Hospital of Horror

Halloween Saturday night. Or at least the night that all of the locals go out to party. There was also some kind of Blood Birthday Celebration. (as in Bloods and Crips... its amazing the things we find out about) I expected wall to wall, non-stop insanity. Not so much. Almost a disappointment. Note I said almost. We weren't busy, thank GOD, but the insanity, yes, it was there.

I got a call in triage, not sure how in the hell this guy got the number, but there he was. gay, Gay, GAY on the phone, going off about a "hypothetical" hepatitis c situation. He wanted to know how long it would take for hep c to convert to full blown liver failure. He actually asked how long would it take for the morbidity and mortality to catch up, because I know its coming, I know it. It just hasn't gotten there yet. He also wanted to have this "hypothetical" person TDO'd because he/she had hep c and did not want treatment.  I could have hung up, I could have said no, but it was too damn funny. He wanted to know who the mental health judges were, since crisis is "only interested if you have insurance and they ain't coming to this neighborhood anyway." I mentioned the name of the only judge I knew and he got all excited and decided to 411 the judge's name and call him at home. Oh dear lord.

I think my favorite of the night was a patient brought in by ems. 21 year old college student dressed like a zombie, assaulted with a garden gnome by a guy in a pink bunny costume. Yeah, not making this shit up. Her nurse came up with a plan to cheer her up. (she really was a sweet kid) He googled pictures of various garden gnomes and printed them out. Then he brought the "lineup" into her so she could identify her attacker. She laughed hysterically as the nurse called out an APB for the gnome known as "Fat Bastard." Yes, I work with some special people.

Another drunk college kid didn't fare so well. He arrived with "Expensive-Private-University's finest" drunk as shit, covered with scratches and a broken nose. He also smelled like hay (not sure what the hell that was about). His story? The PD punched him in the nose. PD's story? He was shitfaced and staggered through some boxwoods before falling down concrete steps. I'm sure mommy and daddy are not going to like that phone call.

We had a pair of 16 year olds come in with the Department of Juvenile Justice. They both had pencil lead stuck in their urethras. It makes you wonder if one said, "hey look at this" and the other tried to outdo him. I'm just saying.....

A teenage mother got hauled out of pedes after getting her 23 month old high and eliciting an asthma attack. She was kicking and screaming the whole way out the door.

We didn't see too many costumes, but I threw on some (fake) pearls with my scrubs and went as one of our attendings who always wears them. Off tonight, no plans. I'm thinking pizza and Treehouse of Horror reruns might be exactly what this girl needs!

Nurse

Does what we do change how we respond to things in our own lives? Does the job become more than a job, but a part of us? I'm not saying that if you work at 7-11 that mixing Slurpees and ringing up Big Gulps is a way of life, but you get my point. A cop is always a cop, on duty or not. A medic or firefighter is the same way. One of my favorite quotes from Backdraft is:

The funny thing about firemen is... Night and day they are always firemen.

I would have to agree with that from a nursing perspective. I am a nurse whether I want to be or not. Its in my head, and its in my blood. Its not something I can magically turn off. My ability to size up a situation, act based on outcomes versus just react and the innate ability to separate from the situation in order to get things done is something that has become as much of me as my Buffett obsession and hate of the Yankees.

It is the ability to separate out that has my interest peaked. My grandfather died this week. He was 90. He survived colon cancer, several strokes and my bat-shit crazy (literally) family. His last stroke in January is the one that started the slide. He has been in and out of nursing homes and the hospital since then. I saw him 3 days before he died. He was still completely with it. My crazy aunt was hovering (as usual) and when he asked for coffee she said no. I said fuck that, got a mouth swab, soaked it in coffee and gave it to him. I also promised to bring him a little bottle of bourbon to spike the coffee when she wasn't looking. I ended my visit with a hug and by telling him that whenever he wanted to sleep to just do it, we would all be just fine. I didn't cry when I found out. I was relieved. I didn't cry at the memorial or the funeral..... because I know that this is what he wanted. My mom was destroyed (not her dad... but they were still close), my sisters cried non-stop and I was the freak who didn't cry. I will miss him, but I know deep down that this is ok. Maybe thats the nurse in me.....

It was mentioned somewhere that this is an "Angry" blog. That I am an angry nurse. Maybe sometimes I am. Looking at where I work and the situations that I deal with I think a moderate amount of anger is not unjustified. If you met me in the hospital would you think of me as the angry nurse? Probably not. In fact, the only people that put two and two together are the ones that know me exceptionally well. As I have said. This all began when I needed an outlet to help me vent before sleep. It was never meant to be anything more than that. I look back on the years and remember who I was and where I was going in my life. Its actually quite an accomplishment. So I will continue to remember the people, the patients and the crazy times. Back for Halloween weekend again. I wonder what the Great Pumpkin has in store this year?

The Big Guys

Have you ever noticed that your night has a theme? You go in and everything looks normal. You get settled and start working and things take a turn for the WTF path. I went in the other night and picked up my zone. A couple of non-compliant diabetics, a kidney transplant (2004) with belly pain and a para with a UTI. Sounds like a nice little variety, doesn't it?

I admitted one of the diabetics, sent the para home on antibiotics, and discharged the other diabetic. Then one of the triage nurses started bringing me the weirdos. As I have mentioned, I am short. Quite literally 5'0. Maybe 5'1 in the Danskos if I really stand up straight. This nurse brought me a HUGE black guy. When I say huge, I mean linebacker big,  6'4, 280lbs. This guy started with chest pain while drinking gin in the club. He really thought he was dying and was having one HELL of a panic attack. He was in the wheelchair next to the bed flailing and swearing that he was going to kill whoever "spiked his drink." I tried to get him to move over onto the stretcher and he refused. Actually, he said he hurt too much to move.

Buddy if you can yell FUCK loud enough to be heard in the trauma room then you can most definitely scoot over. He literally looked at me like I was crazy. Then he decided that he needed to go to the bathroom. Well drunkie-poo if you can't walk then you sure as hell can't go pee. Here's a urinal.

Sidebar***** Why do men always look at me crazy when I hand them a urinal? This is not rocket science guys. It's not THAT difficult a concept to grasp!***

He managed to stand and pee on his own. Then he made it to bed where he was so anxious that I had to explain EVERY LAST THING I DID. This is the blood pressure cuff...its going on your arm... these are stickers for your heart (no I'm not going to shock you)...etc etc etc. He managed to be seen by the resident, got a chest x-ray and then decided he was better and left AMA.

Even before this guy left the same triage nurse brought me another linebacker contestant. This one was 22 and she didn't know what was wrong with him except that he refused to talk above a whisper. I brought him alongside the bed (again) and told him to scoot on over. He whispered, "I can't move." Ok, he isn't paralyzed, his vitals aren't unstable. He was JUST seen at a local Doc-In-The-Box and diagnosed with gastroenteritis. He hasn't filled any prescriptions, he just came straight here. Ok dude, again, I'm 5'0, I'm NOT moving you. He wanted the charge nurse and I to move him... or for us to get his sister out of the waiting room so she could. (Unless she is an amateur bodybuilder she AIN'T moving him) This discussion went on for almost 10 minutes. Finally the attending got involved. He and one of the guys literally had to roll this kid onto the bed. Still speaking only in whispers to the attending the kid was very uncooperative.

So, IV, labs and fluids.... thats whats on tap. I seldom whip out the big guns on the non-traumatic, non-intoxicated souls, but if he's 22 and can't move then its fluid resuscitation time! I was originally going for a 16, until the fucker refused to even move his arm for me. Then I asked the medic (who was dropping off a patient) to go get me orange. The upside of having your boyfriend show up every now and then... he knew EXACTLY what I meant and knows me well enough to know that I was pretty damn pissed to be asking for that. He actually stayed to watch. Orange in the AC without difficulty, labs sent, fluid up. Per the attending... keep giving him fluid until he pees.

My only hold-out was that this kid MIGHT have a low K and that was the issue. Trying to keep SOME faith. Yeah, no. K was perfect, in fact ALL of his labs were perfect. The attending started taking bets on whether the kid would get up and go to the bathroom or pee on himself. I was on the pee yourself, manpants team. 5 liters later he was doing the mad peepee dance the whole way to the bathroom with a steady (and rather swift) gait. I think he had been holding it since about liter 3. So adios kiddo. Way to be a man. He spoke just fine when he asked for my name. The attending has my back if he complaints. This was just RIDONKULOUS!

Fucking Nurses

I usually save my rants for the physicians and the occasional police, corrections guards or medics. This morning I'm frustrated with nursing. I'm mad that being smart and doing the right thing doesn't get rewarded. I'm frustrated that when we have joint staff meetings with the physicians that there are dumbasses that are allowed to talk and make us all look incompetent and shallow. These people are the reasons that I have to scratch and claw to get taken seriously. We are discussing how new renovations to the department are going to change how and where we see patients. Due to some fucking dumb nurses it became a discussion of how retarded department of corrections officers are.

One of the worst is a day shift RN who (after 15 years in the department) STILL doesn't know how to start, maintain and titrate an insulin drip. I have written her up twice in the last 2 months. Nada. But people like me who bust their ass to remain certified and competent above and beyond what is required get second guessed because of her stupidity.

For example: I took a lady with a past history of CVA and a recent fall to CT for a head scan. She currently takes coumadin, so the index of suspicion for a traumatic bleed was a little higher. She got scanned and there was no blood, just the old area of infarct. I brought her back and told the resident that she didn't have any acute findings on her scan. His response.......

how do you know? It hasn't been dictated yet.

I worked in neuro ICU fucktard. You wanna argue this with me? (I actually said... I worked in neuro ICU, I can read my own head scans, thanks)

The medic told me that he can tell when I'm having a good night versus a bad night based on how much I bitch. If its the patients then its usually not a terrible night. If its the staff then it doesn't matter how good the patients are, the night still sucks. My night last night wasn't bad. I worked with good people and the patients weren't too bad either. Our nurse manager picked up a night coordinator shift which (at first) was a little intimidating, but as the night wore on she actually did a pretty damn good job. She made a point of touching base with everyone to see how they were doing and if there was anything she could do to help. There was no micromanaging... just support. I was surprised. I did however have to hide as I chowed down on oreos at 3am. Hey, sometimes you just need a little milk and cookie pick-me-up!

Some days I wonder what they would all say if I made this blog known. How much of a shit storm would erupt? Well, if something ever happens to me I certainly hope that somebody will print this out and drop it in the schedule book...

Here's what was hiding behind the evil smile!!!
Love,
that short nurse.

and now back to regularly scheduled programming!

Bend Over and Take It

Just for the record... I signed up for overtime Friday night. I was going to sit in triage for 8 hours, get paid time and a half and read/work on my bucket list (new goal).

Best of intentions, right?

Before I even left Friday morning I had been moved to Green. I slept like a ROCK Friday and woke up at 8pm to get ready and carry my sorry ass in. When you are greeted by the other charge nurse, the clinical coordinator and an "I'm sorry" maybe you should fake a prolapsed uterus and run for the hills. Yeah, I got FUCKED.

I had WBL (the Wandering Brownie Lady), a nurse who has been here for a thousand years, left and came back (slooooowwww) a decent nurse and an LPN who just celebrated 35 years with the hospital. Ummm.... do the math, I was down an RN. I was expected to do charge, the fishbowls around the nurses station and be backup for the LPN who was assigned a zone. On a Friday night, no less. This place continues to baffle me.

We managed, barely. The WBL took her sweet time and I ended up writing up most of her people. The slow nurse bitched any time I gave her a patient (and then expected that I write them up and get an IV) the good nurse, bless her heart, busted her ass to help me, and the LPN kind of walked around looking lost.

The WBL got a guy who had pain from coughing too much. So, like any other smart citizen of the city, he paid $20 for some liquid morphine off the skreet. He went home, had a beer and took a swig of his new "juice." EMS found him unconscious on the floor with a GCS of 5. A little narcan and he was back with us. Another gem saved from Darwin's evil clutches.

SLOW nurse got a guy who was in and out of VTach with a pulse. He was awake and had stable vitals. She wanted to argue that he needed to go in someone else's zone. At that point all she had was 1 psych patient. I know we have the code room, but I'm not going to overwhelm the good nurse because you are lazy and probably a little scared. (plus, with the way my night was going, I'm sure the best was yet to come).

and it was.... follow your gut friends....

I get a call that there is a possible STEMI (ST Elevation MI) enroute. 39 years old with a past history of htn and that's it. He's in really good physical shape and started having chest pain while watching TV. We don't alert him as an AMI, but we all jump on it nonetheless. His 12 lead showed flipped T-waves in V1-V4. Not an acute MI, but not pretty. He bought himself a nice lil cardiac workup. He was brady in the high 40's to mid 50's but his pain was relieved by nitro and a little fentanyl. Chest xray, nuclear medicine study and labs were negative.

He arrived at about 2am, At 645 I was getting ready to write up a drunk 18 year old who got his ass beat downtown when I hear myself, the coordinator and medics paged to the code room. Our young friend has brady'd down and coded. When I ran to the bedside CPR was in progress and he was in fucking PEA. We threw him on the geezer squeezer,  got him tubed and started doing the code drug thing.

NADA. NO response whatsoever. He was in PEA so we didn't shock him. At 39 years old, what the fuck was wrong with him?!? The attending is one of the younger guys who is much more aggressive than a lot of our docs. He suggested we try a pericardiocentesis. People were yelling for betadine and there was none to be found, so a big squirt of hand foam did the trick. Needle in.... nada out. Bigger needle in.... approx 5cc of blood out. The attending looked a little frustrated when he said "the last thing we have to offer is to open his chest and see if he needs a window.

Immediately a gown and mask was tied on me and the chest stuff appeared from the trauma room. The second year resident and I worked together and cracked this guy's chest. He cut, I pulled. He wedged, I cranked the spreaders. I held lung, he opened the pericardium. I pulled a HUGE clot out while he did internal massage. He suctioned while I did internal massage and then he got the internal paddles ready while I gave intracardiac epi into the left ventricle. All of this with a growing audience and an attending who let me talk the resident through the procedure. After the internal paddles failed to produce a rhythm he was pronounced. All of my special forces were able to look and touch and ask questions, as long as it was done with some dignity and respect. I think there is a picture that was taken of my hands in the chest (no identifying pt info) so if I get it I will put it on here.

The oncoming charge nurse had already gotten report from the other nurses so I didn't have to do that and the guy getting that zone (BLESS HIM!) told me that the only thing I was allowed to do to help him was to carry my tired ass home.

So, that was quite an eventful way to end a very long and painful night. Definitely a first for me, but having the attending pull me aside and say I did a great job did feel pretty good.

My Way

As Sinatra said "I faced it all and I stood tall and did it my way." Yeah, we had some crazy peeps last night that sure as hell did it their way. I don't know the current status of the moon, I'm a firm believer in the full moon phenomenon, but damn there were some crazy people last night.

I rolled into the "code zone" with the isolation rooms and the designated CPR room. Not a bad assignment if you're walking the Green Mile. All male patients, all valid complaints, no real worries. There was a screaming psych patient in the padded room that didn't like me too much. I don't know what I did, but sistapants did not like me. She was screaming at the crazy dude in the room next door until she saw me. Then she started screaming that she was "gonna jump off that motherfucking bridge until that short white bitch got involved." Ummm.... I was asleep when your crazy butt got brought in lady. As she was flailing and screaming in her room the crazy guy next door decided he was going to use his door as a punching bag. Conveniently, the security guard was down the hall talking to... well, we aren't really sure who he was talking to. Nice to know my safety is in this mall-cop-wannabe's hands.

My gold star for the night goes to a 95lb girl who was brought in for being "combative." I now think that combative was a bit of an understatement. "BAT-SHIT Crazy" may be a bit of an understatement as well. This chick was found in the projects, at 230am beating on her boyfriend's momma's door. She said she was looking for him, but he has been locked up in jail for the last 3 months. When PD showed up she went the hell off. She was throwing herself on the ground, growling, biting, spiting and kicking. She managed to get one of the cops in the groin and then bit the paramedic in the leg. 5mg of valium IM didn't touch her. When she came to me it took 7 cops, 3 special forces medics and 2 nurses to get her restrained on the bed. She then tried to headbutt the cop.... this would have been bad enough, but let me paint the mental picture. Long braids.... black and Oscar the Grouch green. I shit you not. Somehow in the fray several of her "soljahs" were ripped out leaving strands of green and black hair sticking straight up. It was definitely a sight to be seen. It took 2mg of ativan, 20mg of haldol and the super restraints to get her down for the count. Even then she was still cussing and thrashing 45 minutes later.

When the time came to road test her she had a cop on each arm and me from behind with a handful of PJ pants (yeah, did I mention she was in her jammies?) in one hand and an ammonia inhalant in the other. Every time she tried to stop or throw herself on the floor I pulled up on the pants, shoved the ammonia home and then dodges the donkey kick that came at me. I was very happy to sent her to lockup.

Finally a little old lady with a fever came in. She was cooking at 102.9 after a drain was removed 2 days ago. We were getting her into a gown when I noticed something wasn't quite right. She had on little old lady underwear... with the crotch completely gone! At 6am I just couldn't let this one go. "Honey, what happened to your drawers?"  Her response...

"I just get to itchin', I guess I scratched it right out."

Damn

I know they made underwear without the crotch, just not Haynes Her Way!

Decompress

Every now and then someone will organize a night out for all of the ER staff. Usually they just pick a bar and a time and people just show up. I have always had to work or had something I couldn't get out of. This time though I was OFF! So I rounded up my little sister to be my DD (see, I practice what I preach!) and away we went.

Its always interesting to see the people you work with 1) out of scrubs and 2) in a more social setting. I guess you never know what to expect. There were attendings, residents, nurses, paramedics, pharmacy and clerks. A few of the ambulance people showed as well. My poor sister didn't know a soul walking in, but I think she had a whole new group of friends on the way out! I drank, played pool badly and took lots of fun cheesy pictures. All in all it was a really great night. I think my sister said it best when she said "If these are the people who are going to take care of me if I have a big accident, I don't know whether to be worried or not."

well said sista pants!

ps: heffeweisen= good
      apple beer= good
      black currant beer= not so good
      something called duvels=FUCKING GROSS!  (theres a picture of me making the not happy beer face somewhere!!!)