24.5557025, -81.7825914

12 more hours of hell on earth and I'm running away to the land of Mojo. I think she had a good thing going and I need to make a return pilgrimage. As much as I am looking for relaxation and a moment away, clarity and inspiration are on the agenda as well. There are questions that have not been answered and I'm waiting for them to work themselves out.

I have long seeded trust issues that I need to bury in the soft sand. I need to look at what is in front of me with unclouded eyes and make a decision. Either be happy with the current path, or get the fuck off it.

I hope that running away from home brings me closer to where I need to be as opposed to just a momentary break from reality. Will see what is on the flip side.


Mahalo nui loa

Management

I have no aspirations to become a Nurse Manager. Why? Well, lets see. First and foremost is the bullshit factor. I know that I am neither tactful or PC enough to deal with the higher ups on any kind of regular basis. Second, I have a "don't blow smoke up your ass" way of looking at people. If a nurse were to come to me bitching about so-and-so there had better be a damn good reason. For example... my foray into blogging from work was foiled by Nurse-Needs-to-Take-Her-Meds. Yes, someone tattle-taled. Fortunately, the fact that I was blogging and not merely surfing the internet was lost on her, so that is a bit of a relief. Her complaint was that I had my Mac in triage. Was I sitting with the computer in my lap while I was seeing patients??? Fuck no! Did I triage everyone under the sun that night? Yes. Do other nurses bring laptops in? Yes.... so my thoughts...? Fuck off and mind your business. As a nurse manager you can't say that.  Oh and per the nurse manager, no more laptops at work... for me anyway.

Another reason I don't want to get into management.... the loss of skills. The more time you spend in that office away from patients, the more you lose the ability to prioritize, be flexible and deal with the staff "in the trenches" versus in the office. The loss of perspective is staggering. Even at the ED Coordinator level it is amazing. We have coordinators that cannot even put a patient into the system and triage them. I feel like they should be a clinical resource instead of just "in charge." They should be up on the protocols, equipment and policy and truly be THE resource for the department. Are they....? Nope. Very seldom do they have to do anything with staffing. When they do they are either in triage or in charge. Again, a loss of perspective.

I feel very strongly that we are defined by our actions. Not just what we do, but how we treat people. I don't pretend to be an angel. I have had my share of fuck-ups. I have an Irish temper that has gotten away from me from time to time. I have a mouth that makes cops and sailors blush and can throw down a 'tude with the best of them. However, the patients love me because I talk to them like they are people. I try to take care of the staff and I learn people's names. I know that one of my favorite residents has a husband in med school and she doesn't seem him often. When he is in town I tease her about ho-ing it up. I know that the housekeeper has lost a son and grandchild within the last year and has been having a difficult time. I have been the first to look at a UPT and to watch someone decide their marriage is over. As a manager....do you look at that? Negative. Its all about what one person says versus another and the bottom line.

Speaking of the bottom line... what are we willing to sacrifice for it? I know that times are tough. There are more patients than ever and fewer people to take care of them. So what gets the axe? In my institution it seems to be anything having to do with morale and staff safety. Our annual Christmas party was cancelled. The physicians still got bonuses though. We can't get metal detectors, but we have opened a new area of the department so we can see even more patients. Staffing sucks, but we still can't get scheduled overtime. Scheduling sucks.... but who needs someone clinical to do the scheduling when a secretary can do it? We are forever running out of things (pt meals, blankets, IV pumps). When there is  shit weather we can stay there.. they can't guarantee a bed, but there might be a stretcher you can use.  The physicians get to bill by the patient too. So why go on diversion when we can just start stacking patients in the hall? I seriously saw patients in the triage room with an attending Saturday night. I triaged them, wrote them up, called him, he saw them, did his paperwork, wrote scripts and  I discharged them. Did I mention it was only myself and the screamer nurse? She kept sending them my way.... and I kept tearing through. Saw 6 patients that way in an hour. In addition to the ones that were triaged and sent to the waiting room. Then (naturally) the computers went down for the next 6 hours. Gotta love that bottom line!

No crazy stories to share today. Have been exploring why I am where I am and what needs to change. No answers yet. I have been lucky to differentiate between the friends who have got my back and those that were more interested in what I could do for them. Like my grandmother always said... its just another FGO (fucking growth opportunity).

One would think that with all this opportunity I'd be taller by now!!!

Petri Dish

As a new grad in the ED I got sick as crap before my health insurance even kicked in. I was living at my grandparents, running a holy shit temp and just waiting for July 1. When the doc looked at my throat she said "Have you seen this?" Never a good sign. The first 6 months were awful. Every bug that came through I caught. There was no way to build PTO, I was using it as fast as I could accumulate it. In the years since I have gotten my flu shot every year and built up one hell of a tolerance. I am (I'm sure) harboring every bug from Acetobacter to Yersinia with a touch of everything in between. I warn people that I date to take their vitamins and get ready for a rough cold/flu season. Most times I'm right.

Unfortunately, I have encountered a new strain. Its the Medic-Mutated-Creepin-Crud. I'm hacking and wheezing, freezing my ass off and aching all over. Fuckin medics!!! :)  They can at least give me this crap on a day other than my day off!

On the horizon... formal gala to raise money for the trauma department. I'm getting some kind of award. Black tie, fancy schmancy. Should be very interesting!

Stupid 101

I little more lighthearted than the last post I present the January-February class of Stupid 101

25 yo male. 3 months of hematuria. Decides to call 911 at 330 in the morning cuz now its an EMERGENCY!

Chronic pain patient complaining of kidney stone pain busted doing the scoop the water out of the toilet trick. No narcs for you, buddy. 

CooCoo for Cocoa Puffs lady that asked the (female) patient care tech to stop and have sex with her on the way to the psych floor

Pt who received a "letter" (= positive for STD) and presents to the ED for treatment. After his shots he hits on the nurse cuz "I'm clean now"

Visitor so fat that she sits with legs apart and belly hanging out of shirt. Stupid nurse (me!) assumes she's just fat. Ummm... nope. Pregnant.  (GROSS! SOMEBODY FUCKED THAT ON PURPOSE?!?!)

Dental pain patient in the trauma room... she says that Superman and Batman are fighting to the death in her mouth. Apparently that causes dental caries.... who knew?

Toilet water for pee man trying to come back and re-register so he can see another doc that he hasn't lied to yet

Intern explaining to me that I really do have to send the cultures before I hang the antibiotics (really?!?! are you serious? we have to DO that? WOW)

Intern (detecting a trend) telling me that the man with the fractured and impacted hip has to be NPO for surgery. Oh my goodness doctor??? Why must it be like that?

Stupid fucking bitchy nurse going to my nurse manager about me having the cell in triage.... blow it out your ass bitch! 

Ahhh..... I feel so much better now!

Introspection

I have sufficiently Whoo-saaa'd after my last shift. I was so angry that poor Ruby (the jeep) took the brunt of  my frustrations. It took a few days off, some tears, beers, chicken wings and quality time to bring me back to myself. Some days I just don't realize how this job gets under your skin. We joke that in Emergency Medicine we really don't have to do the long term stuff. Treat 'em and street 'em or send their asses upstairs. Its a very "hands off" life. The drama and humanity usually rolls off us like water from a duck's back. I can't say that any one patient got to me the other night. Nobody was sick enough or tugged at my heart (at all!) enough to do that. I think it was mostly the staff that got to me.

We talk about this as our dysfunctional family. This is very very true. There are some crazy unhealthy people that work in this field. They are both physically and emotionally unhappy and unhealthy. Everyone has their own way of dealing with the stress of work and home. Some do it better than others. The last 2 1/2 years have been the most insane of my life. I have been places and done things that I never thought  possible. I am now on my own again and doing my very best to enjoy every second and find myself in the process. I continue to fuck up on a regular basis, but the people who love me best realize that as much as I try to be perfect, I will always fall short.

I don't know what the next step is, or even what direction I am headed. I do know that I have the people I love, Maddux, Ruby, a glass of wine and Buffet and Marley on the radio. What more does a jeepgirl need?

Who Dat?

In the fucking Super Bowl madness I think people forgot what the hospital is for. Sitting in triagony, dealing with these dumb motherfuckers I am about done. You know the night is gonna be rough when the first cup of coffee gets dropped on the floor, when there are patients swinging from the ceiling, when the other triage nurses are old as Methuselah and slower than molasses on a fucking cold ass day and (oh yeah!) theres a 29 year old OD on MOTHERFUCKING ECMO in the code room. Seriously guys, I think its time to re-evaluate this diversion is for sissies thing.

Yes, I'm a little bitter. People have been weirdos tonight. My drunk white lady who yells the N-word, yup, she's back. Mousy-looking drunk/psych/cancer hx Dee-da-Dee asshole that fell on the ice at BW3 and refused EMS before peeing on the sidewalk... he's here. He walked out of my triage room to go pee.. again. They are fighting in the adult homes, falling on the ice (come on guys, its been there for a week), getting bitten by every animal imaginable and vomiking on my floor. This shit truly needs to stop.  There was even a drunk girl who fell/was assaulted and knocked an eyeball out. She then proceeded to argue with the EMS crew that she was going to get up and leave. To their credit they handled her much better than I would have. I would have given her a cup, said "use this to bring your eye back when the fucker falls out for real" and let her ass walk. As my mom would say... dedicated healthcare professionals at work!!!

The highlight was one of the old nurses (who must me outside her head or off her meds) telling me that it is inappropriate for me to have my cell phone in triage. I'm not talking on it, its out of sight whenever there is a patient in the room, and I have triaged greater than 1/3 of the total patients in the department in the last 6 hours. Yes, I counted. If I feel like texting a friend, my family, or the man in the fucking moon its really none of her business.

So maybe I am a bitter triage nurse tonight. Thats fine. I don't have to be Miss MerryfuckingSunshine 24/7. The people that deserve it get the sweetheart. The rest of you fuckers better watch out!

The Street

Years ago I made the mistake of telling a firefighter at a controlled burn that they got to have all the fun. He promptly found the littlest turnout gear they could find and sent me in. 4 hours and 3 trips into the building later I stripped out of the bunker pants and jacket, called it the most fun ever and promptly fell asleep. It was a blast, but not as easy as I expected. Part of my paramedic class is to do rotations in the field. I haven't been as diligent with that as I should. I really need to stop procrastinating.

Sitting in triagony you really do see everyone as they come and go. If you are like me and are pretty friendly they stop and chill for a minute. Its a nice break from the monotony. The city EMS supervisor stopped to say Hola last Friday. We shot the shit for a while, he asked about class (the medics think its hysterical that a nurse even wants to be a medic) and he asked when I was going to come ride in teh city with him. Ummm... hows Monday?

Monday it was. It freaking snowed this past weekend, so it was cold as shit and icy when I arrived. A couple of WTF looks from the field providers and it was into the sups truck and away we went. I'm not sure what I expected.... GSW's and MVC's galore driving like a bat outta hell all through the city. Yeah, not so much. There was a lot of dealing with pissed off people, complaints and paperwork. I just wanted to see some damn patients!

We finally squirreled a possible seizure... no shakin and bakin on our arrival. The woman may or may not have had a seizure (ask me if I really cared!) but she was going to the hospital. She walked to the stretcher for the crew and that was that. 

We finally got to drive fast at about 2200. 45 year old dude found down by family. No CPR in progress. Apparently the family kept screaming into the phone and hanging up. We were beyond BFE from the address, but it was fun as hell driving through the city that fast! We arrived about 5 minutes after the ambulance crew. The medic on the truck took one look at us (recognized me from the hospital) and told me to get my ass in there and do the airway. So I tubed while he was on the geezer squeezer and the medic drilled his leg to give drugs. 3 rounds of ACLS drugs, bicarb, narcan (this was dudemans's 16th overdose) and we FINALLY got to call my hospital for cease resuscitation orders. PD had to restrain the son who came screaming into the room as I was turning the monitor off. 

What did I learn from this code??? Always pee before you go on the cardiac arrest!!! Also... firefighters bag too fast. 

We went back to help the crew restock and then back to the streets. A few more complaints and it was time to eat. We were trying to find the Mexican place when we got punched for....another code. This was deep in the ghetto. I walked in the house and there was a smell that I still cannot place. I know there were kerosene heaters everywhere, but there was something else. Girlfriend was naked except for some bright ass turquoise panties. Hubby said she just done fell out. (dfo'd) Unlike the previous code he did do CPR. 

The crew was getting lines and I was drawing drugs as the supervisor went to intubate. This was one of the houses that you really need to check for where you lay before you go to tube. It was that fucking gross. I actually had to check for roaches before I sat down on the floor. The tube was so-so so I got to pull it and throw in a King Airway. We continued to go through a couple rounds of drugs before we called my hospital AGAIN. We stayed with the crew and helped clean up. I think they appreciated that this nurse isn't above getting her hands dirty with them. 

What did I learn from this code??? 1) Always check for roaches 2) Fucking eat when you get a chance! Everything was closed by the time we were done. at 5am I ended up eating a cheeseburger big bite at 7-11 with a Dt Mt Dew and chocolate covered pretzels. What can I say??? Its the breakfast of champions!!!

I left at 6am worn the fuck out. My favorite medic has said that he can dance circles around me in the back of the truck. I respectfully disagree. We will see who is humming the mexican hat dance when this is over!!!

The Screamer Desk

I have frequently referred to the penalty box or triagony. The hospital came up with the "Screamer Desk" after an unfortunate incident with a little old dude. This guy's family brought him in, pushed his wheelchair into the waiting room and bailed. To the observer he was merely asleep and (it would seem) remained "asleep" for several hours before someone realized that he was dead. The staff worked him, although it was obvious that there was no reason to other than to save some face. The problem solving session following this incident was apparantly very... colorful and thus the Screamers Desk was born.

I get the first medical "Hi how are you" and get an initial impression of whether the patient is fixing to crump. Then I either direct them to the triage nurse for the formal triage or take them straight back. Unfortunately, at night we are also the "can pt so-and-so have a visitor" which gets pretty fucking old. We also end up handling social work, the complaint compartment and have a front row seat to the beginnings of the JERRY JERRY JERRY moments. 

Umm.. screamer sucks. We also screen all of the pediatric patients. This solidifies that I don't want to be a pedes ed nurse. The kids aren't so bad... but the parents will make you fucking insane!!! I had a VERY young girl come in last night with her baby. The complaint.... "My baby ain't been doo-dooing all night."  Dear lord, this child has had a baby. Poor kid has no chance in hell. Yet we continue to see the same shit day after day.

Depending on who the screamer nurse is, your night can either suck ass or be tolerable. Take tonight for instance. I am trapped in the hole knonw as triage (my own request, have been feeling kinda crappy the last few days) and the screamer nurse is the size of a small Voltzwagen. She won't be getting up unless there is a disaster or the Krispy Kreme starts delivering in the driveway. This nurse has actually sent a PCT (pt care tech) out to a car where a woman was in labor. The tech then delivered the baby.... and she never did de-ass the chair. Ugh. SO she puts the patients in and sends them my way. On nights like tonight we are short, so its just the two of us out here. When a patient shows up she pops them in the computer and then shoos them in my general direction. The problem comes when I get someone who wants to talk or is actually sick. Then the backup starts. Occasionally she will triage (from the chair of course), but most times she lets you drown. She does take the time to tell you when your triage is inappropriate and then reminds you that she IS masters prepared so she knows what she is talking about.

What-the-fuck-ever.

The upside of the screamer is that you really don't have to do a whole lot. I bring a book and my cell phone and get comfy. Occasionally WBL and I will do some 5am yoga, though my angry white boy music is discouraged...