running out of things to say man candy saturday

I work in a high tech nursing home

When I am in triage I see just how acute our ER has become.  It is one train wreck after another.  People with chronic complicated illnesses. Very old people. People who don't speak english. More and more of the mentally ill.  The homeless.  Drug seekers. Drunks.

The days of lacerations, ankle sprains, appys and such  are long gone and they ain't coming back.  Our inner city ER has become a place for those with complex medical or social problems, on the one hand, or a place for the hood rats to use as a clinic for abdominal pain, back pain, colds, etc.

Sometimes it feels like I work in a high tech nursing home.

I pity the ER nurses of the future.

zdogg MD for president

recommended reading

My dream is to be a dude ranch nurse...

madness is a naughty nurse (surprise)

It seems I have been a naughty nurse. Apparently I broke the rules, stomped on the Nightengale pledge, turned the hospital's mission statement on its ear. So there I was, going along being the professional (!) I am 99.999999% of the time and BOOM! a moment of naughtiness ensues. Or at least, I"VE BEEN TOLD that I am naughty.

It seems I am going to have to spend some time in the ER naughty room in the time out chair explaining my actions. THERE WILL BE CONSEQUENCES that are yet to be determined...LET'S JUST SAY that there will be consequences and I will be watched henceforth for a designated period of time.  If I even THINK of being naughty again, well....lets just say that I WON"T KNOW WHAT HIT ME!! Future consequences may involve being the designated frequent flyer nurse and wearing the "bad nurse" hat.

So I'll be in the ER conference room writing: "Bob's Ghetto Hospital is a wonderful place to work and I will appreciate it from now on and never be a naughty nurse again" 1,000 times.

will winter ever be over man candy saturday

sad but true

In case you didn't catch on, this weeks blog theme is pictures...I'm too tired to write..

triage in a nutshell

yup

we all need a man c. saturday

They'll eat you alive

Have you ever heard of the term "1,000 yard stare". It is sometimes used to describe combat soldiers who have seen too much, are always on alert and just trying to make it through til they go home. Well I think I am developing the ER version of this and its called the "1,000 yard scowl".

When I cross the line into the triage area, I feel a change come over my body and a sneer or scowl start to involuntarily take shape on my face. I try to stop it but it won't go away. I am defenseless against it. There is something about triage that just brings out the beast in me. I sit at the window and have the attitude of "go ahead, make my day"...sometimes I put a battery on my shoulder and dare people to knock it off..(anybody remember that commercial?)

I think deep down inside I am trying to scare people off. But I'll tell ya the people who present at the triage window are not easily scared away. You could be slumped over on the desk, gasping for air and they would still say "I wanna see a doctor". You can have a phone in each ear, a patient in both bays, one in a wheelchair, an ambulance stretcher whizzing by and a line ten people long....but still " hey you I wanna see a doctor...".

Those people at the triage windows are survivors. They won't take no for an answer. They are like the mailman - through rain or snow or sleet or hail nothing will stop me from telling my tale....and no matter how many times you say things like "weren't you just here last week?", "what's going on today Bob?" or when you're having a bad day "you're back again?",they will keep coming back.

If there was a nuclear bomb dropped on the city, like the cockroach they would survive and present in the same whiny voice: "I wanna see a doctor". Triage is like combat. You never know when there will be a surprise attack, you always have to be alert, wary...keep your guard up. If you let it down, they will surround you and eat you alive...they're just waiting for a sign of weakness...(Ok I'm getting carried away...).

I think its time for me to resurrect another symbol that we share with the combat soldier: the short timers calendar. Everyday I'll cross out a day that will bring me one step closer to retirement...

madness is a bad monkey - no banana

Dere is people out dere who be thinkin' dat madness is a cynic, a real bitch. I don' give dose drug seekers the benefit of the doubt and all dat. I am a hard, burned out old witch of a nurse....that goes without sayin', but in my defense...I have been in the ER for many a year. My job is similar to a cops, only I have to keep my mouth shut. The cop can tell your sorry ass to shut the f--- up, I can't. I could but I would lose my job. Need the job, so don't. Cops have guns, madness don'. But we do deal with all the same people. From one end of the spectrum to another.

So excuse me if I have developed jus' a little bit of suspicion, caution, you gotta prove you ain' oneadose drug seekin' idiots attitude. I, along with many of my nurse pals, have been burned. Big.

What folks don' understand about drug seekers is that they are ADDICTS. They will do anything to get the fix. They will lie, fake, tell whoppin' stories...they are really pretty dangerous people. I have seen them get out of control when they don't get what they want. Suddenly that back pain is out the window and they are fightin' security on the floor.

I have seen drug seekers tell MAJOR stories that we all believed. What they are willing to do for the fix would floor you. So check your attitude about me not carin', giving the benefit of the doubt, etc. I have big time intuition about people. I can spot a faker at 50 paces with 99.9% accuracy. Whether you like it or not.

They waste my time, your money. (yeah, dats right mr/mrs taxpayer your money - you don't think THEY are payin' do ya?)Picture this scenario: your mom is having a heart attack and you bring her to us. I can't help her right away because I am down the hall dealing with the out of control drug seeker....thats my job in a nutshell.

half way through winter m. candy saturday

ode to nurses

Nurses are needed more than ever these days. we are becoming the only ones left to actually care for the patients.

Out of necessity, administrators and doctors have become immersed in the business that medicine has become. Administrators, because money, the bottom line, is their business.  Doctors, because their survival is dependent on reimbursement.  Everything they do is controlled by payment.  It overwhelms their profession these days. I'm not saying they don't care for the patients, want to do their best for the patients, they do. They just don't have time to care as much as they used to.

Nurses don't have time either, but they have to make time. Nurses sit between the medical world of money and the patient. We sit between length of stay, decreased medicare reimbursement,  non covered insurance services, downsizing, no available beds and the needs of the patient. We see that, no, granny isn't going to be able to make it at home on her own.  Yes, post op John isn't ready to be discharged..  We realize that 15 year new mom Brittany is gonna need more support at home.

So we fight for them. We demand for them.  Sometimes we win the fight, sometimes we don't.

We, as nurses, have increasingly become the human part of medicine.  When the specialists, the test doers are done running in and out, there we stand to explain what just happened and what it means to the patient and family. We bring in the practical reality of what will be needed after discharge and whether they are ready for it.  We hold grandma's hand.  We reassure John that its going to be all right.  We answer all of Brittany's questions in the middle of the night when all the others have gone home.

Without us, medicine becomes cold, white walls, alarm bells, bad smells, nameless faces. It becomes patients in nicely appointed rooms, alone and scared.

all this and a turkey sandwich

Does someone from Gomer blog work in my emergency department? Either that or all emergency departments across the country have the same box lunch contents:

Turkey sandwich
cookie
apple
milk

I know I sing the praises of this blog, but it is FUNNY.  Here's another funny one

Beverage container left open at nurses station, three dead as a result

They make fun of all the idiotic shit we deal with every day.

the forgotten elderly

The US  is starting to fill up with those 90 and above. It has become commonplace for us to see people in their 90's up to 100. Modern medicine is keeping people alive to an old age

Its always amazing to me how many people are living in their own place at that age. A lot of them
shouldn't be living on their own.  Something happens and they are discovered in an unkept apartment or house unable to really care for themselves. They are brought to us, often times in a disheveled state, dirty clothes  with urine stains when they didn't make it to the bathroom.

We clean them up, throw away the awful soiled clothes.  Do tests. They are of course, dehydrated, probably have a UTI.  BP is up, they haven't been taking their meds. They can't remember the last time.  They are bruised from falls.

They pick at a meal with give them. Not much of an appetite these days.

A lot of the time they don't have children or their children live across the country.

So here they are with us now. They are past the point of assisted living.  Next stop: nursing home. They will be propped up in the hall there in  a wheelchair with the other 90 year olds, waiting to die. It won't take long. Nursing homes are the worst place for them.  Depressing. Understaffed. Things like the flu or intestinal illness spread like wildfire in such an environment.

What are we going to do with all these very elderly folks? Nursing home beds are going to run out.  Then what?

rules of the game

Dear new ER staff:

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