assholes and bullies

There are two kinds of people who come into the ER that I can't stand: assholes and bullies.

Being a nurse, you learn pretty quick that there are people in this world who make an art out of being an asshole. Asshole type #1: Their life is shit and you, the nurse, are going to pay the price for their shitty life. All of that bullshit therapeutic communication they taught you in nursing school isn't going to work with them..

Asshole type #2: This type has an exaggerated sense of their own importance. Everybody is supposed to cater to their every whim. They are more important than the other lowly patients.  If things don't go how they want them to go, look out.

Then there are the bullies. The verbally abusive who sometimes threaten the staff. I have absolutely zero tolerance or patience for these people. Especially those who threaten physical harm.  Ah can you say....SECURITY!

Here's the thing about nurses, assholes and bullies. As a group we put up with them, many times feeling like we have no choice.  True that, they have to get medical care too.  What gets me about a lot of nurses are two things:
1) They feel sorry for people like this.  Oh....they must have had a rough life...
2) They allow themselves to be abused, threatened without doing anything about it.

When I have a asshole patient, sorry folks, I avoid them. I do what I have to do and I don't go in their room unless they put the call light on or do my periodic checks. Now some of you would say, well, why don't you talk to them, maybe they are scared...no, sorry.  I do not have time for people like this.  I won't subject myself to it.

With bullies, I do two things:  If someone is verbally abusing me, I tell t em to stop, tell them it is unacceptable, and if they don't, I leave the room and come back later. If they threaten me physically, I call security.  Just like in a domestic abuse situation, I do not deserve to be treated this way.  I won't be. Again I avoid them, doing only what is necessary.

Perhaps some of you think I am being a hardass. Nurses are supposed to care and understand. Bullshit. Nurses are their to provide care and be treated respectfully.  End of story

YUP.

YUP.

So I'm sitting flippin' through the channels.  I have nothing to do.  I'm old. Its really cold outside.  So sue me.
Anyway....I happen upon the Discovery channel.

Untold stories of the ER is on.   It is a show in which they "reinact" incidents in the ER.  Its a dumb show. End of story.  While I was on Discovery, there was an ad for NY ER.  Hmmmm...never heard of it.  So I tuned in later.

It is a "reality" show.  It is based at Presbyterian hospital in NYC. It follows certain ER staff around, doctors and nurses. As usual the doctors are the stars, the nurses secondary. Of course, it is one trauma after the other. People falling off buildings, jumping off buildings, getting hit by cabs.  Blah blah blah.  I worked in a trauma center and it isn't one case after another, its one, at the most a couple,  per shift.  But hey, what do I know, its NYC, maybe its one after another.

The doctors are all good looking. Apparently the bald headed ER doctors with a paunch were out.  I guess all the handsome ER docs choose to work in NYC, 'cause these guys look nothing like the docs I work with.  The nurses come off as too nice. Sounds funny, but give me a break.  You work in a NYC ER trauma center, you ain't this nice.

There were a couple of good scenes actually.  In one, a woman was appearing before a judge and "fainted". When she came in she was "unresponsive" until they tried to cath her. Then she became real responsive and stood up on the ER cart.  I actually had a patient stand up on his cart one time.

Another one I enjoyed.  LBP by ambulance.  This guy had been getting any dope he could "to treat his pain".
Whats the first thing the doc gave him? Morphine.  Now thats realistic... a junkie getting narcs. Later on he became an asshole because "the monitor kept ringing and I couldn't sleep".

Another woman who was in prison swallowed a couple of toothbrushes (is that talent or what?).  While she was there she swallowed a battery.

All and all?  A pretty good show.  Will I watch it again? No.

things are not always as they seem

My hospital specializes in a lot of shit.  Cardiology, neurology, orthopedics, etc etc etc.  Therefore, as an ER, we get a lot of medically complicated, seriously ill people in addition to the usual ER baloney.
Some days it feels like this is all we get.

So there I am minding my own business at the desk. I'm up for the next patient. One is coming by ambulance. I click on the computer to see whats coming in.  45 year near syncope. Hmmm.  Somebody vaso vageled?  Tey are dehydrated?  Whatever, I can handle it. The're young.  How bad can it be?

Of course, there is way more to the story. Turns out this woman has cardiomyopathy, diagnosed 1 month ago after having increased shortness of breath.  They were found to be in congestive heart failure. Their ejection fraction is 20%.  Had probably been in atrial fibrillation for a couple of years without treatment.  They must have had some episodes of v tach or very rapid heartbeat  because now they have an external defibrillator.

So the simple syncope turns into a big deal.  This is typical.  What looks to be simple is really way more complicated.  Often times when we get a call about an ambulance coming in from medic control, the information is a couple of sentences, failing to mention all of this other shit.  Like they are a quadriplegic or post heart transplant or mentally disabled from a group home.

Sometimes I think, whatever happened to sprains and lacerations and appys and what you would normally think comes into the ER?  They seem to be a thing of the past, replaced by by the MI who is on dialysis, a crack head and of course has no veins....

george clooney doesn't work here (and none of our doctors look like him)

I don't think the public would ever believe what it is really like in an ER.  The people we really deal with.  The average person is not going to come to ER unless they truly are very sick or have an accident or something.  So the majority of people we see are not your average, functioning person.



NOT.

They are the dysfunctional, criminal, crazy people among us.  They are the people you move to the suburbs to avoid. 

Lots and lots of dysfunctional people come to ER, in fact, they are the bread and butter of the ER.  They are the people who have zero coping skills for one reason or the other.  Their life is one crisis after another and if there isn't a crisis, they will create one.  Expecting them to be organized enough in their own life to have a doctor is unrealistic.  When they come in, they act out all of that dysfunction.

We see some really creepy people in the ER too. Guys who want you to "hold the urinal for them". Sex offenders. People who "just got out of jail". Drunks who are so drunk that they pee and poop themselves. Violent people who want to kill somebody.

Then there are the truly mentally ill. People who hear voices. Manic people. People who try to hurt themselves while they are in the ER. People who get out of control and have to be restrained.  People who sometimes won't hesitate to punch us.

And we see the sad people.  Old people who lay on the floor for hours because they have no family to check on them. Young people who are already messed up because their family is dysfunctional.  Abused people.  Women who are raped.  People who are dying or die.  People who have bad things happen to them just randomly, through no fault of their own, and it will change their lives forever.
People who are terrible junkies or drunks and that's all they will be til it kills them.

This is the real ER.  The one you don't see on TV.

ha.....ha....haha...hahahahahhahahah

 

I am sitting at the triage window and as you come up, I take a drink.