Teenagers

A note on teenagers... we all know that many of them have a sense of invincibility. They do crazy stuff and think that nothing will hurt them. Last night was proof that this way of thinking is very very wrong. I had a bunch of traumas last night.... most of them teenage boys, and most of them very badly injured.

19 year old was not wearing a seatbelt while riding in the car with his buddy. When they wrecked the car folded around him. He was unconscious, tubed and had no breath sounds of the right. The flight crew darted his chest 3 times and he would still drop his O2 sats. He crumped on me in the trauma room. When they cracked his chest in the OR both of his lungs were destroyed. He's either going to die or be a veggie like that Terri Schivo person.

They driver had a C1 fracture and promptly told me to go fuck myself rather than touch him. What a grasp of the English language we have there. I whispered sweet nothings into his ear and he shut up pretty fast. Had another 17 year old, no seatbelt, high speed, alcohol and cocaine rolled the jacked up truck and flew (a la evil kenievel) out of the windshield. I told him that this was a reminder to wear his seatbelt from now on. He said "Fuck a seatbelt, I won't wear it." Hmmmm.... lets just crack his chest here and now and save some time. The state trooper has him tail, so enjoy jail buddy.

No matter how many times you tell them these kids just don't fucking listen. What is it going to take? Two of those kids have a very good chance of going to jail... and they totally deserve it. I wish I could take pictures and show them... but I doubt that would work either.

DON"T DRINK AND DRIVE... WEAR YOUR DAMN SEATBELT. I'm TIRED of telling you this!

Tina Tuna and a Shitty Friday

Ok, so I was going to try to post this yesterday as well, but I screwed up the computer. What can I say I'm a nurse, not a computer geek. Thursday night sucked, last night did too.

Thursday I picked up the trauma room from a girl that REALLY didn't need to be in there. Guy had driven into a building and it collapsed on the truck. It took a while to get him out of the truck since his pissed off dog was in the car and was none to happy to see the firefighters. Well, my guy had a BP of 70... dropped to 40... and this nurse didn't do shit about it. I had blood on the level 1 and in in about 2 minutes.

I had another pt that worried me as well. 8 year old way playing in a home under construction and fell out the window. She was flown in from another hospital with a splenic fracture (grade 5 spleen). Picture a ripe plum.... then throw it down as hard as possible. Mush... right? Thats what her spleen looked like. Kept a close eye on her. Her fish's name is Tina Tuna.... hence the name of this post.

So last night sucked pretty bad as well. There is something weird about walking in to work. The ambulance bay is about 100 yards long and can give you an idea of how your night is gonna go. If you walk around the corner and its wall to wall ambulances then you can figure that its going to be a zoo. However, I think I'd rather see a parking lot in the driveway than have it empty. Its eerie, almost ominous that way. Your steps echo and there is a heavy feeling... like you are on the verge of something terrible. I rounded the corner last night and there were unmarked police cars everywhere. Considering I know a bunch of the PD guys through my cop this was a terrifying sight. Something bad was going on. Even closer I saw the captains of several; precincts, the assistant chief and watch commanders. Turns out a recruit was riding his motorcycle home from work and was hit by a surburban. He had coded once on scene and was crashing. I saw him on his way to the OR. I get goosebumps now just thinking about it. I found out later that he died on the OR table. Breaks my heart.

So the night came and went. Bullshit and some real sick people.... and then there was the guy who wanted his toenails cut. UGH... homeless guy. Lets not talk about the smell.

Don't pee on the wall outside the ER. You'll get arrested for that!

Home again

I am so glad I had a few days off. Funny how 3 days not at work can make you feel like a million bucks. My cop was at a conference for a few days, so I tagged along. We were in DC at a NICE hotel. Gotta love being spoiled and pampered. I must say, people up there cannot drive. I spent the whole way home with some Saab driving bitch up my as.

So, back to work tonight. Unfortunately its prom weekend. I hate prom, we always get kids in wrecks this weekend. Even better, we have the NASCAR races in town coming up. I don't worry about the drivers coming in as much as I do the crazy-ass fans. We are guaranteed at least one or two drunks from the track. Last year we had one that fell off the top of the stands (I heard someone dared him to stand on the fence) he fell from the top and bounced! I shit you not. The man had some bumps and bruises, and probably one hell of a hangover, but otherwise was fine.

I only have about 2-3 more weeks of Dr Rock and then he is done with trauma night float. Actually, I heard that he is being held back a year because he has had so many issues. Yeah, he sucks. The doc we have coming next is a rock star. I love working with her. Will have to come up with a good nickname when she starts.

I'm gonna get rolling. Have been bass-ackward schedule-wise and need to get back on the night shift schedule.

When the po-lice say 'Get out of the car' Let go of the steering wheel and get out of the fucking car. (thats for you mr hicks. .. we'll talk more on you later) ;)

Medical

I worked a princess last night. A princess shift is a little 4 hour shift and thats all. (actually was there for 5 but anyway). Picked up a daddys little princess in the trauma room. Not wearing a seat belt ( we have talked about this guys) and has a little ding to her eye. She's gonna be fine, but I think it was more painful for me to talk care of her than it was for her to be there.

One of the things that happens when we start to get busy is we end up putting medical patients in the trauma room. There are still monitors and resuscitation equipment in there, so it becomes just another place to stash a patient. Got a "Gonna give you an asthmatic" from my charge nurse. Not an issue, til the squad got there. 450lbs, frequent flyer. Already yelling that she wants to pee and some ginger ale. Obviously not in too much distress. Told her big ole butt to get up and walk to the bathroom. Sounds bad, I know. But she is here about twice a week. (less now that she has been put in an adult home). Did I mention that this lady is 44 years old? She looks older. Maybe she has had a rough life. Maybe she just needs to lay off the ciggs. 2 packs a day and still puffing.

Had another very nice lady who was in a-fib with a RVR. First thing out of her mouth... "I have to pee." Am I detecting a theme here? So her heart rate was all over the place, but she was actually doing pretty well.

So while thing 1 and thing 2 were having their issues in the trauma room a real trauma was on its way. Man cleaning his gun (.22 I think) dropped it and it went off. Now I'm not the gun person in my house, but I was thinking that if you're gonna clean a gun shouldn't you take the bullets out?? Guy had a hole dead center about 4 inches below his rib cage, trajectory seemed to be going up. Hmmm... not good for the home team. Could be a straight belly shot, or could be near the heart/lungs. Guy had distant heart sounds and blood in his pericardium. Again...BAD. He was on his way to the OR when I was walking out the door. All the while this was happening thing 1 (the asthmatic) was wondering around looking for ice. Lord, sometimes this place is just a little crazy.

We will take our lesson of the day from my last patient of the night.

Take the bullets OUT before you clean the gun.

the docs

I had the biggest punk in the trauma room last night. 18 years old, drunk as hell (3 times legal) on amphetamines...off the road into a tree. I hate when drunks act stupid, but this kid was clinging to the story that he only had 2 beers (just how big were those beers buddy?)and the road was curvy. Mom was a nurse and sooo sooo worried about her little boy who is always a cautious driver.

Had to work with one of my least favorite doctors last night. Actually, come to think of it.. he IS my least favorite doc. We'll call him Dr Tox. Doc Tox is an ED doc that actually mostly does toxicology. He is also WAAAYYY out of the closet (not that we have an issue with that... it is 2006) but he is bordering on a little too far. Lets say your mom/dad/etc etc is having a big heart attack or other such medical emergency and your attending has a tongue stud??? Doc Tox is also prone to making really bad treatment decisions. I think my worst night was when Doc Tox and Dr Rock were in the trauma room together. Lets just say that their egos ended up getting a hole cut in a patients throat that really didn't need to be there. So put up with the fairy tonight. When he acts up we tell him that he doesn't get to be the diva tonight. I think it pisses him off.

One of my favorite residents left today. His program finished early because he did some time in surgery first. I hate when these guys leave. Its like having a kid leave. We watch them grow through their medical experience and become strong docs... and then they go away! Its so sad. This class is really going to get me because I don't think there is one that we are ready to let go. The last few have had some folks that I could care less about... but these guys are great. I will miss them all. I know that if I ever want to go work with any of them wherever they may go all I have to do is call and I will have a job. I should really get one of them to work in the Keys. Hmmmm.....

Am off for a few days. Thank god! Have a ton to do around here and could use a break from this place.

Don't skip dialysis. that is BAD. Take your blood pressure meds. A dissecting AAA is even worse.

Trauma, Drama

Hmmm.. glad last night is over. Were busy.... not terrible, but steady busy. The trauma nurse last night was a little hyper for me. He is a very smart guy, but DAMN does he thrive on trauma. Let me tell you... I am so not into drama.

Was up in Surgery Trauma ICU for a little while last night. Saw my jet-ski guy. He is still intubated, mom was at the bedside. I don't know if she recognized me. Didn't say anything, didn't want to upset her. So people were trying to be sick as shit last night. The medical ER had a code come in... geezer squeezer going and everything. (geezer squeezer=Autopulse. Google it) I love that thing. All the while a psych patient was in the room next door screaming. I'll bet hearing some old lady die really helped her psychosis. So then we got another old lady in respiratory distress. Tube, foley, drugs. No problem.


No big rants to go on today. Am sleepy, hungry and ready to go to bed. Oh, I did see the last guy that I dated before I met my fiancee. When you work in medicine your "dating pool" can become limited. Medics, firefighters, cops, docs. Thats about the extent of my adult dating life. Firefighters in particular. They are everywhere and are the "fun guys" to hang out with. Never expect anything serious, but you will have a good time. Personally I am completely in love with my cop thank you very much!

Women are trouble. Remember that next time you are up shit creek. A woman probably put you there. (I'm a woman... I can say this)

Easter

I could have also entitled this post 'Holidays Suck!' For anybody who works is health care this is a very true statement. Not only do we get to work, we get to celebrate the disfunctionality of everyone else's families. The most brutal, violent nights always seem to follow a good old family get together. Take for example the 'Not So Brady Bunch' that was in the department on my arrival. Seems "Greg" and "Peter" got in a fight over "Marsha" and "Peter" ended up stabbing a couple of Bradys, and got himself shot by "Bobby." "Bobby" got his ass hauled away to jail while the baby's momma watched. Ugh... what would Dr Phil say about them I wonder.

Another thing. Apparently on Easter we thank GOD for sacrificing his only son, and treat the medical staff like shit for doing their job. Another brilliant example. Smarty pants and his girlfriend are on their way back to school and are hit head on by a drunk driver. Total speeds 110mph and 75mph (yeah, the drunk was speeding) Well, said Rhoades scholar proceeds to berate the whole trauma team because there is "just no reason for me to be here!" Obviously this kid is waaayyy more savvy than the American College of Surgeons who (by way of the tiered Trauma Alert system) seem to disagree.

Once Einstein got to me he was being a first rate prick. I tried to be nice to him, maybe it was the handful of jelly beans I'd just eaten, but he continued to tell me just how I was going to do my job. I asked what his major was... he said "Political Science" (great, another pre-law, just what we need)so I mentioned that his choice didn't have dick to do with medicine or, more specifically trauma surgery. I think the best part was when Dad demanded that I take sonny's IV out. (I was on the phone with another hospital) When he started to get loud the Doc intervened. Dad said he would pull the IV himself. Per the Doc "Good luck with that Sir." I was laughing my ass off.

I get so tired of these ungrateful people. You can help them on their worst possible day and it's still not enough. What would happen if I chose not to? Would they rot in the street? Probably. Would the world be a better place. You bet. So why preserve this parasite-driven lifestyle?? Because we can!! Whoo-Hoo!!!

As I was leaving I got some great news. JCAHO, any health care facility's nemesis arrived this morning as I was leaving. Glad I have the next few days off!!

Don't blame me for the cocaine in your pee. I didn't put it there.

Good Friday (my ass!)

Finally made it back into the trauma room last night. I figured that Friday night, its been warm around here.. we're gonna have gun shot central. Nope... leave it to the southeners to play bumper cars in the rain. (you might be a redneck if...) So...I think we had 10-12 traumas last night. Honestly, I lost count. Fortunately the trauma chief and the ed attending had a couple of brain cells to spare and the kept 'Dr Rock' from killing anyone.

So the one weird case of the night was pretty sad. Had a 21 year old Air Force guy going jet-skiing on his Easter weekend off. I don't know what happened, but he ended up mangling his leg on something. When the helicopter landed he was this awful yellow/gray that tells us that he is cold as shit and probably has lost a ton of blood. His leg was awful. I told 'Dr Rock' that he was why we study anatomy. In order to look at this poor guy and figure out what stuff was, and where it was supposed to go. The bone was broken in about 5 different places and almost completely ripped off. He ended up being intubated, getting some emeregncy blood and having to go to the OR. I was in the ICU later last night and they actually had to amputate his leg. Like I said, this kid is only 21. It breaks your heart.

On the flip side, Thursday night we got a self-inflicted stab wound to the left chest. We got all ready for bad juju and were set to get this fool to the OR if necessary. Turns out I knew this guy! (not socially) This is the 4th time this asshole has tried this. I recognized him by the pot leaf tatoo that he always aims for. He has never done any serious damage, and is always a big old waste of time. What an asshole! The last time he tried this I told him that he just needed to jump off the 895 bridge. It would be more effective. Not the most professional thing to say, but chalk it up as patient education.

Oh, one more thing. Had a lady get struck head on by a car going the wrong way on the highway (speed about 100mph). He car caught on fire. While the coward that caused this ran away a police officer came across the scene, cut her seatbelt and pulled her out of the burning car. Now thats what I call heroic.

So stupid patient award of the night goes to: drunk college student who punched the medic that picked him up. You're the proud winner of a trip to lockup and maybe being someone's bitch. Either way you'll have one hell of a hangover!

Don't punch the medics. They hit back.

Quiet

Where I come from quiet is a four letter word. We don't say it, nor do we acknowledge it. Last night, example, was SOOOOO slow. But we can take advantage of it. They (nursing admin) has decided to give the er nurses cell phones to use in the hospital. I think the mistake came when we figured out how to prank call each other throughout the department. Theres nothing like playing hide and seek with the department cell phones. One of the docs kept calling my phone "just to check" and make sure I was still there. Some night I'm gonna call him and flush the toilet.

No good patients. Sorry... back tonight, so we'll see.

don't get drunk and walk down stairs. gravity wins every time

Ugh, work

Wasn't in the trauma room tonight. Probably a good thing since I pissed off the trauma Doc within the first 45 minutes of my shift. What can I say?? He just got here and he's acting like a dick? So I rolled my eyes at him and he got a little offended. Sorry dude, but its not my job to keep you happy. This is the doc that you really don't want taking care of you if you're in an accident. Lets call him Dr Rock just for shits and giggles. Dr Rock has issues with his skills and frequently compensates by talking loudly, making poor judgment calls and pretty much causing mayhem wherever he goes.

So, had a couple of nice patients, poor lady that burned herself with grease and an 18 year old with PID (pelvic inflammatory disease... STD's hmmm.... I think thats another entry). Had a girl at about 4am who got "beat down" by a guy she used to mess with. I'll bet the heroin (pronounced HER-ON) and cocaine really improved her disposition. She started out with the Lordy-Jesuses and proceeded to scream at any staff that walked by the room. I would have to say that she probably deserved it. In fact I would ventue to say that the bitch had it coming.

So, I made a Deal With the Devil. The department was short and needed staff for the next two nights, which happen to be my days off. They offered time and a half plus stay over bonus. Essentially I became the ER's bitch for the next two nights.

So to end the evening, I was driving in the jeep on the way home and managed to lose my parking pass. This state funded hospital has about 80% of patients that don't pay for services and I get charged $50 a month to park in the ghetto ass parking deck. Half the time its shut down so the patients can use it. (they do have their own deck). So driving along, driving along and WHOOSH parking pass blows out of the jeep in an area that this little girl ain't getting out in. My police officer is out looking for it as we speak.

ok, so going to bed so I can wake up and do it all again. UGH.

Get a fire extinguisher for your kitchen. It beats burning the SHIT out of your feet when the pan catches fire.

Gory story

OK, so I haven't been to work since I have started this blog, so have no new stories to tell. I have plenty of old or some reason these "war stories" tie all medical professionals together. We all have them... and from time to time (in appropriate company) share them. You must remember though, when you are at a diner with an early liquor license and a big group in scrubs comes in, you may not what to eavesdrop.

These conversations can be the raunchiest, most graphic that you will hear outside of that email forward of the guy who was skiing and split his groin in two. The reason is that we (as ER staff) have first hand experiences with those "scenes of graphic nature" that may keep your 6 year old up at night and make you want to tilt your head to the side and say "how the hell did they do that?"

For example... Saturdays are known for being pretty rough. Especially if it is warm or the first of the month. One Saturday morning about a month ago I was cleaning up the mess in the trauma room from the night before. Pretty much had been car wreck city with a few beat downs to go with. I got a phone call from my triage nurse telling me that I had an ambulance out on a stab wound to the head. No biggie.. it happens. Just enough to get over the hump to shift change. Then my medic comes in with a bit more information. Its a stab wound to the head alright... with the knife still embedded in the temple.

Well shit.... that ain't good.

So as the rumor circulated, I got mt folks together, had a game plan and was ready to roll when I heard the sirens pull in. Unfortunately every nurse in the department seemed to have a second to pop in and take a peek, so the squad had to fight a crowd of people just to get to the bed. Sure enough, young black male with a hunting knife square in his left temple. He was awake, crying (so much for being all big and bad. Have found that when these guys get shot, stabbed or otherwise maimed they cry like babies. Just don't tell their boys I said that!) and not too happy that the fire guys hadn't pulled the knife out. (*** NOTE If something is impaled in you or your loved one... don't pull it out! You can cause more damage that way***)

Many photos were taken and this poor soul, who was in a fight with baby's momma's new boyfriend, was taken to the CT scanner to see if 1)he did in fact have a brain and 2)if the offending knife had caused any damage to it. The answers came quickly.... YES and NO in that order. The knife was down in the sinus area (this boy is gonna need some serious advil sinus next cold season) and didn't seem to do much damage.

The last I heard of him, he was waiting on the OMFS (Oral-Maxillo-Facial Surgeon) doc to come down and see him. What a way to end the day. Will try to get a picture and post.... but pictures of faces aren't really allowed.

So there you go... first gory story of many...I think I told this one over beer and eggs that morning. Sorry if I ruined your appetite. Have to work tonight... its warm and the natives are restless.... better get some sleep while I can.


Wear your seatbelt, don't drink and drive and don't smoke something that came out of someone else's ass!

In the news... (don't get pissed now)

When I was little I never understood why my dad liked the news so much. Tom Brokaw seemed nice and all, the voice soothingly confidant, and he seemed to know everything. I have found these days that I am hooked on the news. It will give me an idea of how my night will go. If the breaking news is about a "horrible accident that has taken rush hour traffic to a standstill" then I know I have a FUBAR trauma patient is awaiting my arrival. I watch the news and see families that I talked to the night before, scenes that were only described to me and covered bodies of the folks that just never made it to my care.

What bugsme are the families of some of the patients that get on TV. Their family member was not minding his business... it was 3am, he was on a street corner SELLING DRUGS!!! I know this because I pulled the drugs from his butt, more money thant I make in a month from his pocket and a loaded weapon from down the front of his pants. There is nothing you can tell me that will make me think that he got anything than other than what he deserved. He was not mistaken for someone else and was obviously up to no good and someone just as bad caught him.

Tonight on the news I saw a similar situation. I woman was all pissed because she "won't even at home" when the Po-Lice (note the pronunciation here) came and rammed down her door and went in her house. Two words lady "SEARCH WARRANT!" I really don't think that the judge that issued the warrant was just doing so to persecute you. Maybe it had to do with your baby daddy and his friend packaging drugs and hoarding guns in there while your children sleep. My thoughts... keep your welfare sucking lazy butt quiet and maybe go get a job.

These are the folks that show up at the ER with doctor's office complaints, expect to be seen first and want to be seen for free. Their fronts, grill whatever those gold teeth are called cost more than my mortgage.


ok, ok, I know I have ranted on for a while, and I never made any statements that I would be politically correct but there you go. Like it or not... welcome to the 5th most dangerous city in the US.

Wear your seatbelt, don't drink and drive. Don't say I never told you.

Starting out

So this is the blog thing that everyone keeps talking about. Haven't done this before so I make no promises as to deep thoughts and profound coments. Work is bad enought without having to make sense all the time. I work nights, which if anyone else has ever worked the "third shift" you know the people that drift over to the dark side have a bit of a skewed view of things.

Right now I am in the midst of planning a wedding, trying to further a career in medicine and remain the girl my fiancee fell in love with. No pressure though. Its hard to be the girly girl at 8am when I have spent the night in the bowels of a teaching hospital talking a resident through a trauma workup and avoided being vomited on at the same time. God I get so sick of them sometimes. I know they have to learn, but I think the nursing staff should get 1)hazard pay for the work they do and 2)a professorship for keeping the residents and students from killing the patients!

Fortunately, the fiancee works nights too...not in medicine though. He has to come to the hospital from time to time and I just hope he doesn't pass out. He loves the stories though. God knows I have enough of them. Not bitter enough to share them now... but one day I'm sure.

Til then, wear your seatbelts and for f*ck's sake don't drink and drive. I have enough job security as is.