Things I Will and Will Not Do

Patients, for future reference:

I will gladly clean any number of wounds or messes regardless of how long it takes to do so and regardless of how disgusting it smells. It is my job to do so, and it needs to be done. I will not beg you to let me do it. If you are a grown ass adult of sound mind who chooses to not only do nothing for yourself, but wants to scream and complain when I attempt to remedy the situation of you sitting in your own filth because I'm bothering you? Let me stop bothering you. As an adult, you surely understand why dirty ass wounds are problematic. I have other people to take care of that actually want my help, and therefore I don't have time to argue with you about it. Let me just chart that you refused the care I offered you and you can call me when you decide to stop being disgusting and I'll help you. Okay, great.

I will work you up for your intermittent mysterious vaginal bleeding that you've had for two weeks. Sorry you decided during the busiest day of the year that this was now an emergency, but your labs are all back right now, your blood counts are fine, and you're officially not dying, so it's time to take your Flagyl and follow up with a GYN. I cannot magically stop your vaginal bleeding with a pill of some kind or space age laser technology, and I will not tolerate you standing in the staff area yelling obscenities at everyone because you want your f-ing period to stop and we didn't do f-ing shit for you and we just wasted your f-ing time. You're totally discharged. Hi, security?

I will take care of your drunk ass in a kind and gentle manner despite the fact that you have no problems we can help you with here in the ER. You play nice and take your fluid bolus and your warm blankets, I'll turn the light off and you can have a nap and you and me are going to be good friends. We will not be friends if you start cutting up and trying to pull your IV out and threatening suicide and screaming at everyone because now mommy's here and she's mad at you for being a drunk idiot instead of giving you the sympathy you think you deserve. No, I do not have time for you to pull me into your mommy drama, and I will not sit outside the room and therapeutically try to convince you to calm down and stay. If you want to try to manipulate your mom in my earshot by threatening suicide, fine, but you will find your ass in a safe room with a the po-po standing by and mommy out in the waiting room away from your drama before you can say "Haldol". There are literally dying people here today. Act out your Dr. Phil "mommy loved me too much or not enough" bullshit on your own time.

And ultimately these are the people that are going to be determining whether my service was good enough for the hospital to get paid? Why did I stop waiting tables again?

When You Gotta Go, You Gotta Go

I'm taking care of a gentleman last night who was having some seizure activity- nice, normal seeming (by hood hospital standards, anyway) dude. We get him back to a therapeutic level on his meds and I'm just watching him for a while to make sure he's not having any problems before the doctor will discharge him.

It's a decently paced night, so I'm hanging outside his room charting and talking- his door is open so I can see and hear if he starts seizing again. Dude is sleeping peacefully for hours. I hear nothing but the TV and his snoring, until all of a sudden I hear a lot of rustling and moving around on the stretcher. I immediately jump up and run into the room to turn him over, thinking he's having another seizure, but when I get in the room, I find him wide awake and lucid, urinating into his belonging bag with his clothing still in it. I grab a urinal and try to give it to him real quick, but he just kind of shrugs and finishes peeing in the belonging bag.

I feel terrible because I immediately assume he couldn't see his call light where I put it in the bed- I apologize and tell him not to be afraid to yell out if he needs something. Except he's just like, "Nah, it's cool. I knew where it was, I just had to go, yah know? When you gotta go, it's just like, time. " Well, okay! Whatever works for you, I won't make you wear that shirt home. Have a free gown on us, man. Merry Christmas!

Chief Complaint of the Night

Are you ready? Here we go.

Trouble sleeping for 5 years.

Yeop. And was seriously a douche to ER BFF in triage when she asked if she'd seen a doctor or tried any meds before. I guess maybe she was crabby from not sleeping, but still. It's not necessary to be nasty to the triage nurse for just doing her job and trying to collect your information. Anyway. 1,000 cool points were awarded to our new ER doctor, for this conversation:

New Dr: So, what's wrong today ma'am?

Miss Insomniac: I haven't been able to sleep well for 5 years.

New Dr: Yeeeah. So, this is the ER, so I don't prescribe sleeping pills here.

Miss Insomniac, scoffing and rolling eyes: Well, and I haven't had my period in two months either.

New Dr: Okay. Well, now you can go buy a pregnancy test, because you're discharged.

I tried to start a slow clap at the nurses' station, but no one was paying attention.

Things That Are Not Emergent

People sure do get upset when I seem to mention that most of our patients are not having legitimate emergencies. I get these random comments like, "Bitch, how can you say that a UTI is not an emergent complaint? My sister's friend's cousin's baby mama got UTI one time that was so bad that she ended with pyelo and then got intubated and ended up in the ICU!"

Look, they're just not most of the time. And that's fine. I enjoy the non emergent stuff too, plus, if we saw exclusively life threatening emergencies at all time, one, my job would most certainly be in danger, and two, it would be reallllly stressful.

But, in the spirit of Christmas unity and peace on earth, let me just throw one out there that I think we can all agree on. Checking into the ER to get documentation from a doctor that you have the sickle cell trait so you can try to use it to get on disability? Really? Not an emergency. Any questions? Okay, great.

Guess the Complaint

As written:

hirna bother hurt him ril bad

Answer tomorrow, pending day shift coming to take report on time. Winner will receive a lightly used pair of hospital socks and a half eaten bag of flamin' hot cheetos I found in the waiting room.

UPDATE: Well, I seem to have underestimated my readerships' talent for deciphering the writing of the borderline illiterate. There are too many of you that got the answer correct (yup, hernia pain) for me to declare a single winner, but you have all shown that you are qualified to work at the Hood Hospital triage desk, where 99% of your duties consist of explaining to registration what the hell these people are trying to check in for. Hit me up if you're looking for a job where you are verbally abused on a continual basis.

In Response to the News That She Was Going to be Receiving Sub Q Heparin

Patient (who was in the ER for skipping dialysis x 3 weeks to go on a crack bender), with a mouthful of chewing tobacco: Heparin? In my belly? Uh-uh. That don't go in no shot. That only go in the IV for dialysis.

Me: Well, ma'am, I can guarantee you this is a pretty routine order for the prevention of blood clots in the hospital. You can look at the written order here if you like.

Patient: Naw. That don't go in a shot. I ain't takin' that. You nurses here are dangerous.

Me: Alright, well, I can't make you take it. I'm pretty sure skipping dialysis for three weeks didn't kill you, a DVT probably won't either. Also, I'm pretty sure you aren't supposed to chew tobacco in here.

...and end scene.

"We're In a Code"

Go ahead and turn your caps lock on now, butthurt commenters. Here we go.

So, as I may have mentioned before, last night sucked. Hard. I think we had about 4 intubations and 2 codes in the first 2 and half hours in addition to a bunch of other train wrecks and ICU holds that were already down in the ER at this point. At some point in the midst of all the madness, we hear them call a code blue to one side of our ICU (it's split into 2 big hallways) and think little of it. Even procedure whore doc, who usually is calling upstairs to see if they need intubation before the operator is even done announcing the code, payed little mind, as he's already intubated half the patients in the ER at this point and was over it. About half an hour later, they assign me an ICU bed on the hallway where the code isn't happening. I get my stuff together and call up there, and some chick answers the phone and is like, "Um, did you NOT hear the operator? We're in a code right now. Yeah. I think your report's gonna have to wait for a little while." Generally trying to be understanding, I ignore the fact that this woman is talking to me in the same way one would speak to a child who is interrupting the grown ups talking and say, "Oh, I'm sorry, I thought that was the other hallway." I swear I can hear her roll her eyes over the phone as she responds, "Well, up here we all come help", after which the B hangs up on me. Oh hell naw. Let me break this down for you, girl.

One, is it really necessary to act like that? If you'd just been like, "hey, we're all in this code, can the nurse call you back", this would not be an issue and I wouldn't have to make fun of you anonymously over the internet. But now I do. You brought this upon yourself. But seriously. I'm so sorry, I didn't realize the important ICU nurses were still in a code, which I wouldn't understand, because we don't do anything down here besides sew up boo-boos. Let me just get back to handing out ice packs and Norco until the real nurses can call me back and bestow upon me the honor of taking report. Meehh.

But the real point of the post is, how many of you does it take to code a patient? I'm gonna drop a hot opinion on y'all right now and say if it's more than 5, you're probably doing it wrong. I apply that rule to us, too. Okay, if you're coding a patient you need a nurse to record what's happening (1), a nurse to push meds (2) two to alternate between compressions and code gopher (3 and 4) and I'll throw a 5th in there to do other procedures or whatever or to bag if RT isn't there (which they are). Really four is enough, and we've coded patients many a time with three with no problem. If we're really in a bind, I've had days where it's me, super medic and a doctor where I push drugs and record and super medic and the doctor switched off compressions while the doctor ran the code. It's not ideal, but you know what? I would rather have that any day than 10 people in the room. Why? Because if there are 10 people in there, half of them are just standing around anxiously getting in everyone's way, and that is the most annoying shit in the world. If you are standing around in a code, your presence alone is not helping. You are making it worse because you are limiting flow in and out of the room, and you are sucking up everyone's oxygen and making it hotter in there. Get the F out.

If I am the recording nurse, I will actually tell people to get the hell out. If I am helping and a bunch of people come in, I will switch with someone and go take care of my teammates' patients while they're in the code while announcing loudly on the way out that the room is at capacity and the fire marshall is going to come and write us a ticket. In the ICU, I would think this is probably even more true because you often already have lines and an airway established. So you're doing compressions, pushing drugs, and recording . It shouldn't take that many of you. Plus the house supervisor, the chaplain, and everyone else and their mama is up there in your business once that shit gets called overhead. To quote my ICU buddy nurse XY, "It's an ICU room, not a clown car". Leave.

My second point is, that shit must be nice. It would be rad if we were coding one patient down here and if EMS showed up with another super sick patient we could be like, "Nuh-uh! We're in a code! You keep that out in the ambulance bay until we're done! What's wrong with you?" But it doesn't work that way. Sometimes we just have to bag with one hand and do compressions with the other and push drugs with one foot while hoping we remember all this crap, because every patient down here is crashing at the same time. It happens, and I don't feel sorry for myself about it because this is what I signed up for. But do I feel sorry for you when you are asked to step out of a code 15 people are standing around in to take report from the mean, ugly ER nurse so I can fill my room with the next code coming in down here? Nope! That's the way nursing goes. Dry your tears with your fancy cellulose dressings and pull up your disposable one use big girl panties that we don't stock down here and deal with it.

How You Know Your Night Truly Sucks

Last night was the worst. Like, very possibly in my top 5 shittiest shifts of my life. The ICU is full, which basically means we're boned. I thought I lucked out with the 2 code rooms, as I would be guaranteed only 2 ICU admits- unfortunately they were both enormous train wrecks with piles of comorbidities and families who were prone to anxiety while at the same time being unable to really grasp how sick their loved ones actually were. At least they were nice. Anyway.

At about hour 9 at one bathroom breaks and zero water or snack breaks, I'm mixing my patient's smashed BP meds in water so I can give them down the NG tube when I look at the monitor to see that his blood pressure has tanked for some unknown reason. As soon as I process the information in my brain, the next thought that pops into my head is "I wonder if I drank this if I would have a syncopal episode and be able to go home?" Mind you, this is never something I would do or even consider doing, but for some reason like, some other part of my brain took over and was all, "screw this! self destruct!!!" Luckily (?) the generally sane rest of my brain was like, "that isn't cool, plus you're not wearing your cute panties, so you can't pass out here," and I finished my shift relatively uneventfully other than the general awfulness.

So, I guess the moral of this story is, when your brain tries to kill you, it's time to stop picking up extra shifts.

Service Training in Action

Now that our patient satisfaction scores will actually affect reimbursement rates, Hood Hospital is trying to teach all of us ragamuffins down in the ER how to act right so our patients will be happier. Who better to teach us than a bunch of people from finance and upper management who have never taken care of a patient in their entire lives? I can't think of anyone with a better perspective. Anyway. They've been doing mandatory training the last month, and despite the fact I will never get those hours of my life back, at least the things these people think will work to improve our scores are hilarious.

The vast majority of the stuff they are trying to teach is are things that decent nurses already do. Hi, don't start a Foley with the door open, don't talk to the patient about your child support case, explain what the hell you're doing before you do it, maybe talk about the discharge papers a little while instead of just throwing them in the patient's general direction. Yeah, okay. No, the true comedy gold happens when these jackwagons present to us the things they actually think will make our patients happy. It's kind of sad, really, as they've clearly had many a meeting about synergy in healthcare and buzzwords or some other bullshit and come up with some stuff that they probably think is really fantastic and practical, only to be met by icy, dead silence or riotous laughter when they present it to those of us who actually take care of the patients.

So, with that in mind, ER BFF and I thoughtfully considered their suggestions and pondered how they might apply to the situations we encountered that weekend. Here's a couple I'd like to share with you.

"Mr. Homeless McCrackhead, you seem upset. Please allow me to listen without interruption about what the problem is. Yes, I can see you're very upset that we can't bring you a third sandwich and that the staff won't allow you to go into other patients' rooms to ask for their phone numbers. I'm so sorry this is happening to you. Let me see what I can find out for you about a bus ticket to that nudie theater downtown. Thanks for choosing Hood Hospital!"

"Hi Mrs. Abdominal Pain of Mysterious Origin with Multiple Non-Narcotic Allergies! My name is Hood Nurse, and I've been an RN for nearly 3 years and I have a lot of experience starting 24 gauge IVs and pushing Dilaudid through them. I see that Dr. Unnecessary Workup is going to be your doctor today, and let me just say that he comes highly recommended by other patients with problems similar to yours. Today we will use state of the art technology the perform several fruitless tests on you, and when they all come back negative, we will continue to take your pain seriously by giving you criminal amounts of IV Dilaudid. After a couple of hours, Dr. Unnecessay Workup will probably admit you for pain control to Dr. Spazz Hospitalist. I've heard many good sources that he has a pulse, and I've noticed he's been urinating on himself a lot less lately. Please let me know if there is anything I can do to make your stay more like a combination between a spa and a trip to Disneyland. I have the time. And for the 40th time this year, thank you for making Hood Hospital your first choice. We are delighted to take care of you again and hope we have this opportunity to collaborate in your care again soon."

"Mr. Drunken Head Laceration, I'm sorry you're not feeling well today. I realize that hitting and groping the staff might make you feel better. However, we're concerned about some possible issues to your health and safety, so we may have to use some state of the art leather restraints in your care today. We may call in the hospital police to help make your stay more enjoyable. They and their tasers have several years of experience dealing with patients a lot like you, and they are excellent at what they do. Now the doctor is going to use his excellent technique to staple your head closed. We will allow you to voice you concerns in the form of multiple obscenities screamed at the top of your lungs in an uninterrupted fashion, because we respect your point of view. Let me, as an agent of hood hospital, express how sorry I am that the doctor will not prescribe narcotics for your head laceration pain. It seems he is concerned about the possibility of mixing them with alcohol. I recognize that this is unacceptable to you, so I'd love it if you'd stay to talk to our house supervisor, who would be happy to provide you with a gift card to our on campus Starbucks. We'd be happy for you to enjoy a gingerbread latte on us for your trouble. Or, if you really do feel that you would prefer we, as you say, 'shove that up our asses', we would be happy to do that as well, if it would make you more likely to recommend us to your friends and family. As always, thanks for choosing us today!"

I don't see how communication like this couldn't fix all of our problems. I mean, obviously any problems we're having with feedback are certainly solely related to our shortcomings in communicating, as opposed to lack of staff, budget, resources, training, or reasonable expectations.

The Solution to All of Our ER Woes

So, obviously drug seekers are a big cause of frustration and wasted resources in ERs, but I think the number one thing that I deal with that tests my patience the greatest is the douchebags with no medical training that want to micromanage how you do your work. I had people like this recently who were seriously so ridiculous that they wanted to argue with everything we did down to the dosages and types of medications. Might I add, the suggestions in question- yeah, most likely would have been lethal. For a condition that is pretty black and white on how to treat. Rationale was given and was recieved with many a scoff. Efficient care was met with suspicion and hostility. I seriously have no idea what the hell these people's problem was. But, one of our doctors has suggested a solution that I think will please everyone.
He suggests that we can go ahead and just make all of our medicines and medical supplies available to everyone. You want 15 mgs of Dilaudid at once? Cool, go buy it and make it happen! You think you and your layperson family can manage your care better than all these dumbshits down at the ER? Go to the store and get all the supplies and meds you need, and see how it works at home. If it turns out to be harder than you think, you can always come see us, and maybe you'll appreciate the fact that we went to school for this for a reason and let us do our damn jobs. Hey, you can even pay by the hour to rent one our stretchers. You can pay another fee to have Pyxis access and you can pay us by IV set for every start attempt you make. At any time, you can opt to STFU and let us take over.
Look, I realize this is ridiculous, but I'm really curious how many people would call our bluff if we gave them the chance. I bet the attitude would change after about an hour. We'd just have to stock up on Dilaudid.

Overheard In The ER

Mother, angrily to her son who had promptly been discharged with zero tests or meds after checking in for "feeling weird" s/p smoking marijuana- "I TOLD YOU we should have taken the amb-a-lance! They take you more serious and they run more tests when you come in the amb-a-lance! This shit is ridiculous! Let's go home!"

Charting Fail

We have an agency nurse on day shift right now who is- let's say- a little special. We've had a couple of great agency nurses, but as a general rule, we don't exactly get the cream of the crop. This guys is right up there with the winner who finally got fired for getting in a screaming match with one of our NPs about whether it was kosher to give a gram of Rocephin mixed with 10 mls of sterile water IV push. Yeah.

Anyway, despite the fact that everyone who else who came here while we were still using paper charting a while back was appalled that we were so provincial and dated, this guy, who is allegedly a seasoned nurse, seems to be terrified of our computer charting. Since all but a handful of our portable computers broke within the first 2 weeks of getting them, it's not uncommon for us to use a piece of scratch paper while getting an ambulance started and put all the information in the computer later, key statement being put the information in the computer later.

If a patient has gotten there within an hour before shift change, this guy writes a bunch of shit in random places on a blank piece of printer paper and then hands it to you during report like, yeah, here's my assessment, bye. So, not only are you stuck with all the other crap he inevitably leaves you, but his charting too. It's whatever to me- I just collect all the information myself and put it in when I triaged the damn patient, because I don't really have time to sit down and decipher this Son of Sam looking shit that is supposed to be nursing notes. I got some time to look over some of this charting (?) the other day when I was helping a friend catch up, and it was pretty amusing. Among the vital signs and medical history, there were all these notes- I'm guessing observations or reports from EMS, one of which read "pt is tacky".

Tacky? Please elaborate, sir. Were you referring to her attitude or her manner of dress? I mean, she wasn't super cooperative, but I'm pretty sure the nursing home dressed her, so you should at least give her a pass on wearing a nightgown this early in the day. Certainly not any more People of Wal-Mart worthy than any of our other patients. Oh... did you mean "tachy?" Oh, okay. Yeah, maybe the avoiding putting stuff in the permanent medical record route is your best bet when possible.

Let Me Just Say..

...a quick thanks to everyone today and I will try to move on with my life. I am really not eloquent enough to express how much the support I've received from everyone really means, but let me try.

My approach to life and my job at times does not serve me very well. I have high expectations of individuals and humanity. I have even higher expectations for myself. I'm often disappointed on both fronts, but this way of thinking is what makes me want to keep doing what I do and loving it. I try to see the good in everyone and treat them accordingly; some days are more difficult than others.

Even before all this happened, I'd been having one of those periods where I was kind of just being bombarded with foolishness and douchebaggery every time I came to work. I was physically and mentally exhausted and continuing to be tested pretty frequently. I was starting to feel the bitterness set in, and I already kind of just wanted to get away from everything, and then all of this bullshit happened. I really felt powerless to help anyone, and I questioned why I was even trying. I saw a lot of ugliness around me, and a lot of ugliness in myself. It was just an awful cycle of feeling bitter about everything I do and then feeling guilty about feeling the way I did. I felt as if nothing good I really did mattered against the overwhelming amount of apathy and cruelty.

Thankfully, it seems that benevolent and compassionate people have an inexplicable way of recognizing distress. My friends and family have shown themselves to continually be more wonderful than I could ever imagine. But the kindness of those I don't know well has really the most overwhelming part. My gruff, sarcastic coworkers became empathetic confidants; quiet, sweet types who I always liked but never knew well wiped away my tears and offered me their prayers. And people who read this-stuff- stuff, that as far as you really know, may be the elaborate delusions of some crazy person- have been willing to go so far for me. People who don't know me at all who are willing to share stories that no doubt open up old wounds for them to make me feel better. So many of you have offered such heartfelt concerns and comfort to a complete stranger. To those that posed questions as to whether it helped, yes, it absolutely did.

You see, my self blame and doubt about myself is always going to be a facet of who I am. Unchecked, it consumes me- in balance, it just drives me to be better. I'm somewhere in between- in a better place now than I have been. But my doubts about human kindness? Vanquished. Again, I don't know how to say how important this is in me carrying on doing other than to say it's everything. All of your kind words were the answer to my prayers and a huge part of me being able to carry on. Thank you again, and back to the usual crazy soon.

And We Though Heroin IM-ing was Bad

Heroin is really not the drug of choice at Hood Hospital (crack cocaine forever, y'all), but I'd say we still see a moderate amount. When users run out of veins, they often resort to shooting the heroin straight into the muscle- not as quick a high, but it gets the job done. The additives in the drugs combined with the circumstances under which they're taken result in some pretty horrendous looking wounds.

I've seen some pretty horrible shit secondary to drug use. But what happens here is, like many other things, a freaking cake walk compared to what's happening in Russia. My brother sent me an article today about Krokodil. It is to heroin what crack is to cocaine- a cheaper and less pure alternative- except it ROTS YOUR FLESH OFF. It's actually a little more comparable to meth in it's preparation in that it's made from over the counter drugs and a bunch of other shit that's toxic to humans. Apparently in Russia, codeine is available over the counter. The codeine preparations can be turned into desomorphine (similar to heroin) pretty easily in a lab, but the solvents used in this process on the street are pretty much just poison, so when the users inject, they end up with some pretty horrific wounds that often end up being gangrenous. Amputations are not an uncommon side effect. Here is the io9 article if this sort of thing simultaneously fascinates and frightens you as much is it does me. Fair warning- graphic rotten flesh pictures ahoy.

I can't explain why I find this so interesting. I guess the psychology of addiction is just really compelling to me. What is happening inside someone that they really cannot give up a substance that is literally costing them limbs? How does someone willing to inject heroin into their genitals to chase that feeling? Seeing stuff like this makes me feel a lot more sympathy for addicts. The willingness to face this much suffering for a feeling that lasts for a couple of hours is nothing short of insanity. Something inside them is clearly different.

Things That Make Me Stabby

I've had a lot of really difficult, sad cases at work lately. I'm just gonna be honest when I say that I feel like shit and I don't have the energy to write about it at the moment, so I'm just gonna express my sadness as displaced rage like any other healthy American and talk about some stuff that really pisses me off. Well, one thing.

Now that's out of the way- you know what really pisses me off? These idiot assholes who bring their young kids in for asthma and reek of cigarette smoke. It makes me sad to even acknowledge how much it happens. Pretty much without fail I find out while taking care of these kids that it's not their first visit to the ER, either. Oftentimes, they look like shit and need to be IV'd and transferred, and I find out it's not even their first IV start either. Seriously?

If you and your kid both smell like a pool hall, you're obviously still smoking inside your house and probably your car with the toddler in tow. If the kid has been to the hospital for this before, I cannot fathom that you don't understand that this will almost certainly lead to another visit where your child will again be held down by several adults and get another damn IV start. The weather isn't that bad here. Literally the only change you have to make is walking outside for a matter of minutes. Even if you weren't told that this simple lifestyle change could be the difference between your child sitting at home playing or going to the ER and being tortured, which I find very hard to believe, it's a pretty simple cause and effect relationship that anyone who isn't a complete dumbass should be able to observe. The only two options then, are that you're really, really stupid, or you are such a shitty parent that you really don't care about your child's health enough to step outside for three minutes. Judging by the reactions I get from the education I attempt to give on this subject, I'm guessing it's the later. A butthurt "Are you saying this is my fault?" is not generally the response I get from parents that care.

But yes, since you're asking, I am saying that. Because it is your fault. Please, continue smoking. Just not around your small child. It isn't that hard.

Dear Floor Nurses

Hey, I really, really want to be cool. Yes, when I am not getting my ass handed to me, I will make sure that my patient has a brand new, shiny, non field IV started for you at 1201 so that you can keep it a little longer, my paperwork will be impeccable, I will document a skin assessment, draw any pending labs and start the admission fluids and I will give you 5 minutes to call me back so you can talk to the doctor on the other line. I know your job is hard, too. I really do.

Do you think, though, that maybe, just maybe you could try to do me a solid back by not making the 5 minutes actually 30 minutes, or asking me if I filled out the medication form 3 different times? Listen once and you'll save lots of energy in the future. Do you think a sarcastic "really?" is the most appropriate response to the fact that the patient has a 24 gauge IV that flushes very well? Sorry, if I could use voodoo to conjure up veins in dehydrated 98 year old DNR patients whose families rightfully don't want to put them through getting a central line, I totally would, but we didn't have a lesson in ancient magic during my internship. And while we're on that subject, I was also never trained in divination, so I don't know how to answer the question "what is her blood pressure going to be when she gets to me?" Also, riotous laughter about how shocked you are that an ER nurse actually did a skin assessment when I tell you my patient has non-blanching redness on her sacrum is not necessarily the most appropriate response, just so you know. Sorry if on the days I have a combative psych patient, a call light happy drug seeker and I dying ICU patient that I don't immediately think to run into the room of my immobile, non-verbal nursing home patient to explore what's happening under the diaper. I know that makes me an atrocious nurse and I should probably quit right now.

Seriously. It's so good we don't do bedside reporting. There would be so, so much more punching, that that's unprofessional.

ER Party

Family calls police and fire rescue out to their house because they can't get their son to get off the lawn and stop doing ninja moves. Naturally, upon finding him, they bring him to us, with his brother and his friend following close behind. They get there and are obviously toasted as well. I just love it when I get an intoxicated patient and the friends who were with him at the scene show up in sunglasses at 3 am. Yeah, okay.

So, we finally give the guy enough Ativan to get him to stay on the bed and to sit through an entire head CT without trying to grab his junk (it took about 3 attempts). We finally finish up, and wheel him back to his room. I'm talking to his primary nurses as we're hooking him up to the monitor and she mentions that his brother must have gone home. Just as she's saying this, I turn around to see the patient's brother and friend in the empty room right across the hall. The patients brother is dancing to one of the music channels on the TV, doing what appears to be the robot with the call light in his hand. His friend is sitting in a chair right in front of him, staring at the wall without blinking. Family of winners, these guys.

I Think They're Just F-ing With Us Now

Oh, hi local fire medics. So hey, I've resigned myself to the fact that you aren't going to start IVs on diaphoretic patients in respiratory distress with sats in the 40s. I'm over it, I'm not trying to say anything about that.

But can you just do me one favor? Yeah, could you please not stand in the room drinking coffee watching us start the IV and set up the ventilator right where everyone moves in and out? Thanks. And if you're going to stand there, can you at least drink your coffee quietly, as opposed to loudly making fun of our very nice, young enthusiastic RN for explaining paralytics and sedatives to the EMT student because "he's just a basic, he doesn't need to know all that"? Really douchebag? Really?

Do you guys have some kind of bet up there at the station house about who can be the biggest jackass? Because you've got my vote.

Ruined

Nursing has enriched my life outside of my career in so, so many ways. Especially being an ER nurse. Very little truly frightens me anymore. I'm able to help my loved ones if they need me. It's actually helped me overcome my shyness. I generally have a good story to tell my friends.

But. That said, nursing has ruined me for a lot of things. Meat? Yeah, now that I've seen human muscle fibers in all the states I have, I can't eat it. That's been good for me, so whatever. Anything grape flavored is over forever. Once you've done a couple of Kayexalate enemas, that's pretty much done. The biggest change in my life is TV, though.

Like, if a show has terrible medical consulting I CANNOT watch it. I was the biggest Law and Order junkie that ever was, up until they tried to make fetch happen with all their stupid spinoff series, but Law and Order original flavor ruled. I still get pretty excited when a re-run I haven't seen comes on, which is rare. So the other day a re-run of an 80s episode comes on where some kid codes in the beginning. I definitely hadn't seen it, but I could not even get past the code, because it was done TERRIBLY. Like, they call some code blue in the ER overhead, which, whatever, I suppose maybe they do that somewhere, and then they're bagging this kid and not doing compressions, and then they try to shock her out of asystole, and then they call it, like, 2 minutes in. It was awful. I mean, I could not have watched the rest of the episode for anything.

I wish it was only stuff that blatant, but I nitpick so many shows and I know my husband is totally over it by now. We're watching The Walking Dead right now, which is amazing. The medical consulting isn't awful, but it certainly isn't excellent. Like, they threw out this stuff in the last season where they're trying to scientifically explain the zombie virus and this dude in the CDC is all like "it spreads through the brain tissue, like in meningitis." Um, no. And then this week *SPOILER ALERT* Rick's son gets shot and needs surgery and then OMG his best friend who also is kind of a creep and banged his wife after telling her Rick was dead has to go to the local FEMA center which is overrun by zombies with the dude who accidentally shot Rick's son who happens to be a volunteer EMT to get a ventilator and other shit so this veterinarian guy the met can do surgery on his kid. Anyway. You should really watch that show if you're not watching it already. So, they're in there gathering supplies or whatever, and volunteer EMT/kid shooter dude picks up a laryngoscope blade and handle and he's like, " I got me an endotracheal intubator". At which point, I immediately rolled my eyes and said "no one calls it that", shaking my head just in time to look over at my husband, who at that moment had obviously just lost the last bit of enjoyment he had in watching the TV show based on his favorite comic book due to my inability to shut the eff up about any slight medical discrepancy.

Sigh. Sorry, husband. I wish I could get past it, too, but probably not near as much as you do.

What 4 AM lull?

Nothing like a 20-something chick running frantically into the ER screaming that she grew a penis and needs to go to the operating room NOW to get it removed to get your blood pumping in the slow part of the morning.

Family Fun

I get some little old lady last night who came in for weakness- cute, tiny lady who was kind of mildly confused, but pleasant. We're doing the regular weakness/dizziness work up bit with labs and such, and I'm talking to the family about what was happening before the symptoms started as I'm hooking up her EKG leads.

"Well," her daughter tells me, "we were sitting there about to leave for the strip club, but then she started feeling bad, so we called the ambulance." I asked if she was serious. "Yeah!" She told me, "I mean, her husband's been sick for a while and he just died last week, we thought it would cheer her up." Shoot, maybe it would have. Who says ladies in their mid 80s aren't into that kind of thing? Can't fault them for trying!

Although, this is coming from someone who went to a bar with my parents and grandma last week, so maybe I'm not the best person to ask.

Hood Hospital Epidemiology

While speaking to ER BFF during lunch about a patient I'd triaged earlier in the night:

Me: Dude. This chick just checked in for vaginal discharge for a MONTH. And then she left because the wait was too long. Can you imagine that? Like, just letting your cooch rot for an entire month? You just know here normal bacterial flora are now duking it out and mating with whatever kind of STDs are up there, and they're probably gonna meld together and become some kind of gnarly super gonorrhea, and the CDC is gonna come down here and be all up in our business.

ER BFF: Yup, and then it's gonna mutate and become airborne and then we'll be really screwed. They'll have to declare a disaster state down here, and they'll put us in one of those bubbles and stuff-

Me: And then try to set us on fire like that movie Outbreak?

ER BFF: Exactly like that.

So, there it is- if you hear about the government wiping the most ghetto part of a major city on the news (you probably won't, because it'll be a super-secret-covert-black-ops/CDC conspiracy), have a moment of silence for the brave men and women of Hood Hospital, and remember to get your STDs treated promptly. Goodnight and good luck.

Ambulance To Triage

Sassy zero b.s. coworker of emesis bag fame has started acting as charge nurse, which, let me just say, is AWESOME. The one downside, I would have to say, at least as a triage nurse, is about 3 times the amount of ambulances in triage. Pretty much the criteria tonight was breathing and walking. Justifiably so, too, as there were several sick people out there for about 6 to 7 hours thanks to the clusterfuck we walked into.

Yup, the part of me that has a relatively low capacity for drama and conflict would really rather these people just go back to rooms so I don't have to deal with them. The other part of me that's a spiteful b kind of loves it.

Let me explain myself a little further lest I sound insanely hateful. I like it when entitlement and douchebaggery are punished. I'm not so much spiteful as I am the type of person who gets really pissed off when someone thinks they're above the rules. Like, I'm the one who always has to say something to the person who cuts in line or the able bodied princess with no tag that parks in the handicapped space. I'm the one telling the people in the movie theater who are talking to shut the eff up or pay me for my ticket. I know. World police, it's a character flaw. But as this type of person, I absolutely love the moment when the asshole who thought using the ambulance as a taxi realizes, "oh, wow, I'm gonna have to follow the rules and wait like everyone else." LOVE IT.

Anyway. We had one last night who thought he'd come in on an ambulance and get seen sooner for his back pain x 2 days. Nope! To triage you go, sir. Now before anybody with a back pain history decides we're douchebags, not only were there much sicker folks in the waiting room, but homeboy also got Fentanyl IV thanks to the extra generous EMS crew, so he should have pretty much been good to go. But no. He screamed and carried on and acted dramatic- when that didn't work, he told me he felt like he was going to pass out from the pain (I have yet to see that happen in the waiting room. You aren't getting your leg amputated, bro), so I told him to sit down and I would come recheck his vitals. Which were of course fine. But he took that time with me to express how the pain medicine didn't do anything and it was already wearing off. I explained that Fentanyl usually stayed in the body longer that 40 minutes, to which he responded by yelling at me, " This is RIDICULOUS! I shouldn't. Even. Be. Out here. I came in an AMBULANCE!"

I decided at that point to explain to him, loudly, that your mode of transit does not factor into your acuity level. If you're dying, you get seen quickly. If you don't, you wait. I wish more people understood this. It would save tax payers so much money.

The Stupid Flows.

Hood Hospital, for a long time, has had several paramedics in our employ. Over the last several years, however, it's been pretty obvious that they're trying to phase them out. We've hired one new medic in the past 2 years- meanwhile 3 or 4 have left or gotten fired. Word is that before I got there, the medics could do just about anything the nurses could do- give several meds, apply splints, even triage. The triage function was gone before I started, but over the last couple of years they've pretty much reduced their functions to IV starts (which they can't even flush, because oh noes, normal saline is a med, y'all), EKGs and transports. They can't even apply oxygen any more because it's a "medicine". Last week they decided they were going to slash their hours like crazy, and only have one medic working part of the shift on the floor. The others would be helping the charge nurse move patients to rooms and doing EKGS and shit in triage. Really? In case there's been any doubt up to this point, our management obviously has their heads pretty far up their asses.

I know there's controversy, for sure, about paramedics in the hospital setting. For the setting I work in, though, it's pretty much a no-brainer. We need them. Straight up. They save our asses on a regular basis. I'm actually a pretty good example of the average nurse in our ER. Young and inexperienced in any other area that isn't ER. A lot of the times, I'm the "grown up" nurse on my team- it's me with two other nurses that have been at it for less than a year. All the really experienced folks have moved on to either charge or management. Now, don't get me wrong- I can handle just about any ER situation. But when it comes to some of the really obscure stuff, or when I have to be an ICU nurse- I need my medics. Most of these guys can manage a critical patient on their own- they've worked flight before, so they know how to pace, they know how to set up an art line in their sleep- stuff I review once a year at skills day and maybe deal with twice a year other than that. I can't imagine having to do that stuff without them. It'll get done, but it'll be a clusterfuck. And IV starts? Yeah. As good as I've gotten over the last few years, I can't hold a candle to someone who was doing flight transport while I was still taking my SATs.

And now their talking about relegating their duties to moving patients back to a room. Seriously? You idiots think you need to pay a licensed professional to do that? Because that sounds like a job a tech, or shit, a volunteer could do. Here's the thing- when you start treating licensed staff that are an important part of the healthcare time like idiots, you are the ones that end up looking like idiots, because you're paying someone who certainly makes more money to do a job you could pay someone less money to do. Meanwhile, you rob your young staff of someone who has a lot to teach them. We might be able to get away with this crap if we were a hospital full of sage and learned nurses with lots of experience. But we're not. So we're basically just screwing ourselves. Sigh.

I'm gonna throw a fit and argue my case at the next staff meeting, but if they haven't seen these guys' obvious value by this point, I don't know what will change their mind. It's certainly a huge bummer, though.

Chief Complaint of the Night

This little nugget of joy comes to you from a coworker's triage notes from last night:

HPI: Pt c/o right hand pain x 7 minutes after reaching into vending machine in waiting room and briefly getting her hand stuck. No bleeding or swelling noted.

Yeah, I know. What was she doing in the waiting room in the first place? Dude. That's like a philosophical chicken or egg type of question.

Quote of the Night

Sassy lady ER doctor, after seeing me after the visit from my patient's wife- What's going on right now? Hood nurse, are you crying? There's no crying in the ER! No crying!

If you don't know what she was referring to, shame on you.

Let's Play a Game

Are you ready? Here's a game we play at work when captain dumbass from the major city fire rescue squad brings us a patient. It's called "find all the stupid shit on this run sheet". Whoever counts them all is the winner. Go!

On a CPR in progress-
UNIT 123 ARRIVES ON SCENE TO FIND FEMALE PT WITH MULTIPLE LOWER EXTREMITY AMPUTATIONS LYING ON FLOOR OF APT UNRESPONSIVE. PT HAS BLOOD PRESSURE OF 150/90 BUT NO PULSE WITH RESPIRATIONS OF 7. KING TUBE INSERTED AND PT TRANSPORTED TO HOOD HOSPITAL FOR FURTHER EVALUATION.
VS- BP-150/90 HR-- RR 7 ECG-Normal Sinus
GCS-Motor-Obeys commands-6, Speech- Converses normally-5, Eyes- Opens spontaneously-4
Circulation-BL upper extremities-normal, BL lower extremity-normal
Hospital-Patient's choice

Your time starts now. Make sure to show your work.


Disclaimer to the inevitable butt hurt commenters- I promise, there really are not extenuating circumstances- this particular guy is seriously that lazy and that stupid. He stayed at the hospital for 30 minutes putting this together. Just think about that for a minute.

How I Do It

ER nursing is so, so much bullshit. Really. I mean, it's obvious from this blog, but I'd say about the vast majority of the people we see don't need to be there, for various reasons- either they're here for a problem that could be handled by a clinic, or they're looking for drugs, or they have a problem that could have been prevented if they bothered to fill their prescriptions and actually freaking take some responsibility for themselves or their health, or they're just overall not bright and/or educated enough to know that the problem they feel is an emergency is not an emergency at all. I go whole shifts sometimes without seeing anyone in need of help that I can actually provide. A lot of the times I'll go a whole day where everyone I see treats me like total shit.

I have no regrets about my career path, but it's certainly not what I envisioned when I became an ER nurse. I was not prepared for the kind of douchebaggery people dish out in this place. I know I probably sound jaded and hateful sometimes. People ask me pretty regularly why and how I do what I do.

This is how. Night before last, I can truly say I had a role in saving a man's life. A man who wasn't ready to die, who actually had a chance, but who was very much on his way when he came to us. My teammates and I busted our asses for about two hours to save him. I left work an hour late with blood and vomit residue on my scrubs. Exciting, exhausting, stuff, a nice change of pace from the CYA chest pain admissions and nursing home dumps.

Tonight I was back in the midst of my regular routine, when I noticed a familiar face coming around the nurses' station- the wife of my patient from the night before. She walked up and gave me a big hug, and with tears in her eyes, and thanked me and my charge nurse and our doctor for saving her husband's life. She told us he was up in the ICU, doing much better, and that he would probably be released in the next few days. She had so many kind things to say about the care he had received, even in just the short couple of hours he had been with us. She told me she could tell how much I cared, and that she would always remember my face- I couldn't possibly hold back the tears. Even our cocky cowboy doctor was clearly touched.

It's hard to describe the feelings surrounding this, the exhilaration, how important it is. It's not an issue of hearing someone praise you and say nice things about you. It's knowing that you actually changed someone's life, that you were able to help them for the better, and be there for someone who needed for you. It's really not something we get to do a lot here. But when it happens. Wow. It's like being on top of the world. It's something I'll remember forever. Something so wonderful that one million abusive drug seeking trolls can diminish it's joy. It's why I became an ER nurse, and it's how I do what I do.

Real Life Floor Nurse Complaint

In regards to a medic who had just transported a patient upstairs to a room, where he alone moved the patient to the bed, got the patient comfortable in bed and raised both side rails:

"He just took the patient up there and LEFT THEM! He always does that, too!"

Shortness of Breath

Yup, patients, you may have heard of this little thing we use in ER called the ABCs. Meaning, we prioritize based on airway first, followed by breathing, then circulation. So, I suppose you have now inferred that an airway issue would, logically, take priority. Good job! Great intuition on your part. Now, we're glad you chose to be seen at Hood Hospital, and we are here to listen and take your "shortness of breath" seriously. Let me, though, clarify a few things about shortness of breath.

-People who are short of breath are incapable of yelling " I can't motherfucking breathe"repeatedly at a volume that patients at the opposite ends of the ER with their doors closed can hear you in triage.

-People who are short of breath don't generally have the energy to punch the glass at the triage window.

-People who are short of breath do not generally attempt to spit in the face of the nurse trying to evaluate them.

-People who are short of breath do not throw themselves on the ground and fake a seizure when they are told by the nurse that they are indeed satting 100% on room air with clear lung sounds.

So, for future reference, you're on the right track, but you definitely need to modify a few things before you go back to a room immediately. True, you did get seen quickly by a doctor today, but only long enough for him to say that you were, in fact, breathing fine, before the police hauled you off to jail, which I doubt was your goal.

On a related note, a quick hypothetical- If a 90 pound crackhead can break the "protective glass" in your triage area with a single punch, is it still fair to call it protective glass? Just something to think about.

I Probably Should Have Seen That Coming

Nurse Buddy, to me- "Girl. You have got to go take a look at my baby in room 6. It's one of the cutest babies I've ever seen in my life. Seriously."

I walk in there to find indeed one of the most adorable babies I've ever seen, with a tiny adorable baby afro and huge dimples, all chubby and giggly and squee-inspiring. It was especially impressive given the fact that his dad, who was there with him, was a dead ringer for Lil' Wayne, minus the dreads.

I stayed in there for a bit and made a fuss over the baby and then excused myself, making some joke about how the baby was making me want a kid but mine couldn't possibly turn out that cute, so I had better go. Of course, hood hospital Lil' Wayne didn't miss a beat and responded with, "It would if you had the right daddy!", smiling to reveal one of the most ridiculous grills I have ever seen and pointing enthusiastically to himself.

Damn! I walked right into that one. I mean, I'm married and don't want kids any time soon, but I still don't even think that would be a viable back-up plan just based on how many prophylactic antibiotics would be necessary alone.

A Few Words About Actually Giving a Shit

I had a hateful drug seeker last night- the type that gives you a huge sob story and guilt trip, and when it doesn't get them what they want, they resort to swearing and personal attacks- that kind? Yeah? So, as I'm discharging her without a script for Vicodin and actually trying to explain to her calmly that the doctor literally cannot write her one because the other doctor gave her thirty when she was here 2 days ago, she started screaming at me about how I had no compassion for her and I was one of those nurses who "is only in it for the money."

She was obviously a douchebag, but it still bothered me for some reason. I started to think about it when I got home when I realized that is possibly one of the worst things you can say to a nurse who actually does care. It sounds weird, but I would actually rather face a barrage of C-bombs than to have a patient ever say that to me. And I think it's because I see what nurses like that are actually like.

Nursing really is one of those careers where you have to in some fashion, feel a calling to your job and care about what you're doing. You have to care about people and want them to do well. You can do the job, I suppose, by possessing the necessary knowledge and skills to get it done, but if you're not really into what you're doing then you're probably gonna be pretty shitty at it.

We have a nurse on days that's a pretty classic example of this. She's been a nurse for quite a while, she understands what she's doing and why she's doing it, she's not incompetent- but she obviously could care less. She clearly has no interest in her patient's comfort, or even their outcome. It's pretty much expected when I take report from her that I'm going to have to get everyone's pain meds, etc, but this is seriously the douchebag I took report from one day who hadn't started a Heparin drip on a patient with NSTEMI and active chest pain for over an hour because the order hadn't crossed over to our Pyxis yet and it would have generated a report for an unlinked order in her name (i.e. she didn't feel like screwing with the math involved with a weight based drip.) Whenever she sees a call light in front of one of her rooms go off, she actually gets up and walks the other direction. So far she hasn't killed anyone, but if she did I doubt she'd be upset about it.

I guess I really just don't understand this mindset. Why would you get into this profession if you don't care? There are plenty of other jobs out there that pay more and don't require you to clean shit. Especially ER. Why? Why work in on of the busiest and most challenging ERs in the city if you just want to sit on your ass and not deal with people? Even if you don't wanna switch careers, almost any other nursing job is easier than this one.

I'm really feel like if you really have no investment in what happens to your patients then you should GTFO of the profession. Seriously. I don't care if it makes the shortage worse. I would rather double my patient load and get my ass handed to me every night than to work with a someone who would sit at the nurses' station and text while their patient sits in their own waste in pain. There's no worse insult in the world than being lumped in with assholes like this.

Free Parenting Advice

Hi, yeah, I know at 12 you can leave your kid at home unsupervised or whatever, but that does not also mean that you can drop said kid off at the ER for a sports injury he received a couple of days ago that you don't wanna deal with and then go home and tell him to walk back to the house when he's done.

Obviously you know this since you gave the registration people a fake phone number when you dropped the kid off because you didn't want to deal with getting calls from the staff here. You probably shouldn't have given them the real address, though, because now the sheriff's department is there trying to figure out whether or not they can bring you up on child abandonment charges, and CPS is probably going to a pay you a visit there some time real soon. Aaand in the end, you still had to get up off your ass and pick up your kid. Wouldn't it have been easier to just stay in the room and watch The Parent Trap on the hospital movie channel with a complimentary warm blanket? Seriously.

Chief Complaint of the Night

Bear with me, I took the GRE earlier today and I can barely make words my brain is so fried. But here's a short one:

50-something guy on an ambulance- "So, I was smoking my weed like I normally do, right, and I had a couple of 40s of Bud Ice, but then I had one of them Four Lokos and I started feeling real bad, so I thought I just needed to burp and pass gas so I did, but then I kept feelin' bad and the gas kinda moved up to the middle of my chest so I decided to call the Ambulance 'cause my friend lil' K died of a heart attack last week so I just wanted to be safe, yah' know?"

Yup. Absolutely.

He then proceeded to try and figure out my astrological sign when I asked him his birthday for the purposes of verifying his bracelet. Rockin'.

How I Stay Sane in Triage

Seing as how anyone with more than a year and a half of experience seems to be a charge nurse where I work now, I have officially become the go-to triage wench. And as I am neither lazy nor alarmist, I am the top choice to get stuck in the penalty box by myself on the busiest night of every freaking week. Also, I think I've mentioned it numerous times before, but in case you're new to the blog, I HATE triage.

So. How do I keep from grabbing a 10 blade out of the chest tube kit and slashing my wrists? Well, one, I don't have time for suicidal gestures because 15 people just checked in during the last hour and I'm the only nurse in triage, but I also have a game I like to play. It's actually more fun with dramatic patients. What I like to do is think of the most ridiculously painful scenario and present it to them to see if they'll actually say their pain is a ten.

For example, "Okay ma'am, can you rate that pain in your tooth for me on a scale of zero to ten, when zero is no pain at all, and ten is being mauled and disemboweled by a grizzly bear?"

"Sir, you can rate the pain in your throat right now, if zero is no pain and ten is someone cutting of your arms and legs and then dousing you with gasoline and setting you on fire?"

It's awesome. I have yet to meet anyone ballsy enough to rate their pain at a ten, either. If ever do, I look forward to being able to be like, "Really? Your hemorrhoids hurt worse than burning in the pits of hell while having your eyes pecked out by birds of prey? Those must be some hemorrhoids! Okay, here's a pillow to sit on in the waiting room!"

A word of wisdom to those playing at home, it's only fun with people who don't actually need to be in the ER.

More Fun at the Triage Desk with Badass Sassy Coworker

Gastroenteritis-stricken-drama-queen patient: You need to get me back to a room! I need to lie down!

Sassy coworker: I'm sorry ma'am, but it's a very busy night. There's several other people ahead of you and every room we have is full right now.

Drama queen: This is ridiculous! Is this what you do in the ER here? This place is a shit hole! I just told you I need a room! I want to lie down!

Sassy coworker- Well, as of 2 seconds ago there's still not a room back there, so unless you wanna go back there and lay in the floor, you're gonna have to wait. Do you wanna go lay in the floor? No? Okay then, go sit down.

Trendspotting

RSD is the new Fibromyalgia, y'all.

You heard it here first.

Douchebags, everywhere

I'm so over triage. Seriously. So over it. And I'm really over working stupid shift with charge nurses in training and about 3 competent non-lazy people in the entire ER. ER BFF had to go and have a damn birthday at leave me all alone with these effin' cretins.

So hi, B team coworkers, first, if I have a patient with SVT and breathing difficulty and I've had to run back to talk to charge nurse in training because she can't pick up the phone, are you seriously going to stand here in front of me arguing with the charge nurse about what room this patient is going to go to while both of you are sitting on your asses eating snacks? Because, screw you. And while you're at it, are you really going to come up here and fight with me about whether a patient with a cough needs to be seen before some hot mess geri-psych patient who obviously escaped the hospital with her central line in because the grown up charge nurse took over 3 seconds ago and you didn't hear it as a direct order from her lips? I could do without the attitude, thanks.

Quit stealing my damn EKG machine and not bringing it back. There's 8 hour waits, so everyone up in here has chest pain. I need that. And let's everyone not pretend that I'm speaking Tagalog when I tell you for the fifth time that I've dropped up a homicidal psych patient in a room and they need a sitter because she's not in a psych room. They're ALL FULL. If I could just pull ER rooms out of my ass this whole process would be so much easier, but I can't. Now if you'll excuse me, I have to get back to the hundreds of people in the waiting room so they can cuss me out.

Speaking of which, patients? It's an etiquette no-no to run back to a room that another patient was called for when you haven't even checked in yet and just sit back there and act as if nothing's wrong. Really? Other no-nos for trying to get back to a room quicker- trying to lie down across my triage chair whilst sticking you ass in the air is comedy gold, but it doesn't really help convince me that you're too weak to sit in a chair what with all the acrobatic ability required to do what you're doing now.

Also, pseudo seizures are a classic move, but make sure you scan the area for ammonia caps. If caught faking a seizure, maybe you should google "grand mal seizure" again before you tell me that's the kind you have so you don't ever lose consciousness completely.

Expressing your pain in the most dramatic way possible really won't get you anywhere tonight, as we really, literally, no, for real, have nowhere for you to go right now, but if the triage desk nurse just had to try to get you 3 times to be triaged while you finished your cigarette outside, it really won't help, so you might as well just stop. You're bad at acting and you're embarrassing yourself.

Visitors! No, I can't look up a patient by birthday, by what town they're from, which family members are with them, or by what medical problems they have. If you don't know your friend of family member's last name you probably don't know them well enough to be visiting them in the ER. Even if you do, the problem is not that I'm too stupid to work the computer system. The problem is you don't actually know the name of who the hell you're trying to find, and you're coming up here based on secondhand information about that patient maybe being here. Just go home. I guarantee they don't miss you if they didn't call you themselves and tell you they were at the hospital. Shit.

I want to punch everything, and I need a drink.

Chief Complaint of the Night

Mom brings in a school age kid at about 3 AM- she's practically dragging the kid back to triage when I call them. Finally wakes him up enough so that he could stand on the scale on his own. At first I think he must have had some kind of head trauma and this must be some real shit, but no, he just really wanted to be home in his bed because he had been in school and it was three in the effin' morning.

The life threatening condition for which the mother felt he needed to be in the ER for at this time? A nosebleed that had happened 4 hours prior to arrival and lasted about 20 minutes. The bleeding had stopped and the kid had gone to bed, but she was "concerned" and "wanted to get it checked out". And yes, in case you were wondering, his hands were also caked in Cheeto dust. Of course.

Unrelated: I'm studying for the GRE right now, so posts will be short, sweet, and possibly infrequent. In the meantime, I suggest you read the yahoo! answers questions about reproduction if you're having withdrawals from the tales of foolishness.

Confidentiality

So, we have these privacy screens on all our computers at work where you can't see the screen unless you're standing directly behind someone. Complete pain in the ass, but I guess Joint Commission wants us to have them so that no one can see the tracker while walking by lest they find out that other people are there being treated in the ER. Whatever.

I'm up in triage last night going through whatever complaint this lady has and typing away when I noticed she is staring at me looking wicked pissed. I ask her if something is wrong and she rolls her eyes and says, " I know you're not really typing anything! That's just a black screen! I'm not stupid." Oh, no. I hadn't even thought about that angle, but I'm sure now that we're out there charting everyone thinks we're just out there dicking around on the sleeping computers and not getting their meds just to be hateful.

That's almost as brilliant as not being able to put the specific medications on the allergy bands because it's medical information. I'd love to get ahold of whatever the hell they're smoking at these meetings where they come up with this stuff.

Questionable Boundaries For Miles

Early 20 something chick checks in with lower abdominal pain, our bread and butter in the hood. Brings her daddy along for the ride, because I guess he had nothing else to do and because taking your dad with you to the ER to be seen for your female GU complaint is always an awesome call.

We were blessed with the awesome PA who believes in common sense and minimal workup fuckery, so she got a UA and some Tylenol.

Lo and behold, she has a UTI, so I go in to give her an antibiotic shot. I tell dad it might be a good time to step out, as I'm about to expose most of his daughter's butt. Annnd he just shrugs and stands there. So, after her shot time, my friend goes into discharge her and dad gets upset because she didn't get a pelvic and he thinks "she might be back with that Chlamydia again". Wow.

Receptacle Fail

It's a debated issue whether people should bring their possible products of conception to the hospital with them. Most of our providers find it weird, but I know some OB types encourage this type of thing.

But. I think we can all agree that if you're going to bring your possible products of conception, you should bring them in something besides a Cheeto bag? Right? Or at least rinse it out first? Okay? Okay, good.

That's What I Get For Not Changing the Assignment Boards

Patient, to tech passing in hall- Hey! Hey you! Go get my nurse!

Tech- Okay, sir, which one is your nurse?

Patient- I don't know her name. Whatever-the little one. That little frail thing! Go get her!

Welll. Yeah, let me go get you that sandwich but if you're looking for me after that, I'll be downstairs at the fitness center lifting weights.

I Think I Liked You Better When Your Blood Sugar Was 30

A few nights ago, a friend of mine gets an older gentleman from the nursing home- he's cold to the touch and acting kind of like someone who just took a bunch of Benadryl and is trying to stay awake. Medics tell us his blood sugar is in the 30ish range but they couldn't establish IV access, so it's still that way. He gets the doctor in there and we get to work on an IV- dude is a little ball of scar tissue, unfortunately. His EJs are pretty much useless from as many times as they've been stuck, but I managed to get a neonate IV in his wrist, and push an amp of D50 in that bad boy. Woot! Poor guy's rectal temp was about 96, so we also got him hooked up with a little Bair Hugger action and he started to turn around a bit.

He started looking around and was talking in kind of a pleasantly confused way. He knew who he was, but that was about it- he kept referring to my teammate as "my son" and smiling at him. I get him some warmed fluids and go back about my business with my other patients. About a half hour later my friend rechecks his blood sugar and finds it's now only in the high 30's- I run into the room with him to try and find another IV site for a D10 drip as he's giving the second amp of dextrose. Just as he is finishing up with pushing the med, they guy sits right up and asks me what the hell I'm doing. I explain that his blood sugar keeps dropping and that we're going to try to get another IV to give him some dextrose continuously. I then ask if they're giving him Insulin over there at the nursing home.

He scoffs. "Well. OBVIOUSLY, or I wouldn't be here, would I?"

I explain that there are multiple medications for diabetes besides Insulin, to which he responds with, "Oh. Really. And you couldn't figure out that Insulin was what they were giving me? You're a little special, aren't you?"

So, then my friend decides with the mental status change and junk that he should ask his orienation questions again. "What's your name, sir?"

"MR. ANGRY PATIENT MCGEE !!! GOD, YOU PEOPLE!"

"What's wrong sir, you seem upset?"

"I AM upset, because that's a STUPID ASS question!"

I then make a last ditch effort to explain the state he presented in, to which he responds by rolling his eyes and turning away in a manner similar to a 13 year old girl. I take this as my cue to exit.

I hear screaming coming from the room about an hour later and walk in to find him waving the urinal around and yelling about how he got the sample we keep bothering him about. I thank him and take it away. He squints at me and crosses his arms and says, "and where have YOU been?"

"I've been taking care of my patients", I tell him. "I was in here earlier helping your nurse, the guy that's been in and out of here checking on you, but it seemed like I was getting on your nerves so I thought I'd step out for a while." He stares at me for a minute and says, "You know what?" What? "You're a typical woman. That's what you are."

I just busted up laughing at this point. What else could I do? I always thought people were easier to deal with when they were lucid, but I guess not always.

Forgotten

It was possibly the worse presentation I've ever seen in a living person. EMTs bring us an older man, sliding down the stretcher struggling to breathe, caked in layers of his own waste. He's missing both legs below the knees. The story we got was that the man had been staying in one of the local nursing homes when he left because he felt that he wasn't being well taken care of. Considering the place we're talking about, he was probably right. He took his wheelchair and what little money he had, and called his son to meet him at the super market down the street. He waited a long time for his son to show up. He got some food, which made him sick- when night fell, he wheeled himself back up to the nursing home. At this point he was not only ill, but very short of breath, as he had also been all day without oxygen. At some point he fell out of his wheelchair and into the street in front of the nursing home. The staff eventually went outside in the early hours of the next morning to smoke and found him- they left him in the street and called the ambulance to come pick him up.

He was one of the sweetest patients I've ever taken care of. He was so apologetic about the state he was in. "It must've been that fruit I ate", he said, "I'm so, so sorry. This is so awful." I reassured him that this is what we do, all the time, and if I was afraid of poop I would have been pretty foolish to become a nurse. He was one of those people who is just incredibly grateful for even the smallest of gestures. He gushed about how great his care was. "You don't understand," he told me, "not all nurses are as kind as you. I usually go the the VA hospital, and it's not like that there. But you're very sweet." His voice cracked as he spoke. In talking to him, I gathered that he fought in Vietnam, which was where he lost his legs. He suffered from PTSD and for all practical purposes, had nowhere to really call home. He had been in and out of different hospitals and nursing homes for the last several years.

This has been nearly a month ago, and a day hasn't gone by that I haven't thought of him. Here is this sweet, vulnerable old man who has sacrificed more that I can fathom. And we live in a world where he is literally left in the street covered in his own waste gasping for air while people that call themselves healthcare workers walk by on their smoke break without doing anything to help. It hurts me to think about it.

I think about the last time I saw him before I went home- sitting up in bed, finally clean, wrapped in blankets with rosy red cheeks-a marked difference from the hypoxic pallor he came in with. He was sleeping, but he opened his eyes and smiled at me as I waved goodbye.

Lots of people have asked me how I don't burn out doing what I do. The answer is the occasional person like this. Being able to bring a smile to the face of someone who has so undeservedly been bound to miserable circumstances for so long. Knowing that I can bring some comfort to someone who has seen so much suffering, to make them feel important and cared for again is enough to sustain me through the months of bullshit.

Creepers

I'm serving my time at the Hood Hospital triage desk last night when I noticed this disheveled lookin' dude walking through the breezeway smoking a cigarette. Luckily, he puts it out before he gets into the actual waiting room so I don't have to do my "this isn't 1960 where you can still smoke in a hospital" speech, but the alternative is way worse.

He walks in, stares at me with Charles Manson caliber crazy eyes, tells me I'm beautiful, and pulls put his pack of cigarettes. He then slides the cigarettes across the desk to me and asks if I can read him the warning on the side. I look askance at him and then go through the standard surgeon general's warning about how smoking can cause lung cancer and death and such and look up to be met with more crazy eyes. Crazy eyes for days. He stares at me for an awkwardly long period of time, and then says, "Well. All that stuff on there. I hope that does happen to me. Cause then I'll die, and I'll see you."

So, he scampers off back to the treatment area, where I assume he belongs since he's obviously crazy, blowing me kisses the whole time. I don't think a lot of it until one of our cops sees him outside later and starts telling me he is actually a family member of an admitted patient. They apparently had to go talk to him the night before that because he was going outside and rounding up a bunch of homeless dudes and letting them get the free coffee and sleep on the floor of his wife's room.

Wowzer. Hanging out with your buddies and hitting on ladies? Free food and coffee? It's like an all-inclusive resort up in here.

Really?

Last night was a revolving door of drug seekers and ICU patients. I had to resite one lady's IV 3 times in about 5 hours. She told me the first time I had to do it that she was going to cuss me out if I didn't get her on the first stick. Seriously? What do I get to do to you for continually removing them now? I wish I could say that was the last time someone threatened violence against me that shift, but I'd be lying.

I thought I'd been granted serious relief once she got upstairs, until about 35 seconds later, when the charge nurse sent an ambulance containing what might be the single craziest Hood Hospital frequent flyer to the still dirty room. Naturally, she got admitted and was a hold all night, so I had the privilege of listening to her spew all kinds of crazy racial slurs about the asian admitting doctor who cut off her Dilaudid.

The guy in my other room decided to follow suit by cutting up and removing his own IV and slamming doors like an angry teen because I wasn't getting him medicine fast enough for his chronic back pain. I must have resited, like, 8 damn IVs last night. Somehow my shrugging and handing him an AMA form made him decide he actually did want to stay, but at least he scaled back the attitude for the two hours remaining in the shift.

Before you decide I'm mean for my indifference, let me just say that during the time in question that he needed his life saving narcotics, I had just gotten a lady with no IV and a heart rate of 25. Uh, sorry dude, I'll get your Morphine right after this lady's Atropine and transcutaneous pacing junk. I'm here to listen to you and take your pain seriously.

Symptomatic bradycardic lady got worse before she got better, so I traded her for the unresponsive drunk guy that was in the room before. He finally woke up and left with his ride right before shift change, at which point the charge nurse notified me that he had taken a shit in the middle of the floor before leaving as a way of saying thank you. Yeah. Awesome.

Benadryl and Cogentin Seekers?

What the hell. I'm just very curious to see if this happens anywhere else. For the last couple of months, we have had several people- one of them more than once- check in for dystonic reactions. Except, not real dystonic reactions, but really poorly faked dystonic reactions.

I've gathered that IV Benadryl delivers the same "rush" as you might get with narcotics, but other than this, I'm trying to figure out why so many people are doing this now.

Has anyone else ever seen this? Am I crazy for trying to figure out the rationale?

Edumucation

Real run sheet material: "PT ON KEMO FOR LAST WEEK. "

Kemo? Like for Kancer? Just checkin' y'all!

The Chief Complaint That Wouldn't Die

You wanna know what I really, really, more than anything, wish I could say I had only seen once? Well, whatever, I'm gonna tell you anyway. Yeah. Virginity checks. In the ER.

We see this way more often than you would think. It always goes down the same way. Parent finds teenage girl in compromising position with boyfriend, parent immediately drags teenage girl to the ER to find out just how far stuff went, usually with a little STD check/pregnancy test thrown into the mix for good measure (because these tests are very accurate within matter of hours, of course). I also wish I could say we don't touch this foolishness when it comes in, but I'd be lying. If it wasn't bad enough that we're now the local STD clinic, we're now expected to be the local STD clinic for underage girls against their will. Awesome.

So, anyway, I get another one the other day- 13 year old girl with her mom, same story. Great. Homegirl is wearing some kind of athletic short/panty hybrid to the ER, which is think is actually probably a greater infection risk in our waiting room than sexual contact with another teen, but I digress. Mom is going through the whole story, daughter never looks up from her phone. Oh, and while we're here, toddler sibling has also had a runny nose for a week. Why the hell not.

Eventually they go back to a room-I walk by it later on the way to the vending machine. Mom is face down in bed, snoring, while the toddler is running around the room screaming, and the teenage girl is sitting in the corner continuing to text.

Sigh. At this point, I don't really have to say it, do I?

On the Various Definitions of a Real Emergency

Hood Hospital triage, where else-

Hood Nurse-Hi there ma'am! My name is Hood Nurse, and right now I'm just going to check out your vitals signs and collect some medical information. What's going on today?

Patient- Well, you see, I've had this boil for about 5 days now on my butt, and the pain is just really becoming unbearable. I tried to deal with it at home, but it just keeps getting worse, so I decided to come in.

Hood Nurse- I see. How would you rate the pain right now?

Patient- A ten.

Hood Nurse-Okay, well, we'd be happy to get that checked out for you. I'm afraid all the rooms in back are full at the moment, so I'll need you to wait in the waiting room for a bit and another nurse will call you when a room is available.

Patient- So, am I gonna have to wait a long time to be seen for this? I mean, don't you guys have an area for like, sore throats and stuff, and then another area for real emergencies like mine?

We sure do. Next.

Subtlety Fail

One of my lovely, but not very tactful co-workers, to a patient's family member: "So, in addition to being a crackhead, your mother also has a history of hypertension?"

Oh dear. Why don't you start the IV and someone else can obtain the medical history.

Sisterly Love

I'm up in triage last night when what appears to be a nicely dressed, normal young woman walks into my booth- I'm getting my ass handed to me, so I'm not even looking at the tracker before I start asking questions to prepare myself for what these people are checking in for.

The first thing this girl says to me is, " This is so embarrassing", which is never a good start. I then look at my computer screen to see the complaint as "foreign body in vagina", so at that point I kind of cut the formalities and ask her what she's got up there. "A tampon", she tells me. Oh. That's not so weird. I reassure her, as she's obviously mortified. Naw, dude, that's not a big deal. I see that on about a monthly basis. That at least belonged up there at some point, stuff happens.

So, then she continues with, "Oh, that makes me feel better. Yeah. I didn't really want to come up here. My sister made me, though, cause she looked in there and felt around and she couldn't find it, so she said I definitely needed to come to the ER." Uh. WHAT.

That just took it back to weird territory. I mean, maybe I just don't understand because I only have a brother and obviously, that would be even weirder, but for those of you who do have sisters, is it normal for siblings to go digging around in one another's vaginas? Because it seems like it wouldn't be. Please enlighten me on this issue.

In Which Much Swearing Will Ensue

Please allow me to go off on an angry little rant here and then we will continue with our regular programing of people putting various items in inappropriate places or people checking in for cold sores or whatever. So, here at Hood Hospital the fast track area is in a totally separate part of the department from the real shit so the ER doctors don't get distracted by the overwhelming scent of Trichomonas Vaginosis while they're trying to place central lines and stuff. Okay, it works out most of the time.

Except, somehow this has turned a bunch of the physicians into whiny little princesses who all of a sudden think they should not have to see a fast track patient ever again in their entire career. To which I say- bitches, please. One, just because it sound like a fast track patient does not mean it isn't emergency or it doesn't belong in the ER. Guess what? Vaginal bleeding can be a legit emergency. Yeah. I've figured that one out, and I haven't been to medical school, but apparently to some people, being an ER physician means acting like a complete douchebag to the charge nurse and throwing a fit like a three year old about seeing a patient here for vaginal bleeding. Really? Obviously you didn't trust us when we were telling you there were giant blood clots pouring off the side of the bed, but now that you've seen them yourself you wanna start barking off orders to us in front of the patient like we're the ones who have been lagging? Fuck off.

And two, even if they aren't critically ill, is it that hard to see the occasional lady complaint? I can see how you wouldn't want to take the time up when you have a lot of really sick people, but when the midlevel hasn't eaten or peed for 9 hours and you've got your feet up looking at Yahoo sports, would it kill you to help them out instead of staring at the tracker and screaming at the charge nurse about how there's one room that just opened up in fast track? You graduated medical school, you can insert a chest tube, you can read your own x rays, don't tell me you can't figure out how to navigate a vagina. It really isn't hard. See that hole inside that other hole? Yeah, scrape some stuff off of that and send it to lab. There you go.

Okay, maybe that's still too complicated. That's okay. How about a cough? How about a toothache? Yeah, I know People of Walmart is hilarious, I love it too, but I'm pretty sure a mob with torches and pitchforks is actually forming in triage right now. Do you think you could prevent the death of the nurse at the desk up there and maybe just see some of these simple things that have been out there for 5 hours now? No, great.

You know, that must be awesome. I hate inserting NG tubes and doing orthostatic vital signs. The next time you order that maybe I'll just refuse to do it because I don't like to and see how long it takes me to get fired. Excellent. That's just the kind of professionalism and teamwork we need around an ER that's now a total shit storm all the time. Stupid assholes.

Hood Hospital Arachnology

Some chick comes in on an ambulance last night for butt abscesses (why not), tells the doctor that she was pretty sure spiders were biting her on her buttocks while she was sleeping, even though she hadn't seen them (spiders are always the culprit in the hood), but somehow during the conversation, it came to light that the patient also worked as a stripper.

So ER Doc went around asking everyone about the odds of contracting such an infection from spiders vs. sticking your bare ass on a pole covered in multi drug resistant clamydia or super AIDs or whatever. So, being creative I decided maybe it was both. "Well. Maybe the spiders were on the pole. Maybe it was a downtown pole spider. You don't know about pole spiders? Did you even graduate medical school? Shit."

Don't laugh, ya''ll. Pole spiders are serious business.

While We're Here

Chick comes in last night in respiratory distress on an ambulance- she's pretty sick. All stridorous and generally shitty looking. We throw all kinds of crap at her trying to avoid intubation, finally get her relatively settled on BIPAP, and I'm running around the room hanging all these different meds when the patient's husband tells me he needs to ask the doctor a question.

I ask him what the question is and tell him I may be able to answer it- a lot of people don't really understand that nurses have medical training and can therefore answer medical questions.

"It's personal", he tells me. Ruh roh. Something about your wife's care we need to know? Nope. A personal medical question, he tells me. I go ahead and explain to him that the doctor is most likely not going to give any kind of medical advice to someone who isn't a patient, but I'll let him know. ER Doc is in the next room in a procedure and I'm trying to do other stuff, so I catch up with him later and mention the patient's husband wants to talk to him.

I could tell by the look on his face I was too late. Yeah. Apparently homeboy calls poor ER Doc into the room and tells him that sometimes his penis gets red and swollen and drains stuff. He then proceeds to try and show the doctor his penis. Doctor tells him he needs to check in if he wants to be seen for that foolishness and then gets the hell out of the room, stat.

The husband wasn't in the room when I got back, but I didn't think much of it as he'd been in and out smoking for a good part of the night. Until about ten minutes later when I look up on the tracker and see his name up there. He sure did check in to get his penis looked at in fast track while we were still trying to figure out whether or not we were going to intubate his wife. Really.

Congratulations, sir, you just won the Hood Hospital prize for worst two-fer ever, beating out the gentleman who checked in with his wife who was having a CHF exacerbation because he's been walking a lot and had some blisters on his feet. Please exit the hospital and keep walking to claim your prize. It's out there somewhere, I swear.

Things You Can't Unsee

Yeah, I know when the census is finally low and you're out of snacks and you're out of stuff that the monitored internet will let you look up without you ending up in the office, it may seem like a fun idea to use the woods lamp as makeshift CSI light to figure out exactly how much bodily fluid naked to the human eye is still hanging around in the pelvic room, but it's not.

Just trust me on this one.

It's True

Elderly patient, when she, upon being discharged, was referred to our affiliated family practice clinic: "Family practice? I ain't goin' over there. They practicin'."

Well.

No Ma'am.

You know, if you really want pain medicine, calling an ambulance twice probably isn't the worst start, but you probably shouldn't do it totally hammered in the early evening on a weekday, and then start your ER visit off with immediately swearing at anyone within earshot about how you hate this hospital. Also, trying to hit the physician with your cane from the stretcher is another no-no.

If you're trying to convince us you're sober enough to leave AMA now, probably continuing to climb over the stretcher rails to get to the pills in your purse is not the best way to do so. And no sober person tries to eat a sandwich that they dropped off of this floor. Seriously. Nobody. And most not intoxicated people don't try to seductively caress the arm of the paramedic applying their blood pressure cuff.

And- a quick tangent here- if you're serious about trying to bag a medic during your stay here, you should probably not wear low rise jeans with granny panties, and you'd probably have better luck with one who isn't young enough to be your son.

But, if you were not trying to get narcs, but instead just wanted to leave an impression on the staff here, then well played. Not only to we have all the awesome memories of you screaming to anyone who tried to touch you that you have syphilis, but we found pieces of your poorly constructed wig all over everything for at least the next week after your visit here.

You stay classy now.

A Few Minor Changes

Well, despite the explicit instructions otherwise I mixed antihistamines and alcohol and the last thing I remember I was on the blogger template and google image search and now I have a new layout I guess. The underlying theme of my blog is medical waste so I guess it's appropriate.

Anyway. A longer explanation is coming that sounds a lot more eloquent, but basically I'm not really a new nurse anymore and I don't want people mistaking my stupidity for novice, so I'm probably gonna change the blog's name at some point. Maybe. Whatever. I'm open to suggestions is all I'm saying. Go!

Therapeutic Ignore

My ER BFF was talking to me the other day when someone came over the call light with completely asinine request the patient had made for the 4th time or whatever and she just said, "Uh, yeah. I think I'm just gonna therapeutic ignore that for right now." I remember at the time thinking it was kind of funny but sort of mean just because I am the type of sucker who immediately answers the call light regardless of how stupid the request is if I'm not doing something else really important, even if it's just to say "No, I'm sorry, I can't do that" yet again.

Until last night.

Last night my rooms became the unofficial frequent flyer unit. To the point that I'm pretty sure the charge nurse was afraid I was going to harm her physically. It was just realllly unfortunate timing, but I literally had three patients whose medical history and allergies I could recite to them as they were rolling in on the ambulance. I'm pretty sure the amount of Dilaudid I gave to any one of these people last night could kill the average horse. In my 4th room I had a woman who would scream constantly at the top of her lungs, until I asked her any kind of pertinent question, which she would then answer in a fucking baby voice. She too, wanted Dilaudid, but her blood pressure was too low so she pretty much kept that whole routine up the entire night. Awesome.

I tried telling the charge nurse that I had suicidal ideation with a plan, but she refused to put me in a psych room and give me a warm blanket and a sandwich, so I just had to deal with my lot. So after running back and forth getting everything one patient requested med-wise, only to be met with, "you forgot my Shasta", only to have her 5 minutes later vomit said Shasta (her 4th, btw) all over her sheets and the floor along with her life saving Kayexalate (I'm pretty sure to make a point about not getting Phenergan ordered), it totally switched to homicidal ideation. Only then did I truly understand the therapeutic part of the therapeutic ignore.

You know how they tell new parents that it's better to go outside and ignore a crying baby for a minute when you're about to snap instead of shaking the baby? Yeah, well. I think that same concept applies to nurses. When you start looking around your room for pillows for reasons other than keeping your patient comfortable, go outside a minute. Maybe scream, or break something. Go to the bathroom. Then come back. The conversation about Phenergan can wait just a minute. It'll be better for you, and your patient. Therapeutic ignore for a minute, and you'll be a more patient nurse.

An Open Letter to the Borderline Personality Disordered Internal Medicine Douchebag From Hell

Ahem. Dear Broke Ass Dr. House,

Hi! Nice talking to you again! It's always so pleasant when I get to catch up with you on the night shift. Me? I'm 6 hours in with no bathroom break or chance to get a drink of water, so you can bet I'm feeling pretty guilty right now about waking you while you get paid way the hell more than I do to be on call in the comfort of your own home. Sorry my friend. But enough about me, I'm calling about the uroseptic nursing home patient we've been holding down here in the ER for a bit now. I know you told my ER doctor to stop the vasopressors we've been giving her to keep her alive immediately and switch to NS at 50 mls an hour, but since that's dumb as hell, we decided to taper of the pressors gradually, and unsurprisingly to either of us, it isn't working, so we'd like your guidance on the next step. Yes, I do realize that not following your orders exactly is an insult to your infallible judgement as a physician and probably practicing medicine without a license on my part. I'm very sorry about that. Next time we'll just stop the lifesaving medications abruptly and gently hydrate your patient's corpse. We'll call you in the morning after your coffee and omelette about the disposition of the body, just let us know when you usually wake up. Please continue to scream at me about it for the next couple of minutes, though, because it's actually making your patient less sick the more you do it, and it's a great use of my time.

Oh! I see! The real problem is that we started the pressors in the first place without consulting you. Sorry. They started this during the day shift, but I'll pass along to them and my doctor that you would like to have nothing at all done on your patients in the ER until you are asked. We'll make sure not to do any interventions until the average 45 minutes it takes you to return a page. At that time, the patient will be pulseless and asystolic, and we will make sure that you want to use the new ACLS guidelines or whether you, lord and savior or all ER personnel, have your own guidelines for us to follow. After all, you know best about everything because you have "been at this a lot longer than I have", and you're so good you can make these kind of judgement calls without having ever laid eyes on the patient. Also, please continue to refer to call me "young lady" because it make me feel very special and not at all like a child who has done something wrong. What's that? Go ahead and admit the patient to the ICU on pressors because I'm going to do whatever the hell I want anyway? Oh, thank you darling. You're a peach, as always. We'll have to do this again soon, because I really love getting in screaming matches with the doctor on call at the nurses station with the other staff and all the patients in the hall beds looking on. Okay! Bye now! Have a great evening!

Hugs and Kisses, Hood Nurse