. There's snow on the ground. 16 days till Christmas. Time for a blog poll. Please answer the following questions above:

sorry, Mom died

People react to death in many different ways.

Some people wail. Thats the worst for the staff, to hear somebody crying loudly. ER folks are good at putting things in a box and moving on. We tell ourselves things like: they were old, it was there time - its better they died they would suffered, etc. When somebody is crying loudly it forces us to face that this was a human being and someone loved them and now they are very sad. It bothers us because our coping mechanism is shot to hell.

As a nurse in the ER, it is ackward dealing with the family of someone who died. What do you say? You didn't know their loved one. All you can really say is that you are sorry. I don't stay in the room long. I check on them often, but leave them alone.

Some people say thier goodbyes quickly and leave. Some people want to stay a long time and have all the family members come. Some people don't know when to leave.

There have been times when a body has been in the ER for hours, as the family waits for other people to come. Its a very tough situation. On the one hand, you want people to be able to say their goodbyes, on the other hand we can't have bodies sit in the ER for hours. Its very delicate to handle.

Strange things happen around peoples deaths. I have had calls as charge nurse a couple of days later with questions about the circumstances of the death, things like: Why did you------? Usually I wasn't there. Its ackward. People have wanted to go get something out of the pocket of the deceased in the morgue. Late arrivers have wanted the body brought back up from the morgue.

Its weird seeing a dead person, knowing their life is gone. People sometimes appear younger in death, all of their tension and stress gone.

In ER, we can't spend much time thinking about death because there's a line a triage..

are we crazy?

Its 10 am. The fire alarms are going off (being tested). You know how loud they are in a hospital. The guy who uses that big loud machine to clean the floors is currently doing his thing. The monitors are going off. The patient call lights are going off. The phone is ringing.

In the middle of all this I ask myself: are we all insane? Is the ability to work in an environment that would send most people running for the door normal? I don't think it is. The fact that it is like this and yet we continue to keep doing it, makes me wonder about myself. Why would I put myself through this? And I have been doing this for years.

A lot of ER folks like to tell themselves that they are pretty special, pretty great, because they can function in this chaotic, loud, stressful environment. We get off on that fact. But are we special, are we pretty great because we can function in this chaos, dealing with all of these dysfuncitonal people?

Hey I know somebodys got to do it. Thank goodness there are people who will do it. But sometimes I wonder why I would choose to work in a situation like this. A chaotic, stressful, sometimes abusive environment in a place that places expectations that people are unable to fulfill. A nurse who left the ER once told me that she thought working there was self abuse. Hmmmmmm... any thoughts?

what will Dr. Big Work Up do?*

Oh my.....now here's an interesting development (straight from whitecoats blog), it seems JCAHO is proposing a national patient safety goal around overuse of procedures, tests and treatments. Will wonders never cease? Here's the link.

National patient safety goals are things like patient indentification, preventing medical errors, preventing mistakes in surgery. Hospitals have to comply with JCAHO regulations or risk losing accredidation and with it money.
That's why months of preparation go into JCAHO visits to prep the staff to parrot what the surveyors want to hear.

Personally, I think this is great. Hospitals and doctors refuse to stop ordering all these ridiculous, unnecessary tests on people, so apparently the government has to step in and do it. And guess what they don't give a rats ass about all the unfounded fears about liability.

Medical malpractice lawsuits are a real concern for doctors, nobody doubts that but the concern are blown way out of proportion. It is used as an excuse to order all of these tests which bumps up the level of care and puts more money into the hospital and doctors pockets.

What is so fascinating are some of the examples they give which are major areas of profit for hospitals:

1) the myriad of CT abdomens that are unnecessary and could probably be replaced by an ultrasound.
2) Doing angioplasties and stents on people with less than 40% blockage. (How about doing CT angios on every Tom, Dick and Harry that walks in with chest pain?)
3) Inducing labor in women who are less than 39 weeks.

Oh, I just can't wait to see how this all turns out. At the very least, it should start a necessary discussion around overtreatment. That's an accomplishment in and of itself.

*hi nurse k

nurses are not superheroes

Medicine is changing. Hospitals are changing. It has become about business, money. There is no choice in the matter. Its reality.

There is so much emphasis on patient care satisfaction. On standardization of everything across the corporation. More and more complex procedures and polciies are evolving. Lost in all of this is the nurse.

I really wonder if there are other jobs that change as rapidly as nursing. It is constant, overwhelming change. Change it is hard to keep up with. I've given up trying to keep up with it. I try to remember the important stuff and ignore the rest.

Nursing has become a complex job with increasing complex technology and procedures. Nurses handle patients with LVADs, ECMO, hypothermia treatment to name a few. People are being kept alive today that never would have had a chance even ten years ago. Who is keeping them alive? Nurses.

With the emphasis on patient satisfaction, we are expected to handle a diversity of patients with all their perisonality disorders and neuroses with a smile on our face. When it comes down to it, we are expected to be superhuman.

With all the rapid change, emphasis on the bottom line, patient satisfaction - no attention is given to employee satisfaction. We are just expected to grind it out and be happy about it. The thing that is missing in all of this change in medicine is the lack of caring about the employee. What all of these hospitals fail to understand is that if the employees aren't happy, the patients won't be happy. The lack of understanding of that will be their downfall.

they'll eat you alive

Have you ever heard of the term "1,000 yard stare". It is sometimes used to describe combat soldiers who have seen too much, are always on alert and just trying to make it through til they go home. Well I think I am developing the ER version of this and its called the "1,000 yard scowl".

When I cross the line into the triage area, I feel a change come over my body and a sneer or scowl start to involuntarily take shape on my face. I try to stop it but it won't go away. I am defenseless against it. There is something about triage that just brings out the beast in me. I sit at the window and have the attitude of "go ahead, make my day"...sometimes I put a battery on my shoulder and dare people to knock it off..(anybody remember that commercial?)

I think deep down inside I am trying to scare people off. But I'll tell ya the people who present at the triage window are not easily scared away. You could be slumped over on the desk, gasping for air and they would still say "I wanna see a doctor". You can have a phone in each ear, a patient in both bays, one in a wheelchair, an ambulance stretcher whizzing by and a line ten people long....but still " hey you I wanna see a doctor...".

Those people at the triage windows are survivors. They won't take no for an answer. They are like the mailman - through rain or snow or sleet or hail nothing will stop me from telling my tale....and no matter how many times you say things like "weren't you just here last week?", "what's going on today Bob?" or when you're having a bad day "you're back again?",they will keep coming back.

If there was a nuclear bomb dropped on the city, like the cockroach they would survive and present in the same whiny voice: "I wanna see a doctor". Triage is like combat. You never know when there will be a surprise attack, you always have to be alert, wary...keep your guard up. If you let it down, they will surround you and eat you alive...they're just waiting for a sign of weakness...(Ok I'm getting carried away...).

I think its time for me to resurrect another symbol that we share with the combat soldier: the short timers calendar. Everyday I'll cross out a day that will bring me one step closer to retirement...

have a politically correct holiday season*

Fa la la la la lalalalalalala. It's that magical time of year when people frolic through the streets on their way to buy presents...even the hospital and the ER get festive when corporate puts up the generic holiday season display. It is the same throughout the hospital. Brown and gold. Regulation decorations. Politically correct decorations. Don't want to offend any non-Christmas celebratin' folk.

There will be NO traditional holiday colors. There will be NO individual department holiday decorations. EVERYONE will tow the corporate holiday season political line and smile while they are doing it OR ELSE.

Here's an example of the official approved holiday decoration: All lights will be white. NO EXCEPTIONS. Santa will not be making an appearance. There will be no carollers singing "inappropriate songs" espousing a particular religious view point. Any clothing displaying festive holiday decor are banned, along with pins, earrings, necklaces. Every area will be assigned a holiday watch person to catch any infractions of the official corporate holiday policy.

Oh yeah! I love the holidays. Time to throw in my guess for how many bulbs will be left on the "holiday" tree in the waiting room at the end of this holiday season. I understand there is a great prize for the correct guess this year....

*look closely at the picture to see what santa and mrs claus are looking at outside their window

STOP THE PRESSES!! FIBROMYALGIA BREAKTHROUGH!!

NEWS FLASH!! ATTENTION ALL HEALTH CARE WORKERS!!

In breaking news from the United States Department of Fibromyalogy, fibromyalogists (a new sub speciality) have after months of research discovered that it is possible to have fibromyalgia in just one part of the body.

Yes, we all thought that this was a general body disorder and that is true, however, apparently it can also concentrate itself in say the back, neck, abdomen. I recently had a woman tell me that her doctor told her she had fibromyalgia in her abdomen since he/she could figure out no other source of her chronic pain. And get this, apparently the doctor said this with a straight face...

What an advance in science. Now all of those chronic back pain, neck pain and all other areas of pain suffering folks can finally have a fancy new diagnosis that will finally legitimize their ER and doctor visits. What an "I TOLD YOU SO" moment for them.

The makers of Lyrica must be shouting "HOORAY!!" I wonder if I can get disability for my intermittent low back pain that happens after a busy shift...