The Witching Hour

So, it was a slow day in the ER. It's nice to have a change of pace every once in a while. As the day went on, so did the reduction in staff. I don't understand this concept from management. On the floors, yes, no patients means literally nothing for the nurse to do except catch up on e-mails and education courses. I say let them do it and then decide. However, the ER is a different animal. At one moment you can have a few patients and the next, a bus crashes and now you have a mass casualty incident.
Now we have been severely cut back to bare bones staff. Only an hour left of the shift and if you have read my previous post, this does not mean good things for me. It's the witching hour. And that is what happened.....

I get an ambulance call, back pain x 2 weeks. Okay, I wonder why call an ambulance. I get the patient, he walks over to the stetcher without difficulty. I start to ask him questions when he interrupts me, "I'm going to the bathroom."  He pops up and walks down the hall. I'm speechless because I was in the middle of admitting him to the ER. I wait for him to come back and then ask him what happened today that made him call an ambulance to bring him to the hospital.
"Nothing"
"Have you seen a doctor for your back since it's been a couple of weeks?"
"No"
"Okay, so you just decided to call an ambulance?"
"Yes, my son said I wouldn't have to wait if I called an ambulance."
"You realize that's not how it works, right?"
"What?"
"There are not a lot of people in the ER right now, so if you had come on your own, you would have gone straight back. If we were extremely busy, then you would have gone to the lobby regardless if you had come by ambulance or not."
"Oh."
"Also, I want you to realize that if the insurance company does not deem your condition a medical emergency for the ambulance ride, they don't cover it."
"OH!"

I'm taking it one patient at a time, educating one patient at a time - like the story about the child throwing the starfish back into the ocean when someone told him that he couldn't save them all and he said, well, I can save this one. He tossed it into the water. I feel that way with the patients - one a time.

Oh, and true to tradition - 1800 - the witching hour - we got a call from the fire chief about a hazmat call - one patient and two firefighter were exposed. The hospital hazmat team was called in. Part of the ER was closed, sealed off from the rest of the hospital, hazmat suits, decon area set up, closed the ambulance bay, etc. It was a freakin' beautiful thing. I knew, KNEW this would happen when they cut our staff to bare bones. HAHA! It was classic. I guess they'll never learn......

Leibster Nominee

I just discovered that a fellow blogger, adot, http://darngoodandsureofit.blogspot.com/ , received an award called the Leibster Award. Congratulations! I recommend reading adot's blog because it contains a wealth of information that is presented in a reader friendly way. Well, also, because it's a darn interesting blog!

Since I had no clue as to what the Liebster Award is, I looked it up.

The Liebster Award is given to up and coming bloggers who have less than 200 followers. So, what is a Liebster?  The meaning: Liebster is German and means sweetest, kindest, nicest, dearest, beloved, lovely, kind, pleasant, valued, cute, endearing, and welcome. Isn't that sweet? Blogging is about building a community and it's a great way to connect with other bloggers and help spread the word about newer bloggers/blogs.

She nominated my blog and I am suppose to answer her questions posed to her nominees. So here it goes....

11 Questions They Have to Answer:

1. Cat or Dog or Alpaca?   Umm...how about goldfish? It probably sounds animal unfriendly, but there's only so much poop one nurse can clean up. I'm selfish that way.
2. Do you have any allergies?    NKDA  although I am terribly allergic to ragweed. I keep Allegra in business in the fall months. Perhaps I should buy stock options.
3. Say you won $10 000 000 dollars, what would you do with it? (it was going to be 1 000 000, but $1 000 000 doesn’t go very far anymore)   Buy some stock in Allegra, take care of my family, give to a few charities and yes, quit my job. I would find something else to do perhaps a position where I can eat lunch and pee every once in a while. For splurging....I would travel with my hubby and kids. This is probably boring, but it's what comes to mind right now.
4. Where is the furthest place you have traveled to?  Once summer I actually got to travel around the world: California to Japan to Singapore to Malaysia to Bahrain to Malaysia to Netherlands back to the US. It was wonderful!
5. What is your favorite song?   It has always been Pachelbel's Canon. It broke my heart when I heard it used for a car commercial one time. Right now I really like Sail by AWOLNation.
6. What do you spend the greatest percentage of your waking time doing: sitting, standing, or standing?  Standing, definitely standing.
7. Would you live a year without technology?  Sure, why not? Wait, let me think about that....
8. Do you have any piercings or tattoos or rebel-marks?  I haven't heard of rebel-marks???  I did celebrate a milestone with a tattoo. So....I got that going for me.
9. What direction does your bedroom window face? (that wasn’t supposed to be so creepy)  North. That is a unique question!
10. Are you aware of your own health?  I guess so....
11. Do you have a favorite phrase or word?  For the longest time I exclaimed "Shoot a Monkey" instead of a cuss word because of my little kids. I once cussed like a sailor. They changed that for me. I guess it's now "PISS!" when something goes wrong. I didn't realize this until I heard my 9 y/o say this when she was working on a project and something went wrong. At least it wasn't shit!

Thank you, adot, for the nomination and questions!

Missing Mom

I worked the day before Mother's Day. I saw that a fellow nurse had gotten a new patient via ambulance and went into the room to help out. I looked at the patient and knew immediately that he would be admitted to the hospital. He was a really down-to-earth older gentleman and fun from the get go.
I grabbed some supplies to start an IV and draw labs.

The doctor (who has a personality larger than life and hyperactive to boot) comes into the room like a whirlwind, talks to the patient for a minute and declares that he's staying and will be admitted to the hospital.

The patient starts crying. I'm talking about a big sobbing bawl. The doctor leaves the room and the primary nurse collects her paperwork and leaves too. I'm left alone with this large, crying man.

"Hey, hey, hey....you have a chronic disease, this isn't the first time that you had to be hospitalized. You knew that you would stay here, right?
The patient agreed.
"So, what's going on with you?"

"Tomorrow is Mother's Day and I wanted to be there for my mother. I knew I was getting worse and tried to hold out until Monday."

I looked at the patient's age on his band and thought his mother had to be an impressive age to still be alive.

"She's dying and I wanted to be there on this day." More crying.

"Do you visit her on other days?"

"Yes, everyday I see her. But tomorrow is Mother's Day."

"Well, I'm a mother too. My first priority is to make sure that my son is healthy and feeling well. And if he wasn't, I would want him to take care of himself. I would consider every day that my son visits me as Mother's Day. Don't let this one day take away from all the time you spend with her. You know your mom understands and appreciates and loves all of your visits everyday, right?"

He stopped crying and considered what I had said. He thanked me for making him feel better.
My heart broke just listening to how badly he wanted to see his mother on that Sunday. I have no doubt that when he gets out of the hospital, his first stop will be to see his mom.

The Ultimate Shot

I had this older patient in one of my rooms with her husband. When I went in there to perform an assessment, the husband asked me if she was going to live.

"Umm, yes. I'm thinking she's got a chance."

Hubby: Well, she's getting up there in age and if she lives, she may get her "ultimate shot".

"Her what?"

Hubby: If she get's too old, then under Obamacare, they're going to decide she's too old and put her down.

Pt: Shut up honey! Hopefully, they won't do that today. <smiles>

I'm sure they were joking, but I asked.

Hubby: Well, the way that we're headed, I wouldn't doubt it. Obama already said old people don't need a lot of care - just give them a pill. I think it'll be a shot - the ultimate shot.

Later after I went through her discharge instructions, she asked, "so no ultimate shot for me today?"

"No. They were going to give it to you, but I pleaded your case and said you had at least a good year left and they were satisfied with that."

Hubby: After next year, they're going to put all of us oldies down. We're looking to move to South America and finish retirement down there.

Tick, Tick, Tick!

The hospitalist came out of my patient's room and asked me if I noticed anything unusual about the patient's family member. Umm, no. That person was there was the patient first arrived, but left and I guess returned while I was out of the room. He told me that he is covered in bugs. Huh, interesting.

"What kind of bug?"
"I don't know, I didn't want to get close to him."

I walked in there to check it out. The family member said something to me and as he did, he fixed the collar of his shirt. Several little insects crawled out from beneath it and crawled up his neck. Then I noticed he was trying to clean his jacket. There were little bug bodies all over the floor, some were slowing crawling away, others appeared dead.

I told the unit secretary to order a terminal clean in that room after my patient leaves.
Once the room was clear, another nurse and I went in there to investigate. The little suckers were crawling everywhere!

Ticks! The bugs were ticks. I believe this an ER first. Now, we've had lice, scabies, maggots, dead snakes and 1 live snake, but never ticks. How exciting. Housekeeping was not happy about it. It took 2 terminal cleans to get rid of them all. After the first one, I checked out the room and noticed a bunch clinging to the wall and one actually made in out into the hall. He was a spunky tick. I named him Gerald.

It's never boring in the ER!

<A great picture of Gerald>

POST NOTE: After looking at Gerald's photo and comparing it to searches on the internet, I'm thinking Gerald was actually a bedbug. He was still spunky though!

Say Seizure Pads Again!!!

We have a bunch of new graduate nurses working now. Most of them are males and I think they add a fun, new dynamic to the place. One is incredibly funny in an annoying little brother way. I like him. He's smart, witty, and knows his stuff. I'm actually surprised that he's a new grad - he's just that good. Another one is personable, amusing, and seems to know a lot, I think the rest will come with time. He's got potential.
The other one is ....well, down right annoying. He thinks he knows everything already, talks more than any chatty Cathy I know, and is a STAN. In the fire service, a STAN is someone who always tries to 'one up' anything you happen to be talking about. STAN is an acronym for "Shit That Ain't Nothing". Every profession has a STAN, it's not exclusive to firefighting.

I'm not the only one who finds this incredibly annoying where I work. Sometimes, when I'm in the mood, I'll try to top his story and make stories up just to jack with him. Naturally, he's always got another story to one up my fictitious one. I find it extremely funny in a juvenile way.

Anyway, he was my replacement one shift and I was trying to give him his patient pass on reports. Prior to his arrival, I got an ambulance with about 15 minutes left before shift change. I didn't have any assistance, but was able to get the patient into the computer, perform an assessment, and notify the docs that the patient needed to get C-spine clearance. The patient was in the ER for a seizure and was backboarded. I thought backboard removal was priority in case the patient had another seizure and was injured due to being restrained.

I'm giving report to STAN and he asks if I put seizure pads on the stretcher. Umm, no not yet. After doing everything I just mentioned to him, I saw him and wanted to give report on that patient since I was waiting for a doc to clear the board from the patient. I literally just walked out of the room.

STAN: Oh, well we need to get seizure pads on the stretcher.

Me:  Yes, I know. Did you hear what I just told you? The patient just got here and I didn't have time yet to do that. I want him cleared from the backboard. The doc is aware of it.
I started to tell him about the patient and was interrupted.

STAN: Seizure pads. The patient needs seizure pads.

Me: Uh huh. The patient had a generalized tonic clonic seizure....

STAN: Yeah, he needs seizure pads.

At that point, I felt like screaming at him like Samuel L. Jackson did in PULP FICTION with the boy who kept saying "What?!"
Say "SEIZURE PADS again M***** F*****! I dare you! Say it again!!

For those of you have not seen this movie, it is very graphic in language and situations. ***WARNING*** the video is graphic, but expresses my thoughts at that time. Replace WHAT with Seizure Pads and you get my drift.

Schizophrenic or not?

I was admitting this patient into the ER. He was a paranoid schizophrenic who had been off of his medications for a while and was experiencing an agitated episode. He was extremely polite and answered my direct questions coherently. I was quite impressed. He continued telling me about his theories regarding life, the government, and a stream of thoughts about whatever he was thinking about.

The longer I sat there speaking with him and listening, the more he made sense. He made some remarks that I secretly fully agreed with him. He was very articulate and intelligent. Hmmm...it really made me wonder.
Has anyone else experienced something like this?