~ Dust in the Wind ~

In Memoriam

2009-03-07T14:18:00.001-04:00

Manny Grewal

04 February 1971 - 24 February 2009

Our heads are hanging low
And our hearts at half mast
Ever since the day
They took you with it when it passed

Ashes to ashes
And dust to dust
We let go
Because we must

And where does it
Take you when it goes?
No one really knows, it's
Anybody's guess

Some folks say
It's where the wind blows, and
Where the sea flows
And the sun sets

But here we go
On with the livin'
And try to match the love we give
With the love that we've been given

Ashes to ashes
And dust to dust
We let go
Because we must

And days pass
And nights continue to fall
Time moves ahead with it
Like nothing at all

But at some turn
We reach the final page
When we die too young, or
Of old age

Ashes to ashes
And dust to dust
We let go
Because we must

(Ashes to Ashes ~ Jill Barber)

Great Ad

2009-02-07T11:53:00.001-04:00

I love it. Makes me laugh every time!

Not that drunk, eh?

2009-01-31T15:40:00.004-04:00

It was a busy night and we ran from call to call to call with nary a minute to eat or visit facilities. Finally the tones slowed and it looked like we might have a minute to breathe when we got called out again... another trip to the cells booking area to assess more of the nights inebriated young souls prior to their entry to the drunk tank.

Our patient was found with his head and shoulders deep in the garbage can provided to him by our local constabulary. He was moaning and puking with great abandon, totally ignoring the questions of the medics when an officer exits the cells and states to her coworkers "now that crack whore has stripped off her pants and her thong and has thrown them out of the cell. She is standing there in just her bra shouting that she is going to kill us with her coochie!"

Suddenly our fine young citizen pulls his head out of the garbage can, vomit dripping from his face, and states "Awesome! Can I see that?!"

Quote of the week...

2009-01-27T20:04:00.006-04:00

Pepper-sprayed young patient, climbing on the snow bank: "Aaagh! You have to help me!! It burns!"

Nurse masquerading as a student Paramedic: "Come down from there and I can put some drops in your eyes...."

PSYP climbs down, spitting...

NMaSP: "Stop spitting on me!"

PSYP: "It`s OK! I use condoms! I don`t have HIV!"

New Year's Eve

2009-01-01T09:19:00.002-04:00

The snow is falling

The lights are low

The night is quiet

And we are at peace

A new year, full of hope

So much promise

Then the bad choices

Made last year arrive

drunk, disorderly, disrespectful

The magic is broken

It's just another night

Jesse Bear, What will you wear?

2008-11-26T13:12:00.004-04:00

Every day we must decide what to wear to work. We've discussed this before ... yes, this is a segue to an ad... I have added 3 uniform store sites to my sidebar. Please click through my sponsors and have a look - there is excellent selection, and for you readers in the US, there are good deals on shipping.

Thanks for your support.

Waiting Room Watching

2008-10-11T12:53:00.003-03:00

Today I arrived at the hospital triage as a patient, not as a nurse (yes, I'm fine - just a little pneumonia) and got to experience the world of the waiting room... what a hoot! I think that someone should do a study on waiting room behavior. People watching at its finest.... I saw:

* the 'where do I sit' dance - women generally choose to sit by women, but only if there are no seats open where they can sit by themselves; old men sit by other old men, even if there are lots of open seats. Old people sit so they can see the door to the emerg department. Middle aged people sit as far away from the old folk as possible, except when they have kids - then they sit by the alert elderly.

* old man who thought that because he turned his head, none of us could see him pick his nose

* middle aged man who made a point of moaning and sighing whenever a staff member was in sight, but who sat quietly when they were gone

*Skanky mid 30's woman who could not sit still. Could. not. sit. still. I started counting after about 15 minutes and was at 48 times getting out of her chair before I got called in

* youngish man with three children under 10 - are they actually your kids? Because you totally don't have a clue.... It really isn't a great idea to let the twoish year old kid play between the doors - those open by a sensor and go straight out to the driveway... you know... where cars are driving? and the fourish year old? Definitely shouldn't be racing the 8ish year old *over* the chairs in the waiting room (and banging into nosepicker and guy with the cane)

* wife of healthy looking guy with the cane who complained constantly to her husband about how unfair it was that people who could walk without a problem were getting in ahead of him. Constantly. For the entire time I was in the waiting room. Constantly. It was so unfair. So. Unfair. They could walk. Why would they go first. Why?

* elderly gentleman with the kindest smile and most contagious laugh who dramatically improved the mood in the waiting room - excellent counterbalance to the complaining lady. Thanks.

*me. Hacking constantly. Funny, no-one chose to sit by me!

Quote of the week #5

2008-06-30T08:04:00.002-03:00

Man who has been waiting 30 minutes to have the cut on his thumb assessed:

"You call this the emergency ward?! You should call it the death ward - you move so slowly that we'll all be dead before you get to us!"

The Apple and The Tree

2008-06-06T17:51:00.003-03:00

The child is brought in by police for a mental health assessment after engaging in some very high-risk behaviour.

When the hospital phoned the parent for consent to treat, the parent answered the phone and then said "Hang on. I need to put you on hold. I've got Children's Aid on the other line."

When the parent finally arrives at the hospital, hours after the child did, they are observed sporting a t-shirt with a very inappropriate saying and picture, and a ball cap emblazoned with a pro-drug emblem.

Now I'm convinced: losers are made, not born.

Bingo!

2008-05-01T13:51:00.003-03:00

It is 6:45 am, and the Emergency Department has been steady all night - no horribly sick patients, just a constant, unrelenting flow of clinic care style concerns.

The young boy skips in the door, singing. He has a half eaten cereal bar in his hand. He happily approached triage with his Dad and, with a huge smile, states:

"Hi Nurse! I'm sick! Really, really sick! Dad had to bring me to the Doctor first thing this morning!"

Dad follows with:

"He has been up all night with belly pain. He seems fine otherwise - he doesn't have a fever and he hasn't thrown up or had any diarrhea. He didn't eat his supper last night - he doesn't like meatloaf - and only had a cereal bar before he went to bed. Maybe he is hungry? He is eating a bar now and seems to feel better"

Can we please install a piece of rubber on the wall? Banging my head constantly on this hard plaster is starting to leave a mark!

The Things You See When You Don't Have a Gun

2008-04-24T17:38:00.001-03:00

The med student was a bit odd.

He was big (6'2") and brawny (obviously a weight-lifter) but not particularly bright.

When he was on the spot (being pimped by the ERP) his voice was soft and slow with lots of 'umm'ing and 'uhhh'ing, but very few right answers.

When the ERP's attention was elsewhere however he had no problem flirting with the nurses, whistling, humming, drumming on the desk incessantly and wildly playing air guitar around the nursing station. Basically he totally disrupted the entire area with his antics.

The capper was when the doc pulled out the metal detector to investigate a 'piece of metal in foot' complaint. Odd Med Student decided to show us how he could make the metal detector buzz by running it over the pins in his ankle, his prosthetic knee, and...

the piercings in his penis.

ICK.

Tips to Understanding ...

2008-04-16T23:11:00.002-03:00

Understand...

if someone starts a sentence with "I'm usually the most sane and rational person I know..." then you know something irrational or insane is about to come out of their mouth. They know it too - that is why they forewarned you.

Vomick Analysis: the New Diagnostic Tool

2008-04-16T23:03:00.002-03:00

The child presents with abdominal pain and a fever.

"It started all of a sudden 45 minutes ago, and then she threw up!"

The parents are convinced that it must be an appendicitis:

"It must be appendicitis - it came on so quickly!!"

The triage nurse requests a urine sample as part of a thorough work-up to rule out the appendicitis, and to make some use of the 3-4 hour wait this family faces.

After 3 hours and several refusals to void, the child vomits again. The father presents the bowl full of emesis to the triage nurse:

"She vomicked again, and she's not going to pee for you. She doesn't want to, and she doesn't do stuff that she don't want to do! Test this puke instead. It will tell you that it's her appendix."

Different Beds : Same Result

2008-04-16T22:58:00.002-03:00

My friend's kidney is failing. Her third kidney. The one that was a gift from my husband. She has done everything right: good diet, taken her meds, exercised regularly, and still the disease progresses. She waits in the hospital bed to see if the new experimental drug will work. If not, returning to dialysis is the plan.

The child's kidneys are failing. Her two good ones. The ones that were gifts from her parents and God. She has done everything wrong - crappy diet, no exercise and deliberately ingesting a bottle of ibuprofen, and so the damage progresses. She waits in the hospital bed to see if our regular meds will work. If not, starting dialysis is the plan.

Pink

2008-04-08T18:34:00.004-03:00

A long time ago, I completed a meme discussing things I couldn't live without...

No. Go read it. .... I'll wait....

Ok. Good. Now guess what I just bought???

.
..
...
....

a hint? OK. They are pink.... :) :) :) :)

Yippeeee!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

Now can you guess *why* I bought them???????

The Waiting Game...

2008-04-02T09:51:00.002-03:00

It is done. My application for paramedic school is in and complete...

My application interview and testing process is finished...

All that is left is to sit and wait for the phone to ring - a ring means yes and silence means no...

I haven't waited for the phone to ring for 20+ years.

It is hard....

When in Rome..

2008-02-17T13:38:00.003-04:00

Our mental health nurse escorts a mental health patient to the mental health room for assessment, then returns to the desk looking frazzled.

"The bed is up high. Can someone put it down for me?"

The nurses are busy and moving quickly - unusual, I know! - but one takes the time to stop and describe where the pedal is for lowering the bed to floor level.

"No, I can't do it - I need you to come put the bed down. I have a phobia about mechanical things!"

I see.

The Right Decision

2008-01-26T10:42:00.000-04:00

You are a nurse.

You work full time plus.

You have an 8 shift stretch - all 12 hours, with no day off.

You work hard - pump chests, start IVs, push drugs, hold puke buckets, give enemas, pass catheters, assess, assess, assess, chart, chart, chart.

You wash your hands. Constantly. Religiously. You could be OCD. You wash when you start work, when you end work; before you touch a patient, after you touch a patient; before you chart, after you chart; before you eat, after you eat. You use alcohol hand wash and you use soap and hot water. You even use chlorhexidine to scrub before you access that port-a-cath.

You have one day off before you start your next 7 shift stretch.

So what do you do???

You get the kids to school, do some volunteer work there, come home, throw supper into the crock pot, throw in some laundry, pick up toys, do the dishes, sweep and vacuum the floor, fold some laundry and throw in more, get the kids from school, serve supper, and....

...instead of doing the dishes immediately you decide to sit for a minute and have a break. As you sit you notice a funny rumbling in your belly.

That's right - you now have gastro, and spend the next several hours making mad trips to the washroom.

Morning comes. You are a limp washrag, but no longer puking. You are supposed to work. You know that the unit will be short without you, and it has been busy. You want to stay in bed.

So... do you get up and crawl through work exhausted, but still doing your share or do you call in sick?

What is the right decision?

Remembered

2008-01-25T13:10:00.000-04:00

After a sad shift I again remember:

1. S*&t happens. Often.
2. Bad things happen to good people. Children are good people.
3. Miracles are rare. That is why they are called miracles.
4. If the media doesn't know what is happening, they will make something up. Usually what they make up will be completely wrong.
5. Giving someone false hope is worse than giving them no hope.
6. We are good at what we do, but sometimes that is not enough.
7. Death is not necessarily the worst possible outcome.
8. It is hard not to hope, even when you know better.

On the positive side I also remember:
1. A popsicle can be just as good as a hug.
2. A team that clicks makes the difference between a good case and a bad one, regardless of the outcome.
3. My coworkers rock.

Stella and the Pain Pills

2008-01-23T18:27:00.000-04:00

I noticed an interesting trend today while I was in triage: Within an hour I triaged 15 patients and subsequently I had given either acetaminophen or ibuprofen to 13 of them.

Among this group we had:
* 4 'slip and falls' on the ice: one arm, one ankle, one knee and one head - no obvious deformities, some mild swelling and a couple abrasions
* 3 headaches (not migraines, just regular headaches), one of which had started less than one hour prior to triage
* 1 'hammer to thumb'
* 2 lacerations
* 2 kids with fever & cough
* 1 infected toe

So what were the other two?
* 1 chest pain (This patient got ASA and a bed)

and

* a sweet 84 year old lady named Stella (No, not really. Duh!) who had a sore, swollen arm after slipping in the tub 2 days ago. She had taken her own ibuprofen at home and waited to see if it worked before coming in.

As I took care of Stella, I couldn't help but wonder why none of the other patients (all of whom had less serious concerns) had tried medicating themselves prior to presenting to Emerg??? Well, the 'slip and fall's I could excuse, since they were not at home when they got hurt, but the headaches? the infected toe? the lacerations and the hammer to thumb? They all came in because "It hurts!", and the kids with fever were brought in because their parents were worried that they looked so sick with the fever.

Could it be generational?

Stella grew up in a time when help was less readily available. You learned to be independent, to cope with some discomfort and to make do. In contrast my generation, the 30-40 something crowd, had all grown up with easier access to resources of all kinds. We seem not only to look for help more readily (which is not necessarily a bad thing), but to feel entitled to have all pain removed and all difficulties eliminated without any effort on our part (which is a bad thing).

Please don't mistake this post as complaining. It isn't. I definitely do not mind giving out appropriate analgesics in triage. Not only is it part of my job, but I actually enjoy being able to do something right away for the patients, so that they know I care, and that we are doing our best to make them comfortable. I just wondered why people were so reluctant to take ownership of their own care.

That is all.

Rules for being Smart

2008-01-18T16:10:00.000-04:00

1. Don't do cocaine.

2. If you are going to do cocaine, don't do it every day.

3. If you get crushing chest pain that knocks you to the floor (especially after snorting coke) come to the hospital right away, not the next morning.

4. If you wait for 12 hours after your chest pain has started to seek medical attention then call an ambulance to get you to the hospital.

5. If you decide to have a friend drive you to the hospital instead of taking an ambulance then don't yell at him for following the traffic rules and stopping at the red light.

6. When you get to the hospital with your crushing chest pain for 12 hours after daily cocaine use, pony up, be a man, and admit that you snorted the coke, and that the pain started 12 hours ago. Don't blame the pain on stress caused by your friend's driving.

7. Even if you are going to lie about the coke and when the pain started, do what the nurses tell you, get your butt in the wheel chair, back out of the chair, and onto the bed.

8. Once you are in the bed, *lie still* for the EKG.
9. When you have finally stayed still long enough for the nurses to acquire a 12 lead that says you are having a massive MI, let the nurses put in the IVs. It looks particularly stupid if you are covered in ink and have a 10 guage nipple piercing, but are whining and teary about the 18 gauge IV. Stop being a baby. A 45 minute delay in receiving TNK could be the difference between you living or dying.

10. When the doc is explaining to you the risks of TNK, stop whining about how you want a cigarette and listen to him.

11. When the nurse is pushing the TNK and heparin into your IV, stop messing with the other IVs we put in - yanking out an IV after you have just received clot busters and blood thinners will cause an unnecessary blood loss, and a mess. The nurses, doctors, paramedics and housekeeping staff shouldn't have to be exposed to your drug and likely infection ridden blood!

12. Basically, all 11 of the previous rules could be boiled down to one simple life motto ...

**Don't be an idiot!**

or this could be you:

Just Read The Sign!

2007-10-18T00:02:00.000-03:00

But is this for the patients or for the staff??

Red Flags

2007-10-12T01:59:00.000-03:00

You know what follows won't be good when the triage story starts with

"Well I just got out of jail, eh...."

There was a Young Lady...

2007-10-09T02:26:00.000-03:00

A young, sweet looking woman timidly approached the triage desk, a beautiful, smiling and happy baby in her arms.

"I'm sorry to take your time, but I'm really worried" she said.

"This is what I am here for." I replied "What has you so worried?"

"Well" ... she hesitated. I waited patiently, making faces at the baby and making her giggle..."I feel kind of silly, but still....."

I continued waiting....

"Well this afternoon we were playing outside, and there was this fly. It was flying around the baby and I tried to shoo it away, but it flew right in the baby's mouth!" Mom's eyes are huge and round by this point in the story, and the tears are starting to well up in her eyes...

"And she swallowed it!! and then she BURPED!" and with this the mom started to cry in earnst, tears coursing down her face. "I've worried all afternoon that the dirty fly was going to kill her and I just couldn't stand it another minute!!!"

"Oh Sweetie" I said, putting one arm around Mom and handing her a kleenex with the other. "Dry your eyes. Your baby is absolutely fine!" I said. "Look at her - she is happy, smiling and healthy. That nasty fly has no chance at all against her excellent stomach acid!

"Really?!" said Mom "it isn't going to hurt her or make her sick?"

"Positive. There is nothing to worry about. I promise." I stated. I hesitated, but the urge was too great and the words came out... "but if you are still worried we could see if she would swallow a spider..."

Mom looked at me blankly for a second and then started to giggle. Suddenly I was enveloped in a huge hug. Mom kept hugging me and laughed until the tears poured down her face again, this time accompanied by a smile.

:)

What's in a Word?

2007-10-03T23:24:00.002-03:00

The development of language is a amazing series of steps, some slow and some amazingly fast. During this process, young children will reach a stage where they often use a specific noun to characterize all items in a similar category (such as 'apple' for any food or 'dog' for any animal). This is a very normal and common part of learning the language, but it can lead to some confusion in the medical world.

For example: everyone knows that some signs of meningitis are fever and a stiff neck, so when a child with a fever says that their neck hurts parents understandably become concerned and rush to hospital, often without any further discussion. Once in triage the parent describe their concern and then their child points to the pain in his or her neck. Funny enough, they usually point to the front of his neck. If questioned further, the pain is on the inside of his neck... That's right - good guess - they have a sore throat. Instant relief flushes across the parent's face.

However the best of these medical generalizations was relayed to me by another nurse: A young boy was brought to to hospital because he had a simple balanitis (a superficial infection of the foreskin/penis) which he described to the triage nurse as "an ear ache in his penis".

From the mouths of babes.