Time to Retire?

What would you consider to be the "shelf life" of a nurse? Especially one who is still working in a very busy urban ED?


I had the misfortune of being the HBIC (Head Bitch in Charge) in Green last night. As I have said a million times, the staff can make or break your night. A horrible night with a great crew is never as bad as it could be. Last night was a not so great night with a really not great crew. People were actually coming to ask who I pissed off to be stuck with 3 of my 4 nurses. Until 11 I had one of the most senior nurses working a zone. When I say senior I don't mean experienced... I just mean old. She has been in the ER for a million years, but hasn't seemed to evolve past what nursing used to be. She had 3 ready beds when I arrived at 7pm. At 1030 she was finally (?!?!??!) calling report on one of them. Nobody was too sick, she just wasn't able to prioritize and stay organized enough to get shit done. I tried to smooze in and snag the charts (to call myself!) but she would have none of that. So essentially that zone, and nurse, were dead weight for the first 4 hours. She actually retired a couple of years ago, but still works part time. Unfortunately she is more of a hindrance than a help.

My dear friend who busted her ass with me last night got stuck with the weirdo of the night. 28 years old with sudden onset of panic attacks which he attributed to the bite from a 5 week old kitten 3 months ago. In short... he thought he had rabies. Funny how the panic attacks subsided with alcohol. Hmmm..... liquor as a cure for rabies??? I'm sure Ol' Yeller would have appreciated that one!

My same dear friend took care of a very large lady who recently had a TAH. Her staples were intact, bt she was bleeding (heavily) from between them. On arrival there was freaking blood everywhere! She busted her ass to get the patient stabilized, OB/Gyn consulted and the patient cleaned up. No easy task considering that the patient was huge and the nurse was not. When the patient's (very large) family came to the bedside they were not happy. Why you may ask??? Because my hard-working nurse did not wash the bottoms of the patient's feet.

Are you fucking kidding me???


The straw for me was the son of an 85 year old lady who fell at 630pm the night before. Her hip was sore, but she didn't call 911 until 24 hours later. On arrival she was neither shortened or rotated so into the hall she went. X-rays revealed a non-displaced femoral neck fracture. Ortho saw her and consulted medicine (isn't that what ortho always does???) with the plan to surgicize in the AM. The son, however was not convinced. Despite multiple films and views which showed a pretty freaking obvious fracture) he thought that we were probably wrong. Why? because he didn't see the huge displaced, my acetabulum is in another zip code fracture. We tried many many times to teach, point out etc and no go. He was mortified that she was NPO and that we had not given her a bath, brushed the teeth etc. UGH!!!!! Can I retire now?

Para-God?

As if having all those initials behind my name wasn't enough, I have found the next bridge to jump off of. I did EMS in nursing school, but stopped because I could do more as a nurse in the hospital. The closure of my base made me realize that had I been a dual provider I may have had more options. So in the name of getting back in the air I have signed up for my area's first RN-Paramedic bridge program. Unfortunately I have already undergone some hazing from my nursing colleagues.... who seem to believe that this is a step down instead of a chance to broaden my experiences. One even said that I may as well take the RN-Housekeeper bridge (that really pissed me off!).

I also need to get on my CEN and CCRN recerts. Has it been that long already? I sure as shit don't want to take CCRN again.

Note on my last post. The lady who was too fat for the rib spreaders died. (no huge surprise there) I am still trying to figure out what her major injuries were. We also had another child that was struck by a lawn mower that her grandfather was driving. She lost an arm.... she was about 5. I am SO tired of this.

Hitler, Mussolini, Vlad the Impaler.... Oh My!

After nights like this I start to wonder who I was in a former life and why I am being punished. I was in charge in yellow, it was elbows to assholes when I got there and there seemed to be no end in sight. It didn't help that there was a completely incompetent bitch in the trauma room.

I got report from an outside hospital. Drunk dude got beat up. He went there and they did a Max-Face CT (they didn't do a head) and were transferring for OMFS. Cool, no worries, whatever. They gave me a history (Hep-C, ETOH abuse and cirrhosis) with plts of 17,000. They were coming by ground. After about an hour and a half no patient. I heard the helicopter get punched to that hospital for the "multiple trauma from assault." I called to find out what the fuck was going on.... apparantly the patient got loaded into the ground ambulance and "lost" an airway. The Dr attempted to intubate and was unsuccessful. He then crich'd the guy (with plts of 17!) and he was now bleeding out from the head/neck. Oh yeah... and he MIGHT have active TB. Oh and they didn't send a sample to the blood bank so they couldn't start platelets. Oh my fucking god! The nurse who called report was unable to tell me anything about the patients airway... because she had only been in the ER or 2 weeks! (before that all she did was psych!)

4 traumas from the same rool over MVC. Not a one wearing a seatbelt!!! OMAA!!

Poor lady with Lupus, ESRD, HTN ...ect ect fucking ect. "pleuritic chest pain" per the squad. On arrival she was short of breath and had a swollen tongue, neck and face that was unresponsive to benadryl, solu-medrol and sub-q epi x2. She was moved into the trauma room where anesthesia trauma surgery and ENT were at the bedside getting ready to cric her. Thank GOD she went to the OR instead. Just what I freakin need is two airway issues in one night!!!

Because I needed to end my night with a bang.... right at shift change there was an MVC. My patient was ejected and pinned between the car and the ground. Have I mentioned that the patients these days have been the size of small elephants? This was no exception. She had crushed bilateral lower legs, and open femur. On arrival (by ground) to the ER she promptly coded... which is especially shitty when you have no IV access. I pulled out the EZ-IO to drill her humerus.... but she was too fat for it! Trauma threw in two groin lines, the ED resident intubated while the trauma attending (I have called him Yoda on here before) opened her chest. Unfortunately, we were unable to get to her heart because the rib spreaders were too short for her. She was just too fat! After several rounds of drugs and 3 units of blood I was on my way upstairs backwards hanging blood. When I left the OR they were still looking for spreaders that were big enough and Ortho was cutting the leg off.

SO I am trying to decide who I must have been in a former life to deserve this! I had to have a big ol' glass of wine before i was even calm enough to type this.

Pardon the verbal diarrhea but I have to dump this on here so I don't completely blow a gasket!

Pieces and parts.

Just when you think you have seen it all..... I wandered into the trauma room today. The first patient had OD'd on psych meds and jumped out of a second story window. He then ran around the city wearing nothing but a Batman cape. So after multiple sutures and staples Arkham Asylum here we come!

We have also had an influx of jumbo sized patients. I mean REALLY fucking huge. 400lbs is the norm these days. When the patient weighs more than the scooter she is riding how does she even manage to fall off at any kind of speed??? Anybody out there ever hear of a FUPA?!?!? Yeah, saw a lot of that tonight.

MeeMaw is confused as a bedbug with a UTI (and dementia). Will not pee and has to get a foley. Somehow I seem to be the go to girl for the MeeMaw foley cath these days. For a demented old granny she was sure strong as hell. Those little knees were stuck together with superglue. It took four of us to hold her while I dusted off the cobwebs and popped the cath in. She sang the whole time.... it started as a song I remember from church then turned into a sung version of whatever was last said to her.....

.....That tube is in my blaaaaadddddeeeerrrr...... it lets the urrrriiiine run ouuuuuut!!!

I finished the night with a pretty horrific car accident. Four friends were on their way home late at night. They got a flat on one of the bridges and pulled to the side of the road to fix it. All four were out of the car when a drunk dude struck the car at over 70mph. Two of the guys were struck and pinned by the car. Both were literally torn to pieces. The torso of one ended up in the drunk guy's front seat. The trooper showed us pictures.. there were legs torn off and laying in the road, a shoe with a foot still in it and the white sheet with god knows what under it. The other friends were pretty much ok.... but pretty shaken up. The highly trashed driver only had a broken nose, but got the asshole tube as well.

Ended the night with a psych patient who wanted a prescription for marijuana. The nurse's response.... "we don't do that on Wednesdays, check back tomorrow."

The Shit You Can't Make Up

This was kind of the whole point of this blog. That, and to help me get to sleep after a long ass night in the department. How often does someone say "we should be writing this down" and I smile and nod.

I walked in to a 24 year old who was complaining of blood from the penis. Sounds like the standard STD workup to me. I told him the whole adage about not putting your pole in a green pond, smiled and walked out of the room. The chart went to one of my favorite residents who got a bit more of the story than I did. The patient's roommate told him that it was because he masturbated too much. (go ahead and ask, I did........ ) How much is to much? He admitted to 15 times per day. Who has time for that?!?! 15 per day plus almost a 2 pack per day cigarette habit, no wonder he doesn't have a job!!! The patient was also convinced that he didn't have an STD because he was banging a lesbian behind her girlfriend's back. OMAA..... again, can't make this shit up!

Stupid Attending

I think that I have bashed the residents enough over the course of this blog. Since it is July I will be nice and lay off. They don't know any better...yet. The attendings however need a bit of abuse. If you are going to be an ED attending in a Level 1 urban department then you'd better know your shit.

The attending from last night graduated from our program about 6 years ago. He was a shitty, stupid resident and has been no better as a moonlighting attending. I don't feel like a Level 1 ED should be your part time job.

So my major malfunction with this guy is twofold. 1) He is slow as molasses in February. Patients that could be seen and dispo'd in an hour or less were taking over 2 hours to even be seen. That seriously slows shit down. 2) Let me tell a story.....

60 year old dude with wicked ascites. He looked about 10 months pregnant and was complaining of... guess what?!?!? SOB and abdominal pain. (Big freakin surprise) The nurse, who is a pain in my testicle, alowed him to lay flat... and what pray tell happens when you lay a 9 mo pregnant person flat? It compresses the aorta and shits out their BP. So I think this is what happened. We walk in the room and dude man is guppy breathing, has a pressure in the shitter and is completely unresponsive. Did I mention he looked pregnant? We estimated his weight at 120kg. When we went to RSI him the attending didn't know the dose of rocuronium (instead of Sux due to renal status). I blurted out 1mg/kg which was our protocol when I was flying. The doc disagreed. He wanted to dose at .3mg/kg. (I think he got the roc dose confused with the etomidate dose). After my insistence he at least went up to 50mg of roc which was less than half of the appropriate dose. UGH!!!! It is so frustrating trying to explain this to people who aren't going to listen.

So once we got this guy tubed I threw down an NG tube and got some fluids going. The doc attempted to place a femoral line. He missed (we thought) and then tried to convert to an a-line. When I got the a-line set up we saw a very distinct waveform..... a CVP waveform. He went through the vein and artery and shredded both! FUCK ME I don't want my name on this chart.

The patient's nurse (not me) witnessed the beginning of this pseudo-code... and then disappeared. When we looked he was in the nurses station documenting... he had nothing to do with his patient. At least the son of a bitch said thank you before I left this morning!

Hot and Cold

When I am in charge it runs either hot or cold. We are either wide the fuck open or completely dead. Unfortunately, last night was the former. There were seriously patients on every available surface that we could find and trauma after trauma inbound. As soon as I could get a room open I would move a trauma out of the room (to make a bed for the next contestant) or triage would bring some absolute bullshit back from the waiting room. Truth be told, if I have an available bed I don't need a complete report from triage. The nurse in that zone is more than capable and I really don't give a flying fuck what size shoe the patient wears and how many times they had the shits today. ABC's intact?... yup. Dying right this second? No... ok then. Room 2.... leave me the fuck alone.

So 75 year old man on a roof. Am I the only person who has a problem with that? Falls through the rafters 12 feet onto concrete. Transfers in from another hospital with about a million rib fractures, a hemothorax and oh yeah, did I mention he was 75? Chest tube put out over 900cc of blood. WTF?!?!?! Why were we fucking around here? He was in the trauma room for almost 2 1/2 hours. That's fucking ridiculous. He finally went up after he put out another 200cc of blood and received 2 units of PRBCs. His family was upset that the trauma docs weren't available to come to the phone and talk to some random family member from West-by-God.

Another thing I have learned.... when the guy with the gun says "Give me your money!" ... fucking give it to him. 20 year old college student wanted to argue and got her ass shot in the leg. Is it sad that she was in the trauma room a matter of 10 minutes, and then was moved out. She just wasn't sick enough to stay in there!

In the midst of the 50 million traumas we get a dude that walked out of the bar and got his ass fucking beat down. He was altered on arrival and complaining of chest pain. (24 years old with an MI hx) He was also really REALLY drunk. He got through CT and then the switch got flipped. He turned into the biggest drunken prick. His IV's got ripped out and his skinny white ass wrapped in a blanket went running out of the trauma room. We were perfectly content to let him go, but the trauma attending wanted him kept, so the police got involved and his scrawny ass got TDO'd. (what can I say.... it was a beautiful thing!)

When we have traumas inbound, the communications room will call back to the charge nurse (me) and give report on whats coming. I seriously gave up on paper and started writing on my hand, arm, pants... you name it. I seriously have about 5 patient reports written on me right now, including a dude who was a pedestrian struck by a truck and (somehow) had an unconfirmed lac to the penis.... in addition to other injuries. After a trauma evaluation it was found that Mr Winky did indeed have a lac, but how the hell did that happen? Walking done the street at 3am with your wang out? WTF?!?!?

All this fabulousness was marred by one of the cranky bitches who was none to happy that I was in charge. She had a crap-ass attitude the whole time. She even had an orientee with her and had to do very little work and she was still a complete bitch. I'm starting to think that bitch may be an acute disease process!

Waste?

What pisses me off about the holidays is the absolute waste that we see. How many drunks cross our threshold? People that should have known better but chose not to make the decision to not drive, stay where they were or call a fucking cab. The saddest part are those that are victims because of the stupidity of others. Over the last week we have seen a rise in fatal accidents (no shit, right?). Unfortunately, many of the victims have been children. In just 24 hours there were 2 fatal accidents that killed three children ages 12 and younger. Parents either lost control or fell asleep and their unrestrained children paid the price.

There was also a young child (5, I think) that was struck my a lawnmower and lost a good portion of a hand and fingers. Where the hell was the supervision? I know I wasn't allowed in the backyard if dad was cutting the grass. In the car... we didn't move unless everyone had seat belts on.

I also had the pleasure of being in charge on the night of a million transfers. Seriously, we had about 15 patients transferred from all over the state. Some were traumas, there was a liver/anal cancer patient that was bleeding like fuck from esophageal varices (I so generously sent that one down the hall to the Green ED), many a drunk that slept it off out in the drunk tank and a code that had been down for over an hour, shocked 6 times and was PURPLE from the nipple line up (hello PE anyone?).

Oh yeah... and the interns are here. I taught one how to do an NG tube on a drunk with a BAC of 5800 (no shit there..... too bad we weren't betting). We taught another how to use a geezer squeezer and discussed at length what the appropriate dose of Motrin is in a BS drug seeker. Truth be told, I think this group will be pretty good once we break them in a bit.

31.... Gonna Be About The Things I Love

So.... 31. Not my 20's anymore. Not the milestone that is 30. Better make it something good then. This year I resolve to do the things that I love, to make myself happy and hopefully, have a little self-discovery in the process.... So here goes...

First thing today (0001) Glass of Noche wine and DMB concert on TV. Very very chill.

Sleeping in my bed with the 600 thread count sheets

Bubble bath and Aveda tea

Wine and cucumbers with an amazing person

Lunch with Mom

Frisbee with Maddux

Tuna, green beans and couscous for dinner

Not too impressive, but very relaxing. I'm going to do things because I want to, not because I feel obligated. This is going to be a very good year!

In The End

I tried so hard

And got so far

But in the end

It doesn't even matter

I had to fall

To lose it all

But in the end

It doesn't even matter

Some days you just remember. Not because the day itself was special or memorable, but you just know who you were with and what you did. Exactly 1 year ago today I was working at the flight job. My base manager was my partner and Baby had some required maintenance due so we were down for the morning. We had breakfast at Cracker Barrel and did some errand running. I got my 30 something driver's license and he picked up his military dress uniform. We did a cath lab flight that day and I sat on the skids on a perfectly clear night and recognized how fortunate I really was to be doing what I loved.

1 year later I must say that memory has become bittersweet. I wondered then where I would go from here and that (unfortunately) has not changed. Where do you go once you have lived your dream, if only for a brief time? Everything else (including the ER) seems a bit dull in comparison.

So in memory of that great night 1 year ago I will take a moment, remember how happy I once was and (hopefully) ponder again where I go from here.

PS: The interns are here.... everyone be careful!