shit yeah

I'm sorry but I could not resist sharing this photo with you.  Is this man pretty or what?

WTF???!!!!

Medical assistance in my state can restrict you to one hospital, one doctor, even one pharmacy.  It can be for a couple of reasons.  They can assign you to an HMO and you have to pick a hospital.  Probably the biggest reason is because you are a, shall we say, frequent user of hospitals.  In your frequent hospital use, you tend to go from hospital to hospital.  I would imagine the most common reason you go from hospital to hospital is because you are looking for narcotics, but then thats just my personal experienced opinion...I mean if you don't get what you want at one place, try another, right?

Of course, people always act like they are shocked, albeit horrifed,
(what the fuck???!!!!), that they are restricted to one hospital, and lo and behold, it isn't this one.  Either they are stunned or they say, "Oh I changed all that, I'm now assigned to this hospital".   No.  No you aren't.  Sorry.  Nice try though. A for effort.

I don't know if the ER gets paid for the visit or not.  I understand that they don't get paid if they are admitted
inpatient.

Here's the thing, people on medicaid are not stupid, even if we think they are.  They know the system.  They know we can't refuse them, with EMTALA and all.  So why should they give a shit if they are restricted. We are going to see them and our doctors are going to treat them, like they would treat anybody else, including give them narcotics.  So in effect, this program is a joke.  It no doubt employs an office full of people who run it who get a paycheck, but other than that it is completely useless.

I'm glad we are employing people to do this.  This, along with the office full of people who make sure 25 year old healthy adults on medicaid get their taxi rides too and from the ER helps me sleep at night.

you can't make this shit up

I could make a million dollars selling this button to ER nurses.

ex cons, dead people and drunks: welcome to work

You know its gonna be a bad day when you note that there are overflow patients in the area you are about to open, and one of them is dead.  No one has had time to arrange for them to go to the morgue. 

You pass triage and some guy is saying in a loud voice: "I just broke my Dad out of jail". 

You pass a room and another guy is loudly telling a nurse that he, "just got out of the penitenary 3 weeks ago". He's drunk.

Okay there is a theme developing and I don't like it. 

Its downhill from there ending with a drunk guy who doesn't speak english and proceeds to talk loudly for the next 2 hours in his native tongue and of course he is right near the desk...

"staff to triage for assist out of car"

Its that dreaded page: "staff to triage for assist out of car"...you never know what your gonna get when you head to the car.  Could be some goofy person with back pain.  Could be a woman giving birth.  Somebody shot...

Anyway, its a typical day, the teeming hordes presenting with their various tales of woe.  I have a moment of respite, sit down for a moment.  I get a call.  Somebody is calling before they get there to say they will need a wheelchair for their friend.  Yeah...whatever buddy..

So they get there and a couple of people go out to get the friend. Friend gets up, sits in the wheelchair and promptly dies. Ride provider/wheelchair requester has already left. Why, who knows?

When I first saw Friend, they were being rushed down the hall by a nurse, almost losing limbs the nurse wase going so fast.  They legs were swinging out to the side, bumping into things.  Friend had that DEAD look.  No color.  He was in cardiac arrest. Uh-oh.

Friend was put in the bed.  CPR was started until we could get the CPR device (automatically gives compressions). I started an IV and we started the meds.  It went on for an hour.  Meds, shock when he came back with a shockable  rhythm. On and on and on. Like we always do.  Finally he was declared dead. He was 53.

And thats how life in the ER can change in an instant.