charge.... cont

A nice follow up to my night of charge last week. Crazy-won't-shit-on-the-toilet-girl had stool cultures sent and what do you know??? Strep A positive. Just what I need going into my vacation! Yumm-O!

Gotta love getting those phone calls that want you to contact Employee Health and Infectious Disease!

Charge

I have been lucky that my nights in charge have been hellacious on a minor level. Day shift gets things into such an uproar that it takes several hours just to chill them the fuck out! I walked in yesterday in charge of the Yellow ER. There were patients everywhere, we had been on diversion for 6 hours and the trauma light was already flashing. What I SHOULD have done was kept the Jeep on the highway and headed to the beach as fast as I could get there. There was a tubed ICU player in each zone and NO ICU beds in the house.

I love my job!

Why do the freaks come out on holiday weekends? The day shift attending had the pleasure of pulling a blue sparkly vibrator out of some guy's butt. It had been there for 3 days! Dude didn't even want to keep it, so there it was in the dirty utility room in a plastic bag. I wanted to give it to one of the nurses who has been going through a dry spell, but that got vetoed.

When you are 19, sexually active enough to get PID and end up in the ER for it one would think that certain developmental milestones must have been achieved. This crazy bitch had diarrhea and was wearing a diaper. When she wanted to get up and go to the bathroom I figured that was a good thing. Time to step out of the Pamper and into the life of a toilet sitter. She stopped dead when we got to the bathroom to ask a very interesting question... is this an automatic flush toilet?

To the untrained observer I was calm and cool when I explained that I didn't care what type of toilet it was... as long as it worked. She FLAT REFUSED to use it. She was scared of the toilet! Seriously, scared of the fucking toilet! I stood there,in all the commotion and calmly explained that the toilet wasn't alive, couldn't hurt her and if it flushed her butt would get a little wet. I had to go into the bathroom with her (a practice that I don't normally do!) and try to get her to sit, not hover and have massive diarrhea all over the toilet. Because she was hovering the shit was going everywhere! Oh my aching ass.... I should have called in sick!

So, another Darwin nominee last night.... 29 years old, having sex with her significant other and the condom came off. She was worried that she might have been exposed to something so she called 911 and took an ambulance to the ER at 5am! Oh, did I mention that she thought he MIGHT have HIV? Oh, and she called the HIV hotline (this is per the patient!) and they told her to douche with bleach? This was not a small woman... and I had a very clear mental picture of her squatting with a bottle of Clorox up in the VaJayJay.

Memorial Day weekend, its warm, its beautiful, its a Saturday night. I'm working. Where are my skills best utilized??? Tonight.... back in motherfucking triage. I say again... I Love My Job! (hell at least I have one!)

Triagony

Once you get a little experience under your belt and prove you have some common sense the powers-that-be will ok you to go to triage. My hospital is so busy that on any given day (or night) we may have between 3-4 nurses doing triage at once... usually. When there is a call out or a hole, that's the first place that they rob Peter to pay Paul from.

So picture me.... 12 hours, stuck in the same little box room. I have been going fucking crazy! Oh, and lets not forget the little "thou shalt not play on the Internet" decree that was handed down a couple of months ago. Forgive me father, but I break that one EVERY night. What the hell else am I supposed to do??? I never stay put... I am always wondering into the back to check things out, or to the communications room where the paramedic gets all the incoming ambulance and helicopter calls. That room is closed off from the waiting room and those crazy fuckers can't get to me there!

Thus far in triage I have been chased, hit on, cursed to hell, looked at toilet paper with God-knows-what in it. I have wrestled drunk/high teenagers back into wheelchairs while convincing their equally dunk/high friends that they weren't dying... just drunk and high. We pull drive up traumas out of cars and (last night) dragged a heroin OD out of the driveway where his buddies (so kindly) dumped him.

Last night I had a IVDA (aka IV drug abuser) that was seen at an outside hospital for back pain, discharged with anti-inflammatories and was PISSED she didn't get narcotics. So she sat in a wheelchair in the middle of their ambulance drive and refused to leave until someone called an ambulance to take her to us. We, so kindly, pulled her off the ambulance, ran her through triage (not me!) and popped her ass in the waiting room. I did mention that the wait time was about 5 hours and she was unthrilled. She wanted us to bring her a cot, because the wheelchair was uncomfortable and she refused to sit in the hospital chairs.

Its sad... but we recognize a problem child when we see them!

5 minutes later patients started coming up to me to tell me that she was now laying on the floor, refusing to get up. We checked her out, determined it was status dramaticus, told the attending and hauled her off the floor back onto the chair. About 30 minutes later.... same shit. 15 more minutes that attending and clinical coordinator didn't care that she was on the floor. She had documented stable vitals and was no closer to the top of the list. On the floor she stayed. The visitors remained "concerned" and kept making sure I knew she was on the floor. A self-proclaimed doctor from John's Hopkins (that's what he told me) came to explain that I was not allowed to do that, he was a doctor and we were not treating her appropriately. He looked like a self-proclaimed jackass guido from Jersey to me (shirt open, bloodshot eyes, smell of etoh) so I ignored his threat to call 911. When the college popo showed he was nowhere to be found. Hey, at least the popo helped get the bitch back into the chair AGAIN!

Triage= A fun-filled trip to Adventureland or 12 hours of sheer HELL

Triagony it is!

I thnk I'm going to put this sign in our waiting room! JCAHO will love it!

Whiskey Tango Foxtrot

12 hours in the trauma room. Nada too bad, but its never good when the AIC (attending in charge) accepts 8 transfers within the first hour of the shift! (to quote a dear friend.... Whiskey Tango Foxtrot is that about!) I think what saved my ass was that the ceiling was around my ankles and nobody was flying. So instead of an influx, there was a steady flow of trauma for the first 7 hours and then things got better.

We got a call from security at 6am stating that a person had fallen on the escalator in one of the buildings (not the Main building, but another huge building). So I grabbed an Aspen collar just in case and some buddies who were just as bored as me and away we went. When we got to the "scene" granny was head down, feet up and semi-conscious. (WTF again!) Usually when we get called for this stuff it is complete and total bullshit. (the "code" that had a syncopal episode) So my inner EMS goddess kicked in, someone took c-spine, another went to get a backboard and stretcher while I started my primary and secondary assessment

The lady was going up the escalator, stumbled and then fell backward hitting the back of her head (please God, no coumadin!). The fall was witnessed by her son, who was on his way to the OR for a brain tumor resection and her two deaf-mute daughters. (WTF!)We got her boarded, on the stretcher and to the ER without any issue. She went in the trauma room due to lack of space and got her treatment started. Our clinical coordinator did not agree with what we did. Apparently we were not supposed to respond, but have security call 911, let them do exactly what we did, drive around the block and drop her back at the ER. I spoke to the administrator who said 1) per policy, we should have let security call 911 instead but 2) we did the right hing for the patient. She ended up having no head bleed or c-spine injury. I went home and slept without any issues. I would have done it again.