Lurch

Have you ever worked with someone who just pissed you off every time you look at them? I'm sure... we all have. For me its a nurse who I'll call Lurch. He does not look unlike this picture, however he has worse acne and shorter hair. Lurch wants to be a flight nurse as well, and has taken his resume fluffing a bit overboard. I've been a nurse for about 2 years longer than he has, but he always likes to tell me how to manage trauma patients. He has actually re-arranged all of the patients he had just so he would get a cardiac arrest that was coming and I would not. (I didn't want to clean up the dead guy anyway!) Last night he just pushed me a little too far. The trauma room was empty, but I had 2 pediatric traumas coming. He walked in, declared that he was the pedes trauma nurse and that he could handle both patients. Naturally, my eyebrows went up, mouth stayed shut and I waited for the punchline. It was: "you're going to get the grandmother, they are just loading her up now. She'll be here in a hour and a half" LOL funny huh? I was less than thrilled. I ended up having to take care of one of the kids, because contrary to previous statements, Lurch couldn't do so himself.

There were 2 high points in my night. At 2300 when Lurch left (you can take your Star Trek watching, know-it-all ass out of my trauma room) and the 430AM trauma light. After the kids and grandma came in I got 4 more traumas. It took until about 4am to get them all straight. Finally got the room empty... was gonna check it and get the hell out. Seems fate had other ideas for me.

430AM, the room is checked, all is qu.... You know the rest. We don't say that q word around here. Then BAM the light goes on. I was so pissed that I said to myself, 'this had better be a fucking GSW to the chest." Not one, but TWO GSW's to the chest!! The attending even gave me a high five. Lets just say, we love to crack chests. Especially if there are 2, then the ED doc will do one and trauma will do one. Neither got cracked though, at least not in the trauma room. The first was only 16 and had 2 shots center mass just below the sternum, He was tubed and in the OR pretty damn fast. I think he got cracked there... just under more controlled circumstances.

The second was shot up like swiss cheese. Chest (graze), back of neck, hands, arms. He will be ok I'm sure. He's just smoking the plastic (intubated) for the time being.

Funny thing though. My cop knows these kids. There were shot in the county, but are both from the area that he works.


So I have one more shift tonight and then I'm off for a week. My birthday is coming up and we're going to try to get out on the boat. That is if the water isn't too high. I was so tired when I left that I didn't even bother to check where I am tonight.

Oh I have one more rant before I close up for the day. I took care of a young married couple (just got married may 19) last night. He was driving, neither was restrained and the car rolled multiple times. Both were ejected. She went to the ICU and he is fine. What pissed me off??? He was drunk as hell and she was sober. Why the HELL wasn't she driving??? I asked him the same thing. He said "whatever." I don't think theses guys are going to see a 2 year anniversary much less a golden one!

$0.25 beers are all well and good until your drunk stupid ass starts driving.

Foiled Again

We tried to go back out to the movies again tonight. Why do I even bother wasting my time? 1030 on a Sunday night and the place looks like a club on the weekend. The cop took one look at the place and was "oh hell no." I wanted to take the top off the jeep, load up the shotgun and the glock, ride downtown and pop off some drug dealers. My dad calls it population control (talking about deer hunting of course). The cop didn't think it was the best idea. I think he's just worried I'll shoot better than he does.

I have thought lately about things I want to invent.. I'd make a million easily. It goes something like this.

-We have a drug called Narcan. It works for heroin and any opiate-based narcotic overdose and completely reverses the effects. The subject ends up feeling like shit because we took their high away. (we also use it when someone reacts badly to pain meds) I want something that does that for alcohol. Squirt some of that in my drunks and sober them up pretty quickly. They get to keep the hangover though.

-Trauma patients frequently have to get a belly CT scan. The stuff they have to drink (we call it the milkshake) is supposed to taste like bananas, but it really tastes like crap... and I tell patients that. We usually have to threaten to put a NG (nasogastric) tube down if they won't drink it. My solution... make it beer flavored. They would suck it up like the real thing!

-BODY BAGS THAT WON'T TEAR!!! What a pain in my ass!

I must also include the dictionary of my favorite abbreviations... note they are not in alphabetical order... cuz I'm too damn lazy to think that much about it!!! Let me know if you need clarification on what they mean.

DRT: Dead Right There
CTD: Circling the Drain
OMAA: Oh My Aching Ass
CAS: Crazy as Shit
CCFCP: cuckoo For Coco Puffs
DFO or DFO'd: Done Fell Out
DWPA/DWRA: Death with Paramedic/Resident Assistance
LOL: Little Old Lady
LOL DFO: see above and figure it out
FTD: Fixin to Die
The O Sign: Open mouth, FTD
The Q Sign: Open mouth with tongue sticking out (usually now DRT)
ABC: Ass Blood Catheter (trauma ABC's) or Ambulate Before Carry
FDGB: Fall Down Go Boom
PIA: Pain in Ass
FOS: Fill of Shit
OOB, OTD, OTB. AMFYOYO: Out of Bed, Out the Door, On the Bus, Adios Mother Fucker You're on Your Own (courtesy of Dr B)

Alcohol

There is a song by Brad Paisley about this very subject. It talks about all the stupid things that alcohol makes us do. At no point in that song does in mention getting shit faced drunk and being a trauma team alert.

I figured that after my crappy night on Friday, the Karma Gods would grant me a pardon for tonight's festivities. It wasn't terrible. 4 traumas... That's lightweight for me, especially for a summer Saturday night. No GSW's, almost all drunk assholes.

Thus the topic of today's post.

#1 Decided to get on the moped, drink a beer while driving it on a curvy back road, lost control and hit a metal mailbox. Open femur fracture (bone sticking through skin). He was a 4 time loser. Didn't even have a license anymore. His comment to me. "At least I was wearing a helmet" Touche' my friend.

#2 Out at 'Da Club' drinking with his boys. Picked a fight with the wrong guy. Got sucker punched in the face. Went backwards, hit his head on concrete. Bought himself the asshole tube. On CT he has a subdural bleed and a skull fracture.

#3 What a bitch. Young girl got shitfaced with girlfriends at a local Mexican restaurant. Too many margaritas. When the time came to leave she walked on out and didn't look both ways (we learn that in kindergarten sweetie) and got plowed by a car. Her shoulder went through the windshield. Lots of fractures. I try to be nice to most of these patients. She was evil. Smartass, rude. Graduate of THE University. Just like every other girl I went to high school with. Ugh.

People wonder why I don't go out to the city.

Old Ladies Screaming

There are nights when I just say "what the hell am I doing?" Last night was one of them. I love nursing, its in my blood and I know that. I walked in to green last night and there were people everywhere. Usually we can count on being busy until about 1am and then things start to settle down. I don't think we were able to sit down until almost 530 this morning. At one point I started feeling like a robot... so task oriented that I wasn't able to help my patients. I was just following orders.

I can't blame poor staff or the docs on this one. We had a great, hardworking group that just got hammered left and right. A couple of my cops friends brought a drunk in. He got stupid, got sprayed and when the ambulance showed up he told them to fuck off. OK, well just take him to lockup. There is a condition that is spread when assholes approach the doors to lockup... they get short of breath, chest pain, anything to get them out of jail for a little longer. This fucker got there and decided that he wanted his eyes rinsed and he was short of breath and his back hurt. When he finally got to me, his only complaint was that the cops took all his money. He started screaming and swearing. One of my favorite docs was the attending. I think I have seen her yell about 3 times in the 4 years that I have known her. She let him have it and then told him to get the hell out of her ER. I wish I had that on tape!

Oh, I have some very bad news. It seems that all the complaining that we did about Dr Rock was pointless. He is going to be a chief this year. Which pretty much means that he will be the (almost) final word when it comes to management of trauma patients. The trauma attending and ed attending will be able to veto him. If we have strong attendings, then things will be ok. I don't have my hopes up. The up side is that he won't be on trauma all the time. He shares the chief role with about 3 others.

I have to get some sleep. I decided to go in tonight and make some extra money for the wedding/honeymoon. Nursing doesn't pay that great, but there is overtime to be had everywhere you look.

Looking Back

I've been off for a couple days. No good work stuff to say. As I mentioned a few days ago, I graduated from high school about 10 years ago. I've been thinking a lot about that lately. While I was pretty shy, I did have my little core group of girlfriends that I hung out with. Randomly, I got an email from one of them, with everyone else's email on it as well. That started a big, "HI, how are you, its been a long time" slew of emails to all of them.

So everyone wants to know how I'm doing, what I'm doing etc. I just find it weird to recap almost 10 years of life in a 2 paragraph email. I can say I'm an ER nurse. That always gets a "wow I'll bet you can tell some stories." DUH. But can I tell the stories that I tell on here or with nursing buddies?? Probably not. I guess you just make nice, save the gory stories and put on the smiley face. Still not sure I'll go to the reunion. Its at a local vineyard.. which would be one of the only reasons I want to go.

Anyway, enough of the walk down memory lane. Gonna get up and going. I know, its evening and I slept all day... but thats why I work nights!!!

Bad drivers

This one is for all the cabbies out there. I know there are a few that read this. I don't know how you do it. I was thinking this one my way to work tonight. Driving along, driving along and some Lexus cut in front of me, across 3 lanes of traffic (including a city bus) just to make it to an exit that was just as clearly marked a half mile ago. I've taken some physics in my day and I'm thinking that your 'HOT SHIT' little car is not going to survive the city bus. People in general can't drive for shit. This becomes all the more obvious once you enter the sanctum of the trauma room.

Had a little old lady, 76 years young. With (per her admission) recovering alzheimers. Ummm... didn't know that you recovered from that, but go on.... OK, she was in her little truck, pulling out of her driveway when "some bitch hit me! I looked both ways and there were no cars, so I pulled out" The officer who witnessed the accident had a different opinion. He said she pulled right into oncoming traffic and a 16 year old in her moms car hit her and flipped the truck. Granny crawled out and proceeded to berate the 16 year old for hitting her. Let me tell you, this woman must have been outside her head. What a nut. She screamed at everyone!! Especially the cop when he charged her for the accident.

There is another sweetheart here now who can't drive either. He was found next to a wrecked motorcycle, no helmet and his face is all smashed. The only verbal response he has is "fuck you" good use of the language there buddy. I guess the cocaine and 3 times legal alcohol level isn't helping either. Lets ship him the hell outta here and come back later!!!

GSW and soccer girls

What a night... I was in green, started out busy as hell and stayed that way. Theres some bad heroin out there now. We had a couple of bad OD's last night. Had to work with Lurch, the male nurse that I just don't like. He makes me so nuts. Anyway, occasionally we get people with orthopedic injuries that we have to set in the room. We do a procedure called conscious sedation with them. We give them just enough pain and sedation meds to make them sleepy, but not so much that they need to be intubated. Theres a fine line.

I had a girl about my age who broke her wrist playing soccer. When we went to do her sedation she started talking like crazy! (some people act drunk as hell when they get these meds) She was killing me. I got to hear details about her fiancee, her family in the midwest and all kinds of other stuff. One of my favorites was "this stuff is fucking fabulous" and "honey my butt itches.... can you fix that?" She was a riot.

So... finally..... I got pulled into there trauma room for a gsw to the back. He coded enroute. They were coding the shit out of him when he came in. They cracked him right there. The weird part was there was no injury in the chest. His chest was completely atraumatic. It looks like he hit a vessel in the belly and just bled out. Hid heart was empty when we got to it. I even had to get out the internal paddles in case we were gonnna shock him. My cop was pissed because he wasn't there to watch. He can't stand blood in most cases but seems to think he can watch a thorocotomy!!!

I had a man with a sinus infection that sat in the waiting room for about 10 hours. When we were doing his discharge he started threatening both myself and the resident. The cops had to haul his ass out!!!!

I'm going to try and get some sleep. (lol try. I'll be out in 2 seconds!)

Any sentence that starts with "I was just minding my business..." is probably going to be bullshit!

OUCH!

Today was a hard day anyway. My littlest sister (I'm the oldest of three) graduated from high school. While we were watching her walking across the stage and I was (tear) feeling so proud, I realized... I was there 10 years ago, and my reunion is coming up. Not sure if I'm gonna go yet. I was both quiet and shy im high school and am not interested in seeing most of those people again.

After the post graduation shindig at my house, I grabbed a 3 hour nap and woke just in time to make it to work... but NOT in time to make it to Starbucks. There were a bunch of shootings the previous night, so I expected thing night to be nuts. But DAMN...

In my career here I have a couple of records. Most dead in one night (5, all but one under 20) and most traumas in a 12 hour period. Before tonight the record was 15. After tonight... 16.

I wouldn't even say they were all in a 12 hour period. They started at 8pm and continued until a little after 3. So 16 traumas in about 7 hours. Yeah, that was painful. However, after tonight my definition of painful has changed.

We had a professional bull rider come in tonight. 25 year old kid was thrown from the bull (it happens) and landed on hands and knees. As he was trying to get away from the bull it came from behind and gored him in the ass. When I say ass.... I mean IN THE ASS. The horn went right up the guys butt. OUCH!!! One ting I have learned about cowboys, they seldom complain. Its 'yes, mam... no mam, sorry to be a bother mam.' Plus they are all so damn cute!!!


Whoops, number 17...


****12 hours later****
that last trauma light ended up not being a real trauma. Had my heart going there for a minute. SO I made it out alive. Thank god. I was worried there for a few minutes. I should have known my night was gone be bad. There was a police officer in the trauma room when I got there. He was chasing a bad guy and when he caught him they got to wrestling. The bad guy pushed the officer backwards through a plate glass window. (note... if given the option always go backwards vs forwards... it doesn't expose the large vessels in your hands and arms as much!) The officer was ok. Needed LOTS of stitches, but went home. I met both the chief and assistant chief of police this time. They were nice, joking but the chief didn't look so comfortable with the blood. I had him back up, can't have another DFO situation. (DFO= Done Fell Out, southern expression)

Lets see, what else was there? I had 2 jumpers. Yes, jumpers are falling from everywhere these days. It seems that they didn't get the memo that I put out. 2 stories doesn't count. There are plenty of high buildings with balconies around here. How bout you go there and save me some time. There were a bunch of accidents also, so many that I can't remember details. I just remember being exhausted.

So back again tonight. Then I get one whole day off. WOW, this working like a dog thing is GRRREAT!

Plate glass window..... always go backwards!!!

Drunk Boys

Ok, as much as I get on my soapbox about not drinking and driving I am proud to say that NONE of my trauma patients last night were drunk drivers. In fact, I only had 1 MVA in the trauma room at all! Maybe the word is finally spreading!!! (riiiggght... they were out there, they just had a lucky night).

Or maybe they were bored with getting shit faced and driving 80mph with no seatbelt into a tree, guardrail, another car whatever. They thought of more creative things to do. About midnight we got a heads up for a 40+ foot fall. Fall or jump? We didn't get to hear that part. Young guy, strapped down hollering for all he had that he didn't jump "I'm not that kind of person... I'm not crazy!" ... just drunk huh? Seems as though this genius got into an argument with the soon to be baby momma. She was standing between him and the door and wouldn't let him walk out. So he went out to the balcony. When she followed him he climbed onto the rail and just let go! One thing I can say with absolute certainty. Drunks bounce!

He will be fine. They will discharge him just in time to see the baby momma's first ultra sound.

Had another drunk boy come in trying to make us work. I got about 2 minutes heads up on this one. (average is 5-7 mins). I see the stretcher round the corner and hear a familiar voice. I mentioned that the dating pool around here is shallow and muddy? A former boyfriend and firefighter is bringing me my next guest. This one was trashed... 3 1/2 times legal and we think he fell asleep with a cigarette. The room he was in went up in flames. We don't know if he was hypoxic (low oxygen) or just too drunk, but he was so combative that the firefighters had trouble getting him to leave the house. When they finally did, he went berserk in the ambulance and was hitting the crew. (They looked 12) My ex was sitting on his chest when they got to me.

One thing I have learned about combative patients, they are much more fun when we paralyze and sedate them. I started his line while he was still on the ems stretcher (with a medic sitting on him) and we sedated, paralyzed and tubed him right there. What can I say... its all about creativity down there! It seems like this guy was in the smoke-filled room longer than we thought. His carboxy-hemoglobin was really high. This pretty much tells us that he inhaled way to much smoke. The best treatment for this is a hyperbaric oxygen chamber... which we don't have. The closest can't take an ICU level patient, so the next closest is the next trauma center over. The flight time would be about 25 minutes, but Alberto seems to have lowered the ceiling to midget level, so flying him out isn't going to work. So off to the burn unit he goes. Let them deal with it!

Other things drunks have done...


sleep on railroad tracks
"basejumped" off the bridge into the river
fallen off of balconies, down stairs, up stairs
fallen out of trees
had trees fall on them
try to fly planes (long story)
steal a police car
steal an ambulance
shot at a mouse/dog/cat/raccoon and hit themselves in the foot
played with power tools (never good. this is usually the men)
put arms/hands/legs through windows

Not sure what else... but many deserve an honorable mention in the Darwin awards. Had they actually taken themselves OUT of the gene pool then we would be so proud!!!

Don't run from the police dog. You are nothing but a giant, barbeque flavored chew toy to them.

The Smelly One

Green... what can I say?

Did you ever see 'Big Daddy' with Adam Sandler? The little boy's teacher is talking about him being "the smelly kid." In the ER we run the risk of having the smelly patient. I have found that smelly patients are like hurricanes... they can end up anywhere, but everyone can get one at some point. Fortunately, they seem to rotate pretty evenly through the department so you aren't always stuck with them (unless your sense of smell does not work, and then you are S.O.L.) .

Well, tag, I was it last night. Picked up this 96 year old nursing home patient with "belly pain." Not sure how the nursing home came to this conclusion, but oh well. Maybe it was the chronic diarrhea she had. So, for the record... necrotic bowel and oral contrast that has run the length of the gi tract... bad combination. The surgeon actually described it in her note as "tomato bisque." OK, so I'm never eating that again!

I cleaned this lady up several times, but the scent lingered. You know its bad when other parts of the department are complaining about the smell. I had other nurse's patients gagging from the stench!!! Usually we try to put them in one of the few rooms with a door, but a curtain is all that separated my old lass from the rest of the ER.

This poor lady was so sick. She had a valid DNR with both she and her grandson signed. THANK GOD! When given the details of her illness he wanted to revoke it!! The doc had to remind him that he witnessed this document and these were the patient's wishes. Finally he said, "if you want to change her DNR status, then you need to come in and do it." It helped that it was almost 2am.

Not too much else to talk about. Nice patients otherwise, quiet night. I'm gonna get my ass kicked tonight!

Things I recommend...
wearing seatbelts
not drinking and driving
having a power of attorney (POA) for healthcare
respecting the wishes of people who are DNR/DNI

Pissed

Let me preface this by saying that this particular post will not have much, if anything to do with trauma, medicine or work in general. I was off the weekend. Slept late after my horrible night at work. Actually, slept ALLL day. It was nice, especially after cleaning up dog crap. Went to the luau last night. That was nuts. I have been to some good parties, but they did this one up well. There was an actual bar set up with our host (and fellow officer) mixing drinks. I must say, he makes a mean margarita. One of the female officers was manning the grill. She is nuts anyway, but give her a few beers, loud music and a hula skirt and she looks like a dashboard ornament gone wild.


Needless to say, a good time was had by all.

We got some stuff done around the house today and decided to go on a "date" tonight. We really don't get to go out much, so I was really excited. We went to the good ol chain seafood restaurant not long before they closed. We got served fast, but I am reminded that the food (save the biscuits) pretty much sucks. I do love seafood though, so we stuck it out and got outta there pretty fast.

We decided to catch the latest showing of that Disney movie Cars. I hadn't been to that theater since we moved, and now I know why. The reason I go to late movies is so that I don't have to deal with the little shits and their over-indulged asses. We got there early and sat way in the back. (this theater can be a little sketchy at night and the cop likes to sit with his back to the wall) All was good, even through the first few minutes of the movie. Then these little shitty teenagers showed up. They were talking on the Nextel phones (I hate that freaking chirp), yelling, waving glow sticks, etc etc etc. It was hard to hear the movie over their noise. At one point one of them started throwing the glow sticks. The cop was livid. I think he stuck around because I was really enjoying the movie. It is a cute movie. When they really got loud I actually reached for his gun. I would never use it, nor could I get it out of the holster, but I surprised him.

Finally, after he told them to shut up, I walked out. I have never done that in a movie before. I've moved seats, but never left. He had trouble catching me.... Apparently I was walking pretty fast. The manager got quite an earful from us both. There was even another movie person that followed us out for the same reason. I doubt she even heard us. She found out where they were sitting, gave us free passes and that was it.

I'm sorry, but if you can't tell, I work almost all the time. I'm tired of going out and having to deal with behavior like this. I didn't act that way when I was a teenager because I knew better. I was not brought up to act like that. Its not just at the movies, its everywhere. The mall, restaurants, I am scared to even go to amusement parks. I'm just fucking tired of it.

So we came home, cracked open a bottle of wine from Key West and sat on the deck with the tiki torches. He pooped out early (lol, for night shift anyway). So, I'm sitting up, researching honeymoon locations watching Wild Things. Its a skanky movie, but I figure I'm entitled to a guilty pleasure after the night I've had.

I think what angers both of us is that in our jobs when people act like that we can take action and do something about it. He can arrest them, I can throw them out of the ER. Or, worst case scenario we can paralyze and sedate them (see the 'Asshole Tube' post).

Ok, I'm going to try to relax and wind down. Maybe I'll make it to bed before 5am.

A finger or a tube

OK, when we have trauma patients there are a few messed up little statements that you will hear us say. "A finger and a tube in every orifice" is one, "therapeutic touch" which is a direct reference to the rectal exam is another. The ABC's of trauma are "Ass, Blood,Catheter" instead of "airway, breathing and circulation." Yes, we are our own breed of deranged little lunatics operating at a hospital near you.

So if you can't tell by the attitude and sarcasm, yes, I got my ass handed to me last night. There must be something in the air, but it was a no bullshit kind of night. There was a female from an accident in bed 1 when I got there. She Got back from the CT scanner and promptly dropped her BP to "oh shit" right in front of me and my nursing students. They got to see her get 2 chest tubes, emergency blood and a quick trip to the OR. Yep, she died.

Next...

Lady was standing at the top of some stairs, got dizzy, fell, bumpity bump bump, all the way to the bottom. Couldn't move her left side, stopped breathing... then EMS brings her to me. She had a HUGE bleed in her brain. The neurosurgeon had to do a ventriculostomy. Picture a hand boring drill. Drill a hole in the skull, put a small plastic straw right into the middle and drain the spinal fluid out. (the students got to watch that too, they were psyched about the ER when they left).She then went to the OR. Yep, she died.

Next...

Dude minding his bidness as usual. Shot twice in the abdomen and leg. Entrance in the right, bullet in the left hip. Nicked the abdominal aorta. He went to the OR emergently. Can you guess what happened next??? Yep, he died.

Are we seeing a trend here?

Had a guy not wearing his seatbelt (grrr) wrecked, went through the windshield. He had every bone broken in his face, had a huge bleed in his head and assorted other injuries. I went to touch his forehead and it felt lie a helium balloon with the air half out. Squishy with a touch of crunch. He's gonna die.

State Police officer was in pursuit of a vehicle. High speed under the back of a tractor trailer. Given my affinity for cops I am happy to say that he is going to be just fine.

But the rest of the night was a bitch. There were other traumas and other patients but I can't really remember them now. Too tired. I got home and my cop told me I looked pitiful as we walked in the door together. My plan was to change into pj's, write a little on here and then sleep til the luau tonight. The dog had other ideas. I have a 100+ lab named Maddux. Maddux apparently didn't feel well last night. He puked twice on the carpet and you could smell the huge mess in the kitchen when we walked in the door. Diarrhea everywhere. Ugh.... The cop almost puked. I sent him to the store for breakfast stuff and lysol spray to cover the stench.

So, we had 3 dead, one in progress and all the other freaks and drunks from a Friday night. God, I'm tired. Doing the luau with the cops tonight, should be fun. Plus I have some good gross-out stories!

When you are a trauma alert and die, don't come haunt me. I'm the nice one!

Being Green

Have you ever heard the song that Kermit the Frog sang 'It's Not Easy Being Green?' Well, thats how I felt last night. I wandered in to the green ER with my Crocs on and 8 hours of sleep under my belt thinking, Hey, I only have 2 more nights and I'm off for the weekend. Lets just say to those of us who believe in Karma, if you get what you give, then I think I must have been a serial killer or lawyer in a previous life, 'cause last night sucked! I had wall to wall little old ladies with "terrible pains" with a side of mean and crazy as shit.

With 2 noteworthy exceptions, the nurses working with me were awesome though. When you get a good group the night goes so much better. We help each other out and have a good time doing it. My friend K was back there, crazy as ever. Even the docs and residents were kick ass. However, until 2300 we had a day/evening shift nurse with us. Let me tell you she was about worthless. This lady usually does days, and gets here at the crack of dawn so she can sit on her ass in the radio room in triage and just deal with ambulance and helicopter calls and play on the computer. When she does work the back, like tonight she is freaking painful. She can't manage 1 slightly sick person, much less her whole zone. (we routinely have 4 pts to a zone, but can be more if we are busy). So instead of keeping up with out patients, the whole side had to take care of the patients she couldn't handle. I was SOOO glad to see 11pm get there.

At 11 we got a nurse from Supplemental Staffing. They help fill in holes in our staffing, which keeps us running smoothly. These nurses choose several departments to work in and can be in a different area daily. For their "flexibility" they get paid about $30/hr more than your regular staff nurse. (no paid time off or benefits though) Most of them are Rock Stars in the dept and are a blast to work with. The girl we got last night was an exception. She didn't speak to any of us. She didn't help anyone and was never around, especially when her patients needed something. The charge nurse ended up running her whole zone. I found out later that this same nuse was written up the last time she was in the department. Apparently, there was a code in one of her rooms. When we get a code the whole nursing team jumps in to help. So while her patient was coding, she sat in the nurses station and ate crackers. She was called to come help,again, it was HER patient, but didn't do so. I'd have booted her then and there.

I am back in trauma tonight, then off for 2 days. Am going to a cop party Saturday. That should be interesting. These guys are nuts when they get together. As long as I don't end up in handcuffs or sprayed with OC (pepper spray) I'll be a happy girl.

'We Are the People Our Parents Warned Us About'..... so true.

Darwin

I have mentioned before my belief in social Darwinism. It is SO evident in the trauma room. Last night started out slow, got crazy, throw some drama in and even had free food. Gotta love this place.

So, shall we start with moron #1?

A man shows up in the ER with a sealed tupperware container. He tells the triage nurse that his (adult) sister has been complaining about an itchy bump on her neck for a few days. She had it looked at down at their local hospital. Yes, I think they were from the boonies. I think 'Applatchian American' is the pc term these days. Well, tonight the bump turned into an open sore and she felt something moving. Guess what crawled out....???

Ok, this is not the "actual picture" My camera on the cell phone gave me a blurry picture. But yep, thats a centipede. That sucker was almost 2 inches long and had been living in homegirl's neck! The reason the brother brought this thing in was that she didn't have a problem with it and didn't want to be seen. Ummmm... HELLO? Are we just going to name the eggs it laid in your body and keep them as pets? "This is my pet Bubba, his sister Jolene, her daughter Precious...." etc etc etc. Oh my aching ass!


Moron #2

I heard this one from one of the other trauma nurses and my cop confirmed the story. 2 nights ago out fine young friend and his buddy were up to no good. What makes me say that, you ask? They were sawing off the barrel of a shotgun. (I can understand 'Need for Speed', but is this a worthwhile pastime... I think not). Anyway, they sawed the barrel off without incident. Then Dumb and Dumber decide to saw off the stock. So here's a mental image. One guy is holding the gun steady while the other saws the stock off from the front. Did I mention the gun was loaded? Yuppers.... I'll bet you can guess what happened next. That thing blew a huge hole in the boys groin. He actually hit the femoral artery and the other major blood vessels in the pelvis. Died on the OR table. Friend tried to tell the po-lice that the guy shot himself. When the detective yelled at him about the bullshit story the kid peed himself. Damn, I would have paid to see that!

Moron #3

"Borrowed" the girlfriend's truck. (we call that grand larceny kiddo) Got his drinky drink on... (19 years old) got chased by the cops. Hit another car, broke that driver's neck.... he came in as a trauma code. Other driver died. This kid is looking at 40-50 years in prison. He had abrasions to the forehead and will be just fine.

Sometimes I really love my job! Did I mention we had free dinner and breakfast today? Drug reps are the best. Free food, pens, trauma shears and all the Starbucks dark Roast I can drink. FUN!

Note for the kids...
DON'T RUIN YOUR LIVES!!! Don't drink and drive. Damn, I've said this TOOOO much!

PS, yes I have learned to put pictures on here. we'll see what my new ability does for my outstanding language skills!

Buffett II

I was laying in bed last night after drinking too much Jamaican Beer, thinking about Buffett. I don't think that I mentioned the shit you have to deal with while you are there. Last year I got my ass grabbed by a drunk frat boy. NOT a good idea when the cop/boyfriend is right next to me. He chased him through the crowd, caught him and (I'm pretty sure) was about to knock the shit outta him until his (sober) mind got control again. I think he's lucky I didn't catch him first. This guy was all of 6'2, 200lbs+, drunk and off balance. I'm 5'0, was wearing a sarong and bikini top and had no issues with knocking bozo down to my level. If you listen to the Bristow, Va concert from last year I bet you can hear the drama over Buffett's 'Tripping Billies' cover!

There is always drama at Buffett. My friend and her husband (also a cop) got into a beer fight after the show one year. He finally got pissed and left her in the lot. We had to drive her, crying, back to the hotel. They promptly made up. grabbed more beer and jumped into the pool fully clothed.

I must rant a bit about the 3 old farts and the pervert that were behind us this year. It was warm and beautiful all day until 5 minutes before the show started. The beachballs were flying as usual and the old lady behind me got hit with one and spilled her 3ft margarita. She was so upset that she spilled on her 'nice' blanket. (*don't bring nice stuff to buffett, it get trashed*) so she poured water on the waterproof side to clean it up. The water went ALL over me! Bitch! Her perverted son/husband whatever, kept trying to dance all behind me. The cop had to get behind me and (subtly) remind him to get his old ass away from mine. They got cold in the rain and left early. Awwwwww.... too bad, so sad.

Also, to the driver of the big black truck with personalized plates that make reference to a buffett character who 'sings for his supper every night'... you need to learn to drive. You almost hit my car a couple times and the cop was armed and ready to pull you out of the truck. (this was in the parking lot).

I have a question...
we went to taco bell after the show. It was the only thing open. The line was LONG but they were fast, friendly and got our order right. Can we get these kids to talk to the chihuahua up the road? They screw up everything!

Back to work for the next 3 nights.

Don't call me nurse, baby, boo, bitch, teeny bopper, shoty or anything else along those lines. I'm here to save your ass, not kiss it.

Buffett

OK, as much as I love trauma, it can't rule my life. Most of the nurses and docs that I work with have something else that they love. Some have horses, music, one of the docs owns (?!?!?) a small plane and flies it himself to all of his meetings and conferences. I am a HUGE Jimmy Buffett fan. The nurses always know when Buffett-season is upon us. I'm bringing in bootleg concert cd's and the rest of the collection. (Or can be seen dancing in the trauma room with my IPOD)

Fortunately, my cop is as much of a parrothead as I am. Last year we did 3 shows, including Labor Day weekend at Wrigley. That was the best show ever!!! Buffett shows are as much about the tailgating as they are the show. The sights in the parking lot rival those in the trauma room on race weekend. Maybe thats why I enjoy the parking lot so much.

Sights From the Charlotte Show:

10) Fin on an RV
9) Golf Cart with Lifeguard stand on the back
8) Drunk guy in the lifeguard seat
7) 6 year-old with a mohawk painted green, white and red (kid was dressed like a parrot)
6) Margaritaville Chicken 'Best Breasts' temporary tattoos
5) Sign 'Show your Tits, Get a Balloon' (they didn't get any takers)
4) Frat Boys in grass skirts and coconut bras (one with his bare ass hanging out)
3) 3 foot tall Margaritas
2) Miss Margaritaville with boobs hanging out of too-small coconuts
1) 30,000 parrotheads standing in the pouring rain doing 'Fins' (yes, it rained the WHOLE TIME!)

Don't drink the 3 foot tall Margarita an hour before the show. You'll have to pee in the middle!

The Asshole Tube

Ok, this is a note on a very taboo subject in Emergency Medicine. We have a prime example in the yellow er right now. The asshole tube is a last resort of managing a very uncooperative patient. The guy tonight was brought in by the po-lice after some dude beat him up. Now after meeting prince charming, there was never any doubt in anyone's mind as to why he got the shit kicked out of him. PC was very intoxicated and yelling, swearing etc. We drew labs, and tried to do a CT scan of his head. All was well and good until he started punching the CT scanner. Let me explain that this is a piece of equipment that costs more than shit head would make in a lifetime. (Several million). So asshole, excuse me, Prince Charming was brought into the trauma room to be intubated. No problems, and he got his CT done without incident. Aside from several facial fractures and the suprising fact that he does have a brain, he will be woken up shortly and head off to jail. Yes, the police officer has a couple of felony warrants for our dear friend.

I must also add that while this was done against the patients will, it was also done under a TDO from the city judge. Dr B spoke to him and got the ok. (I don't recommend the asshole tube without a medical TDO.... otherwise it is assault). I guess I should have prefaced this with "Dr B was on tonight..." Obviously, you don't fuck with Dr B.

Otherwise my night has been great. Couple of traumas earlier, but nothing worth mentioning. Room is checked and quiet and I have Buffett on my IPOD. What could be better?? Ok, OK, as one of my medics would say... " we need a gunshot to the chest right about now" I would have to agree. It's been awhile since I've cracked one.

Oh lord, forgot to mention Dr Moron. New trauma intern.... works under the girl who took over for Dr Rock. She kicks ass. He hardly speaks English. Earlier we had a patient with a small bone broken in his foot. He asked me... (I shit you not) "Who do I page, plastics?' HUH?!?!? Broken bone buddy... how about ortho??? Grrr... This month is going to be painful. Will try not to kill him. I just thank GOD that Dr Rock and Dr Moron weren't on at the same time. I think I would have just walked out!!!

Final Thought: (a la Jerry Springer)

DON'T PISS DR B OFF!!!!!