thoughts from the night shift

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!