Gomergram

rerun...

The bain of our existence: charting.  More and more required charting, to the point where it will drive us all insane.  In the interest of collegeiality here are some abbreviations that might help you:  

 

AQR - Ain't Quite Right

Call Button Jockey - patient that uses call button, every few minutes  for no good reason

SALT Same as last time

CTS - Crazier than shit

DQ - Drama Queen

ETOH - Extremely Trashed or Hammered

FMPS - Fluff My Pillow Syndrome (attention/sympathy seeker), like Call Button Jockey

FOS - Full Of Shit

GOK God only knows

Gomergram - Ordering all available tests because the person is unable to explain what is wrong with them

JPS - Just Plain Stupid

PRATFO - Patient Reassured And Told to Fuck Off

LGFD - looks good from door (but not closely examined, possibly an obnoxious patient)

OBS - Obvious bullshit

Urban Outdoorsman - Homeless person

MFC measure for coffin

SWAG scientific wild ass guess

 

Additions anyone?

a day in the life of a junkie

When you work in the ER, you take care of ALL KINDS of people. Old people. Young people,  Black, white, purple people.  Neurotic people and even some normal people.  And you also take care of people who are on the bottom rung of our society.

Prostitutes. Junkies.  Prostitute junkies. People who have  sunk so low in life, that in order to support their habit, they stand on a street corner in the cold, waiting for someone to stop and give them 10 dollars for a quick you know what. Those  guys on their way back to the suburbs to the wife and kiddies. Suburban Steve keeps the heroin flowing from dealer to junkie.

Then the prostitute junkie goes and buys that heroin and shoots up. They end with abscesses from sharing dirty needles They end up passed out on the street.  Some "good samaritan" calls 911.  They end up with me.  Out of it. Barely able to stay awake to answer a few questions.

What are we going to do with them?  Not much.  Eventually they will come around, the junk will wear off.  We'll give them a sandwich and send them on their way to start the whole thing again. Another day, another fix.

do you have a metal plate in your head?

The ER has become a place where we screen for EVERYTHING.

You came in for a one inch cut on your finger? Along with asking you your allergies and if you had a recent tetanus shot, you will be asked about 30 other questions which have nothing to do with why you are there.

Are you allergic to latex?
Do you have any implanted devices? A metal plate in the head perhaps?
Do you have any skin problems? Any big zits?
Have you fallen recently? Excluding after a night out on the town
Have you ever had MRSA, VRE, MDRO?
Do you have:
                  a hearing problem? HELLLLLOOO???? I guess you do.
                  speak a different language? ¿Hablas inglés?  你会说ENGLSIH  .لا تتكلم englsih
                  financial trouble? If you do, the staff will be happy to
 take up a collection...

                  cognitive problem?  Are you dumber than a post?
                  etc. (can't remember the rest)

Is anyone verbally abusing you?
                physically abusing you?

And now some new added bonus questions:
                              What do you like to be called?  (Personally I prefer Queen Madness)
                              Who will be a spokesperson for you?
                              What is their phone number? (In case your laceration repair goes bad)

And now, the winner, the fiesta restistance of the screening questions, just recently added:

                  Are  you involved in any medical studies or clinical trials? (You know that study of cocaine users?

So you see, that 1 inch lacerations has become very complex.  We want to know your story back to
the Mayflower. If you answer yes to most of these problems, are we going to do anything different? NO.

Keep in mind all of these questions are supposed to be answered in triage where we have all kinds of time for this shit.

man candy Saturday one day late

Alas, I am exhausted from working 60 hours last week. I am in need of a man candy Saturday, even if it is a day late....

the window

As an  ER nurse, everyday you see human suffering.  Sounds dramatic doesn't it, human suffering?  But its the truth.  You have a window into so many peoples lives who are going through bad stuff. People are living with illnesses that are mad worse by stress.

They have a chronic illness that just happened to them.  They didn't do anything wrong.  Now they lost their job, the insurance runs out at the end of the month.  Who will take care of them? How will they get their medication?. Hopefully they will be able to afford health care under the new system.  Meanwhile all this stress exacerbates their illness.

Then there is the person who has just been diagnosed with an illness and they wonder how it will affect their life. They are young. Will they be able to keep working?  What does their future look like?

Their are families whose loved ones are dying and they aren't ready to face it yet.  They are angry, ready to blame someone else. You have deal with them too.  

There's mom and dad bringing in teenage son who is addicted to heroin.  This wasn't supposed to happen to their family.  They live in the suburbs.  He had everything.  Yet here they are, not knowing what to do, scared out of their minds, wanting some, any kind of help.  In the end we will only offer numbers and names and send them on their way.

I am left to wonder what I would be like in these situations.

yup

Freddy the fascinating frequent flyer felonious frickin' faker

I sometimes wonder how many frequent flyers we have. At least a couple of hundred. They range from "your name sounds familiar" to "have a seat John, we'll be with you shortly".  Frequent flyers lives usually revolve around trying to get something for their chronic pain flare up.

There is this weird phenomenon that goes along with frequent flyers.  If you mention them they will show up.
Last week I was saying, "Hey, I haven't seen so and so lately", and boom within an hour they were there.  I kid you not.

Phenomenon # 2:  If you are busy, they will show up.

Phenomenon
#3: Being the clever drug seekers that they are, if the docs grow weary of giving them narcs for their chronic problem, they will develop another problem (painful of course) as a sort of end-around to get drugs another way.  It is fascinating to see what a drug seeker will go through to get what they want.  If they put the kind of effort into their life that they put into their elaborate ruse to get drugs, they would be millionaires.

They cost the economy millions of dollars every year.

man candy saturday

Eric Church - I love his song: "The Outsiders"

will nursing have a slow, agonizing death?

What do I really think of nursing? If you read this blog regularly, you probably think I hate it.

Nursing frustrates the hell out of me.  I really am not cut out for it. I'm not exactly a timid little mouse (har).  I speak my mind.

I cannot stand how nurses allow themselves to be shit on as a profession. I think that underlying nursing this idea that we really don't think we are all that valuable. If we thought we were valuable, nursing would be in a whole different position.

We are the backbone of the  medical profession. Without us, it would collapse. I think we have the hardest and most important job in healthcare. We spend 24 hours a day with the patient. If we don't do a good job, the patient won't get well. We coordinate everything, make sure everything gets done. We ensure that  all the other people do their job for the patient.

We do another thing that is probably the most important and valuable aspect of nursing: We make sure the patient doesn't die or get worse. :The fact of the matter is, lots of people could be trained to do the tasks of nursing.  The value of nurses is their experience. With experience, we learn to recognize when
something is going wrong and when to intervene. Patients lives are literally in our hands. We prevent problems.  We can look at the overall picture to decide what the patient needs.  We are the only person in the health care team that is in a position to do this.

What bugs the shit out of me is how little we value ourselves and what we do.  We desperately want others to recognize us, value us. How can they do that when we don't even value ourselves?

As nurses, we don't take control of our own profession. How we get educated is an example::  Who ever heard of a profession where you can enter it with either a 2 or 4 year degree?  I''m a 2 year grad, but I think all nurses should have a bachelors degree.  It just makes sense as a profession.

I would like to see us take control of our profession. Stop having other people who aren't part of nursing dictate how we will practice.  Take the power we have and use it to better our profession and improve patient care.  Become so powerful that nothing in healthcare happens without us at the table.

If nurses don't start valuing themselves, fighting for thier profession, nursing will cease to exist.  Healthcare is in the middle of a huge change that will change medicine forever.  If you can't prove your value, you will be replaced.

OMG

Alas, my Norway curling team has run into a string of bad luck....losing to that boring Sweden 5-4 and dasterdly Canadians 10-4 (ouch!).  Hang in there boys.

so ya wanna be an ER nurse hahahahaha

Top ten characteristics of an ER nurse:

1) toughness - be able take being called a racist bitch, a fat cow, be swung at, etc

2) Strong stomach: I have seen every color of everything that can come out of a person and everything that can be done to the human body and had to smell it too

3) Sales ability: you have to be able to sell ice to an eskimo in order to talk people into you doing painful or uncomfortable things to them

4) Acting ability 1: you have to be able to act like you care even if the patient is a complete jerk

5) Acting ability 2: you have to be able to keep a straight face no matter what someone tells you: yeah they did put that there...

6) Nerves of steel: you have to remain calm when a couple of hood rats run into triage with their friend who is shot in the head

7) morbid sense of humor - you have to find gross, cruel things funny

8) physical fitness - you have to have the ability to not eat for up to 12 hours, hold you bladder for up to 12 hours, help lift those upwards of 500 lbs, contort your body to do things in a room the size of a closet

9) good instincts - you have to be able to spot a drug seeker a mile away, know when someone is about to go down the toilet

10) be humble - ask for help when you need it, know you don't know everything

Anything to add?

my boys are on a roll

Norway beats Germany 8-5! '

the haunting of the emergency room

I've seen my share of dead bodies over the years.  Its part of working in the ER. Some are expected and some aren't. Some are dead when they get here, some arrive living, then die.

Those that arrive living, but are expected to die, are usually people at the end of a long battle with cancer or something like that.. Some have a sudden event outside the hospital, make it to the hospital, but the decision is  made by the family to stop treatment.  Sometimes we just can't save them, its just their time to go. They are very elderly and the doc decides to stop treatment after a while.

Then there are the unexpected deaths. The people who had something catastrophic happen, be it trauma or some medical event.  Yesterday they were fine, today they are dead. Sometimes they are young.  It feels unfair they are dead.  One thing you learn in ER, life is certainly unfair. The family is stunned. These are the people you will hear crying loudly, it breaks your heart how they are suffering.  It makes you want to cry too.

These deaths are tragic, but you can point to a reason for them.  Something bad happened and death resulted. Its sad, but your mind tells you that is what happens sometimes.

Then there are the deaths that happen unexpectedly in the ER.  They don't happen often. They are the people who walk up to the triage window.  They are walking and talking.  Here's the thing: this is the last time they will be walking.  They will die shortly after they arrive.  These are the people that just kill the ER staff.

Sometimes they have very specific complaints like chest pain,, shortness of breath.  They go right back. Sometimes they have vague complaints. They have stable vital signs. They look OK. I had one like that recently.  I put them on a cart in the back of triage. There were no beds. They only were back there about 5 minutes before they went back to a room.  Within a half an hour they were dead. Boom just like that.

In this situation, someone went to the room, they are unresponsive. They have no pulse.  They are rushed to a stab room.  Everything is tried.  It usually goes on for a long time until we realize it is futile. They aren't coming back. They are declared dead.

We are left saying to ourselves: What just happened? They were OK when they got here.  We start second guessing ourselves. Could I have done something different? Did I miss something? It takes you a while to realize that there is nothing you could have done.  It wouldn't have made a difference. OK, you tell yourself, but they still will haunt us for days.

Now its time to try and find the family.

  .

Norway smashes US and Russia

Good news!  The Norway mens curling team won their first game against the stinky US team! Final score 7-4.  And they looked GREAT doing it!

This just in!! Norway beats that foolish Russia 9-8 in 2nd game! 

MADNESS: TALES OF AN EMERGENCY ROOM NURSE - official sponsor of the Norway mens curling team.

Susie the cheerleader takes a dirt nap

Heroin is getting a lot of attention these days. Why?  Its a huge problem and its getting worse.  Other why? Suburban white kids are the new face of heroin. .

Crack, whether it is true or not, has a black face.  Its an inner city problem. It doesn't affect them, so middle class and above people don't care. Pretty much the same with meth, its a rural white problem.  We as a society pretty much write these two groups off.  Doesn't affect us, who cares?

When suburban white kids start dying it gets attention. Suburban white kids who have everything, live a nice life, aren't supposed to get addicted to things like heroin. They are supposed to go to college, get married  and have 2.2 kids and buy a house in the suburbs down the street from their parents. Blond Susie the cheerleader isn't supposed to be on heroin. But she is.

So we are in the middle of a heroin epidemic. I see it everyday.  High school kids on heroin. Overdoses. I am seeing it more frequently. Its sad and depressing to see yet another drug destroy communities.

Recent articles have traced the use of heroin back to prescription drugs.  Here's the scenario:  Mom or Dad goes to the doctor for lets say back pain.  Doctor willingly gives them a script for Percocet or Vicodin. No prob. Back pain resolves, not all of prescription is used.  Mom or Dad puts it in the medicine cabinet, not wanting to throw it away.  Junior sees it, takes it, maybe goes to a part and throws it in a bowl with all these other collections of narcotics the other kids brought from their parents medicine cabinets. Junior likes the feeling. Gets addicted.  Its an expensive habit on the street. Pills going for 5-10 dollars a piece on the street.  Friends introduces them to heroin, cheap, better  high.  And so the saga begins...and ends either dead or in the ER with an overdose.

And we are right back where we started: at the docs prescription pad.  I have ranted on this for years: the overprescribing of narcotics.  The docs of this country's responsibility for it. Why don't they stop doing it? Old news. Not changing anytime soon.

Perhaps we should be asking a different question: Why do we live in a country with such a massive drug problem? Why do we as a country feel the need to dope ourselves up in order to cope with life? We are constantly telling ourselves what a great country this is, blah blah blah.  I don't think so. We are fooling ourselves. This is a sick society.  We pretend it isn't as our kids are dying.

madness blog sponsors olympic team

I have become an official sponsor of the Norway curling team.  How can I not with their great outfits?

 Go guys!

when you are having that really bad day...

I think this should be part of every ER nurses yearly benefits.  I just want one....

man candy saturday

7 signs you shouldn't be at the emergency room...

If you say the following at triage, chances are, you shouldn't be here:

"I don't know if I should be here..."

"I feel silly being here..."

"I shouldn't be bothering you..."

"Do you have an urgent care?"

"Its probably nothing...."

"My mother, sister, aunt said I should come..."

"Do you think I should be seen?"

"How long is the wait?"


The end.

queen of the drunks

I've been lax on the blog.  Worked a lot last week.  Gloomy weather.  Mid winter blues, etc.

Onward...

Is it just me or are the frickin' drunks coming out of the woodwork?  Either that or we are becoming the local alternative to detox.  We be gettin' those serious drunks.  The ones that live life at .4. They have a masters degree in drunkenness. They are veritable experts in their field.

Here's the thing, I really have little sympathy for drunks or druggies for that matter. I know its a disease, etc.  Hell, I've had close family members who were addicts.  I grew up with it in my family and it affected my childhood.  Sorry, still no sympathy. These people not only destroy themselves, they destroy the lives of people around them. They are a nuisance to society.  They cost millions and millions of dollars in  health care every year.  They are the basis for most of the crime in the country.

So moving on, I have been queen of the drunks.  In all their forms.  From the drunk who is still functioning, has a job and a "fiance" (here's a clue: if your future husband can drink 3/4 liter of vodka a day and remain conscious maybe you SHOULDN'T MARRY HIM ) to the drunk who pissed their pants and everybody in between.

The best drunk is one that just goes to sleep and shuts up. The best situation is that there is a detox bed and in a couple of hours we can shuttle them down there.

Dear John/Jane Q. Public:  Do us a favor...if you see a drunk laying on the street, leave them.  They sleep on the ground every night.  We will do nothing for them in the ER other than spend thousands of your tax dollars to house them until they sober up.

   

man candy saturday

After all the cold and snow this week, its a good day for man candy Saturday...