tomorrow...I become just another nurse..

Well, tomorrow is the big day. The day in which Madness puts away her polyester white uniform dress, white hose, cap forever. The things that gave me an identity and made me stand out in a crowd, gone. I now just become another nurse in the same dreary color as the rest of the nurses. Apparently that is the way the management wants us. Yes tomorrow is the onset of the new "uniform program".

We will all look alike, just like the postman, the UPS driver, those who work at McDonalds. Just drones working on an assembly line. All in the name of "patient satisfaction". Yes "patient satisfaction" dictates that all the little nurses all dress alike in their little scrubs.

Next we'll probably have to all have the same hairdo. The same eye color. The same phony smile. Then we'll all be robots just like they want us to be.

HELLO HUMAN PATIENT

I AM MADNESS, YOUR ROBOT NURSE

I WILL BE YOUR NURSE TODAY.

WHAT SEEMS TO THE PROBLEM?

OH THAT IS TOO BAD.

LET ME GET YOU A WARM BLANKET, FOOTIES, A BOX LUNCH, A WARM WET TOWEL FOR YOUR FOREHEAD, A CAB VOUCHER OR TOKEN. THEN OF COURSE ALL OF THE NARCOTICS YOU WANT...

I AM MADNESS, YOUR ROBOT NURSE.

your life in my hands

That's me at the triage window. The one who looks exhausted and a little bit peeved. I watch you walk down the hall towards me and, like it or not, I sum you up in seconds just by the way you carry yourself. I watch you walk in and see how you approach me.

Are you shuffling? Are you frantic? Do you have to stop to rest on the way? When you get to the window do you go into excruciating detail going back five years about why you are here? Do I have to pull what's wrong with you out of you? Are you hanging over the desk in a dramatic fashion? Are you pale, sweating? Short of breath? Did you come alone? Do you come with a posse? Do you immediately ask me how long the wait is? Do I need to run you right back? Are you accompanied by the police? In handcuffs?

I will have a pretty good sense of the seriousness of your condition and what kind of person you are before you even come through the triage door. After about a year in ER you are pretty much an expert on the human race and all its quirks and personalities.

I can go into a room and take one look at you and sum up how sick you really are. You might think that sounds unfair. I am not giving you a chance. Its reality. I have to be able to sum you up quickly. If I can't tell if you are real or fake, a wimp or really sick, I'm not doing my job.

I am the first one to see you. I have to develop an instinct for people. If I don't you might die. If I assess you in your room and you are in trouble and I don't intervene immediately or call the doctor, you probably going to go down the toilet.

When people come to the hospital, often they concentrate on the doctor: when can I see the doctor? Where is the doctor? You really should be concentrating on me because I'm the one who will prevent you or your loved one from deteriorating. I'm the one who spends the time with you, monitors you, trusts my gut when dealing with you. Your life is really in my hands. Especially if you really have a real emergency.

that will be $500 up front maam

The public doesn't realize something about medicine, about hospitals. It has become a business, a corporate business. The days of the individual hospital fell by the wayside years ago. The vast majority of hospitals are now part of corporate conglomerates. Most hospitals are nonprofit. That gives the public the mistaken impression that they aren't in it for the money. Wrong.

The whole nonprofit thing is a misnomer. Nonprofit means there are no individuals who own stock who make money off the hospital. The profits go back into the organization. Here's the thing, INDIVIDUALS are making huge profits off these nonprofit hospitals: CEOs, administrators, doctors. CEOs or these hospitals often make millions in salary and bonuses. Doctors, especially specialists such as interventional cardiologist, neurologists, surgeons can make several hundred thousand a year easily. You don't think this leads to unnecessary procedures do you? Oh..of course not.

The nonprofit hospitals put the money where they make the money. Where do they make the money? Cardiology, neurology, orthopedics. In other words those profitable angioplasties and other cardiac procedures, strokes and interventional radiology, joint replacement surgery. This is where they put the money and this is where the specialists make the most money. Often times the rest of the hospital, that doesn't make as much money or loses money is left to deteriorate.

Now these nonprofitable hospitals are beginning to hire firms to aggressively seek payment up front of deductibles and co pays. Staff are trained via "scripts" to convince people in ERs, for example, that they have to cough up the money while they are still in triage. The fact that they are sometimes too agressive is front page news in my state after an attorney general investigation.

This is modern medicine folks. Do profits and money and health care mix? What do you think?

nursing thy name is Madness

Dear Madness the nurse:

I am a second year nursing student and I look to you as a role model. To me, you are the epitome of what a nurse is. Thank you for being an inspiration.

Sincerely

A Secret Admirer

Dear S. Admirer:

Oh, I do declare, you make blush..I do leave the other nurses in the dust don't I? A familiar scene in my ER: Me doing CPR with one hand, pushes meds with the other, on the phone to lab, shouting orders to the lesser minions, all while dancing a jig.

***

Dear Madness the nurse:

Nurses uniforms have changed so much over the years. They have gone from looking like a nun to scrubs with cartoon characters. In your opinion, what is the proper uniform for a nurse?

Sincerely,

Just Curious

Dear J. Curious:

I have been wanting to speak about this subject for a long time. The only proper uniform for a nurse is a polyester dress with a zipper up the front. Its all that I will wear. Of course, I wear a starched cap, white hose and white "nursing shoes". I of course, carry a fanny pack. I think nurses who carry fanny packs look so professional. Here is what I have in it:

kelly clamp
scissors
tape
alcohol wipes
emesis basin
urinal
bed pan
gloves
IV catheters
dressings
nasal cannula
neb kit
IV bag
IV tubing
motrin
eye drops
breath mints
snickers bar
diet pepsi
kleenex
pens
toothbrush and toothpaste
cell phone

I know thats a lot of stuff...its a very large fanny pack, more like a back pack...quite unweildly at times...it has saved many a life.

oh its true, its damn true..

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.