The Shit You Can't Make Up

This was kind of the whole point of this blog. That, and to help me get to sleep after a long ass night in the department. How often does someone say "we should be writing this down" and I smile and nod.

I walked in to a 24 year old who was complaining of blood from the penis. Sounds like the standard STD workup to me. I told him the whole adage about not putting your pole in a green pond, smiled and walked out of the room. The chart went to one of my favorite residents who got a bit more of the story than I did. The patient's roommate told him that it was because he masturbated too much. (go ahead and ask, I did........ ) How much is to much? He admitted to 15 times per day. Who has time for that?!?! 15 per day plus almost a 2 pack per day cigarette habit, no wonder he doesn't have a job!!! The patient was also convinced that he didn't have an STD because he was banging a lesbian behind her girlfriend's back. OMAA..... again, can't make this shit up!

Stupid Attending

I think that I have bashed the residents enough over the course of this blog. Since it is July I will be nice and lay off. They don't know any better...yet. The attendings however need a bit of abuse. If you are going to be an ED attending in a Level 1 urban department then you'd better know your shit.

The attending from last night graduated from our program about 6 years ago. He was a shitty, stupid resident and has been no better as a moonlighting attending. I don't feel like a Level 1 ED should be your part time job.

So my major malfunction with this guy is twofold. 1) He is slow as molasses in February. Patients that could be seen and dispo'd in an hour or less were taking over 2 hours to even be seen. That seriously slows shit down. 2) Let me tell a story.....

60 year old dude with wicked ascites. He looked about 10 months pregnant and was complaining of... guess what?!?!? SOB and abdominal pain. (Big freakin surprise) The nurse, who is a pain in my testicle, alowed him to lay flat... and what pray tell happens when you lay a 9 mo pregnant person flat? It compresses the aorta and shits out their BP. So I think this is what happened. We walk in the room and dude man is guppy breathing, has a pressure in the shitter and is completely unresponsive. Did I mention he looked pregnant? We estimated his weight at 120kg. When we went to RSI him the attending didn't know the dose of rocuronium (instead of Sux due to renal status). I blurted out 1mg/kg which was our protocol when I was flying. The doc disagreed. He wanted to dose at .3mg/kg. (I think he got the roc dose confused with the etomidate dose). After my insistence he at least went up to 50mg of roc which was less than half of the appropriate dose. UGH!!!! It is so frustrating trying to explain this to people who aren't going to listen.

So once we got this guy tubed I threw down an NG tube and got some fluids going. The doc attempted to place a femoral line. He missed (we thought) and then tried to convert to an a-line. When I got the a-line set up we saw a very distinct waveform..... a CVP waveform. He went through the vein and artery and shredded both! FUCK ME I don't want my name on this chart.

The patient's nurse (not me) witnessed the beginning of this pseudo-code... and then disappeared. When we looked he was in the nurses station documenting... he had nothing to do with his patient. At least the son of a bitch said thank you before I left this morning!

Hot and Cold

When I am in charge it runs either hot or cold. We are either wide the fuck open or completely dead. Unfortunately, last night was the former. There were seriously patients on every available surface that we could find and trauma after trauma inbound. As soon as I could get a room open I would move a trauma out of the room (to make a bed for the next contestant) or triage would bring some absolute bullshit back from the waiting room. Truth be told, if I have an available bed I don't need a complete report from triage. The nurse in that zone is more than capable and I really don't give a flying fuck what size shoe the patient wears and how many times they had the shits today. ABC's intact?... yup. Dying right this second? No... ok then. Room 2.... leave me the fuck alone.

So 75 year old man on a roof. Am I the only person who has a problem with that? Falls through the rafters 12 feet onto concrete. Transfers in from another hospital with about a million rib fractures, a hemothorax and oh yeah, did I mention he was 75? Chest tube put out over 900cc of blood. WTF?!?!?! Why were we fucking around here? He was in the trauma room for almost 2 1/2 hours. That's fucking ridiculous. He finally went up after he put out another 200cc of blood and received 2 units of PRBCs. His family was upset that the trauma docs weren't available to come to the phone and talk to some random family member from West-by-God.

Another thing I have learned.... when the guy with the gun says "Give me your money!" ... fucking give it to him. 20 year old college student wanted to argue and got her ass shot in the leg. Is it sad that she was in the trauma room a matter of 10 minutes, and then was moved out. She just wasn't sick enough to stay in there!

In the midst of the 50 million traumas we get a dude that walked out of the bar and got his ass fucking beat down. He was altered on arrival and complaining of chest pain. (24 years old with an MI hx) He was also really REALLY drunk. He got through CT and then the switch got flipped. He turned into the biggest drunken prick. His IV's got ripped out and his skinny white ass wrapped in a blanket went running out of the trauma room. We were perfectly content to let him go, but the trauma attending wanted him kept, so the police got involved and his scrawny ass got TDO'd. (what can I say.... it was a beautiful thing!)

When we have traumas inbound, the communications room will call back to the charge nurse (me) and give report on whats coming. I seriously gave up on paper and started writing on my hand, arm, pants... you name it. I seriously have about 5 patient reports written on me right now, including a dude who was a pedestrian struck by a truck and (somehow) had an unconfirmed lac to the penis.... in addition to other injuries. After a trauma evaluation it was found that Mr Winky did indeed have a lac, but how the hell did that happen? Walking done the street at 3am with your wang out? WTF?!?!?

All this fabulousness was marred by one of the cranky bitches who was none to happy that I was in charge. She had a crap-ass attitude the whole time. She even had an orientee with her and had to do very little work and she was still a complete bitch. I'm starting to think that bitch may be an acute disease process!

Waste?

What pisses me off about the holidays is the absolute waste that we see. How many drunks cross our threshold? People that should have known better but chose not to make the decision to not drive, stay where they were or call a fucking cab. The saddest part are those that are victims because of the stupidity of others. Over the last week we have seen a rise in fatal accidents (no shit, right?). Unfortunately, many of the victims have been children. In just 24 hours there were 2 fatal accidents that killed three children ages 12 and younger. Parents either lost control or fell asleep and their unrestrained children paid the price.

There was also a young child (5, I think) that was struck my a lawnmower and lost a good portion of a hand and fingers. Where the hell was the supervision? I know I wasn't allowed in the backyard if dad was cutting the grass. In the car... we didn't move unless everyone had seat belts on.

I also had the pleasure of being in charge on the night of a million transfers. Seriously, we had about 15 patients transferred from all over the state. Some were traumas, there was a liver/anal cancer patient that was bleeding like fuck from esophageal varices (I so generously sent that one down the hall to the Green ED), many a drunk that slept it off out in the drunk tank and a code that had been down for over an hour, shocked 6 times and was PURPLE from the nipple line up (hello PE anyone?).

Oh yeah... and the interns are here. I taught one how to do an NG tube on a drunk with a BAC of 5800 (no shit there..... too bad we weren't betting). We taught another how to use a geezer squeezer and discussed at length what the appropriate dose of Motrin is in a BS drug seeker. Truth be told, I think this group will be pretty good once we break them in a bit.

31.... Gonna Be About The Things I Love

So.... 31. Not my 20's anymore. Not the milestone that is 30. Better make it something good then. This year I resolve to do the things that I love, to make myself happy and hopefully, have a little self-discovery in the process.... So here goes...

First thing today (0001) Glass of Noche wine and DMB concert on TV. Very very chill.

Sleeping in my bed with the 600 thread count sheets

Bubble bath and Aveda tea

Wine and cucumbers with an amazing person

Lunch with Mom

Frisbee with Maddux

Tuna, green beans and couscous for dinner

Not too impressive, but very relaxing. I'm going to do things because I want to, not because I feel obligated. This is going to be a very good year!

In The End

I tried so hard

And got so far

But in the end

It doesn't even matter

I had to fall

To lose it all

But in the end

It doesn't even matter

Some days you just remember. Not because the day itself was special or memorable, but you just know who you were with and what you did. Exactly 1 year ago today I was working at the flight job. My base manager was my partner and Baby had some required maintenance due so we were down for the morning. We had breakfast at Cracker Barrel and did some errand running. I got my 30 something driver's license and he picked up his military dress uniform. We did a cath lab flight that day and I sat on the skids on a perfectly clear night and recognized how fortunate I really was to be doing what I loved.

1 year later I must say that memory has become bittersweet. I wondered then where I would go from here and that (unfortunately) has not changed. Where do you go once you have lived your dream, if only for a brief time? Everything else (including the ER) seems a bit dull in comparison.

So in memory of that great night 1 year ago I will take a moment, remember how happy I once was and (hopefully) ponder again where I go from here.

PS: The interns are here.... everyone be careful!

Throw Down

We have different types of security in the ED. The university has its own police department with an officer posted in the ED at all times. We also have the security guards (think fat, slow and not so bright). I have had a patient kicking my ass and they don't help. One did however berate me for texting while in triage. The intermediate are the "security specialists." They are retired police officers that bridge the gap between the real cops and the tubby doughnut eaters.

The specialists were recently charged with putting together a class to help keep the ED staff safe. We refer this to the "Throw Down Class." Its a defensive tactics class for the staff. So before work the other night I spent 4 hours learning how to prevent patient from choking me, pulling my hair and otherwise kicking my ass. There's nothing like learning how to throw a 200+ pound ex police officer across the room! Not sure if any other hospitals do similar training, but for a "required education" it was fun as hell!