Don't Lie - A Public Service Announcement

I recently came across this YouTube video:

This is utterly stunning that someone would make a video like this. As a public service, I will tell you that it will not work. If you come into the ER with a non life threatening condition, then you may have to wait. Life is difficult sometimes, suck it up and put you big kid panties on.

As an example, I had this one patient come in complaining of chest pain. We are a certified chest pain center, so he was immediately taken back and the "million dollar" work up began. He asked about his other complaint, but it was a minor one (it was the real reason he wanted to go to the ER). He was told in no uncertain terms that it would not be addressed since the chest pain is a major concern and it would take precedence over anything else. Epic fail on his part. He confided in me later and told me his doctor told him to complain of chest pain so he wouldn't have to wait. I was flabbergasted. What doctor would tell a patient that? I got the name of the doctor and told the patient that I hope he realized that the chest pain complaint would now be in his medical record, that the confession would be part of his chart and that he would be financially responsible for the whole work up. He said he didn't know. I informed the ER doc who, upon hearing the new discovery, shrugged and said he will call this doctor about his poor advice and the patient will only be seen for his initial complaint - he could go to his doctor or an urgent care clinic for his minor symptom.

So take this patient's hard knock lesson - don't pretend to complain of something you don't have to get into the ER faster. You may get harmed if we give you medications for the complaint thinking it is legitimate, you will be financially responsible for what we do, your deceit will be charted in your records, and you probably will not have your original complaint addressed. The other more important reason, you took nurses and doctors away from someone else who was truly experiencing something serious.

The Christmas Card

I wait patiently this time of year for a certain person to send me a Christmas card.

Over ten years ago, when I was working as a firefighter/paramedic, I went on a CPR call. This was the most unusual CPR I've ever worked. The patient was found awake with defibrillator pads on his chest that were placed by a bystander who was a nurse. She saw my confusion and said that she had shocked him several times and performed CPR - he would "wake up" after each shock.
My partner and I quickly did a 12 lead ECG. It wasn't pretty.

We rushed him into the back of the ambulance while the patient told me what happened. He said he knew  when "it" was coming and then wouldn't remember anything, feel extreme pain and then wake up.
As we were throwing a quick IV into him, the patient quietly said, "Uh oh, here it goes again."
His face turned bright red and he coded. We shocked him and immediately afterwards he yelled, "AAAAAARGHH - don't DO THAT AGAIN!!!"

Our eyes were as big as saucers - I've never experienced that before. During the ambulance ride, he coded a few times more and each time, waking up yelling and then apologizing to me for being rude.

"AAARRGH, you did it again."
"Well, you did it again. Stop doing that!"
He laughed, but I could see the fear in his eyes.
"We're going to get through this. We're almost at the hospital. Just stay with me, okay?"
"Okay." And he held my hand.

Later, we were told by the cardiologist that he had what's called "the widowmaker", a 99% occlusion of the left anterior descending coronary artery, more than 90% of people with this type of occlusion die.
The patient and his family visited our fire station about 2 months later and thanked my partner and me for saving his life. It was a very nice gesture since most of the time, we never get to find out what happens to the patient after they leave our care in EMS.

Since that year, every Christmas, my patient and I exchange Christmas cards. I look forward to hear from him every year. I have never done this with a patient before our meeting or since. There was something special about this patient and we bonded during that unfortunate call.
I received my card the other day and my special patient is enjoying another year with his family and grandchildren. His card reminds me that what I do matters to people and sometimes I need that to recenter myself.
I needed that reminder this year and I thank God for him still being in my life.

Empty

I haven't been motivated to write lately, especially after a certain shift that left me, well ....empty.
We had three codes that day. The first 2 were run of the mill, "it was just your time" type of code blue. This probably sounds horrible to non medical people, but it's a fact. I question the family's knowledge and decision when they want grandpa 'saved' at all costs regardless of the quality of life he will endure after the code. It's sad.
The last code was a pediatric one due to an accident at the house. Due to the nature of the circumstances, there was never any hope that the child would be resuscitated, but we tried. We tried everything we could think of to save that kid. All efforts were futile. The other nurse and I prepared the body for the parents to come into the room while the doctor went to talk with them. I was okay until I heard the unearthly wailing of both parents. I don't think I can truly describe the sound. I lost my composure and escaped into the break room bathroom and cried for a few minutes. I've never cried at work before. Once I got myself together, I had tons of paperwork to do and was interrupted occasionally because I had to cover my ears due to the wailing. I couldn't even finish everything that needed to be done because other patients, the ones that had such minor reasons, medical problems that should have been seen in a doctor's office or a clinic, continued to come out to complain about the wait or that they wanted food. I tried to explain that there had been several critical patients that tied up the doctor's time and they would be seen soon. They didn't like that or didn't care, one actually had the audacity to tell me that they were critical too. I looked at the reason for his visit - a complaint that he has had for over a year. I had three dead people in nearby rooms and this guy was giving me a hard time. I lost my capacity to tolerate stupid people for the rest of the day and counted the hours to go home.
I keep thinking about that mother, hoping she doesn't blame herself for her child's death. I can't even imagine going through that experience. I went home that night and hugged my children for a very, very long time.
My daughter noticed and asked, "Did you have a stressful day at work today, Mommy?"
"Yes baby, I did."

No Dilaudid for You!

A patient that is well known to us arrives by ambulance. We all know what he wants....the prized fix of dilaudid. He only comes in for that and amazingly seems to get it.

The doctor on shift today is one that everyone likes and respects. I think it soared to new levels after his assessment and subsequent handling of our frequent flyer.

The doctor told the patient he would do everything in his power to help him with his pain except he was not going to give him dilaudid. The patient told him, no thanks! He will sign the AMA as soon as the nurse could bring it because he said he can go down the road to another hospital that would give him the drug he wants.

Our patient who was incapacitated with so much pain, jumped off the stretcher and walked away without so much as a hitch in his step. 

Bravo Doctor! Bravo!

They Don't Like It.

I've worked the past several days at both ER's I do PRN work. The hot topic of discussion was the ACA aka "Obamacare" which was brought up by the patients. I never bring up controversial topics with patients. 1) It's not professional 2) I don't have time to get involved with deep discussions unless it's with regard to the patient's health 3) I don't want the appearance of biased based care.

With that being said, the patients I spoke with hate the ACA. They're angry, they are afraid, especially the elderly. On one shift, I was the float nurse. It's a position where you are not assigned any rooms or patients and you float around and help people with doctor's orders or catch up on patient care. We affectionately call that position "the turd". Get it? ha. ER humor.

I was helping this one nurse with a new arrival. The couple was originally from a European country and came to the US years ago. They were awesome, friendly, and had a sense of humor. I wanted to shrink them and place them in my pocket for the day. As I performed my assessment and started the IV, they told me about their original country and why they came to the US. It was fascinating. The wife expressed her absolute fear and where this country is heading and the direction of the ACA. "You must stop this. You don't want this. We left a country with this type of healthcare and it is horrible. Many people, the old people, will die just because they are old. They don't consider if you're healthy and old - they see the age and won't spend any money to help you because of it." They also both expressed their fear of the dwindling privacy in this country and compared it to the rise of the Gestapo and Hitler since they were there during that time and remembered it. "You have to understand what this all means to this country. I don't think the Americans truly understand because they haven't experienced something like this before. We will all lose our freedoms."

I don't know if they thought I personally had a way to fix this, but their passionate hushed tones and pleading made me feel like I did.

The other patients did not have the same story as this couple, but were all against the law for various reasons: lack of privacy, more money to pay, fear of losing freedoms and not having control over their health. I even had a few conversations with different doctors I know all in various specialties. It was unanimous, doctor's didn't like it either.

I'm not saying that my little world represents the entire country, but I'm sure there are more areas like mine.

Thanks to Barbie, I'm an Orthopedic Surgeon!!

My daughter was talking about school and how they were discussing professions. She said everyone told the class what one of their parents did for a living. So I asked her if she spoke about me or her father.

"I told them what you did Mommy and how you are an orthopedic surgeon."
"WHAT??!!"
"Aren't you an orthopedic surgeon?"
"What did your teacher say?"
"She said, 'Wow, I did not know that.'"
"Our neighbor is an orthopedic surgeon, I am not one. Where did you get this from?"
"I thought you were one."
I'm utterly confused at this point. "Uh...no. Where do I work?"
"The ER."
"What do I do there?"
"Umm, you're a doctor?"
"What? No, I'm a nurse, honey. I didn't go to medical school. You should know that."
"But don't you cut people open in the ER?"
"I try very hard not to." (lol)
"But you fixed Lisa's (a friend of my daughter) Barbie leg that time. Remember?"
"Yes, but fixing a doll's leg doesn't make me an orthopedic surgeon. I'm an ER nurse."

If I had known that popping Barbie's legs back into their sockets made me a surgeon, I would have been billing patients a long time ago.

Making Simple Things Difficult....

I've been frustrated with my daughter's school lately. Actually, it's been a growing frustration. I remember (decades ago) carrying multiple books home with me in elementary school to do my homework. These kids have copied work sheets - no books to bring home. I've requested to see her books in the past just so I knew what the heck they were learning. How are parents suppose to monitor and help their children with homework if we have no idea of what they are suppose to be learning?

I also thought math is math - you can't change the basics, however, apparently you can. She showed me her worksheet and it was basic multiplication:  135 x 23 for example. I told her, "You know how to do this, is this just a review?"
Nope. They have to solve the problem using the distributive property of multiplication. Now are they just trying to confuse the hell out of these kids or are they preparing them for algebra? Shouldn't they just practice the normal way of solving this problem to master the basics? She's in the 5th grade - I don't foresee algebra until high school.
So, using that example from above this is what you have to do for the problem:

135  -->     100+30+5
x23  -->      20+3
-----------------------
100 x 3 =     300
30  x 3 =      90
5 x 3 =         15
100 x 20 =   2000
20 x 30 =     600
20 x 5 =       100
_________+_______
                   3105

I asked my daughter if she remembered how to do this problem 'normally' and she did. I guess I'll have to contact the math teacher and find out what this is all about. I bet these teachers think I'm a pain in the ass because I usually ask for materials and writing notes because I want to know what's going on with their classes when I see something strange to me.

So she comes home this past Friday with a failing grade on a science test. I'm surprised because she loves science and is normally a very good student. She's learning basic chemistry and she was able to bring the book home. We reread every chapter this past weekend together, reviewed her old test and I had her take the make up exam on her own. She had one question that she didn't understand. I read it and couldn't answer it, I showed it to my husband and he couldn't either. He said, "This is a bullshit question." We both have multiple degrees, certifications, and he has a graduate degree - together we couldn't answer this question - how is a 5th grader suppose to do it?
So I wrote yet another note to the teacher requesting that she allow my daughter to bring home the book once a week so I can review it with her.

So now I have math & science to do with my daughter, keep an eye on my son's schoolwork, and prepare for my next degree starting in January. If we could add another few hours in the day, I might be able to do this all. Sigh.