Tuesday, April 29, 2014

Another day in the hood

I work in the ghetto, so of course, folks from said ghetto visit the ER on a regular basis. A lot of them use us as their clinic, waiting hours to be seen sometimes. Hey, no big deal.  Grab a Big Mac, settle back and watch TV in the lobby.

So in comes Mr. Man for one of those clinic type complaints. Does his time in the lobby.  Goes to the room.  Apparently he becomes bored, leaves before being seen.

He promptly goes out into the main hospital and robs a guy who handles the vending machines of $300.  Goes on his way.  Another day in the hood.

Monday, April 28, 2014

thump, thump, thump....

You know what sucks? Sitting outside a room at the nurses desk hearing the thumping of the "lucas" automated chest compression machine.  Someone in there is dead. They were dead before they got here. They aren't coming back.  The machine thumps on.

You know, sitting there, that when things have gone on this long with no return of pulse its over.  It is almost obligatory to continue the code going for a while.  Especially when the spouse chooses to be in the room. Especially when the person is only in their 50's.  Too young to die.

 So it goes on, med after med is given. Nothing changes. It gets to the point where you just want it to stop.  The thump, thump, thump.  Its painful to hear after awhile. Knowing what is coming.  The stopping.  The doctor sitting down next to the spouse and telling them its time to stop.

The anguished cry.  The weeping. The rest of the family arriving.  The young adult children stunned and wailing.  Thinking about that could be you, laying there, or bent over your now loved ones dead body.
Those could be your stunned children.  You don't know them, but you feel like crying about their loss.
Wondering how they will go forward. Thinking about yesterday they were alive and today they are dead. How do you deal with that?

I can't believe I forgot...

Yes I can't believe I forgot MAN CANDY SATURDAY!  Busy week.  Here's three:

Saturday, April 19, 2014

man candy saturday

reminds me of my first boyfriend back in the day

Thursday, April 17, 2014


Contact precaution Barbie

a country that won't say no

I started adulthood as a bleeding heart liberal.  Then I got a job in the emergency room. I am for helping poor people.  I really am. Circumstances can cause terrible situations where people need help.

The thing is there is definitely a group of people in this country who expect to be taken care of by the government or whoever just by virtue of their existence.  These are the people who expect you to pay for their medications.  They take that free cab ride home two blocks even if they are a healthy 25 year old. They get free health care. Their care will always be paid for no matter what.  They don't have to worry about an ER co pay or their insurance company only paying 80% of their bill and they will be responsible for the bill. So they use the ER as a clinic.  There are no consequences, so why not?

I know its not easy being poor.  I grew up poor. My mother was a single parent of two kids who didn't have any higher education.  She wasn't making big money by any means. A couple of times things happened where we had to go on welfare for a little while.  She went off as soon as she could.  It was a temporary helping hand not a lifestyle.

I have a feeling that if all of this was tightened up the world would not come to an end. People would survive. They would have to do what they needed to survive whatever it took. It would take effort, but that would be good.  We are afraid to say no to people nowadays.

Wednesday, April 16, 2014

the ER shit show

One of my co workers once told me that since she had decided she "hated the ER", it has been easier to come to work.  I know you are probably thinking ...hey...why don't you just get another job?  Well, hours, pay, seniority, self scheduling.

Saying this sounds negative and defeatist...but maybe not? What if it says acceptance? I accept that working in the ER is often a shit show.  I'm not going to pretend it is anything else anymore. I'm not going to expect anything else. It is what it is.

You are letting go of your expectations that people will be nice to you.  You know it will be busier than shit. Accept that the ER is not set up for your convenience. Its old and shabby.  However, I chose to keeping working here for whatever reason,

Its the serenity prayer applied to ER:

God grant me the serenity
to accept that the ER is mostly a shit show
and I can't  change it
Courage to change my naive notion that it will change
And the wisdom to face reality. *

the way no offense to AA or Alanon who I think all great organizations.

Tuesday, April 15, 2014

duck duck grey duck


Mental health patients are treated like 2nd class citizens in emergency rooms. These days there is a shortage of psychiatrists and beds.  They ended staying hours in the ER, sometimes overnight.  Either that or they are transferred to other hospitals locally or around the state.  Not a good situation.

There are times we have 7-8 psychs in our ER.  We have 3 rooms set up for mental health.  What this means is there is a cart, with nothing on it or underneath it, just a sheet. There is nothing else in the room except a camera.  When we have more than 3 patients we have to put them in regular rooms, using up rooms that could be used for medical patients.  It gets to be a real problem when there are no beds in psych.

So of the nurses came up with this idea.  Why not put a few of them together in one of the bigger rooms. (GUFFAW) The idea being that it frees up other rooms. Um..

Perhaps we could hold group therapy.   Play board games. Sing a longs. How about a rousing game of duck-duck-greyduck?

So there are 3-4 patients sitting on chairs in the room. The cart have been moved out. There is no TV. (don't even go there with me) The patients are in green scrubs. Everybody dressed alike brings prison to mind.. The patients sit and stare at each other. of the patients is becoming agitated. Another patient is talking to himself.  The other patient is scared shitless. Agitated Alan starts pacing in the little space there is.  Hallucinating Harry starts getting paranoid. The 3rd patient runs from the room.

Its hopeless. Nice try thinking outside the box though. Here's a thought: Why don't we treat the mentally ill in this country the same way we treat the physically ill?  What a concept.

Monday, April 14, 2014

I have a well deserved day off.

This is a typical day off for me doing the grocery shopping. 

Sunday, April 13, 2014

people get ready... there's a change a comin...

Get ready.  The Affordable Care Act is here, "Obamacare".  Its in place and people are signing up for insurance and they will keep doing that. It ain't going anywhere.  Its going to change healthcare.

Why? It is going to force medicine to decrease costs. Its going to expose how ridiculously expensive health care is in this country.  How inefficient. How medicine has basically become a "cover your butt" and "order as many tests as possible" system.

Health care in this day and age is about one thing: money  Making more of it. for hospital corporations and their administrators salaries and bonuses,  doctors in specialties, insurance companies, drug companies, medical supply manufacturers.  Gone are the days (is they ever really existed) of trying to help people and do whats best for them, replaced by greed.

So how will all of this affect nursing?  You can just about guess.  Here's a list:

1) Just because there may be more patients, don't expect more nurses.  You will be expected to do more and more.
2) Layoffs.  They're coming. The corporation I work for has said they need to cut $100 million in the next year. This is code for: get ready for layoffs.
3) Cut in benefits. Most nurses have decent health insurance. Expect to be changed to lesser plans with higher deductibles. Pensions are on the way out.  Raises will be small.
4) Attempt to use paraprofessionals: Do you work with EMTS in ER? Get ready for management proposing they start to do more nursing tasks.
5) Part of your evaluation will talk about whether you have had any complaints. "Patient satisfaction" is the new buzz phrase

Pretty depressing huh? Yeah it is. I feel I have lived in an era that  future.nurses will look back on and wish they could have worked during it. With unions we have had good pay raises, benefits, control of our profession.

That's changing. Young nurses, like young people do, don't realize what went into getting nurses to this point. They don't care. They don't plan on spending 20 or 30 years in one place. Retirement is far off. They are healthy so insurance isn't as important.

I honestly wonder if nursing will survive the huge changes ahead of us.

Saturday, April 12, 2014

man candy saturday two for the price of one

don't bother to ask why

Life ain't fair.  That's what I was thinking sitting in my car, crying, a couple of days ago. How do you make sense of it? You don't.

My friend has ALS (amyotrophic lateral sclerosis).  Lou Gehrigs disease. They found out about it about a year ago. Since they live out of town I don't see them all that much.  Its been six months. In that six months the disease has taken its toll. They have to use a electric wheelchair for long distances. Their body and face look different. ravaged. They look like they are dying, which they are.

Its only going to get worse. There is no cure. They will die. As they are dying it will get harder and harder as their muscles waste away.  They will be unable to eat, breathe. Its an awful way to die.

They have two young children, a wife. How do you explain this to children? How do you explain Daddy is going to die?  I don't know.

Friday, April 11, 2014

20 uses for duct tape in the ER

1)IV pole broke: Tape the IV bag to any nearby surface: the monitor, the wall, the patients relative, etc.

2) Demented Donald trying to get out of bed? Duct tape will keep him in bed.

3) Duct tape that irritating drunks mouth shut.

4) No security available to watch your suicidal patient? Duct tape will keeep them in bed and SAFE.

4) Out of arm slings? Fashion one out of a piece of cardboard and tape.

5) Patient hairy and need to put him on the monitor? Duct tape will remove that hair for lead placement.

6) Backboards all in use? Take the sliding board, some rolled towels and tape and fashion your own version of spine stablization.

7) Duct tape your manager to a chair.

8) Low on suture or staples: A quick and easy laceration repair.

9) Tape patients gown together for trip to bathroom.

10) Out of adult diapers: use towel and duct tape substitute.

11) Tape NG, ET tube, foley in place.

12) Tape patients wig or toupee in place.

13) Never lose it again: tape you pen, scissors, roll of tape, stethoscope to yourself.

14) Make letters RN on uniform so patients will know you are their nurse.

15) Afraid your patient might wander off? Put their name on it, room number and attach to gown.

16) Cheap shoulder immobilizer.

17) Confused grandaa will never pull out her IV again.

18) Tape your nostrils together for that smelly clean up

19) Cheap eye patch.

20) Help reset dislocations.

your ideas?

Thursday, April 10, 2014

let's party people!

Frequent flyers.  The bane of every ER's existence. They come in many shapes and sizes.

Some are just incapable of being organized enough to have their own doctor or they just don't care. They use the ER as their personal clinic.  Some are drunks who end up in the ER when people get tired of them laying on the street. A lot of them have chronic pain in one form or the other and their doctors are sick of them. Then there are the chronically mentally ill.

What do all of these people have in common?  Anxiety. Depression.  Loneliness.  Ineffective coping skills. They need a friend, a lot of them.  Somebody to listen to them. Have fun with them.

So I have this scathingly brilliant idea...  let's have a party.  We invite all of the frequent flyers. It will be a large party, God knows.  Put on some tunes. Get some cheetos. Punch.  Party games.

They have a lot in common.  They could talk to each other about their terrible lives. Make friends. Perhaps there will even be a spark of romance.  More friends and less lone
liness = less visits to ER =  happy ER staff. Everybody wins.

Wednesday, April 09, 2014

a romantic moment in the ER

Every once in a while something romantic happens in the emergency department.  Not often, but when it does it warms the cockles of this old  heart.

Here comes Brandon and Brittany up to the triage desk.  They both want to be seen.  What do they want to be seen for? STD check.  Isn't that romantic?

The fact that they could share this moment with us is special. Apparently for them, this is another day in the relationship of Brandon and Brittany. They don't think anything of it, laughing and joking with each other.  They shared a romantic lunch at Mickey D's  prior to arrival, as evidenced by the apple pie Brittany is munching on.

Hey I think we need to do something special for this cute couple. Lets put them in room 6, the pelvic room/honeymoon suite.  We'll turn the lights down low..

Tuesday, April 08, 2014

I have crossed over into....THE TWILIGHT ZONE

There is a frequent flyer that comes to our ER on a regular basis.  Usually he is found laid out on the street and some "good samaritan" calls 911. (Personally I think these good samaritans should come in and take care of the drunks they call about.)  

This guy is a mean drunk.  Passive aggressive. He verbally abuses the staff, then ten minutes later says he is scared. In other words a royal pain in the ass.  Recently detox decided they needed a vacation from him so they banned him for a couple of weeks. Wonderful.

So day I am at the triage desk and here comes Mr. mean drunk. He comes up and says that he left his ID in the ER.  Here's the thing: Mr. mean drunk is dressed in clean, decent clothes. He is not wasted.  He is probably .20 which for him is not drunk.  He is drunk at .40. So he is polite.  He goes to sit down while I look for his ID.  No fuss, no muss.

What in the BLUE HELL?!!  AM I ON CANDID CAMERA??? I look around to see if there is anyone hidden someplace filming me....Something isn't right here.  Is the world coming to an end?  Did I just have a polite exchange with Mr. mean drunk?  The guy who called me a DIRTY BITCH last week? I am afraid. Very afraid. The world has turned on its axis...(cue twilight zone music)  

Of course, we don't have it.  Mr. mean drunk isn't happy, says a loud "fuck!", but goes on his way out the door without a scene. It seems there is a human under all that mean drunkenness. Maybe...for a little while...until his next alcohol soaked visit anyway.

Monday, April 07, 2014

hell week highlights

Hell week is done. I survived. Barely.  Today I am a zombie. Everything is sore. I will sit on the couch, starting and drooling most of the day.

Highlights of the week:

1) Afore mentioned Mr. sore throat and "fiance" go down the street from our ER and call 911 fiasco.
2) Angry perfectly normal woman who wanted another nurse because I wouldn't enthusiastically remove her shoes for her.
3) Idiotic PA order #345 - Put foley  in trauma patient who had "blood or something" in bladder by ultrasound. Ah, I don't think so....
4) Round one of the decreased reimbursement "we are going to have to tighten our belts" emails.
5) Idiotic PA order #453:  Do MRI.  No don't do MRI.  Do MRI..
6) Patient presenting with insomnia complaint.
7) Psych patient you had day before still there next day  because of lack of psych beds.
8) Sauna bath atmosphere ER when temperature outside goes above 50 outside.
9) Incident # 789 of non english speaking immigrant presenting to triage desk asking for someone admitted to hospital  but only knows first name.
10) Detox is closed.

Saturday, April 05, 2014

man candy saturday two-fer

Mr. sore throat and his "fiance" visit the ER

I really am sorry sir, I know your earache hurts but I'm afraid you and your "fiance" are going to have to have a seat in the lobby. Alas, there are no beds to be had. I know this is upsetting, but the other people in the lobby are just as upset  as you are..

Ms fiance, no we still don't have any rooms available. I see you are upset. Other people have gone ahead of your future husband? Oh you mean that 90 year guy with shortness of breath? Yes, I'm afraid he had to go ahead of you...

Oh sir you are back again...I have already explained the triage process a couple of times...Your agitated movements and yelling are not going to help. Exit, stage left, back to waiting room..

What is this, Mr sore throat is now shouting and swearing in the waiting room. security called.  Oh what's this, Mr sore throat is headed out the door?  Oh no. Here comes security.  The group heads out the ER door where a long conversation ensues between Mr sore throat and "fiance".  At one point, "fiance" takes a swing at security.

Off they go, Mr sore throat and his "fiance" down the street about a block where they call 911 for an ambulance. When the ambulance arrives and puts Mr. sore throat in the back, the medics say they are going to take them down to the county hospital, Mr. sore throat gets out of the ambulance and refuses to go.

Oh my.....what will become of Mr. sore throat and his "fiance"?

Thursday, April 03, 2014

we're a tough group

Any ER staff is a tough group.  We have to be to work in the environment we work in. You have to be calm under stress. You have to be good at multi-tasking.  You have to be dependable and know your stuff. I have to be able to depend on you to help me when we have that train wreck,

When you are new to the ER, whatever role you are in, everybody is watching you. We are watching to see how fast you pick things up. How are you in a critical situation? Can we depend on you to do what you have to do?

Everybody has a role in a critical situation from the HUC to the EMT to the nurse to the doc. When the shit hits the fan, you have to be able to function. That isn't a time for asking questions.

If you don't learn to function really quickly, you will pay the price. You will be labelled.. Its not fair maybe, but it happens. We have big expectations of you and you aren't meeting them. We can't depend on you. We will eat you alive, unfortunately.

I've seen it happen. Its tough to see. I've seen people leave. We may seem like a bunch of meanies but not really. We deal with life and death sometimes. Things have to be done rapidly and correctly. Lives can depend on it. Unfortunately, the ER isn't for everybody.

You might be thinking: Oh woo hoo, you think you are a big time ER nurse, la la la. Yeah true (har har). Hey I'm proud of myself. However I know that there are nurses in many specialties that are excellent. Everybody just has to find their niche.

Wednesday, April 02, 2014

the batshit crazy club

After many years in the ER, I have developed certain talents. I would say one that I have perfected is the ability to keep a straight face. You could tell me that you have are growing a second head or have a tuba up your behind, and I would tell you "okay, have a seat in the waiting room,  There is little that you could tell me that would stun me. Heard it all, seen it all.

With that in mind, may I say that there are many bat shit crazy, freak-deaky people in this world,and eventually, they make their way down to the emergency room. I had one a couple of months ago. This dude seemed to be making a game out of how far he could go with all these bizarre facts about himself and his life. I'm not even going to get into it here because it is just too weird.

I thought what is this guy getting out of this? Telling me all this weird shit. Is he doing it for attention? For effect? Is he trying to freak me out? All I thought about him was that he was a fucking nut. I avoided him as much as I could.

I didn't discharge him, the charge nurse did. She said to me she hadn't know he couldn't hear. I said, couldn't hear? The man had been talking to me and hearing me just fine. It turns out when she went in to do the discharge, he starting using sign language like he couldn't hear. Bat shit crazy, just like I said. This world is a crazy place. There are more lunatics than you realiz