the batshit crazy club

After many years in the ER, I have developed certain talents. I would say one that I have perfected is the ability to keep a straight face. You could tell me that you have are growing a second head or have a tuba up your behind, and I would tell you "okay, have a seat in the waiting room, we'll be with you shortly". There is little that you could tell me that would stun me. Heard it all, seen it all.

With that in mind, may I say that there are many bat shit crazy, freak-deaky people in this world,and eventually, they make their way down to the emergency room. I had one a couple of months ago. This dude seemed to be making a game out of how far he could go with all these bizarre facts about himself and his life. I'm not even going to get into it here because it is just too weird.

I thought what is this guy getting out of this? Telling me all this weird shit. Is he doing it for attention? For effect? Is he trying to freak me out? All I thought about him was that he was a fucking nut. I avoided him as much as I could.

I didn't discharge him, the charge nurse did. She said to me she hadn't know he couldn't hear. I said, couldn't hear? The man had been talking to me and hearing me just fine. It turns out when she went in to do the discharge, he starting using sign language like he couldn't hear. Bat shit crazy, just like I said. This world is a crazy place. There are more lunatics than you realize

don't I know you?

second class citizens

Don't even get me started on the gun debate.  Grrrrr... The thing that irritates me the most is talking about the mentally ill.  Doing a background check, one aspect would be to check about whether you have any mental health problems.  Intervening with people who are mentally ill before they can get to the point of shooting people.  It is obvious that the people who talk about this have no clue about psychiatric care in this country.

1) Clue #1: There are not enough psychiatrists.  Especially those who are willing to work in hospitals.

2) Clue #2: There are privacy laws called HIPPA which prohibit sharing any kind of information about patients. Think about this: It is hard enough to go and get help, do you think people will go if they know their name will be shared with others?  Who will determine who is on the list?  The whole thing is a preposterous idea.

3) Clue #3: The mental health care system in this country is abysmal.  Those who seek care for their mental health are second class citizens.  Their care, for example counselling, has to be pre-approved by insurance companies and is limited.

There are a very limited amount of mental health beds.  Apparently caring for the mentally ill is not profitable.  Here is a fairly frequent scenario when you come into an ER, using my ER as an example.

It is typically at least a 4 hour visit.  It takes that long to decide what to do with you. I see you.  The doctor sees you. Then a mental health person comes to see you and talk at length about your problem and they are the ones who decide whether you need to be admitted. The majority of people do because they are usually suicidal. There are typically two of these people for a 35 bed emergency room.  There can be 5-6 patients in the ER for mental health at one time.  Their evaluations take time.  You may wait to see them for a while.

Once they see you, they have to call the psychiatrist and discuss you with them to decide whether you should be admitted. Once they decide to admit you, they have to call your insurance company to get approval. This gives you a clue how we view mental health right here.  Does the doctor have to call your insurance company  to get approval to treat your for a heart attack?

So you are approved for admission.  Let the bed shennanigans begin.  Maybe it will be your lucky day and there will be a bed.  You may have to wait a few hours for someone to be discharged. There may not be any beds at all,  Then they will look for a bed in the rest of the city at another hospital.  You will be transferred there.  No beds in the city? They will look statewide.  You could be transferred 50-400 miles away.  I have seen people transferred to a bordering state. There may be no beds anywhere.

In that case, you will spend your time waiting in the ER.  I have people have to wait 24 hours to get a bed. They lay on an ER cart, with nothing to do.  Many of them escalate during this time.  I have people need to be restrained, sedated because they get out of control in this situation.  Who can blame them?

This is how the mentally ill are treated in this country. Perhaps the politicians who tout all the shit about mental health treatment would like to come and go through this process?

endangered species: nursing

Whitecoat, one of my favorite bloggers has an entry about how the state of California is realizing that it won't have enough doctors to take care of the people who will have insurance with Obamacare.  He seems to indicate that their solution will be to let people like PAs, NPs, optometrists (?) and such care for people because they are cheaper.

Of course docs are against all of this. Less money for them. Here's the thing: You are  looking at the future of medicine.  NPs and PAs as primary care providers, doctors as specialists.  Its inevitable.  Like I said, they are cheaper.  Docs don't want to do primary care. There aren't enough docs.

Healthcare is undergoing a radical transformation right now and this is just the beginning. The group that will be most affected by all this: docs.  The days of them being at the top of the health care system are done.  They are another cog in the wheel.  They can be pissed, but its reality.  Unfortunately, even they can be replaced.

Speaking of being replaced, I often think about the nurses coming into nursing now. I feel sorry for them.  The job is becoming more and more stressful.  Another thing that concerns me is worrying about nurses being replaced.  I think employers will move to replace nurses with paramedics, medical assistants or others, with nurses as supervisors.  They are cheaper. Its already happening.  I worry that young nurses, like most young people, don't realize what it took to get nurses to this point. I worry that nursing as a profession is so weak in having a national strength to stand up for us. I worry that we are too exhausted to fight for our profession.  I worry that we are an endangered species.

hell week and combat pay

Subject #1: Hell week.  Thats what we call it when you work 60 hours in a week in the ER.  Five 12 hour shifts. Usually its the week of your weekend.  You are scheduled five out of seven days.  By day 3 I am ready to commit homicide.

Nursing is so ridiculous.  In any other job you would be paid overtime for this. But here's the thing: The first three days are in one pay period.  The next two are in a different pay period.  Thats how they get away with not paying overtime.  It is such a crock.  Nursing are like slaves.

Subject #2:  I was once in the military, in a war zone.  I got what was called "hazardous duty pay".  It is extra money because you are in an area of danger.  You know what?  Nurses in the ER deserve hazardous duty pay.  Everyday we deal with the bottom rung of society: junkies, criminals, drunks, assholes.  Some of them are verbally abusive, even physically abusive.  They threaten us.  They sometimes get out of control.  We never know whats coming through the door and what they are going to do next. They can be shot, stabbed. Their gang buddies could show up.

ER nurses are on the front line of medicine.  They deserve more money because of that fact.