Tuesday, May 29, 2012

Holiday Crud

I've been sick the past few days which has been inconvenient due to the holiday weekend. It started Saturday night and went into full bloom on Sunday. I had to work Sunday. As the day slowly ticked by, I felt worse by the minute. My charge nurse tried to get someone in to replace me, but no one would answer the phone.
I don't blame them, we have been consistently short handed and everyone has been working OT to the max.
So, with no other choice, I soldiered on, caring for people far less sicker than I was.

The ER doc, Dr CoolGuy thankfully was working and wrote me a script for Tamiflu. It sure felt like the flu. I waited for the end of the shift wondering if the hospital cared if I was possibly exposing my non sick patients and transforming them into future sick patients. <shrugs shoulders> Probably not.

Dr. CoolGuy and I have a taste for the same kind of soda - Diet Rite. He loves raspberry and I always have a hankering for white grape. He's able to find my kind around where he lives and I have no problem finding his around my grocery store. The first time I bought him a 12 pack of raspberry, he offered to pay me.

What?! No! "Quid pro quo douche bag!"  I said in my best imitation of Mr.Chow from The Hangover.

We have an understanding. I bring him his, next time he brings me mine. If he gives me a pity script, I pay with Diet Rite. I owe him a 12 pack for this one.

Now it's Tuesday and I'm still feeling like a big ball of crud. Better than before, but crappy all the same. The true diagnosis has presented itself, so I tried to make an appointment with my doctor this morning. I need some antibiotics and a medrol pack. Perhaps my doctor's office changed how they make appointments. Usually, I have to call the appointment clerk who is this young, bitchy girl - she's downright mean. She'll argue with you until you have to be just as mean to her and then she'll give you an appointment. This time no one answered. The patient has to leave a message and is told they will call back. Surprisingly, I got a call back about an hour later. The lady had a strong Indian accent. I think my doctor started using a call service for his appointments. She asked me why I wanted to see the doctor. After I told her, she was confused, "What?"
"I'm sick."
"All right, you can have an appointment at 3:15."
Is that what offices are doing now? Using call services? I'm wondering if mean girl will be there to take my copay or I'll just have to swipe my card at an automated self serve check in. Perhaps that's why some people use the ER as a doctor's office - it's so difficult to see their PCP.


Friday, May 25, 2012

House Calls by Dr. Finger

A patient comes into the ER with chest pain.
His wife is bedside and both had awesome personalities. I start the usual workup: assessment, IV, blood work, 12 lead, ASA, NTG. Racked the chart and waited for the doc to do his assessment and orders.

When I received the chart, I noticed something out of the ordinary - a guaiac. For the non medical readers, this is a test where stool is smeared on a card, chemicals are placed on the card to determine if there is occult/ hidden blood which means that there is bleeding somewhere in the gastrointestinal tract.

Perplexed, I asked the patient about it. He mentioned that he told the doctor he noticed a small amount of blood in his BMs recently. Okay. I informed him what I would have to do in order to get the sample and why I was doing it. I quickly got my sample.

"Hey doc!" He shouted out.

"No, I'm your nurse. Are you all right?"

His wife was next to him smiling. "When you stuck your finger in my ass, my chest pain stopped immediately! I feel so much better."

"I'm sure the medication I gave you started working."

"Nope. It didn't. It was your magical finger!!"

Later, after going over the discharge instructions, the patient's wife asked me if they could get my home phone number. Both of them were smiling as she said, "This way, if he has chest pain again, you could come over and stick your finger in his butt again and make it go away. He really hates coming to the hospital."

I looked at my magical finger, imagining all of the power it must possess.

Then I wondered how much I would charge for it to make house calls.....



Thursday, May 24, 2012

The Costs of Stupidity

Last week, my Dad was visiting from my home state. He stays about a week for his yearly visits. He normally makes his trip in July, when the weather is sweltering hot. The temperature is comfortable for this time of year, but the thermometer is gradually climbing which means turning on the A/C switch.

One morning, I walked out of my bedroom. "Does it seem warm in here to you Dad?"
The temperature control showed the air conditioning was running, but the thermostat reading did not confirm that it was doing any good. I started to investigate.

Circuit breakers - none tripped
Outside unit - running and clean, no debris around or in unit noted
Wiring - intact
Copper tubing - not stolen, no ice
Attic thingamajig - switch was on and running
Jumped up on the counter to feel the air vents - cool air, but hardly blowing

I called my hubby to tell him that I checked everything I knew to check and couldn't figure it out. I called the A/C people and a time was scheduled for the next day.

The next morning, this kid (20's) showed up and started doing the same checks I performed yesterday.....except for one.

"Did you change your filters?"
"Huh?"
"Your filters? When was the last time you changed them?"

I looked at my husband. "You changed them after the contractors put the hardwood floors in last week, right?"
"No. I thought you did."

Ugh.
I replaced all 3 filters in the house with the kid smirking a bit. He then went around and measured the airflow and temperature.
"It seems all right now. That'll be $____"

I wrote him a check and handed it to him, visibly peeved about the filters.
"Thank you ma'am. Next time you may want to check the filters before calling," he advised with that damned smirk.
I felt like telling him, 'well, yeah - no shit.'

My Dad sat there with a similar smirk on his face. "I don't want to hear it from you too, old man." I said jokingly. The smirk never left my Dad's face.

Perhaps this is a sign.
A sign from God warning me to think nicer thoughts when my patients do really, really stupid things.......

yeah, I didn't think so either.









Wednesday, May 23, 2012

From the Mouth of Babes...

I was a guest speaker at my kids' elementary school career day. I spoke to children in grades K-5th grade. It was an amusing experience. Some grades seemed to be fascinated by only one subject, asking questions that spurred more questions on only that one subject. The popular questions involved blood and guts, "gross stuff", strokes, and dead people.
My daughter returned from school proudly stating that all of the kids really liked my presentation except one fifth grader said "it sucked". My daughter was upset by this. I comforted her by saying, "Well, not everyone is going to enjoy it, that's okay." It didn't work. So, I said, "He's probably a turd who doesn't like anything." For some reason, she was satisfied with the boy being a turd. Mission accomplished.

Here are some of the endless questions asked by the kids:

"Do you know Jessica?"
"How many dead people have you seen?"
"Is it gross to see all of the blood and guts?"
"What is a stroke?"
"What is a mini stroke?"
"What happens when you have a stroke? Do you die?"
"Have you ever had a kid with a broken jaw? Because that was me."
"What happens when you get sick?"
"What happens when the ER is closed? Where do the people go?"
"Do you know David?"
"Have you ever had someone shot?"
"Did you stick your finger in the bullet hole?"
"What if someone pukes on you?"
"Do you take vacations?"
"What do you do with the dead people?"
"When someone has to go on the ventilator, how do you get his permission?" <this one was from a 4th grader>
"Have you ever seen bones sticking out of big cuts on people?"
"What is the weirdest thing you've seen?"
"I forgot my question, could you call on my again when I remember?"
"Can people leave the ER and then come back the same day?"
"Do you have to touch boogers? I can't deal with boogers."
"Have you ever had a patient named Ann?"
"Do people ever die in the ER?"
"How do you work around all gross people everyday?"
"Do people come in for spider bites?"
"I like bugs. I went to the ER for a spider bite. Do you remember me?"
"My mom works in the ER and she comes home and tells me about all the mean and stupid people. Do you know her?"

It was very enjoyable!


Thursday, May 3, 2012

Another Shift, Another Day...

I've been a naughty nurse and haven't posted in a long time. Actually, I have been busy with construction on the house, shuttling kids to and fro and my seemingly endless pursuit of more degrees. Also, I've been just plain ole uninspired to write anything.

I split a shift with another nurse so she could see her kid's baseball game. I thought it would be a nice, quick few hours until I found out she was assigned to triage. Triage, for me, literally sucks the life force and compassion from my body and leaves me a bitter shell screaming inside my mind...."Really? REALLY!!!?"

The amazingly trivial things people come to the ER for is mind blowing.

Once I arrived, I started the cattle call of patients to be triaged: a scraped knee, a cold, a panic attack....pretty much a sea of ESI level 4s that any doctor's office, urgent care clinic, or Mom kissing a boo boo can handle.

The most interesting and serious case was an insect bite.

"Do you take any medications on a daily basis?"

""Just my vitamins""  the patient was 77 yrs old.

"Do you smoke, drink alcohol, or take any illicit drugs?"

""Oh no, no....but I'm thinking perhaps we should all start.""

This brought a smile to my face and the patient turned out to be what I deem "a spunky chick". I enjoyed my short time with this patient and wished I could go back to the rooms and be her nurse. We'd have fun.

About 5 minutes prior to shift change, a registration clerk approached me as I was returning from bedding a patient.
"I tried to get someone from the back to look at this child."

"What's wrong with her?"

"She has a cut and the parents don't speak English."

Okay. I walked out to the registration desk and immediately became alert. The kid was limp, fixed gaze, covered in blood, deep laceration to the head, and with agonal respirations. "A cut" was an understatement of this kid's condition.

I'm wondering why ER registration clerks aren't required to take some basic first aid or perhaps a class on noticing when a person is in a life threatening situation. I'm not blaming the clerk, just wondering how long the family was standing there as I was bedding a patient. I'm sure if the clerk had emphasized the urgency to which this patient should have been seen, the other nurses would have dropped whatever they were doing and re-prioritized. Because they certainly did when I grabbed the kid, yelled for a trauma code and started working the patient in a trauma room.

I'm still praying for that kid - I hope she lived with neurological function intact.
However, after taking a look at the CT with the Docs, I don't think there's much of a chance....