You know what I can't stand?; (No, what can't you stand madness?)  I can't stand nurses who act like those of us who are REALISTIC about nursing are somehow denigrating the profession.  I particularly remember one blogger saying we should be "lifting up the profession".  Why is it that a  statement like that irritates the shit out of me?

Nursing is a damn hard job that keeps getting harder. Especially if you work in a hospital.  What is expected of us is ridiculous.  More and more is dumped on us with no real increase in pay.  We are responsible for the patient 24/7 and aren't compensated for that responsibility and liability.  We are expected to learn technology that is more and more complicated.  We are expected to retain mountains of information.   We are supposed to smile in the face of verbal and sometimes physical abuse.

So I ain't gonna sugarcoat it folks. It take a tough person to be a nurse.  We don't give ourselves credit for doing one of the most difficult jobs out there. It is mentally, emotionally and physically exhausting on a daily basis. The fact that we are able to do it at all is amazing.

One of the reason the public has this unrealistic picture of nursing is that we don't portray it realistically.  Nurses need to tell the truth about their profession.  How complicated and hard it is.  Nursing schools need to tell students how it really is, so they will be prepared.  If nursing was portrayed more realistically, you would know what you are getting into.

There is an ER God after all.  How do I know? Today was a day of respite.  It was mysteriously slow.  A welcome departure from the two days I worked  this past week which sucked.

I should have known the day would be different when I walked to the back of the ER and there were no drunks sleeping it off.  And last night being St Patricks eve and all....weird.

I worked in triage and I didn't turn into the incredible hulk like I usually do.

I didn't go home mentally and physically exhausted. I wasn't gnarly with my family like I usually am.  I haven't said: "I HATE THAT PLACE!" once since I have been home. Its like I am a normal person or something. Very strange.  A feeling I don't often have.

When there is a rare day like this, I say to my co-workers that the world has come to an end and we are the only ones left alive...thats what it feels like.

You know what I hate?  I hate the fact that HIPAA has gotten to the point of such ridiculousness that when I send a critical patient upstairs, I can't even find out what happened to them.  I wonder if they survived.

When you have a patient who you know is in a life threatening situation and you work hard to stabilize them, naturally it affects you more.  You send them up to ICU hoping they will be OK.  Maybe they won't.  Thats the kind of case that you think about longer than normal.  You are amazed they lived this long.

So naturally you want to know what happened.  You can't go into their chart to see if they made it.  Thats a no no. You can't call the station and ask about them.  Thats a no no.

Nurses don't want to know what happens to their patients out of some kind of malicious intent.  We want to know because we care.  We helped them live a little longer. We want to know if it made a difference.  Now a days we are left wondering.

I've been slacking on the blog lately.  Why, you ask? Winter boredom.  Winter blues. I live up here in the frozen tundra.  Last year we had unseasonably warm temperatures.  It was in the frickin' 70's on St Pats day last year.

This year it is NORMAL.  Normal means a long, cold, snowy March that is excruciating.  Every day is gray.  Every other day it snows just enough to make it annoying to drive.  Like yesterday it had snowed about an inch.  This is the time of year when it gets warm enough to melt the ice during the day, then it freezes again at night.  That inch of snow covered the ice.

Now here is a formula:  ICE + inch of snow + people = too many people coming to the ER.  Another formula:  ICE + inch of snow +  too many people coming to ER + madness the nurse (working triage and charge all in one day) =  a depressed and gnarly madness the nurse.

After 12 hours of running my butt off, today I am exhausted and my bones are feeling their age.

Sometimes people have a bomb dropped on their lives in the emergency room.  Sometimes we find out things that no one expected and its really, really bad.  The doctor has to deliver some news that will change their lives forever. So the doctors breaks the news.  The nurse goes in to deal with the aftermath.

This is what nurses do. We deal with the human part of medical problems. Not only do we do the treatment necessary, we help people deal with what is happening to them. Whenever there is a threat to a persons physical self, its damn scary.  Some times its more scary than others. It is the beginning of an ordeal that could last for months, even years.  Many times they will die. We know they will die, but we don't tell them in the beginning.  No one wants to hear they are going to die on the day of the bomb drop.

We are saying to ourselves: "oh shit..this isn't good..." We feel sad, knowing what the person will go through.  We wonder what will happen to them.  We will never know. Is it better that way?

Triage. Every ER nurses nightmare.

Here's what triage is like:  Pretend you are at a carnival.  You sit at a booth.  There is a sign that says: HIT THE PERSON OVER THE HEAD, FREE OF CHARGE.  You are being paid to sit at the booth.  Being the reasonable person that you are, you assume that most people are nice enough to not hit you over the head. What surprises you is how many people are willing to hit you.  The first few times you are shocked. Then you get pissed.  I mean seriously, what is wrong with these people?  Hitting another human being over the head! The thing is, you can't leave, not if you want to get paid. You have to let them hit you.  Oh BTW, the owner of the booth wants you to have a big smile on your face while you are sitting at the booth.

There is a lot of emphasis on patient satisfaction these days. Reimbursement is starting to depend on it. So the goal is to make the patients happy. Noble goal. Triage is the gateway to the "patient experience". Triage is first contact.  It sets the tone.  Blah blah blah.  The triage staff needs to be polite, professional, etc.  More noble goals.

Reality: triage is difficult as shit. You are bombarded continually from all different directions:

patients presenting for care, sometimes all at once
ambulance phone calls
doctors phone calls
dealing with relatives, friends
you are an information desk for the whole hospital
   -looking up where patients are
   -directing everybody everywhere
dealing with unhappy people in the waiting room

People are impatient, angry, hysterical, anxious when they present to triage. They don't understand why they can't go right back.  Sometimes people act out in triage: crying, yelling, sometimes throwing themselves on the floor.  Often times there are people in back of triage in carts.  These are the people who can't be in the lobby.

Add to this the constant worry of the triage staff about putting people in the lobby who shouldn't be in the lobby.  In other words they are sick enough to go back, but there are no beds. Hopefully they'll be okay in the lobby.

In the middle of all this lies the triage nurse, trying to manage it all.  You are stressed in that role.  You are abused in that role.  You are sometimes overwhelmed in that role.  To expect nurses not to express their stress, frustration is unrealistic.  We who work triage are human. We are expected to be superhuman and do all of this with a continual smile.  Its not possible.

Whats the solution?

1) Eliminate as many phone calls as possible:
          -maybe ambulance calls can be handle in the main ER
          -put and end to doctors calling in about their patients
2) Have a  desk/person to field questions at the triage desk about directions, information, dealing with families.
3) Be realistic with patients about wait times.
4) Don't keep people in the ER for 4-5 hours at a time, backing up the waiting room.

Think you have a hard job as a nurse? On Chicago's south side, where the murder rate is out of control, home health nurses  have you beat.  Due to the danger of the neighborhood, they have to be accompanied by an armed guard as they go to care for their patients.  The armed guard is often a retired police officer.  They travel in a car together with a police radio.  If there is trouble in a particular area they either reroute or may decide not to go at all.

I wouldn't have the guts that they have.  Read their story here.

Don't even get me started on the gun debate.  Grrrrr... The thing that irritates me the most is talking about the mentally ill.  Doing a background check, one aspect would be to check about whether you have any mental health problems.  Intervening with people who are mentally ill before they can get to the point of shooting people.  It is obvious that the people who talk about this have no clue about psychiatric care in this country.

1) Clue #1: There are not enough psychiatrists.  Especially those who are willing to work in hospitals.

2) Clue #2: There are privacy laws called HIPPA which prohibit sharing any kind of information about patients. Think about this: It is hard enough to go and get help, do you think people will go if they know their name will be shared with others?  Who will determine who is on the list?  The whole thing is a preposterous idea.

3) Clue #3: The mental health care system in this country is abysmal.  Those who seek care for their mental health are second class citizens.  Their care, for example counselling, has to be pre-approved by insurance companies and is limited.

There are a very limited amount of mental health beds.  Apparently caring for the mentally ill is not profitable.  Here is a fairly frequent scenario when you come into an ER, using my ER as an example.

It is typically at least a 4 hour visit.  It takes that long to decide what to do with you. I see you.  The doctor sees you. Then a mental health person comes to see you and talk at length about your problem and they are the ones who decide whether you need to be admitted. The majority of people do because they are usually suicidal. There are typically two of these people for a 35 bed emergency room.  There can be 5-6 patients in the ER for mental health at one time.  Their evaluations take time.  You may wait to see them for a while.

Once they see you, they have to call the psychiatrist and discuss you with them to decide whether you should be admitted. Once they decide to admit you, they have to call your insurance company to get approval. This gives you a clue how we view mental health right here.  Does the doctor have to call your insurance company  to get approval to treat your for a heart attack?

So you are approved for admission.  Let the bed shennanigans begin.  Maybe it will be your lucky day and there will be a bed.  You may have to wait a few hours for someone to be discharged. There may not be any beds at all,  Then they will look for a bed in the rest of the city at another hospital.  You will be transferred there.  No beds in the city? They will look statewide.  You could be transferred 50-400 miles away.  I have seen people transferred to a bordering state. There may be no beds anywhere.

In that case, you will spend your time waiting in the ER.  I have people have to wait 24 hours to get a bed. They lay on an ER cart, with nothing to do.  Many of them escalate during this time.  I have people need to be restrained, sedated because they get out of control in this situation.  Who can blame them?

This is how the mentally ill are treated in this country. Perhaps the politicians who tout all the shit about mental health treatment would like to come and go through this process?

Whitecoat, one of my favorite bloggers has an entry about how the state of California is realizing that it won't have enough doctors to take care of the people who will have insurance with Obamacare.  He seems to indicate that their solution will be to let people like PAs, NPs, optometrists (?) and such care for people because they are cheaper.

Of course docs are against all of this. Less money for them. Here's the thing: You are  looking at the future of medicine.  NPs and PAs as primary care providers, doctors as specialists.  Its inevitable.  Like I said, they are cheaper.  Docs don't want to do primary care. There aren't enough docs.

Healthcare is undergoing a radical transformation right now and this is just the beginning. The group that will be most affected by all this: docs.  The days of them being at the top of the health care system are done.  They are another cog in the wheel.  They can be pissed, but its reality.  Unfortunately, even they can be replaced.

Speaking of being replaced, I often think about the nurses coming into nursing now. I feel sorry for them.  The job is becoming more and more stressful.  Another thing that concerns me is worrying about nurses being replaced.  I think employers will move to replace nurses with paramedics, medical assistants or others, with nurses as supervisors.  They are cheaper. Its already happening.  I worry that young nurses, like most young people, don't realize what it took to get nurses to this point. I worry that nursing as a profession is so weak in having a national strength to stand up for us. I worry that we are too exhausted to fight for our profession.  I worry that we are an endangered species.

Subject #1: Hell week.  Thats what we call it when you work 60 hours in a week in the ER.  Five 12 hour shifts. Usually its the week of your weekend.  You are scheduled five out of seven days.  By day 3 I am ready to commit homicide.

Nursing is so ridiculous.  In any other job you would be paid overtime for this. But here's the thing: The first three days are in one pay period.  The next two are in a different pay period.  Thats how they get away with not paying overtime.  It is such a crock.  Nursing are like slaves.

Subject #2:  I was once in the military, in a war zone.  I got what was called "hazardous duty pay".  It is extra money because you are in an area of danger.  You know what?  Nurses in the ER deserve hazardous duty pay.  Everyday we deal with the bottom rung of society: junkies, criminals, drunks, assholes.  Some of them are verbally abusive, even physically abusive.  They threaten us.  They sometimes get out of control.  We never know whats coming through the door and what they are going to do next. They can be shot, stabbed. Their gang buddies could show up.

ER nurses are on the front line of medicine.  They deserve more money because of that fact.  

I had 1,000,000 hits about 4 people ago on the counter.  I feel like I should have confetti and balloons drop and a big sign that says: "YOU ARE THE 1,000,000th VISITOR TO THE MADNESS BLOG".  You win a weeks supply of percocet or something.

Unfortunately I don't have prescribing ability. So thats out. Maybe we could share a glass of champagne. Yeah...that sounds good.  Especially after I just finished my fifth 12 hour shift in the last 7 days. I could use a drink.

Wonder how I have keep this blog going for this long? I don't know.  Its become a habit I guess. Just something I do every one to two days. II don't write long dissertations on the ER or nursing (at least not that much).  Most stuff is pretty short.

Over the years, I have seen many nurse blogs come and go, even ones with lots of readers like Emergiblog. Crass Pollination seems to be gone. There are 3 blogs I read every day:

Adventures of Hood Nurse

White Coat

What should we call nursing

Anyway, thanks for reading.

Old people can be really funny.  They are often times some of the nicest patients we have.  I had a woman recently who was 90 and her boyfriend was 60.  Showed me his picture. This woman told me that she came of age in the world war II era and the average person from that time lived to 92, so she had two years left.  She was sharp as a tack.  I  knew her life story by the time she was gone.

I've noticed something about people who live into their 90's:

1) They are almost all women.

2) They are thin.

3) They don't take many medications.

It has always struck me as ludicrous that doctors give cholesterol meds, blood thinners and all the other shit they throw at people these days.  I mean, seriously?  Who cares what your cholesterol is at 92?  And do the risks outweight the benefits of coumadin at 90?  Don't give me any of that shit. I'll take my chances...

Its hard to believe that somebody can dislocate something like a hip.  But they do.  More often than you think.  Usually its some little old lady who had a hip replacement or something.

The thing is, it is like watching torture when they try to put it back in. The patient is out.  It is usually difficult to do. They yank and they yank, like they are going to tear the leg off.  Then one of the docs will decide to stand on the cart to do it.  That usually works.

It makes me wince, the whole thing.  I want to shout: "JUST GET THE DAMN THING BACK IN, WILL YA?!!"  There is a collective sigh of relief when it is done.

The thing is once its back in, the patient can walk and its all good.

I sort of had the assignment from hell today:  triage/urgent care.  Now you would think that when you are getting away from the regular ER patients, it would be a nice break. WRONG.

I go from a mild mannered nurse to the INCREDIBLE HULK when I cross into triage.  Its not anything I can control.  It just happens.  You start to dread people coming up to the window with  their tales of woe. Oh please...no....I don't want to hear it.

Then urgent care just sucks the life out of you.  The people who come to this part of our ER are the neighborhood riff raff with their abominal pain, back pain, sore throat, blah blah blah.  I find myself doing a lot of eye rolling. Then when you have to start an IV on a 20 year who has been vomitting for 4 hours, you just want to go ballistic.  GRRRR.....

Over the years I have seen a lot of bad things happen to people in the ER.  Sometimes they have been my coworkers. What brings this up? Right now, somebody that has worked in the hospital for years is very ill, and although they are doing well now, they will eventually die of their disease.  I don't know them very well, but it bothers me anyway.

I have had two co-workers who I worked with for years die when they were only in their 50's.  One died suddenly.  The other died over the course of year.  I had worked with them for many years. It was very hard.  I watched thier children grow up through pictures and stories. They were a big part of my life seeing them at work every day.  Then suddenly they were gone.

When you work in a place for a long time, you see a lot of things.  I have seen my co-workers - doctors, nurses, techs get fired for drug use.  One staff member committed suicide. People have had cancer and survived it.  People have lost children in tragic ways. I seen pretty much seen it all.  Your job becomes a microcosm of life in general and all its triumphs and tragedies.

Good things have happened to, don't get me wrong.  People have had great success - become nurses, doctors, lawyers. Many peoples children have grown up and gone to college.  But somehow, the bad things that happen to such good people seem to stand out more sometimes...

There are two kinds of people who come into the ER that I can't stand: assholes and bullies.

Being a nurse, you learn pretty quick that there are people in this world who make an art out of being an asshole. Asshole type #1: Their life is shit and you, the nurse, are going to pay the price for their shitty life. All of that bullshit therapeutic communication they taught you in nursing school isn't going to work with them..

Asshole type #2: This type has an exaggerated sense of their own importance. Everybody is supposed to cater to their every whim. They are more important than the other lowly patients.  If things don't go how they want them to go, look out.

Then there are the bullies. The verbally abusive who sometimes threaten the staff. I have absolutely zero tolerance or patience for these people. Especially those who threaten physical harm.  Ah can you say....SECURITY!

Here's the thing about nurses, assholes and bullies. As a group we put up with them, many times feeling like we have no choice.  True that, they have to get medical care too.  What gets me about a lot of nurses are two things:
1) They feel sorry for people like this.  Oh....they must have had a rough life...
2) They allow themselves to be abused, threatened without doing anything about it.

When I have a asshole patient, sorry folks, I avoid them. I do what I have to do and I don't go in their room unless they put the call light on or do my periodic checks. Now some of you would say, well, why don't you talk to them, maybe they are scared...no, sorry.  I do not have time for people like this.  I won't subject myself to it.

With bullies, I do two things:  If someone is verbally abusing me, I tell t em to stop, tell them it is unacceptable, and if they don't, I leave the room and come back later. If they threaten me physically, I call security.  Just like in a domestic abuse situation, I do not deserve to be treated this way.  I won't be. Again I avoid them, doing only what is necessary.

Perhaps some of you think I am being a hardass. Nurses are supposed to care and understand. Bullshit. Nurses are their to provide care and be treated respectfully.  End of story

YUP.

So I'm sitting flippin' through the channels.  I have nothing to do.  I'm old. Its really cold outside.  So sue me.
Anyway....I happen upon the Discovery channel.

Untold stories of the ER is on.   It is a show in which they "reinact" incidents in the ER.  Its a dumb show. End of story.  While I was on Discovery, there was an ad for NY ER.  Hmmmm...never heard of it.  So I tuned in later.

It is a "reality" show.  It is based at Presbyterian hospital in NYC. It follows certain ER staff around, doctors and nurses. As usual the doctors are the stars, the nurses secondary. Of course, it is one trauma after the other. People falling off buildings, jumping off buildings, getting hit by cabs.  Blah blah blah.  I worked in a trauma center and it isn't one case after another, its one, at the most a couple,  per shift.  But hey, what do I know, its NYC, maybe its one after another.

The doctors are all good looking. Apparently the bald headed ER doctors with a paunch were out.  I guess all the handsome ER docs choose to work in NYC, 'cause these guys look nothing like the docs I work with.  The nurses come off as too nice. Sounds funny, but give me a break.  You work in a NYC ER trauma center, you ain't this nice.

There were a couple of good scenes actually.  In one, a woman was appearing before a judge and "fainted". When she came in she was "unresponsive" until they tried to cath her. Then she became real responsive and stood up on the ER cart.  I actually had a patient stand up on his cart one time.

Another one I enjoyed.  LBP by ambulance.  This guy had been getting any dope he could "to treat his pain".
Whats the first thing the doc gave him? Morphine.  Now thats realistic... a junkie getting narcs. Later on he became an asshole because "the monitor kept ringing and I couldn't sleep".

Another woman who was in prison swallowed a couple of toothbrushes (is that talent or what?).  While she was there she swallowed a battery.

All and all?  A pretty good show.  Will I watch it again? No.

My hospital specializes in a lot of shit.  Cardiology, neurology, orthopedics, etc etc etc.  Therefore, as an ER, we get a lot of medically complicated, seriously ill people in addition to the usual ER baloney.
Some days it feels like this is all we get.

So there I am minding my own business at the desk. I'm up for the next patient. One is coming by ambulance. I click on the computer to see whats coming in.  45 year near syncope. Hmmm.  Somebody vaso vageled?  Tey are dehydrated?  Whatever, I can handle it. The're young.  How bad can it be?

Of course, there is way more to the story. Turns out this woman has cardiomyopathy, diagnosed 1 month ago after having increased shortness of breath.  They were found to be in congestive heart failure. Their ejection fraction is 20%.  Had probably been in atrial fibrillation for a couple of years without treatment.  They must have had some episodes of v tach or very rapid heartbeat  because now they have an external defibrillator.

So the simple syncope turns into a big deal.  This is typical.  What looks to be simple is really way more complicated.  Often times when we get a call about an ambulance coming in from medic control, the information is a couple of sentences, failing to mention all of this other shit.  Like they are a quadriplegic or post heart transplant or mentally disabled from a group home.

Sometimes I think, whatever happened to sprains and lacerations and appys and what you would normally think comes into the ER?  They seem to be a thing of the past, replaced by by the MI who is on dialysis, a crack head and of course has no veins....

I don't think the public would ever believe what it is really like in an ER.  The people we really deal with.  The average person is not going to come to ER unless they truly are very sick or have an accident or something.  So the majority of people we see are not your average, functioning person.



NOT.

They are the dysfunctional, criminal, crazy people among us.  They are the people you move to the suburbs to avoid. 

Lots and lots of dysfunctional people come to ER, in fact, they are the bread and butter of the ER.  They are the people who have zero coping skills for one reason or the other.  Their life is one crisis after another and if there isn't a crisis, they will create one.  Expecting them to be organized enough in their own life to have a doctor is unrealistic.  When they come in, they act out all of that dysfunction.

We see some really creepy people in the ER too. Guys who want you to "hold the urinal for them". Sex offenders. People who "just got out of jail". Drunks who are so drunk that they pee and poop themselves. Violent people who want to kill somebody.

Then there are the truly mentally ill. People who hear voices. Manic people. People who try to hurt themselves while they are in the ER. People who get out of control and have to be restrained.  People who sometimes won't hesitate to punch us.

And we see the sad people.  Old people who lay on the floor for hours because they have no family to check on them. Young people who are already messed up because their family is dysfunctional.  Abused people.  Women who are raped.  People who are dying or die.  People who have bad things happen to them just randomly, through no fault of their own, and it will change their lives forever.
People who are terrible junkies or drunks and that's all they will be til it kills them.

This is the real ER.  The one you don't see on TV.

Red flags in the ER:
1) You say you have "chemical sensitivities".
2) You have more than 2 allergies.
3) You have fibromyalgia, chronic fatigue syndrome, some kind of syndrome no one has ever heard of.
3) You bring your MRI or CT with you, usually of your back, stating you can't get into see the doctor for a "couple of weeks".
4) You say you just moved here from out of town.
5) You bring a suitcase with you.
6) You brought something in a bag that you want to show me.
7) You can't tolerate the "pain" of an automatic blood pressure cuff.
8) You're allergic to haldol or thorazine.
9) You are 40 and your mother is accompanying you
10) You say another emergency room "don't know what they're doin'".
11) Your medical problem started in 1930.
12) You say "yes ma'am a lot.
13) Your relative is taking notes.
14) The medics want me to come outside of your room to give me report.
15) You are taking more than 3 psych meds.

Oh BTW let the chronic patient shit storm begin....3....2....1...go!

I've been an ER nurse for 23 years, actually 24 this year.  Is that unbelievable or what?  Am I crazy?
How did I work there so long? I raised a son. He kept me distracted from concentrating on the job.  The job was just part of my life. 

I've been thinking a lot about retirement.  I can retire early. So I will. I'll have to keep working though because I am quite a ways from real retirement age.  I need health insurance and the other benefits too. I've been thinking about what kind of job I would get. I want to stay in nursing because its good money.  Best money I'll make.

I've even started looking at jobs. None of them appeal to me. So it started me thinking about really leaving the ER. 

ER nurses have a love/hate relationship with their job. It is the most frustrating, overwhelming, stressful, exhausting job you could have.  Dealing with the sick public pretty much sucks people.  I hate to bust your Florence Nightengale bubble people, but it does.

So I think: What would it be like to not work in the ER any more? My life would be a lot less stressful. No more 12 hour shifts. No more exhaustion. Here's the thing: Despite feeling like I can't stand the job some times, there is a part of me that thinks I would miss parts of it.  OMG did I just say that?

There is part of met, despite the fact that I want to hit myself over the head for saying this, gets satisfaction out of it being so hard.  It is a perverse satisfaction, but there it is. A part of me enjoys the weirdness, the humor and variety of it.  A part of me thinks it is pretty cool that I can help save someones life.  A part of me likes the challenge. 

Then there is the part that is very tired. 

Yesterday sucked.  I was charge and it was one critical patient after another with no ICU beds. So people were there for hours.   Families unhappy.  Staff unhappy. Not fun.

So today was my 5th shift this week. Bleah. Not looking forward to today.  And then....and then.....a miracle occurred.   The God of emergency rooms decided to shine down on us.  The day was reasonable, so reasonable that it was almost eerie. 

Here's the thing:: When you work in ER, although you delight in, and celebrate, slow times, it also makes you very nervous.  Everybody is on edge waiting for the other shoe to drop.  No one talks about it.  The lack of patients.  We don't want to jinx it.  ER staff are very, very superstitious. 

So as the day goes on and it remains really, really nice, even WE, people of the ER, relax..  We shoot the breeze, fool around, generally just enjoy a breather.  Especially after the last month, with the rampant flu, that  has been horrible. We relax. Something we don't do often.

With relaxation comes reluctance to work.  So when patients come in there is a collective groan.  No, go away. We don't want any. Its almost harder to work when the day is slow than when it is crazy.

So it is so slow that I get to leave 2 hours early, unthinkable in the last couple of months.  Yay!!! There is no better feeling than being able to leave early. As I leave, I feel a little scared, scared for the night shift.  No doubt they will pay the price for our good times.  After all, everybody knows, eventually the ER universe always balances itself one way or the other.  If not tonight, then tomorrow. Fortunately for me, I'm off tomorrow!

This is the kind of crazy shit that goes on in my ER.  We give a narcotic injection to someone with chronic pain, who by the way, is currently in treatment.

You know its going to be a bad day when you are walking up to the ER entrance and there is a pool of vomit in front of it. Uh oh.

The first thing I hear is a man yelling at the top of his lungs. Hey, I recognize that guy.  He was here last time I worked.  Went to our observation unit.  It seems after carrying on all night there, he has boomeranged back to us. And of course there is no bed available inpatient.  So for the next 8 hours we get to hear about q30 minutes how unhappy he is with his life. Wonderful.

On a day when someone is yelling for hours in the ER, I feel like I am working in an insane asylum or a torture chamber, take your pick.  Its a - either the patient gets a shit load of Ativan or the staff does, type of situation.  Take your pick doctor.  Maybe some of the patients would like some too, since they are suffering right along with the rest of us.  Hey, Ativan for everyone...its an Ativan party!

You have to laugh on a day like this or it will kill you. It becomes comical really. You laugh so you don't cry.

Finally they come up with a bed and peace returns and the quiet feels kind of weird.  Like something is wrong.  Something bad is going to happen, I just know it...