Unwritten rules of the ER

1) If you come in on a backboard you will have to go to the bathroom within minutes of arrival.
2) If you come in with a probable broken hip you 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 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.

I don't care if you can't chunk a deuce/you're inability to defecate is not my problem

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:

*****CONSTIPATION IS NOT AN EMERGENCY. I REPEAT. CONSTIPATION IS NOT AN EMERGENCY. THAT IS ALL. GO ABOUT YOUR BUSINESS.*****

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.

Attention all ER docs: IF YOU ORDER AN ENEMA, ESPESCIALLY A TAP WATER ENEMA, YOU WILL BECOME A HATED FIGURE. THAT IS ALL. GO ABOUT YOUR BUSINESS.

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.

Nina Pham, nurse who contracted ebola, settles lawsuit

Nina Pham, the nurse who contracted ebola treating the first patient with ebola in the United States, Thomas Duncan, has settled a lawsuit with Texas Health Presbyterian Hospital.  The basis of her lawsuit was that the hospital did not have the protocols in place, or equipment needed, to care for such a patient leading to her contracting the virus.

She felt her privacy was violated with publicity in the press about her situation. At one point a doctor came into her room with a camera to talk to her. That film was later released to the press. I wonder if the hospital had to deal with any HIPAA violations around that issue?

She continues to suffer from physical symptoms since her illness. One of the reasons for the lawsuit was concern about possibly needing care for the rest of her life.

It's interesting that this lawsuit was filed 2 years ago and just came to trial a week ago.  The hospital, instead of settling with her two years ago, chose to go to trial, then quickly changed their mind when they realized the bad publicity that would result.  The settlement was not disclosed. Hopefully she got millions.  Texas Presbyterian Health Hospital threw her and the other nurse Amber Vinson, under the bus, in their scramble to save their own asses.

There are spiders crawling around your bed with you

Apparently throughout America there are spiders sleeping in our beds on a nightly basis.

It seems people figure any bite or sore with an unknown origin is automatically a spider bite and requires a trip to the local emergency room.  I wish I had a nickel  for every person who showed me a bite and  said "I think it's a spider bite".  I'd be a rich woman.

Don't even try to challenge that maybe this isn't a spider bite. The patient is always confident that this is indeed a spider bite and you are foolish to think otherwise. Their auntie told them so.

Out of the thousands of different kinds of spiders in the world, very few would bite humans, and even fewer of them are harmful. They are just trying to get through their day as a spider. Thinking about having to spin that damn web, whether any juicy insects will get caught today..

Have you ever heard that you are never more than 6 feet away from a spider?  There is one on the other side of your husband right now and they are sizing you up for dinner right now....

The most likely to score a percocet script drug seeker

Is it just me or is everyday just an endless parade of drug seekers?  In all their different forms.

Maybe instead of betting on the drunks alcohol level, we should bet on which drug seeker makes a score.

Here is a synopsis of the "Most likely to score a percocet script drug seeker".

1) White

2) Woman

3) Dressed normal (no cleavage, short shorts)

4)  Educated

5) Apologetic

6) Polite

7) Accompanied by concerned male (preferably husband) version of 1,3,4

Other factors:

1) Is doctor in bad mood?

2) Is doctor busy?

3) Is doctor tired?


And there you have it folks, "the most likely to score percocet drug seeker" in a nutshell.

STD rates are soaring

Q

I started as a nurse in 1985. It was at the height of AIDS hysteria. Back then we would wear a space suit into rooms of patients with AIDS:  gowns, goves, masks. Everyone was scared to death. Nurses quit nursing because of the fear. It was an awful time. Taking care of patients dying of AIDS was brutal, watching mostly young men suffer was awful.

Then as time went on and we became more educated, things changed. At this point it is a rare occurrence to care for someone with AIDS. We still see people with HIV but it has become a chronic illness, rather than a death sentence, with treatment.

Why the change? People stopped having unprotected sex. Now we seem to have entered an era when this generation, who never saw the devastation of the AIDS epidemic, are having unprotected sex once again. STD rates are soaring.

Last year there were 1.5 million cases of chlamydia.  Two thirds of the cases were women aged 15 to 24. Chlamydia can go undetected causing infertility. There were over almost 400,000 cases of gonorrhea last year. The majority were men who have sex with men. The problem is gonorrhea has become harder to treat because antibiotics are becoming resistant. Syphilis cases are also increasing.

Bottom line? People aren't using condoms. They are not being educated. Another problem is health clinics are being closed. Planned parenthood funding is being cut. Funding for clinics and education must be a priority. Education should start in the emergency room. I wish we could have a supply of condoms.

Sex brought me to the ER

Just when you thought it couldn't get any weirder, I see an advertisement for a new ER reality show: "Sex sent me to the ER" on a cable channel coming this month to a TV near you. No doubt this will be a real laughfest...

I've been in the ER a long time and I have, for the most part, missed out on sexual shenanigans that brought patients in, although I have heard stories from my co workers. Mostly along the line of somebody put something up their butt and they can't get it out and oh by the way, its still buzzing for everyone to hear.  People getting stuff stuck on their johnson and it has to be cut off.

Hearing these stories amuses us, but seriously ya heard one of these you heard 'em all.  Whatever. Mostly we just look at people in these situations as stupid.

This is brought to you by the same people who do the show "Untold stories of the ER".  They contacted me once and encouraged me to send in an unusual story.  The kicker is they want you to be on the show to be part of the story.  Ah...no thanks.  So I'm wondering will that be the case with this show?  Will the doc or nurse be on the show?

The freak show that is triagr

I take my seat at the window.  No one is in front of it, thank God. I have already transformed into the incredible hunk as I do every time I am assigned to triage.

 I hate our triage set up.  It was designed to drive the staff insane.  There is a camera that looks at the entrance, so we have a screen where we can see cars pull up, people walking up. Its a long way from our entrance to the desk.  A ridiculous design.  A cruel design.  It allows us to watch people walk a distance to the desk.  This allows many to put on a performance.  Sometimes a person who strode up to the entrance on camera will be practically crawling when they get near the window.

Let the freak show begin. It often resembles the cantina scene in Star Wars. There are goths.  Tattoed people. Pierced people. Women with so much cleavage,  I worry the girls will escape.  Twitchy people.  Falling asleep people.  Yelling people. Hostile people.  People who go to the floor. People who want to show me something on their butt people.  Drunk people.  People who have smoked dope.  Reek of cigarettes and beer.  People who make you feel like you are in the twilight zone.  People who make the hair on the back of your neck stand up.  Whispering people.  People who brought gruesome "samples" in little jars.  Vomitting people. Coughing people. People who can't breathe.  People in pain. Pale people. Flushed people.  Bleeding people. Broken people.  Sad people.  Crying people.  Anxious people. Dirty people.  Smelly people. Plain people.  Good looking people. People in wheelchairs.  No english people. Funny people. Mean people. Nice people.

Once in a while there is a Marilyn.  You know Marilyn who was on the Munsters.  She was the only "normal" member of the family.   The rest of them were monsters.  Marilyn allows you to relax for a moment.

bad monkey no banana

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.

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

Allina nurse strike continues

4800 nurses in Minnesota are going into their 6th week of a strike. I support them. Among the issues they are striking over are workplace safety. All of who work in the ER face daily verbal and physical abuse. Among their proposals:24/7 security in ER. A no brainer. Why do nurses even have to ask for this? They want the charge nurse to have no patients. What a concept, they can be the actual charge nurse. Another issue, they want them to go to a shitty health care plan. Not even nurses working in healthcare can have decent healthcare.

These nurses are will to make this sacrifice for all nurses really. They are willing to put their families economic stability on the line to fight for better conditions.

They started a gofundme page. I gave. If you can, I encourage you to give too. Press donate button below. Please share this post.