Monday, March 02, 2009

Good Medicine/Bad Medicine

Ironically Bad Medicine' this was the song I listened to on the way to work Friday night. I was walking the Green Mile, but this time I had good help. I am orienting a new nurse to the department. She hasn't been a nurse long (a year and a half) and has a background in burn, so she's a pretty smart cookie and I do like her a lot. She is pretty close to the end of her orientation, so the goal is for her to fly on her own and I am just backup.

Unfortunately, together we have pretty bad juju. We had "the corner" which includes the code room, 2 isolation rooms and another monitored room. We started with an OD on tylenol and 3 sick sick sick cardiac patients. For someone with very little cardiac experience she did very well. I helped with IV's and getting folks started, but she kept up and things went smoothly.

We got a person (I WILL NOT call her a girl) who was "performing" at the lesbian club. I cannot imagine what she could have been doing. She was shorter than me (if that is possible) and as wide as she was tall. She looked like one of the ghetto boys that we see in the trauma room. Boxers, jeans hanging off her butt and a white wifebeater. She had a "seizure" after getting extremely drunk. Funny how she stooped seizing when you told her "Hey, stop it." My orientee got to experience first hand how an ammonia inhalant will fix almost anything! Big girl went to CT and yacked for distance in the hall. It was pretty damn funny!

Years ago I blogged about Dr Rock.... what a jackass. Well, we have an ER counterpart. I'll call her Dr Strychnine. She is a third year ER resident and nobody can stand her. I don't know her well, since her first 2 years I was 1)in neuro 2) flying. So I haven't been present for many of her misadventures. I know the nurses got together and wrote the residency director to ask thatshe not be given Chief Resident. She treats nurses horribly, talks down to them in front of patients and gets very bitchy when she is intimidated by a nurse who knows their shit and doesn't back down. A couple of months ago she tried to get me to put an IV in a diabetic (!) IV drug user's foot (!) so we could run Vancomycin in. When I flat refused she said in front of the patient and family "well, if you aren't comfortable enough to start an IV then I can do it." We also had a disagreement on how to treat symptomatic SVT. I was ready with the adenosine and EKG, she wanted to fluid bolus and wait. Guess who won that one???

So that night we got a transfer with a brain mass. The neurosurgeon and I are good buddies, so he will call and tell the resident just to do whatever I want since I know what to do! (I bet that chaps her ass!) As soon as I started the decadron the guy started seizing! (Neurosurg was at the bedside). A bunch ativan later he settled down. So this guy had a ready ICU bed, report had been called when she finally checked his chest xray. Skinny HIV positive dude man had a spontaneous pneumo that she hadn't picked up on! So everything in green came to a screeching halt so she could do the chest tube. We had Special Forces medics there who would sell their left nut to put the tube in, but she would only let them watch. These guys are trained for this and I have been really impressed with the current group. But no, she had to do it. I refused to watch or help. I wanted nothing to do with this fiasco. She got sterile, made her (humongous) incision and (attempted to) put the tube in. Since her incision was too big she got a motherfucker of an air leak, couldn't get it sealed off and the patient ended up with a chest full of subcutaneous air! Did I mention that she didn't get consent? It wasn't an "emergency" he wasn't unstable and it wasn't a tension. I wouldn't let this bitch touch my enemy's pet rock! It is scary that she will be an attending somewhere (not with us!) soon.

We are currently snowed in with 8inches and still coming. I don't have to work until 2300 Wednesday night. The cop and I are keeping our collective asses here with the puppies, good food and good movies!!!

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