thoughts from the night shift

Baby Hell

2011-09-06T15:37:00.000-04:00

Still no flight jobs available. I missed one of the postings which thoroughly pissed me off. Now is just a hurry up and wait situation. Working on staying on top of my alphabets and looking into RN-BSN programs. I started one at my hospital but stopped after I got hired to fly. To be honest, I fucking hated it. I was never one for the classroom anyway. If you want me to explain how a head bleed or stemi happens then give me a patient, an EKG or a CT scan. I'm your go-to-girl. Don't care about the aura around patients or the "healing power of music." (one of the girls in my class seriously did a research paper on that.... mine was on family presence during non-traumatic resuscitation)

So this semester the gods have blessed me with a nursing student of my very own. I haven't met him yet, but I have already heard good things. The only downfall is that there seems to be more of a focus on the paperwork and less on the actual experience itself. I am super excited to have a student.... but I think I'm going to need hazard pay for the paperwork!

In the meantime I have been picking up overtime left and right. I have a new AC unit to pay off, big ass tires on the jeep and (oh yeah) a house to refinance. Second job anyone? I applied hourly in the pedes ER. The nurse manager precepted me as an extern 11 years ago (?!?) and we get along great. I gave her a heads up via email and was responded with "BEAUTIFUL, GORGEOUS FANTASTIC will give you a call next week.... with your start date." So much for an interview! So it looks like I will be cutting my teeth in the pedes ER, aka "baby hell." ER, Pedes ER, ICU and flight experience should make me marketable as hell, don't ya think?

180 hours

2011-09-05T04:36:00.000-04:00

430am while I was hard at work (working an inferior STEMI who was given nitro pre-hospital to be exact) my power came back. I returned to a 68 degree, well-lit home and made the medic and I a warm breakfast for the first time in forever. I slept like I haven't slept in a long time. There was a relief and a relaxation that lifted a weight off my shoulders.

As I get my house back together I will get caught up. It has been an interesting week.

Adapt and Overcome

2011-08-31T21:45:00.000-04:00

101.5 hours and counting. People at work knew I didn't have power. The mismatched scrubs and Pippi braids gave it away. Not to mention that I wasn't actually on the schedule (whoops) and I begged to stay. (I think it came across as "please don't make me go home to that hot dark house!)

So I got home, crashed and prayed for power and tried to sleep. Woke up in the hot dim afternoon. So tonight I've said FUCK IT and taken up residence in the Holiday Inn Express. Will indulge in several hot baths, ice cold drinks, comfy, cool bed and pray to the power gods for better luck tomorrow.

Plague?

2011-08-29T15:41:00.000-04:00

Fire, earthquake, tornado and hurricane. Now on 48+ hours with no power. This Buffett-cation was spoiled! Hopefully back online (and hot showered, air conditioned and well-rested) soon.

Window Licking Good

2011-07-23T10:32:00.003-04:00

First and foremost, I'm a little pissed right now. I worked nights, am on the way home and the major-ish roadway that turns into the minor-ish road that I live off if is a parking lot. Cars bumper to bumper. Its 97 degrees, the top is off, I'm in scrubs and I can see my damn turn. WTF?!? Then it gets better. I find out that there is no accident, no life-threatening emergency that has shut down traffic in order to land a helicopter.... the fucking mega-church down the road from me is giving away free gas. Every ghetto rat and trash in the area has clogged my egress from work and is on their way to MY turn, MY road, behind MY Kroger for free gas. Fucking ridiculous.

In other brilliant news the ER renovation is in full swing. Triagony has been moved to a completely new building so the "hole" has been replaced by the "back 40." It is quite a hike to the treatment area. It is even longer when you have an out of control psych patient, sick patient or any combination of not-so-good that walks in. On the upside, the triage rooms are BIG, have their own sinks, there is a room for EKGs and the screamer desk now has bullet resistant glass. The whole area is completely locked so you can't just get in. Much MUCH more secure than before. They have even upped our police presence which has been a noticeable and welcome change. (with the exception of puny girl who is only doing the university police thing because of daddy's connections. She has yet to impress me and is currently being investigated for NOT acting when the 21 year old the other day went off and she walked away). The bullet resistant glass even has those microphones like at banks so I don't even have to SMELL the patients when they come in. BONUS!

The windows do get pretty raunchy though. People are always touching and knocking on them. I had a drunk girl use it to blot her lip gloss and many many people sneeze and cough on it. (No vomit yet). I once had a drunk psych patient lick the window. I wonder if he could taste the Berry Craze Lip Smacker?

One of the other upsides to nights is breakfast. Greasy spoon diner that has an early liquor license, great food and will let us in and serve us as soon as we show up. Normal opening times doesn't apply to the ER staff! So had a nice wind-down breakfast with a cute boy and then headed home to get my sleep on before 12 hours in charge.

One more

2011-07-22T16:29:00.002-04:00

... for the cheap seats....

I told a first year dumb-ass resident to go to hell in the middle of the nurses station. He had it coming. My attending laughed so hard he choked on his drink. One of my prouder moments. :)

July Effect

2011-07-22T16:23:00.000-04:00

I have never been this long without posting... ever. I half expected this thing to be gone when I got back. Drama on the home front has kept me away. Work is what it always has been. Will give the highlights sometime. I am going to continue to try to keep this a little more up to date. I think I need the time to clear my thoughts and bring myself back to center again.

For the record: Last shift 2 of our Police officers were spit on by a psych patient. (who had the courtesy to yell "I have Hep C" just before he did it). I had 2 city medics forcibly restrain some son of a bitch who said he was going to bash my skull in. (said SOB is a frequent flier from the bus station who was being seen for "malaria and bee sting") and another adorable 21 year old came in naked, strapped down and under arrest for spitting in the EMS provider's face. Let it also be said that he only had 1 brownie from that strange dude which probably contained the 'shrooms, exstacy and booze that caused him to act like that. He was a little more subdued when the magistrate walked in and then he walked out in police custody.

I also had the surgery intern tell me that my attending couldn't put the chest tube in a lung cancer patient with a tension until her chief got down. To which my attending told her to "get out of my department." God I love an attending with balls that isn't afraid to use them in July. Yes, it is july. There is even an article on the wall of our breakroom that outlines the "July Effect."

July Effect

I think that about covers it.

Catch Up

2011-04-16T03:44:00.000-04:00

There is not enough time or web space to catch up for the last two months. In a nutshell.... I started running (first race not too long ago), the ER is a hot mess. We have a new director who looks promising, however that doesn't make up for the fucked-up-ness (new word) that the management left behind has implemented. We have had sad cases, our frequent drunks are the same and sometimes people work together and the job gets done. I told one of the bitches to fuck off when she tried to boss me around and even got the clinical coordinator to tell her to back down. I took a lot of shit off these old wenches and that day is done. Nobody is going to just walk over me anymore. That might cause some waves, but in my opinion that is exactly what that shithole needs.

Hope to keep up a little better.

Welcome to Paradise

2011-02-11T17:25:00.000-05:00

Not sure why I do this to myself. Last week.... 5 12 hour shifts in a row. 1 day off then back for 4. Was I on crack, or was it the schedule lady? How many licks does it take to get to the brain of a work-a-holic ER nurse? The world may never know.

Tired, a bit punchy and ready for this stretch to be over. At least I have Mt Dew and Monster to keep me company tonight. Charge again.... because the last time went SO well. Had a mini breakdown and had to have 10 minutes of "me time" when I was in charge last. That is a story for another post and another day. Right now I just don't want to go to work. I tried to get myself TDO'd to St John's, but to no avail. We must have open psych beds for a change.

Oh well..... back to the trenches for me. Hi Ho, Hi Ho its back to work I go!

Float

2011-02-05T16:57:00.000-05:00

I started an 8 hour shift in triage quite literally playing on the computer, triaging STD's and watching WBL sleep at the desk. The coordinator called and said that pedes was getting hammered and could I go help them out a little? (when I flew we had some sick kids) So sure.... I'm up for a challenge. Pedes nurses, especially pedes ER and ICU are very protective of their patients. They don't want just any adult nurse to come take care of them. Even though I have known some of these girls for a while, they were hesitant to let me do more than grunt work.

I'm not one to sit on my butt, even in that situation. I jumped in right away. Grunt work, whatever. The charge quickly saw that I was there to work and that I had worked with kids before. They then started having me starting IV's, medicating kids, discharging.... you name it. I was even taking a patient or 2 of my own after a while. They were so grateful to have the (competent) help. I told them that I have been trying to officially cross-train over there but have been getting the push-back from administration. They wrote down my name and I have a feeling I might have a part-time job offer by the time this week is out.

Do I want to be a dedicated pedes nurse? No. But since I work so much overtime it can help prevent adult ED burnout and provide a new opportunity to learn something. Plus, from a flight standpoint it will look really good if I have Adult ER, Adult ICU, Pedes ER and flight experience. I'm just sayin'......

Plague

2011-01-17T19:31:00.000-05:00

This time of year is always interesting in the department. Last year it was the Swine Flu panic. We had a special waiting area for any flu suspects and we were all vaccinated for both regular flu and swine. This year I lined up for my flu shot as usual. (hell, 9 years flu free... I'm going to keep it up) I don't know what the hell is hitting the department now, but its terrible.

The current plague that is hitting the staff is the GI bug from HELL. Seriously starts as a little abdominal pain and maybe some diarrhea then turns to full on puking, pooping nightmare. People get hit and then its on. We try to get a line in the staff and tank them full of saline and zofran before we send them home. The ones who can't go home (like my bestie, the doc) get an IV, long sleeved shirt and a bag of saline at the nurses station. When they aren't seeing patients they plug in. Its an absolute nightmare. Last night we had 2 of our Special Forces medics go down. Bless their hearts, they were hell bent that they were going to keep working until we had to lay down the law.

The coordinator actually has a list of who is currently sick and who has had it. I though this was a joke until I saw it with my own eyes... over 25 people currently out... no clue how many have been sick total. I have been lucky.... very very lucky. I have a little uri right now.... little cough, no voice but I feel fine. I have, however, stocked my house with the "necessities" just in case. (Gatorade, jello, saline, zofran, chicken soup) Will continue to bathe in hand sanitizer after every patient contact and scald the first 3 layers of skin when I get home.

What amazes me is the people who are showing up via ems for this shit. Seriously, we are sicker than you are and we are still working. Hunker down at home, do what you have to do and life will get better after a couple of days. Too bad the ER didn't do some sort of group "Biggest Loser"... I think we'd have it, hands down!

Epic Fail

2011-01-05T04:31:00.002-05:00

I don't know how to put the last week into words. Epic... maybe. Heartbreaking... definitely. An opportunity to really stretch my brain cells? Absolutely.

Jan 30: I was in charge in green. We have been steady busy leading up to New Year's. People are drinking, partying and generally not taking care of themselves. I started my night walking in to get my shoe covers. (I walk through so much crap that I don't want my new and FABULOUS zebra danskos to get gross). The pharmacist is looking for me. The attending in green is having a problem with an intubated patient on a levophed drip. Her solution...? Wait until I get there and let me sort it out. I guess that is a pretty profound compliment. The levo was for an intubated inmate with crap pressures who was going to the ICU. The femoral line was running well, but the leg was mottled and cold to the touch. The question was: is the leg mottled from the levophed extravasating or from something else. I checked the line, the pulses above and below it (including dopplar) and the CT scans. My conclusion: there was a known clot in the iliac artery. The levo was clamping down and preventing and further collateral circulation. In short, the leg is toast... as well as the patient.

My next call from from our communications room. 74 year old, down greater than 10 minutes, King Airway in place, CPR and drugs (via IO) in progress. So 30 minutes into the shift we get a code. We have a great team and everyone is ready. I then got a call that the patient is one of our paramedic's grandfather. FML. I told the coordinator, the chaplain and the attending. Everyone else was told afterwards so as not to compromise the resuscitation. It went well, but there was nothing we could do. The medic is also a city firefighter and he took it very well.

The rest of the night was steady, but not bad. At 645 I get another one of those calls. Found down in a truck, warm to the touch, CPR in progress. Another code that went very well with my great team. What a way to start and end a night.

Jan 31 New Year's Eve: NEVER A GOOD NIGHT

Let me say that again. New Year's Eve is terrible. As my EMS friends say "Welcome to the SUCK." I started out "floating" in yellow. There was an old dude hit by a car in the trauma room. He was pretty stable. As I was clocking in we got the call that an 11 year old girl hung herself in one of the projects. The crew couldn't get her intubated and CPR was in progress. They worked her for a while. The anaesthesia attending had to intubate because her airway was so destroyed. The EMS crew was a wreck. I tool them over to a waiting room and just sat with them. They are amazing providers who were just taking this very hard. She (obviously) didn't make it. It was a difficult code and a lot of people were affected.

After she was moved home dude in the trauma room promptly tanked and coded. His scrotum was swollen to the size of a volleyball.... obvious internal bleeding. We worked him, squeezed blood in and (for the first time in my career) they actively did external CPR... he didn't get opened... all the way to the OR. He survived, but not sure how bad the outcome will be. Our next contestant was a transfer via helicopter that was either run over by a car or assaulted. He had a depressed skull fracture and a degloving of the scalp down to the skull. Intubated with a GCS of 3. All of this was in the span of about 3 hours. I also helped one of the nurses give tPA to an acute stroke. She went to the ICU and is currently better and terrorizing the staff.

I spent the rest of the shift at the screamer desk fielding the many walk in assaults and their many MANY drunken family members. We did make it outside to hear the midnight gunfire... until it started to sound really close. There was also a pretty big fight at one of the drag clubs. Weave was ripped out and "girls" were struck in the face with beer bottles, wine bottles etc. To Wong Foo + Fight Club. Holy Shit I love my job.

Jan 1: Princess in triage. 4 hours that were beautiful and wonderful. What can I say? :)

Jan 2: Trauma Room Started my evening with a transfer GSW to the chest. He had a pressure of 80. He got tubed, chest xray, 2 units of blood in and to the OR pretty damn fast. He had a liver injury but will probably be ok. The next was a scene gsw. The other half of the first. They apparently shot each other. This guy was not doing so well. He was awake, but his shot to the flank had much more devastating aim. He was paralyzed from the waist down. The bullet went through his cord, took out the head of the pancreas, some spleen and bowel and DESTROYED a kidney. He also went to the OR pretty quickly.

Following that I was blessed with an overdose on Seroquel, Trazadone and Xanax. There was also some heroin and marijuana thrown in for good measure. (I found the pt's stash in one of the pill bottles) She was very large and very, very disgusting. She smelled like she hadn't bathed in weeks. One we got her tubed we started to strip down and clean up. There was a very old and foul pad that was part of the culprit. Bleh. She was moved out to another room to continue to get treated. The nurse was going to put in her foley when I heard my named yelled. She was pierced.... everywhere you can imagine. Head to toe. If you can pierce it, it was pierced. Now I have 2 in each ear and a belly button. My skill with piercings is simply because of my experience. The nurse said she called me because I seemed to know "everything about everything." From a nurse who I really respect that was another great compliment. I went to work with a pair of hemostats and a ziplock bag. I lost count but my best guess is... maybe 25-30 piercings. There were 2 that I couldn't get out and that was because they were placed with a biopsy needle. The metal was actually embedded in the skin.

To end my wonderful run of days in a row. A young girl decided to kill herself. She goes to the pest control business that she works at, Writes a note and takes a canister of chemicals. She sits in her car breathing in and possibly drinking the crap. She then calls the police to tell them where she was and what she was doing. They get there when she was still alive and break out windows to get her out. Fire douses her with the hose and brings her to us. She seizes in our driveway and it just doesn't stop. We intubated and then coded her for over an hour. Her airway was burned, she was pale and mottled. We couldn't get calcium and bicarb in fast enough. She had so much pink frothy sputum coming from her ett that we couldn't keep up with the suctioning. This of the WORST flash pulmonary edema you have ever seen and then act like its a faucet turned on. I was lucky I was gowned, masked and covered because I got sprayed, big time. She went from sinus tach, v-tach without a pulse, brady, v-tach, v-fib, pea and then asystole. It was awful. Who on earth would want to die that way?

We then had to decon the room, bag and tag her appropriately and call the ME. We also had an engine company, ambulance crew and half a platoon of police officers who had to either be decon'd or observed for a couple of hours. They were all great guys who knew this was just something that had to be done. I made a lot of friends that night. I don't know if they found her family. They didn't come to the hospital.

So I am on a 4 day break. No hospital. Craving somewhere warm away from it all. Maybe its time to put that overtime to some good use.

Fire

2010-12-31T08:53:00.000-05:00

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

2010-12-16T17:21:00.000-05:00

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

2010-12-12T23:26:00.000-05:00

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

2010-12-07T10:35:00.000-05:00

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

2010-12-06T09:45:00.000-05:00

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!

Thanksgiving Leftovers

2010-11-30T09:23:00.001-05:00

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'

2010-11-22T10:23:00.000-05:00

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

2010-11-17T08:18:00.001-05:00

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

2010-11-10T12:41:00.000-05:00

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....

Hospital of Horror

2010-10-31T14:36:00.000-04:00

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

2010-10-29T15:29:00.000-04:00

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

2010-10-24T10:02:00.002-04:00

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

2010-10-20T09:28:00.000-04:00

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

2010-10-19T06:35:00.000-04:00

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

2010-10-08T09:01:00.000-04:00

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

2010-10-03T11:55:00.000-04:00

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!!!)

Life Comes First

2010-09-21T02:55:00.000-04:00

Sometimes life just has to come first. Thats what I have been telling myself when it comes to this blog. I keep meaning to get back to it, but theres always something. Lately it has been the WiFi that I use in the neighborhood. Yup, I'm too cheap to pay for it. Even better, I got rid of the cable TV so I have really been out of the loop.

The uniform day came and went. I went to some site on the internet and ordered the requisite blue scrubs. Actually, I needed some help as I have been wearing hospital scrubs for so long that I'm not sure what sizes to get. (Mens Medium with the orange drawstring doesn't translate to Allheart.com). The girls got me hooked up and there ya go. I keep getting compliments about losing weight.... a combo of divorce and more form fitting uniforms I guess.

The downside of uniforms? I am now more careful about what I do. I know, I know, we should always be careful. What I mean is I have to think more about what I'm wearing than what I'm doing. Case in point: in the trauma room I had a 400lb patient pour gasoline over herself and light on fire. (No shit... 90% 3rd degree.... between the rolls and her feet were the only not burned areas) I went to put in her foley. Usually with the big girls I just crawl up on the foot of the bed and its no biggie. I went to do that and had to stop and think "these are MY scrubs from home... I have to drive home in these." I hollered for a few towels to kneel on and proceeded with caution.

As a side note: she died.

I got into it with one of the trauma residents as well. I have learned to listen to my gut. If nobody takes anything else from this blog forever and ever please Please PLEASE listen to your gut. This guy was an MVC vs a tree. He was pinned by the belly for greater than 20 minutes. His BP by the flight crew was 115 systolic and he had a rigid abdomen. We did our thing and I sent one of the other (stable) patients out of the trauma room to an open bed in the ER. The resident jumped my shit because I didn't ask him. I told him to take care of this new patient who was much sicker. The resident called me "snarky" and continues to bitch. I reminded him that we weren't doing this in the trauma and to please go take care of his patient. He finally did an ultrasound and declared the belly "fine." Meanwhile the bp has dropped and this 32 year old is becoming more and more tachycardic. I questioned this a couple of times... including asking about a rectal exam for blood and a foley for CT cysto.... No (per the resident) to both.

The patient went to CT.... I stayed in the trauma room with 2 other patients. Apparently, "Oh My GOD..." was the diagnosis. This kid had a belly FULL of blood. He had transected his colon/bowels in several places and may have ruptured his bladder as well. Some days I told you so just isn't enough....

Anyway, I need sleep. Will try to be better at the blog from now on but, as I said, these days life comes first. I'll do my best.

Is it December Yet?

2010-08-09T17:46:00.000-04:00

Would love to say that July went in like lion and out like a lamb. Unfortunately, that is not the case. The learning curve appears steep again and the phrase "it is July" seems to drop from my mouth daily. Around here it will be "July" until at least mid to late December. The July bug seems to be catching though and (as my favorite resident has said) "its NOT July for you" has been said to many a resident who has been here more than 30 days. Maybe stupid has finally evolved into an ICD9 code-able disease.

The university, in their infinite wisdom, (and new nursing direction) has decided to make some changes. Not one at a time, but all about a month apart.

June 1: Non-Smoking Campus (I don't smoke, but that has gone over really fucking well) We have a huge campus, so people just go down the street. That hasn't stopped the hospital from hiring security who's job it is to walk the outside of the hospital and prevent people from smoking. I wonder how much that cost?

July 1: INTERNS. I should say 'nuff said, but like I said, the hospital is being fucktarded. Not only do we have to suffer through the interns, but the new ER computer charting which can be compared to pulling fucking teeth. Every attending and resident has to do a computerized note. We have a limited number of computers and and even more limited number of chairs. Can you imagine what the nurses station looks like? Yup, doctor city. Neither a chair, nor computer (or phone) to be had.

July 10: Medics have been shafted. We have a strong group of overtrained, under paid paramedics that work in our department. They are my right hand in traumas, they responded to codes on the floors, they transport ICU patients, they help with IV access, meds (within their list of meds they can give.... which is pretty liberal) and all in all help with the pace and flow of patients through the department. Not to mention they bust their asses and are of more use to me than an intern. Our brilliant nursing leadership has decided to pull their privledges. They are now nothing more than glorified stretcher pushers. They can draw blood, but not flush afterwards (saline is a med you know). They can transport a patient upstairs, but if they code they no longer have intubation and code med access. They are actually no longer to even put a patient on oxygen. These people are more trained than (a lot of) nurses and they are being fucked, hardcore. How are we supposed to claim to be the best and most forward thinking of departments when we are moving backwards? Hospital management is considering forming a committee to decide what to do with the medics now. I am calming myself enough to write a letter to the CNO. I think calling her a stupid yankee bitch with no goddamn clue would be bad. B=Maybe I'm not calm enough yet.

August 1: Uniforms. Yes friends we have sunk to that. We have always been on the forefront of research in cardiac, stroke and trauma emergencies. There are things all over our walls to prove it. Nursing management has decided that success is not enough to portray a "professional nursing image." As of August 1 all nursing has to wear the same color scheme. (we have the choice to wear all blue, all white or a combination) I work in the ER dammit. I get covered in the grossest shit on a regular basis. With the exception of my ICU time, I always wear hospital-issued scrubs. Its cheap and if I get god-knows-what on me, I can go to the machine and change. We tried to explain this to the all-knowing management and their response was something along the lines of "Based on out research ER nurses are no more likely to get soiled than any other nurse. They just need to remember to take the proper PPE precautions." Ok Doctorate and Masters in Nursing dumbasses.... I will ask the drive-up GSW, active labor, GI bleeders and drunks to not get blood, stool, vomit and god knows what else on me until I am ready with my PPE. Seriously? We no longer require ER nurses to have ACLS because we can't afford to pay for it, and what do we do with it anyway, but God forbid we aren't all dressed alike.

Sometime in August: Tracking systems. Whose brilliant idea this was I don't fucking know. It started with putting tracking devices on our equipment. That way if it needs to be fixed or is just missing from the unit we can track it down. The newest idea... lets put it on the staff so we always know where they are. I do about 10 miles in walking a night (wore a pedometer for about a week), I don't sit a lot. But I don't need to be low-jacked. I don't need big brother to know just how long I take in the bathroom or where I go to find Diet Mt Dew when we are out downstairs. we are told that this is simply a tracking device and will not be used against us. I highly doubt that. I have a feeling that our tracking will start coming up during any discipline or patient relation problems. This way they have someone to pin shit on. I have every intention of hanging my tracker from the computer in the nurses station or tagging a piece of helicopter equipment with it. That should make for some interesting tracking. Fuckers

Any of this sound like a good idea to you? The no-smoking I can get behind. It doesn't stop the random psych pt from harassing us outside (even though I don't smoke), but its a start. Uniforms, tracking? Gestapo Germany anyone? Just checking.

I'm Back

2010-07-29T06:26:00.000-04:00

Its been awhile. As some of you have (wisely) said, life comes first. Personally, things are all over the place. Its hard to find a true direction. I am trying to keep my integrity intact and stay positive. Some days that is harder than others.

From a work standpoint... it is the first of the intern year again. As I have cautioned, they are out there, younger and more naive than ever. I took my customary few days off around new doctor day and my birthday... a move I consider more and more brilliant every year.

The Sheriff's Deputy from the accident died. She was in the hospital for ortho surgery and we think she threw a PE. They last saw her at 4am for meds/vitals and she was found dead on ortho rounds at 6am. One of the OLD nurses who pseudo-retired but still works weekly has been put to pasture. Details aside, (I was in triage, only to pick up her zone at 2300) she had a septic patient that she didn't recognize how sick she was. A bp of 50 for over an hour may register with most of us, but not her. When I got there at 2300 I was just in time to work a 90 minute code.

The ER has been going on diversion daily. There is a new electronic charting system that the docs have to use that has slowed things considerably. Not to mention, the interns. I had to remind one to sign her prescriptions the other day. Management has been letting us stay off diversion until our census is in the triple digits. It was one such night when I wheeled back a 75 year old, semi-conscious with known history of SBO and heart disease. As I waited in line for a room (behind the homicidal schizophrenic and copperhead bite) a fight broke out in one of the rooms. Yelling, screaming thumps and bumps.... a pile of police and one skinny white kid in handcuffs falls out of the room. The kid was on either meth or pcp and was going after the officer's gun. My old friend and I were booking it backwards down the hall when PD tazed his ass in the middle of the hallway. Not a flinch from our friend. He was hauled off in cuffs with 8 of the city and university's finest.

That same night I had a 26 year old who bailed on a $250.00 bar tab. He ran out, got in a fight, when the bouncers broke up the fight and went after another, he and his buddy hopped in the car and took off. After a pursuit with PD he wrecked and then proceeded to blame the driver for both the tab and the boot scoot outta there.

So I'm hanging on. The stories are getting more interesting as we get more and more busy. The medic proceeds to bring me more and more winners. Can't say what my next move is going to be. Still want to fly, could always go somewhere warm. We will have to see.

Why Me?

2010-06-14T09:30:00.000-04:00

There are some people who can go through day to day and have calm and quiet little lives. They work every day and go home to their families and don't think a thing about it. I think if my time in the ER has taught me anything, it is that I won't have that kind of life. Normal just doesn't seem to fit in my vocabulary these days.

I have been seeing a city medic who is the exact opposite of me. He's tall where I'm short, outgoing when I'm quiet, but makes me laugh every day and I'm a very happy girl. He and I were sitting in triage last night when we heard a screech and then a loud crash. We exchanged a WTF look and both took off for the door. My first thought was that some dumbass had hit one of the ambulances in the ER driveway. Instead we look down the driveway and see the rear of a car and smoke blowing. As we went to check it out we found a sheriff's deputy car had lost control and struck the building. There was smoke coming from under the hood and the inside was filled with smoke from the engine and the airbags. The deputy was screaming bloody murder as the medic used a fire extinguisher to put the engine out. I held c-spine and had our university police take her gun. (just what we would need is a hysterical chick getting ahold of her gun as we get her out). The medic's partner helped me get her out of the car and backboarded and we took her into the er.

I'm still getting over whatever crud I had down at the beach. I start hacking and wheezing from whatever the hell I've inhaled. I ended up in Green having one of my friends take a listen to me. She concluded that 1) I must have had a RLL pneumonia while at the beach (she can still hear the rhonchi) 2) whatever I breathed in has pissed my lungs off. I get put in a room, pulse ox on and breathing treatments. Let me just say... I really don't like albuterol. My normal heart rate is around 60. The medic started laughing when it hit 100 and I got the shakes. When it hit 120 I really started to feel like shit. Fortunately I had my friends checking on me and the medic to keep me entertained. 2 treatments, advair and 3 hours later I was discharged home with 2 inhalers and a 4 day work note.

So I've spent the last few days laying low, being a good patient, staying out of the heat (which is killing me!) and trying not to be bored.

Time to Vacate

2010-05-30T03:45:00.000-04:00

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

2010-05-21T16:53:00.000-04:00

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

2010-05-13T09:20:00.000-04:00

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

2010-05-02T19:39:00.002-04:00

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!

The Dogs

2010-04-28T10:01:00.001-04:00

Trying to get out of the ER rut and find a little more excitement. In the ER we see everyone and I make friends pretty easily. I have learned never to say "you have it easy" or something to that effect to police/fire/ems folks. They LOVE to take me out of my element and see what I do!

The last police ride-along I did was a bunch of years ago. I rode with one of the cops friends (chick) who was crazy as hell. This time I was with a guy I've known for years. He was a little more pro-active than she was so it involved a lot more driving fast and "getting into stuff." We did a couple of traffic stops, wrote a couple tickets (suspended licenses, reckless... no BS stuff), rode through the projects, checked the make-out spots, stuff like that. I met on of the Pike's fabulous Shemale hookers. "She" was wearing what looked like a t-shirt with Baby Phat written on it than barely covered her.... nevermind. She had a long wig and strappy heels that were about 4 sizes too small. I was doing my very best to keep a straight face as she and the officer debated perception of her just walking down the street at 2am. When "she" noticed me checking out the shoes she asked if I liked them. What do you say when a 6'3 trannie (she said no penis... I didn't want to know) dressed like that asks if you like her shoes? You smile and say... yep!

Our next pass through the pj's (projects) we found a random white dude in a work truck. He seemed high as hell and as the officer I rode with talked, his partner searched the truck. He came up with prednisone and 3 bottles of pee. Not sure why the hell you need pee in a work truck except for a pee test, but can't prove that one. As the truck drove away the officer was complaining that he got pee on his hands... my response??? "Welcome to my life dude!"

As we left we saw something in the road... it was a small dog, maybe even a puppy that had just been hit. It was still breathing/whimpering. We were going to take him to the emergency vet, but as we (and about 3 other officers watched) the poor little guy's breathing slowed, then stopped. One of the guys was actually petting it as it died. So much for cops being arrogant assholes, huh?

We then went into another pj to help an officer who was chasing someone. We checked alleys, yards etc for a guy on a bike. We found the bike outside an abandoned house with a broken window. Someone suggested they get the dog. So I got to watch a police dog track a suspect and do a search of the house. Very cool. We frequently see the aftermath of the dog's searching (aka the police dog bite) in the ER. No luck on finding the suspect, but still an interesting scene to watch.

It was a long night. My back was sore the next morning, but I had a great time. It was a nice change from the ER. Plus I have a great idea of what I can be for Halloween this year!

Arrruuuggghhhh

2010-04-14T05:44:00.000-04:00

The screamer nurse has struck again! I was a princess tonight. Nothing I can't handle for 4 hours, right? The first person I saw was my new boyfriend. In his 60's, history of schizophrenia, was assaulted in his group home. He was sitting next to the triage desk (too crazy for the waiting room, not sick enough for the back) singing to everyone who passed. The fun part? He had a decent voice and was doing the best of the 70's. I was trying to get settled as he sang "Get Down Tonight.." Hard to not smile and dance along with the song. He took requests too. "Jungle Boogie" was my favorite. The communications room called asking what his 1-800 number was so they could vote for him!

Welcome to the College of Knowledge, where we save even the biggest shitball with the most ancient of equipment. The screamer computer has been on its last leg for months. I can hardly get people into the computer as is. Throw multiple patients including a couple of chest painers and it becomes impossible. Some chick came in (no joke) complaining that she got shampoo in her eye. Seriously? Waiting room please. 15 year old unresponsive via squad after drinking a whole bottle of Absolut Vodka..... mom didn't show up for almost 2 hours.

In the midst of all this fun I get a call from a city police officer. He was out with a dead guy who had a medical history (don't they all). He wanted me to give him some info for the death certificate. Ummm.... negative ghost rider, call the ME for this one. Home-dude got a little attitude when I said no. I got another police call looking for a guy who matched a description they gave me. Up until now nobody has matched up. Tonight, of course, they hit paydirt. Their suspect was in yellow.... I had screened him and knew exactly what he was wearing. Weird. When it hit 11 I turned into a pumpkin.... didn't stick around to see if they caught him or not.

The TIger Song

2010-03-31T08:34:00.000-04:00

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

2010-03-30T03:36:00.000-04:00

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

2010-03-26T16:58:00.000-04:00

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

2010-03-23T00:31:00.000-04:00

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

2010-03-20T08:19:00.000-04:00

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.

(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

2010-03-15T20:26:00.000-04:00

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

2010-03-05T09:44:00.000-05:00

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.

24.5557025, -81.7825914

2010-02-25T11:38:00.000-05:00

12 more hours of hell on earth and I'm running away to the land of Mojo. I think she had a good thing going and I need to make a return pilgrimage. As much as I am looking for relaxation and a moment away, clarity and inspiration are on the agenda as well. There are questions that have not been answered and I'm waiting for them to work themselves out.

I have long seeded trust issues that I need to bury in the soft sand. I need to look at what is in front of me with unclouded eyes and make a decision. Either be happy with the current path, or get the fuck off it.

I hope that running away from home brings me closer to where I need to be as opposed to just a momentary break from reality. Will see what is on the flip side.

Mahalo nui loa

Management

2010-02-22T07:21:00.000-05:00

I have no aspirations to become a Nurse Manager. Why? Well, lets see. First and foremost is the bullshit factor. I know that I am neither tactful or PC enough to deal with the higher ups on any kind of regular basis. Second, I have a "don't blow smoke up your ass" way of looking at people. If a nurse were to come to me bitching about so-and-so there had better be a damn good reason. For example... my foray into blogging from work was foiled by Nurse-Needs-to-Take-Her-Meds. Yes, someone tattle-taled. Fortunately, the fact that I was blogging and not merely surfing the internet was lost on her, so that is a bit of a relief. Her complaint was that I had my Mac in triage. Was I sitting with the computer in my lap while I was seeing patients??? Fuck no! Did I triage everyone under the sun that night? Yes. Do other nurses bring laptops in? Yes.... so my thoughts...? Fuck off and mind your business. As a nurse manager you can't say that. Oh and per the nurse manager, no more laptops at work... for me anyway.

Another reason I don't want to get into management.... the loss of skills. The more time you spend in that office away from patients, the more you lose the ability to prioritize, be flexible and deal with the staff "in the trenches" versus in the office. The loss of perspective is staggering. Even at the ED Coordinator level it is amazing. We have coordinators that cannot even put a patient into the system and triage them. I feel like they should be a clinical resource instead of just "in charge." They should be up on the protocols, equipment and policy and truly be THE resource for the department. Are they....? Nope. Very seldom do they have to do anything with staffing. When they do they are either in triage or in charge. Again, a loss of perspective.

I feel very strongly that we are defined by our actions. Not just what we do, but how we treat people. I don't pretend to be an angel. I have had my share of fuck-ups. I have an Irish temper that has gotten away from me from time to time. I have a mouth that makes cops and sailors blush and can throw down a 'tude with the best of them. However, the patients love me because I talk to them like they are people. I try to take care of the staff and I learn people's names. I know that one of my favorite residents has a husband in med school and she doesn't seem him often. When he is in town I tease her about ho-ing it up. I know that the housekeeper has lost a son and grandchild within the last year and has been having a difficult time. I have been the first to look at a UPT and to watch someone decide their marriage is over. As a manager....do you look at that? Negative. Its all about what one person says versus another and the bottom line.

Speaking of the bottom line... what are we willing to sacrifice for it? I know that times are tough. There are more patients than ever and fewer people to take care of them. So what gets the axe? In my institution it seems to be anything having to do with morale and staff safety. Our annual Christmas party was cancelled. The physicians still got bonuses though. We can't get metal detectors, but we have opened a new area of the department so we can see even more patients. Staffing sucks, but we still can't get scheduled overtime. Scheduling sucks.... but who needs someone clinical to do the scheduling when a secretary can do it? We are forever running out of things (pt meals, blankets, IV pumps). When there is shit weather we can stay there.. they can't guarantee a bed, but there might be a stretcher you can use. The physicians get to bill by the patient too. So why go on diversion when we can just start stacking patients in the hall? I seriously saw patients in the triage room with an attending Saturday night. I triaged them, wrote them up, called him, he saw them, did his paperwork, wrote scripts and I discharged them. Did I mention it was only myself and the screamer nurse? She kept sending them my way.... and I kept tearing through. Saw 6 patients that way in an hour. In addition to the ones that were triaged and sent to the waiting room. Then (naturally) the computers went down for the next 6 hours. Gotta love that bottom line!

No crazy stories to share today. Have been exploring why I am where I am and what needs to change. No answers yet. I have been lucky to differentiate between the friends who have got my back and those that were more interested in what I could do for them. Like my grandmother always said... its just another FGO (fucking growth opportunity).

One would think that with all this opportunity I'd be taller by now!!!

Petri Dish

2010-02-15T19:05:00.000-05:00

As a new grad in the ED I got sick as crap before my health insurance even kicked in. I was living at my grandparents, running a holy shit temp and just waiting for July 1. When the doc looked at my throat she said "Have you seen this?" Never a good sign. The first 6 months were awful. Every bug that came through I caught. There was no way to build PTO, I was using it as fast as I could accumulate it. In the years since I have gotten my flu shot every year and built up one hell of a tolerance. I am (I'm sure) harboring every bug from Acetobacter to Yersinia with a touch of everything in between. I warn people that I date to take their vitamins and get ready for a rough cold/flu season. Most times I'm right.

Unfortunately, I have encountered a new strain. Its the Medic-Mutated-Creepin-Crud. I'm hacking and wheezing, freezing my ass off and aching all over. Fuckin medics!!! :) They can at least give me this crap on a day other than my day off!

On the horizon... formal gala to raise money for the trauma department. I'm getting some kind of award. Black tie, fancy schmancy. Should be very interesting!

Stupid 101

2010-02-12T09:39:00.000-05:00

I little more lighthearted than the last post I present the January-February class of Stupid 101

25 yo male. 3 months of hematuria. Decides to call 911 at 330 in the morning cuz now its an EMERGENCY!

Chronic pain patient complaining of kidney stone pain busted doing the scoop the water out of the toilet trick. No narcs for you, buddy.

CooCoo for Cocoa Puffs lady that asked the (female) patient care tech to stop and have sex with her on the way to the psych floor

Pt who received a "letter" (= positive for STD) and presents to the ED for treatment. After his shots he hits on the nurse cuz "I'm clean now"

Visitor so fat that she sits with legs apart and belly hanging out of shirt. Stupid nurse (me!) assumes she's just fat. Ummm... nope. Pregnant. (GROSS! SOMEBODY FUCKED THAT ON PURPOSE?!?!)

Dental pain patient in the trauma room... she says that Superman and Batman are fighting to the death in her mouth. Apparently that causes dental caries.... who knew?

Toilet water for pee man trying to come back and re-register so he can see another doc that he hasn't lied to yet

Intern explaining to me that I really do have to send the cultures before I hang the antibiotics (really?!?! are you serious? we have to DO that? WOW)

Intern (detecting a trend) telling me that the man with the fractured and impacted hip has to be NPO for surgery. Oh my goodness doctor??? Why must it be like that?

Stupid fucking bitchy nurse going to my nurse manager about me having the cell in triage.... blow it out your ass bitch!

Ahhh..... I feel so much better now!

Introspection

2010-02-11T12:20:00.000-05:00

I have sufficiently Whoo-saaa'd after my last shift. I was so angry that poor Ruby (the jeep) took the brunt of my frustrations. It took a few days off, some tears, beers, chicken wings and quality time to bring me back to myself. Some days I just don't realize how this job gets under your skin. We joke that in Emergency Medicine we really don't have to do the long term stuff. Treat 'em and street 'em or send their asses upstairs. Its a very "hands off" life. The drama and humanity usually rolls off us like water from a duck's back. I can't say that any one patient got to me the other night. Nobody was sick enough or tugged at my heart (at all!) enough to do that. I think it was mostly the staff that got to me.

We talk about this as our dysfunctional family. This is very very true. There are some crazy unhealthy people that work in this field. They are both physically and emotionally unhappy and unhealthy. Everyone has their own way of dealing with the stress of work and home. Some do it better than others. The last 2 1/2 years have been the most insane of my life. I have been places and done things that I never thought possible. I am now on my own again and doing my very best to enjoy every second and find myself in the process. I continue to fuck up on a regular basis, but the people who love me best realize that as much as I try to be perfect, I will always fall short.

I don't know what the next step is, or even what direction I am headed. I do know that I have the people I love, Maddux, Ruby, a glass of wine and Buffet and Marley on the radio. What more does a jeepgirl need?

Who Dat?

2010-02-08T01:16:00.001-05:00

In the fucking Super Bowl madness I think people forgot what the hospital is for. Sitting in triagony, dealing with these dumb motherfuckers I am about done. You know the night is gonna be rough when the first cup of coffee gets dropped on the floor, when there are patients swinging from the ceiling, when the other triage nurses are old as Methuselah and slower than molasses on a fucking cold ass day and (oh yeah!) theres a 29 year old OD on MOTHERFUCKING ECMO in the code room. Seriously guys, I think its time to re-evaluate this diversion is for sissies thing.

Yes, I'm a little bitter. People have been weirdos tonight. My drunk white lady who yells the N-word, yup, she's back. Mousy-looking drunk/psych/cancer hx Dee-da-Dee asshole that fell on the ice at BW3 and refused EMS before peeing on the sidewalk... he's here. He walked out of my triage room to go pee.. again. They are fighting in the adult homes, falling on the ice (come on guys, its been there for a week), getting bitten by every animal imaginable and vomiking on my floor. This shit truly needs to stop. There was even a drunk girl who fell/was assaulted and knocked an eyeball out. She then proceeded to argue with the EMS crew that she was going to get up and leave. To their credit they handled her much better than I would have. I would have given her a cup, said "use this to bring your eye back when the fucker falls out for real" and let her ass walk. As my mom would say... dedicated healthcare professionals at work!!!

The highlight was one of the old nurses (who must me outside her head or off her meds) telling me that it is inappropriate for me to have my cell phone in triage. I'm not talking on it, its out of sight whenever there is a patient in the room, and I have triaged greater than 1/3 of the total patients in the department in the last 6 hours. Yes, I counted. If I feel like texting a friend, my family, or the man in the fucking moon its really none of her business.

So maybe I am a bitter triage nurse tonight. Thats fine. I don't have to be Miss MerryfuckingSunshine 24/7. The people that deserve it get the sweetheart. The rest of you fuckers better watch out!

The Street

2010-02-05T05:54:00.002-05:00

Years ago I made the mistake of telling a firefighter at a controlled burn that they got to have all the fun. He promptly found the littlest turnout gear they could find and sent me in. 4 hours and 3 trips into the building later I stripped out of the bunker pants and jacket, called it the most fun ever and promptly fell asleep. It was a blast, but not as easy as I expected. Part of my paramedic class is to do rotations in the field. I haven't been as diligent with that as I should. I really need to stop procrastinating.

Sitting in triagony you really do see everyone as they come and go. If you are like me and are pretty friendly they stop and chill for a minute. Its a nice break from the monotony. The city EMS supervisor stopped to say Hola last Friday. We shot the shit for a while, he asked about class (the medics think its hysterical that a nurse even wants to be a medic) and he asked when I was going to come ride in teh city with him. Ummm... hows Monday?

Monday it was. It freaking snowed this past weekend, so it was cold as shit and icy when I arrived. A couple of WTF looks from the field providers and it was into the sups truck and away we went. I'm not sure what I expected.... GSW's and MVC's galore driving like a bat outta hell all through the city. Yeah, not so much. There was a lot of dealing with pissed off people, complaints and paperwork. I just wanted to see some damn patients!

We finally squirreled a possible seizure... no shakin and bakin on our arrival. The woman may or may not have had a seizure (ask me if I really cared!) but she was going to the hospital. She walked to the stretcher for the crew and that was that.

We finally got to drive fast at about 2200. 45 year old dude found down by family. No CPR in progress. Apparently the family kept screaming into the phone and hanging up. We were beyond BFE from the address, but it was fun as hell driving through the city that fast! We arrived about 5 minutes after the ambulance crew. The medic on the truck took one look at us (recognized me from the hospital) and told me to get my ass in there and do the airway. So I tubed while he was on the geezer squeezer and the medic drilled his leg to give drugs. 3 rounds of ACLS drugs, bicarb, narcan (this was dudemans's 16th overdose) and we FINALLY got to call my hospital for cease resuscitation orders. PD had to restrain the son who came screaming into the room as I was turning the monitor off.

What did I learn from this code??? Always pee before you go on the cardiac arrest!!! Also... firefighters bag too fast.

We went back to help the crew restock and then back to the streets. A few more complaints and it was time to eat. We were trying to find the Mexican place when we got punched for....another code. This was deep in the ghetto. I walked in the house and there was a smell that I still cannot place. I know there were kerosene heaters everywhere, but there was something else. Girlfriend was naked except for some bright ass turquoise panties. Hubby said she just done fell out. (dfo'd) Unlike the previous code he did do CPR.

The crew was getting lines and I was drawing drugs as the supervisor went to intubate. This was one of the houses that you really need to check for where you lay before you go to tube. It was that fucking gross. I actually had to check for roaches before I sat down on the floor. The tube was so-so so I got to pull it and throw in a King Airway. We continued to go through a couple rounds of drugs before we called my hospital AGAIN. We stayed with the crew and helped clean up. I think they appreciated that this nurse isn't above getting her hands dirty with them.

What did I learn from this code??? 1) Always check for roaches 2) Fucking eat when you get a chance! Everything was closed by the time we were done. at 5am I ended up eating a cheeseburger big bite at 7-11 with a Dt Mt Dew and chocolate covered pretzels. What can I say??? Its the breakfast of champions!!!

I left at 6am worn the fuck out. My favorite medic has said that he can dance circles around me in the back of the truck. I respectfully disagree. We will see who is humming the mexican hat dance when this is over!!!

The Screamer Desk

2010-02-05T05:23:00.001-05:00

I have frequently referred to the penalty box or triagony. The hospital came up with the "Screamer Desk" after an unfortunate incident with a little old dude. This guy's family brought him in, pushed his wheelchair into the waiting room and bailed. To the observer he was merely asleep and (it would seem) remained "asleep" for several hours before someone realized that he was dead. The staff worked him, although it was obvious that there was no reason to other than to save some face. The problem solving session following this incident was apparantly very... colorful and thus the Screamers Desk was born.

I get the first medical "Hi how are you" and get an initial impression of whether the patient is fixing to crump. Then I either direct them to the triage nurse for the formal triage or take them straight back. Unfortunately, at night we are also the "can pt so-and-so have a visitor" which gets pretty fucking old. We also end up handling social work, the complaint compartment and have a front row seat to the beginnings of the JERRY JERRY JERRY moments.

Umm.. screamer sucks. We also screen all of the pediatric patients. This solidifies that I don't want to be a pedes ed nurse. The kids aren't so bad... but the parents will make you fucking insane!!! I had a VERY young girl come in last night with her baby. The complaint.... "My baby ain't been doo-dooing all night." Dear lord, this child has had a baby. Poor kid has no chance in hell. Yet we continue to see the same shit day after day.

Depending on who the screamer nurse is, your night can either suck ass or be tolerable. Take tonight for instance. I am trapped in the hole knonw as triage (my own request, have been feeling kinda crappy the last few days) and the screamer nurse is the size of a small Voltzwagen. She won't be getting up unless there is a disaster or the Krispy Kreme starts delivering in the driveway. This nurse has actually sent a PCT (pt care tech) out to a car where a woman was in labor. The tech then delivered the baby.... and she never did de-ass the chair. Ugh. SO she puts the patients in and sends them my way. On nights like tonight we are short, so its just the two of us out here. When a patient shows up she pops them in the computer and then shoos them in my general direction. The problem comes when I get someone who wants to talk or is actually sick. Then the backup starts. Occasionally she will triage (from the chair of course), but most times she lets you drown. She does take the time to tell you when your triage is inappropriate and then reminds you that she IS masters prepared so she knows what she is talking about.

What-the-fuck-ever.

The upside of the screamer is that you really don't have to do a whole lot. I bring a book and my cell phone and get comfy. Occasionally WBL and I will do some 5am yoga, though my angry white boy music is discouraged...

Its gonna be...

2010-01-30T01:48:00.001-05:00

a fucked up night....

I usually don't blog from work. 1) don't have the time, 2) don't wanna get busted and 3) I use it as a way to decompress before I go to sleep. Tonight is gonna be one of those nights that if I don't record as I go then really good shit is going to be lost and I might end up saying some pretty inappropriate things and get shit-canned!!!

First and foremost this is an overtime shift. I came in at 2300 out of the goodness of my heart. There is also a 100% chance of snow tonight. In the south this means that the grocery stores have been emptied for several days and its full-blown panic time. I have seen nary a snowflake yet. I am also sitting in tragony with the WBL (Wandering Brownie Lady for those of you late to the party) and with one of her cronies who is always late, slow and takes hour long lunches in-between naps.

Drunk 24 year old, trying to impress a chick at a bar. Decided he would try to break a pilsner glass over his own head.... told me he does stupid shit when he's drunk. Told him not to steal Tyson's tiger and put him in the waiting room.
22 year old female "banked by some girls" (apparantly this means got her ass beat). The punched, kicked and otherwise fucked her shit up. They pulled her weave so hard that she is basically bald (!) and set her coat on fire. She was more concerned about the fact that her braids were fucked up rather than the fact that she had a 2 year old child with her when this happened.

We also have the stupidest security guard in the world workiing the desk immediately behind my triage room. I used to think that the jackass phone Nazi was the worst, but this is the female version that he trained. Talk about dumb and dumber! This bitch's whole job tonight is to control the main door to the ED. Essentially not let anyone in unless they are supposed to be there. Fire brings us a cardiac arrest. We know this ahead of time.When a squad comes through the first set of doors doing compressions you OPEN THE FUCKING DOOR!!

Ummm.... no...

They had to scream at her to open the door.

2 minutes later we get a drive up vomiting blood. One of the squads in the driveway throw her onto a stretcher and run her back... with the family (I use the word loosely) in tow. Lets just say there would be no way of confusing the family with EMS providers. The chick had on a spandex dress so short that I got the Ob/Gyn view, and the guy was dressed like he was in a rap video. Ems rolls in with the patient, family running behind. This security chick has learned to open the fucking door alright... and she just lets them all in. Then when I go chasing after she doesn't do a damn thing. I had to get the University police officer to go bring them back!
.... and yes, I've been here 2.5 hours. Its really gonna be one of those nights!

2010

2010-01-28T00:40:00.000-05:00

Not trying to make excuses here, but I figure I'd better explain the long absence before the search party gets sent out. I'm sorry to report the slow and painful death of my old laptop with associated disappearance of the WiFi router. Its been a tough holiday season, but I think me and my new friend Mac will come out better for it!

So, insanity and drama have been the name of the game these past few weeks. That the best I can do to sum it up. I will try to include some of the more interesting characters, but unfortunately, some may be lost to the post-Christmas psyche.

A couple of gems from the "Shit You Can't Make Up" file:

Little old guy, brought it with PD under a TDO. Told his little old wife that he was going to end it all. He has all those guns at home, ya know? So he comes to us, calm, cooperative and cute as a button with the Urkel jeans and the Teamsters belt buckle that was as big as he is. Blood sent, no worries. He gets up to pee in the cup and has little success. "I had the surgery you know." Being super psych nurse I go to straight cath him.

There are some things that you should really know before you cath someone. Whether you need a mask? Whether you are going to go in and see little beady eyes looking back? Male vs female? Those are my red flags. well imagine my surprise when I found... no penis. Yup, thats right, no penis, but a big 10-4 on the balls. The doctor neglected to tell me that he had a penectomy due to penis cancer. (ok, ok, I thought it was bullshit too!) Me= sterile. Him=no penis. Whats a girl to do? Me? I asked..... "Dude, wheres the hole?" With a little direction, and nerves of steel I went looking and found said urethra opening... behind the balls! OMAA!!!! 900cc of urine later, demented teamster grandpappy bout himself a ticket to medicine vs the psych floor. I think they decided to hold the psych bed for me!

Same night, I'm still working the psych zone. EMS brings in a drunk white lady who was soooo in love with the "hot black police officer" that he had to ride with them to keep her from going off. She then decided she hated black people, stood on a stretcher, stripped naked and screamed the N word at the top of her lungs. (my least favorite word.... plus, NOT one you want to yell in an urban ED).

I had the misfortune of being in charge New Year's Eve. Last year it started slow and built into a frenzy after 12. This year it was off the fucking chain from 7pm on. At 1215 I had every ambulance in the city headed my way... not to mention most of the 4th police precinct and all the city EMS brass. I told the white shirts that if they were gonna keep watching us work I was going to find something for them to do!!!

Really... REALLY????

2009-12-26T15:34:00.000-05:00

First and foremost let me preface this by saying this is not gonna be one of those "Lights, please..... this is the true meaning of Christmas" posts. Nothing against Linus, he is my all-time favorite, by a Charlie Brown Christmas it was not.

I was already scheduled to work Christmas Eve. Seriously, a silent fucking night. I went into the trauma room awaiting the massive reindeer pileup and possibly a few DUI elves. No such luck. I was, however, blessed with a 19 year old, drunk as shit who rolled his car multiple times. His present??? He was restrained. He had an open knee fracture. The lump o' coal included his 2 buddies, both ejected, 1 dead on scene, the other tubed, flown to another hospital and dead there. His dad's take.....???? They can't prove this was the kids fault, so don't say a fucking word. Way to evoke the spirit of Christmas there. The rest of the night was painfully slow and boring, with the exception of tall, dark and handsome elf that brought us some crazy bitch that OD'd on 3 percocet and 1 dilaudid po.

Christmas, was a completely different story. I was in charge and it was busy as fuck. (of course it was) Everyone who didn't get percocet and methadone in their stockings decided to come to the ER and get it. I had a less than optimal group at 7pm. WBL (wandering brownie lady) was in the back... which is unfortunate because you can't sell your fucking brownies when there are sick patients in your zone. I have said many times, every nurse is not created equal. I had one nurse tied up with a hypotensive pt who was 14 weeks pregnant and miscarrying so I had to handle her other 5 patients. TBL had 4.... 1 with a ready bed, 1 with discharge orders and 2 that weren't that sick (I know because I took care of one of them as well!). 2 hours later she finally got her 2 beds freed up..... I gave her a sickler and a chest pain.... about 45 minutes apart. Not unheard of. The chest painer had a rate of 140. 30 minutes later had he had a BP done yet? Nope. Access? Nope. EKG? Yes, the ER medic did that one. OMFG people! In the meantime her sickler was SCREAMING bloody murder about how we were unprofessional and insensitive because she hadn't gotten (haha) her methadone and dilaudid yet. In fact, her port-a-cath hadn't even been accessed. Multiple people (including the trauma nurse) tried to get in and help TBL, but she would have none of it. Even the resident was asking for her help with central line placement to which she said she was too busy. Seriously? Really?

I begged the coordinator to send her to triage at 11. At least that way I would get a nurse who was strong enough to run a damn zone without having to hold her hand.

I don't know how many little (and not-so-little) fires I had to put out because of her. I was in the coordinator's office more than one time. She even had the balls to write up one of my medics. I'm sorry... but I love my medics. This one was working her ass off trying to help and was in the room with a doctor who was sterile and needed help. My take?? If the medic goes down for something completely fucktarded then paint a target on me, cause I was in charge and will take any and all responsibility. You don't fuck with my medics!!!

It continued like this for most of the night. Asshole, ungrateful patients that ran us ragged. Frequent flier drunk with AMS that was found down. We put him in the hallway and ignored him for 8 hours. Amazing how fast the pee can accumulate in the sheets. We had a drunk come in with the police after a fight with family. He was a little crazy until my favorite resident went to evaluate him. When he kicked her with both legs all 6 officers took him down. Ker-thunk onto the floor. He got the rest of his exam pinned to the floor.

Ended the night with a self-inflicted GSW to the right chest. Some nights you can't get out fast enough.

Santa Baby... next year I just want some peace and quiet.

Christmas Eve, Baby

2009-12-24T11:05:00.000-05:00

I could very easily change the name of this post to

Christmas Eve Baby

I mentioned a while ago, never, never get complacent in the ED. You never know whats around the next sliding door. I was having a VERY chill night in triage. Music on, feet up, working with two of my favorite nurses. What can I say? I was a great, albeit boring, night. When I saw the stretcher going towards the driveway I figured it was just another Meemaw that wouldn't get out of the car. Gloves on, I walked out to help. From the back of a 4-door I heard one of the nurses voices say.... "I think thats a head."

FUCK

I slipped in (having done this before) and surprise surprise it was, in fact, a head. Mom wanted to push, there was no nuchal cord, so push (and pull for me) she did. 10 fingers, 10 toes little girl with lots o black hair. She cried immediately and her 1 minute APGAR was 8. Poor little munchkin was probably freezing.... it was 20 degrees out! Once weighed she was 7lbs 12 oz. Mom had a scary hypotensive moment that required pitocin and some fluid boluses but rebounded well. The nurses suggested that mom name her after me. I highly doubt that there is gonna be a black baby in the projects with an Irish name!

One of the girls in triage decided to make some new nametags for the stork crew. After all the sadness with the loss of our collegue this made us all smile. Happy Birthday baby!!!

The Fam-Damily

2009-12-21T16:27:00.000-05:00

You know when you're home when the jokes are frequently at your expense, the laughter flows like water and they know your deepest and darkest secrets and still love you. This dysfunctional family that I have been a part of these last 8 years has given more to me than I could ever give in return. I love my little ER family. Case in point. Last Friday we were hit with a motherfucker of a storm. Snow starting on my way in and continuing all night long. I sat in my little triagony box with music, a book and the highly valued space heater killing time and visiting with all the bored staff from the back. It was almost like an actual snow day from school. I think I triaged 4 people. I took 1 straight back because he was on chemo and had a temp of 103. The others I took back because there was nobody in the waiting room.
Then theres the obligatory "check the weather" walk outside that turns into the all out staff snowball fight with a couple of city EMS providers thrown in for good measure. Something about the attending chasing the patient care tech and a medic shoving snow down my shirt that brings back all those good memories from childhood. I did manage to get said medic back with a snowball to the face. As I was trying to escape back into the ER my shoe covers kicked in and I went (gracefully) KER-THUMP onto the floor. My butt still hurts! Thank GOD I had the space heater to dry out my clothes!

Unfortunately, in any situation the unfettered joy is always tempered by a heavy dose of reality. We were pulled aside that same night to speak with our coordinator about another staff member. Young nurse, well liked with a history of diabetes was a no-call, no-show and work Thursday. She was found dead in her apartment Friday morning. She worked days, so I didn't know her super well, however we always got along, worked well together and she made people laugh. She was one of those slightly funky but sweet people who could wear purple sparkle mascara and look completely adorable. She had a dog that was the light of her life and her current Facebook picture is of the dog dressed as a Christmas elf.

Something about medicine in general reminds us that things always want to be balanced. Ins vs outs. BMP, CBC, ABG..... we want balance. Ironically, life seems to do the same for us as well. An amazing snow night balanced out by profound sadness. I hope that all those she met and cared for realized how special of a nurse they had.

Our ER family may not consist of Mom+Dad and kids, we may try to kill each other from time to time but this is so much more than just a job.

Ridin'

2009-12-16T12:43:00.000-05:00

Part of my RN-P bridge includes doing ride-alongs with the local EMS agencies. The idea is to get the nurses out of our proverbial comfort zone and out onto the streets. The medics think it is absolutely hysterical to watch us as fish-out-of-water. My goal is to look like an ass as little as possible! It helps that I did do some EMS in a former life before nursing school.
Yesterday was my first day on the streets. I hooked up with an old friend who is a paramedic near where I grew up. The upside of being "the nurse" is that I promptly got put onto the QRV (quick response vehicle) and away we went. The QRV is basically the county squirrel. We can respond to any call we want and if ALS is needed then it’s all me. Is it cheating? Maybe. I get to play with a minimum of bullshit.

After breakfast I got my corned beef hash settled to the bottom of my stomach and was ready to rock and roll. Our first call was a complete and total bullshit chest pain. Productive cough, FEVER (yeah, 99.1). Worse after smoking. She wasn't short of breath and was able to scream at her husband from across the room. We walked her to the ambulance and sent her 5 minutes down the road to the hospital. We followed in the QRV just for something to do. As we were waiting we got punched for a call in the medical office building right across the street from the hospital. Cardiac arrest with CPR in progress.
I did warn the guys that I have a decent sized black cloud, so my first "real" call being an arrest wasn't a big surprise. We arrived to find a surgeon that I remember well (and fondly) doing CPR in his office lobby. Fire had the AED on and he had a mask and oral airway in. My thoughts were... primary ABC's intact. I'm gonna tube this guy. Got my equipment out and ready, told the Battalion Chief that I wasn't going to use the King Airway (http://www.kingsystems.com/PRODUCTS/AirwayDevices/KINGLTSD/) and got ready to intubate. The paramedic on the fire engine tried to take the handle away from me! Oh hell no! I got the tube on the first pass without any trouble. The firefighter actually looked surprised when he heard breath sounds! WTF?!?!?! A couple of rounds of ACLS drugs (no amnio... my fault!) and we started across the street. The patient actually had a pulse on arrival to the ER, but quickly lost it. After 30 minutes more he was called. So I knocked out yet another ETT and a ton o meds. Talked to the Squirrel, my former work-husband on the helicopter and he was probably more excited than I was!!!
The rest of the day was pretty anti-climatic. Little riding around, no great calls. Still on the King Kong high from my code. Will be riding with another agency as well. I doubt they will let me be the princess in the QRV this time. I'll just ride in the back and learn from the best how to run circles around the back of an ambulance! I've really missed this!

Weirdos

2009-12-11T18:42:00.002-05:00

A few words of advice to the new nurses out there... hell, to any nurse who may be interested in the ER.

1) Don't be afraid to say No. To patients, visitors and doctors. Our right to refuse (unsafe treatment, poor behavior or to be manipulated) is one that we as nurses don't use frequently enough.

2) Always follow your gut instinct. If the little voice is telling you something isn't right, figure it out. Work the problem until you know you have things under control.

3) Always remember the other people. Social Work, environmental services, chaplains, EMS. They will bail your ass out when you need it the most... and it helps to know their names when you thank them.

4) Never, NEVER assume that you have seen it all. Something is out there that will shock the shit out of you.

I picked up the dancehall Thursday night. That used to be where we stored the drunks and undesirables. Now that our census is WAY up and our diversion is WAY down there are actual sick people out there. So this woman is a G10P1 with many many spontaneous abortions due to Rh incompatibility and incompetent cervix. She was pregnant and had a miscarriage the end of Thanksgiving, but returns with belly pain. She was clutching her bible and doing the "Dear Baby Jesus" rock back and forth. She wouldn't let go of the bible, even when we went to do her pelvic exam. I found out that when she had the last miscarriage she kept the POC (products of conception: she was only about 12 weeks, so it was more tissue than baby-looking stuff) in a ziploc bag. The bag was wrapped in a cloth tissue and was put in the bible. Yeah, thats where it was. Pieces of dead baby in the woman's bible. Fucking gross. I can't imagine the smell!

Once I get to triage it really becomes like reality TV auditions. Everyone wants the starring role in the back. They make things sound 100% worse than they really are. An ingrown toenail can become an unsteady gait with stroke symptoms and who the hell knows what the common cold can be inflated to... the Bubonic Plague, maybe? I am the Simon Cowell of triage. You really have to be sick to get a rise out of me. I'll put you in the waiting room at the drop of a hat. I had a 22 year old come in with a nosebleed. It had been bleeding for a couple of hours. She was a little upset, but very appropriate. I sat her down and was in the process of doing the "Hi, my name is.... and what seems to be the problem" while slipping her jacket off.... she looked up and blinked hard and then blood came out of her freaking eye. Like out of the tear duct and down her face. She continues to cry and blood poured from her eyes.

Ok, WHAT THE FUCK?!?!?

I popped her up, no vitals, put her in the wheelchair and took her straight back. The charge nurse started to give me shit until I explained that this was more than just a run-of-the-mill nosebleed. I don't freak out about much, but I must have had a WTF look on my face. She was whisked into a room and the attending was not far behind. I'm not sure what the blood in the eyes was really coming from, but she had no other medical problems and platelets of 8. Here's to good nursing assessments, huh?

Signs

2009-12-04T17:18:00.000-05:00

There are some signs that are obvious. We ask for signs and symptoms of CVA, tension pneumothorax and heart attack. We see them every day. They keep us on track and show us the way. Some are more subtle than others. You have to read between the lines and interpret what they really mean. I think this loose association is what separates the "human" signs from the ones we see on street corners.

For example yesterday It got absolutely no sleep. I claim that myself. I decided to do one of my first ambulance days in between a run of shifts. Maybe not the brightest idea, but it was a great oppotunity I had a wonderful time. So I sacrificed sleep. After 24 hours awake I can be little punchy, but this was a bit much. My normal bubbly personality was replaced by a filterless pitbull. I truly tried to hang the "Leave Me the FUCK Alone' sign, but to no avail. FYI: When you are tired, Mt Dew, triple lattes and starbucks Dark Chocolate Espresso beans are not an idea situation. SVT is not pretty on me!

When I am tired/cranky my personal space frequently becomes an issue. I simply want to be left the fuck alone. Back off, don't crowd me and let me do my thing. If I want to see you, I will seek you out or open that door. Unfortunately, the normal happy me is thrilled to sit and chat with anyone so when the aforementioned filterless pitbull is around they seldom recognize. I was in triagony all night last night with one of my buddies and another lady that we have dubbed "The Wandering Brownie Lady." She has started a business making gormet style brownies that she frequently brings to work to sell. Thats all nice when you need a chocolate fix, but when we are busy as shit with patients everywhere and she is.......? Who knows where? It was all I could do to string intelligible sentances together and not strangle every needy motherfucker that came to the desk.

After a teeny nap (my 30 min lunch break, of course), I was still filterless but in a slightly better mood. Maybe I need to try to get a little more sleep next time!

Thin Skin

2009-12-02T17:12:00.001-05:00

As much as I am out there both on here and in the ER, I am usually a kind of shy person. When I do lectures, no matter what the subject matter or audience, I get really fucking nervous. I worked on my neuro lecture for a really long time. I collected pictures, worked on how I could break things down and make the subject more entertaining. The lecture itself went well. No big hitches. Very few off the wall questions.... except for the random chick who is in every class and has 50 million questions no matter what. I got home, popped on the computer and started to wind down.

That is... until I got onto one of those social networking sites. Yes, I have a facebook. I check it often. I like that I can keep up with people without having to have the "Hi, how are you?" phone call, or run into them in public and not remember they have 3 kids and are not pregnant with #4 (despite what they look like). I rarely add people as friends. Thats not really my style. Working in the ER, or flying I ran across a ton of people that added me and I don't know them all super well. So I'm checking people's statuses... nada big. When I come across a very recent posting. It was from a medic who was in my class. (in fact, she was still there.... in the afternoon class) She openly bashed my lecture and questioned how much she had paid for the class. She actually used a couple of my phrases in her posting. I think she probably forgot that she had added me as a friend.

I was devastated. Seriously. I try to put myself out there and make the class both educational and worthwhile and this is what I get in return. I'm all for constructive criticism. If there was a way I could have presented the subject matter better, or if there was a more specific area that needed to be covered then sure, have at it. But thats not what this was about. This was about me personally. I won't lie... I was in tears. I felt about 2inches tall and vulnerable as hell. It took about 24 hours for me to take a step back and just say FUCK IT.

I spoke to the course coordinator about this as well. I didn't want to be a tattletale, but god knows she's gonna put this on my evaluation and I didn't want him to see it and have a WTF moment. It was really hard to tell him what happened. I was embarrassed and scared that this would be the end of my teaching. I shouldn't have been. He was both pissed (at her) and very supportive of me. That conversation helped restore some confidence. I am curious what her reaction will be when she sees me in the ER. My response will be to maintain my composure, show the class that she (obviously) doesn't have, and tell her to go fuck herself (in my head, of course)!

Gobble Gobble Gobble

2009-11-27T08:47:00.000-05:00

There are days where I know my family puts the fucked up in dysfunctional (hey... it works when I spell it!). Some days the drama of being married to a cop proves difficult. There are hard decisions and sometimes feelings get hurt. What can you say? It's not personal... some people don't see integrity as worthwhile until its questioned.... I, on the other hand, beg to differ. Without getting into details... I won't have any problems sleeping over this decision.

So the trauma room was just what I needed last night. Stocked and ready to rock. The ER was dead... just a couple of drug seekers and a little bit of bullshit on the side. Had a rollover with an open fracture to the leg. Nice guy, sober, appreciative of all of his care. Ate with the ER family.... I stopped feeling sorry for staff that works night shift on Thanksgiving... we have the BEST leftovers! Had a super huge spread with some of the greatest people I could work with. What a family!!!

Ended my night with a "found down" in the rain. He was out at least 4 hours and had a core temp of 83. We decided he needed to be tubed.... no SOCM medics or lower type peons around. I asked and they said yes! Got the tube on the first shot... save a little green vomit it was easy as hell! His lactate was nearly 20 and his pH was 7.0.... poor sick guy. I hope he enjoyed his turkey today.

Irritated

2009-11-18T10:56:00.000-05:00

Sitting in triagony the other night. Not sure where the sense of entitlement comes from these days. We were busy as hell. Sick patients, transfers, traumas is addition to all the other associated bullshit. If you have flu-like symptoms, want a work note or just have a headache and are out of Percocet you really, REALLY aren't getting in before the wheezer that can't talk, the walk-in stab wound to the chest or the seizing head bleed. I had more people up in my face screaming about the wait time and that "people that walking in after me are getting seen first." (see also: the WALK-IN stab to the chest)

I have mentioned the intellectual Olympians known as our hospital security (not police). Again sitting in the penalty box when a young lady walks in with a box marked "Perishable" with biohazard tape. She stopped at security and asked how to get to the OR. (anyone getting the drift here?) He told her that she would have to go back out of the ER, down to another building and through the ass-backward way to another security checkpoint and waiting room. Absolutely not! This chick goes straight up! There is a patient prepped, tubed and (probably) open waiting on this kidney that has already been out of the previous owner for at least 3 hours. (She just arrived from another big teaching center about 3 hours away)I walked her up to main control myself and the kidney-bean got where it needed to go. This fucker seriously cares more about me texting at the desk than getting a fucking organ where it needs to go on time. Yup, I wrote it up!

Am trying to get a proposal to one of the state EMS conventions. I want to do a neuro lecture about traumatic brain injury and pre-hospital treatment. With my neuro, ems and flight background, plus the fact that I have lectured before you would think it would be a slam dunk, right? Negative. One of my coordinators is on the committee and he was giving me a hard time.

• have you lectured before? we don't want anyone cutting their teeth here
• do you really think you can lecture for 90 MINUTES?!?! (my normal lecture is 4 hours)
• have people actually heard you speak? who was it?
• do you think you could have a proposal ready in time? (told him my whole 4 hour lecture was at home on the computer.... could email it the same day)

whatever.... I'm qualified, organized and am a pretty decent teacher. I gave him my proposal, but I'm going to email it to someone else on the committee as well. Ugh... we will see. There is no monetary reimbursement, but it would be one hell of a resume builder.

Dear God...

2009-11-11T18:04:00.000-05:00

I understand that there is a reason behind everything you do. I can't begin to understand the grand plan or meaning behind it all. I guess my role is to keep faith and roll with the punches. I have tried to give more than I take and make my time here worthwhile. The last 18 months have been challenging to say the least. My professional, personal and family life have hung in the balance at some point or another. I hope that I have used these opportunities to grow and make myself a better person. So now, after ANOTHER sleepless night, this time worrying about my mom (who was taken to the hospital as I flew back from my trip) I ask.... can I get a freakin break?

Thank you

Amen

The trip itself was incredibly relaxing. Jamaica is infinately sad and beautiful at the same time. So much poverty amid all that green water and blue sky. I had champagne with breakfast every morning and something called a Dirty Banana from the beach bar (or swim up bar) any other time I needed it. It rained every day... I didn't care. Got a ton of sun, ate great food and swam in the ocean every day. What can I say.... it was fabulous.

Called in tonight so I could spend more time with mom (and getting moms house together so she wouldn't have to). Back to the grind tomorrow.

Somedays....

2009-11-02T15:42:00.000-05:00

... you can't win them all.

Last night I don't think I won any! Some nights everything you touch turns to gold and then there are nights like mine. Seriously, don't know where this shit comes from.

I was supposed to be walking the green mile again last night. Not in charge, just rowing with the others. One of the nurses absolutely hates the trauma room and asked if we could switch. Easy enough and the world swings my way for a change. I picked up the room from one of the guys who is both thorough and laid back. If only he worked nights! The room was both empty and stocked..fan-freakin-tastick. The trauma docs immediately decided to put one of the traumas back in the room for chest tube placement. 18 year old female, t-boned on the driver's side. Rib fractures 4-11 on the right side with a hemo/pneumo. The doc did an incredible job of numbing her and with a little "liquid margarita" (aka dilaudid) she did great.
Once she got settled, the trauma started rolling in. 3 from another accident.. nada too sick. Two rolled out and we got another upper airway burn from a house fire. This guy went into his burning house after his cat. He made it out, the cat did not. Nice 22 year old guy with a history of asthma. He was wheezing, but still managed to laugh and joke despite the house (and the cat) being a total loss. Got scoped at the bedside, and then to burn ICU for overnight observation.
Did I mention we were on diversion with very few inpatient beds? OK, just checking....

Local EMS agency overrides diversion (it happens) for a man with chest pain, in a 3 degree heart block and 10/10 pain. One thing I have picked up along the way: if you have to use a towel to wipe the sweat off, THEN use benzoin to get the 12 lead EKG and normal EKG patches to stick.... life is NOT Good today. Get your shit ready. This poor guy had a rate in the 50's, a pressure in the 200's despite 180mcg of nitro. Bad juju my friends. He was awake, talking to me while 50 million things happened around him. Hemocult, heparin bolus and drip, projectile vomiting + zofran = baby asa and plavix PO. IV morphine and titrating the shit outta the nitro. Consented for cardiac cath by the CICU and rolled out 35 minutes after hitting the trauma room. (no other bed when he arrived). He coded as soon as he hit the cath lab..... died 45 minutes later. 50 years old..... I kept telling him to hang in there and that things would be ok.

Next contestant. 86 years old, from the nursing home. Dementia, prostate cancer, vomiting blood, being bagged on arrival. The nurse didn't think she was supposed to send the DNR. We were fixing to get medieval on him as the charge nurse convinced the NH staff to fax the goddamn DNR already. It finally, thankfully showed up. He was fluffed, puffed wrapped in blankets, put on a NRB and left the hell alone. What a damn relief. In an effort to reverse my karma I grabbed a COW (computer-on-wheels) popped up Pandora on some Michael Buble and put that in his room as well. Hell, if the man is going to die he may as well have some relaxing music!

He had just gotten settled and I was feeling a little better when we got the next call. Flash pulmonary edema 2 minutes out. Pt shows up on CPAP via a transport service (not 911 type EMS). 28 years old, 450lbs from a respiratory-type nursing home. She had been short of breath for greater than 40 minutes and the facility chose not to call 911, but to wait for their normal transport service. She was awake and saying "help me" when she arrived. As we watched she stopped breathing on CPAP and the game was, unfortunately, on. Bagging her was a BITCH, I had to pull her hair just to open her airway and it took 3 of us to get a good seal. Roc and etomidate... the resident got the tube on the second look. (long story involving the dumbass attending.... better saved for a later rant) Even with color change she looked horrible. Purple and mottled no matter what we did. Confirmed tube placement a million times... she dropped her rate from 140 to 60... but never brady'd down like our shit-airway people usually do. Shit BP + Shit O2 sats.... femoral pulses impossible to feel through the FUPA and the cheese down there was disgusting. We coded her for 11 minutes the first time, and got a pulse back after 2 rounds of drugs. Lost it again after I art-stuck her for labs. Coded again for 15 more minutes.... everyone took turns with compressions as she was too big for the geezer squeezer. P's and T's... everything covered. Even darted her left chest just to see if it changed things. Over an hour of coding the big girl when we were finally done, followed by cleaning the hell outta the room and the quest for a bariatric body bag.

As we were zipping her up, my transfer... self inflicted GSW to the right temple with an exit in the left temple. He said he was cleaning the gun and it was an accident. (yes, awake and talking... just destroyed both eyes) Accident my ASS!

So on the advice of one of our university police officers my breakfast consisted of "Jameson's, 3 fingers with 5 ice cubes." Perfect for a night like that.

Hot Now

2009-11-01T09:03:00.000-05:00

Last night was exactly what we anticipated. Fucking insane all night long. I had a great group walking the green mile, but some nights even a great group can only take you so far. There were some superfreaks out and about. I didn't get to see any "real" costumes, but I still wonder about what people were wearing when they left the house last night.

Sad case, college level math professor from somewhere in Africa found wandering. No idea who he was or where he was. CT scan showed a BIG head bleed. He was still awake, but squirrely as hell. We were, of course, too short on security and extra staff to have someone watch him, so we all basically did a drive-by of his room whenever we could. Ditto with the drunk that fell at 3pm and bonked his head. He was still metabolizing to freedom 13 hours later. Lots and lots of drunk bastards last night. Some more functional than others.

Trauma, on the other hand was wide slam open with MVC's and GSW's. Some dumb fool pulled a gun on three other dudes. He got off a round or two before the other guys lit his ass up. 4 total GSW's in a span of 15 minutes in addition to the multiple accidents that were coming in. I ended up pulling multiple patients out of the trauma room back to the green mile just to make room. Oh, and of course all of this happened when the computer was down.

My all-time favorite Halloween patient.... 29 years old, found down in an alley. Combative as hell. He came in proned out, handcuffed and strapped down all the while flicking us off. If Criss Angel and the guy from The Crow had a psychotic child then this would be him. Black stringy hair, crazy black eyeliner, tattoos and fake blood all over him. When he pancake flipped him he arched up off the bed, head back and screamed "I'm going to kill you all!" I looked up and said... "Holy Shit, it’s the Devil!"

Had an unrestrained female hit some guy head on. She was pregnant and until we unstrapped her she was normal. When we logrolled her she went apeshit and grabbed my male nurse by the cahones. It was not a pretty picture.

I figured that since we all worked that extra hour we deserved a well earned break. The CC knew I was going to the "bathroom" as I drove through the monsoon to get hot. fresh doughnuts and coffee for the department. It was just what we needed to make it through that last hour. So am glad to be home, dry and happy.

FYI: I am NOT doing this SHIT next year!

Its the Great Pumpkin

2009-10-31T08:52:00.000-04:00

Do you ever wonder about the Perfect Storm? A series of events that individually wouldn't be a big deal, but when combined are a big fuckin nightmare? Well thats what I'm seeing tonight. Its Saturday (sucks), its Halloween (sucks ASS), its fall-back day(FUCKER), the computer system is going down at midnight (MOTHERFUCKER) and oh yeah..... I'm in CHARGE tonight! ARRRUUUGGHHH!!!

Fuck that shit.

Pardon my language. Given the pending gloom and doom I think it is warranted. I have a feeling the the Green ER is not going to be the most sincere pumpkin patch this evening. Maybe the Great Pumpkin will rise outta another patch and bring all the drunks and psychos to the most deserving ED (and leave us and our Influenza-Like-Illness aka ILI alone!).

Fat chance.

Fuckin Flu

2009-10-28T11:41:00.003-04:00

So nada good going on in the ER these days. The flu is rampant (of course) and I think there must be a psychological component because these have to be the stupidest patients I have seen in a while. Kids with temps of 103 and the parents, when asked about tylenol/motrin etc respond "that’s why I brought him here." At 2am with the rest of your damn family. I actually had a mother bring a kid in for a runny nose that didn't think they should have to wait in the waiting room because she didn't want her kid to get sick. I explained that this IS a hospital, not a mall and that if she wanted a mask for her child then I could give her one. She refused. WTF?!?!? People are so fucking stupid.

Before I leave my flu rant in the dust let me also vent my frustrations about the management. They KNEW this was going to be a fucking nightmare. I think we all knew that this flu season was going to be bad. Did they prepare ahead of time? Negative. They have a "Flu Tent" that has been up in years past. Was it up when this shit started? Nope. They have decided to move the different areas around to make a dedicated "Flu ER." Did they know how they were gonna staff it??? Nope. I got a call yesterday. It was a recording from the ER saying that "We are excited to announce our new Flu ER! We are giving you the opportunity to work overtime from 9a-9p. Please call to schedule your shift!" Ummmm so what happens when NONE of us want to work there? I'm entertaining it just for extra Christmas money. Will check the schedule tonight and see just how fucked up this thing looks.

My paramedic class has gotten a touch of drama on as well. These Type A bitches are really pushing my Type B buttons. We are a new hybrid of the paramedic class. Things that are generalizations towards other classes don't fit ours and there is some flexibility that has to be accepted. That said..... we spend greater that 20 minutes each class hashing out the drama for the type A's in the group. This is all well and good when I have slept the night before and am slowly drinking my coffee and waking up. However, when I worked in flu hell the night before, haven't gotten my coffee on and generally not in a great mood... you'd better watch out. It was all I could do to keep my mouth shut. Even better?!?!? When the lecture started it was trauma and neuro. The teacher kept going to me with the classes because of my background. I should have just taken a nap!
Yesterday I got a call from the queen of the high maintenance bitches in my class. She had her first clinical in my ER. I was expecting she was gonna fly off the deep end. We are a bit off the chain these days and I didn't think a super control freak would feel comfortable there. I was wrong. She was blown away by our little shithole. She actually said that I was very fortunate to work in such an amazing place and that the experience as very humbling. Wow.... very interesting.

Finally, on the advice and support of friends (including you guys!) I have decided to just say FUCK IT and run away for a couple of days. Super nice, all inclusive resort in the Caribbean here I come! (In less than 2 weeks!!!!) Every time someone starts bitching about the long waits, the flu or getting super Type-A, I just hum some Buffett and Marley and go somewhere else.

Please sir, I want some more....

2009-10-20T11:46:00.000-04:00

For the second time this year I have had the privilege of a phone call from work saying "hey... your (first was the husband, this time grandmother) is in the trauma room." She is 76, still driving and managed to hit another car head on in the rain. The other folks are ok; she spent the weekend in Trauma ICU and is now terrorizing the nurses on the floor. The upside (again) is that I know all of the trauma docs very well and they have kept me well updated.

I'm a firm believer that god doesn't put anything on your plate that you can't handle, but damn this has been a full plate this year.

I picked up a day shift yesterday. Let me just say... the HELL with that! Even with the staff, who were mostly evening shift doing overtime, it sucked ass! Too many people in too small a space. Too much drama and not enough common sense. People keep telling me that I will give up on night shift someday.... I highly doubt it. I truly don't think that I need 20 people in the room to work a post-cardiac arrest. Give me 2 strong nurses, a medic, a really good resident and an attending and I think we can take on the damn world. I couldn't even get to the monitor yesterday for all the people!

Let me also say that the flu is out in full force around here. So much so that all of the triage nurses are now to classify anyone coming in with flu symptoms as "ILI" in the chief complaint box. ILI= influenza like illness. This way our total visits can be tracked. Unfortunately, unless you are sick as dogshit we aren't going to do much for you.

Ugh.... I think I need a vacation.

Just freakin' gross

2009-10-16T17:08:00.000-04:00

There are some statements that truly need to be repeated. I once told a special forces medic that the texture on our temperature sensing foley was "ribbed for his pleasure." (I have yet to live that one down)

Occasionally, our male nurses have to chaperone a pelvic exam. They don't like to do it and bitch like crazy afterwards. Yesterday one of the guys had to go in on a less than appetizing exam. His response... "that looked like a bulldog eating mayonnaise."

The mental picture still makes me cringe.

Crazy as shit psych/seizure patient went ape-bonkers last night after enough ativan to kill a horse. I counted 4 cops, 2 docs, 2 special forces, 2 nurses (me and lurch) and a medic. How I always end up on the bottom of the pile on these, I will never know. We were convinced that he shit himself until we realized that the smell was dudeman's breath. He went upstairs after a B52 of ativan, haldol and benadryl. I tried to ignore the distinct crunch of his wrist when I put the restraints on!

Holding down the fort

2009-10-15T06:04:00.000-04:00

Some days it’s nice to walk in, not be in charge and not be in triage. Just holding down a zone or (gasp!) the trauma room is somewhat relaxing. As I have said many times before, we have some staff that are really scary. Maybe even to the point of negligent. Honestly though I doubt this is a purposeful act... and maybe blissfully ignorant is a better word. I think they would be exceptional school nurses, clinic nurses maybe even basic (and I mean BASIC) med-surg teachers, but they have absolutely no place in the world of acute emergency medicine!

I took the trauma room over from one such nurse the other day. The room was absolutely trashed. All kinds of shit missing to include Ambu bags, stylets in the airway carts and suction equipment. I asked the charge nurse what the hell happened.... she said the nurse's name rolled her eyes and then told me there was one trauma in there ALL day..... thats it! Ugh.... so this bitch can't even handle an easy, not-so-sick trauma. What is she going to do when they open a chest? Work a big burn? Or god forbid a police/fire/rescue person where tensions are ALWAYS high? One of the docs listened to me rant and suggested that I write her up. Unfortunately, until I actually see her fuck up or hurt someone I have no grounds to say that she is a moron.....even though it is a well known fact!

After cleaning the room from top to bottom, pulling all of the extra crap out of the carts and reorganizing, I was finally ready to rock and roll. We took a transfer from a Level 2 trauma center. 65yo F that had central cord syndrome from an MVC. She arrived fully dressed from the waist up.... although they had taken the time to cut her pants, unsnapped her little girdle-leotard thing and placed a foley. She had not been taken off the backboard or hard collar at the other hospital. Her accident was at 1300.... she arrived to us at 2045! Almost 8 hours on the fucking backboard! That is criminal! We got her off the board, into an aspen collar and into a warm gown. Ironically, once she was off the board all of her peripheral weakness went away and she was just fine. CT's were normal but she stayed for observation (and possible workup for decubs and rhabdo!).

As it gets cooler we are getting more of the "street variety" type patient. Is not so cold that they are complaining of chest pain or suicidal ideations (that warrants an actual workup) they are just coming in drunk. The new PC term for the homeless???

Urban Camper

I love it!

PS: had an exposure to a known swine flu patient for the second time in 2 months. That nasal spray better fucking work!

How Many?

2009-10-09T05:07:00.000-04:00

How many grown police officers does it take to control a crackhead?

I really wish I had take pictures to illustrate. I was sitting in triage after one HELL of a first 8 hours trying to catch up on my reading for paramedic class, when an officer we all know well comes through needing some help. One of his guys has the wagon and is bringing a "crazy crackhead" for us to check out. I grab a stretcher and some friends and we head out to the ER driveway. Our buddy the officer is out there with gloves, another officer pulls up, and another and another. Before the wagon even arrived I counted about 12 officers gloved up and ready to roll. We even had staff members from other units who had come outside to smoke and stayed for the show.

As the wagon (finally) pulled up I asked "So is this chick a sasquatch or something?" Apparently not. The doors opened and... nothing. Absolute silence. Someone in the back even asked "is she still in there?" Yup... huddled in a corner, a 21 year old, 120lb girl who had been so cracked out of her mind that she gave a 6'0, 200lb officer a run for his money. They hauled her out of the wagon by her arms and legs, plopped her face down on the stretcher and she rode, Superman-style, into the ER. She didn't start fighting until she got into the room and the Dr came to evaluate her.

Stress???

2009-10-07T09:16:00.000-04:00

In my last flight interview I was asked... "What stresses you out?" I answered without pause... "Being in charge." I don't enjoy it even though I am told that I do a decent job. Being charge at a Level 1 Trauma Center... esp. when diversion is considered a sign of weakness is like a combo of air traffic controller, ultimate fighter ref and psychotherapist all rolled into one. Most nights I am able to keep it together, control the flow and check most attitudes at the door. Last night was not such a night. Well, I take that back... the latter half was pretty freakin good.... it was the first that sucked my will to live.

For example.....

There are some smells that stick with you. Coffee, cinnamon at Christmas, burned hair/skin, the coppery smell of blood AND.... TAAADAA... the funk of a scrotal abscess that has been festering greater than 2 weeks in the pants of an unwashed crackhead who cannot for the life of him keep the hands OFF the twig and berries. GROSS!!! There was some discussion whether his breath or balls smelled worse. I think urology found out quickly that they were getting the short end of this deal.

Also.... the moon MUST be full. I can't tell from looking because it has been too busy for me to even go outside at night to see. The psych patients have literally come in droves and have overflowed the normal "psych zone" and are now in the hall, down the hall and around a corner. Today as soon as I got report one such patient decided to enlighten us all with the info that 1) he was a teacher and when he gave blood Obama was elected president 2) we can't keep him here and 3) we had better give him his fucking pain medicine or he was gonna whoop our asses. I figured we could stand about a foot out of his reach and do whatever we wanted.... he wasn't leaving. Paralysis is a bitch like that, huh?

I think the closest I came to actually fucking someone up was a 45 year old dialysis patient who was late for her dialysis, had chronic neck pain and wanted her Percocet refill, dammit! She raised holy hell that the MD was only going to give her Tylenol, she didn't want her blood dawn and she NEEDED 3 mayos for her turkey sammich. When she demanded that the Medicaid cab ride take her somewhere other than her home address she was escorted out by her resident and some of the University's finest.

We also came up with a brilliant idea. Had to send an extra fluffy resp patient home (to cont smoking her 2 packs a day!) via ambulance for the O2. A complete waste of time in my opinion. Our solution... have her put her head out the window on the way. 55 mph should afford at least 5 of PEEP! Hell, have the driver speed up and slow down and she is on Bi-level!!!!

Finally, OMAA.... we got medieval on the only real sicko of the night.... Hep C, Liver CA, varices, SOB and vomiting over 2L blood PTA. We were dressed, draped and ready to rock and roll. He had 2 lines, 4 liters of NS, EKG, CXR and labs in the 20 minutes from arrival until shift change. (My nurse refused to place an NG... and I had her back 100%.... the attending could do that... we don't drop NG tubes in someone with bleed fuckin varices! Give me a break!) I had to explain to the stupidest charge nurse in America why this was a RED patient. I would question if she was truly that fucking stupid, but yes, she is.

So yes... please let the chief flight nurse AND the educator and whoever else that wants to know. Being in charge fucking stresses me out!!!

Silver Lining

2009-10-02T03:50:00.000-04:00

New adventure??? Who knows? Tonight I ran into an old acquaintance who presented a new fork in the road. She is an organ procurement coordinator. She evaluates donor candidates, (occasionally) consents families and then manages the care of the patient from consent to OR. I have worked with these patients before. Donor patients are the sickest and most challenging that I have ever taken care of. With my background I could probably be pretty successful.
What about flying? I still miss it every day. I still dream about it at night, and can't help but smile when I hear an aircraft overhead. Not ready to give up on that dream yet, but the ER is still sucking my will. I don't know that I would be happy in the ICU. It took all I had just to suffer through neuro as long as I did. Will a cardiac surgery or pedes ICU be any better? Hell if I know. ARRUUUGHGGGH.....

A Year in the Life

2009-09-28T13:53:00.001-04:00

Five Hundred Twenty-Five Thousand Six Hundred Minutes.

I have never seen Rent, but my (former) mechanic was astute enough to point out that at 8am tomorrow will be a year from the day my base was shut down. Most people have moved on.... effortlessly in some cases. Most are stil flying somehwere. Thats a hard realization for me. I think I probably took the closing a little harder than everyone else and have spent the last year just trying to get over it. I feel like there are still scars there.... just not as visable as they used to be.

So maybe that will mark the end of my getting over it and start the moving on process.

HBIC (Head Bitch in Charge)

2009-09-26T19:03:00.000-04:00

I am still completely fascinated with the idea of 'Emergency Hair.' Seriously, is this some shit that was just made up? I asked the charge nurse as I was getting charge report last night and she had an epiphany. (this from a blonde hair/blue eyed Scottish girl) Emergency Hair: when you have your hair weave/braid put in you get extra little braidy things to sew in if one falls out. Wow, that makes a lot of sense! I tried to confirm on Wikipedia, but no such luck. My only confirmation is from the weirdo white clerk who randomly got braids put in a couple of months ago.

Being in charge always stresses me out a little bit. It really does depend on who you have on your "side" and how well they all work together. Last night in green I had an incredible group. They were all strong, nice people who worked well together, especially when it was hitting the fan. The way staffing fell, there was a Sausage-Fest (all boys) in Yellow... and only a token boy in green with me. We started out ready to prank them all night... as they have done to us in the past, but unfortunately it was just too damn busy!

Someone explain this to me..... 65 year old lady with MS, CVA HTN, lives in a nursing home with a PEG, colostomy, decubs everywhere and contractures. Are we getting the picture here? She is usually completely with it (yeah right) and became altered 36 hours before she showed up. The staff sent some labs and waited. It became an emergency at 0215. She arrived with a temp of 103, tachy and (THANK GOD!) not hypotensive. The staff at the home refused to give EMS any more info.... but they were more than willing to call and question when we were going to admit her. The nurse refused to talk to them (she was Sooooo pissed) so as charge I got to tell them that she was being admitted and then promptly hung up on them.

While MeeMaw was sick, we were keeping a lady up on CPAP and tubing another asthmatic that wasn't moving any air. The asshole husband of some abd pain patient had to be told to get out of the asthma patient's room, and the crazy psych patients were moving in. Seriously, some girl went to the bathroom, put on PJ's and slippers and was reading a book instead of talking to the psych doctors.

Some people just irritate the hell outta me. The attending last night was the only real downside. He's a jerk, plain and simple. The highlight was when the resident walked in to the tubed patient's room to tell us what a dick the attending was!

Emergency Hair and the Crazy Check

2009-09-25T08:31:00.000-04:00

I made the mistake of telling someone that I don't need a great night's sleep before being in the trauma room simply because I don't HAVE to think very much when I'm in there. Things come naturally to me and it just flows. Unfortunately, last night flowed a little too well. I am dog-ass tired and my feet are killing me. Multiple GSW's that (even though they were nice enough) just fucking sat there. Nada acute going on with them so just in a holding pattern.

What really chaps my ass is that while I was full in the trauma room, there were multiple open beds out in the treatment area. Nurses were out there shooting the shit and chilling while I ran around like crazy with 2 GSW's, a self-inflicted slice to the arm (hypotensive) and a BIG FAT MOMMA 82 year old with oozing leg ulcers. Don't ask me how the last one got stuck with me, she just did. Once I got everyone stable I went from bed to bed drawing all of the repeat labs, cleaning, getting people off of wet gross sheets, into gowns and under warm blankets. All the while my faboosh colleagues were hanging out with empty rooms. I should have said something to the charge nurse, so I guess it’s partially my fault. However, she is a little flighty and one of the lazy bitch nurses (who I have mentioned before on here) was out there and wanted to do as little work as possible. She has recently left the ED full-time, thank god, and will now come work 8 hour shifts from time to time. This change has done nothing for her attitude. So she had open beds all night and just watched me work. I could strangle her ugly neck!

Ok Ok, so this comes across a little bitchy, but I am tired of telling people to do their jobs. Not even HOW to do it.... but just to motivate people to fucking work in general.

I also heard a couple of new terms this week. 18 year old girl is under arrest for assault. She is getting medically cleared before going to lockup. The officer went to check her purse and asked what was in there so he didn't have any surprises. She rattled off the normal purse-stuff and then said "my emergency hair is in there too." WTF?!?!?! Emergency hair.... seriously? The officer reached in and pulled out a couple of little plastic braids. ........gross.

One of the housekeepers has a son who is in jail. He is getting out in a couple of years and she mentioned that he needed to apply for his "Crazy Check." Again.. what the fuck is that about? It sounds like the excuse is that he was in jail so now he has PTSD and needs disability. Why the hell does a healthy 25 year old need disability? Does anyone have the answer to that?

So my exposure to big momma crotch and the emergency hair has caused PTSD for me... can I apply for a "crazy check" and retire in luxury at 31? Just checking.

.

Bimbo?

2009-09-23T15:36:00.000-04:00

You know what tweaks the hell outta me? The fact that I can walk into an interview, know all the answers, but cannot make the words leave my brain and spill out of my mouth. I had yet another interview today. It went ok, not a slam dunk. I know I wasn't a complete ding dong, but not as strong as I wanted to be. I just wanna call back and say "give me another freaking chance!" Even better, come watch me work. See me in my natural habitat.

Is it a confidence thing? Maybe. Where does the confidence go when I leave the bedside, put on heels and sit behind a table? How do you overcome that? Fuck if I know. I guess the more you interview the better you get??? Grrrr..... back to the trenches tonight. Trying not to think or worry. Again, thoughts, prayers, VooDoo, reptile sacrifices (frogs scare the hell out of me) and anything else would be appreciated.

Me and my Karma

2009-09-22T20:15:00.000-04:00

So I'm about ready to cash in about 75% of my good karma. Have spent the past week and a half splitting my time between work, class and studying. 0930 tomorrow will see if the hard work has paid off. Thoughts, prayers, bribes and whatever else you have to throw in would be greatly appreciated.

My medic class stated a few days ago as well. What can I say other than nurses are some high maintenance bitches. Seriously, what part of "work with us and we will work with you" do these people not understand? Many are downright pissed that they have to come to my ER to do clinical shifts. Apparantly BFE memorial hospital should be more than adequate ER experience. Ummm..... because I'm sure this is a common occurance there.

Yeah... thats me on the right. Will keep the medic updates coming... am curious to see how this class goes. As I said, these are some high maintenance chicks and they just LOOOVVVEEE to hear themselves talk. I told one that "my filter is comin' off in 20 minutes" (I had worked a 12 the night before and had been up 22.5 hours at that point) she had NO CLUE what I meant. OMAA!!!

Back to the books (and a great glass of 2007 Reisling).

Eyes, Ears, Mouth and Nose

2009-09-13T09:27:00.001-04:00

Yup.... thats exactly where the septic patients vomit went. Mouth open (EWWW), glasses on (thank God). Vomit all over me. Gastrocult positive, MRSA confirmed. I brushed, rinsed with peroxide and changed my scrubs. I wanted to gargle with bleach but that wasn't exactly recommended by the dr. I also stuck my bare hand into a puddle of still warm urine and had yet another patient vomit on my arm. ** This last one was a bachelorette party gone awry. The MOB and groom were unthrilled that the bride got that shit faced!

Last night sucked ass. Can you tell? Any time you but 100,000 drunken partiers together with an urban environment, a warm day and a Saturday night you know you are royally fucked. I also have a big belief in the radio on the way to work. A little Marley and Buffett, things are mellow and chill. Last night was "Highway to Hell" and "Its the End of the World As We Know It." The green mile was not the place to be... thats for damn sure.
I didn't make it into the trauma room, but the notables were...

*T-bone MVC trauma code. The driver was HIGH and had neat, individually packaged pouches of "baking soda for my teeth" in his pocket
*Dude man who was robbed and then throat slit ear to ear. DAMN!
*House fire, 60% third degree burn

WTF?!?!!? I am soo very happy to be home. Trying to decide between food and sleep. I think sleep is winning!

Something to believe in

2009-09-10T16:26:00.000-04:00

I have been on a bit of an 80's wave here recently. Not sure what has brought about this trip down memory lane, the 80's were most definitely NOT the highlight of my life so far. I find myself humming along with the familiar songs from back when.....

I keep waiting for some inspiration. Something that leads me back to why I love ER nursing and re-lights the proverbial fire under my ass. I look to others for guidance and direction down the right path. When I'm in charge and my feet (and ass, head... hell my whole body is to the fire) I try to channel one of the nurses who I have the deepest respect for. She is calm, competent and rarely loses her cool. I try to keep it together until I am out of view.... then the full-out jumping up and down temper tantrum begins. A solid minute of breakdown followed by a good ol Namaste and Whoo-Saaa, often in Tree Pose and I am back at it. I try to take care of my folks they way I wish others did with me. I try to still mentor the younger nurses and medics (especially those who are so interested in "doing it right" versus just getting by).

So where is the mentor for me? Even on the, hopefully, short road to the next step (flight). Who do I look to for that simple gesture of pointing me in the right direction, slapping my ass and letting me go? I guess when I look for someone to mold myself after I simply see the mold, not everything else that is mashed into it. Some people can effortlessly juggle the personal and professional making life in general look easy. Some are experts at maintaining the spotless veneer on the outside but inside are a big ol mess. I have found that those are more prevalent than I even knew. Am I wrong for expecting more from people? People who have the job I love and are, in some respects, squandering the opportunity? I just want to scream "I expected better from you!!!!" Get it together and live your best life. Make it worth something.... there are people who look up to you watching.

As described... consider this my minute in the back room, jumping up and down screaming.

Deep cleansing breath, hands to heart-center. Breathe.

Namaste
Thanks for listening

Just call me Chuck

2009-09-09T08:14:00.000-04:00

When you nominate enough people for the Darwin Awards you get to call him by his first name.... when 90% of your patients are nominees... well, Chuck and I are now old friends. A complete shutout in the trauma room Monday night. Very surprising I must say. I guess the rain kept most of the morons inside. However, let me mention a call we got from our communications room.

45 year old man, unrestrained versus a wall at 30mph. Did I mention that he was in a lawn chair in the bed of a pickup truck? There was definitely a disparity in the teeth to tattoo ratio and there was a death in the vehicle. Yes my friends, I regret to inform you that the Miller High Life did not survive the crash. After x-rays, CT scans and multiple sutures in the face/mouth area he was ready to go. I identified a good "teaching moment" and asked him what he had learned from this experience.....

His response...? "I won't ride wit my brothers no mo."
Oh my lord.

Let me also point and laugh at one of my favorite residents. He is a third year, is a great doc AND treats the nurses really well. The ER was dead.... nada going on. Again, very surprising for a Labor Day Monday. A patient is brought back from triage with 3 days of abdominal pain. On further evaluation we find out that he is a heroin addict (her-on for those of you watching pronunciation), and has chronic pain issues, takes methadone and God knows what else daily.... are we getting the flow here? No BM x 3 days, walking like he was in labor. The resident wanted the nurse to give the guy a fleets or milk and molasses (anyone else have to do those?).... the nurses voted that we just give him one and send his ass on his way. No No No... he must have it done here.... so the charge nurse took him to the bathroom where he hollered and grunted without results. Did I mention that the resident was laughing at the charge nurse as he took the guy to the bathroom?

So after no results guess what.....???? The resident got to gown up and manually disimpact him. Let me have the honor of announcing the birth of a 2lb, brown hair, brown-eyed hunk of shit! We are going to name him Dr Junior after this resident.

Disillusioned

2009-09-03T08:28:00.002-04:00

When I started in the ER (almost 8 years ago!) as a new grad I was convinced that I was hot shit. The ER had not hired new grads in years.... I was fresh out of nursing school and had been offered every job (all 3) that I had applied for. All I wanted was to play in the trauma room... that's where my love was. 8 years later I sit and wonder what the hell has happened? I have seen more tragedy and gore than more people do in a lifetime. I have literally clawed my way as close to the top of the ED as I am willing to go. I have no aspirations of being a coordinator or management in the department. It seems like as soon as you leave the bedside that all sense of solidarity with the nursing staff is lost.

Case in point.... We are seriously up to our assholes in patients. The acuity is way up. Patients that usually get put in rooms and monitors are in the hallway. There are NO inpatient beds and the traumas just keep coming. Given the situation the charge nurse called the coordinator (its becoming well past unsafe here) and is promptly hung up on. It wasn't until the house administrator came down to investigate the 4,000 trauma pages and saw the zoo that we finally went on diversion "for 2 hours to decompress."

I also noticed that the ED education staff seems to think that this is a democracy. Everyone should be equal and allowed to "do everything." So folks that can't handle a 4 patient zone are being trained for triage, charge and trauma. One refused to check the airway cart because 1) its the dr's job and 2) I don't use any of that stuff. Many don't know how to care for a mechanically ventilated patient (100% fiO2 and pO2 of 430 is not really a good thing!) and ACLS is no longer a requirement.

I am starting to feel like a rat in a sinking ship (again). I want to stay because I know this is what I am good at. I doubt that I will leave the ER completely, but I need something more challenging that makes me think. There is no way in hell that I am going back to neuro. I will kill the troll and they really dislike my use of the f-word. Ugh... don't know where this restless feeling is coming from.

Had to work with one of my least fav doctors the other night. He is the quintessential community doctor who has blessed us with his presence in a level 1 teaching hospital. He is a "white collar worker" who looks down on everyone else. Seriously, he called nurses blue collar workers with no integrity or work ethic. When he starts talking with other "colleagues" you WILL NOT get a word in. I had a patient that was not doing well but could not get his attention to tell either he or the resident about it. He is one of those doctors that will be nice to the patients face and completely bash them as soon as he leaves the room.... no matter what their injury or education level. They are below him. He is also the medical director for our special forces medics.... so when they are around he is all about teaching and being involved. As soon as those guys leave.....he doesn't give a shit. So to my dearest Dr BORED....

FUCK YOU.

love.... one of those blue-collar-nurses!

Naked Old Guy

2009-08-29T01:49:00.002-04:00

When I started in the ER years ago we were steady busy at night from about 1900-maybe 0300 and then it just DIED. We would turn the hallway lights out and (when it was really dead) the nurses would take turns catching naps in the fast track ER. As the cliche goes, those were the "good ol days."

These days we arrive to patients on every exposed surface. Literally. The rooms are filled, the halls are filled. There are rooms like 4.5, 14.5, ice machine, outside trauma, chairs by the entrance... you get the point. The waiting room (which is not very big in comparison to the volume) is packed to capacity with patients overflowing into the hallway.

So I think the mental picture has been painted. We were busy as hell. EMS brings us an old man who was found running naked around a busy intersection in the city. No Batman cape (I asked!). He wouldn't speak, and got a little combative when the two female officers went to restrain him. He came in tied to the stretcher with a "What the Fuck" look oh his face. My best guess would put him at mid 70's, early 80's. We popped him on our stretcher, and tied his wrists with soft restraints just as a precaution. He didn't fight... in fact he kind of started off into space.

I was charting, getting caught up.... stuff like that when the clerk yelled.... "There's a naked man running through the hall!" Gramps had gotten out of the restraints and was truckin' it towards the door. I ran after him and when he saw me coming he started running faster....or as fast as an old guy can run! One of the nurses caught him from the front (Thank God!) and I had him by the shoulders. He fought a little as we redirected him back and one of the older nurses looked at him and yelled "don't you know what you look like???" It was all I could do to keep from sitting on the floor and laughing.

The Bullshit Flag

2009-08-25T13:40:00.002-04:00

I am going to get a red piece of parachute silk, write BULLSHIT in sharpie on it and tie a rock to one end. That way when I throw said Bullshit Flag it will flutter before hitting the ground.

A few things that warrant the Bullshit Flag....

*The city medic who has insurance puting her children on medicare "cuz its cheaper"

*The woman who comes in with tooth pain at 2am, via ambulance, with 3 young children in tow. Oh, and she needs a medicare cab home too

*Having the trauma intern (aka I've been a real Dr for about 2 months) giving me orders in the trauma room

*Trauma nurse saying she didn't check the airway carts because thats the medic's job (wtf?!?)

*Mandatory hospital-wide class 4 hours one evening smack in the middle of my days off

*Hospital security sleeping at the desk

*Working hard, paying bills on time and watching people travel, shop and otherwise have a fabulous time (maybe not having to work OT) and not knowing how the FUCK they do it

*Applying for a dream job over and over. Fighting politics and other bullshit just to have them hire someone else, or raise their standards every single time. As soon as you meet them the bar gets higher

*Insomnia!

Crazy Nurses and Toilet Babies

2009-08-20T18:50:00.002-04:00

I hate to say that my post vacation good mood was wasted, but with the drama that I walked into it was a little hard. G12 (maybe not that high, but you get me) P4 comes in with vag spotting after intense pain over 24 hours before. She hops of the stretcher to go to the bathroom and promptly drops the fetus in the toilet. Our best estimate was 16-18 weeker. Mom went over to the pelvic room and I took care if the "baby stuff." Anyone who has been in the ER knows what I mean. Usually these parents are understandably and appropriately upset. This one really didn't care about the baby, she was more worried about when I was going to let her 1) smoke 2)go outside 3) take more morphine/methadone (or crack, maybe?). She bled like stink, and the placenta didn't deliver. After 4 hours L&D was still too busy to take her, I hadn't seen a one of my other patients and to the OR we went. After those 4 hours I was begging to go out to triagony for the next 8. I was just DONE.

Last night I was in the penalty box for 12. That's our "screener desk." I do the "hi, WTF brought you here", make sure nobody is actively dying and then send them to the triage nurses. The triage nurses, one their own, are pretty cool. But together (they are both crazy as fuck AND good friends) they don't do shit. Seriously, they kept disappearing. People would go wait to be triaged and after 15 or so minutes I ended up having to triage many myself. What BULLSHIT! The hard part is that they are in the "battle axe " group that saying anything to the coordinator would be worthless.

The upside of screening is you seriously get first crack at the acute walk-in patients. When someone walks in complaining of chest pain you get a feeling if they are real or not. As soon as I saw this guy AMI popped in my mind. History of stents and htn, chest pressure for 3 hours. My triage EKG was a LBBB.

(I will admit freely that cardiac has always been my nemesis. I hate it. I can fake it like a motherfucker, but when interviewing for flight jobs that's not good enough. A very smart person has been helping with the learning curve. While I'm not an expert, I'm getting better)

So seeing a LBBB in a patient with a vague cardiac history, I hauled ass to the back, gave the EKG to the attending and puled up the old one which (TA-DA!!!) showed no block. The AMI page was sent out and the patient was in the cardiac ICU within an hour of my "hi how are you." Yea me! The triage nurses had no idea that I was even gone.

Bitches.......

Finally I must lament that college classes are starting again. The drunk freshmen are here. One got carried out from the ED by 6 people last night. 1 on each extremity, 1 on the collar and one by the belt..... he looked like a pig on a spit!

Perspective!

2009-08-18T09:29:00.002-04:00

Can you believe I took this picture? After a shit night at work (more later), driving all night eating Twizzlers and then randomly finding this deserted beach at sunrise. I don't even think the picture does it justice.

So my little beach break was exactly what I needed. I learned that I really don't vacation like other people. I didn't need to get shit faced drunk and pass out on the beach. I read 2 books (not medical at all!), got some serious sun, ate a little, slept just ok and woke up at 0630 every morning. Got my walk on through the little fishing village, found the locals coffee hangout and even met a bloodhound named Ellie Mae.

My last night of work consisted of a young bride on her way home from her honeymoon with her husband, his brother, the brother's wife and the brother's dog (a boxer). When the husband fell asleep they decided to scare him to wake him up. Unfortunately he wasn't the only one they scared. The dog woke up and chomped down on the girl's face. The brother in law actually had to pry the dog's jaws off of her and got bitten in the process.

I hate dog bites.... there never seems to be anything good about them. (unless its the police dog... then its funny as shit!) If its a pet then its even sadder. In this case the husband was also a police officer (not local) and the sister in law was pregnant. What a freaking disaster.

My perspective on it though.... (this took some time on the beach) They are able to get the "for better or worse" part put to the test pretty early on. If they can find the strength of family through this then they should be able to hang on through other tough times.

As for the old couple a week or so ago.... my thoughts are now... how many people lose a loved one and don't get the opportunity to say good-bye? How many people don't get 60-some years together. Yes, he should have died in his sleep in his own bed, but seriously, how many people are lucky enough to have that?

So pondering the next big move. I promised my nurse manager long ago that I would not permanently leave...but trying to decide what the next step should be. Where do I want to go and what will get me there? Am thinking of looking into the PICU actually. Hmmmm.....

So back to my dear sweet Mecca tonight. Gonna try to remain me and not the old battle ax. I do start paramedic class in about a month too.... that should be... interesting!!!

The Recovery

2009-08-11T16:57:00.003-04:00

Still getting over the aches and pains from my last shift. Don't usually blog BEFORE shift, but....

The last few weeks at work have been pretty hard on me. There has been a lot to take in that I really need to let marinate. So the grand plan is to take a little time for myself. Going on a girls trip to the beach for a long weekend. The plan is to relax, soak up the sun with a side of Maker's Mark and gain some perspective.

Painful

2009-08-10T09:04:00.003-04:00

The last two nights have been painful... physically and mentally. I get home, kick off the danskos and wait for the feeling to return to my feet.

Saturday night... the trauma room was empty when I got there. I walked in, threw on my shoe covers and the trauma light went off. Go fuckin figure.... 12 traumas later I staggered...almost literally... the hell out. I was also livid that the.... bitch (I almost used the really bad word) that was coming in wanted me to stay late and stock the room with her.

*** drunk parents driving home from the beach with 2 children in the back. the parents get into a physical fight and drive off the road into a tree. no dui charge, but we called cps

***i got threatened with an assault charge by a drunk bastard. I wouldn't let him sit up and leave. the trooper got him settled down.

***GSW to the head.... .22 we think. dude was, of course, minding his own business

***24 year old dove into the shallow end. C4 fracture with nothing below the nipple line. he vomited and aspirated in MRI. intubated yesterday. nice kid, nice family. very very sad.

Sunday

I tiptoed into the trauma room and the light started going off. the first 2 hours were hell on wheels. I told the communications room that all 3 of their traumas were not coming in the room because there was only 1 bed. That stupid fuck actually wanted me to check with the attending first. Sure, because if he said so I would LOVE to put all 3 in 1 bed!

*** 20 year old mvc with a fracture/dislocation of the hip. we did conscious sedation to pull that thing into place. I was pulling from the shoulders up while 2 guys held the hips, 2 pulled on the leg and the attending gave propofol. 20 minutes later my arms were screaming for a break and the hip still wasn't in. 150% of my weight pulling against these dudes... 300mg of propofol and we were still fighting.

***I also had to help restrain a dude who was either post-ictal or high as fuck. He broke the regular restraints and go put in the "big boy" restraints.

Finally.... the drama. Of course there is drama, its a hospital. Lately it has seemed a bit more like General Hospital versus Trauma: Life in the ER. There are some things that I wish I didn't have to hear about..... and there are times when I want to scream "NO DON'T DO IT!!!" Grrrr..... Sorry the last part is so vague... just need to vent a touch!

Boys in Dresses

2009-08-07T09:22:00.003-04:00

Some nurses can make the funniest situations completely boring, while others can have you laughing at the most ridiculous and even mundane situations. A princess in charge in yellow on a fucking insane Thursday evening. I was getting report from a good buddy who totally has a way with words.

Bed 1: "I don' know what the fuck is wrong with him... but he has a bed so who the fuck cares"

Bed 3: "So yeller that he looks like a pumpkin... lookee there, pumpkin walkin' to the bathroom"

Bed 6: "Shemale with sickle cell. Doing the hormones, but still has the twig and berries, you know. Got a little dilaudid, still 10/10 pain and eating McD's chicken nuggets. Trying to scratch, but keeps forgetting that there are chicken nuggets in his/her hand." (I have to investigate myself and there is seriously a dude in a dress with makeup scratching its face with a chicken nugget) OMAA what has my job come to?

Bed 7: "She a big girl in a big pink robe... its a tent you know. She fell down getting dressed and broke her ankle"

Bed 15: "Complaining of the discharge. Has a female name, but Suzy says its a dude. It looks like a dude, a pretty fucking ugly dude with the 5 o'clock shadow" (another that I had to investigate. She/he did say there was a discharge.... brown. Vaginally?? "yes" Ummmm..... do you have a vagina?? Loooonnnnggg pause..... noooo. Well then its not fucking vag d/c then!)

I laughed so hard that I almost peed in my pants! All I was missing was the other pre-op dude who shoves things in his penis because he was really a woman.

There was entirely too much to do for a princess shift. My staff was marginal. A great and experienced trauma nurse who fucked up his back and could hardly walk, the fucking douchebag that killed that poor old lady a while back, a nurse who bitches no matter what and a good buddy of mine who was busting his ass to keep afloat and help with the slack. I was mucho happy to see 2300 arrive and say peace out motherfuckers.

Limbo..

2009-08-06T08:24:00.002-04:00

...or maybe I should just call it purgatory. The trauma room was a heavy place last night. Heavy in emotions and heavy in conversation. What do you say when you simply don't know what to say? Or in a situation where you are witness to what will be a defining moment in two people's lives?

I watched a couple who had been married for 68 years say goodbye last night. They were in an accident and both pretty badly injured, he was far worse off. The trauma doctors had told them both (and their children) that he would probably not make it out of surgery and if he did, he would never be strong enough to come off the vent. So as he was packaged I put their beds together, rails down as they held hands and said goodbye. How often do we see moments like this and not feel the true depth? Do we use our jaded sense of humor to dull down the situation so much that we can't see things for what they truly are?

I have found that when I allow myself the luxury(!) of letting the emotional side kick in that my head begins to swim in a way that almost seems out of control. I begin to question all the things that I know so well.... like how I feel when a patient is sick as shit (calm and joking on the outside with the best of Buffett in my head)... how the trauma room looks (smells!) when all the patients have left and the lights are off... why I still care what certain people think and why a peer's opinion can matter so much.

Have I become a big fish in a little pond? I can do everything in the ER (charge, triage, trauma, orient). The nurses and coordinators come to me as a resource. Am I banging my head on the ceiling, but am too ignorant to allow opportunity to knock? A very wise and sweet person pointed this fact out to me (maybe a bit more tactfully than I have here). I am starting to think that finding what really makes you happy is frequently viewed as a selfish act. Why is it not a priority, instead of an afterthought?

So before I make myself crazy I am going to soak in the tub with a glass of chocolate wine and allow the more pleasant parts of my night drift through the crazy currents of my mind.

Dick for a Day

2009-08-05T08:33:00.002-04:00

Once upon a time there was a boy in a dress. His friend was stabbed a couple of times and whacked in the head with a hammer. He came with her to the ER and made a scene with his friends about how she was dying and what a bitch the triage nurse (me) was. In the meantime a trauma shows up. A man has been stabbed multiple times to the chest and back. Our boy in the dress is ID'd as the bad guy. (literally, the pt said "it was a boy in a dress") The boy in the dress takes off and is nowhere to be seen. The University PD is on his tail (haha!) and catches the boy in the dress in the parking deck. He and his other well dressed friends are bought back to the ED in handcuffs and taken promptly to the men's bathroom to pee. (I thought only women went to the ladies in groups!)

Another patient is being transferred from a local hospital. Actually, they wanted to fly him. Let me mention that this hospital is about 10 miles (or less) from us. Fortunately, someone with some brains decided that flying would be a stupid idea. He was been shot with buckshot in the back and head. He is awake and doing fine on arrival to the trauma room. His story... he was just walking and some dude shot him.

In the meantime a friend of the cop's shows up. He's looking for "some guy shot in the ass." His guy was breaking into someone's garage when the garage owner caught him and shot him.... with buckshot, in the ass. That sounded a little too familiar. I sent him into the trauma room to investigate.... you know, cop stuff. Guess what?!?!? Bad guy found. I asked for the CrimeSolvers $1000.00 reward, or at least the Det. badge for the day. (dick, haha!)

Finally..... any story that starts with "there were these two drunk ass bitches....." is probably one you don't wanna get involved in!

What To Do?

2009-08-04T10:21:00.002-04:00

So many nurses that I work with are in the MSN program. They want to teach, be nurse practitioners or management. I haven't heard too many mention CRNA school, but I know they are out there as well. I know I can't work in the ED forever. I will turn into what I hate... bitter, unhappy old battle axes that forgot what they love about emergency nursing.

I hated nursing school with a passion. It wasn't hard.... it was boring as hell. I did very well, with little effort. The instructors even mentioned that the only time I paid attention was Critical Care and Emergency. Nothing else did it for me. So do I want to teach? Fuck NO! Not in the classroom anyway. I don't give a shit about care plans, concept maps and all that other crap. Nurse practitioner's seem to have some autonomy, but when it boils down to it... its the same old crap day after day. Even the acute care NP's (cardiology, trauma) usually get stuck with the crap that the doc's don't want to do. I think I would be bored as shit. CRNA's seem to have a good life. Normal hours, good money lots of autonomy. Two years of school, you can't work while you are in the program.... so we would have to live on a cop's salary for two years. Not exactly feasible. Then I would get to stay in an OR, within four walls behind a sheet. Does that appeal to me??? Fuck no!

So where does that leave me? I don't want to teach within a school, I don't want to do someone else's scut work (even advanced scut!) and I would be miserable trapped in the OR day in and day out.. no matter what I got paid. I wonder what is out there for me? I love flying, but I know that even that isn't a job you end a career with (not that I am ANYWHERE near the end!). As a dual provider will that open some more doors? Who the hell knows. There are days when I see the residents and think to myself... "I can do that." But do I really want to? I'm not interested in giving up another 7 years of my life.

If I could travel, maybe do (pseudo-advanced) medical care in places far away. I think that is what might suit me. Any suggestions?

On a lighter note... I overheard this the other night when I was in charge.

Doctor: "Ms Smith we think you have had a small heart attack, so you will be here for the duration."

Patient's Adult Child (after Dr leaves): "Mama... whats a duration?"

Time to Retire?

2009-07-30T09:12:00.002-04:00

What would you consider to be the "shelf life" of a nurse? Especially one who is still working in a very busy urban ED?

I had the misfortune of being the HBIC (Head Bitch in Charge) in Green last night. As I have said a million times, the staff can make or break your night. A horrible night with a great crew is never as bad as it could be. Last night was a not so great night with a really not great crew. People were actually coming to ask who I pissed off to be stuck with 3 of my 4 nurses. Until 11 I had one of the most senior nurses working a zone. When I say senior I don't mean experienced... I just mean old. She has been in the ER for a million years, but hasn't seemed to evolve past what nursing used to be. She had 3 ready beds when I arrived at 7pm. At 1030 she was finally (?!?!??!) calling report on one of them. Nobody was too sick, she just wasn't able to prioritize and stay organized enough to get shit done. I tried to smooze in and snag the charts (to call myself!) but she would have none of that. So essentially that zone, and nurse, were dead weight for the first 4 hours. She actually retired a couple of years ago, but still works part time. Unfortunately she is more of a hindrance than a help.

My dear friend who busted her ass with me last night got stuck with the weirdo of the night. 28 years old with sudden onset of panic attacks which he attributed to the bite from a 5 week old kitten 3 months ago. In short... he thought he had rabies. Funny how the panic attacks subsided with alcohol. Hmmm..... liquor as a cure for rabies??? I'm sure Ol' Yeller would have appreciated that one!

My same dear friend took care of a very large lady who recently had a TAH. Her staples were intact, bt she was bleeding (heavily) from between them. On arrival there was freaking blood everywhere! She busted her ass to get the patient stabilized, OB/Gyn consulted and the patient cleaned up. No easy task considering that the patient was huge and the nurse was not. When the patient's (very large) family came to the bedside they were not happy. Why you may ask??? Because my hard-working nurse did not wash the bottoms of the patient's feet.

Are you fucking kidding me???

The straw for me was the son of an 85 year old lady who fell at 630pm the night before. Her hip was sore, but she didn't call 911 until 24 hours later. On arrival she was neither shortened or rotated so into the hall she went. X-rays revealed a non-displaced femoral neck fracture. Ortho saw her and consulted medicine (isn't that what ortho always does???) with the plan to surgicize in the AM. The son, however was not convinced. Despite multiple films and views which showed a pretty freaking obvious fracture) he thought that we were probably wrong. Why? because he didn't see the huge displaced, my acetabulum is in another zip code fracture. We tried many many times to teach, point out etc and no go. He was mortified that she was NPO and that we had not given her a bath, brushed the teeth etc. UGH!!!!! Can I retire now?

Para-God?

2009-07-29T07:23:00.002-04:00

As if having all those initials behind my name wasn't enough, I have found the next bridge to jump off of. I did EMS in nursing school, but stopped because I could do more as a nurse in the hospital. The closure of my base made me realize that had I been a dual provider I may have had more options. So in the name of getting back in the air I have signed up for my area's first RN-Paramedic bridge program. Unfortunately I have already undergone some hazing from my nursing colleagues.... who seem to believe that this is a step down instead of a chance to broaden my experiences. One even said that I may as well take the RN-Housekeeper bridge (that really pissed me off!).

I also need to get on my CEN and CCRN recerts. Has it been that long already? I sure as shit don't want to take CCRN again.

Note on my last post. The lady who was too fat for the rib spreaders died. (no huge surprise there) I am still trying to figure out what her major injuries were. We also had another child that was struck by a lawn mower that her grandfather was driving. She lost an arm.... she was about 5. I am SO tired of this.

Hitler, Mussolini, Vlad the Impaler.... Oh My!

2009-07-25T09:12:00.002-04:00

After nights like this I start to wonder who I was in a former life and why I am being punished. I was in charge in yellow, it was elbows to assholes when I got there and there seemed to be no end in sight. It didn't help that there was a completely incompetent bitch in the trauma room.

I got report from an outside hospital. Drunk dude got beat up. He went there and they did a Max-Face CT (they didn't do a head) and were transferring for OMFS. Cool, no worries, whatever. They gave me a history (Hep-C, ETOH abuse and cirrhosis) with plts of 17,000. They were coming by ground. After about an hour and a half no patient. I heard the helicopter get punched to that hospital for the "multiple trauma from assault." I called to find out what the fuck was going on.... apparantly the patient got loaded into the ground ambulance and "lost" an airway. The Dr attempted to intubate and was unsuccessful. He then crich'd the guy (with plts of 17!) and he was now bleeding out from the head/neck. Oh yeah... and he MIGHT have active TB. Oh and they didn't send a sample to the blood bank so they couldn't start platelets. Oh my fucking god! The nurse who called report was unable to tell me anything about the patients airway... because she had only been in the ER or 2 weeks! (before that all she did was psych!)

4 traumas from the same rool over MVC. Not a one wearing a seatbelt!!! OMAA!!

Poor lady with Lupus, ESRD, HTN ...ect ect fucking ect. "pleuritic chest pain" per the squad. On arrival she was short of breath and had a swollen tongue, neck and face that was unresponsive to benadryl, solu-medrol and sub-q epi x2. She was moved into the trauma room where anesthesia trauma surgery and ENT were at the bedside getting ready to cric her. Thank GOD she went to the OR instead. Just what I freakin need is two airway issues in one night!!!

Because I needed to end my night with a bang.... right at shift change there was an MVC. My patient was ejected and pinned between the car and the ground. Have I mentioned that the patients these days have been the size of small elephants? This was no exception. She had crushed bilateral lower legs, and open femur. On arrival (by ground) to the ER she promptly coded... which is especially shitty when you have no IV access. I pulled out the EZ-IO to drill her humerus.... but she was too fat for it! Trauma threw in two groin lines, the ED resident intubated while the trauma attending (I have called him Yoda on here before) opened her chest. Unfortunately, we were unable to get to her heart because the rib spreaders were too short for her. She was just too fat! After several rounds of drugs and 3 units of blood I was on my way upstairs backwards hanging blood. When I left the OR they were still looking for spreaders that were big enough and Ortho was cutting the leg off.

SO I am trying to decide who I must have been in a former life to deserve this! I had to have a big ol' glass of wine before i was even calm enough to type this.

Pardon the verbal diarrhea but I have to dump this on here so I don't completely blow a gasket!

Pieces and parts.

2009-07-22T08:33:00.005-04:00

Just when you think you have seen it all..... I wandered into the trauma room today. The first patient had OD'd on psych meds and jumped out of a second story window. He then ran around the city wearing nothing but a Batman cape. So after multiple sutures and staples Arkham Asylum here we come!

We have also had an influx of jumbo sized patients. I mean REALLY fucking huge. 400lbs is the norm these days. When the patient weighs more than the scooter she is riding how does she even manage to fall off at any kind of speed??? Anybody out there ever hear of a FUPA?!?!? Yeah, saw a lot of that tonight.

MeeMaw is confused as a bedbug with a UTI (and dementia). Will not pee and has to get a foley. Somehow I seem to be the go to girl for the MeeMaw foley cath these days. For a demented old granny she was sure strong as hell. Those little knees were stuck together with superglue. It took four of us to hold her while I dusted off the cobwebs and popped the cath in. She sang the whole time.... it started as a song I remember from church then turned into a sung version of whatever was last said to her.....

.....That tube is in my blaaaaadddddeeeerrrr...... it lets the urrrriiiine run ouuuuuut!!!

I finished the night with a pretty horrific car accident. Four friends were on their way home late at night. They got a flat on one of the bridges and pulled to the side of the road to fix it. All four were out of the car when a drunk dude struck the car at over 70mph. Two of the guys were struck and pinned by the car. Both were literally torn to pieces. The torso of one ended up in the drunk guy's front seat. The trooper showed us pictures.. there were legs torn off and laying in the road, a shoe with a foot still in it and the white sheet with god knows what under it. The other friends were pretty much ok.... but pretty shaken up. The highly trashed driver only had a broken nose, but got the asshole tube as well.

Ended the night with a psych patient who wanted a prescription for marijuana. The nurse's response.... "we don't do that on Wednesdays, check back tomorrow."

The Shit You Can't Make Up

2009-07-15T11:45:00.003-04:00

This was kind of the whole point of this blog. That, and to help me get to sleep after a long ass night in the department. How often does someone say "we should be writing this down" and I smile and nod.

I walked in to a 24 year old who was complaining of blood from the penis. Sounds like the standard STD workup to me. I told him the whole adage about not putting your pole in a green pond, smiled and walked out of the room. The chart went to one of my favorite residents who got a bit more of the story than I did. The patient's roommate told him that it was because he masturbated too much. (go ahead and ask, I did........ ) How much is to much? He admitted to 15 times per day. Who has time for that?!?! 15 per day plus almost a 2 pack per day cigarette habit, no wonder he doesn't have a job!!! The patient was also convinced that he didn't have an STD because he was banging a lesbian behind her girlfriend's back. OMAA..... again, can't make this shit up!

Stupid Attending

2009-07-13T08:24:00.004-04:00

I think that I have bashed the residents enough over the course of this blog. Since it is July I will be nice and lay off. They don't know any better...yet. The attendings however need a bit of abuse. If you are going to be an ED attending in a Level 1 urban department then you'd better know your shit.

The attending from last night graduated from our program about 6 years ago. He was a shitty, stupid resident and has been no better as a moonlighting attending. I don't feel like a Level 1 ED should be your part time job.

So my major malfunction with this guy is twofold. 1) He is slow as molasses in February. Patients that could be seen and dispo'd in an hour or less were taking over 2 hours to even be seen. That seriously slows shit down. 2) Let me tell a story.....

60 year old dude with wicked ascites. He looked about 10 months pregnant and was complaining of... guess what?!?!? SOB and abdominal pain. (Big freakin surprise) The nurse, who is a pain in my testicle, alowed him to lay flat... and what pray tell happens when you lay a 9 mo pregnant person flat? It compresses the aorta and shits out their BP. So I think this is what happened. We walk in the room and dude man is guppy breathing, has a pressure in the shitter and is completely unresponsive. Did I mention he looked pregnant? We estimated his weight at 120kg. When we went to RSI him the attending didn't know the dose of rocuronium (instead of Sux due to renal status). I blurted out 1mg/kg which was our protocol when I was flying. The doc disagreed. He wanted to dose at .3mg/kg. (I think he got the roc dose confused with the etomidate dose). After my insistence he at least went up to 50mg of roc which was less than half of the appropriate dose. UGH!!!! It is so frustrating trying to explain this to people who aren't going to listen.

So once we got this guy tubed I threw down an NG tube and got some fluids going. The doc attempted to place a femoral line. He missed (we thought) and then tried to convert to an a-line. When I got the a-line set up we saw a very distinct waveform..... a CVP waveform. He went through the vein and artery and shredded both! FUCK ME I don't want my name on this chart.

The patient's nurse (not me) witnessed the beginning of this pseudo-code... and then disappeared. When we looked he was in the nurses station documenting... he had nothing to do with his patient. At least the son of a bitch said thank you before I left this morning!