Really... REALLY????

First and foremost let me preface this by saying this is not gonna be one of those "Lights, please..... this is the true meaning of Christmas" posts. Nothing against Linus, he is my all-time favorite, by a Charlie Brown Christmas it was not.

I was already scheduled to work Christmas Eve. Seriously, a silent fucking night. I went into the trauma room awaiting the massive reindeer pileup and possibly a few DUI elves. No such luck. I was, however, blessed with a 19 year old, drunk as shit who rolled his car multiple times. His present??? He was restrained. He had an open knee fracture. The lump o' coal included his 2 buddies, both ejected, 1 dead on scene, the other tubed, flown to another hospital and dead there. His dad's take.....???? They can't prove this was the kids fault, so don't say a fucking word. Way to evoke the spirit of Christmas there. The rest of the night was painfully slow and boring, with the exception of tall, dark and handsome elf that brought us some crazy bitch that OD'd on 3 percocet and 1 dilaudid po.


Christmas, was a completely different story. I was in charge and it was busy as fuck. (of course it was) Everyone who didn't get percocet and methadone in their stockings decided to come to the ER and get it. I had a less than optimal group at 7pm. WBL (wandering brownie lady) was in the back... which is unfortunate because you can't sell your fucking brownies when there are sick patients in your zone. I have said many times, every nurse is not created equal. I had one nurse tied up with a hypotensive pt who was 14 weeks pregnant and miscarrying so I had to handle her other 5 patients. TBL had 4.... 1 with a ready bed, 1 with discharge orders and 2 that weren't that sick (I know because I took care of one of them as well!). 2 hours later she finally got her 2 beds freed up..... I gave her a sickler and a chest pain.... about 45 minutes apart. Not unheard of. The chest painer had a rate of 140. 30 minutes later had he had a BP done yet? Nope. Access? Nope. EKG? Yes, the ER medic did that one. OMFG people! In the meantime her sickler was SCREAMING bloody murder about how we were unprofessional and insensitive because she hadn't gotten (haha) her methadone and dilaudid yet. In fact, her port-a-cath hadn't even been accessed. Multiple people (including the trauma nurse) tried to get in and help TBL, but she would have none of it. Even the resident was asking for her help with central line placement to which she said she was too busy. Seriously? Really?

I begged the coordinator to send her to triage at 11. At least that way I would get a nurse who was strong enough to run a damn zone without having to hold her hand.

I don't know how many little (and not-so-little) fires I had to put out because of her. I was in the coordinator's office more than one time. She even had the balls to write up one of my medics. I'm sorry... but I love my medics. This one was working her ass off trying to help and was in the room with a doctor who was sterile and needed help. My take?? If the medic goes down for something completely fucktarded then paint a target on me, cause I was in charge and will take any and all responsibility. You don't fuck with my medics!!!

It continued like this for most of the night. Asshole, ungrateful patients that ran us ragged. Frequent flier drunk with AMS that was found down. We put him in the hallway and ignored him for 8 hours. Amazing how fast the pee can accumulate in the sheets. We had a drunk come in with the police after a fight with family. He was a little crazy until my favorite resident went to evaluate him. When he kicked her with both legs all 6 officers took him down. Ker-thunk onto the floor. He got the rest of his exam pinned to the floor.

Ended the night with a self-inflicted GSW to the right chest. Some nights you can't get out fast enough.


Santa Baby... next year I just want some peace and quiet.

Christmas Eve, Baby

I could very easily change the name of this post to

Christmas Eve Baby



I mentioned a while ago, never, never get complacent in the ED. You never know whats around the next sliding door. I was having a VERY chill night in triage. Music on, feet up, working with two of my favorite nurses. What can I say? I was a great, albeit boring, night. When I saw the stretcher going towards the driveway I figured it was just another Meemaw that wouldn't get out of the car. Gloves on, I walked out to help. From the back of a 4-door I heard one of the nurses voices say.... "I think thats a head."

FUCK

I slipped in (having done this before) and surprise surprise it was, in fact, a head. Mom wanted to push, there was no nuchal cord, so push (and pull for me) she did. 10 fingers, 10 toes little girl with lots o black hair. She cried immediately and her 1 minute APGAR was 8. Poor little munchkin was probably freezing.... it was 20 degrees out! Once weighed she was 7lbs 12 oz. Mom had a scary hypotensive moment that required pitocin and some fluid boluses but rebounded well. The nurses suggested that mom name her after me. I highly doubt that there is gonna be a black baby in the projects with an Irish name!

One of the girls in triage decided to make some new nametags for the stork crew. After all the sadness with the loss of our collegue this made us all smile. Happy Birthday baby!!!

The Fam-Damily

You know when you're home when the jokes are frequently at your expense, the laughter flows like water and they know your deepest and darkest secrets and still love you. This dysfunctional family that I have been a part of these last 8 years has given more to me than I could ever give in return. I love my little ER family. Case in point. Last Friday we were hit with a motherfucker of a storm. Snow starting on my way in and continuing all night long. I sat in my little triagony box with music, a book and the highly valued space heater killing time and visiting with all the bored staff from the back. It was almost like an actual snow day from school. I think I triaged 4 people. I took 1 straight back because he was on chemo and had a temp of 103. The others I took back because there was nobody in the waiting room.
Then theres the obligatory "check the weather" walk outside that turns into the all out staff snowball fight with a couple of city EMS providers thrown in for good measure. Something about the attending chasing the patient care tech and a medic shoving snow down my shirt that brings back all those good memories from childhood. I did manage to get said medic back with a snowball to the face. As I was trying to escape back into the ER my shoe covers kicked in and I went (gracefully) KER-THUMP onto the floor. My butt still hurts! Thank GOD I had the space heater to dry out my clothes!

Unfortunately, in any situation the unfettered joy is always tempered by a heavy dose of reality. We were pulled aside that same night to speak with our coordinator about another staff member. Young nurse, well liked with a history of diabetes was a no-call, no-show and work Thursday. She was found dead in her apartment Friday morning. She worked days, so I didn't know her super well, however we always got along, worked well together and she made people laugh. She was one of those slightly funky but sweet people who could wear purple sparkle mascara and look completely adorable. She had a dog that was the light of her life and her current Facebook picture is of the dog dressed as a Christmas elf.

Something about medicine in general reminds us that things always want to be balanced. Ins vs outs. BMP, CBC, ABG..... we want balance. Ironically, life seems to do the same for us as well. An amazing snow night balanced out by profound sadness. I hope that all those she met and cared for realized how special of a nurse they had.

Our ER family may not consist of Mom+Dad and kids, we may try to kill each other from time to time but this is so much more than just a job.

Ridin'

Part of my RN-P bridge includes doing ride-alongs with the local EMS agencies. The idea is to get the nurses out of our proverbial comfort zone and out onto the streets. The medics think it is absolutely hysterical to watch us as fish-out-of-water. My goal is to look like an ass as little as possible! It helps that I did do some EMS in a former life before nursing school.
Yesterday was my first day on the streets. I hooked up with an old friend who is a paramedic near where I grew up. The upside of being "the nurse" is that I promptly got put onto the QRV (quick response vehicle) and away we went. The QRV is basically the county squirrel. We can respond to any call we want and if ALS is needed then it’s all me. Is it cheating? Maybe. I get to play with a minimum of bullshit.

After breakfast I got my corned beef hash settled to the bottom of my stomach and was ready to rock and roll. Our first call was a complete and total bullshit chest pain. Productive cough, FEVER (yeah, 99.1). Worse after smoking. She wasn't short of breath and was able to scream at her husband from across the room. We walked her to the ambulance and sent her 5 minutes down the road to the hospital. We followed in the QRV just for something to do. As we were waiting we got punched for a call in the medical office building right across the street from the hospital. Cardiac arrest with CPR in progress.
I did warn the guys that I have a decent sized black cloud, so my first "real" call being an arrest wasn't a big surprise. We arrived to find a surgeon that I remember well (and fondly) doing CPR in his office lobby. Fire had the AED on and he had a mask and oral airway in. My thoughts were... primary ABC's intact. I'm gonna tube this guy. Got my equipment out and ready, told the Battalion Chief that I wasn't going to use the King Airway (http://www.kingsystems.com/PRODUCTS/AirwayDevices/KINGLTSD/) and got ready to intubate. The paramedic on the fire engine tried to take the handle away from me! Oh hell no! I got the tube on the first pass without any trouble. The firefighter actually looked surprised when he heard breath sounds! WTF?!?!?! A couple of rounds of ACLS drugs (no amnio... my fault!) and we started across the street. The patient actually had a pulse on arrival to the ER, but quickly lost it. After 30 minutes more he was called. So I knocked out yet another ETT and a ton o meds. Talked to the Squirrel, my former work-husband on the helicopter and he was probably more excited than I was!!!
The rest of the day was pretty anti-climatic. Little riding around, no great calls. Still on the King Kong high from my code. Will be riding with another agency as well. I doubt they will let me be the princess in the QRV this time. I'll just ride in the back and learn from the best how to run circles around the back of an ambulance! I've really missed this!

Weirdos

A few words of advice to the new nurses out there... hell, to any nurse who may be interested in the ER.



1) Don't be afraid to say No. To patients, visitors and doctors. Our right to refuse (unsafe treatment, poor behavior or to be manipulated) is one that we as nurses don't use frequently enough.

2) Always follow your gut instinct. If the little voice is telling you something isn't right, figure it out. Work the problem until you know you have things under control.

3) Always remember the other people. Social Work, environmental services, chaplains, EMS. They will bail your ass out when you need it the most... and it helps to know their names when you thank them.

4) Never, NEVER assume that you have seen it all. Something is out there that will shock the shit out of you.


I picked up the dancehall Thursday night. That used to be where we stored the drunks and undesirables. Now that our census is WAY up and our diversion is WAY down there are actual sick people out there. So this woman is a G10P1 with many many spontaneous abortions due to Rh incompatibility and incompetent cervix. She was pregnant and had a miscarriage the end of Thanksgiving, but returns with belly pain. She was clutching her bible and doing the "Dear Baby Jesus" rock back and forth. She wouldn't let go of the bible, even when we went to do her pelvic exam. I found out that when she had the last miscarriage she kept the POC (products of conception: she was only about 12 weeks, so it was more tissue than baby-looking stuff) in a ziploc bag. The bag was wrapped in a cloth tissue and was put in the bible. Yeah, thats where it was. Pieces of dead baby in the woman's bible. Fucking gross. I can't imagine the smell!

Once I get to triage it really becomes like reality TV auditions. Everyone wants the starring role in the back. They make things sound 100% worse than they really are. An ingrown toenail can become an unsteady gait with stroke symptoms and who the hell knows what the common cold can be inflated to... the Bubonic Plague, maybe? I am the Simon Cowell of triage. You really have to be sick to get a rise out of me. I'll put you in the waiting room at the drop of a hat. I had a 22 year old come in with a nosebleed. It had been bleeding for a couple of hours. She was a little upset, but very appropriate. I sat her down and was in the process of doing the "Hi, my name is.... and what seems to be the problem" while slipping her jacket off.... she looked up and blinked hard and then blood came out of her freaking eye. Like out of the tear duct and down her face. She continues to cry and blood poured from her eyes.

Ok, WHAT THE FUCK?!?!?

I popped her up, no vitals, put her in the wheelchair and took her straight back. The charge nurse started to give me shit until I explained that this was more than just a run-of-the-mill nosebleed. I don't freak out about much, but I must have had a WTF look on my face. She was whisked into a room and the attending was not far behind. I'm not sure what the blood in the eyes was really coming from, but she had no other medical problems and platelets of 8. Here's to good nursing assessments, huh?

Signs

There are some signs that are obvious. We ask for signs and symptoms of CVA, tension pneumothorax and heart attack. We see them every day. They keep us on track and show us the way. Some are more subtle than others. You have to read between the lines and interpret what they really mean. I think this loose association is what separates the "human" signs from the ones we see on street corners.

For example yesterday It  got absolutely no sleep. I claim that myself. I decided to do one of my first ambulance days in between a run of shifts. Maybe not the brightest idea, but it was a great oppotunity I had a wonderful time. So I sacrificed sleep. After 24 hours awake I can be little punchy, but this was a bit much. My normal bubbly personality was replaced by a filterless pitbull. I truly tried to hang the "Leave Me the FUCK Alone' sign, but to no avail. FYI: When you are tired, Mt Dew, triple lattes and starbucks Dark Chocolate Espresso beans are not an idea situation. SVT is not pretty on me!

When I am tired/cranky my personal space frequently becomes an issue. I simply want to be left the fuck alone. Back off, don't crowd me and let me do my thing. If I want to see you, I will seek you out or open that door. Unfortunately, the normal happy me is thrilled to sit and chat with anyone so when the aforementioned filterless pitbull is around they seldom recognize. I was in triagony all night last night with one of my buddies and another lady that we have dubbed "The Wandering Brownie Lady." She has started a business making gormet style brownies that she frequently brings to work to sell. Thats all nice when you need a chocolate fix, but when we are busy as shit with patients everywhere and she is.......? Who knows where? It was all I could do to string intelligible sentances together and not strangle every needy motherfucker that came to the desk.

After a teeny nap (my 30 min lunch break, of course), I was still filterless but in a slightly better mood. Maybe I need to try to get a little more sleep next time!

Thin Skin

As much as I am out there both on here and in the ER, I am usually a kind of shy person. When I do lectures, no matter what the subject matter or audience, I get really fucking nervous. I worked on my neuro lecture for a really long time. I collected pictures, worked on how I could break things down and make the subject more entertaining. The lecture itself went well. No big hitches. Very few off the wall questions.... except for the random chick who is in every class and has 50 million questions no matter what. I got home, popped on the computer and started to wind down.


That is... until I got onto one of those social networking sites. Yes, I have a facebook. I check it often. I like that I can keep up with people without having to have the "Hi, how are you?" phone call, or run into them in public and not remember they have 3 kids and are not pregnant with #4 (despite what they look like). I rarely add people as friends. Thats not really my style. Working in the ER, or flying I ran across a ton of people that added me and I don't know them all super well. So I'm checking people's statuses... nada big. When I come across a very recent posting. It was from a medic who was in my class. (in fact, she was still there.... in the afternoon class) She openly bashed my lecture and questioned how much she had paid for the class. She actually used a couple of my phrases in her posting. I think she probably forgot that she had added me as a friend.

I was devastated. Seriously. I try to put myself out there and make the class both educational and worthwhile and this is what I get in return. I'm all for constructive criticism. If there was a way I could have presented the subject matter better, or if there was a more specific area that needed to be covered then sure, have at it. But thats not what this was about. This was about me personally. I won't lie... I was in tears. I felt about 2inches tall and vulnerable as hell. It took about 24 hours for me to take a step back and just say FUCK IT.

I spoke to the course coordinator about this as well. I didn't want to be a tattletale, but god knows she's gonna put this on my evaluation and I didn't want him to see it and have a WTF moment. It was really hard to tell him what happened. I was embarrassed and scared that this would be the end of my teaching. I shouldn't have been. He was both pissed (at her) and very supportive of me. That conversation helped restore some confidence. I am curious what her reaction will be when she sees me in the ER. My response will be to maintain my composure, show the class that she (obviously) doesn't have, and tell her to go fuck herself (in my head, of course)!