a shitstorm

I actually ran at work yesterday. I mean move the legs full out run.

I don't run. I'm not a runner. At work.  I saunter.  I may walk fast once in a while.  Rarely. I'm not excitable.

This was one of those "Oh shit! That wasn't supposed to happen!" moments. But it did and I ran. It wasn't even our patient.  They were alive when they left the ER.

I started charge at 3 pm. Within a half an hour we had a  stroke come in.  Then a half hour after that the Oh shit! moment happened.  Then during that an MI came in.  Then here is news that there is a helicopter landing and guess what, the bed isn't ready.  Helicopter = critical patient.

Yes, folks, we got ourselves a GENUINE shitstorm happenin' here.

Six hours later I dragged my butt home.

our ER becomes the Target ER

My ER is shabby, old, falling apart, embarrassing really.  We are an inner city ER and last on the list for renovation because of that. Every other ER in the system has been redone, but then most are located in the suburbs where people have insurance and wouldn't come to a broken down ER.  Since the poor and elderly city folks don't have a choice, they still come to ours and don't expect a shiny new ER.  So the heads of the corporation don't really give a shit what our ER looks like.

So I have an idea.  We get Target to sponsor our ER.  We become the Target ER.  Target pays for the renovation.  We put a big bulls eye on the front of the ER.  The employees all dress in red scrub tops and tan pants with a target bulls eye on the pocket.  Everywhere you look there are signs that say: "This ER brought to you by Target".  Our patients are called guests...Target could advertise that they sponsor us at different events, on TV, the internet.  Its win-win for everybody.

In fact lets just extend this whole concept to all of medicine.  I mean health care has become a corporate, profit motivated environment anyway.  Lets go all the way.  Lets let corporations sponsor hospitals, clinics, every part of it.  It would save our system from economic collapse.  Companies would compete with each other to be sponsors of hospitals.

Becoming the Target ER is the only way I can think of that we will ever get a renovation.

ode to nurses

I was reading a book recently and one of the main characters was a nurse.  She worked in pediatric
oncology.  It talked about her work periodically in the book.  There was one patient she had that she grew close to who was a teenager.  He was on the floor for a while.  He was hanging in there.  Then he got pneumonia and died.  This person she grew to really care for. This family too.  It brought tears to my eyes.

It was just a book, a fictional book,  but it got me to thinking about nurses. What we do.  How much I respect and admire all of us. The nurses who work with kids with cancer, knowing they are probably going to die.  The nurses who work with quadriplegics who are adjusting to a life in which they will never walk again.  The nurses who work with the teeny tiny premies for months hoping they will make it. The nurses who stay with families while their loved ones die.  The nurses who relieve the pain of the people who are suffering terribly.  All of the nurses, day in, day out who care for the sick and vulnerable among us.  Its a tough job, but they keep going back every day to do it anyway.    

docs: put on your big boy/girl pants and change

Could it be that there is teeny tiny movement starting around the overprescribing  of pain medications that is an epidemic in this country?  In January Mayor Bloomberg (gotta love this guy) announced an initiative at the 11 public hospitals in NYC.  The VOLUNTARY initiative states that emergency departments "will not prescribe long-acting opioid painkillers, can only prescribe up to a three-day supply of opioids, and will not refill lost, stolen or destroyed prescriptions". What a concept....Read about it here.

In Washington state, a health care system has placed limits on how painkillers are prescribed.  Doctors are told " abide by the guidelines or face the consequences".  The states also now requires patients who are on high does of pain killers with little improvement to be referred to pain clinics.   Read the article by Kevin Pho MD here.

Here's the thing: This is really great.  Finally someone is paying attention and putting the responsibility for the epidemic where it lies: doctors.   The thing is, what politicians don't recognize is that health care has become a business, like any other business.  What is a business' goal?  Make money, stay afloat.  How do you do that? By making the customer/patient happy, so they will come back.   Lots of patients are made happy by getting that almighty narc script. Hospitals are even being paid more or less based on patient satisfaction, and therein lies the dilemma.  

Doctors fear patient complaints, poor satisfaction scores.   So what. The only people who will stop this epidemic will be doctors.  They are going to have to stand up as a group and say no.  They are going to have to stop whining about losing control of their practice, blah blah blah. 
They are going to have to put on thier big boy/girl pants and take responsibility for, change a culture, that they have created. 

Its official: I'm going insane

OK its official.  I am going insane...

Every year we have to go through a "which frickin' waste basket do you put the moutain of waste we generate doing patient care?" education session.   Is it that red one, the pink polka dotted one, or the evil BLACK one? As of now, there are 8, count 'em 8, different plastic garbage containers with various names.  

I am sorry, perhaps I am a complete moron, but I can't keep track of what goes where. Its too much for my feeble little brain to comprehend...or maybe it is INSANITY to think we can remember.  Ya think?

Well, I'm doing the education online and actually reading it...not skipping to the end hoping to pass the test.  I come across a piece of information I had not known, may have skipped, subconsciously blocked out in an effort not to spontaneously combust:  The little chloraprep thingies we use to clean skin before IV insertion are considered HAZARDOUS WASTE.  OK...let me get this straight...the thing that I use 20 times a shift is hazardous waste.

Those little 1 1/2" x 1/2" cylinder thingies are hazardous waste...meaning they have to be put in a ziplock bag and into the EVIL BLACK plastic container that are only in certain areas of the ER?  You are kidding right? So I need to hold this EVIL cylinder, which by the way I have just applied to the patients skin, two feet in front of me as I go to search for a ziplock bag and then place it in the EVIL BLACK plastic container?

Now, take the amount of nurses who work in a day x amount of IVs they start and you will have many ziplocked EVIL cylinders to be disposed of.  We are gonna need a way bigger EVIL BLACK container.
In other words, it ain't gonna happen.

Here's the thing about all of this: The disposable system is very complex but its okay for us to waste narcotics galore down the sink, into the sewer, whose contents go to the water plant to be "purified" and straight into your kitchen...