Dear God...

I understand that there is a reason behind everything you do. I can't begin to understand the grand plan or meaning behind it all. I guess my role is to keep faith and roll with the punches. I have tried to give more than I take and make my time here worthwhile. The last 18 months have been challenging to say the least. My professional, personal and family life have hung in the balance at some point or another. I hope that I have used these opportunities to grow and make myself a better person. So now, after ANOTHER sleepless night, this time worrying about my mom (who was taken to the hospital as I flew back from my trip)  I ask.... can I get a freakin break?

Thank you

Amen

The trip itself was incredibly relaxing. Jamaica is infinately sad and beautiful at the same time. So much poverty amid all that green water and blue sky. I had champagne with breakfast every morning and something called a Dirty Banana from the beach bar (or swim up bar) any other time I needed it. It rained every day... I didn't care. Got a ton of sun, ate great food and swam in the ocean every day. What can I say.... it was fabulous.

Called in tonight so I could spend more time with mom (and getting moms house together so she wouldn't have to). Back to the grind tomorrow.

Somedays....

... you can't win them all.

Last night I don't think I won any! Some nights everything you touch turns to gold and then there are nights like mine. Seriously, don't know where this shit comes from.

I was supposed to be walking the green mile again last night. Not in charge, just rowing with the others. One of the nurses absolutely hates the trauma room and asked if we could switch. Easy enough and the world swings my way for a change. I picked up the room from one of the guys who is both thorough and laid back. If only he worked nights! The room was both empty and stocked..fan-freakin-tastick. The trauma docs immediately decided to put one of the traumas back in the room for chest tube placement. 18 year old female, t-boned on the driver's side. Rib fractures 4-11 on the right side with a hemo/pneumo. The doc did an incredible job of numbing her and with a little "liquid margarita" (aka dilaudid) she did great.
Once she got settled, the trauma started rolling in. 3 from another accident.. nada too sick. Two rolled out and we got another upper airway burn from a house fire. This guy went into his burning house after his cat. He made it out, the cat did not. Nice 22 year old guy with a history of asthma. He was wheezing, but still managed to laugh and joke despite the house (and the cat) being a total loss. Got scoped at the bedside, and then to burn ICU for overnight observation.
Did I mention we were on diversion with very few inpatient beds? OK, just checking....

Local EMS agency overrides diversion (it happens) for a man with chest pain, in a 3 degree heart block and 10/10 pain. One thing I have picked up along the way: if you have to use a towel to wipe the sweat off, THEN use benzoin to get the 12 lead EKG and normal EKG patches to stick.... life is NOT Good today. Get your shit ready. This poor guy had a rate in the 50's, a pressure in the 200's despite 180mcg of nitro. Bad juju my friends. He was awake, talking to me while 50 million things happened around him. Hemocult, heparin bolus and drip, projectile vomiting + zofran = baby asa and plavix PO. IV morphine and titrating the shit outta the nitro. Consented for cardiac cath by the CICU and rolled out 35 minutes after hitting the trauma room. (no other bed when he arrived). He coded as soon as he hit the cath lab..... died 45 minutes later. 50 years old..... I kept telling him to hang in there and that things would be ok.

Next contestant. 86 years old, from the nursing home. Dementia, prostate cancer, vomiting blood, being bagged on arrival. The nurse didn't think she was supposed to send the DNR. We were fixing to get medieval on him as the charge nurse convinced the NH staff to fax the goddamn DNR already. It finally, thankfully showed up. He was fluffed, puffed wrapped in blankets, put on a NRB and left the hell alone. What a damn relief. In an effort to reverse my karma I grabbed a COW (computer-on-wheels) popped up Pandora on some Michael Buble and put that in his room as well. Hell, if the man is going to die he may as well have some relaxing music!

He had just gotten settled and I was feeling a little better when we got the next call. Flash pulmonary edema 2 minutes out. Pt shows up on CPAP via a transport service (not 911 type EMS). 28 years old, 450lbs from a respiratory-type nursing home. She had been short of breath for greater than 40 minutes and the facility chose not to call 911, but to wait for their normal transport service. She was awake and saying "help me" when she arrived. As we watched she stopped breathing on CPAP and the game was, unfortunately, on. Bagging her was a BITCH, I had to pull her hair just to open her airway and it took 3 of us to get a good seal. Roc and etomidate... the resident got the tube on the second look. (long story involving the dumbass attending.... better saved for a later rant) Even with color change she looked horrible. Purple and mottled no matter what we did. Confirmed tube placement a million times... she dropped her rate from 140 to 60... but never brady'd down like our shit-airway people usually do. Shit BP + Shit O2 sats.... femoral pulses impossible to feel through the FUPA and the cheese down there was disgusting. We coded her for 11 minutes the first time, and got a pulse back after 2 rounds of drugs. Lost it again after I art-stuck her for labs. Coded again for 15 more minutes.... everyone took turns with compressions as she was too big for the geezer squeezer. P's and T's... everything covered. Even darted her left chest just to see if it changed things. Over an hour of coding the big girl when we were finally done, followed by cleaning the hell outta the room and the quest for a bariatric body bag.

As we were zipping her up, my transfer... self inflicted GSW to the right temple with an exit in the left temple. He said he was cleaning the gun and it was an accident. (yes, awake and talking... just destroyed both eyes) Accident my ASS!

So on the advice of one of our university police officers my breakfast consisted of "Jameson's, 3 fingers with 5 ice cubes." Perfect for a night like that.

Hot Now

Last night was exactly what we anticipated. Fucking insane all night long. I had a great group walking the green mile, but some nights even a great group can only take you so far. There were some superfreaks out and about. I didn't get to see any "real" costumes, but I still wonder about what people were wearing when they left the house last night.


Sad case, college level math professor from somewhere in Africa found wandering. No idea who he was or where he was. CT scan showed a BIG head bleed. He was still awake, but squirrely as hell. We were, of course, too short on security and extra staff to have someone watch him, so we all basically did a drive-by of his room whenever we could. Ditto with the drunk that fell at 3pm and bonked his head. He was still metabolizing to freedom 13 hours later. Lots and lots of drunk bastards last night. Some more functional than others.

Trauma, on the other hand was wide slam open with MVC's and GSW's. Some dumb fool pulled a gun on three other dudes. He got off a round or two before the other guys lit his ass up. 4 total GSW's in a span of 15 minutes in addition to the multiple accidents that were coming in. I ended up pulling multiple patients out of the trauma room back to the green mile just to make room. Oh, and of course all of this happened when the computer was down.

My all-time favorite Halloween patient.... 29 years old, found down in an alley. Combative as hell. He came in proned out, handcuffed and strapped down all the while flicking us off. If Criss Angel and the guy from The Crow had a psychotic child then this would be him. Black stringy hair, crazy black eyeliner, tattoos and fake blood all over him. When he pancake flipped him he arched up off the bed, head back and screamed "I'm going to kill you all!" I looked up and said... "Holy Shit, it’s the Devil!"

Had an unrestrained female hit some guy head on. She was pregnant and until we unstrapped her she was normal. When we logrolled her she went apeshit and grabbed my male nurse by the cahones. It was not a pretty picture.

I figured that since we all worked that extra hour we deserved a well earned break. The CC knew I was going to the "bathroom" as I drove through the monsoon to get hot. fresh doughnuts and coffee for the department. It was just what we needed to make it through that last hour. So am glad to be home, dry and happy.

FYI: I am NOT doing this SHIT next year!

Its the Great Pumpkin

Do you ever wonder about the Perfect Storm? A series of events that individually wouldn't be a big deal, but when combined are a big fuckin nightmare? Well thats what I'm seeing tonight. Its Saturday (sucks), its Halloween (sucks ASS), its fall-back day(FUCKER), the computer system is going down at midnight (MOTHERFUCKER) and oh yeah..... I'm in CHARGE tonight! ARRRUUUGGHHH!!!

Fuck that shit.

Pardon my language. Given the pending gloom and doom I think it is warranted. I have a feeling the the Green ER is not going to be the most sincere pumpkin patch this evening. Maybe the Great Pumpkin will rise outta another patch and bring all the drunks and psychos to the most deserving ED (and leave us and our Influenza-Like-Illness  aka ILI alone!).

Fat chance.

Fuckin Flu

So nada good going on in the ER these days. The flu is rampant (of course) and I think there must be a psychological component because these have to be the stupidest patients I have seen in a while. Kids with temps of 103 and the parents, when asked about tylenol/motrin etc respond "that’s why I brought him here." At 2am with the rest of your damn family. I actually had a mother bring a kid in for a runny nose that didn't think they should have to wait in the waiting room because she didn't want her kid to get sick. I explained that this IS a hospital, not a mall and that if she wanted a mask for her child then I could give her one. She refused. WTF?!?!? People are so fucking stupid.

Before I leave my flu rant in the dust let me also vent my frustrations about the management. They KNEW this was going to be a fucking nightmare. I think we all knew that this flu season was going to be bad. Did they prepare ahead of time? Negative. They have a "Flu Tent" that has been up in years past. Was it up when this shit started? Nope. They have decided to move the different areas around to make a dedicated "Flu ER." Did they know how they were gonna staff it??? Nope. I got a call yesterday. It was a recording from the ER saying that "We are excited to announce our new Flu ER! We are giving you the opportunity to work overtime from 9a-9p. Please call to schedule your shift!" Ummmm so what happens when NONE of us want to work there? I'm entertaining it just for extra Christmas money. Will check the schedule tonight and see just how fucked up this thing looks.

My paramedic class has gotten a touch of drama on as well. These Type A bitches are really pushing my Type B buttons. We are a new hybrid of the paramedic class. Things that are generalizations towards other classes don't fit ours and there is some flexibility that has to be accepted. That said..... we spend greater that 20 minutes each class hashing out the drama for the type A's in the group. This is all well and good when I have slept the night before and am slowly drinking my coffee and waking up. However, when I worked in flu hell the night before, haven't gotten my coffee on and generally not in a great mood... you'd better watch out. It was all I could do to keep my mouth shut. Even better?!?!? When the lecture started it was trauma and neuro. The teacher kept going to me with the classes because of my background. I should have just taken a nap!
Yesterday I got a call from the queen of the high maintenance bitches in my class. She had her first clinical in my ER. I was expecting she was gonna fly off the deep end. We are a bit off the chain these days and I didn't think a super control freak would feel comfortable there. I was wrong. She was blown away by our little shithole. She actually said that I was very fortunate to work in such an amazing place and that the experience as very humbling. Wow.... very interesting.

Finally, on the advice and support of friends (including you guys!) I have decided to just say FUCK IT and run away for a couple of days. Super nice, all inclusive resort in the Caribbean here I come! (In less than 2 weeks!!!!) Every time someone starts bitching about the long waits, the flu or getting super Type-A, I just hum some Buffett and Marley and go somewhere else.

Please sir, I want some more....

For the second time this year I have had the privilege of a phone call from work saying "hey... your (first was the husband, this time grandmother) is in the trauma room." She is 76, still driving and managed to hit another car head on in the rain. The other folks are ok; she spent the weekend in Trauma ICU and is now terrorizing the nurses on the floor. The upside (again) is that I know all of the trauma docs very well and they have kept me well updated.


I'm a firm believer that god doesn't put anything on your plate that you can't handle, but damn this has been a full plate this year.

I picked up a day shift yesterday. Let me just say... the HELL with that! Even with the staff, who were mostly evening shift doing overtime, it sucked ass! Too many people in too small a space. Too much drama and not enough common sense. People keep telling me that I will give up on night shift someday.... I highly doubt it. I truly don't think that I need 20 people in the room to work a post-cardiac arrest. Give me 2 strong nurses, a medic, a really good resident and an attending and I think we can take on the damn world. I couldn't even get to the monitor yesterday for all the people!

Let me also say that the flu is out in full force around here. So much so that all of the triage nurses are now to classify anyone coming in with flu symptoms as "ILI" in the chief complaint box. ILI= influenza like illness. This way our total visits can be tracked. Unfortunately, unless you are sick as dogshit we aren't going to do much for you.

Ugh.... I think I need a vacation.

Just freakin' gross

There are some statements that truly need to be repeated. I once told a special forces medic that the texture on our temperature sensing foley was "ribbed for his pleasure." (I have yet to live that one down)

Occasionally, our male nurses have to chaperone a pelvic exam. They don't like to do it and bitch like crazy afterwards. Yesterday one of the guys had to go in on a less than appetizing exam. His response... "that looked like a bulldog eating mayonnaise."

The mental picture still makes me cringe.

Crazy as shit psych/seizure patient went ape-bonkers last night after enough ativan to kill a horse. I counted 4 cops, 2 docs, 2 special forces, 2 nurses (me and lurch) and a medic. How I always end up on the bottom of the pile on these, I will never know.  We were convinced that he shit himself until we realized that the smell was dudeman's breath. He went upstairs after a B52 of ativan, haldol and benadryl. I tried to ignore the distinct crunch of his wrist when I put the restraints on!