Fire

It has been bad lately. Really really bad. One of the headlines in today's newspaper is that traffic fatalities are at an all-time low this year. From where I stand, its very difficult to see that. We have had multiple fatality accidents in the last 3 days.... and I'm sure tonight will be its usual nightmare. We have also seen a HUGE increase in house fires. One of the Docs said last night "'tis the season." Actually, no. It doesn't have to be the season. People are not having smoke detectors, not using them or just plain being stupid. The burn ICU is filling as fast as it can be emptied. By emptied I mean ANOTHER burn patient has died. I can count.... 6 fatalities in less than a week. I can't even remember how many fires. Its old, painful and emotionally taxing on us all. 

I have been slack at posting recently but will try to do better. I am not in charge tonight... THANK GOD. But we will have to see what happens. Am working on New Year's resolutions. Running the 10K is one, taking more time for myself another. I would try to give up the Dt Mt Dew, but how's a girl supposed to survive???

WBL

Short note tonight because its snowing like a motherfucker and I have to leave early. WBL's brownie days are numbered. Seriously, gonna feel like I'm killing santa here, but you can be a nurse... or you can sell brownies. You cannot sell them to patients and families while working the desk. You can't leave your patients in the back to go sell them on the floors. You can't be "working the phones" or work with email orders while being in charge. I'm done, seriously. DONE.

Not sure how to handle from now. This has to end. She sold brownies and slept all night last night. We were busy as fuck. I'm much calmer now, but holy crap. The medic had to calm me down so I didn't tell her what was really in my head. I'm back in triage with her tonight. God help me.

Burn

My last of 4 straight, the day before my long weekend with fun plans. I'm in triage. Praise the lord, I can relax, read and not be completely exhausted. I can watch whats happening in the back, but am not stuck having to deal with the drama. I had a couple of sick ones come in, including a young hispanic guy with varices that bled about 2 weeks ago. (he was in green when I was in charge and had a hgb of 4) He was back, with a trash bag full of blood. Bleh.....

At 315 I get a phone call.... "we need you to go to the trauma room, the nurse has to go home." Normally, not a big deal. Tonight though the chief is a chick I went to middle and high school with. I didn't like her then, and I don't like her now. She is one of the people that I mentioned previously. Her whole childhood through adulthood she has been groomed to be a doctor. She really has no other worldly knowledge and has always been a little "holier than thou." Not a good way to deal with a nurse who has been here longer than you have, and has bailed your ass multiple times. But there we go......

I picked up a burn patient. He was asleep in a trailer when it caught fire. He was burned from the nipple line up and circumferential bilateral arms to the elbows. It was a white guy... but you wouldn't know it to see his head/face... he was THAT burned. The flight crew had him tubed and I picked him up in the CT scanner. Why the hell she decided to scan a burn, I have no fucking clue. Car accident with fire, yes, explosion, yes. Simple house/trailer fire? WTF?!?!? So the patient's transfer to the burn unit and procedure room has been delayed because you want to shotgun scan this patient.

On arrival back to the trauma room I started hanging more fluid. I asked the docs what the rate needed to be... (hello parkland formula friends?) The didn't know.... So I hung LR on the pump to each line and told them to pick a damn number. They had 1) done a cyanide kit since there was furniture burning in the trailer so the urine was grape-ape purple  2) been unable to place a foley. As I'm trying to get the lines straight, urology was setting up to dilate and then place a foley. There were 8 doctors watching this process. Myself, respiratory therapy and urology were at the bedside. These fuckers kept yelling out orders..... I had to assist urology, get the fluids squared away, get the patients sedated since he had NO sedation, have him loosely restrained so he wouldn't pull his tubes and continuously listen to...

"has he had a tetanus shot?"
"he needs a gram of Ancef now"
"why isn't he on the monitor?" (he was still on the portable one..."
"why aren't we monitoring his pulse ox?" (because all of the places to put it are BURNED dumbass....plus he is on the capnography)
"why doesn't he have an a-line?' (did you put one in you stupid bitch?)
"why doesn't he have versed and fentanyl hanging?" (did you order it?)
"has he had a tetanus shot?"

The burn fellow proceeded to yell at me because he had received a liter of normal saline before going to LR. This had been done by the flight crew, and had completed in CT.... before I ever saw the patient. But it was now my fault.... a problem that I reminded him was not going to stay with me. I have known the burn fellow for a long time as well and don't take kindly to being yelled at for something I have nothing to do with. All 8 of these fuckers continued to bark orders like a firing squad as I took care of the patient. I was too pissed off to even think straight. RT saw my face and was helping as best she can. The intern jumped in.... she was a medic in the ER and is a smart girl. We got as much as we could done..... and I called burn to give them an update. Their complaint? The patient hadn't had a bronchoscopy done yet. Again..... not my fucking problem.

In the elevator on the way back down I went OFF. Respiratory was laughing so hard we missed our floor. She said that I kept my cool very well.... but I continue to call the chief an ignorant-cow-worshiping-c u n t behind my mask. Not very politically correct, and I'm sorry if I offend, but that's how I feel about her.

Go eat a burger and stay the hell away from me, thanks.

ER

A long time ago... or at least it seems that way, I was in middle/high school and I LOVED the show ER. I loved the cool medical stuff they got to do and how things happened so quickly. I watched the show for a long time... or until whats-his-face got his arm cut off. I never really cared about the drama. I have the first season on DVD. Its an interesting thing to watch now. I look and see the reality behind the drama. Almost every patient or storyline rings true to something I have seen in some way, shape or form. I never thought I would be doing the things that, at one point, I only saw on tv. Maybe I'm a little more appreciative of my job these days. Some days still suck ass and management has a new trick up their sleeves regarding our schedules and how to make the nurses "more friendly." I had a coworker pull me aside the other day to tell me that I am an outstanding nurse (her words, not mine). That was a really great feeling.

That same night one of our RTs came in with an acute asthma attack. I have taken care of her before and know how sick she can get. I had her in the first room I saw, lined with mag and albuterol before the doc even walked in. She couldn't even talk, so I talked for her. Like I said, we have a history.... she was so appreciative. We kept her from getting tubed, but she did end up on Bipap in the ICU. At the same time I was pulled into another room to help give tPA to an acute stroke. Other than the charge nurse and myself, nobody in  green had worked in my ED longer than a year. That makes for a tense situation when we are busy and have 2 high acuity patients early in the shift.

We have unfortunately come to the time of year when it gets COLD. I mean really fucking cold around here. The first snow Friday night brought in the drunks and those who were unprepared for the weather. AKA: the homeless who were unable to get into the shelters in time. We had a run of "chest pain" and "suicidals" who by-the-way needed a place out of the cold for the night. We also have a new frequent flier... she is from the southern area of the state and came to us as a transfer about 2 months ago hen she hadn't been to dialysis in over a month. Since then she has been in and out of the hospital for a million different reasons. He family now refuses to take care of her, so she is essentially homeless. She has been staying in a local hotel on the hospital's dime with the promise that she will pay when her check comes. We all know that's gonna be the same day I start as forward for the Knicks. She has been kicked out of the hospital multiple times and has started the hippity hop around the city.

I guess if this was TV, someone would adopt her, or find her a place to live. In the real world.... who the hell knows. She will be back this week, I can promise that.

Med Students

We deal with a lot of students. Nursing students, medic students, PA and NP students. The overwhelming majority are med students. Their third and fourth years are spent doing the rounds through the different departments and specialties. I guess the idea is that they will get a taste of everything and then know what they want to be when they grow up. I mostly see them when they are on trauma (third year) and when they do ER electives (fourth year). 

One thing I have found... they are not created equal. They ones that I seem to click with the most are the ones who have had real life experiences. They have worked real jobs and know that life isn't handed on a silver platter. One of my best buddies (and a damn good doc) was a bar tender prior to med school. She is able to relate to people on a real level. I think that is why she is so successful. I have run into students who have never had a real job. Their whole existence has been focused on "becoming a doctor." I think once that happens they have to realize what was lost in the process. How can you be a doctor for people if you don't really know who people are?

That's one of the things that I do love about emergency medicine. We see everybody. A couple of weeks ago I took care of a state senator.... and then some drunk dude who wanted "512's" (512=percocet.... one of the many lessons I have learned). I have cared for nobel prize winners, celebrated physicians and minor celebrities. My last night in the trauma room I was the nurse for a cute 23 year old navy kid who is being deployed and a young girl who starts nursing school in a couple of weeks. 

My students that night in the trauma room were great. One was a city medic who is going through med school. Most of the medics that I know who have gone through med school have been excellent. There are a few who have forgotten where they came from. They forget that going through school doesn't make you better or more important.... just a little more, or differently educated. 

I try not to forget where I have come from. I remember what it was like to be new and learning things. I think that's why I like students so much. I love teaching... when they want to be there and learn. 

Ok, boring as hell today, this I know. I will have to remember some more of the night that stupid fell from the sky and update then!