Thanksgiving Leftovers

I did the good and thoughtful thing this Thanksgiving.... I went in early for a friend. She was having 15 people at her house and needed a little extra time. So I had breakfast with mom and my sisters, watched the parade (didn't know half of the people in it.... God, I'm getting old), took a short nap and went to work. The trauma room had been empty all day. There were 2 turkeys on rotisserie in the back, and enough sides and dessert to feed a small army. This was just the day shift!

About an hour in I got the call. Helicopter outbound on a GSW. Fan-freakin-tastic. 61 year old decided to show the kids and grandkids the old WWII era gun he bought. In his turkey-laced state he dropped said (loaded) weapon and it went off... right into his belly. He was rock stable for the flight crew. No issues... until he hit the roof and was loaded in the elevator. He puked turkey, stuffing, mashed potatoes, greens and probably some pie ALL OVER the elevator. He then arrived in the trauma room and crapped out his bp. He stayed awake the whole time, but looked like complete shit. 1 unit of blood and we had him rocking to the OR.

I made my way back down thinking I have now done my 2 good deeds for the holiday and gearing up for the night shift showing of the Thanksgiving feast. Yeah.... the trauma light was on when I got back. 20 year old, 36 weeks pregnant, no seatbelt, head vs windshield in MVC. Ugh. She was stable, very sweet girl. L&D and the OB attending came down to check her out. They put her on the toco monitor and guess what? Yup, fucking contractions. Regular, with a decent fetal heartbeat. CT for a head and c-spine and then to labor and delivery for monitoring and ultimately, delivery, of a healthy baby boy.

I made it back down for yet another red light special. This one was unrestrained, rollover, who also puked her dinner.... every-fucking-where. It was pretty damn gross.

This trend continued through the night. All night long. Almost every hour, on the hour, I got a trauma. I managed to get some turkey in the wee hours of the morning... or little pieces that I was able to load onto a tostito's scoop and cram in my mouth in CT. No stuffing, no green bean casserole and sadly, no pumpkin pie for me this year. After 14 hours of this I was exhausted. I couldn't think, I could barely walk. The world was talking about Black Friday and all I wanted was my bed and electric blanket.

The complaint of the night that made it all worthwhile....

My foot hurts, I dropped the frozen turkey on it yesterday and I think its broken.
         Well, why didn't you come in sooner?
I had to cook the turkey first

Omaa.......

Talkin'

There are things that I am amazed come out of my mouth. I told someone last night... "I used to be sweet, then I started working here." I had a frequent flier psych patient that ALWAYS shows up drunk and suicidal. Last night he was bitching about getting bills from the hospital and EMS. He didn't understand why he was getting bills if he wasn't being admitted. Plus, he didn't even want to be there. My response was twofold. First... "you called us, we didn't call you. We were doing just fine when this bed was empty." I also said "Just because you aren't admitted doesn't meant we didn't treat you. Besides, we aren't gonna see that money anyway."

Maybe not my most therapeutic communications.

I have also found myself using the most basic and common slang out there. Diabetes and hypertension have been dropped to "the sugars and the pressure" (or depending on if you are a little more rural, htn becomes the "high blood").  I know that Epsom salts will fix any skin or GI ailment and that a BC Powder will damn near fix anything you've got from abscesses to the grouch (gout for you southern-slang naive). You can have a "touch" of pressure or sugars, or you're "suffrin with the arth-a-ritis."

Let me also mention my Darwin winner of the night. 18 year old college kid picks a fight with his roommate, who has 5inches and 50lbs on this kid, over the damn XBOX cables. Roommate proceeds to slam the kid's head onto the floor a couple of times. The kid shows up in the ED with the chief complaint of...... dehydration. Did I mention this was at 4am? His major malfunction? He had the inside of one of his cheeks stuck in his braces. We had to get oral surgery to come pry him loose and sew the lac. What have we learned from this semester there kids?

Charge

I'm not a perfect charge nurse. I try, but I get bored and wander, I play with my crackberry and I generally avoid our clinical coordinators like the plague. That being said, none of that happens when we are busy. I try to help every way I can, I do the gross, time consuming crap so the nurses can more people up and out. I have found that the more time I spend doing charge, the more I am aware of what others do (and more importantly) and don't do for their staff nurses.

I try my hardest to get into every room with every new patient. Even if I just put the patient on the monitor or start a line while the nurse is doing an assessment. That way I get a very good idea of whats going on and just how sick this person is. If I can, I will actually write the patient up for the nurse, frequently doing the monitor, ekg and line, just to save him/her some time. If someone in their zone is sick as crap I will watch the rest of their patients so they can do what needs to be done.... and I can be a resource for them if something crazy happens. (thoracotomy on a chest painer).

My charge the other night was a space cadet. She has been in the department for years and has been farmed out to triage. We have some older, and less than physically capable nurses who get put to pasture and occasionally get sent to the back where they are put in charge. The idea is they have to do  less work this way. As you can see, it depends on the nurse just how much work they will actually do. (one of the more lazy ones will do "care from the chair" she doesn't de-ass the chair for most of the night)

I picked up my least favorite zone. I had an MR pt with AMS, a guy with a ready bed, a new CHFer and a chest pain. The nurse gave me report and left me with.... 1)MR kid needs urine and an IV 2) Call report on the guy with a ready bed 3)Nothing has been done for the CHFer.... no line, no ekg, no monitor, no foley, no lasix, no nada. 4) Needs cardiac enzymes sent.  Not a way to start your night. My charge, did nothing to help. She couldn't even take a charge call from our communications room letting us know about a CPAP patient that was coming. I had to take the call and pull my bed 4 out so I could get the new guy. I also got a new DKA from triage who's chief complaint was the "boils" in her crotch. She also had a blood sugar of 910. She got 15 units of insulin IV, 3 liters of NS, an insulin drip and her blood sugar still never dropped below 650. She was also 23 and a royal pain in the ass! As the resident and I were draining her multiple abscesses my CPAP patient (a frequent flier) scratched his EJ out and bled everywhere and my CHFer puked like a gyser. Thank god for the other girls who saw I was drowning and came to bail me out.

One of the girls actually apologized for my crappy night.  She was very appreciative of what I do to help her when she has a bad night. Hers was a little more exciting (if not as acutely sick) as mine. This was her patient....





Everyone turn your head the appropriate direction and you'll see that this is a human bite to the eye. Pretty fuckin nasty, huh? Optho wasn't sure what to do with it. He was sent to an optho/plastics specialist.

Court

I got to go to General District Court today for a legal blood draw this morning. On my day off, at 930 in the morning. Talk about some bullshit. I was up and getting ready when I realized.... it doesn't make a shits bit of difference what I wear, people show up in their pajamas and slippers. So I threw on some clothes and carried my ass in. I have learned not to bring a damn thing in with me. Seriously, nothing. The exception is a sweatshirt (with hospital logo) in case I get cold.

I am always amazed at what I see in the courthouse. The shit people show up in is amazing. Have you ever seen www.peopleofwalmart.com? This could be its own site. Www.peopleofgdc.com. If only I could take pictures. I saw a big lady in all black skin tight clothes and stiletto pumps, people in dirty work clothes, kids in suits with their lawyers (usually the suits are brand new or don't fit), house coats, slippers, flip flops, sweats... you name it. Curlers in the hair, hair half braided. Its a circus. I looked (per the girls at work) like a walking Gap ad. No wonder people kept staring!

I have learned... get there early, don't bring anything, keep head down, avoid eye contact and I ALWAYS sit right behind the cops. Nobody wants to sit there, so there are always extra seats! So I walk up when my chick gets called. She promptly asks for a continuance and the public defender wants to know what the tech is available to come back. Ummmm.... I looked around, no techs here ma'am. This RN will come back when you need her. Hell, it IS overtime. Now I have 3 pending cases. 2 dui blood draws and a blood draw from a fatality MVC.

If I plan my wardrobe out maybe I will wear some pj's and my penguin slippers....