assholes and bullies

There are two kinds of people who come into the ER that I can't stand: assholes and bullies.

Being a nurse, you learn pretty quick that there are people in this world who make an art out of being an asshole. Asshole type #1: Their life is shit and you, the nurse, are going to pay the price for their shitty life. All of that bullshit therapeutic communication they taught you in nursing school isn't going to work with them..

Asshole type #2: This type has an exaggerated sense of their own importance. Everybody is supposed to cater to their every whim. They are more important than the other lowly patients.  If things don't go how they want them to go, look out.

Then there are the bullies. The verbally abusive who sometimes threaten the staff. I have absolutely zero tolerance or patience for these people. Especially those who threaten physical harm.  Ah can you say....SECURITY!

Here's the thing about nurses, assholes and bullies. As a group we put up with them, many times feeling like we have no choice.  True that, they have to get medical care too.  What gets me about a lot of nurses are two things:
1) They feel sorry for people like this.  Oh....they must have had a rough life...
2) They allow themselves to be abused, threatened without doing anything about it.

When I have a asshole patient, sorry folks, I avoid them. I do what I have to do and I don't go in their room unless they put the call light on or do my periodic checks. Now some of you would say, well, why don't you talk to them, maybe they are scared...no, sorry.  I do not have time for people like this.  I won't subject myself to it.

With bullies, I do two things:  If someone is verbally abusing me, I tell t em to stop, tell them it is unacceptable, and if they don't, I leave the room and come back later. If they threaten me physically, I call security.  Just like in a domestic abuse situation, I do not deserve to be treated this way.  I won't be. Again I avoid them, doing only what is necessary.

Perhaps some of you think I am being a hardass. Nurses are supposed to care and understand. Bullshit. Nurses are their to provide care and be treated respectfully.  End of story

YUP.

YUP.

So I'm sitting flippin' through the channels.  I have nothing to do.  I'm old. Its really cold outside.  So sue me.
Anyway....I happen upon the Discovery channel.

Untold stories of the ER is on.   It is a show in which they "reinact" incidents in the ER.  Its a dumb show. End of story.  While I was on Discovery, there was an ad for NY ER.  Hmmmm...never heard of it.  So I tuned in later.

It is a "reality" show.  It is based at Presbyterian hospital in NYC. It follows certain ER staff around, doctors and nurses. As usual the doctors are the stars, the nurses secondary. Of course, it is one trauma after the other. People falling off buildings, jumping off buildings, getting hit by cabs.  Blah blah blah.  I worked in a trauma center and it isn't one case after another, its one, at the most a couple,  per shift.  But hey, what do I know, its NYC, maybe its one after another.

The doctors are all good looking. Apparently the bald headed ER doctors with a paunch were out.  I guess all the handsome ER docs choose to work in NYC, 'cause these guys look nothing like the docs I work with.  The nurses come off as too nice. Sounds funny, but give me a break.  You work in a NYC ER trauma center, you ain't this nice.

There were a couple of good scenes actually.  In one, a woman was appearing before a judge and "fainted". When she came in she was "unresponsive" until they tried to cath her. Then she became real responsive and stood up on the ER cart.  I actually had a patient stand up on his cart one time.

Another one I enjoyed.  LBP by ambulance.  This guy had been getting any dope he could "to treat his pain".
Whats the first thing the doc gave him? Morphine.  Now thats realistic... a junkie getting narcs. Later on he became an asshole because "the monitor kept ringing and I couldn't sleep".

Another woman who was in prison swallowed a couple of toothbrushes (is that talent or what?).  While she was there she swallowed a battery.

All and all?  A pretty good show.  Will I watch it again? No.

things are not always as they seem

My hospital specializes in a lot of shit.  Cardiology, neurology, orthopedics, etc etc etc.  Therefore, as an ER, we get a lot of medically complicated, seriously ill people in addition to the usual ER baloney.
Some days it feels like this is all we get.

So there I am minding my own business at the desk. I'm up for the next patient. One is coming by ambulance. I click on the computer to see whats coming in.  45 year near syncope. Hmmm.  Somebody vaso vageled?  Tey are dehydrated?  Whatever, I can handle it. The're young.  How bad can it be?

Of course, there is way more to the story. Turns out this woman has cardiomyopathy, diagnosed 1 month ago after having increased shortness of breath.  They were found to be in congestive heart failure. Their ejection fraction is 20%.  Had probably been in atrial fibrillation for a couple of years without treatment.  They must have had some episodes of v tach or very rapid heartbeat  because now they have an external defibrillator.

So the simple syncope turns into a big deal.  This is typical.  What looks to be simple is really way more complicated.  Often times when we get a call about an ambulance coming in from medic control, the information is a couple of sentences, failing to mention all of this other shit.  Like they are a quadriplegic or post heart transplant or mentally disabled from a group home.

Sometimes I think, whatever happened to sprains and lacerations and appys and what you would normally think comes into the ER?  They seem to be a thing of the past, replaced by by the MI who is on dialysis, a crack head and of course has no veins....

george clooney doesn't work here (and none of our doctors look like him)

I don't think the public would ever believe what it is really like in an ER.  The people we really deal with.  The average person is not going to come to ER unless they truly are very sick or have an accident or something.  So the majority of people we see are not your average, functioning person.



NOT.

They are the dysfunctional, criminal, crazy people among us.  They are the people you move to the suburbs to avoid. 

Lots and lots of dysfunctional people come to ER, in fact, they are the bread and butter of the ER.  They are the people who have zero coping skills for one reason or the other.  Their life is one crisis after another and if there isn't a crisis, they will create one.  Expecting them to be organized enough in their own life to have a doctor is unrealistic.  When they come in, they act out all of that dysfunction.

We see some really creepy people in the ER too. Guys who want you to "hold the urinal for them". Sex offenders. People who "just got out of jail". Drunks who are so drunk that they pee and poop themselves. Violent people who want to kill somebody.

Then there are the truly mentally ill. People who hear voices. Manic people. People who try to hurt themselves while they are in the ER. People who get out of control and have to be restrained.  People who sometimes won't hesitate to punch us.

And we see the sad people.  Old people who lay on the floor for hours because they have no family to check on them. Young people who are already messed up because their family is dysfunctional.  Abused people.  Women who are raped.  People who are dying or die.  People who have bad things happen to them just randomly, through no fault of their own, and it will change their lives forever.
People who are terrible junkies or drunks and that's all they will be til it kills them.

This is the real ER.  The one you don't see on TV.

ha.....ha....haha...hahahahahhahahah

 

I am sitting at the triage window and as you come up, I take a drink.

 

deja vu to you

Red flags in the ER:
1) You say you have "chemical sensitivities".
2) You have more than 2 allergies.
3) You have fibromyalgia, chronic fatigue syndrome, some kind of syndrome no one has ever heard of.
3) You bring your MRI or CT with you, usually of your back, stating you can't get into see the doctor for a "couple of weeks".
4) You say you just moved here from out of town.
5) You bring a suitcase with you.
6) You brought something in a bag that you want to show me.
7) You can't tolerate the "pain" of an automatic blood pressure cuff.
8) You're allergic to haldol or thorazine.
9) You are 40 and your mother is accompanying you
10) You say another emergency room "don't know what they're doin'".
11) Your medical problem started in 1930.
12) You say "yes ma'am a lot.
13) Your relative is taking notes.
14) The medics want me to come outside of your room to give me report.
15) You are taking more than 3 psych meds.

Oh BTW let the chronic patient shit storm begin....3....2....1...go!

out to pasture

I've been an ER nurse for 23 years, actually 24 this year.  Is that unbelievable or what?  Am I crazy?
How did I work there so long? I raised a son. He kept me distracted from concentrating on the job.  The job was just part of my life. 

I've been thinking a lot about retirement.  I can retire early. So I will. I'll have to keep working though because I am quite a ways from real retirement age.  I need health insurance and the other benefits too. I've been thinking about what kind of job I would get. I want to stay in nursing because its good money.  Best money I'll make.

I've even started looking at jobs. None of them appeal to me. So it started me thinking about really leaving the ER. 

ER nurses have a love/hate relationship with their job. It is the most frustrating, overwhelming, stressful, exhausting job you could have.  Dealing with the sick public pretty much sucks people.  I hate to bust your Florence Nightengale bubble people, but it does.

So I think: What would it be like to not work in the ER any more? My life would be a lot less stressful. No more 12 hour shifts. No more exhaustion. Here's the thing: Despite feeling like I can't stand the job some times, there is a part of me that thinks I would miss parts of it.  OMG did I just say that?

There is part of met, despite the fact that I want to hit myself over the head for saying this, gets satisfaction out of it being so hard.  It is a perverse satisfaction, but there it is. A part of me enjoys the weirdness, the humor and variety of it.  A part of me thinks it is pretty cool that I can help save someones life.  A part of me likes the challenge. 

Then there is the part that is very tired. 

Be afraid. Be very afraid.

Yesterday sucked.  I was charge and it was one critical patient after another with no ICU beds. So people were there for hours.   Families unhappy.  Staff unhappy. Not fun.

So today was my 5th shift this week. Bleah. Not looking forward to today.  And then....and then.....a miracle occurred.   The God of emergency rooms decided to shine down on us.  The day was reasonable, so reasonable that it was almost eerie. 

Here's the thing:: When you work in ER, although you delight in, and celebrate, slow times, it also makes you very nervous.  Everybody is on edge waiting for the other shoe to drop.  No one talks about it.  The lack of patients.  We don't want to jinx it.  ER staff are very, very superstitious. 

So as the day goes on and it remains really, really nice, even WE, people of the ER, relax..  We shoot the breeze, fool around, generally just enjoy a breather.  Especially after the last month, with the rampant flu, that  has been horrible. We relax. Something we don't do often.

With relaxation comes reluctance to work.  So when patients come in there is a collective groan.  No, go away. We don't want any. Its almost harder to work when the day is slow than when it is crazy.

So it is so slow that I get to leave 2 hours early, unthinkable in the last couple of months.  Yay!!! There is no better feeling than being able to leave early. As I leave, I feel a little scared, scared for the night shift.  No doubt they will pay the price for our good times.  After all, everybody knows, eventually the ER universe always balances itself one way or the other.  If not tonight, then tomorrow. Fortunately for me, I'm off tomorrow!

crazy shit

This is the kind of crazy shit that goes on in my ER.  We give a narcotic injection to someone with chronic pain, who by the way, is currently in treatment.

the boomerang patient

You know its going to be a bad day when you are walking up to the ER entrance and there is a pool of vomit in front of it. Uh oh.

The first thing I hear is a man yelling at the top of his lungs. Hey, I recognize that guy.  He was here last time I worked.  Went to our observation unit.  It seems after carrying on all night there, he has boomeranged back to us. And of course there is no bed available inpatient.  So for the next 8 hours we get to hear about q30 minutes how unhappy he is with his life. Wonderful.

On a day when someone is yelling for hours in the ER, I feel like I am working in an insane asylum or a torture chamber, take your pick.  Its a - either the patient gets a shit load of Ativan or the staff does, type of situation.  Take your pick doctor.  Maybe some of the patients would like some too, since they are suffering right along with the rest of us.  Hey, Ativan for everyone...its an Ativan party!

You have to laugh on a day like this or it will kill you. It becomes comical really. You laugh so you don't cry.

Finally they come up with a bed and peace returns and the quiet feels kind of weird.  Like something is wrong.  Something bad is going to happen, I just know it...

liar, liar pants on fire

Humanity never ceases to amaze me.  There are people who come into the ER on a regular basis and they outright lie about themselves.  I'm not talking about their physical state or drugs or that kind of stuff.  I'm talking about their lives.

They make up stories about their lives. I have actually had a person tell me that they just got back from Washington DC because they were there lobbying for transgender rights. Ah...okay.  This same person tells this ongoing story about they are going to school to be a  rocket scientist (har).   They actually think that we think, knowing that they are the shall we say, low functioning individual that they are, would be going to school for anything.

Then there is the person who says that they have  this prestigious job at a local business. In fact they are so good at their job, that they recently were flown to new York and put up at a fancy hotel in order to compete on a reality show, which by the way they won.  They are expecting a check for $15,000 in the mail any day now.  OK, and I'm the next president.

Maybe they are playing a game with us.  I hope so, because...well I don't wanna think about if they aren't.  We are like sitting ducks in these situations.  We have no choice but to take care of them, despite the bullshit.  I usually just say...oh is that right...hmmmm..

When you work in the ER you realize just how many crazies there are walking around among us.

stand back.....shocking

Sometimes you only learn about the latest technology available by having patients coming in wearing the devices.

For instance, I had no idea there was such a thing as an wearable external defibrillator.  This is a device that is worn as a harness on the upper chest.  It continuously monitors the heart.  It has a built in defibrillator.  If the monitoring device senses v fib or v tach (fatal rhythms)  it sounds an alarm to warn the patient and then defibrillates them.

It is apparently used for patients with CHF (heart failure) or cardiomyopathy (enlarged heart) who may be too risky for surgery for an internal defibrillator.  It can also be used pre insertion of defibrillator.

I've only seen it once.  Its amazing whats out there.

dilaudid ala carte

You know what I just love? Those people who come in thinking that they are going to dictate what happens.  You know, the kind of person who requests what medication they want and how they want it.  They tell you what tests they want. They even tell you they want to be admitted and don't plan on going home.

Well, guess what folks? This isn't a cafeteria with different selections...you don't get a menu to choose from here.  You do what the doc decides.

Entitlement comes from all levels of society.  From the poor, who expect that you are going to arrange for a cab home to the upper middle class folks who think they can dictate how the visit is going to go. Espeically  irritating are those who say they know somebody in the administration or they know a doctor who works here. So what.

This happens a lot in triage, where people become irate because their doctor didn't call us to say they were coming. . I have seen people treat the triage nurse like shit calling them a liar, when told their doctor didn't call.   They think they will get in ahead of everybody else.  Not. they

up your nose with a rubber hose

Reason # 58 not to come to the ER for your flu symptoms:

Other than sitting for hours in the waiting room, we will be doing a "flu swab".  That is, if we have any.  There is a shortage of flu swab culturettes.

So what is a flu test like?  You know when you accidentally get water up your knows, that kind of painful feeling?  That's kind of what getting a flu test is like.  The culturette is a long wire thing with a qtip type thing on the end.  We stick it into your nostril. It has to go in a ways to get the sample.  Its not fun.

So don't come if you don't want us cranking something up your nostril

a bad butt implant

You wouldn't think we would deal with this in the ER - cosmetic surgery - but I have. 

I once had someone who had an infected buttock after getting a butt implant.  Yes apparently this persons butt wasn't big and round enough and they wanted an implant.
Apparently a silicone piece of stuff is placed in there and hopefully it stays where its supposed to.

Once I had someone with a tummy tuck problem.  Another infection.  In this one, fat and skin are removed that have stretched out.  What woman, after having given birth, wouldn't want a firmer stomach?  The thing is most of us aren't willing to go undergo major surgery with anesthesia to do it.

Last but certainly not least, a hair transplant.  It turns out this guy, who came in for another problem, mentioned he was also having trouble with his recent "Barclay".  "Barclay" I asked, what is that?  Apparently that is the name of the company that did it. The guy proceeded to take off his hat.  He had a ring of gray hair, and below that some straight, string brown hair. Hmmmm.....I didn't see any signs of infection and instructed him to put the hat back on... 

death warmed over

I'm thinking of taking a 3 month leave of absence.  Why? I absolutely, positively, dread the next few months because the flu season is already out of control.  ERs around the country are overwhelmed.  Yesterday our ER saw 60 more patients than we normally do.

Let me tell you how a bad flu season affects hospitals: Not only will ER waiting rooms be full, but hospitals will have no beds.  A lot of the time the flu hits the elderly, the very young and the chronically ill particularly hard.  Those people end up being admitted.  Now add those people to a hospital with a normal census and you have a recipe for disaster.  I already hear talk that there is a shortage of ventilators.

What does this mean for the ER? If you have to be admitted, you will be waiting hours for a bed, in fact you may be in the ER overnight waiting. What does this mean for the normally healthy people choosing to make a bad decision and come to the ER for your flu symptoms?  You will have at least 3-4 hour wait, if not longer, in the waiting with a mask on.  The people who need admission to an inpatient bed have backed up the ER making no beds available to those in the waiting room.    So prepare to set up housekeeping out there.

 Don't come if you are normally healthy and are not severely dehydrated, short of breath, confused,  elderly, a baby or have some other chronic illness.  Please??

Don't have the flu? Don't want to get it?

1) Get a flu shot.  Drugstores give them for $25.  Might be the best 25 you spend this winter.
2) WASH WASH WASH your hands. In fact invest in some of that stuff you can carry around to clean your hands.
3) Stay away from coughing people or people who look like death warmed over.

a typical shift in the ER

When you work in the ER, you see everybody from the drunk who passes out on a daily basis on the street to Mr. billionaire owner of an international corporation and everybody in between.  If they present at the triage desk or brought in by ambulance you have to deal with them.

So yeah, you're gonna to have to take that drunk that crapped his pants if you're up for next patient. You're probably gonna have to clean him up too.  And here's the thing, he will be here for hours because detox is full.

And you're also going to have to take Mr. VIP with his private duty nurse and hovering family who put the light on every 5 minutes because dad needs to be repositioned, needs a drink of water, has just one more question.  And don't you act impatient, because VIP daughter knows the hospital CEO and won't hesitate to call her.

Oh and that sex offender in bed 3, you're going to have to take him too even though you want to take a shower every time you exit the room.

The gangbanger who has been shot and isn't happy your trying to help him. He just wants to go and is using words even you who have been working in ER for years, have never heard.

Oh by the way, there is frequent flyer Francis who last time she was here and couldn't get narcs, through themselves on the floor and had to be carried out. 

Uh oh, there is Anna the allergy princess.  She has 75 allergies and many "chemical sensitivities".  She who has that darn abdominal pain that "nobody can figure out" despite a few exploratory laps.  Several doctors have "fired" her.

Last but not least for this shift: There is heroin addict Hortenz who has a nasty abscess on her arm from a contaminated needle. Oh, did I mention she has MRSA and is HIV+?  Sorry forgot....

Just another day in the ER....

the most interesting man in the world

I like to share my interesting finds with y'all...

Dear John/Jane Q. Public:

Dear John/Jane Q. Public:

You have the flu.  That sucks and is a shame, etc. Its a bad year and right now ERs are filled with people with the flu.  Which is stupid. 

ATTENTION ALL FLU VICTIMS:

Follow this closely:
DO NOT, REPEAT, DO NOT,  COME TO THE EMERGENCY ROOM FOR YOUR FLU SYMPTOMS UNLESS YOU ARE:

1) >98 or < 1  years old
2) are dying

There is nothing we can do for you people. You are just going to have to ride it out.  You are going to have to do what people used to do in the old days: rest, fluids, perhaps chicken soup.

You are clogging up ERs right now, leaving less beds for the truly sick.  Your mother could be having a heart attack and we don't have a room for her because you and your flu are taking that bed.

If you do come, you will wait for hours in the waiting room with a mask on your face.  That doesn't sound very fun does it?

One last thing, DO NOT call an ambulance for flu symptoms.  It will not get you a bed in the ER any faster.  You will go out to the waiting room with everybody else.

That is all. Go about your business.

you getting older means I'm getting older

My son is 20 today, no longer a teenager.  Yikes. 

Perhaps this is inappropriate, but he knows how inappropriate I am anyway...

saturday night fever

I have already told you about the sophisticated, two hour long post bed bug patient visit shenanigans that is now policy at my hospital.  Well, now I have a new thing to add to the fight against vermin.

This has been around for about a year. It is a robot vermin destroyer. It looks like R2D2. It uses ultraviolet light to destroy bacteria.

Picture this: Its 1979. You are in your spiffy dress, you boyfriend in his 3 piece suit. You are on the dance floor at the local disco doing a bad imitation of John Travolta and that girl in Saturday Night Fever.
Strobes of light hit you and your partner as you get funky, get loose in the middle of the dance floor.

Thats what the robot looks like when it is doing its thing. A disco.  I am tempted to go in there and let my inner Donna Summer (RIP) out.  Anyway, at this point it is being using for post c diff visits.  BTW,  each robot costs $80,000.    Worth it?

we interupt this blog...

***PUBIC SERVICE ANNOUNCEMENT***

Attention all citizens:

The following are not emergencies:

1) bug bites - unless it have swollen to the size of a baseball

2) the fact that you cannot control your teenage daughter or son

3) you are fatigued or can't sleep

4) you want your son, daughter, brother, sister, etc. to get chemical dependency treatment

5) the condom broke

6) you are hungover

7) G tube not working

8) the cut is less than 1"

9) any kind of medication refill

10) menstrual cramps

That is all...go about your business.

post christmas santa follies

I know Christmas is over...but this is too funny to pass up.
From one of my favorite docs: ZDoggMD