Friday, January 30, 2015

tom brady fired

In a timely bit of sarcasm, everybody's favorite blog: The Gomer Blog, presents this gem:

Respiratory Therapist Tom Brady Fired for Underinflating ET Tubes

Wednesday, January 28, 2015

interesting video

The best thing about this video is this fact: between 1991 and 2010 prescription narcotic prescriptions went from 75 million to 210 million. Unbelieveable.

Monday, January 26, 2015

I am sick of jackasses

When you are frustrated and your kid is sick, does that give you the right to throw a tantrum at the triage window?


When you wanted to be admitted for some bogus shit, does that give you the right to cuss and carry on, on your way out?


When you and the nurse didn't get along, does that give you the right to come out to triage and go on at length about it in a loud voice?


I am fed up with people who come in and act like complete assholes because they think their problems give them the right to act like fucking idiots.

I have decided that from now on I am just going to walk away from these people and let them sit there for a few minutes.  If they continue when I return, call security. I am done putting up with abuse.

Friday, January 23, 2015

a new era in the emergency room

Have we entered a new era in hospital/ER medicine?  It is so much more busy than it used to be over the last few months. Every day we are full with a full lobby. At first, I thought it was the flu, seasonal illness, but it has kept going.

The hospital has been full too. So people wait in the ER. Mental health beds?  Forget about it.

Is it obamacare and people having insurance? It feels like we now see two types of patients in the ER: those with serious problems and those with urgent care problems. We are seeing more and more urgent care patients.  Patient who are willing to sit in the lobby for 3 or 4 hours for a sore throat.

We are also seeing a lot more mental health patients, especially adolescent mental health patients.

We used to get an occasional day when things were reasonable and we could breathe a little bit. Seems like those days are over.

Wednesday, January 21, 2015

mental health patients are treated like caged animals

In the modern ER if you are a mental health patient we kind of treat you like an animal. (I know, I know, I'm always harping on this, but it bothers me.)

We take you and put you in a room with a cart. There is nothing else in the room out of our fear your will use it to hurt yourself or us All of your stuff, including your clothes will be taken from you. You will be watched on a camera. There is nothing to distract you in the room.  You have walls to stare at, thats about it. We will throw food your way three times a day. To be honest, most of the time we will be too busy to spend much time with you.

You will stay in the room for hours, sometimes days. These days most of the time there are no psych beds. Anywhere, sometimes in the whole state.

You will have plenty of time to sit and think about what brought you there, your problems. You will also have plenty of time to get pissed off because you are sitting there for hours or days. You may lash out, run down the hall, thrown something, get out of control.  Then we will restrain you and sedate you.  Its like we are tranquilizing you in order to have control of you.

This is the modern day emergency room mental health experience. It isn't going to change anytime soon.  It is dangerous for the patients, dangerous for the staff.  The thing is, nobody cares.

Tuesday, January 20, 2015

madness: beacon of virtue

Every once in a while (okay its rare), I say to myself: Madness, you have to change. You have got to stop the profanity on the blog. You have to stop being an evil bitch (oops). Stop being so damn (!) cynical and hateful and acting like all the patients are dumb losers. Be the professional you were trained to be. You know - caring and skilled, soothin' fevered brows, sheddin' an occasional tear, lots of nodding in sympathy, etc. That usually lasts about one blog post and I'm back to my normal's a hopeful endeavor...

May I just say that I get a perverse delight pissing people off on the blog. When all the dysfunctionistas and dysfunctionistos come forward calling for my head, it is fun. They call me an unsympathetic, uncaring nurse who should leave the profession, get a new job, etc.  They are right. BADA BOOM.

I don't fit in with what a nurse is supposed to be: kind, gentle, caring, self sacrificing, understanding, etc. I am kind of at the opposite end of that spectrum. If you are nice to me, I'll be nice to you. If you treat me like shit, I'm not going out of my way for you. Sorry. Just because I am a nurse doesn't mean I have to put up with abuse, rudeness, yelling, cussing, threatening, etc. Sorry not gonna happen.

I especially enjoy the fibromyalgiers, migraineurs, chronic back painers when they comment. They often go back to their friends on forums or sites that they frequent and tell everybody to go to the blog and comment. May I just say: I welcome you. Come one. Come all.

I fancy myself kind of like lady liberty, a beacon of virtue in the emergency room...

This is the motto I try to live by:

"Give me your tired, your dysfunctional,
your huddled back painers, yearning for one more script for percocet,
The wretched sunglass wearing migraineurs wanting benadryl with their dilaudid,
Send these, the fibromyalgiacs, with their fauning families to me,
I sneer inside the emergency golden door."

Of course this is based on the inscription on the statue of liberty:
Give me your tired, your poor, 
Your huddled masses, yearning to breath free, 
The wretched refuse of your teeming shore, 
Send these, the homeless, tempest tost to me,
I lift my lamp beside the golden door.

Monday, January 19, 2015

I don't care if you can't chunk a deuce/flo nightengale is rolling over in her grave tonight

Sometimes the ER smells like a pig pen. Literally. Shit is running off of carts and on to the floor.

Speaking of poop, why does anyone ever come into the ER with constipation? ATTENTION ALL CITIZENS OF THE US:


If you come into the ER with constipation, you will be viewed as the frickin' idiot that you are. I don't care if you are 102, the fact that you haven't had a bowel movement in 3 days is not an emergency. While we're at it, why is it that old people are obsessed with having bowel movements? Its like if they don't have a daily poop, its a crisis...

By the way, I don't believe you when you say you haven't crapped in 2 weeks. Don't believe you. Sorry. You wouldn't be able to eat, drink. Go home.


When I see a constipation coming my way, I run for the med room, staff lounge, bathroom, pop machine, develop a sudden interest in my patients personal life.

Don't come to the ER for constipation. The ER staff will hate you. And while I am at it, don't bring in granny or grandpa either. Have you ever tried to give an enema to an 85 year old? Its a recipe for diaster for all concerned. Now we hate you and your whole family.

Now come forth, o readers, tell me in the  comments how your case of constipation WAS DIFFERENT, how I am a terrible, unfeeling nurse who should just quit because Flo Nightengale is probably rolling over in her grave right now.  I'm feeling kind of evil tonight.

Sunday, January 18, 2015

good or bad day?

ER nurses guide to whether it was a good day or a bad day:

1) Do you feel like you have been hit by a truck?  BAD DAY

2) Do you just have the usual backache, feet hurt, mild headache?  GOOD DAY

Friday, January 16, 2015

Larry, Moe and Curly visit the ER (a typical Friday morning)

Hey I'm sorry if your life is shit, but that doesn't give you the right to become so enraged that you tear the receiver off the wall phone and throw it across the room hitting the wall. The wrath of madness will be upon you. You endangered us and we don't like that.

Hey I'm sorry you are a pathetic drug addict who told us you are suicidal. That doesn't give you the right to make a run for it. You are fast, but we are faster. It is our security's pleasure to tackle you out in triage. They live for that shit.

Hey, I am sorry that your life has gone badly, but that doesn't give you the right to light up a cigarette in the patient bathroom. That does not endear you to the staff or the other patients. The tenor of your visit has now changed. Not in a good direction.

How was your Friday?

Thursday, January 15, 2015

triage in 3 stages

This is me in triage:

before triage:

during triage:

After triage:

Wednesday, January 14, 2015

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.rrupt

Tuesday, January 13, 2015

what a naughty ER patient

Emergency department no-no's:

1) Don't fall and come in by ambulance and have a baggie of crack in your sock that the doctor finds when he examines you. At age 65 no less. Then keep coming out of your room yelling that we have no right to take your property.

2) Don't come in with your girlfriend (the patient) and then go out to the ER entrance and try the door on a car that is sitting there and get in and look around for something to steal. Then go back in your girlfriends room like nothing happened.You see my dear moron, we have cameras at the entrance, so smile you are BUSTED!

3) Don't come in with your boyfriend and both of you ask to be seen for the same thing: chronic back pain. Then expect both of you to get a supply of Vicodin. I don't think so.

4) Don't go in the bathroom and down a bottle of jack daniels before you are admitted to mental health.

5) Don't come in after being banned from 3 local hospitals because you were sexually aggressive and threatened to kill the staff, then set your sights on our hospital.

6) Don't adjust your own IV pump to cause yourself another medical problem so you can be admitted.

7) Don't call us on the phone and ask if we do c-sections there because you are "tired of carrying this baby".

8) Don't pack some hospital sheets and towels into a patient belongings bag and try to leave with them. EWWWW!

9) Don't come in for something related to your pregnancy and then steal the fetal heart monitor that we used to hear your baby's heartbeat.

10) Don't tie up your dog at the emergency entrance and then come in to be seen.

Sunday, January 11, 2015

Which ER supplies the softest, most cuddliest and toasty warm blankie?

I'm thinking about starting a new local ER website. As a service to humanity.

On this site would be listings of every ER in the city and the waiting times on their websites. Listed in order of least waiting time to most. Length of typical visit.

In the interest of serving the community, there would be a list of whether the ER has:

1) box or bag lunches and their contents and rotation
2) types of (cold, icy) juice and selection of crackers
3) whether they supply warm, cuddly, toasty blankets.
4) footie availability and color selection
5) whether they have TV (with HDTV cable or DVD availibility)
6) probability of getting a cab voucher or bus token
7) probability of you scoring a script for percocet
8) probability of you taking an ambulance in for a sore throat and getting back to a room versus being put in the lobby
9) comfort of chairs in lobby and presence of TV, fish tank, vending machines (quality of snacks, selection of sodas), play area
10) whether your car can be valet parked on arrival

There would be a comment section in which you could name names about which docs at which ERs were Dr Feelgoods.

Oh the fun that could be had! The comments section could be entertaining in and of itself.

Hey...its a competitive world out there and patient satisfaction is the goal of every single solitary person in the ER, including of course, yours truly, thus the web site...

Saturday, January 10, 2015

m. candy saturday

memo to drug seekers

Dear drug seekers:

The following are drug seeker presentations that we see on a daily basis. In other words, don't need to be a lot more original.

1) "I lost/they were stolen/I forgot..". You lost your prescription, bottle of pain pills. You forgot them at your home 150 miles from here. Some dastardly dude stole your pain pills while you were napping.
2) "I am allergic to ibuprofen, tylenol, toradol, darvocet, ultram..." The only thing that works for you is that magic percocet.
3) "I can't get into my doctor until next week". That unempathetic doctor doesn't care about you.
4) "I used to have (back, neck, foot, etc) pain years ago and now it is flaring up so I don't have a doctor anymore".
5) "I am out in the car and I need help (probably a str
etcher) because I am in so much pain". (Somehow I got into the car at home...)
6) "Let me get on my knees or lay down in triage to show you how much pain I am in".
7) "Let me be as polite as I can and call you yes maam and maybe you will think I am a nice guy" and not a drug seeker.
8) "I am so terribly sorry to bother you at all, I know you are so busy, but I couldn't stand it anymore".
9) "I just moved here from (fill in city) and don't have a doctor here/left all my pain meds back in (fill in city)".
10) "I went to (fill in ER) and they didn't do anything for me".
11) I have surgery scheduled at (fill in hospital) next week and I need something to tide me over til then".
12) "I am not looking for narcotics".
13) "Is Dr so and so working? He was so nice last time I was here".

Friday, January 09, 2015

sometimes triage is a cesspool

The triage lobby is a weird place.  Its like a  dysfunctional little community out there.  Sometimes it takes on a life of its own.

There can be children running in circles around the lobby.  Drama queens loudly telling their tales of woe so everybody knows the details.  It can be a scary place with scary looking people.  Maniacal laughing, weeping,  Angry exchanges. Wailing children.  Stinky people.  People vomitting.  Thats Penny the prostitue sitting next to Clara from the suburbs who is sitting next to the homeless guy who hasn't had a bath in a few months. Sometimes you have no choice who you sit next to. People chow down on entire meals out there. People fall asleep. People pace.  Its a cesspool of the human condition.  You never know what your gonna get.

Different days have different atmospheres.  Some days its quiet.  You could hear a pin drop.  Other times its a dull roar of different conversations.  People talk to people they don't know.  Tell their stories.  Some days it feels like they are conspiring against us.  I see them looking at us. They are fomenting revolution, coming for us, I just know it....har.  Some days people are angry.  The wait has been long. They hate us.

When the wait has been long, one them finally has had enough, they approach the desk and ask: "How much longer will it be?  Where am I in the line?"  They tell us they are feeling faint, etc. They have to get to work.  Grandma is in a lot of pain.  They ask that age old triage question: "Why are other people going ahead of me?".  They are never  satisfied with our answers.  Its not what they want to hear. They may get mad, cuss a little bite, roll their eyes.  Sometimes they leave, deciding they aren't an emergency after all.  Most sit back down.  Here's the thing we know: Now they have done it.  They have given permission to all the other people in the lobby to make a pilgrimage to the triage window.  Now they are all mad together. Sending disgusting looks our way.  It gets to a fever pitch, about to explode.  Then the triage door opens, I say: "Fancy Parker, you're the next contestant...".  The tension is broken.   For now....

Tuesday, January 06, 2015

this is an ER nurse

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?

Monday, January 05, 2015

how I became a bitch

Working in the ER changes you.

It is unlike any other place in the hospital. You are dealing with a constant stream of people who are having some kind of stressful event in their lives.  We may not think it is a crisis, but for them it is.

The ER never ends. It never closes. Its 24/7.  There is never a break. It can be quiet one minute and chaos the next. You can be dealing with a stubbed toe and in rushes someone with a gunshot wound or a cardiac arrest We live our life on the edge.

You are dealing with everyone from A to Z.  Many of the people who frequent ERs are living dysfunctional lives. They bring that dysfunction into the ER with them. They can be drunks, junkies, criminals, the homeless, the mentally ill, the neurotic.  We deal with violent drunks, drug seekers,  homeless people who haven't bathed for months, out of control psych patients, manipulative people who can turn on a dime if they don't get what they want.

We work in a chaotic environment of ringing alarms, yelling patients, ringing phones, overhead paging... When it ramps up its overwhelming.

You know all of the above going in, or at least you think you do.  When you choose to take a job in the ER, you are the kind of person who thrives on chaos and crisis.  Bring it on.

Here's the thing about the ER that people don't get: It is not like ER on TV.  We are not constantly dealing with a car accident, a shooting, a cardiac arrest.  We get critical patients. Often. That's actually the fun part of my job. Ninety nine percent of the time it is routine, dull even.

My job is the everyday world of the ER: the abdominal pains, back pains, chest pains, mental health, etc. etc. etc. that make up the daily operation of an ER.  Its boring really.  Its predictable.

Being an ER nurse, you see a lot of tragedy.  Tragedy in the form of suffering people with cancer who are dying, terrible chronic diseases or conditions, unwanted elderly people..  People die.  Families suffer.  It is sad.

Then you see people who are such ineffective copers that a cold sends them over the edge and into the ER.  They are the type of people who will never have their own doctor.  There lives are such chaos that the concept is foreign to them.

Every day you deal with drug seekers in their various forms.  They lie and manipulate to get what they want.  You learn to recognize them a mile away.

Then there are the just plain mean people. You learn just how many of them there are in the world. They yell at you, verbally abuse you, threaten you, may try to hit you and succeed. They are the out of control people down the hall yelling at the top of their lungs because they didn't get what they wanted.

All this changes you.  Hardens you.  Makes you cynical..  You develop a shell that protects you most of the time. It changes your view of people, the world.   It exposes you to things most people don't see. It gives you a perspective on your own life and how it ain't so bad.

Being an ER nurse is so very difficult.  You cannot understand how difficult unless you do it. The only things that saves you is the occasional thank you, the thought that you made someone feel better or participated in extending someones life at least enough to get them out of the ER.

Last but not least, you will work with people who are hilarious, smart, dedicated and some of the nicest people you will ever meet.  They keep you coming back.

Thursday, January 01, 2015

flu announcement

It has been so busy in my ER and I have been so exhausted, I have been neglecting the blog.  The flu is rampant. Of course people are coming in, in droves.

On behalf of ER nurses everywhere I am making the following announcement:

                        ***ATTN ALL THOSE WITH ZERO COPING SKILLS****