year...new....happy

geez madness why don't you get all serious and shit

We don't think about this much but we see tragedy every day as ER nurses.We almost get used it. Some are worse than others. Some stay with you and haunt you.  You think about the person for days afterwards.

There are two kinds of tragedies: Those that happen to people through no fault of their own and those that happen because of stupid choices in life.  The inclination would be to feel more sorry for those that happen to people at random.  In the end, its all the same for whatever reason it happens.  The person will suffer.  The family and friends will suffer.

One thing about being an ER nurse, you really just how unfair life really is. You realize how much a lot of people are suffering in this world. Its reality and it hits you in the face on a daily basis.

How do we, as nurses, cope with it? I've been doing this a long time and I wonder how I have lasted so long considering all the bad stuff you see. Most of it I leave at the door when I go home.  I've developed the ability to let it go, maybe put it in a box.  I think people in ERs use humor a lot to get through.  We develop tough exteriors as a way of protecting ourselves.  That's only natural.

The thing is there are those cases that stay with you for a while.  Eventually you let them go too.  You just hope for the best for that person and their family.  Its all you can do.

hahahahahaha

working in the ghetto

I was thinking how much my ER has changed over the years. When I started, even though we were in the middle of a poor neighborhood, we were more like a suburban ER.  Our clientele was more suburban, white, very few neighborhood folks came in.  They went to another hospital in the neighborhood.  Then that hospital closed.

More neighborhood people starting to come in, but a lot of them still went to the county hospital downtown. I think eventually they figured out that if they came to us, the wait was less. They also figured out the chance of scoring some narcs was higher with us.

Now our ER has become what it always has been: an inner city ER in the middle of the ghetto.  We see lots of neighborhood people now.  We are seeing more of the folks living on the edge of society: drug users, criminals, drunks. People you would expect an ER in our location to see.  Its not unusual to have a heroin OD in one room, a crackhead in another and some guy getting arrested in yet another.

The rest of the hospital still maintains its suburbanite feel for the most part.  The areas of medicine that the hospital specializes in attract people from all over for admission. The specialties are where the money is in medicine. Thats where the money goes.  Those areas are brand new.  They have to be.  They attract the people with insurance where the reimbursement is better.  Its what those with insurance expect.

Meanwhile the ER looks like the  neighborhood we serve: rundown, falling apart.  We aren't a priority in todays healthcare.  Our patients are on medicare and medical assistance,  not money makers.

We live in a different world in the ER, compared to the inpatient side. We are like run down  island of the poor and dysfunctional in the midst of a shiny suburban mall.  No one pays much attention to us.

a Madness Christmas Eve

So I worked Christmas Eve.  I hadn't worked it in years.  I don't have to work holidays anymore because I have been a nurse since time began.  I did it for the money.  Yes, its true, it wasn't out of a need to soothe fevered brows at Christmas. I make triple time on Christmas.  Its all about the benjamins. I worked an evening shift.

Now, naive me, I thought it would be slow because, really, who is out on Christmas Eve? Everybody is all nestled snug in their beds and shit, right?  Waiting for the arrival of the Big Guy. Wrong. It was no different than any other night.We had the usual fun patients.Here's an ode to one of my favorites...

Join me kiddees as we sing that old favorite: "Sally the Crackhead Prostitute" (to the tune of Rudolph the Red Nosed Reindeer):

There were neck pains and chest pains, and headaches and finger lacs,
earaches and sore throats, and  calf pain and people with sore backs,
But do you recall, the most irritating patient of them all?

Sally the crackhead prostitute,
Had a very bad tooth pain
And if she didn't leave soon
We would all go insane.

All of the other patients,
tired of all of Sallys screams
knew that this ER visit
would cause them to have bad dreams

Then about eleven twenty three
The Er doc came to say
Sally with your silly antics
you won't get any narcs from me
Then all the ER staff loved him
they had to take no more
Sally the crackhead prostitute
get your ass out the door!

on this day

On this day when we all get together with our families, I ask that you remember our soldiers who are away from their families all around the world.  Right now 150 marines are waiting to go into a very dangerous situation Sudan to rescue Americans there. Say a prayer for all of our brave men and women today.

Merry Christmas.

an ER night before Christmas

TUESDAY, DECEMBER 20, 2011

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, 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 on 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 tied 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.

the Airing of the Grievances

I'm a little late with this...Festivus was officially yesterday, but I've been busy.  So I have to do this today.  Yes, its time for the "Airing of the Grievances", one of the hallmarks of any Festivus celebration.

So, of course, my grievances will be geared toward my job. (what a shock)

#1 I understand the need for more efficiency and clarity when it comes to charting, thus the coming of the electronic medical record. Hey I really don't mind it, except it has done nothing to make things more efficient.  It has added lots of time to charting. As time goes on, "tHe EvIl ChAnGerS" (see Dec 12 blog post), are coming up with more and more blanks to fill in. My job has mostly become blank filleriner.  So, don't lie and say EMRs improve health care.

#2 I understand the need for more safety when administering medications, thus the invention of the drug scanning device. Every medication we give now requires us to log into the computer, scan the wristband,
scan the med, chart the med...no big deal right? Wrong. ER nurses often give multiple meds. (You can never give too many meds right?)  We can give compazine, benadryl, zofran, dilaudid for the simplest case of nausea and vomitting.  Safety comes at the expense of more time consumed.

#3 Once again, I understand the need for more safety when administering medication, thus the pharmacist these days check every med that we administer.  They have to approve it before it appears in the pyxis and we can take it out.  Wonderful right? No mistakes. Wrong.  It can take, depending of the day, up to 45 minutes to get the approval.  Delaying care, making care less efficient.  We can override a lot of meds, but no oral meds, including things like tylenol, motrin, aspirin.  We can't be trusted to take those out without approval.

#4 I appreciate when I get a gift from someone in an effort to show appreciation for what I do through the year. However, when that gift costs about $1 and bears the logo of the group giving it out, I'm sorry, perhaps I am ungrateful, but don't bother. I break my butt for our ER and you and this is the thanks I get? Another nail in the coffin.

Thus ends this years Airing of the Grievances. Good night.

Dear Mr. drug seeker..

Dear Mr. drug seeker:

Some friendly advice: When you come in for pain and nausea and after you are triaged, tell us you are heading for mickey d's before you go back to a room, then you chow down in the lobby, we are probably not going to take you very seriously...

In fact, we will look at you as a moron.  The triage staff will document your activity in the waiting room.  The doctor will look at it and you will get tylenol.  Except for your gourmet meal at Micks this was a waste of your, our, and the taxpayers, money.

Sincerely,

and with a shitload of affection,

Madness the nurse

man candy saturday

our social worker is a softy

Y'all probably think I hate my job reading this blog.  You'd be right. Har. Bada bing.

Seriously there are things I like about it.  One of the things I like best is how funny it is. You might think, how the hell can an ER job be funny?  Being about tragedy and shit? Yeah thats true some of the time.  That part sucks.  What what keeps us coming back are the funny parts.

Like yesterday.  I'm in triage.  A guy comes up to the desk and asks to see the social worker. Thats it. Doesn't want to be seen, just wants to see the social worker.  Whatever.  I call our long suffering social worker and she agrees to come out and see this guy.

Oh BTW, did I mention that when he originally came up to the window, he asks if he could take the pop cans from the recycling bin home?  I said no, I don't think we can let you do that. You know me, I'm a bitch.

So anywho, the social worker comes out and goes out to the waiting room to talk to him. Turns out he came to ask if he could get some money for Christmas presents... Well, unfortunately our Christmas present fund was at zero, so sorry, we won't be giving you any Christmas present money.

But now listen to this! Our social worker told him he could take the pop cans! She said, ONLY FOR TODAY THOUGH, you can't come back..  What a softy.

And that folks is why we keep coming back.

bad mom

The blogs been a real bummer these past couple of days.  Here's a change of pace.

Remember when you were little and you just couldn't wait for Christmas morning to open your presents?  You begged to open one early?  Please, MOM, JUST ONE?????!!! Well Mom finally gave in...

Its worth watching the whole thing.

hospital killings

The epidemic of violence in this country comes to medicine. In last month there have been 3 incidents in hospitals and one at a doctors house.

1) In Reno today two people were killed, others injured when a gunman came into a hospital.

2) A nurse in Texas was stabbed to death and 4 others injured in a hospital in late November.

3) Man killed fleeing from Childrens hospital in Milwaukee after brandishing a gun when police tried to arrest him there in mid November.

4) In my area a doctor was killed when the son of a former patient killed him at his home.

Scary fact: From 2000-2011 there were 154 hospital based shootings with 235 victims.  (from 2 minute medicine) 

Not only do we have to worry about violence by the patients, now there is increasing violence from the outside as well.

Our ER has no metal detector.  We are wide open.  Its scary.

Do you have metal detectors? How do you control movement in and out of the ER?

don't forget them

Sorry about the lack of blog posts this week.  I have been making lots of bracelets for the customers in my etsy shop.

Today we learned that 6 American soldiers died in a blackhawk helicopter crash.  Keep their families in your prayers.  Please don't forget the soldiers who are deployed this holiday season.

man candy saturday

sex brought me to the ER

Just when you thought it couldn't get any weirder, I see an advertisement for a new ER reality show: "Sex sent me to the ER" on a cable channel coming this month to a TV near you. No doubt this will be a real laughfest...

I've been in the ER a long time and I have, for the most part, missed out on sexual shenanigans that brought patients in, although I have heard stories from my co workers. Mostly along the line of somebody put something up their butt and they can't get it out and oh by the way, its still buzzing for everyone to hear.  People getting stuff stuck on their johnson and it has to be cut off.

Hearing these stories amuses us, but seriously ya heard one of these you heard 'em all.  Whatever. Mostly we just look at people in these situations as stupid.

This is brought to you by the same people who do the show "Untold stories of the ER".  They contacted me once and encouraged me to send in an unusual story.  The kicker is they want you to be on the show to be part of the story.  Ah...no thanks.  So I'm wondering will that be the case with this show?  Will the doc or nurse be on the show?

Lastly, what kind of person would agree to have their sex problem stories be told to the world at large? Morons, that's who.

where evil lurks

They live in the basement, back in a dark, damp corner.  Thats them with their laptop, sitting on their cot, conniving against us.  They exist in the shadows, never coming out into the light. They slink around the hospital... unseen but always looming, always waiting, ready to pounce. Who are they?

They are the people who make your life a living hell.   The people who MAKE THE CHANGES. (ThE EVIL cHanGerS)  They are the ones who decide to buy the stupid new products because they get a good deal.   They change the electronic charting to "make it better".  They come up with irrelevant new policies.

Of course ThE EVIL cHanGerS make twice the money you do. They haven't seen a bedside in 20 years. They have a lot of letters after their name. They wear REGULAR clothes.  They like to gather in groups to scheme about new changes. They seem to breed like rabbits.

They buy things like the new .5 mg Dilaudid syringes which take a rocket scientist to figure out how to use and actually come with a video to explain it. They buy IV tubing in which connecting tubing to a saline lock or connecting a piggyback requires 20 attempts. They change charting to "become more efficient".  The thing is it requires 20 more steps to complete. It makes charting a blood transfusion akin to building a nuclear reactor.

They give us more gray hair. Make us want to go running screaming from the building.  Want to wring somebodys neck.  Make us spend the majority of our time away from the patients filling in blanks.

They are  ***ThE EVIL cHanGerS****.  Some day the nurses will rise up.  They will hunt them down and there will be hell to pay.

ain't no flo

I got to thinking: Why do I do the blog?

I have been doing the blog for 8 years now. I'm one of the few that are still around when I started. I miss those other guys. (Tex, Nurse K, hood nurse, scalpel, etc.)

This blog started as a place to let off steam.  I have been a writer all of my life.  So it was a natural thing to do.

At the core of this blog is the idea of presenting a realistic picture of what it is like to be a nurse, particularly an ER nurse.  To tell you how bizarre it really is to work in the ER. To tell my fellow nurse, hey you are not alone. I go through the same things you do on a daily basis. And lastly, to give my opinion on stuff related.

Perception and reality in nursing are at the opposite ends of the scale. What the public perceives about who nurses are and what they do is way out of whack.  I think they still perceive us as florence nightengale types who fluff pillows, hold hands, soothe fevered brows and are always smiling and caring while they do it.  When in actuality, nurses are highly educated, tech savvy multi taskers who hold the medical system together. We keep you alive. End of story.

Even nursing students have no idea what they are getting into.  They learn an idealized version of nursing in nursing school and are often shocked by the reality. Healthcare corporation executives, doctors, mangers, etc. hold expectations of nurses that are impossible to meet.

People who become nurses care. We probably care more about people than your average person. Otherwise we couldn't do the job.  So we have a gooey center. As the reality of how damn hard this job is sets in, we develop a shell around the goo.  We have to if we are going to survive. We are in one of the most demanding jobs you can have.  Changes happen daily and many times they are not small changes. Technology becomes more complex. Demands on what we have to do increase daily. Every single day of being a nurse is stressful and challenging. Lives depend on us. A mistake could kill someone.

And then there is the taking care of  people part. Oh yeah that. Most people are nice. Then there are those are shitheads.  There are more in the world than you think. They are just plain mean, manipulative. We have to deal with them whether we like it or not.

So this is the reality of nursing. Its what I try to communicate here. A lot of people, including a lot of my fellow nurses, would rather pretend that nurses are florence nightengales  I just can't do
that. I ain't no Flo.

no goodbye for Dad

One of the hardest things about my job is watching families deal with elderly Mom or Dad. Dad is, lets say, in his 80's.  He is in bad shape for various reasons.  He isn't going to get better.  In fact, he is going to get worse.  He is worse today.

Here's the thing: he's full go.  He is so fragile that if CPR was performed, several of his ribs would break.  He would never get off the vent. In other words, its time to just keep him comfortable and enjoy the time that has left.

Of course thats not going to happen. Family is not ready to let Dad go.  Daughter is crying during Dads current visit.  Everybody else is tearful.

Dad says he feels fine.  He sits on the ER cart getting treatment that anyone would find uncomfortable.  It has become a habit for him to be brave for the family. He doesn't want the kids or his wife to suffer.  When the doctors have asked him about resuscitation he went along with being a full go.

So Dad will keep coming in, spending repeated visits in ICU.  Family will keep hoping that somehow he will get better.  He won't.  This will go on until one time he arrests. We can't revive him. Family is devastated.

They didn't get a chance to say goodbye. To tell him what a great Dad he was.

man candy saturday

yes

 

Its Christmas at the candy store

I've been working more lately.  Picking up shifts.  Son of Madness is in college.  Thus the sparse blog postings.

Why is it that working an 8 hour shift, especially a 7-3 seems to fly by?  I like it.

There is the usual tomfoolery going on in the ER like always. There are stomach bugs going around.  Of course the non-copers among us run to the ER at the first sign of nausea.  Like the guy who came in and cried and whined while 3 of us tried to get an IV in.  No success.  I mean seriously dude, if you are going to come in for a frickin' stomach virus this is what you are going to go through...you shoulda stayed home.  You'll get no sympathy from us.

Here's a question for the ages: Why is the BLUE HELL do we have to put an IV in every Tom, Dick and Susie that comes in with one episode of womiting or a wittle tummy ache.  ODT Zofran was invented for a reason guys.  No one under the age of 60 should get an IV for a virus unless they have at least 10 underlying diseases.  Thank you.  And they certainly don't need Dilaudid for their tummy ache.  Are you frickin' kiddin' me?????

So as you probably already noted, its business as usual at the candy store. Only difference these days are the two pathetic Charlie Brown christmas trees in the lobby that are decked out in a "neutral holiday hospital approved" fashion of beige and tan. Real festive...
 How many bulbs do you think will be left on December 26th?  Fa la la.


Oh BTW RIP Mandella

yup

Dear Person on Probation:

I hate to break this to you, but none of the staff or other patients in the emergency care about your probation officer problems.  We do not care to hear you talk at the top of your lungs to your PO about how you will probably have to go back to jail.  You are an idiot.

Sincerely,

the emergency department staff and patients