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!

Percocet Twins

Not identical, not fraternal, not even related... but they could have been twins. One had chronic back pain and said he had chest pain in order to be seen. The second had bleeding ulcers and stomach pain that the Vatican (catholic hospital) gave him percocet for. Both were side by side in my zone last night. Bleeding ulcer said that we wouldn't be able to get an IV in him unless he was in a room (versus out in the hallway). His blood "locks up" if he is in the hall. Back pain dude was looking around the curtain in the room, demanding that the doctor see him because his pain was so much worse. Both wanted percocet Rx.... the magic pill that fixes htn, iddm, chest pain and STD's. All is right with the world when everyone gets a little percocet.

Neither got it. They both got a "security escort" out the door. One kicking and screaming, the other threatening to sue.

Bullshit's Many Levels

There are somethings that you expect to see in the summer. Sunburns, spinal cord injuries from diving and intern fuck-ups. I have said numerous times... don't be a trauma patient or a patient with anything more than a splinter or sore throat in July, August or September. In the spring the seniors really step up and take charge and the interns have (in theory) learned enough NOT to kill the patients. Do you see the irony here?

Last night a transfer came from an outside hospital. 50 something with a spontaneous pneumo that had a chest tube placed by another physician. When he got to us the chest tube was pouring blood (not exactly the pneumo that was presented). The soon to be second year surgical resident (aka intern) was at the bedside attempting to put in another chest tube. There was no joy in Mudville when the intern did strike out. Chest CT showed that the first tube went through the diaphragm into the liver (?!?!) and the second ended up between the aorta and esophagus. The sad part? As I was leaving the family was writing comment cards about how nice the staff had been to them.

We received an email from our nurse manager yesterday. "Concerns" have been brought up by day shift about the assignments and how busy we have been lately. Our assignments are 4 beds each with the charge nurse backing folks up and the trauma nurse having the room and possibly the drunks in the hall. Now everyone gets 4 beds, the charge nurse has 2 patients, AND has to back up the rest of the nurses. The trauma nurse is responsible for the pelvic room, which is all well and good until a sick as fuck vag bleeder or miscarriage rolls in. The other brilliant suggestions include... leaving a monitored bed open in each treatment area (uh huh... so we will tell the STEMI we can't take up the last bed), triage walking all acuity patients back from 3a-9a and triage doing patient transports upstairs during those same hours. All this is well and good until its 3am and there are still 20-some patients in the waiting room.

I have my moments where I am so over the management here. They work as charge or triage maybe once a year and haven't run a zone in 7 or more. The knee-jerk reaction is such bullshit. I learned that not spouting off to these stupid management emails is probably the more mature thing to do. I will sit back and watch.. but you don't have to make me like it!

Found Out

It is not a full moon. I made a point of checking last night. Where the crazy fuckers are coming from... I couldn't even begin to explain. Not necessarily psych patients, but the run on the mill public gone wild. Someone explain to me what the hell is up with young guys punching stuff. Seriously, you get mad... and you hit something that is going to totally fuck you up, but you do it anyway. Lockers, brick walls, cars... you name it. I don't want to be a advocate for violence, but doesn't it feel better to hit something that you actually hurt? Smart boy last night decided to punch and elbow a plate glass window. (hasn't this been covered in episodes 1, 2 and 10 of this blog?!?!) So he shows up drunk as fuck (obviously!) with a laceration to the left wrist through the vessels, ligaments and nerves bleeding like fuck everywhere, he also had a lac to the bone on his right elbow that, fortunately, wasn't bleeding as badly. 5 hours, 200 of fentanyl, 2 of ativan and 8 of zofran (yes he was a puker) he finally had a decent bp and was not bleeding everywhere. His excuse... "I was mad and I'm a fucking retard." No arguments here buddy.


I actually got another patient banned from the hospital the other day. Why does that feel like a great accomplishment? Dude came from the Marriott and had been in some kind of fight. He had a tiny laceration that might need about 3 stitches but was convinced that he was bleeding to death. When I didn't jump to he became violent... beating on the desk and threatening to fuck me up. Our "security" was a huge help. They called the police for me! The officers hauled his ass out and had him in handcuffs pretty fast. Our clinical coordinator aka "fearless leader" banned him from the grounds and all was right with the world again.

So, question... I have kept this blog pretty quiet. The cop knows about it.... mom knows it exists and that's about it. What happens if I get found out? If someone I know finds and reads... then figures out who I am? I find myself worrying what that person will think about what I have to say and if I am really as crazy as I come across here. Ugh.... no pressure now!

I need another vacay!

So vacation was wonderful. Very relaxing. Never long enough.

The first week back to work was busy as hell. Non-stop insane patients. I had the trauma room Friday night. From 7p-0200 there were 5 traumas. Most with emotional issues that made them think it was ok to whine, yell, curse and essentially act like assholes. I didn't kill any of them, but the thought crossed my mind.

At 0200 the floodgates opened. The next 5 hours there were 14 traumas. 14! The grand total for the night was 19. The room was full and the light just kept blinking. Accident after accident... nobody could drive for shit. In the midst we were told that the helicopter was outbound to an accident.... when the pilot showed up without the crew we knew it was gonna be bad. Trauma codes don't get flown..... that's the standard. So the crew came by ground with a guy riding a moped that was struck by a car. The passenger on the moped was killed and this guy had coded twice prior to arriving in the trauma bay. When a patient's foot is facing 180 degrees in the wrong direction and his whole body from the pelvis down is jello and that is the least of his problems.... you know you're fucked!

The light was still blinking when I left. I was happy to get outta dodge. I was going to dinner with one of the er residents. We desperately needed a girls night out after the beat down in the trauma room. Work called a couple of times while we were at dinner. I ignored it.... work cannot interfere with girls night, ya know?

I also got a call from one of the nurses... that is when I checked my voicemail. They didn't want me to work... the cop had been in a motorcycle accident and was a trauma patient! SO I trotted my high hells to the ER just in time to watch ortho inject his knee joint. He was admitted with road rash, torn ligaments and a degloving injury to the knee. I stayed the whole week, through 2 surgeries and finally got home yesterday. I will update on the crazy floor crap I saw later. Its just a lot of LONG stories.

Back to work tonight.... Will cont to update the blog and cover all the last week's insanity!

Incommunicado

Jeepgirl is officially on VACATION. Mucho stories when I get back and (hopefully) some good news and the start of a new adventure. Until then... here's the Mad-dog kickin it on the beach this morning!