Saturday, May 31, 2014

man candy saturday

drunks have nine lives

How does someone fall 40 feet and live to tell about it?  Or at the very least not break a bunch of bones?

Apparently you have to be drunk off your butt to do it.  I had a man the other day who accomplished just that feat.  Dislocated a shoulder, thats it.  This guy was a homeless chronic drunk whose daily existence consists of begging to get enough money to buy a bottle.

You or I would probably end up paralyzed or something.  Drunks get beat to a pulp, stabbed and they seem to survive to go out and do it all again.  Its amazing.

Its like they are a cat with
nine lives.

Thursday, May 29, 2014

the morbidly obese in the ER

Let me preface this by saying: I could lose a few pounds....

Is it just me or are the number of morbidity obese 350 lbs and up patients increasing?  I swear we get 5-6 a shift nowadays. We have one lift in the department.  It is WAAAAYYYY over on the other side of the ER in an area we don't visit much.

There are so many really big people coming into the hospital these days that we have someone in charge of having the products we need to take care of this population.  Bigger chux, depends, gowns.  We have a bed in the ER that doesn't have to be pushed manually, it has controlled to have it move itself.  There are "bariatric beds" in the hospitals.

Upstairs they have lifts for just about every bed, meaning the nurses aren't going to break their back.  In the ER, one.  If they have to go on a bedpan, its a team effort. 

When I see the medics come in with a big person, I wonder how they got them onto the cart. I worry they will hurt themselves.  Sometimes they have to call the fire department to help.

This is modern emergency medicine. Its something that has to be dealt with.  We see it more and more. Its not easy.

Monday, May 26, 2014

sunshine lollipops


Sunshine, lollipops and rainbows 
everything that's wonderful
 is what I feel when we're together.

Sunday, May 25, 2014

just keep telling yourself this is a great country

And that doesn't include those that were shot and survived.

bring back the draft

I have been a patient at a VA hospital in the past. I had no problems. I thought they did a great job. I thought the staff was dedicated to taking care of vets. You could eat off the floor of that hospital it was so clean.

The current controversy about vets not being able to be seen for months never happened to me. Apparently at other VAs it has happened and "resulted in some deaths".  Would they have died anyway? Who knows? Maybe.

There is no doubt that veterans deserve care, the highest level of care.  The fact that there are problems at some hospitals isn't surprising.  Like the rest of healthcare, they are trying to provide care with limited money just like all other hospitals. They are dealing with thousands of people they were not ready to deal with.  Its kind of like what Obamacare will do to non VA hospitals.

I agree this should be fixed  What bothers me about it is the fact that politicians, 90% of whom never served in the military, use this issue to get their face in the news.  Perhaps thinking this will help them get re-elected.
On the backs of veterans.

This country has a lot of guilt about veterans.  We have essentially hired a mercenary army to fight our wars for us.  Doing that makes war so much easier. Your son or daughter or YOU don't have to be deployed 3-4 times or come back in a body bag.

Guilt comes in the form of "thank you for your service", blah blah blah. We watch those moving videos showing veterans showing up at their childrens school.  We may shed a tear or two.  While you are thanking and crying, soldiers remain in Iraq, Afghanistan, Korea, now Nigeria risking their lives daily, while you go about your life back here.  We don't give them much thought.  Why would we?  It doesn't involve us.

Bring back the draft.

Friday, May 23, 2014

sadistic human race hater

I think that a reader/commentor has finally summed up the essence of who I am:

 That about sums it up.

Monday, May 19, 2014

your grandma is my typical patient these days

Why does it seem like my job is getting more stressful?  I mean I have been in the ER for a long time, can handle most anything, but I'm feeling overwhelmed these days. What has changed?

Its weird, I don't think we are getting that many more patients. I think what it is, is that patients are sicker. A typical patient I would say is:

1) 70's, female, living in assisted living
2) limited mobillity, overweight
3) Hx: CAD, HTN, arthritis, UTI, TIA etc.
4) now you have another problem

Here's the thing: You will have the $10000 work up. Monitor. CBC, lytes, troponin, UA at the very least. EKG. Chest xray. No doubt CT of some part of you. Start an IV because why not? Its something to do. Give you nausea meds or pain meds.

You require a lot of my time getting you started.  Then your numerous bathroom needs. You are old and you go often and you have to use the commode. Your family arrives and I have to spend time talking to them. Meanwhile I have 3 other patients, the same or worse than you. I could have an out of control psych, someone who is unstable.

After 4 hours you are admitted of course. I wait at least another hour for a bed if not longer if there are no beds.

In other words, I am running my butt off for 12 hours. We don't have enough nurses. With the whole "decreased reimbursement" baloney.

A nurse I work with dropped a pearl of wisdom this past week: "I'm at the point where if they are still breathing, I will eventually get to them".  In other words, stop stressing out and just plod along and it will all get done like it always does.  I like that.

Wednesday, May 14, 2014

help wanted: jack of all trades

This blog entry inspired by ER Nurse Insanity.

My job is really hard. Every time I come home from work I am exhausted physically and mentally.  Why have I stayed so long?  Its hard to remember.  My cynical sarcastic burned out self prevents me from remembering.

I tell myself its the hours, the 12 hour shifts.  I get a lot of days off.  The thing is I could get 12 hours in another area.  I say I like my coworkers.   Chances are pretty good that I would like my coworkers in another area too.

So if I clear away all of the crusty burnout and get down to the core of me, here's what I would say:

1) Its challenging. Every day.
2) It has variety.  Every day is different. You see all different kinds of people and cultures.
3) Its fun sometimes.  People are crazy and weird and what they do is funny a lot of the time.
4) My co workers are cool.  They are interesting, funny, bold, caring.
5) I'm good at it.
6) You are always learning new things.
7)  We do help people.

So ...I don't think of these things very often.  Most of the time I can't stand it.  Every day I think about looking for another job.  But I don't.  After working in this kind of environment for so long, what am I gonna do? Home care? Clinic? Insurance company?  I wouldn't last 5 minutes.  So here I am..still plugging along.

Tuesday, May 13, 2014

What you talkin bout Willis?


No....come on...I am mean I have to wait?  You mean I might have to wait a couple of hours? What?

Yes I am afraid that it is a Monday (or any other day for that matter) and this is an emergency room.  We only have so many beds. I know this is hard to believe but  THERE ARE OFTEN MORE PATIENTS THAN THERE ARE BEDS.....I know...shocking.

Here is another shocking fact:  WE SEE PEOPLE IN ORDER OF HOW SICK THEY ARE!  I know...stunning.  This isn't how things work out in the OTHER WORLD.  In the other world you get in line and when the line gets to the front, you are dealt with.  Unfortunately, THAT ISN'T THE WAY THINGS WORK HERE.  Unfair...shocking...stunning...I know.

Stunning fact #3: WHAT YOU CONSIDER AN EMERGENCY VERY WELL MAY NOT BE WHAT WE CONSIDER AN EMERGENCY.  Yes, yes...I know...your 1/2" cut is bleeding...oh no! Your queasy stomach is annoying...but here's another stunner:  THAT PERSON GASPING FOR BREATH, THE ONE CLUTCHING THEIR CHEST, THAT GUNSHOT WOUND TAKES PRECEDENT OVER YOU.  Shocker.

Now, let me say this: I know that in the world you live in you are a VERY IMPORTANT PERSON, probably much more important than any of these other people.  YOU HAVE THINGS TO DO FOR CRIPES SAKE!  I get it. I get it. People in your world probably cater to your every whim.

Here's the thing: YOU HAVE ENTERED MY WORLD. My world doesn't work like your world. In my world its all about who among the teeming masses presenting at the window:

1) Are going to go down hill fast if I put them in the lobby.  That would be messy.  I DON"T LIKE MESSY.
2) Who might die if I don't rush them back. SORRY, NO DEATHS IN TRIAGE ON MY WATCH.

So sorry MR/MRS VIP, yes you will wait. You may wait a couple of hours. Your angry words, red face, lawsuit threats, sending your relative/friends to the window to report your 1/2 cut starting bleeding again (oh no!), that queasy stomach is still queasy WON"T MAKE ANY DIFFERENCE. In fact, you taking my time at the window, only delays things further.

GO SIT DOWN. Unfortunately, MY WORLD doesn't work like YOUR WORLD.

Saturday, May 10, 2014

just kill me now

I am in the room with the PA listening to him assess the patient.

Let me set the stage: The patient is sitting on the edge of bed facing toward the wall.  The PA is leaning against the wall facing him.  I am leaning against the opposite wall in back of the patient.

The PA starts asking questions.  About one minute in, it happens.  An involuntary eye roll.   I mean honestly I couldn't help it. It happened without conscious thought. It was one of those "You have go to be kidding me?!  WTF?" moments that we have a hundred times a day in the ER.

Over the years, I have learned to school my emotions. I work in triage a lot, where you have to keep a straight face no matter what:  You put what where? Okay have a seat (or maybe you should stand) in the waiting room...  Little green men chasing you?  Next...

Here's the thing: There are just some people who live in an alternate universe and have no concept of the words: TOO MUCH INFORMATION.  DO NOT GO THERE. WE DON'T WANT TO KNOW. WE DON'T WANT TO KNOW THE DETAILS OF YOUR WEIRD, GROSS LIFE. STOP BEFORE I BURST INTO FLAMES! The kind of people who make you want to shoot yourself.

I have never burst into flames.  I have been able to put a kabosh on the situation and am really good at redirecting the nature of the conversation.  Either that or I make a hasty exit, making some kind of excuse like: I'll be back.  Then I don't go back.

The INVOLUNTARY EYE ROLL hasn't happened many times but there are times when things get so bazaar that my subconscious seizes up and reacts for me.. Its that or I yell: NOOOOOOOOO!!!!!

Thursday, May 08, 2014

hood nurse

Turns out one of my favorite bloggers (hood nurse) is back to do guests posts on er nurse insanity. Check them out.

where in the world is harold?

Harold came in with his son.  Harold was very old and he was struggling. Depressed, not eating, just not doing well.  He needed help. Poor guy.

So back he went, Harold and his son.  They saw the nurse, the doctor.  Had a more comphrehensive assessment by someone from mental health.  Now it was time to wait.  Son decided to go out to the car to get something, leaving Dad alone.

Dad got up, maybe looking for the restroom or looking for his son.  He wandered down the hall.  He ended up going through a door by triage.  Here's the thing: It was a door to a stairwell. The problem is you can enter the stairwell, but you can't come back into the ER. The door doesn't open.

So there is Harold, in the stairwell, no doubt looking for a way out.  Never shouted, pounded on the door.  Of course, the nurse discovered he was gone. Looked everywhere..eventually had the hospital operator page for him to come back to the ER.  An alert gray was called (an old person wanders off). Didn't  find him.

Well it just so happens there was a inpatient doctor in the ER.  He was leaving and decided to walk up the stairs.  He went into the stairwell where Harold had gone. There was Harold standing there looking lost.  He was brought back into the ER and everybody lived happily ever after.

The thing is: What if that doctor had decided to take the elevator instead? How long would it have been before someone discovered Harold?

Wednesday, May 07, 2014

oh its true, its damn true...

Dear new ER staff:

As you start your wonderful new career in ER, here are a few unwritten 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.

It was'n me/I'm innocent

Proof positive that I have the sense of humor of an 8 year old boy....

(BTW, this isn't the med room where I work. I found in on the internet.)

Tuesday, May 06, 2014

strange-but-true crime stories to brighten your day

A person is seen and discharged. Wanders over to our closed urgent care area to look around. Found a crash cart. Emptied contents of crash cart into a patient bag and then had a scathingly brilliant idea. Goes to the triage desk and tells the staff that she has lost her cell phone and $100. Staff notes patient bag. Tells patient to look through bag to see if they are in the bag. Helps patient look through the bag. Discovers patient has crash cart contents in bag. Security called. Patient arrested. End of story.

Person is seen heading down hallway to ER entrance with a cart with something on it covered by sheet. ER staff stops patient and discovers patient has computer on cart. Person says nurse told them it was okay to take computer. Person runs away. Computer recovered. Person escaped. End of story

Monday, May 05, 2014

the year I got a vibrator for nurse week

I kid you not.  One year the hospital got us all vibrators for nurse
week. No doubt the thought was we could massage our old tired muscles but really: A VIBRATOR???!! What were they thinking?
I have to say the jokes out of that gift went on for a long time...

Every year Advanced Healthcare Shop gives a gift certificate for the worst nurse week gift. Here are some selections from entries this year:

From ANN, RN, Florida: Having been an RN for 38 years and working in five different states, I have received varied "gifts" over the years. The usual pens, pins, mugs, tote bags, lunch bags and sweets have all been received. Having thought I had seen it all by now, I was stunned when our clinic administration gave us a bar of soap for Nurses' Week! We opened our "gift bags", our jaws dropped and we looked at each other wide-eyed and said simultaneously, "A bar of soap?!?!" Laughter erupted when one of the nurses said "Look! It's cellulite soap!" Sure enough, peering closely at the label it was a bar of soap touting its ability to treat cellulite. We all laughed and said "Well, that does it, we get chocolate next year!" Periodically, months later someone would say, "You know I used that soap and look, it didn't do a thing!" We were hoping the message wasn't what it seemed, but in true Nursing fashion, we saw the humor in it and moved on, doing our jobs and doing them well!

From GINGER RN, PHN, New Jersey: Nurses at a small Philly hospital were given a special gift from one of the TOP surgeons. He told everyone this was his tribute to the BEST nurses he'd ever worked with... It was a 3 X 5 color photo of his great dane dog, "Lilly White", with a nurses cap on her head. Really!

From CAROLINE, RN, North Carolina: The worst nurses week gift I got was when I was on the GI unit at a hospital. I received an enema bottle filled with brown M&M's. It was very distasteful to say the least. We kept trying to figure out where the bottles came from. Yuck!!

From ALESSANDRA, RN, Texas: Now I don't want to sound unappreciative, but sometimes a Thank You is best. Nurses week is usually a big deal in our hospital system. In the past we have gotten nice T-shirts, insulated lunch boxes, insulated coffee cups, etc. Last year, they must have been hurting financially. We received these very thin, very ugly beach towels. They didn't have any hospital logo on them, no nursing phrase, no healthcare ditty, nothing. As a matter of fact, it had a winter scene on the front. We are in South Texas, in May it’s very hot - clearly summer. Although appreciated, I graciously gave mine to another employee and as I did so, the fibers of the towel began to pull. Some of the threads came loose and started coming undone! A very poor attempt at being cheap.

From PATRICIA, RN, New York: The absolute worst gift I ever received was an old fashioned, white, chipped porcelain bedpan that was filled with dirt and was planted with numerous flowering live cacti.

What was your worse nurse week gift?