The TIger Song

I'm now attracting a new niche of patients. Crazy cracked out pregnant ones. The latest and greatest was my age (?!?) last used crack 2 days ago, missed her methadone clinic appointment and was 8 months pregnant. She came in for suicidal thoughts and dental pain. Now thats one HELL of a combo. The doc gave her lido jelly, 130mg methadone and a psych consult.

Another winner last night... random dude that showed up at a friends house acting batshit crazy. He was hog tied and spitting on arrival. We put our "big boy" restraints on, cut the EMS cravats and he tried to bite his own hand. Once he was tied down he continued to yell and thrash. One of the nurses and I started quietly singing the Tiger Song from The Hangover. http://www.youtube.com/watch?v=48aFJVMh_8Q
Ironically, it settled him right down. The paramedic students, ems and the resident thought we were crazy until they saw it work.

I spent the remainder of my night in triagony trying to stay awake. The normal screamer nurse was out there.... she sits, directs from the chair and takes breaks. Thats about it. Occasionally, when the timing is right she may go to the back to "evaluate" a forensic patient. These seem to take the greater poition of an hour after which she really does need a break.

There are days where I just want to scream at the top of my lungs and go running out of that shithole. The people, the management and the staff are really starting to make me crazy. I doubt it showes because Mis MerryFuckingSunshine wouldn't dare frown because one of those nosy bitches would probably write me up!!!

Opinions

are like assholes, right?

Like I don't have enough crap going on, I have been filling some of my (nonexistant) free time volunteering back on the ambulance. This is where my initial hook into healthcare started, so its nice to take it full circle. I have an interesting perspective having done this for years both inside and outside of the hospital. At dinner the other night there was an interesting debate about healthcare and some of the city's more interesting residents.

A new EMT wanted to talk about how the residents of the housing projects really aren't given a fair shot. They don't have anyone to teach them how to grow up to be responsible adults that find value in things beyond simply material. Her thoughts were that we, as a society, don't do enough to educate people and allow them to find value in their own lives. The medic (who also works in the city) obviously had a different point of view. He sees the citizens at their worst. The crumble down homes where people treat each other more like animals than people. These same homes (or apartments) that have plasma TV's, aquariums, guns hidden within reach of children and drugs being sold from the front porch. I feel myself a little conflicted when it comes to that debate. I would love to take the optimist side and hope that with education, support and direction, that people from the projects would embrace a more traditional "better" life. Realistically, I think thats bullshit. There are people my age and younger that don't work, because they don't want to. They get a check for being disabled (ADHD, depression, PTSD) you name it. They have no care in the world how they are going to pay for Christmas gifts, mortgages, car payments or children's doctor visits. The ER is just as good as primary care and we can get them a cab ride home. Its an infuriating state of affairs. I suggested that the new EMT ride in the city. She might change her tune a little.

That night we ran 5 calls. 4 were patient refusals. 3 involved stupid drunk people that called 911 for a variety of reasons (assaulted, hives and...someone put bleach in my drink). 1 was a dumbass chick who fakes seizures to get valium. I've seen her twice in my ER in the last week. The last time she got pissed, told us to fuck off and left. The medic has transported her a couple of times also. I was a little irritated that he was being nice to her. Not that I am a bitch to my patients, but she certainly wasn't gonna get the "sweetheart" treatment from me!

 The last call was a girl who was punched by her uncle while she was driving on the highway. She was a tiny thing and he popper her in the mouth, pulled her hair and ripped her shirt. Why? She says he wanted to drive the car (he was suspended). The state police hauled his ass to jail.

Spider Monkeys

About a year ago I celebrated "Beat the Fuck Out of Your Nurse Day." AKA the day the chick that hit me got off in court. Yesterday I celebrated "Don't Kick Your Fucking Doctor Day." Christmas night some drunk asshole in police custody managed to donkey-kick one of the residents. He got the rest of his lockup eval facedown on the floor. So his day in court arrived. I went with the doc so she wouldn't have to go alone. Going to court sucks enough without having to be on your own. This little bastard was 1) still in custody and had been since Christmas (insert Eliot in the Morning insane laugh here) and 2) had the balls to plead not guilty. After a few tense words and some priceless advice form his court appointed lawyer, he changed his tune. He got 12 months with 6 suspended. So 6 months in jail. Not bad... not great, but better than a walk.

Things have settled down a bit in the aftermath of last weekend. People are holding it together and life goes on. The moon must be coming to full soon, because the freaks are out and about. Last night some lady told me that the spider monkey in her purse kept telling her to kill her sister. My first thought was to check her purse and make sure there wasn't actually a monkey in there. Yes, we have had monkeys in the department before. No monkey, psych consult, haldol.

I also received a pretty fucked up call from communications the other morning. One of the psych adult homes was sending a patient to us. She was pregnant (not sure how far along), and delivered in her room with her roommate. They cut the cord, tied it around the baby's neck and then dressed the baby in adult clothes. The staff didn't find out until 3 hours later. The baby was (obviously) dead and mom was schizophrenic and had no idea what the hell she had done.

No words

I know I can't do the remainder of this weekend justice with my words here. I don't think there are any words to fully describe Saturday night. I started in triage. No big deal. Not busy, not even steady. At 2300 we were told there were multiple aircraft inbound. No specifics, they just needed another nurse. It turns out that a man had walked into his family home, shot his wife in the head, his 10 year old boy in the head and an 11 year old daughter in the chest. Thats all we knew at the time. As the team got organized and prepared to wait we wondered what the hell else had happened? The boy arrived, intubated and unconscious. I saw his wound (point blank with a .22 to the right temple) and his CT (catastrophic).

While we waited for the rest of the family to arrive, multiple other traumas rolled in. 2 from an MVC with crazy bad ortho injuries and a woman with a partially ruptured dialysis graft. There were also 2 stab wounds one who was sexually assaulted prior to being stabbed.

Mom and another daughter showed up and more of the story was brought to light. After dad shot the 3 family members, he proceeded to rape a 13 year old daughter before turning the gun on himself. After he shot himself, the 13 year old picked up the gun and finished off the clip into her father.

I mentioned what it was like watching the death of a family the night before. This was just as awful. There was something in the air this weekend that was just wrong. All of the staff pulled together, but it obviously took a toll on everyone. Saturday night there were over 20 traumas. People were physically and mentally exhausted. Is there support for the staff after a weekend like that?

Nope

For Brad

8 hours is not a princess, nor is it a full shift. I was described as a super-princess (yeah!) or (as I put it) a glutton for punishment. 8 hours in triage on a Friday night. Hell, at least it's overtime!

I continue my super-freak streak with the 3 Crazy Boys:

1) His balls itched for a few days. Then his penis began to itch. Then his penis began to swell, but only where he had scratched it. Oh, and the skin don't feel right. Its supposed to be smooth and its all pebbly. But I don't got the std cause I be haven that before. 

                        OK, Have a seat in the waiting room, we will get you registered and seen

2) The note from the screener nurse said "Knot on leg" Take that for what it means. When I think leg I think LEG. 6'6, 300lbs, the first thing he does when he walks into the triage room (which has 3 out of 4 walls all glass windows!) is drop both pants and boxers on the floor and whip his junk out. WHOA! I seriously wasn't expecting that. Turns out the "knot on leg" was a hematoma up in his groin. He truly wanted me to feel it. 

                         Ummmm..... I don't have gloves on. Pull your pants up, have a seat in the waiting room                                                                   and we will get you registered and seen. 

3) 

                       (AM I DONE YET?!?) My night has been shitty, I'm tired and its 5 minutes to shift change. 

"Assaulted" on the screener note. I was assaulted by 20 people at 6 last night. I got tired so I went to bed. Mmmmm, you are pretty.... 

                         Thanks, so what happened next?

Well, I went to sleep and woke up. Damn, you are pretty girl. What your name?

                         You woke up and then what?

Where your ring? Ain't you got no husband? 

                           I don't wear a ring at work. What medical problems do you have?

Schizophrenia and bipolar

BZZZZZZzzzzzzZZZZZzzzz

Its the return of the bug zapper!

I think that as I have matured as a nurse some things have begun to bother me more than others. There was a time where I could strictly focus on the physicality of an injury. Mom, daughter and daughter's friend driving home. Somehow there is an accident and the car hits a tree. The daughter is flown to us with leg trauma, facial trauma and is promptly intubated. The friend comes by ground. Other than a leg fracture, she will be ok. Parents show up as the first child arrives, but before the second. Dad, who is alone, is asking about his daughter and where his wife is. 

Wife is still pinned in the car. They have shut one helicopter down and are still trying to cut her from the wreckage. I can't tell her husband that. I just tell him that we haven't heard from the helicopter yet, but that I will let him know when I hear something. 

The flight crew finally calls in report (it took over an hour to free her from the car). She was unconscious, unresponsive the whole time and has coded in the aircraft. The crew is doing CPR. I can't tell him this. His world is going to change, this will be the worst day of his life and I have to pretend that nothing is going on. Unfortunately, I couldn't handle it. I asked one of the other triage nurses to take the screamer desk and bailed. I saw her come around the corner into the trauma room. She had dead person's feet. (for those of you who understand what that is). After 45 minutes they got a pulse back and she went to the OR. I still couldn't go back to see her husband. I couldn't look him in the eye after that. It was like watching the death of a family, but the family doesn't even realize it. 

That stuff didn't used to bother me. I didn't look at the humanity of trauma, just the traumatic injury itself. So to my friends out there.... hold your families close today. Realize how lucky you are. Make time for the ones that you love, because all that other stuff will be there tomorrow. You family may not. 

BZZzzzzz

4 hours of trauma, 8 hours of triagony. Started the shift with a self-inflicted GSW to the chest. .50 caliber muzzle loader, tachycardic and hypotensive on arrival. Unbelievably, trauma decided to crack his chest BEFORE he coded, drop a couple of units of blood in him and whisk off to the OR. For only the second time in my career we might have an ED thorocotomy that walks out of the hospital.

Out in triage things were a different story. Sitting at the screamer desk wondering if crazy is attracted to me like mosquitoes to a bug zapper. Random, skinny white person, it wasn't until she spoke that I knew it was a woman. I thought she was just homeless, looking for a place to stay. When she came back to the desk and started rambling I realized that she was batshit crazy and delusional. My dear, would you like to talk to someone about your worries (please say yes!)? Yes? Ok, lets get you in the computer and you can go talk to the triage nurse.  BZZZzzz!!!

Lil old guy walks up to the triage desk. Socks pulled to the knees, flannel shirt and thats about it. It was a windy night and he was flappin in the breeze. He wanted to be seen because his wife hit him in the head with a frying pan. Really honey? Is that what happened? Did she steal your pants too? While the police talked to him about possibly filing a report the other nurses got him a gown. The coordinator stood in the background quietly singing "pants on the floor, pants on the floor."
BZZZzzz!!!!

I walked into green the other night and found multiple police surrounding a crazy looking black guy in one of the hall beds. He was naked (noticing a trend here?) with his boxers tied around his neck. He apparently did this in front of the hospital security. As they tried to remove the shorts he shoved a sock in his throat.
BZZZzzz!!!!

Gotta love it!

Screw Jet Blue

My relaxing long weekend in the Keys was foiled by the incompetency of a freakin airline. We had weather issues, cancellations, lost luggage, problems with re-booking... you name it. So instead of arriving in Islamorada Friday evening, we got into Key West Saturday evening. No swimming Bahia Honda, no taking our time through the Keys. Honestly though... when you are in good company this really doesn't matter.

Beers and pool at Captain Tony's, slurpees on Duval Street and a walk on the 7 Mile Bridge at sunset were exactly what this little girl needed.

I'm not going to say that reality is any easier now that my little runaway is over, but that certainly took the edge off.