the crappie floppers

a deja vu to you...

There are a lot of what I would, if I were being generous, call "ineffective copers" in the world. These are the people who can't tolerate a punture wound without doing a crappie flop in front of triage.
deja vu to you..
They run to the ER at the drop of a hat and as they cross our threshold revert to behavior similar to that of a 2 year old. Here's the thing, they fill thousands of ER beds across the country. The public thinks ERs are full of people who are really sick or injured. Wrong. They are filled with these kind of people.

These are the people with "chronic pain". They will keep coming back until someone labels them with some kind of syndrome or dubious condition to try and get rid of them.
They have achieved their goal. Now they have finally have a title for themselves. They can tell everybody: see, I told you I had something wrong with me. Even drug companies are taking advantage of the thousands of ineffective copers by developing drugs for them.

Instead of dealing with their underlying depression and emotional problems, they become their diagnosis, it becomes their identity. Their lives revolve around it. They suck their family into it.

They suck the life out of the ER staff. They unnecessarily fill beds that seriously ill people could be in. They spend millions of health care dollars a year on their syndromes and conditions. They are part of the reason your health insurance is so high.

The Vicodin Follies

Come on down, you're the next contestant on the Vicodin Follies...

Someone came in for something, had no pain whatsoever before their visit or during their visit, but still got a vicodin script.

Patient making 3rd visit this week for same thing, got more vicodin each time.

Have bronchitis? Here's a script for Vicodin.

Apparently today was VICODIN GIVEAWAY DAY. Nobody told me. I was halfway into the shift, before I realized it. Wouldn't it be easier if we just had bottles of Vicodin to give away to each patient as a parting gift? None of those unsightly prescriptions needed.

One guy, I guess he didn't know it was VICODIN GIVEAWAY DAY, actually left before he got his Vicodin script. I tried to run after him, but he was already gone. I guess the next patient will get 2 scripts for Vicodin..

don't judge a book by its cover

She looked like a 1960's reject. Long hair, parted in the middle. Granny glasses. In her late 50's. She had called 911 for herself somehow. When she got there she was incoherent. Medics only knew her first name, they got her last name from 911 which listed her at that address.

If you called her name, she would say "huh". That was about it. Couldn't answer questions, follow commands. My first thought was, as a veteran cynical ER nurse: she's on something. Couldn't answer whether she had been taking drugs.

She looked okay. Breathing OK. Vitals signs stable. The only thing was, she kept asking: AM I GOING TO DIE? AM I GOING TO DIE? I told her no. When someone asks you if they are going to die, what are you gonna say: yes, you are going to die? I'm not sure... Of course you are going to tell them they aren't going to die.

Periodically she would become more coherent, then less coherent. Did a CT scan, labs. See where this is going: Yup, she had a big brain tumor. No doubt inoperable. Turns out she is going to die. Not that day, but in the very near future. Its really, really sad. I wonder what her life was like.

don't bug me

Why do people come to the ER for bedbugs? THERE IS NOTHING WE CAN DO FOR YOU. I am sorry you have bedbugs. Its an awful thing that no one wants. However, your bites can be treated by going to the drugstore. If you want to relieve the symptoms of your bites go to the drugstore and ask the pharmacist for some anti itch medication.

We don't want you to bring bedbugs to the emergency room. Then we will have bedbugs. We don't want bedbugs just like you don't want bedbugs. I can think of at least two occasions when we have had a bedbug skitter across the triage desk. GROSS. Not only have you brought us an unwanted vermin but now I am going to be scratching myself all day just because of the idea that a bedbug is living in triage.

When you come to the hospital with bedbugs we have to follow a special procedure. The room has to be specially cleaned now. Housekeeping does it. You know how slow housekeeping is. That room is closed until it is done. So grandma can't get into the ER. That's her sitting in the lobby waiting until your room has been cleaned.

SO PLEASE DON'T COME. Oh and while I'm at it, don't come for lice, scabies or "spider bites" either. Unless your rash is infected, go to a drugstore or call your own doctor. Thank you on behalf of ERs everywhere...

larry, moe and curly visit the ER (a typical Friday morning)

Hey I'm sorry if your life is shit, but that doesn't give you the right to become so enraged that you tear the reciever off the wall phone and throw it across the room hitting the wall. The wrath of madness will be upon you. You endangered us and we don't like that.

Hey I'm sorry you are a pathetic drug addict who told us you are suicidal. That doesn't give you the right to make a run for it. You are fast, but we are faster. It is our security's pleasure to tackle you out in triage. They live for that shit.

Hey, I am sorry that your life has gone badly, but that doesn't give you the right to light up a cigarette in the patient bathroom. That does not endear you to the staff or the other patients. The tenor of your visit has now changed. Not in a good direction.

How was your Friday?

the old you is dead, the new you is alive, but tattered

Being a nurse is like going through the stages of grief.

You finally graduate from that Godforsaken nursing school and you passed the boards and you actually have a job! Yippee! So what if its rotating D/N. You begin the grieving process...

Stage one: SHOCK AND DENIAL. You go through orientation and things go OK, you are ready to be on your own. Or at least you thought you were. You quickly figure out that you don't have enough time in the shift to accomplish what needs to be accomplished, espescially if something goes wrong. You go home exhausted, made more so by rotating shifts. You can't believe it, what they told you in nursing school has no practical application to the actual daily work of a nurse. You tell yourself things will get better. They don't

Stage two: PAIN AND GUILT. You realize that you have just spent four years to do a job that is actually impossible to do. Now what? You have all those loans to pay off, you have to pay the bills. You find yourself saying: What have I done?!!!

You begin to feel guilty that you can't do all you are supposed to do for the patients.

Stage three: ANGER. You start to get pissed off that they expect you do all this stuff and you don't have time. There is never enough staff. You start to get a little burned out.

Stage four: BARGAINING.You tell yourself, maybe I can change things, I'll join a unit committee.

Stage five: DEPRESSION, REFLECTION, LONLINESS. You keep complaining to your significant other, family members, friends about how bad it is. They lose sympathy for you. They tell you to buck up, you're making a living, stop complaining.

You start to feel lonely. Nobody understands or they don't care, you tell yourself. You ask yourself, whats the use? I work really hard and I'll never get it all done. By the way, the comittee? Accomplished nothing, they rarely do. You quit it.

Stage six: ACCEPTANCE. You start talking to other nurses. You realize we all feel this way. Its some consolation. You have since got married and a baby is on the way. You can't quit now. You begin drinking (guffaw). You accept that the job is what it is, pretty much out of your control. You do the best you can. You develop a tough exterior. You'll need it in this job. You get onto evening shift, making life a little easier. Pretty soon you've been a nurse ten years and can't believe how time has flown by.

what do you expect?

There were 60 of them. About 12 litters and 48 ambulatory. It was me, another nurse and 3 techs. In the back of a C130 cargo plane flying over the desert. They had a variety of injuries, none critical. There were more psychs than you would think. Back then, those with mental health problems were sent home, not given SSRIs and sent back. No one with PTSD would ever have been sent back.

It was the biggest load I had. The charting was on a tag that was attached to every person. We were expected to chart something on every person, even if they were on the plane only a half an hour. Most often written: Tolerated flight without problem. The flights were short, you would call them hops rather than flights. We flew from base to base for about 12 hours, letting people off, taking people on and some how keeping track of it on paper.

The litters went four high. I had to climb on the first two, to get to the top one. It was noisy. We told them to wave their arm if they needed help.

Back then no one would have been expected to return over and over, up to four times. Like I said, the psychs were sent home. The injured would never have come back. You knew who the enemy was and where they were.

Nowadays the soldiers don't know who the enemy is, where they are hiding. They can't travel safely for fear of having an IED explode under their vehicle. They travel anyway. The injured go back. Those with PTSD are counselled, given medication and sent back. The depressed are given meds and kept over there.

We have essentially hired ourselves a low paid mercenary army to fight our wars for us. The wars really don't affect us unless you know somebody in the military. When it doesn't affect us, its easy to forget about it and think it is OK. Because we don't think about it much, we are surprised, shocked, horrified when something goes terribly wrong. Like Staff Sgt Rober Bales kills women and children. He had been deployed 4 times, had part of his foot amputated, had PTSD, his friend had his leg blown off the day before. Doesn't excuse what he did obviously, but does give some insight into it.

We are forcing these soldiers to do for us what we don't want our own sons and daughters to do. Over and over. When we do that over and over they crack.

I been robbed, I say, I been robbed

Here are the top ten things stolen from our emergency room:

1) syringes - before drawers were locked

2) linen - sheets, towels and wash cloths

3) phones off the wall

4) fetal doppler

5) lap top

6) bandaids, bandages

7) box lunches

8) gowns

9) oximeter

10) staff purse


Extra added bonus points:

thermometers

ornaments off Christmas tree in lobby

everybody exits stage left, and there I stand

Being an ER nurse is weird sometimes. Especially when it comes to death. Most often when someone dies in the ER they are near death or dead on arrival. They die within a half an hour say, sometimes a lot quicker.

What usually happens is the doctor pronounces the patient. They tell the family they are sorry for their loss and exits stage left. Everyone else has already left. And there stands the nurse. The nurse is always the one left standing in the room when someone dies. Its like you can't leave. Someone has to stay with the family at least for a little while.

But it is awkard. You don't know the patient. You don't know the family. After you tell them you are sorry for their loss, then what? What do you say to someone who has lost a member of their family? Someone they have known and loved for years? Sometimes I will ask about the patient and listen for a while. Then I leave. I leave them alone. What else can you do? Hopefully there is more than one person so they aren't alone.

Of course people react differently to death. Some leave quick. Some want to stay for hours and have all the family members come to see the body. Some wail, some cry quietly. Some people don't know when to leave. It is often the nurse who has to gently suggest its time to go. Who else is going to do it?

My point in all this? Death is sad. Death is often unexpected. People react many different ways. No one trains us how to deal with sudden, unexpected death.

wanted: unemployed exorcist

I don't know if y'all are old enough to remember the movie, the exorcist. I never saw it, but who hasn't seen scenes from it where the little girl who is possessed, spews green shit and her head spins around..

Well, there are times (like today for example), when I think that that little girl is visiting our ER. There are people who when they yell, have this almost evil sounding voice. I don't want to go behind the curtain for fear that their head will be spinning, slime will be dripping down the siderails.

I often wonder what the other patients think as they listen to all this stuff. Does it scare them? A lot of times they will say: "you must be used to that kind of stuff". You honestly think that I get used to someone who sounds like they have a hankering to take possession of my soul? We need an exorcist.

you ain't fooling anybody

I find myself with an eerie sense of foreboding these days. Along with that eerie feeling, comes anger and yes, fear. Something bad is going to happen. The universe has to right itself and all that shit.

You see, dear readers, yours truly lives in the frozen tundra, way up north, so far north you would never even think of going there for fear of becoming a popsicle. (and thats the way we want it)

What usually happens in the frozen tundra in the winter, I say what usually happens in the frozen tundra in the winter? (shout out to Foghorn Leghorn) Thats right, all ye who read this blog, thats righ - snow, cold, ice, wind. But alas, this year we never had more than 3-4 inches of snow on the ground. No cold, some ice, little wind. Its like the universe has turned upside down and we are having fall in winter.

TODAY, MARCH 14, 2012 I ACTUALLY WENT OUT WITHOUT A COAT. NO COAT, people. It is 68 balmy degrees outside. There is no snow, no ice. The trees are budding. They too have been fooled.

Here's the thing, I am not fooled. I have lived here too long, suffered too much. I KNOW we will pay the price for this brief respite. I haven't yet put away my galoshes, my hand warmers, my shovel. YOU DON'T FOOL ME MOTHER NATURE. I am on to you. Next week I anticipate 2 feet of snow. It is basketball tournament time and we all know what happens then: blizzard.

All the other fools are gleefully frolicing through the dead grass. They have put away their moon boots. Not I. I stand ready, poised for the deluge I know is coming.

I'm scared.

don't cry, histrionic Harold, don't cry

I was gnarly last week, I admit it. Working too much with too few days off. No time for recovery of sanity.

So its my last day before a few days off. The black cloud that was hovering over me is slowly lifting. Then HE comes in. Histrionic Harold.

Red flags:

1) Medics wanted to give me report outside the room

2) From the time he arrived and was transfered to the cart, he made this WOOOOOOOOOOOO!!! sound while sitting there with his eyes closed.

3) Daughter arrives and does not want to go into room with Dad.

4) He normally gets care at another hospital.

So we manage to get throught the first few minutes. I am entering stuff in the computer and He is rambling on about all of his medical history back to the Mayflower. And I let him ramble. Half listening. Not really caring what he is saying.

I didn't give him the call light. I'm no fool. At some point he requested to have the call light and I had to hand it over. Mistake.

Periodically throughout the visit I hear WOOOOOOOOOOOO!!!

At some point daughter leaves in disgust.

First he will go home. Then he will stay. Then he will go home. Finally a bed is ordered. I consider making a run for it out the door.

I actually maintain my patience remarkably well. One thing about the ER, eventually even the worst patients leave. Besides, I'm off for a few days starting the next day, so its all good

an ER nurses guide to happy ER nurses

If I were in management I would have some rules about how ER nurses work. With the wealth of wisdom (guffaw) I have come by over the years I offer the following ideas/rules to retain your ER nurses and keep them sane:

1) Offer 10 and 12 hour shifts. Insane as it may sound, nurses like 12 hour shifts because it lets us have more days off. 98% of our staff work these shifts and we have been doing it for years.

2) No nurse can work more than two 12 hour shifts in a row. Three in a row is too much. By the third 12, the average nurse is ready to wring somebodys neck by the afternoon.

3) In a 7 day period, no nurse can work more than four 12 hour shifts. There are times when I work five 12 hour shifts in a week usually the week I work my weekend. Its way too much, especially if it has been a busy week. (see previous week re: wringing of neck)

4) A nurse can be scheduled only 2 out of 4 mondays in a month. Mondays suck. End of conversation. Nobody should be working every monday.

5) If possible, break up the shifts. Half the shift in one area, half in another area. So move the staff around to main ER, fastrack, triage, charge. Makes a shift a lot easier.

6) Have your staff do self schedulling. We have been doing self schedulling for years and it is probably the main reason people stay over the long term.

7) Put the important information the staff needs to know in a weekly email instead of throughout the week. Our manager has been doing this for a long time and it has cut way down on the emails.

8) When your staff has a really hectic, difficult day, thank them for working so hard.

9) Have good coffee in the break room instead of shitty coffee. They deserve it. (Small stuff makes a big difference)

10) On those rare slower days, allow the staff to sit around and socialize for a while. They need it.

rich patient, poor patient

There are areas of medicine that are profitable: cardiovascular medicine, stroke management, orthopedics (ie hip surgeries), diabetes care. In other words the problems that the now retiring baby boomers will soon be dealing with.

You can see hospitals setting themselves up to specialize in these areas where the money will be, building new wings with state of the art equipment and hotel like furnishings. Getting certifications in these areas so that they can make a big banner touting their "expertise" and hang it on the side of the building.

The parts of the hospital where people go who don't fit into the above categories are left to deteriorate. The medical/surgical floors, the emergency room. They don't make the money, so the money doesn't go there. You aren't going to find wood floors and single rooms in the med/surg areas.

This is especially true in a private inner city hospital. The places where the insured people go are nice. The med/surg area and the emergency room where the people on medicaid/medicare end up are shabby. Is this the future of medicine?

a full fledged shit storm

Take a full moon and put it in a pot. Add a few solar flares from the sun that somehow messes with geomagnetic shit. Add a 58 degree day yesterday that melted the snow. Stir in this mornings temperature of below 30 degrees which took those puddles and turned them into ice. Now add just enough snow this morning to cover those icy spots.

What do you get? I SAID WHAT DO YOU GET?!! A shit storm, thats what you get.

My first three patients shortly after arriving at 9 am were 2 psychotics and a drunk. That should have told me all was not well in the world. Then at 10 am the shit hit the fan. Throngs of people (yeah I said throngs) started appearing at the triage window with various pains from falling on the ice. This continued through the day.

Now these people were not your usual "I fell on my tookus and now I got an owie". Many of these people had broken bones. The day was a nightmare that didn't quit. It was one of those days when you said, this is insanity, what am I doing here?

change to the change that was changed

They told us when we got electronic charting that it would make things so much more efficient. No more paper etc.

Here's the thing with electronic charting...it is constantly changing and being updated. All to be more efficient right? Of course not. Every time some area of it changes, they add more things to do!

For example charting an IV start has become nightmarish. Here is what is required: size, site, time, date, prepped according to hospital policy (yes/no), number of attempts, things used to help you (ultrasound,etc), inserted prior to arrival?

Same for a blood transfusion. First of all, figuring out how to even find it is a challenge. First you release the unit in the computer. Fill out a paper !! and send to blood bank. Go in computer and fill out following: kind of blood product, unit number, expiration date, patient blood type, patient med rec number, special blood patient number, patient teaching, permission from patient to get blood, vital signs, administration rate, verify all of above with another nurse.

Don't even get me started on conscious sedation and what that requires...so if you wonder why your nurse doesn't spend much time with you - they are at the computer filling in the hundreds of blanks they have to fill in on a daily basis.

big mac with an advil chaser

Here's the deal..if you are sitting in the ER lobby with your injured "girlfriend" and you have the time and make the effort to:
1) go to McDonalds and order a #3 big mac and fries with a frosty coke
2) stop at the gift shop to get advil for your "girlfriend" sitting in the lobby waiting to go to an ER room

Chances are (tho you wear a silly grin) you probably could have managed at home. If you have the energy and are clever enough, self sufficient enough to get medicine for your "girlfriend" from the gift shop, you should have stayed home.

I am always amazed at the people who come in for minor things but they didn't even try a flippin' tylenol at home.

no pain, no gain in the ER

...and how was your work day?

deja vu..

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.

Thufferin' Thucotash!/naughty kitty

A lady gets in her car with a friend and goes on the freeway. They hear a strange sound and wonder if it coming from the radio, so they turn it off. Not coming from the radio. Its a distinctive: "meow....meow..."

They pull off the freeway and look under the hood, there sits a kitten curled up on the engine. She goes to pull the cat out and puddy don't like that, so it proceeds to bite her hand. Bad puddy tat.

Puddy tat runs away. Person comes to the ER a day later. There is no swelling or redness on the fingers that were bitten, but doc calls someone who connects her to the "state veterinarian" (who knew we had a state veterinarian? And why do we need one?) That person tells her that last year there were 7 cases of rabies from cat bites. Sounds bogus to me, but then I'm no the one decidin' what to do.

The patient will have the rabies injection. When a rabies series is given it is given in 3 steps. The first step is to take half of what is ordered and "infiltrate" the area around the wound. (stick a needle into it) Ouch. Then the other half is given by injection - 2 shots. Next step another shot one week later. Next step another shot 2 weeks after that. No fun for anyone concerned. Naughty kitty.

***DISCLAIMER DISCLAIMER DISCLAIMER***

I don't do disclaimers. I don't have a HIPAA disclaimer. But alas, due to the concern of a reader, I feel the need to make a disclaimer about my own personality...

I no doubt come off as a cynical, hard, burned out nurse bitch on this blog who thinks everyone I take care of is basically an idiot. True that (guffaw). Not really. I am basically a cupcake with a gooey creamy center of goodness.

I really don't hate the patients, I just don't like them. Bada bing. Seriously, most of the people I deal with are decent and believe it or not I think that humanity as a whole is basically decent.
My job is hard. Very hard. People in crisis are difficult to deal with. This blog reflects that. I talk about the more difficult and yes, idiotic among us, because it is more fun to talk abou them. It entertains me and you. I am prone to a bit of sarcasm, (ya think?) and even dramatic licence on this blog at times. (REALLY???)

So relax, sit back, enjoy. I go to work every day, do the best I can and go home just like everybody else. I can't help it if I work in a circuslike atmosphere and enjoy talking about the more bizarre aspects of it. So shoot me.