Tuesday, February 21, 2012

2:30 pm: complete chaos

There are times in an ER when you lose control. When I say lose control I mean the entire ER is in a state of complete chaos. That happened at about 2:30 PM today. It was total chaos.

In comes a respiratory arrest, followed about 20 seconds later by another patient in cardiac arrest. Meanwhile the ER is already very busy. Those two threw us over the edge into the chaotic abyss. Two intubations going on at once with CPR in progress and everything else that goes along with an arrest.

It was that kind of day. At one point I had a man who has about a 90% chance of having TB and did I have a mask on at the beginning of his visit? Of course not. At the same time one of my other patients who happens to be 99 years old has a BP in the 70's, is in renal failure and is septic. The other patient is a frequent flier dialysis patient who is in with his usual chest pain. All this is going on while the two arrests are being dealt with. The guy from dialysis is an anxious man with emphysema who has the patience of a two year old. They decide to admit him and the charge nurse decides to have someone take him to his room upstairs while I call report. When I call report they tell me they can't take him after all, so soon as he gets there he will be heading back to us.

Wonderful. Then the nephrologist comes in and decides that he can be discharged, writes orders but can't talk to our ED doc who is in desperately trying to intubate one of the arrests. So we start making arrangements to send the guy back to the nursing home. I mention to the ED doc, when he is done intubating, something about this guy going home and he blows up. He says that the guy isn't going anywhere, he's going to be admitted. And get that nerphrologist on the phone right now.....OK so now he is back being admitted again. Then the patient says he wants to be transferred to the VA where he normally gets his care....OK somebody shoot me before I completely lose it.

Oh by the way did I mention that at 3 pm I assume the coveted position of charge nurse? So in the midst of all this shit, I dive in. Did I also mention that we have been down two nurses on days? Eventually, after a couple of hours, during which we wentr on divert for ambulances, the ER settles down and as the evening winds down it actually calms down enough to have some empty beds.

This is the time when you sit back and wonder why you do this shit? Why do you kill yourself working these twelve hour shifts? One of my co-workers told the story of being in such a zombie like state of exhaustion one night this week on the way home that she drove away from the gas pump with the nozzle in her gas tank and took the hose down....Why do we do it? I don't know. I'm just trying to make it to retirement. I think I'll start a calendar like they do in jail or during a war....


rnraquel said...

I have had several of those days lately. I fantasize about becoming a barista at Starbucks.

Anonymous said...

This blog post seems disrespectful of patients' privacy. I understand that you have a stressful job and need to vent, but please don't air your issues at patients' expense. Someone reading your post might know one of the patients you mention or might even be the patient. How would you feel if you needed treatment and someone wrote about you in this way?

Anonymous said...

Ooooh brother - PLEASE BE QUIET a fellow ER Nurse -- this post could've been an about 9 out of 10 patients that float through the ed on a given day. whatever dude!

Dana (dh418) said...

@anon at 2.39pm: My mother is a nurse. She could have been the one dealing with that crap in TX. I don't think girlvet works at my mom's ER.

She was venting. She had a bad day. However, she didn't give enough info for the patient to be identified. Sheesh!