tomorrow...I become just another nurse..

Well, tomorrow is the big day. The day in which Madness puts away her polyester white uniform dress, white hose, cap forever. The things that gave me an identity and made me stand out in a crowd, gone. I now just become another nurse in the same dreary color as the rest of the nurses. Apparently that is the way the management wants us. Yes tomorrow is the onset of the new "uniform program".

We will all look alike, just like the postman, the UPS driver, those who work at McDonalds. Just drones working on an assembly line. All in the name of "patient satisfaction". Yes "patient satisfaction" dictates that all the little nurses all dress alike in their little scrubs.

Next we'll probably have to all have the same hairdo. The same eye color. The same phony smile. Then we'll all be robots just like they want us to be.

HELLO HUMAN PATIENT

I AM MADNESS, YOUR ROBOT NURSE

I WILL BE YOUR NURSE TODAY.

WHAT SEEMS TO THE PROBLEM?

OH THAT IS TOO BAD.

LET ME GET YOU A WARM BLANKET, FOOTIES, A BOX LUNCH, A WARM WET TOWEL FOR YOUR FOREHEAD, A CAB VOUCHER OR TOKEN. THEN OF COURSE ALL OF THE NARCOTICS YOU WANT...

I AM MADNESS, YOUR ROBOT NURSE.

your life in my hands

That's me at the triage window. The one who looks exhausted and a little bit peeved. I watch you walk down the hall towards me and, like it or not, I sum you up in seconds just by the way you carry yourself. I watch you walk in and see how you approach me.

Are you shuffling? Are you frantic? Do you have to stop to rest on the way? When you get to the window do you go into excruciating detail going back five years about why you are here? Do I have to pull what's wrong with you out of you? Are you hanging over the desk in a dramatic fashion? Are you pale, sweating? Short of breath? Did you come alone? Do you come with a posse? Do you immediately ask me how long the wait is? Do I need to run you right back? Are you accompanied by the police? In handcuffs?

I will have a pretty good sense of the seriousness of your condition and what kind of person you are before you even come through the triage door. After about a year in ER you are pretty much an expert on the human race and all its quirks and personalities.

I can go into a room and take one look at you and sum up how sick you really are. You might think that sounds unfair. I am not giving you a chance. Its reality. I have to be able to sum you up quickly. If I can't tell if you are real or fake, a wimp or really sick, I'm not doing my job.

I am the first one to see you. I have to develop an instinct for people. If I don't you might die. If I assess you in your room and you are in trouble and I don't intervene immediately or call the doctor, you probably going to go down the toilet.

When people come to the hospital, often they concentrate on the doctor: when can I see the doctor? Where is the doctor? You really should be concentrating on me because I'm the one who will prevent you or your loved one from deteriorating. I'm the one who spends the time with you, monitors you, trusts my gut when dealing with you. Your life is really in my hands. Especially if you really have a real emergency.

that will be $500 up front maam

The public doesn't realize something about medicine, about hospitals. It has become a business, a corporate business. The days of the individual hospital fell by the wayside years ago. The vast majority of hospitals are now part of corporate conglomerates. Most hospitals are nonprofit. That gives the public the mistaken impression that they aren't in it for the money. Wrong.

The whole nonprofit thing is a misnomer. Nonprofit means there are no individuals who own stock who make money off the hospital. The profits go back into the organization. Here's the thing, INDIVIDUALS are making huge profits off these nonprofit hospitals: CEOs, administrators, doctors. CEOs or these hospitals often make millions in salary and bonuses. Doctors, especially specialists such as interventional cardiologist, neurologists, surgeons can make several hundred thousand a year easily. You don't think this leads to unnecessary procedures do you? Oh..of course not.

The nonprofit hospitals put the money where they make the money. Where do they make the money? Cardiology, neurology, orthopedics. In other words those profitable angioplasties and other cardiac procedures, strokes and interventional radiology, joint replacement surgery. This is where they put the money and this is where the specialists make the most money. Often times the rest of the hospital, that doesn't make as much money or loses money is left to deteriorate.

Now these nonprofitable hospitals are beginning to hire firms to aggressively seek payment up front of deductibles and co pays. Staff are trained via "scripts" to convince people in ERs, for example, that they have to cough up the money while they are still in triage. The fact that they are sometimes too agressive is front page news in my state after an attorney general investigation.

This is modern medicine folks. Do profits and money and health care mix? What do you think?

nursing thy name is Madness

Dear Madness the nurse:

I am a second year nursing student and I look to you as a role model. To me, you are the epitome of what a nurse is. Thank you for being an inspiration.

Sincerely

A Secret Admirer

Dear S. Admirer:

Oh, I do declare, you make blush..I do leave the other nurses in the dust don't I? A familiar scene in my ER: Me doing CPR with one hand, pushes meds with the other, on the phone to lab, shouting orders to the lesser minions, all while dancing a jig.

***

Dear Madness the nurse:

Nurses uniforms have changed so much over the years. They have gone from looking like a nun to scrubs with cartoon characters. In your opinion, what is the proper uniform for a nurse?

Sincerely,

Just Curious

Dear J. Curious:

I have been wanting to speak about this subject for a long time. The only proper uniform for a nurse is a polyester dress with a zipper up the front. Its all that I will wear. Of course, I wear a starched cap, white hose and white "nursing shoes". I of course, carry a fanny pack. I think nurses who carry fanny packs look so professional. Here is what I have in it:

kelly clamp
scissors
tape
alcohol wipes
emesis basin
urinal
bed pan
gloves
IV catheters
dressings
nasal cannula
neb kit
IV bag
IV tubing
motrin
eye drops
breath mints
snickers bar
diet pepsi
kleenex
pens
toothbrush and toothpaste
cell phone

I know thats a lot of stuff...its a very large fanny pack, more like a back pack...quite unweildly at times...it has saved many a life.

oh its true, its damn true..

Dear new ER staff:

As you start your wonderful new career in ER, here are a few unwrittent rules you should know about.

1) If a patient comes in on a backboard they will have to go to the bathroom within minutes of arrival.

2) If a patient comes in with a probable broken hip they 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 will 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.

I don't care if you can't chunk a deuce

Sometimes the ER smells like a pig pen. Literally. Shit is running off of carts and on to the floor.

Speaking of poop, why does anyone ever come into the ER with constipation? ATTENTION ALL CITIZENS OF THE US:

*****CONSTIPATION IS NOT AN EMERGENCY. I REPEAT. CONSTIPATION IS NOT AN EMERGENCY. THAT IS ALL. GO ABOUT YOUR BUSINESS.*****

If you come into the ER with constipation, you will be viewed as the frickin' idiot that you are. I don't care if you are 102, the fact that you haven't had a bowel movement in 3 days is not an emergency. While we're at it, why is it that old people are obsessed with having bowel movements? Its like if they don't have a daily poop, its a crisis...

By the way, I don't believe you when you say you haven't crapped in 2 weeks. Don't believe you. Sorry. You wouldn't be able to eat, drink. Go home.

Attention all ER docs: IF YOU ORDER AN ENEMA, ESPESCIALLY A TAP WATER ENEMA, YOU WILL BECOME A HATED FIGURE. THAT IS ALL. GO ABOUT YOUR BUSINESS.

When I see a constipation coming my way, I run for the med room, staff lounge, bathroom, pop machine, develop a sudden interest in my patients personal life.

Don't come to the ER for constipation. The ER staff will hate you. And while I am at it, don't bring in granny or grandpa either. Have you ever tried to give an enema to an 85 year old? Its a recipe for diaster for all concerned. Now we hate you and your whole family.

sitrep: OUT OF CONTRL

You know those days when its bright and sunny and then you see it on the horizon: a line of ominous looking clouds...You think to yourself: Its OK they'll probably just go around us, la de da, as you frolic through the meadow full of daisies. The wind starts to pick up a little bit. It cools you off, feels really good, frolic, frolic. The line of clouds move closer, its cooling off. Uh-oh...better start thinking about leaving the meadow and heading home. Its starts to rain a little...no big deal.. you still have time to get home. Then all of a sudden- WHOOOSH!! its a downpour, hail starts bouncing off your noggin, there is a crash of thunder. Here's the thing: There is no where to go. You are stuck in the middle of a thunderstorm and there's no way out.. And that describes today in the ER perfectly.

We are half full, the staff is actually able to interact with each other, goofing off a little. Its start to pick up. Four or five patients in triage. No big deal. Then suddenly there are ten people in triage. There is a critical patient on the way. They have a problem that needs immediate attention but they aren't going to take a dirt nap anytime soon. Then you hear it: Stab to the room next door to your room with the critical patient. A few minutes later, overhead: "help needed in the ambulance garage". A really bad thing. When help is needed out there, the patient has crumped.

Here they come, CPR in progress...you know the rest. About five minutes into that: Stab to the 3rd stabilization room. Its raining..damn it hailing with winds of 60 MPH...I think I see a funnel cloud..the ER is officially OUT OF CONTROL.

a cockroachectomy

Ah, the modern cockroach. A miracle of nature really. Rumor has it that it could survive a nuclear holocaust. Not a fun thing to have in your house, thats for sure. Not a fun thing to have crawling around on yer bod either. But it happens. You could be snoozing, sawing logs as it were, and in it goes to your ear. Seems like a good place to set up shop..

You wake up and feel something in your ear, maybe hear something in your ear. You may suspect its a bug. So who ya gonna call? Certainly not ghostbusters. No y'all know exactly where yer goin", right on down to yer neighborhood emergency room.

Here's the thing about having a cockroach in your ear that the average ER nurse enjoys: we don't have to have anything to do with it..this operation is all about the doctor. It is most certainly out of my scope of practice to have anything to do with going inside somebodys ear. Its one of the few times that the doctor has to deal with something icky. Its one of those few times when the doc can't say: "bed 3 (who has been having diarrhea q10" since arrival) needs to get on the bed pain" and gleefully walk away.

The doctor has to look and see that indeed, there is a squirming roach in your ear. Most of the time, they put in a gelatinous substance called viscious lidocaine which not only numbs the ear, but suspends said cockroach in a gooey substance for easy removal. Down the toilet it goes and out the door you go happy as a clam.

my brothers and sisters need help

Here is something shocking: every 80 minutes, a veteran commits suicide.

Do you care?

its no fun being a drug seeker any more

Dear Mr/Ms drug seeker:

Let me preface this by saying: I FELL SORRY FOR YOU. Your glory days are coming to an end. The time of easy access to drugs, at least in a hospital, is slowly changing. Yes, believe it or not coming in to score an easy Percocet script is becoming a little harder these days.

Now I know a lot of you aren't exactly rocket scientists, so let me explain it to you.

1)With the advent of electronic medical records, we are able to see if you have been at other hospitals in our system to try and score narcs. Its all there in clear type, accessible as you soon as you give us your name. Most of you don't know which hospitals are affiliated with each other, so you don't realize we can look you up.

2)There is now a statewide system in which all narcotic prescriptions are tracked. All prescriptions written are required to be reported. All MDs, NPs, including those who work in ERs have access to this system. We know if you have been prescribed narcs last week.

3)Many of you are very dumb, in that you tell us you were at so and so hospital about this same problem. Of course, then we are going to ask your permission to review those records from the other hospital. Nowadays, this is very easy to do, often can be done right on our computers. If you refuse permission, forget any kind of prescription.

4)Most ERs require photo IDs at triage these days. There are policies in place that MDs will refuse to write you a narcotic prescription if you don't have an ID.

5)Many hospitals/ERs are developing policies in which they refuse to give narcotic prescriptions to those with chronic pain. They will not replace lost, stolen, expired prescriptions.

Alas, life becomes rougher for the drug seeker...

Sincerely,

madness the nurse

triage: before and after

This is me in triage:

before triage:

during triage:

After triage:

ten, count 'em ten, weird moments in the ER

In my 59 years in the emergency here are a ten weird things that have happened:

1) A man comes up to the triage window and says his car broke down a couple of blocks away and can we borrow him some money. He promises to pay us back.

2) My 250 pound patient becomes so agitated he stands up on the ER cart, swinging his arms around and almost goes over the side.

3) I am triaging a woman and when I ask her when her last period was, she says, "I'm not a woman". Fooled me.

4) A kitten is found wandering down the hall in the ER. My coworker takes it home and adopts it.

5) A man ties up his dog outside the ER and comes in to be seen.

6) My husband is sitting outside the ER entrance waiting for me to come out. A car pulls up in front of him. Suddenly 3 or 4 cars appear and people jump out with guns and rifles, pointing them at the car. A cop yells to my husband to "get down!". It turns out that the guy in the car was wanted for murder and the cops had been trailing him.

7) A man comes in with a cat bite. He and a friend had been driving on the highway and heard a strange sound coming from the front of the car. They found a kitten curled up under the hood apparently trying to stay warm on a cold day. When they went to get the kitten out, it bit him. Rabies shots.

8) A man is on a flight from an Asian country to Canada. He becomes so drunk that they can't arouse him. They divert to our city and he is brought to ER. He doesn't speak any english of course.

9) A man comes up to the ER desk and says that he is God. He says it took him a long time to figure this out. Does he want to be seen? No he just wants to know the way to McDonalds.

10) A man in his sixties comes in and for some reason that I can't recall, we take his shoes off. Lo and behold there is a baggie of crack which we confiscate and give to security. They flush it down the toilet. At the end of the visit, the man becomes irate because he wants his crack back...

And the beat goes on...

Letters to the Editor

Dear Madness the nurse (AKA Girlvet):

I don't understand why you continue to be an ER nurse. You seem to hate everything about it: the patients, the management, etc. I'm sure that your hateful attitude is reflected in your care. I think you should quit for everybodys sake.

Sincerely,

Persephone Patterson

My dear Persephone:

You are right. I hate my job. I hate the patients, the doctors, the management, even my co-workers. At this point, I am only staying with the job to punish people who have done me wrong (i.e. the people already mentioned).

Yours always,

Madness

***
Dear Madness the Nurse (AKA Girlvet):

How do you deal with all the disgusting things that come out of humans: poop, pee, snot, vomit? Its so gross..

Sincerely,

Peter Patterson

You silly boy Peter,

To deal with it, I push it off on my co-workers, usually techs, who are after all, "under the direct supervision of a registered nurse" and therefore, I rule their world. 'Nuff said.

Hasta la vista

Madness

***

Dear "Madness" the nurse (AKA "Girlvet"):

Is this blog real? Some of the stuff seems proposterous. I mean really, no job is this bad. Come clean, who are you really?

Sincerely,

Philomena Patterson

Dear "Philomena",

"Philomena"? Who names their kid "Philomena"?

Anyway, "Philomena", okay ya got me. My wife, Gladys, works as a housekeeper in an ER. Every night I have a Bud light ready for her and she sits down in the lazy boy and regales me with stories until she passes out from one too many Buds. Then I go to the computer and take on my "Madness the nurse/AKA Girvet" persona. As Madness I am a cranky, cynical, old bitch who's been an ER nurse way too long. I'm burnt to a crisp. I think that unless your arm is hanging by a thread, you ain't an emergency. Eerily, its almost like I have become Madness. Gladys doesn't know about this little side activity of mine. Don't tell her. Its our secret...

Don't take any wooden nickels,

Madness

cool pictures

don't turn your back

I don't scare easily. After all the years in ER, dealing with all different kinds of people, you almost get used to dealing with nefarious characters.

There are times though when I have been scared of a patient. There are some people who make the hair on the back of your neck stand up. You sense that they aren't like everybody else. Most of the time there is some good left in junkies, drunks, etc., Especially when they sober up.

Then there is the hardened criminal. Somebody who has spent time in prison, in a ruthless environment where it is survival of the fittest. Either that or the person is a sociopath who doesn't know right from wrong and just doesn't care. These people have an edge and you can almost see the violence in them. Its like they are living life on a knifes edge, poised to strike out at a moments notice. Commit violence. You sense that this is not someone you want to piss off, because they wouldn't hesitate to slam you into the ground.

Those are the people that scare you. Those are the people that you immediately call security and don't approach them without them being right there. You never go in the room alone with them. You never turn your back to them. You never allow yourself to be cornered, you always stand near the door, an escape route. Sometimes the people we deal with are really dangerous.

all nuts, all the time

Man I have had some really weird patients lately.

Someone ran out of their room, heading for the door and was tackled by security. Almost hurtled over a bed coming around the corner. After the patient in the bed saw the person running, they got up and ran to the main lobby thinking that some criminal was escaping.

One of my patients through a phone receiver into the wall as hard as they could.

Then there was the person who doing acrobatics on ER cart in a fit of rage. Of course they took their clothes off before the acrobatics began.

I had somebody who was out of it and would literally not sit still. Restraints weren't an option.

People yelling at the top of their lungs because they didn't get admitted/didn't get the narcotic script they wanted, having to be escorted out by security.

People smoking in the bathroom.

Scary ex convicts with a pensity for violence needing to be restrained.

All this in the last 10 days. Has the world gone nuts?

thats about the size of it