Baseball and Hematomas

Well, it's that time of year again for my kids to start baseball and softball season. This means hours spent at the fields in cold weather watching them run around the bases, drop fly balls and swing endlessly at curve balls.
I was at the parent/ coach meeting outside where we would get all the information and have the kids fit for their uniforms. My son was playing with some other boys running around like escaped lunatics. This one in particular was especially rowdy past the point of being obnoxious. I told my son to stay away from him when he started throwing dirt and rocks at other kids. As the meeting progressed, suddenly we hear a scream, crying and a bevy of children running up to parents to 'tell on' the rowdy kid who threw a large rock at another kid's head. The boy came limping up to his father looking like a horror movie actor - blood all over his face and arms, blowing snot everywhere.
I must say, the father showed more restraint than I would have. He loudly told the kid a thing or two and then attended to his bleeding son. I figured that the dad and another adult had the situation under control, but then by watching them, I decided to walk over there to see if I could help. I got a roll of paper towels someone had grabbed out of the little concession stand at the field and led the boy into the bathroom so I could see the cut.
He didn't require sutures, but had a decent hematoma with no obvious skull deformities palpated. I cleaned him up and helped him blow his nose because snot was dripping off of his chin and it was grossing me out. I told the dad what I thought, that ice needed to be applied to the head and then started to advise him of signs and symptoms to watch for and then he interrupted me, "I know these things, I've coached in the past."
"Oh. Okay. Well, I'm going to tell you anyway and you can ignore what you already know."
I continued on and when I was finished, he said, "Oh, I didn't know about those last two things."
Yeah, well, if you notice any of them then take him to the ER for a head CT.
By the time I returned to the meeting, it was wrapping up and I only missed the boring parent behavioral agreement that they have to review with us.
The kid is fine now. I never saw that derelict kid's parents. I wonder if they were even there.

Update

Update to the downward spiral of my ER:

To my knowledge the last of the nurse resignations happened a few weeks ago. We had two mass movements of resignations, so we are extremely short in the nursing department. The admin decided to fill in with agency nurses for the time being. Last week, 2 new nurses were fired for legitimate reasons and our brand new director was also canned. She since has been replaced with a newer director. Also, our hospital chaplain retired because according to him "he saw the writing on the wall" and knew he would be laid off next. Unfortunately, he won't be replaced. He provided an invaluable service to our patients and families during critical times and codes.
I was begged to work the other day because they only had 3 nurses on shift for the whole ER for all of day shift. I agreed to work because I felt bad for my coworkers stuck in the schedule and I knew it would be a horrendous day regardless of how busy it was for them. Well, it was a terrible day. As I triaged patient after patient in the little triage room without a break (I managed to leave once to use the restroom), I became angrier with all the bullshit reasons coming into my triage area. I had to take a little mental break because I wouldn't be able to finish the day without yelling at someone. Everyone felt like they had an emergency or that their problem was the most important of the day. People had to wait, a long, long time and they got angry about that. A patient actually called ahead of time to make an appointment which we told her she couldn't do.
I was able to get quick rooms for the truly emergent patients, thank goodness. Those who had to wait for trivial things such as not wanting to buy tylenol for their kid or decided that today would be the day to take care of a problem they had for over a year sat in the lobby. After hours of hearing the snide remarks, the yelling and the insults - I stopped caring about catering to their whims and complaints. We did not have the nurses to open more rooms, their problems were not emergencies and simply put - they would have to wait.

Flying would be fun.

Surprisingly, I had an opportunity proposed to me for a different job. There is a flight nurse position open and I have a contact to get me in the door. This has always been the most difficult part, you have to know someone in order to get your foot into the door. However, there are many drawbacks. The base is 2 1/2 hours away from me. The upside is that they offer 12 hours shifts instead of the usual 24. They do have a base very close to my house, but presently, they are waiting to move it to a neighboring town, so no new positions at the moment. I was told that I could start at the one 2 1/2 hours away and transfer later. The closer base would be massively hiring sometime in the future. The other down side is that the salary is depressingly low. I'm guessing they bank on everyone wanting to have the cool job of being a flight nurse, so they get away with paying lower than normal for a critical care nurse.
Although I want to jump for joy about the possibility of flying, I have to be realistic under the present circumstances. I guess I'll have to wait and see about the hiring at the closer base and make a decision then.

Praying...

This post is meant to be extremely vague.
Recently, I have seen the aftermath of true, raw evil and it has haunted me. I haven't felt the desire to write this month because of it.
I came home from my shift, hugged my children tightly and told them how much I loved them.
It is unfathomable to me that someone could perform those acts of cruelty on a child.
I've prayed long and hard for this patient. Although the damage will never be undone, I hope there's a chance of a normal life for this little person in the future.

Vasovagal Morning

One morning this weekend, I was about to get ready for work. It was early in the morning, my family was still asleep. I walked in to the kitchen to get a drink before jumping in the shower and somehow slipped, lost my balance and fell backwards. I didn't seriously hurt myself, but hyperextended my thumb and it hurt like crazy. I couldn't move it and it started to go numb. What happened next was bizarre and uncontrollable.

I had a vasovagal response to my thumb trauma. I suddenly felt that something was not right. I sat on the stairs and couldn't catch my breath. I was acutely aware of what was happening. My heart rate dropped, my blood pressure did the same and I became extremely hot. Sweat was pouring off of my face as I tried to take deep breaths to keep from passing out. The tachypnea was a response to the hypotension and bradycardia.
I thought, "Wow, I'm having a vasovagal epsiode. I need to lie down. Damn, this is my IV starting hand - I hope I can function."
It took about 10 minutes for it to pass. Once my breathing had normalized and my heart rate increased, I felt better. I got up, got ready for work and left.

It was a strange occurrence and I wondered why a simple thing like thumb pain caused it to happen. I've been injured worse before. Who knows? My thumb is sore and swollen, but functional.
Huh.

And It Begins.....

The first wave of the predicted mass exodus of nurses has begun. Four nurses have given notice and we are in our last two weeks of having a full complement. One of the nurses said that she knows that another clump of resignations will happen soon, but she didn't want to give any names.
I heard the next wave of lay offs are going to be implemented soon. I was told that CNAs, techs and unit secretaries will be next. I don't know if there's truth in any of it, but if that happens, then I guess I'll have no choice, but to give my notice and move on to less hazardous pastures.
I hope this is just a nasty rumor although I thought the same thing with the rumors about security and housekeeping. I asked our big honcho ER doc if they were planning on closing our hospital and he said 'no'. He said that if we see him jumping ship, then we should do the same.
All eyes are watching him closely.....

We Don't Need No Stinkin' Badges!!

Some recent developments at my hospital has everyone in an uproar. The CEO decided that my hospital no longer needed security. The whole department was laid off. Now I know the CEO did not realize (or care) that security is mentioned throughout our ED SOPs or that we normally require their presence in the ER for violent or unruly patients. Basically, we were told that we were on our own - wait, no......the clinical staff was not told anything, we found out by one of the guards who had the heart to finish his last shift.

Some of the staff, doctors and nurses alike, started scouring our state's laws regarding carrying weapons in a hospital. Some decided that they were going to carry a piece of medical equipment that could double as a weapon. One called the police department and asked how to handle a future threatening situation and was told police would only come if we were already assaulted and would not respond to the threat of assault. Others (mainly nurses) are looking for other jobs. If things don't change, I'm quite sure that the CEO is not prepared for a mass exodus of nurses. No nurses means no one to care for patients which means the revenue that the CEO thought he was saving by firing security will be moot.

The other gem is the cut back on housekeeping. Last year, the hospital fired the housekeeping department and replaced them with contract employees. Now, the CEO cut back on the working hours of the contractors and told the nurses to clean the rooms. Now, working in the ER, we (sometimes) have a quick turnover of patients. The nurse or tech will perform a wipe down of the bed and areas touched by the patient and change the linens. This is typical in the ERs in my area. Now they want us to sweep, mop, take out the garbage, etc. We just had to shake our heads and sigh. Yeah, right....we have all the time in the world to do this. We rarely get to eat a lunch due to dealing with the amount of patients we have, when do they propose we do this? Will the CEO come down to the ER and clean rooms? Will the administrative staff come help us with watching a suicidal patient? Come help us deal with a drugged out violent meth patient?

There will be some bad mojo on the horizon for my wonderful, dysfunctional little ER family. Although I have vented and complained about my job, the one shining star has been the awesome people I work with on a daily basis. I guess we'll see what happens from here.......