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.

Coming to a town near you

From Massachusetts Nurses Association:

RN ALERT: Commonwealth Wants to Allow Unlicensed People to Administer All Medications to 

Patients in Any Setting, including Acute Care Hospitals and Schools

08.31.2016

FYI for nurses and everyone making calls on the unlicensed medication administration proposal:

Gov. Charlie Baker has already begun trying to deflect blame on this issue. But he owns this dangerous plan. Baker has appointed six of the 14 current members of the Board of Registration in Nursing, which has proposed allowing unlicensed people to administer medication. The executive director of the board is also a Baker appointee.

Baker came into office declaring he would overhaul state regulations. This proposal would do just that, and in doing so jeopardize patient safety. Baker’s plan would endanger patients in every health care setting. Call Gov. Baker at 617-725-4005. Tell him you know it is his plan, proposed by his appointees, and urge him to stop #BakersBadMedicine.

nurses strike in minneapolis

Right now, as we speak, 4800 nurses are striking Allina Healthcare in Minneapolis Minnesota.  The issues are health insurance, workplace violence and staffing.

The corporation wants to take away the union insurance and put them on a high deductible insurance. The nurses want 24/7 emergency room security, safety measures put in place.  Better staffing and a policy that charge nurses don't have to take patients.

Nurses are standing up for themselves and we need to support them.  Go to Minnesota Nurses Association and show your support.

Hi.

Hi.

hospitals nationwide try to take down nurse unions

Hospitals are on a nationwide effort to take down nurses unions, figuring they will do it before the next shortage.  Nurses in unions have won good benefits in many states when negotiating contracts in the past.  We took advantage of our power. 

With the economic downturn has come an effort to take back the health insurance and pensions that that nurses made many sacrifices to obtain.  Hospitals say no one gets good insurance any more.  They say pensions are outdated.  They pit groups of workers in hospitals against each other.

Nurses sacrificed a lot to get to decent benefits for ourselves. We went on strike.  We sacrificed wages for benefits.

We still have the power we have always had.  We are the ones who take care of the casualties from something like the Orlando bombing.  When they stream into the emergency room, it is the nurses who receive them and take care of them.  It is an upside down world when the people who have the skills to care for complex patients have to fight for their benefits while the paper pushers get exorbitant salaries and bonuses.  It is the nurse who helps the doctor save lives not the administrator.

The question is: Will nurses take the power they have, as the backbone of the medical field without which it cannot function, or will we back down?  Its up to us. The future of nursing is at stake.

Here's to the staff at the Orlando Regional Medical Center Emergency Room

After hearing about the orlando shooting, one of my first thoughts was of the local emergency rooms who would care for the victims.  It must have been overwhelming to have all those patients come at once.  They did what ER staffs always do: dive in and go to work. What allows them to do it? Their co-workers.  Knowing they will have their backs. The video below is an example of that. The night staff arrives to work the next night and are greeted by their colleagues. This is why people stay in ERs.  So here's to the staff at Orlando Regional Medical Center....we are proud of you and thank you for your skill and dedication.

there is hope for nursing yet

Nurses are bad at standing up for themselves. Why is that? Is it because we were taught to be good little boys and girls who always behave? Is it because deep down inside we don't think we deserve any better? Is it because it's a way of taking care of other people, not wanting to make them feel bad, even if they shit on us? After all, we are caretakers to the bottom of our souls.

We are professionals with college degrees who do a complex job that requires skill and brains.  Yet we are often treated like children by our administrators,  stupid servants by doctors and bad mothers by patients and their families.

We as a profession, ALLOW ourselves to be treated this way. It drives me absolutely INSANE.  I have told mysef, too many times to count, that I was not cut out to be a nurse.  I am a fighter, a rebel, outspoken.  I don't fit in with the profession. Never will.

All of this seems depressing, yeah? Don't despair my little flower blossom. Alas, every once in a while, we, the nurses, stand up for ourselves. We actually say -ENOUGH!

I am part of one of those *ENOUGH* moments right now. It's a beautiful thing to watch.

What is left behin

Jessica Gray wears the shirt of her late husband, Army Staff Sgt. Yance T. Gray. He was killed in Iraq in 2007.

***from CNN

E coli as enemy combatant

Here comes news that there is a super freak e coli strain that has now arrived in the United states.  It is apparently considered an enemy combatant  because it's arrival was announced by the department of defense.  This is a super bug that doesn't respond to ANY antibiotic.  It kills 50% of the people who get it.

What this brings to mind is the sepsis extravaganza that is going on every hospital
in this country.  If you have a temp of 99 and a pulse of 101 you are a possible sepsis.

If your labs are off - OMG!!!!!!- you get the triple whammy .  Ceftriaxone, Flagyl, Vancomycin for you. There will be no germ left in your body dammit!!

This is only the beginning of a long line of resistant organisms.  It's a science fiction movie come true.

Cowardly chicken hawk donald trump dodged draft

Chickenhawk (also chicken hawk and chicken-hawk) is a political term used in the United States to describe a person who strongly supports war or other military action (i.e., a war hawk), yet who actively avoids or avoided military service when of age.

I am a veteran. So naturally I have STRONG feelings about veteran issues. I cannot stand people who use veterans (or even veterans who use their military service) for personal gain or attention.  To see one of the presidential candidates crow about being the greatest supporter of the military that ever lived sickens me. When they sponsor a fundraising event using veterans for political gain and lie about the results - where and to whom the money went, it enrages me.  Guess who I'm talking about? Yeah, that fucking idiot donald trump, a man who after 4 deferments,  wasn' t drafted due to " bonespurs" in his foot. Poster boy for being a chicken hawk.

Even the lowly UA has become complicated

UAs. So easy. So routine. One of the easiest things I do as an ER nurse. Used to be anyway....

Now even the lowly UA has become complicated. Instead of taking the UA cup , labeling it and sending it off, now they have added steps.  You, my dears, the UA cup is no longer just a UA cup. It has become a complex specimen creating contraption.

Allow me to elaborate: Your friendly neighborhood urine cup now has a hollow tube in the middle. On the top of the container is a a needle with rubber over it.  Said urine cup comes with two specimen blood type tube with the usual rubber stopper. Once you get the specimen you have to put the tube on the needle and it fills the tube with urine all spiffy like. You send the tube to lab, not the specimen cup. The specimen cup is thrown in a waste basket with all the other urine specimen cups. For some reason the urine is not emptied out before being tossed. Apparently there is a gnome in the basement whose job it is to empty all the urine down the sewer....

My thoughts about all of this: just shoot me now.

I wouldn't wish a nursing career on my worst enemy

My job has become overwhelming.  It used to be there were days when it wasn't that busy, when there was time to talk to my co workers, relax a little bit.  Those days seem to be gone.  There is not a day that goes by that it is not busy from morning til night. The waiting room is full.

The patients have become sicker.  I think most people think of ERs as places where people go for broken bones, appendicitis, car accidents, etc. Maybe that was the way it used to be.  Not any more. ERs have become high tech nursing homes.  Our patients are the elderly, the chronically ill, the mentally ill.

People are living into their 80's and 90's routinely these days.  Their health inevitably deteriorates the older they get.  They are the majority of our patients.  The next group is the chronically ill, those with heart disease, diabetes, cancer, the disabled,etc. Naturally they are in the ER more than most. Last but most certainly not least are the mentally ill.  There has been an explosion of mental health patients in the last five years, especially adolescent psych patients.  Due to lack of psych beds, they sometimes stay days in the ER waiting for a bed to open up.  They can be violent.

One other group I didn't mention are those who live at the bottom of society:  drug addicts, criminals, drunks, people whose lives are a pile of shit.  They make up a percentage of the ER traffic too.

When the patients are sick, they get more tests, procedures. Everybody gets an IV and IV meds.  They are complicated, a lot of work.

Add this to the fact that there every time I come to work I have about ten emails telling me the changes that have happened since the last time I was at work. 

Charting has become a nightmare.  We spend about half our time filling in blanks to make accrediting organizations happy.

Everything has become a protocol these days with many steps and lots of charting involved.

All this in the middle of dealing with patients and families fears, anger, demands.  Throw in short staffing and you have an overwhelming job that I wouldn't want my worst enemy to have. 

Duh, hey, Dr, maybe ya ought stop giving out narcs like candy...

At last, a well known doctor, Sanjay Gupta, is acknowledging that doctors are the ones who need to: read here on cnn

1) Finally acknowledge their MAJOR ROLE in the prescription drug epidemic. Ain't nobody else writin' those scripts...

2) Acknowledge that they need to stop giving out narcs like candy.

3) Stop using excuses about why they continue to foster the epidemic: The patients complaints will bring down patient satisfaction scores. Who cares?  Patents expect it. And they will continue to expect it until you stop. It's easier to do it and avoid confrontation. Why are you a doctor? Seriously.  Etc etc etc

Excuse me while I shed a tear..

My old pal ZDoggMD brought a tear to this cynical bitch's eye.....it's nurses week folks...I didn't realize..I'm in the middle of some days off....guess I'll miss the package of gum...

Wasting away in frequent flyerville

Death can be funny

RIP Prince

Back in the day.   

ain't that the truth

Yeah i'm still here. I still work in the nut house.

donald drumpf

It's like I have gone through the grieving process with election.....first I was shocked....really...?Donald Trump?   REALLY?! DONALD TRUMP?!!!!  OMFG DONALD TRUMP.

Next I tried reason with myself: This will never last.....it can't can it?  Hahaha it's all pretty funny....6 months later and he we are poised on th edge of a cliff, teetering precariously.

Then I got angry...this so wrong.  I can't believe I ever thought this was funny...I must have lost my mind.  Who the hell are these mindless robots following HIM into the abyss?

then came the sadness....this is what it's all come to after the struggles that have been fought and won in this country.....all the people died in the wars...we honor their sacrifice by becoming the laughing stock of the world?

Finally acceptance....this is it...this is where we are....this is the where I look for tickets to anywhere but here. **

I think this article in the Washington Post explains it nicely:https://www.washingtonpost.com/blogs/compost/wp/2016/02/26/but-seriously-how-do-we-turn-this-donald-trump-thing-off/

** word of warning to those who would defend him in the comments, think twice. I will hunt you down like the dog that you are.

Home at last...

Me, after a bad 12 hour shift.

Yeah..I still wear the hat..SO WHAT!!

That guy

I'm such a romantic

I'm warped but I think this funny...

Doctor gets 30 years for overdose deaths

It  completely amazes me what the job of doctor has become. Being a doctor used to be a highly respected profession, so much so that doctors were godlike creatures that nobody questioned.

I myself have respect for many doctors but overall I have lost respect for the profession as a whole.  It has become a racket.  A money making racket. 

Doctors order thousands and thousands of unnecessary tests every year with the excuse they don't want to be sued for missing something. It is complete bullshit. This is done to bump up levels of care and increase billing.

Then there is the whole prescription drug problem.  In the news today, a doctor was sentenced to 30 years in prison for the overdose deaths of 3 of her patients.  She had a pattern of prescribing unnecessary pain pills. What a disgrace for the medical professiion.

Why do so many doctors give out pain med prescriptions?  To avoid unhappy patients. Because patients expect it. Because it's easier to do it. In other words for cowardly reasons.  Doctors could stand up, as a profession and stop this. They choose not to. As far as I'm concerned the addiction crisis lies squarely on their shoulders.

More and more the government and insurance companies are taking over how medicine is practiced.  Part of the reason is costs. Tests are ordered that are unnecessary creating a ridicously expensive health care system. Pretty soon the government will play a huge role in narcotic prescribing, since doctors can't regulate it themselves.  Doctors will have to justify every pill they prescribe. 

Doctoring used to be an honorable profession.  That ended years ago.

Ah....sweet, sweet karma...

Karma is indeed a motherfucker

Do ER Nurses have PTSD?

Here's a great blog post written by Edwin Leap MD, a doc who has been around the BLOGOSPHERE for years. He writes a blog at the Huffington Post: http://www.huffingtonpost.com/edwin-leap-md/


Here's the post about PTSD:  http://www.huffingtonpost.com/edwin-leap-md/suffering-and-burnout-in-_b_8448704.html

Wasting away in frequent flyerville

When you work in an ER for any length of time, you realize that there are a substantial group of people who you see on a regular basis. A few hundred actually. These we refer to as the dreaded "frequent flier".

Yes, these are the people who appear at the triage desk and you don't have to ask their names because you already know them. They are there so often that if you don't see for a couple of weeks you wonder if they died.  You ask you co-worker if they have seen so and so lately.q

Yes, they sometimes come in weekly, even daily, sometime even 2 or 3 times in a day. There are some who come in only on weekends. They are the drunks, the migraineurs,  the chronic painers, the depressed, the obsessive constipationists, etc etc etc.

Some of them, when you see their name on the triage screen, you want to run for the hills.  Others, you think whatever... They are not the kind of people who get the concept of primary care.  We are part of their life, the ER for them, is like you and I going to the grocery store. It's just routine.

We will keep seeing them, that won't change. The only thing that will stop them from coming is if they move away or die.

Step away from the tylenol!

There have been a lot of advances, shall we say, in my ER since the dark ages when I started. We have a lab in the ER now. The techs draw the blood an do some of the blood tests. That's cool.

We now have a pharmacist. With the pharmacist comes the practice that EVERY med has to be approved by them before we can get it out of the million dollar drug dispensing machine. There are exception of course, many actually.  Anything we would need right away, narcotics even. We can override the machine.  Here'the thing: something like Tylenol can't be òverridden.  Bacitracin (yes it's now in the machine - IT IS a drug you know) can't be overriden.  So let me get this straight - I can take out ten pounds of dilaudid but I can't get a tylenol?  OKAY THAT MAKES SENSE.....