Monday, December 10, 2012

Fast track....or not.

I was relieved to be assigned to fast track for a shift. I'm usually assigned the trauma rooms along with the other critical care areas, so it was a nice change of pace. The nurse who normally is assigned there protested a bit.

"I thought you hated working there."
"No, I never get assigned to fast track. I never said I hated it."
"I thought you only liked working with the critical patients."
"No, I always get assigned to work the critical rooms."

What I wanted to tell this nurse is that the charge nurse feels like she couldn't handle the critical patients and that's why she doesn't get assigned there. The charges have expressed that sentiment. There are a couple of nurses who fit that description and I think it does a disservice to them.

I happen to disagree with it. If you're going to be an ER nurse, then the nurse should be able to handle all types of patients - not just the weenie cases. Those that don't have the experience need to be assigned the typical critical care beds and have a strong nurse willing to help them. It makes the nurse stronger and the unit as a whole. But what do I know? I'm not a charge nurse. But if I was......

All of my patients were either on shot time, waiting for discharge or waiting to be sutured, so I had an open bed. I figured I'd help the triage nurse out because she had a bunch of doc office type patients in the lobby waiting to be triaged. I plucked out the longest waiting patient and brought her back to the available bed.

She was a wispy, bone thin woman. I started taking a good look at her while typing in the triage information in the COW (computer on wheels). Emaciated, scabs all over her face, bad teeth, long sleeve short on a warm day. I concluded she was a meth addict and possibly IV drug user. She had a wound that I originally thought would need sutures then discharge.

"I hate the hospital. I didn't want to come here."
"I understand. Let me see where you're hurt."

Shit. What I saw wasn't a fast track type of wound. She would need surgery. Great. That blows my whole 'bring you in, get you out' type of fast track flow.

She denied all of the drug use questions - of course. Patients always lie about it, but we're going to find out about it anyway. Why don't they just fess up in the beginning? It would make it easier for everyone involved. forward to when I was told that the OR team was on their way NOW.
"Where's the dang chart? If you want her ready for surgery - I need it now."

When I finally get it in my hands, I roll my eyes. Couldn't the NP say anything to me about all the extra crap I have to do before calling the OR team? Nah, that would be too easy.
I went to the patient and started drawing some extra labs ordered and hanging her antibiotics.

"I'm really scared. I don't want to stay overnight. Can't they just let me go home afterwards?"

It was then that she confessed all of her drug use.
"I know."
"How do you know about that?"
I told her and she was blown away.
"Did you tell the surgeon who is in here talking to you?"
"Well, he needs to know. You'll have to stay in the hospital after the surgery and he needs to know how to take care of you. I'm not judging you, but if you go cold turkey on these drugs, you'll run into more medical problems while you're here. I need to tell him about it for your own sake."

She was whisked away by the OR nurse. As she left, she thanked me for being nice to her.
It made me think. Here was a person who didn't want to abuse the system to get her drugs, but really needed medical care because of a simple accident which grew into something worse because she was afraid of being morally judged by us.

Sometimes it's little scenarios like this that change one's thinking.

1 comment:

  1. It sounds like the old adage, "a little knowledge is a dangerous thing"; except in this case it was her sense of morality. She didn't have strong enough morals to stay away from the drugs; but she had enough to know that using them was wrong. Had she no morals at all, she would have been in there sooner like the frequent flyers you see saying, "Yeah, I'm a drug user but I got a cold and I want you to do something about it!"

    Too bad that her sense of right and wrong coupled with her shame made her hesitant to seek treatment.