Saturday, August 24, 2013

What If.......

My son has been going through a long period of asking "what if..." It drives me crazy at times.

'Honey, don't climb on the outside of the stair railing, the railing could break and you could get hurt.'
"Mommy, what if it broke?"
'Then you could fall backwards and get hurt.'
"What if I got hurt? What would I hurt?"
'Well, you would hurt your back and hit your head and have a head injury.'
"What if I had a head injury?"
'Then I would have to take you to the ER and I'm not going to work today.'
"What if..."

One day he asked me about knee replacements. What?!!
He wanted to know all about them, what they used, how they do it, what the scar would look like.
I told him the basics of what I knew, but he wanted to know very specific things. I told him to ask the orthopedic surgeon that lives in our neighborhood because I didn't know.
'Wait, why do you want to know about knee replacements?'
He shrugs, "I was thinking about it."
'How do you know about knee replacements? Where did you hear about them?'
"I don't know."
My son is seven years old, why knee replacements?!!

Endless questions for all situations of what if...

The other day I decided to mess with him. He wanted me to take a sip of his sour lemonade which he loves and I dislike. I declined to take the sip. He insisted.
"Well, what if you were at the bottom of a well and you had no food or drink except this lemonade to drink. Would you take a sip then?"
'A well?!! What am I doing at the bottom of a well?'
"You fell into it."
'How did I do that?'
"You were walking and fell in."
'Where was I going?'
"To the store."
'What type of store?'
"A grocery store."
'If I was going to the grocery store, then I would drive the car. Where is this well?'
"Ummm...I don't know."
'Then how would you give me the lemonade?'
"So you're not going to take a sip?"
'No, peanut. You drink it.'


Thursday, August 22, 2013

Blue Light Specials

Apparently, I did not receive the notice that my ER was running specials on testicular pain and meth overdoses caused by swallowing multiple baggies of the drug when the police are trying to pull you over.

So, if you have one of the two aforementioned (or both), please stop by my ER - we have a special in the works just for you!

As a Public Service Announcement:

When the police are trying to pull you over, for whatever reason, and you have bags of meth on your person - you have a choice! The fastest and easiest course of action would be to pull over and receive the consequences of your actions. The long term course would be to swallow all of the bags of meth. You then can be transported to the ER where you will experience the lovely experience of a full blown cardiac arrest. After you are saved, you will enjoy all the comforts of the ER personnel placing a tube in every orifice you possess and a trip to the ICU for an undetermined amount of time. If you survive that, ultimately, you will come full circle and the police will embrace you after your lengthy trip.
The choice is yours! Please choose wisely!
Thank you.
This has been a Public Service Announcement.

Wednesday, August 14, 2013

Triage Zen

I've been in triage lately and from previous blog posts (if you read them) I normally despise triage.
I have adopted a zen like attitude towards it now which, hopefully, will last a while.

"Do you have any medical problems?"
"I think I have fibromyalgia."
"You think? Has a doctor diagnosed you with that?"
"No, but I read about it on the internet. And a friend of mine has it, so I think I caught it from her."
"You can't "catch it", it's not infectious."
"Well, I think I did."
"Okay".......ooooohhhmmmmmm. Takes a cleansing breath and smile. :-)
"You wrote down that you have ovarian pain? Have you had that before? Have you had ovarian cysts?"
"Then how do you know you have ovarian pain?"
"I looked at a picture on the internet."
"Where is your pain?"
She points to her pain.
"Your ovaries are not way up there."
"Well, mine are.....and that's what the picture showed."
Breathe in, breathe out.
"Could you be pregnant?"
"Absolutely not."
"All right, what type of birth control do you use?"
"I don't use birth control."
"Do you have sex?"
"Uh, yeah."
"Have you had a tubal ligation or a hysterectomy?"
"When was your last menstrual period?"
"I don't know, it's been such a long time."
"Then you could be pregnant."
"But I don't want to be."
Ooooooohmmmm....aren't wishes nice things?
"Do you have any medical problems?"
"Great. Do you take any medications?"
"Yes."  The list was lengthy.
"Why do you take these medications if you have no medical problems?"
"Well, after I had surgery and the cancer, I had a stroke which caused a heart attack......"
"Do you understand that those are medical problems?"
"Well, they really aren't problems."
<No, of course not.>

I think I got through the day with a good attitude and did not want to run like a mad woman swinging a bat at various strangers after my shift.
I believe I'm making progress.....

Sunday, August 11, 2013

Golden Showers.....

Nurses in my ER have a 1:4 patient ratio, regardless of acuity. Of course, if someone has a critical patient, other nurses will help out with the less acute patients although this is not always a given. When I'm hit with 2-3 new patients all at the same time, I quickly assess just how sick they are. If all the new patients are pretty much equal in acuity, then I'll start the "to do" list: starting IVs, drawing blood, collecting urine samples, etc.

I let this one patient know that I would need a urine sample in the near future. She said she couldn't give me one at this time. As time passed and her lab results were coming in, the tech said he checked and still nothing. I went into her room and told her the only thing we were waiting on is her urine. I let her know that in the ER, when "things" don't come out, we will "go in" and "get them". This normally motivates people to try to urinate for me.

A little later, she had her sample. I had an ambulance coming into another room and wanted to finish up with this patient because it would be a while before I could return to her.

"I have my pee."

"Awesome! I'll send it to the lab and results shouldn't take too long."

"Okay, that's the last thing you needed from me?" She said as the tech came into the room to tell me the ambulance had arrived and he would send the sample to the lab. He smiled and stated, "Glad we have this - thanks!"

"You guys sure get excited about pee."

I joked and let out a little laugh, "I bet no one has ever been excited about your urine before."

"Well, boyfriend. He likes it when I stand over him and pee on him."

All righty then!

Saturday, August 10, 2013

It's not about the sex, darling....

When my patient arrived via EMS, she was wearing a sort of jeweled turban, large dark sunglasses and a lovely satin pajama set. I thought she looked like one of those 1940's actresses. She was in her 90's and did not even look close to mid 60's in age.

"Daaarling, I really don't want to wear one of those ugly shirts you gave me. They're hideous. I needed to get my hair done this morning, so I just had to throw on my headdress."

"ummm, okay."

She was quite demanding and talkative.
"Do you know how long I'm going to be here? I need to be out by the weekend to go dancing and I do not want to disappoint my boys. I need some soda crackers, be a dear and get some for me."

"Your boys?"

"Yes. I just broke up with my male 'friend', he was in his 50's and couldn't keep up with me, poor soul. I had to let him go. The boys at the club are naturally happy about it."

"Naturally. Your boyfriend was in his 50's?"

"Yes, men my age are decrepit. They're too old. It's going to be awful when I reach 100."


"I want a young man. It's not about the sex honey, it's companionship. I want a man who will go out dancing, travel, be alive! Although the sex would be nice too."

"Well, of course."

Wednesday, August 7, 2013

Motorcycle Driving Freshman

Whenever I have pediatric patient, I love to joke with them (I call it "mess" with them). I normally ask if they go to college or drive a car - they normally laugh and say 'no silly, I'm only 6 years old!'. It's goofy, but I have fun with them.
The doctor asked if I had just a few minutes to sit with this kid in the hallway while he examined his family member. Sure. I started my little routine about asking the questions to pass the time.

"So, do you go to school?" The boy was 5 years old.
"Do you go to college?"
"Yes." He was serious. I was amused.
"Really? What year are you?"
"What's your major?"
"I don't know yet."
Hmmmm.....This kid is a good fibber.
"How do you get to classes? Do you drive?"
"What kind of car do you have?"
"A motorcycle."
He then talked about his motorcycle. He was very specific.

Maybe he was in college too.....

Sunday, August 4, 2013

No Dignity...

Like most people in the medical field, I've witness a lot of deaths. Deaths from medical reasons I seem to be okay with, I mean if you have a disease or condition, eventually it'll get the best of you. It's fun to do the detective work and try to turn it around.
Traumatic deaths cause me to get philosophical. One minute you're there, BAM, now you're dead. Other than the trauma causing it, I can't find the reasoning behind it other than "it was his time to go".

The Trauma Code was called out over the loudspeaker. The code was quite short. I wondered why this person wasn't just covered at the accident as a DOS (dead on scene). The patient was a broken, bloody mess. I was doing compression until time of death was called shortly after the patient arrived. I always look up at the same clock when death is called and note the time. I thought about how many times this clock was used for a death announcement when I looked at it and remembered some of the most recent deaths in this room.
I looked down at the mess of a patient. She was young. I bet, never in a million years, did she wake up this morning, shower, eat breakfast, go out with her friends and know that this was the day she was going to die.

That is why I hate trauma. It's so random.

"Is she missing part of her head?" There was a large towel saturated in blood around her head. "No, we put that there because of spraying blood".
I looked around at the numerous firefighter/paramedics, the flight crew and the ER nurses - all covered in blood and moving around to get paperwork started, equipment together. I noticed that I was bloody up to my elbows and realized I needed to scrub.
I looked back down at her, clothes cut off, spinal packaged, tubes coming out of everywhere and said my silent prayer for her like I do after every death I work.

There's no dignity in this death, or any death come to think of it. At least not the ones I witness. I hope that when I die it's either in my sleep or if it's a trauma, that they just throw a blanket on me at the accident scene. Otherwise, I think the whole CPR to the hospital is horrific. I probably won't care since I'll be dead, but for me envisioning going through it, it sucks. And another reason to hate trauma, I get too damned philosophical!

Thursday, August 1, 2013

Self Diagnosis

I had a patient come in for a migraine. She self diagnosed herself as having meningitis.

I looked at her vitals and asked some questions:

"Why do you think you have meningitis?"
"Well, my neck is sore and I work in the hospital."
"What do you do in the hospital?"
"I'm a nurse."
"Have you been around anyone with meningitis?"

Ummm, okay. Nothing I saw would raise the meningitis red flag. She proceeded to act like she was dying and suddenly was unable to do simple things like raise her arm to apply the blood pressure cuff.
Come on! Seriously?!!
I told her since she thought she has meningitis then she would have to wear a mask for the duration of her visit. I also told her that since she stated she was too weak to get into the wheelchair to go to radiology (she walked into the ER) and raise her arms for a BP cuff, that she would have to use a bedpan. I don't think she liked that very much.

I caught the doctor before going into the room and let him know why the patient was wearing a mask for a migraine. He smiled and said, "Oh yes, precautions must be taken since she knows she has meningitis."

Miraculously, she was cured of all symptoms by the end of her visit and she gained enough strength to walk out of the ER on her own. We truly are miracle workers!