Time to Vacate

Its that time again. Time for the Jeepgirl to run for the damn hills (the beach in my case). If there was ever a time where I needed to get away, its now. The big D is almost final, work is as stressful as ever and I'm still trying to make this whole thing work on my own.

So here it is, 330am, the day I am supposed to leave. I'm almost packed, almost done cleaning and almost ready to go pay the water bill which is overdue. I have also managed to be exposed AGAIN to both Group A Strep and TB. Just what I want before vacation. The mold at the rescue squad has gotten me sick, and I have (apparently) been bordering on dehydration for the last couple days. Yes, its time to go. Maddux is packed and ready while I am convinced that I'm going to forget something.

My solution to the stress? The Holiday on DVD, swigging cough syrup from the bottle and venting non-medical BS on here just to quiet my crazy mind. I know I'm happy. I'm happy in a situation that very few could be happy in. I like the direction my life is going.... but I don't always love the road I'm on. I see my friends living their lives and I wonder if mine is anywhere near as exciting or busy as that. Am I crazy? Maybe. I'm kind of ok with that right now.

The jeep leaves at 9am-ish. The -ish depends on me getting packed and hitting the bookstore when it opens. Maddux and I will have the beach house to ourselves for a couple hours before the rest of the family arrives. Peace and quiet, sun and sand, here I come.

Straight Back

When Im in triage you really have to work to get brought straight back. Yes, I have sympathy, but at the same time I am a realist. For example, homegirl (39) with chronic menstrual cramping who is 1)here every month like clockwork and 2)can't take OTC meds because of some odd reason is not going to go straight back. I've had cramps, yes they suck. The ER at 4am is not the time or place.

 

The chest pain that one of the sleepy nurses gave a semi-urgent acuity... with a history of MI and stents x11. Yeah, He was going straight back. My mind was made up BEFORE i did he EKG. Before I saw him go into a run of V-Tach. Before I sent the EKG back to the attending to get looked at as I got him in a wheelchair and (gracefully) hauled balls to the treatment area.

 

The GSW to the back that a medic and I hauled out of a car in the driveway. He was a white-black man (in the words of the medic). He was cold, clammy and didn't have a radial pulse. He went directly to the trauma room. The resident, who is a giant douchebag, gave us a hard time about rushing straight back. The patient had a shit BP and went right to the OR.

 

Finally I got a "are you fucking kidding me?" from one of my favorite attendings. There are some things that I never thought I would get a chance to type in a triage note. Bit while boyfriend was giving oral sex is one of them. They seriously thought I was kidding....

 

Nope, this is my job. Gotta love it

Vomit Stew

You know the night in the Green Mile isn't going to go well when it starts like this.... Bed 5.... open the curtain and there is pink vomit everywhere with chunks of what looks (and smells) like feta cheese. The off-going nurse and I rush to get towels down to absorb the disgusting mess. She accidentally bumps the bedside table and knocks the full urinal onto the floor. The subsequent swamp-like mess in addition to the kayexalate shit in the bedside commode is the holy trinity of vomit stew. To think, I only had to wait 15 minutes into my shift for this one.

My last oh-so-pleasant vomit episode was at the END of my last shift when a trauma pt decided to projectile vomit as soon as the rocuronium was pushed. Anesthesia, being the geniuses they are first shoved a yaunker down, and then proceeded to roll the patient towards me! (cardinal sin friends.... vomit always gets rolled AWAY from the nurse!)So vomit ends up all over me, including in my mouth. Blech! Thankfully all HIV/Hepatitis/etc was negative, so all I have is the memories.

The rest of my night on the Mile consisted of avoiding the bitchy nurse who apparently didn't take her bipolar meds and was having a down night, and helping with a code that got lined, a-line, dopamine, paced (they were gonna transvenous pace.... I was the only nurse who knew how to do that one) and coded a couple of times to boot. My charge nurse was upset that I spent so much time helping the nurse in that zone. To which I told the CC.... if there is another CCRN who know how to do this shit then bring her in... if my charge can do it better, then let her take over. Otherwise, shut the fuck up and let me do this!

I also had the pleasure of rinsing out a pair of ears that had obviously not seen soap, water, or a q-tip since the Nixon administration. I put docusate and lido jelly in dude's ears. Let it marinade and then flushed. Earwax (cerumen) is supposed to be yellow/orange.... right? This shit was BLACK, with what looked to be brown and mold too. Fucking disgusting. I couldn't even get it al. He has to go to the ENT clinic to get it removed.

There are nights where I get to scratch my brain and I truly love my job. Teaching the cardiology resident how to effectively use our pacer was fun, but the associated BS with the charge nurse was painful. This place is so painful these days, its hard not to feel burnt out.

The Insanity

Friday.... bought Buffett's new CD (Encores.... its fucking fabulous), dropped the top in the Jeep and cruised into work happy as a parrothead can be, minus the margarita and cute boy that is. Walked in and found I was in charge in Green. Grrr... but its ok, we are gonna be fine. Not even sitting down before the psych OD in the unmonitored, padded room yacks her charcoal and Seraquel/Xanax/Ativan/Percocet combo all over the room and goes unresponsive. A little musical chairs and she is moved to a monitored room, intubated, OG'd, tied down and ICU called. Did I mention that we already had CPAP on an asthma patient in one zone, a 600 pounder (minus boobs.... mastectomy) next door and a new chest pain who was 400lbs, contracted from being bedbound and had crotch-rot from hell? YEAH!!

We decided that it must be dumb-bitch night. Every one who came through our door to be treated was a dumb bitch of some kind. Lots of drunks, some under arrest, some given the jail vs hospital option. Guy spent his dilantin money on booze and heroin and seized. We loaded him up and sent him home. He went home, accused his son of stealing his wallet and tried to kick his butt. The son beat the shit out of dad and back he comes in PD custody.

The WBL was in a zone and had a sick guy come in. AMS from drinking and upper/lower GI bleeds. She can't do shit with him. He seizes and she doesn't get the Ativan that the doc was screaming for. He does, however have all of his blood cultures sent. He has snoring respirations, she wipes his mouth and nose.... I throw in an oral airway and grab the O2. She was a damn mess all night.

The trauma room is getting destroyed. MVC's, GSW to the butt, assaults. You name it. Phone call that 4 more are coming and there are no rooms in Yellow for them to go.... so I get all 4 traumas (already worked up) down to green. WBL gets the ass shot who has a lactate of 16 (!) and needs a bicarb drip since he got contrast. We also got a drunk, high bipolar old lady who ran he car into a pole. She had already escaped the trauma room once. She ran out of the hospital naked and had to be brought back in. So she is tied down, screaming in the hall waiting for a ready bed. I looked up when the screaming stopped.... and she was GONE!

The cops with our drunk seizure guy saw her go through a door to another (closed) treatment area. She had gone into a bathroom, locked the door and turned out the lights. I pounded on the door, called my boss, the University Police and we tried every key we had. Nothing doing. 10 minutes of this crap. Lights intermittently being cut off and on, so we know she's alive in there. Finally, she flushes, and opens the door.... her excuse "I just had to go to the bathroom." OMFG!

Ended my night with a guy who got punched in the eye and had some facial and orbital fractures. He had been there 20 minutes and was demanding that we call the nursing director because he had been there an hour and this bitch (me) hadn't given him his pain medicine. Let me also mention that he pulled his IV's out, drank from the sink when I wouldn't give him a ginger ale and refused to stay on the monitor. He also kept going into other patients rooms looking for me so he could yell. Me 5'0, nose to ... well.... whatever with this evil drunk motherfucker. I didn't back down an inch and he went back to his room. Special forces medics were with us that night... they thought it was hysterical! Maybe I should have been a Drill Sgt!