Saturday, August 29, 2009

Naked Old Guy

When I started in the ER years ago we were steady busy at night from about 1900-maybe 0300 and then it just DIED. We would turn the hallway lights out and (when it was really dead) the nurses would take turns catching naps in the fast track ER. As the cliche goes, those were the "good ol days."

These days we arrive to patients on every exposed surface. Literally. The rooms are filled, the halls are filled. There are rooms like 4.5, 14.5, ice machine, outside trauma, chairs by the entrance... you get the point. The waiting room (which is not very big in comparison to the volume) is packed to capacity with patients overflowing into the hallway.

So I think the mental picture has been painted. We were busy as hell. EMS brings us an old man who was found running naked around a busy intersection in the city. No Batman cape (I asked!). He wouldn't speak, and got a little combative when the two female officers went to restrain him. He came in tied to the stretcher with a "What the Fuck" look oh his face. My best guess would put him at mid 70's, early 80's. We popped him on our stretcher, and tied his wrists with soft restraints just as a precaution. He didn't fight... in fact he kind of started off into space.

I was charting, getting caught up.... stuff like that when the clerk yelled.... "There's a naked man running through the hall!" Gramps had gotten out of the restraints and was truckin' it towards the door. I ran after him and when he saw me coming he started running faster....or as fast as an old guy can run! One of the nurses caught him from the front (Thank God!) and I had him by the shoulders. He fought a little as we redirected him back and one of the older nurses looked at him and yelled "don't you know what you look like???" It was all I could do to keep from sitting on the floor and laughing.

Tuesday, August 25, 2009

The Bullshit Flag

I am going to get a red piece of parachute silk, write BULLSHIT in sharpie on it and tie a rock to one end. That way when I throw said Bullshit Flag it will flutter before hitting the ground.

A few things that warrant the Bullshit Flag....

*The city medic who has insurance puting her children on medicare "cuz its cheaper"

*The woman who comes in with tooth pain at 2am, via ambulance, with 3 young children in tow. Oh, and she needs a medicare cab home too

*Having the trauma intern (aka I've been a real Dr for about 2 months) giving me orders in the trauma room

*Trauma nurse saying she didn't check the airway carts because thats the medic's job (wtf?!?)

*Mandatory hospital-wide class 4 hours one evening smack in the middle of my days off

*Hospital security sleeping at the desk

*Working hard, paying bills on time and watching people travel, shop and otherwise have a fabulous time (maybe not having to work OT) and not knowing how the FUCK they do it

*Applying for a dream job over and over. Fighting politics and other bullshit just to have them hire someone else, or raise their standards every single time. As soon as you meet them the bar gets higher


Thursday, August 20, 2009

Crazy Nurses and Toilet Babies

I hate to say that my post vacation good mood was wasted, but with the drama that I walked into it was a little hard. G12 (maybe not that high, but you get me) P4 comes in with vag spotting after intense pain over 24 hours before. She hops of the stretcher to go to the bathroom and promptly drops the fetus in the toilet. Our best estimate was 16-18 weeker. Mom went over to the pelvic room and I took care if the "baby stuff." Anyone who has been in the ER knows what I mean. Usually these parents are understandably and appropriately upset. This one really didn't care about the baby, she was more worried about when I was going to let her 1) smoke 2)go outside 3) take more morphine/methadone (or crack, maybe?). She bled like stink, and the placenta didn't deliver. After 4 hours L&D was still too busy to take her, I hadn't seen a one of my other patients and to the OR we went. After those 4 hours I was begging to go out to triagony for the next 8. I was just DONE.

Last night I was in the penalty box for 12. That's our "screener desk." I do the "hi, WTF brought you here", make sure nobody is actively dying and then send them to the triage nurses. The triage nurses, one their own, are pretty cool. But together (they are both crazy as fuck AND good friends) they don't do shit. Seriously, they kept disappearing. People would go wait to be triaged and after 15 or so minutes I ended up having to triage many myself. What BULLSHIT! The hard part is that they are in the "battle axe " group that saying anything to the coordinator would be worthless.

The upside of screening is you seriously get first crack at the acute walk-in patients. When someone walks in complaining of chest pain you get a feeling if they are real or not. As soon as I saw this guy AMI popped in my mind. History of stents and htn, chest pressure for 3 hours. My triage EKG was a LBBB.

(I will admit freely that cardiac has always been my nemesis. I hate it. I can fake it like a motherfucker, but when interviewing for flight jobs that's not good enough. A very smart person has been helping with the learning curve. While I'm not an expert, I'm getting better)

So seeing a LBBB in a patient with a vague cardiac history, I hauled ass to the back, gave the EKG to the attending and puled up the old one which (TA-DA!!!) showed no block. The AMI page was sent out and the patient was in the cardiac ICU within an hour of my "hi how are you." Yea me! The triage nurses had no idea that I was even gone.


Finally I must lament that college classes are starting again. The drunk freshmen are here. One got carried out from the ED by 6 people last night. 1 on each extremity, 1 on the collar and one by the belt..... he looked like a pig on a spit!

Tuesday, August 18, 2009


Can you believe I took this picture? After a shit night at work (more later), driving all night eating Twizzlers and then randomly finding this deserted beach at sunrise. I don't even think the picture does it justice.

So my little beach break was exactly what I needed. I learned that I really don't vacation like other people. I didn't need to get shit faced drunk and pass out on the beach. I read 2 books (not medical at all!), got some serious sun, ate a little, slept just ok and woke up at 0630 every morning. Got my walk on through the little fishing village, found the locals coffee hangout and even met a bloodhound named Ellie Mae.

My last night of work consisted of a young bride on her way home from her honeymoon with her husband, his brother, the brother's wife and the brother's dog (a boxer). When the husband fell asleep they decided to scare him to wake him up. Unfortunately he wasn't the only one they scared. The dog woke up and chomped down on the girl's face. The brother in law actually had to pry the dog's jaws off of her and got bitten in the process.

I hate dog bites.... there never seems to be anything good about them. (unless its the police dog... then its funny as shit!) If its a pet then its even sadder. In this case the husband was also a police officer (not local) and the sister in law was pregnant. What a freaking disaster.

My perspective on it though.... (this took some time on the beach) They are able to get the "for better or worse" part put to the test pretty early on. If they can find the strength of family through this then they should be able to hang on through other tough times.

As for the old couple a week or so ago.... my thoughts are now... how many people lose a loved one and don't get the opportunity to say good-bye? How many people don't get 60-some years together. Yes, he should have died in his sleep in his own bed, but seriously, how many people are lucky enough to have that?

So pondering the next big move. I promised my nurse manager long ago that I would not permanently leave...but trying to decide what the next step should be. Where do I want to go and what will get me there? Am thinking of looking into the PICU actually. Hmmmm.....

So back to my dear sweet Mecca tonight. Gonna try to remain me and not the old battle ax. I do start paramedic class in about a month too.... that should be... interesting!!!

Tuesday, August 11, 2009

The Recovery

Still getting over the aches and pains from my last shift. Don't usually blog BEFORE shift, but....

The last few weeks at work have been pretty hard on me. There has been a lot to take in that I really need to let marinate. So the grand plan is to take a little time for myself. Going on a girls trip to the beach for a long weekend. The plan is to relax, soak up the sun with a side of Maker's Mark and gain some perspective.

Monday, August 10, 2009


The last two nights have been painful... physically and mentally. I get home, kick off the danskos and wait for the feeling to return to my feet.

Saturday night... the trauma room was empty when I got there. I walked in, threw on my shoe covers and the trauma light went off. Go fuckin figure.... 12 traumas later I staggered...almost literally... the hell out. I was also livid that the.... bitch (I almost used the really bad word) that was coming in wanted me to stay late and stock the room with her.

*** drunk parents driving home from the beach with 2 children in the back. the parents get into a physical fight and drive off the road into a tree. no dui charge, but we called cps

***i got threatened with an assault charge by a drunk bastard. I wouldn't let him sit up and leave. the trooper got him settled down.

***GSW to the head.... .22 we think. dude was, of course, minding his own business

***24 year old dove into the shallow end. C4 fracture with nothing below the nipple line. he vomited and aspirated in MRI. intubated yesterday. nice kid, nice family. very very sad.


I tiptoed into the trauma room and the light started going off. the first 2 hours were hell on wheels. I told the communications room that all 3 of their traumas were not coming in the room because there was only 1 bed. That stupid fuck actually wanted me to check with the attending first. Sure, because if he said so I would LOVE to put all 3 in 1 bed!

*** 20 year old mvc with a fracture/dislocation of the hip. we did conscious sedation to pull that thing into place. I was pulling from the shoulders up while 2 guys held the hips, 2 pulled on the leg and the attending gave propofol. 20 minutes later my arms were screaming for a break and the hip still wasn't in. 150% of my weight pulling against these dudes... 300mg of propofol and we were still fighting.

***I also had to help restrain a dude who was either post-ictal or high as fuck. He broke the regular restraints and go put in the "big boy" restraints.

Finally.... the drama. Of course there is drama, its a hospital. Lately it has seemed a bit more like General Hospital versus Trauma: Life in the ER. There are some things that I wish I didn't have to hear about..... and there are times when I want to scream "NO DON'T DO IT!!!" Grrrr..... Sorry the last part is so vague... just need to vent a touch!

Friday, August 07, 2009

Boys in Dresses

Some nurses can make the funniest situations completely boring, while others can have you laughing at the most ridiculous and even mundane situations. A princess in charge in yellow on a fucking insane Thursday evening. I was getting report from a good buddy who totally has a way with words.

Bed 1: "I don' know what the fuck is wrong with him... but he has a bed so who the fuck cares"

Bed 3: "So yeller that he looks like a pumpkin... lookee there, pumpkin walkin' to the bathroom"

Bed 6: "Shemale with sickle cell. Doing the hormones, but still has the twig and berries, you know. Got a little dilaudid, still 10/10 pain and eating McD's chicken nuggets. Trying to scratch, but keeps forgetting that there are chicken nuggets in his/her hand." (I have to investigate myself and there is seriously a dude in a dress with makeup scratching its face with a chicken nugget) OMAA what has my job come to?

Bed 7: "She a big girl in a big pink robe... its a tent you know. She fell down getting dressed and broke her ankle"

Bed 15: "Complaining of the discharge. Has a female name, but Suzy says its a dude. It looks like a dude, a pretty fucking ugly dude with the 5 o'clock shadow" (another that I had to investigate. She/he did say there was a discharge.... brown. Vaginally?? "yes" Ummmm..... do you have a vagina?? Loooonnnnggg pause..... noooo. Well then its not fucking vag d/c then!)

I laughed so hard that I almost peed in my pants! All I was missing was the other pre-op dude who shoves things in his penis because he was really a woman.

There was entirely too much to do for a princess shift. My staff was marginal. A great and experienced trauma nurse who fucked up his back and could hardly walk, the fucking douchebag that killed that poor old lady a while back, a nurse who bitches no matter what and a good buddy of mine who was busting his ass to keep afloat and help with the slack. I was mucho happy to see 2300 arrive and say peace out motherfuckers.

Thursday, August 06, 2009


...or maybe I should just call it purgatory. The trauma room was a heavy place last night. Heavy in emotions and heavy in conversation. What do you say when you simply don't know what to say? Or in a situation where you are witness to what will be a defining moment in two people's lives?

I watched a couple who had been married for 68 years say goodbye last night. They were in an accident and both pretty badly injured, he was far worse off. The trauma doctors had told them both (and their children) that he would probably not make it out of surgery and if he did, he would never be strong enough to come off the vent. So as he was packaged I put their beds together, rails down as they held hands and said goodbye. How often do we see moments like this and not feel the true depth? Do we use our jaded sense of humor to dull down the situation so much that we can't see things for what they truly are?

I have found that when I allow myself the luxury(!) of letting the emotional side kick in that my head begins to swim in a way that almost seems out of control. I begin to question all the things that I know so well.... like how I feel when a patient is sick as shit (calm and joking on the outside with the best of Buffett in my head)... how the trauma room looks (smells!) when all the patients have left and the lights are off... why I still care what certain people think and why a peer's opinion can matter so much.

Have I become a big fish in a little pond? I can do everything in the ER (charge, triage, trauma, orient). The nurses and coordinators come to me as a resource. Am I banging my head on the ceiling, but am too ignorant to allow opportunity to knock? A very wise and sweet person pointed this fact out to me (maybe a bit more tactfully than I have here). I am starting to think that finding what really makes you happy is frequently viewed as a selfish act. Why is it not a priority, instead of an afterthought?

So before I make myself crazy I am going to soak in the tub with a glass of chocolate wine and allow the more pleasant parts of my night drift through the crazy currents of my mind.

Wednesday, August 05, 2009

Dick for a Day

Once upon a time there was a boy in a dress. His friend was stabbed a couple of times and whacked in the head with a hammer. He came with her to the ER and made a scene with his friends about how she was dying and what a bitch the triage nurse (me) was. In the meantime a trauma shows up. A man has been stabbed multiple times to the chest and back. Our boy in the dress is ID'd as the bad guy. (literally, the pt said "it was a boy in a dress") The boy in the dress takes off and is nowhere to be seen. The University PD is on his tail (haha!) and catches the boy in the dress in the parking deck. He and his other well dressed friends are bought back to the ED in handcuffs and taken promptly to the men's bathroom to pee. (I thought only women went to the ladies in groups!)

Another patient is being transferred from a local hospital. Actually, they wanted to fly him. Let me mention that this hospital is about 10 miles (or less) from us. Fortunately, someone with some brains decided that flying would be a stupid idea. He was been shot with buckshot in the back and head. He is awake and doing fine on arrival to the trauma room. His story... he was just walking and some dude shot him.

In the meantime a friend of the cop's shows up. He's looking for "some guy shot in the ass." His guy was breaking into someone's garage when the garage owner caught him and shot him.... with buckshot, in the ass. That sounded a little too familiar. I sent him into the trauma room to investigate.... you know, cop stuff. Guess what?!?!? Bad guy found. I asked for the CrimeSolvers $1000.00 reward, or at least the Det. badge for the day. (dick, haha!)

Finally..... any story that starts with "there were these two drunk ass bitches....." is probably one you don't wanna get involved in!

Tuesday, August 04, 2009

What To Do?

So many nurses that I work with are in the MSN program. They want to teach, be nurse practitioners or management. I haven't heard too many mention CRNA school, but I know they are out there as well. I know I can't work in the ED forever. I will turn into what I hate... bitter, unhappy old battle axes that forgot what they love about emergency nursing.

I hated nursing school with a passion. It wasn't hard.... it was boring as hell. I did very well, with little effort. The instructors even mentioned that the only time I paid attention was Critical Care and Emergency. Nothing else did it for me. So do I want to teach? Fuck NO! Not in the classroom anyway. I don't give a shit about care plans, concept maps and all that other crap. Nurse practitioner's seem to have some autonomy, but when it boils down to it... its the same old crap day after day. Even the acute care NP's (cardiology, trauma) usually get stuck with the crap that the doc's don't want to do. I think I would be bored as shit. CRNA's seem to have a good life. Normal hours, good money lots of autonomy. Two years of school, you can't work while you are in the program.... so we would have to live on a cop's salary for two years. Not exactly feasible. Then I would get to stay in an OR, within four walls behind a sheet. Does that appeal to me??? Fuck no!

So where does that leave me? I don't want to teach within a school, I don't want to do someone else's scut work (even advanced scut!) and I would be miserable trapped in the OR day in and day out.. no matter what I got paid. I wonder what is out there for me? I love flying, but I know that even that isn't a job you end a career with (not that I am ANYWHERE near the end!). As a dual provider will that open some more doors? Who the hell knows. There are days when I see the residents and think to myself... "I can do that." But do I really want to? I'm not interested in giving up another 7 years of my life.

If I could travel, maybe do (pseudo-advanced) medical care in places far away. I think that is what might suit me. Any suggestions?

On a lighter note... I overheard this the other night when I was in charge.

Doctor: "Ms Smith we think you have had a small heart attack, so you will be here for the duration."

Patient's Adult Child (after Dr leaves): "Mama... whats a duration?"