Humanity never ceases to amaze me.  There are people who come into the ER on a regular basis and they outright lie about themselves.  I'm not talking about their physical state or drugs or that kind of stuff.  I'm talking about their lives.

They make up stories about their lives. I have actually had a person tell me that they just got back from Washington DC because they were there lobbying for transgender rights. Ah...okay.  This same person tells this ongoing story about they are going to school to be a  rocket scientist (har).   They actually think that we think, knowing that they are the shall we say, low functioning individual that they are, would be going to school for anything.

Then there is the person who says that they have  this prestigious job at a local business. In fact they are so good at their job, that they recently were flown to new York and put up at a fancy hotel in order to compete on a reality show, which by the way they won.  They are expecting a check for $15,000 in the mail any day now.  OK, and I'm the next president.

Maybe they are playing a game with us.  I hope so, because...well I don't wanna think about if they aren't.  We are like sitting ducks in these situations.  We have no choice but to take care of them, despite the bullshit.  I usually just say...oh is that right...hmmmm..

When you work in the ER you realize just how many crazies there are walking around among us.

Sometimes you only learn about the latest technology available by having patients coming in wearing the devices.

For instance, I had no idea there was such a thing as an wearable external defibrillator.  This is a device that is worn as a harness on the upper chest.  It continuously monitors the heart.  It has a built in defibrillator.  If the monitoring device senses v fib or v tach (fatal rhythms)  it sounds an alarm to warn the patient and then defibrillates them.

It is apparently used for patients with CHF (heart failure) or cardiomyopathy (enlarged heart) who may be too risky for surgery for an internal defibrillator.  It can also be used pre insertion of defibrillator.

I've only seen it once.  Its amazing whats out there.

You know what I just love? Those people who come in thinking that they are going to dictate what happens.  You know, the kind of person who requests what medication they want and how they want it.  They tell you what tests they want. They even tell you they want to be admitted and don't plan on going home.

Well, guess what folks? This isn't a cafeteria with different selections...you don't get a menu to choose from here.  You do what the doc decides.

Entitlement comes from all levels of society.  From the poor, who expect that you are going to arrange for a cab home to the upper middle class folks who think they can dictate how the visit is going to go. Espeically  irritating are those who say they know somebody in the administration or they know a doctor who works here. So what.

This happens a lot in triage, where people become irate because their doctor didn't call us to say they were coming. . I have seen people treat the triage nurse like shit calling them a liar, when told their doctor didn't call.   They think they will get in ahead of everybody else.  Not. they

Reason # 58 not to come to the ER for your flu symptoms:

Other than sitting for hours in the waiting room, we will be doing a "flu swab".  That is, if we have any.  There is a shortage of flu swab culturettes.

So what is a flu test like?  You know when you accidentally get water up your knows, that kind of painful feeling?  That's kind of what getting a flu test is like.  The culturette is a long wire thing with a qtip type thing on the end.  We stick it into your nostril. It has to go in a ways to get the sample.  Its not fun.

So don't come if you don't want us cranking something up your nostril

You wouldn't think we would deal with this in the ER - cosmetic surgery - but I have. 

I once had someone who had an infected buttock after getting a butt implant.  Yes apparently this persons butt wasn't big and round enough and they wanted an implant.
Apparently a silicone piece of stuff is placed in there and hopefully it stays where its supposed to.

Once I had someone with a tummy tuck problem.  Another infection.  In this one, fat and skin are removed that have stretched out.  What woman, after having given birth, wouldn't want a firmer stomach?  The thing is most of us aren't willing to go undergo major surgery with anesthesia to do it.

Last but certainly not least, a hair transplant.  It turns out this guy, who came in for another problem, mentioned he was also having trouble with his recent "Barclay".  "Barclay" I asked, what is that?  Apparently that is the name of the company that did it. The guy proceeded to take off his hat.  He had a ring of gray hair, and below that some straight, string brown hair. Hmmmm.....I didn't see any signs of infection and instructed him to put the hat back on... 

I'm thinking of taking a 3 month leave of absence.  Why? I absolutely, positively, dread the next few months because the flu season is already out of control.  ERs around the country are overwhelmed.  Yesterday our ER saw 60 more patients than we normally do.

Let me tell you how a bad flu season affects hospitals: Not only will ER waiting rooms be full, but hospitals will have no beds.  A lot of the time the flu hits the elderly, the very young and the chronically ill particularly hard.  Those people end up being admitted.  Now add those people to a hospital with a normal census and you have a recipe for disaster.  I already hear talk that there is a shortage of ventilators.

What does this mean for the ER? If you have to be admitted, you will be waiting hours for a bed, in fact you may be in the ER overnight waiting. What does this mean for the normally healthy people choosing to make a bad decision and come to the ER for your flu symptoms?  You will have at least 3-4 hour wait, if not longer, in the waiting with a mask on.  The people who need admission to an inpatient bed have backed up the ER making no beds available to those in the waiting room.    So prepare to set up housekeeping out there.

 Don't come if you are normally healthy and are not severely dehydrated, short of breath, confused,  elderly, a baby or have some other chronic illness.  Please??

Don't have the flu? Don't want to get it?

1) Get a flu shot.  Drugstores give them for $25.  Might be the best 25 you spend this winter.
2) WASH WASH WASH your hands. In fact invest in some of that stuff you can carry around to clean your hands.
3) Stay away from coughing people or people who look like death warmed over.

When you work in the ER, you see everybody from the drunk who passes out on a daily basis on the street to Mr. billionaire owner of an international corporation and everybody in between.  If they present at the triage desk or brought in by ambulance you have to deal with them.

So yeah, you're gonna to have to take that drunk that crapped his pants if you're up for next patient. You're probably gonna have to clean him up too.  And here's the thing, he will be here for hours because detox is full.

And you're also going to have to take Mr. VIP with his private duty nurse and hovering family who put the light on every 5 minutes because dad needs to be repositioned, needs a drink of water, has just one more question.  And don't you act impatient, because VIP daughter knows the hospital CEO and won't hesitate to call her.

Oh and that sex offender in bed 3, you're going to have to take him too even though you want to take a shower every time you exit the room.

The gangbanger who has been shot and isn't happy your trying to help him. He just wants to go and is using words even you who have been working in ER for years, have never heard.

Oh by the way, there is frequent flyer Francis who last time she was here and couldn't get narcs, through themselves on the floor and had to be carried out. 

Uh oh, there is Anna the allergy princess.  She has 75 allergies and many "chemical sensitivities".  She who has that darn abdominal pain that "nobody can figure out" despite a few exploratory laps.  Several doctors have "fired" her.

Last but not least for this shift: There is heroin addict Hortenz who has a nasty abscess on her arm from a contaminated needle. Oh, did I mention she has MRSA and is HIV+?  Sorry forgot....

Just another day in the ER....

I like to share my interesting finds with y'all...

Dear John/Jane Q. Public:

You have the flu.  That sucks and is a shame, etc. Its a bad year and right now ERs are filled with people with the flu.  Which is stupid. 

ATTENTION ALL FLU VICTIMS:

Follow this closely:
DO NOT, REPEAT, DO NOT,  COME TO THE EMERGENCY ROOM FOR YOUR FLU SYMPTOMS UNLESS YOU ARE:

1) >98 or < 1  years old
2) are dying

There is nothing we can do for you people. You are just going to have to ride it out.  You are going to have to do what people used to do in the old days: rest, fluids, perhaps chicken soup.

You are clogging up ERs right now, leaving less beds for the truly sick.  Your mother could be having a heart attack and we don't have a room for her because you and your flu are taking that bed.

If you do come, you will wait for hours in the waiting room with a mask on your face.  That doesn't sound very fun does it?

One last thing, DO NOT call an ambulance for flu symptoms.  It will not get you a bed in the ER any faster.  You will go out to the waiting room with everybody else.

That is all. Go about your business.

My son is 20 today, no longer a teenager.  Yikes. 

Perhaps this is inappropriate, but he knows how inappropriate I am anyway...

I have already told you about the sophisticated, two hour long post bed bug patient visit shenanigans that is now policy at my hospital.  Well, now I have a new thing to add to the fight against vermin.

This has been around for about a year. It is a robot vermin destroyer. It looks like R2D2. It uses ultraviolet light to destroy bacteria.

Picture this: Its 1979. You are in your spiffy dress, you boyfriend in his 3 piece suit. You are on the dance floor at the local disco doing a bad imitation of John Travolta and that girl in Saturday Night Fever.
Strobes of light hit you and your partner as you get funky, get loose in the middle of the dance floor.

Thats what the robot looks like when it is doing its thing. A disco.  I am tempted to go in there and let my inner Donna Summer (RIP) out.  Anyway, at this point it is being using for post c diff visits.  BTW,  each robot costs $80,000.    Worth it?

***PUBIC SERVICE ANNOUNCEMENT***

Attention all citizens:

The following are not emergencies:

1) bug bites - unless it have swollen to the size of a baseball

2) the fact that you cannot control your teenage daughter or son

3) you are fatigued or can't sleep

4) you want your son, daughter, brother, sister, etc. to get chemical dependency treatment

5) the condom broke

6) you are hungover

7) G tube not working

8) the cut is less than 1"

9) any kind of medication refill

10) menstrual cramps

That is all...go about your business.

I know Christmas is over...but this is too funny to pass up.
From one of my favorite docs: ZDoggMD

I hate to say this....but  I am REALLY sick of taking care of people. I've been doing it for a long time and I am just tired. I'm tired of cleaning the butts of people I don't know. Is that okay?

Before you say, you knew what you were getting into blah blah blah.  Time for you to quit blah blah blah. Don't say it.  I will be gone within the year.

Is it possible to get a job where you sit in front of a computer, make the same money I do and only work a couple of days a week? Har.  I am looking for the ideal job. The pickins are slim.

You go up close and personal to look at a Christmas manger scene.  Somehow you fall, right into Joseph, knocking his head off...

A question and a couple of comment:

1) You are going to hell. God don't go for that knocking Josephs head off shit.
2) Is God punishing you by breaking your ribs?
3) Next time, admire it from AFAR.   Geez.

Merry Christmas to all of you.   See you next week.

The patient satisfaction thing has officially gone off the rails.

I read that an emergency room in Massachusetts is starting a policy in which nurses can order pain medication on their own. Due to medicare reimbursement being linked to patient satisfaction scores, a policy has been developed in which nurses can order anything from tylenol to vicodin to morphine to dilaudid after using some kind of pain assessment scale. The goal is to treat pain within 30 minutes of arrival.

Isn't this outside the scope of nursing practice?  Isn't this practicing medicine without a license? Doesn't this open nurses, hospitals, the doctor up to a whole lot of liability?

With the increasingly common use of NPs and PAs in the ER, along with stuff like this, why do we even need ER docs?

Your thoughts?

SE PEOPLE

Some people won't like this. Oh well.

As the hours go on since the shooting of 20 babies, I find myself feeling ashamed.  I am ashamed of living in a country, of being part of a society where this has happened. It is the latest of a series of  mass shootings.  There is something very wrong with a country where this is starting to occur on a regular basis, now affecting babies. 

I am hearing the same thing that always happens: This guy was a nut, blah blah blah.  Nuts shouldn't have access to guns blah blah blah.  If we could have everybody who bought a gun be psychologically profiled this wouldn't happen blah blah blah.  When are we going to stop fooling ourselves? 

We live in a culture in which violence is acceptable.  It is celebrated in movies, on TV, in music.  Its entertainment. We think it is okay for our children to play video games in which they "pretend" to shoot people.  We have become immune to violence. We don't really care that there are 30 shootings a day in the country, 1,000 shooting a month, 100,000 shootings a year.  It doesn't affect us personally, so whatever. If affects "those" people. They aren't like "us". 
There are 300 million guns in a country with a population of 350 million. Why do we need all these guns? I hear the answers: for hunting, for self protection.  Guns are rarely used for self protection.  They are mostly kept in lock boxes.  I guess its the psychological idea that we have a gun in the house that makes us feel better.   It protects us from "those people" out there, the ones that would harm us if they could. 

Why are automatic weapons that are mostly designed to be used in war, available for purchase to the average person? Why can you buy as many bullets as you want?  Under what circumstances would you, personally, need to use an automatic weapon? 

We hold ourselves up as this great country, always bragging about how great we are.  Number one, etc.  Best in the world. Others should aspire to be like us. There is nothing great about a country in which 20 babies are killed and it is the third incidence of mass killings in the last 6 months.  Our culture is twisted. It is sick in so many different ways. If the killing of these babies does not cause a massive national examination of where we are headed, what we are about,  then    it is only a matter of time before this country ceases to exist. 

Why is mental illness treated so much differently than physical illness in our society?  Is it part of the individualism that this country so highly values?  Pull yourselves up by your bootstraps and stop  complaining,whining.  Be strong. Get it together.

Mental illness is no different from physical illness. It is not something that an individual chooses.  It happens due to circumstances, stress, heredity.  It is a chemical imbalance that very often needs medication to manage.  Not always, but more time than not.

Mental illness is an epidemic in this country, but we don't treat it that way. The way we treat it reminds me of how those with AIDS were treated when it first started being recognized.  There was fear, blame, stigma. So many people never get treatment because they don't want to be labelled.  They believe what we are told that going for help means you are weak.  So their illness gets worse.

When it gets to the point of no return, they can't deal with it anymore, they present to ER.  They are feeling suicidal, have attempted suicide. They come into an ER that is not  prepared to deal with them.  Physical stuff can be dealt with, maybe fixed.  Mental illness? Not so much.  ER staffs don't    have time to spend listening.  Often patient sit waiting for hours.  Their admission, unlike physical illness problems, has to be pre-approved.  There is a shortage of psychiatrists.

Their are often few, if any, beds available.  Mental health beds are not a priority for hospitals. They're not money makers.  When their are no beds, people have to be transferred to another local hospital, and in some cases, to a hospital a couple hundred miles away.  Sometimes they spend 24 hours in the ER.

That's what happened to a lady I had last week.  They wanted to transfer her to a hospital about 150 miles away. She was not rational to begin with, this caused her to lose control.  Security was called.  She ended up not going to the other hospital, after a few hours she got a bed with us.

When I see these kinds of things happen, I think about how hard it must have been to come in the first place. Then you sit for hours.  Then you are told you will be going 150 miles away from your family to be hospitalized.  Its a crime how mental health is handled in this country.  

What can you say about 20 babies being killed? Nothing. All you can do is pray for their families.

I was gnarly last week, I admit it. Working too much with too few days off. No time for recovery of sanity.

So its my last day before a few days off. The black cloud that was hovering over me is slowly lifting. Then HE comes in. Histrionic Harold.

Red flags:

1) Medics wanted to give me report outside the room

2) From the time he arrived and was transfered to the cart, he made this WOOOOOOOOOOOO!!! sound while sitting there with his eyes closed.

3) Daughter arrives and does not want to go into room with Dad.

4) He normally gets care at another hospital.

So we manage to get throught the first few minutes. I am entering stuff in the computer and He is rambling on about all of his medical history back to the Mayflower. And I let him ramble. Half listening. Not really caring what he is saying.

I didn't give him the call light. I'm no fool. At some point he requested to have the call light and I had to hand it over. Mistake.

Periodically throughout the visit I hear WOOOOOOOOOOOO!!!

At some point daughter leaves in disgust.

First he will go home. Then he will stay. Then he will go home. Finally a bed is ordered. I consider making a run for it out the door.

I actually maintain my patience remarkably well. One thing about the ER, eventually even the worst patients leave. Besides, I'm off for a few days starting the next day, so its all good

I had an older man who got his first tattoo at 72 years old.  Then he got another one after that.  One on each arm. They actually didn't look bad.  He was kind of a heavy man so his skin didn't sag where the tattoos were.  Apparently his kids wanted him to get them. His sister was mad he got one at his age.

When he went to the tattoo parlor he asked the person doing it if he was her oldest customer. He wasn't.  She told him that there was an older women she had done.  Being a religious women, she went to her priest and asked what kind of tattoo would be okay.  The priest told her a cross. So thats what she got.

I really enjoyed taking care of this guy.  He seemed to enjoy life and have a lot of fun. He made my day go faster.

Got any interesting tattoos?

Well its a winter f--kin' wonderland out there: "Isn't it pretty blah blah blah?" Our first major snowfall  of the season and of course, people go nuts. Its like bumper cars on the streets.  300 accidents as of this afternoon.  Every Tom, Dick and Harriet comin' in with their fender-bender neck pain, back pain.  Blah blah blah.  Willing to sit in the waiting room for hours to get their non-existent injury looked at.  Whatever, easy patients for us.

What always amazes me is the people who despite the blizzard like conditions, still make their way to the ER for their chronic back pain, puncture wound, STDs.  I swear there could be 6 feet of snow on the ground and they would tunnel their way through.

So anyway, at mid day it was chaos.  Ambulances bringing in two patients at once.  Then by evening there were 5 people in the ER.  I  got to leave early.  Yeah!

Being an ER nurse is so damn hard. The patients are more acute these days.  I've been trying to figure out lately why the job seems so much more stressful  than it used to be.  I ask myself, is it because I'm getting older and dealing with stress is harder?  I wonder about the other nurses. I mean I have been at this a long time.  I can handle just about anything.  If I am feeling like this, how are the other, less experienced or new nurses feeling?

Most people in this world are decent, doing the best they can.  The thing is, and this job teaches you this, there are just plain mean people and there are a fair amount of jerks in the world too.  They make the job even harder.

In nursing school, you are taught "therapeutic communication".  You are told that people react to stress in different ways.  Its like you are taught, "they can't help it, they are hurting, under stress, etc.".  Its your job to take care of them and understand and if you communicate with them in the right way, you will be Florence Nightingale and they will be the perfect patient and everybody will live happily ever after.

So right off the bat, there is an abyss between what you come out of nursing school thinking, and reality.  The first time someone calls you a "FUCKING BITCH!" its a shock to the system.  This isn't the way its supposed to go.  Flo runs screaming from the building and you are left standing there by yourself. This is the point where you follow Flo right out of the nursing profession or for, various reasons, you decide to stick it out. You develop a protective shell around yourself.  You do the best you can, realizing the perfection that is expected is impossible.

You get tired, weary, angry at times. Just when you think you can't take it anymore,  someone says thank you. Two little words. It stuns you.

So to all my fellow nurses.  Your job sucks a lot of the time. I know that you hate it at times. I know you go home exhausted. You wonder why you still do it. You get angry some times.  To all of you, I say thank you.  Thank you for doing a great job under impossibly stressful circumstances.

Story #1: A person gets in their car with a friend and goes on the freeway. They hear a strange sound and wonder if it coming from the radio, so they turn it off. Not coming from the radio. Its a distinctive: "meow....meow..." They pull off the freeway and look under the hood, there sits a kitten curled up on the engine. She goes to pull the cat out and puddy don't like that, so it proceeds to bite her hand. Bad puddy tat. Puddy tat runs away. Person comes to the ER a day later. There is no swelling or redness on the fingers that were bitten, but NP calls someone who connects her to the "state veterinarian" (who knew we had a state veterinarian? And why do we need one?) That person tells her that last year there were 7 cases of rabies from cat bites. Sounds bogus to me, but then I'm not the one decidin' what to do. The patient will have the rabies injection. When a rabies series is given it is given in 3 steps. The first step is to take half of what is ordered and "infiltrate" the area around the wound. (stick a needle into it) Ouch. Then the other half is given by injection - 2 shots. Next step another shot one week later. Next step another shot 2 weeks after that. No fun for anyone concerned.  story #2: Man comes in to the hospital to visit his wife who is an inpatient. Man is a insulin dependent diabetic. He takes his insulin that morning. He doesn't eat anything for breakfast. Nurse who comes in at 7 am notices him and he seems to stumble a little bit and she thinks hes drunk so she walks on. Two hours later the patient is found on the floor next an elevator by the ER. His blood sugar is less than 20. He is brought back around with D50W and orange juice, at which time he tells the ER staff, "I never eat breakfast". He has no idea how lucky he was to be in a hospital when this happened and have access to immediate help. He is sent on his merry way, but he just doesn't seem to grasp things when we tell him if you don't eat breakfast you could die or become seriously disabled.....Just another day on the cold, lonely prairie....

You know its gonna be a bad day when you note that there are overflow patients in the area you are about to open, and one of them is dead.

You pass triage and some guy is saying in a loud voice: "I just broke my Dad out of jail".

You pass a room and another guy is loudly telling a nurse that he, "just got out of the penitenary 3 weeks ago". He's drunk.

Okay there is a theme developing and I don't like it.

Its downhill from there ending with a drunk guy who doesn't speak english and proceeds to talk loudly for the next 2 hours in his native tongue and of course he is right near the desk...