Friday, August 29, 2014

Dear Mom...

Dear Mom:

You can stop talking now.  Yes this is your "child", but they are a grown adult, well into adulthood.
Stop talking for them.  They really CAN speak for themselves.

I hate to say this, but your are overbearing. Yes, your "child" has a chronic illness but it isn't anything thousands of others deal with everyday. They can go on with their lives with the help of medication.

I know that you had to advocate for them growing up. You had to be an expert.  That was your job BACK THEN but not now. Now they are responsible for themselves, but they sit their passively, letting you take over to speak for them.  They are used to you.  They don't have to do anything because you will do it for them.

What are you doing here anyway? They are perfectly capable of coming here all by themselves. They don't need their Mommy when they are over 30.

I know you have their best interest at heart. You worry, like all mothers do. Here's the thing: The best thing you could do is BACK OFF. Let them take care of themselves. You are disrespecting them by thinking you know best. You don't.


Madness the nurse

Wednesday, August 27, 2014

drugs are as american as apple pie

I was reading an article on CNN and its headline was "Drugs are as American as apple pie".  I thought that was a really good way to describe it.  It was about the heroin epidemic going on in the country.  Heroin is a lot cheaper than prescription drugs and so has become the drug of choice. Every ER in the country is dealing heroin ODs on a regular basis.

I got to thinking...with all the escalating emphasis on patient satisfaction,  it is playing right into the dealers hands.

There is a lot of talk these days of prescription drug abuse.  How it is completely out of control.  Who writes the prescriptions?  Doctors of course.  They are under pressure to stop giving out so many scripts.  On the other hand, there is this patient satisfaction sweepstakes.  Patients feeling about their experience at the doctors office and hospital is now being closely monitored.  Payments are being linked to their opinions.  Result: Give the patients what they want so they won't complain = given them a prescription for narcs.

What happens then?  A certain percentage get hooked on pain pills. Pain pills are too expensive on the streets.  Heroin is cheaper.   People get hooked on heroin.  Dealers make out like bandits.

Little white suburban Brittany and Dylan are now smoking heroin so, of course, America sits up and takes notice.  Mommy and daddy are stunned.  This isn't supposed to happen in our American dream subdivision.

The thing mommy and daddy don't realize is that their own government has become complicit in our growing drug problem in its supposed reforms of our health care system.

Tuesday, August 26, 2014

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.

Friday, August 22, 2014

We interrupt this blog....


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.

Tuesday, August 19, 2014

drug seeker fail

What is lower than being a failure as a drug seeker?

Lets set the scene:  You have a headache. Never had one before and IT IS SO BAD.  "I don't know what's wrong with me!!" (Cue look of alarm).  You had even gone to your doctor and were given a non narcotic prescription which you tried....but alas, you had what could only be described as an anaphylactic reaction that involved your throat closing up.  Did you seek help with your anaphylactic reaction at the nearest ER?  No you went home, drank a lot of fluids and it resolved on its own.  Wow..

Do you have any allergies?  Why of course you do and they are all to the medications that are a non-narcotic choice for pain.  Here's the thing: You have the same anaphylactic throat closing thing with all of them.  You tell me about 8 of them and state "I have more but I can't remember what they are"...

You are taken back to a room where you tell the NP that the headache may have resulted from the terrible fall you took at work (the plot thickens). By the way, you say, "I work in the medical field".  So you couldn't possibly be drug seeker/surely you'll be sympathetic because of that (the whole comraderie of medical workers thing)/I know what I'm talking about when it comes to this allergy idea.

Grade: FAIL

You really need to refine your presentation.    


I have been watching the events in Ferguson the last few nights.  Let me preface this by saying, I know that often in demonstrations there are a few people who want to provoke violence.  I used to be a protester back in the day and it was a known fact that this would happen sometimes.

However, what is happening in Ferguson is totally ridiculous. It is so obvious that the police are out to start something every night. Its like they have a meeting every day and they make a decision what time they are going to line up 1,000 deep across an intersection. This angers the protesters who are peacefully demonstrating.. Eventually the police start lobbing tear gas, smoke canisters and sometimes rubber bullets.

I have watched the reports on TV where police officials say molotov cocktails provoke these nightly tear gas episodes.  No one who is actually at the front line of these things have ever seen molotov  cocktails.  A molotov cocktail is a bottle with gas in it, with a piece of cloth that comes out of the top.  It is lit on fire and then thrown.  I assume it would cause a small explosion or fire.  None of this has been observed by reporters or protesters.

There is a lot of talk  by the police and government officials about how much they want people to be able to protest.  So a couple of nights they have a curfew.  Then tonight they tell everyone they have to be moving all the time or will be subject to arrest.  In other words they are interfering with their right to protest.  Freedom of assembly is part of our constitution.

To say that this has been mishandled by the local police, the governor of the state and other officials is a vast understatement. They have come off as bumbling idiots.

No doubt this officer will be arrested eventually.  He will probably go to trial.  Its the only thing that CAN happen.  If he is never arrested,
 these protests will explode across the country.  The Ferguson thing will seem like peanuts when that happens.


Monday, August 18, 2014

the lighted rock thingy in the lobby

Welcome to hood hospital. Allow our valet to park your car. Here is a member of the administration to direct you to your destination as you enter the door to our feng shui appointed lobby. Notice our lobby resembles a hotel with its muted tones, player piano, large wall fountain, some kind of large lighted rock thingy.

Up the stairs to your right you will find a coffee shop with lattes, mochas or a light snack for your convenience and enjoyment. A little more hungry than that? Let me show you to the 23 hour unhealthy fast food restaurant premises. There you can mix with the colorful locals. 

Need toiletries? Our gift shop will provide what you need along with books, magazines, flowers and assorted doodads.

 Don't forget to step outside to our "healing garden". There you will find benches, tables, a waterfall with streaml and beautiiful trees and flowers to soothe your stresses away. 

Here for a heart problem? Step into our state of the art heart hospital with individually appointed rooms with tv with cable (of course), wood flooring and pull out couch for family members to spend the night. Each floor has a well appointed lobby with fireplace, some with balconies. 

Hungry? Order directly from our "room service menu? between the hours of 6am and 6 pm.  

Feeling particularly stressed? The nurse can put you in touch with the "rich person who wanted their name on something integrated holistic healing centerr", all part of our services here at hood hospital. Employees will be happy to give you a massage, provide aromatherapy and music therapy and even accupuncture. We also have "energy healing including Reiki and healing touch".

There is a convenient hotel down the street for your guests and family and there is a shuttle to take you there. You don't want to walk through the hood after all...

By the way, avoid walking in the area surrounding the hospital. Your safety may be compromised as you note the neighborhood is home to the street gangs and various hoodlums. Never fear, we have crack security staff that patrols in cars, on bikes, in golf cars, on foot, equipped with tasers and batons to protect you and your loved ones. We have a "they ain't gettin' in here" philosophy when it comes to our neighbors. 

Yes we can meet all your needs here at hood hospitals, and by the way we also provide medical care...

Saturday, August 16, 2014


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....

Friday, August 15, 2014

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.

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.

Thursday, August 14, 2014

MRI is cash cow

One time I was over in MRI with a patient, sitting at th
e desk with the tech and he told me that there are 2 places in the hospital that make a lot of money:

1) Radiology

2) Surgery

I have noticed that doing MRIs has become a part of emergency medicine.  I can remember a time when we NEVER did MRIs in the ER.  It just wasn't done.  Now I would say we probably do 10 a day.  Most of them are brain MRIs for dizziness and some for strokes.  Lets say an average MRI costs about 1,000 dollars (they vary widely in price).  So thats 10,000 dollar a day x 365 days = $3,650,000 a year.   That's just in the ER.  Think about the inpatient and  outpatient MRIs being done.  Our hospital has 3 MRIs.  I work in a large hospital.  Lets say each scanner does 20 MRIs a day.  $1,000 x 60 = $60,000 a day x 260 days (eliminating weekends) = $15,600,000 a year.  So thats about  $20,000,000 a year off the MRI department.

Consider the other tests that are now done routinely like CT cardiac angios.  If you have a hint of family history, take cholesterol pill, have high BP, off you go. CTs are another big source of income, especially CT abdomens which are routine.

When you look at the money being made, you can see why all of these tests are ordered:

1) more money for hospital

2) bumps up level of care in ER = more money for docs

Lots and lots of these tests are unnecessary.  I wonder if with all the changes coming in health care if this fleecing of the hospital patient will stop.

on the streets of America

 Left: Ferguson, MO    Right: Afghanistan

Wow....very scary...this is your government telling you, you better not protest. #Ferguson

Wednesday, August 13, 2014

the name game

One of my favorite blogs: Gomer blog (satire at its finest) , had a recent post that cracked me up.  Anybody who works in the ER will relate to it: Mother Furious With Post Partum Nurse Who Mispronounced Her Baby’s Name

The story is about a lady who decided to name her kid -elle (Dashelle). She was so much more clever than all the other girls who spends months coming up with a "unique" name.  She took it one step further and uses a - instead of the word dash, then gets pissed when the nurse can't pronounce it. 

Well, natch, that got me to thinkin'....along this line what would be some clever names using punctuation or symbols or whatever?  Here's a few: 

' =  Apostrophe Johnson

( )= Parenthesis Smith (has an ancient Greek vibe)

* = Asterick Dodd

? = Question Mark Davis

$ene = Dollarene Williams

:elle = Colonelle Watson

% = Percentage McDowd

.... = Etcetera London

17 = Seventeen Jones

3cy = Threecy Ford

So simple, no muss, no fuss.  I think we're on to something here.. 

BTW. my solution to having no idea how the name is pronounced?  I usually just go with Mr or Mrs last name.

the queen of the night

The queen of the night has arrived. Brought by the royal coach, she is brought in by two footmen who transfer her to the royal suite. Along the way, she waves to her subjects, calling out, "whatcha lookin' at motherf--er?!"

I am tonights maidservant and get an update on the mood of her royal highness (HRH) from the two footmen. Its seems HRH is in a bit of a mood tonight, having overindulged in the grog, as it were.  "Ah ha" murmur the subjects.  All those living in the realm are well aware of HRH love of the grog. Alas, this happens thrice weekly at least.

The queen is a bit of a passive aggressive old fart. One minute she is shouting curses at me and the other maidservants, the next minute she is as meek as a mouse.

Oh well....the royal robes must be changed. We can't have HRH in soiled duds. So change them we do, of course. Next is the royal meal, the most important part is the presenting of the shortbread cookie.  The queen loves her sweets.

The queen has settled down, taking a short nap.  There is a pause in my duties. I have enough time to make THE CALL. It is one I have made many times on the queens behalf. I try to make it as soon as possible after HRH's arrival.  Verily, the queen is a pain in the arse...

The call is made, there is room at the royal detoxification centre.  The foot man are called.  The chariot awaits.  The queen is gently awakened.  Of course, the news of her departure is not received well.  A big of a struggle ensues.  At last the footmen secure the queen, rushing her out to the royal carriage as HRH screams obscenities threatening the lives of her loyal subjects.

Once again, there is peace in the realm.  For a couple of days anyway...

Monday, August 11, 2014

is this blog dead?

I think I'll just sit back on the couch and make my blog into a meme blog or a man candy blog.  It's just so much easier...bada bing.

I have become lax on the blog of late as far as blog entries go...its summer and the livin' is easy and all that.

Its also a kind of blah blah woof woof SSDD situation too.  I mean I have been at it so long that a lot of things aren't novel anymore, they're just boring.

So what now?  I have been doing this blog for about 7 1/2 years now. I have had 1,207,386 visits in that time.  I have outlasted people who I thought would be around forever: emergiblog, crass pollination, nurse ratched.  I guess they just have some kind of life and I don't....(rim shot)

So I'll keep at it for now, try to post more..we'll see what happens.

the drugstore is closed

Sunday, August 03, 2014

lonely old people

There is going to be a lot of lonely old people in the future.  The elderly population is exploding.

Every day I see old people, mostly women, who are alone in life. They never had children.  Their children live in another state.  They are estranged from their children.  A lot of the women have a lot of anxiety. They have nothing else to think about but their various ailments.  So they ruminate on them.

They are the kind of little old ladies who drive you up the wall.  The other day I had a person who was so anxious, it was just terrible.  The first inclination is to just tell them to calm down.  That only ramps them up a lot of the time. So I finally just asked "why are you so anxious?"  The bottom line is they felt out of control with their situation.  They were not in their own place anymore in life, at the mercy of a nursing home
staff.  Unfortunately they were the kind of person who no one could every do anything right for them.

Then the tears started and I learned their only child was in another state, was disinclined to have much to do with them.  No doubt they had their own family to care for and Mom was a bit of a pain in the ass. Mom wanted desperately to go and be with childs family where they lived.  That probably wasn't going to happen. Mom probably burned some bridges long ago.

So here was mom, desperate and lonely, feeling out of control, trying desperately to control things around her, alienating everyone who came in her path.  Now what?  I don't know. Maybe someone will listen to her story once in a while and she can have some temporary attention that she desperately needs.