Wednesday, December 27, 2006

The Dead Ones

You really shouldn't deliver dead people to the ER. There's not a whole heck of a lot we can do for them. Above all, you should not deliver dead people to the ER when a brand new attending and a brand new nurse are on duty. This is not a good combination.

Billy Bob's family pulled up into the ER bay - well, came screaching in sideways with smoke coming from their brakes would be a more accurate description. Billy Bob's brother jumped out of the truck. "OH MY GOD MY BROTHER IS DEAD!" he screams as he runs into the waiting area. "He's dead, he's dead, he's dead! HELP HIM!" he yells at Dr. S, grabbing him by the front of his scrubs.

"Ummmm............. OK", Dr. S replies. (This is where you can see me rolling my eyes and heading off to lunch. I'm a cold hearted bitch sometimes)

You know how stories grow as they get passed on to new people? They grow and develop a completely different storyline than what actually happened? I'm not so sure that's not what happened here. This story took on a life of it's own (no pun intended of course).

So Newbie Nurse runs out to the ambulance bay with Dr. S. Dr. S proceeds to open the back door of the Mercedes and comes face to face with Stone Cold Stiffy. Stiff as a board (coincidentally, not light as a feather), sitting upright in the back seat. Hands curled under his cheek as if he's daydreaming.

Dr. S touches him. No response. "Uh, Dr. S, I think he's dead," Newbie says. (ya think? He's stiff.)

Dr. S checks his carotid and says in a surprised voice "He doesn't have a pulse." (figured that one out all by yourself, did ya?)

Dr. S makes his first big mistake - "Bring him on in to the trauma bay" he says.

"Seriously?" Newbie replies.

"Yes, seriously. Bring him in."

"Shouldn't we just call the police or the funeral home or......?"

"Absolutely not" Dr. S replies. "We'll bring him in and hook him up."

"H....h....hook....h...him....up-p?" Newbie stutters. "But he's dead"

"He's not dead until I say he's dead" Dr. S replies

OK, now do we believe this? Not sure - but it makes for a great story. Dr. S is a bit of .......... well, that's better left unsaid. Newbie, bless her heart, obeys him. She's sweet and unsullied - naive to the ways of ER nurses. "Um...OK" she says. Um..........OK my ass. My reply would have been somewhere along the lines of the following:

"You wanna bring the dead guy in Dr S, feel free. I'm not wasting anyones time hooking up some obviously cold, stiff, and dead guy to the cardiac monitor to prove he's dead. He's dead. He aint' moving (insert poke to guys head here). Call the cops or the funeral director. Hell, call the national guard. I don't care. I'm going back in to take care of the guy who's on the verge of crumping in room 3. When you feel the need to grace the ER that is full of sick patients with your presence, just let me know. But I'm not BRINGING IN THE DEAD GUY!"

"Um, OK" sounds so much nicer, doesn't it?

Anyway, they bring Mr. Stiffie into the trauma bay, proceed to hook him up (by the way, he's in complete rigor so he is still in a sitting position) and discover that he is in (everyone gasp here) asystole. Duhn duhn duhn.

Quick! Shock him! (SNORT - this isn't Lifetime Movie Network people. Here at ERTV we don't shock asystole - we give 'em a thump on the chest and they'll magically convert to sinus rhythm!)

Dr. S heads out to have a family conference and Newbie covers Mr. Stiffie with a sheet and calls the morgue. Charts are started, dictation is completed. Resources are wasted.

Did this really happen?

The only truth I know is I saw a sheet shaped an awfully lot like someone with their knees in the air being wheeled to the morgue as I returned from lunch. You learn not to ask questions.

Saturday, December 16, 2006

ER Rap

I am in love with this video. Please follow the link and pick the media you'd like to view it on.

Thursday, December 07, 2006

The (un)Reality of TV

Forgive me, for I have sinned. I watch medical dramas. Yes, I do. I watch them and I giggle, then I snort, then I guffaw, then I shout at the TV "THAT'S NOT HOW YOU DO IT YOU IDIOT!". Meanwhile my husband rolls his eyes and walks out of the room. We have a cool relationship like that. He rolls his eyes and leaves whenever I yell at the TV. We've bonded.

Let's do a low down on this fall's TV shows (medical drama or not)

1. One Tree Hill

Do the powers that be seriously think that we will believe CPR compressions are performed on the abdomen? And did you know we're supposed to check a carotid pulse after every 3 compressions? Wow - these must be the new 2005 guidelines everyone is up in arms about. What is even more amazing is that Lucas (yeah - that's the character's name. Not George Lucas, he probably would have gotten it right) was supposedly "not breathing" yet a simple oxygen mask stimulated his respirations and created enough of a BiPap pressure to keep him alive. Wow! The studies that we could do on this.

Don't even get me started on Hailey. Seriously - hit by a car, thrown into the air, pregnant, and unresponsive. Cut to the doctor telling her husband that she has several fractures in her leg and she won't wake up. Oh - and he can't worry about the baby right now, he has to save the mother's life (yeah, OK so I agree there - don't tell anyone). Cut to the next scene where Hailey is in a hospital bed with no oxygen, IV, or monitors in place. She also has a cast on her right lower leg with it suspended in a sling - but no traction pulleys are in place on the bed. It's a miracle! She also wakes up with a clear voice, not the scratchy one we usually hear from someone who hasn't spoken in ages. Hmmmm.............. Oh, and of course all is well with the baby.

2. Grey's Anatomy

Residents who purposefully endanger the lives of a patient so they can get to the top of an organ donor list are not graciously allowed back into their programs because they "meant well". Residents that are pissy whiney babies don't go far in medical school without a serious "come to Jesus" meeting. Oh - and IV tubing that ends nowhere doesn't help the patient much. Just a few thoughts there people. Give me time. Give me time.

3. ER

If there is an IV bottle hanging beside the patient, make sure 1) the bottle is dripping, and 2) the patient has an IV site. Easy peasy? Please, for the love of all that is holy, please correctly identify heart rhythms. Afib is not the same as a 2nd degree block. It's really not. Finally, not every ER nurse has an affair with an attending. Some, but not all.

4. Soap Operas (all of them)

People on ventilators need an ET tube coming out of their mouth, and noone uses those black accordion "shwish shwish" ventilators. Not even rural hospitals.

5. Any other show on television or major motion picture

Everybody all together now: "You do not shock asystole, You do not shock asystole". Good job class.

Gold stars all around!

Thursday, November 23, 2006

R-E-S-P-E-C-T, Find Out What It Means To Me

There are many things I try to be nonjudgmental about. I try not to think you're a big whiney baby when you come to the ER to have a sliver removed from your foot. I try not to think you need to be committed when you come to the ER to have a q-tip (or some other foreign object) removed from your nether regions. I try really hard not to think you need to step off the edge of a cliff if you come in screaming that you're dying when in reality all you need to do is fart.

I try. I usually fail.

I guarantee that I will treat everyone with respect, no matter what. I will treat you the same, but I will think you are a lunatic in my head.

If you tell me that your child has kept you up for 5 nights in a row, you haven't had an ounce of sleep, and you need some medicine to put your child to sleep so you can get a moment's peace - I won't believe you. And I'll probably think you're a bad parent. I will still treat you with respect.

If you tell me that the Vicodin you've been taking for 3 months isn't working and now you want to try something else, and "why no ma'am, I haven't been to any other doctors for this" - I won't believe you. I will find the 5 pharmacies and 13 doctors you've been getting drugs from. I will still treat you with respect.

If you tell me the president is an alien who comes into your head everynight and tells you to place foreign objects in your orifices - I won't believe you, and I will call for a mental health evaluation. I will still treat you with respect.

If you are a doctor who is yelling and screaming at me, spittle flying out of your mouth, face turning red, telling me I'm a bad nurse - I won't believe you, and I probably won't like you. I will still treat you with respect.

I will treat you with respect, and I will expect the same. I am a nurse, yes. I work in the ER, yes. But I am still a human and deserve to receive the same respect that I give. You don't have to like me. You don't have to think I'm a sane, rational, compassionate person. I probably don't think any of those things about you. Yet, I will treat you with respect.

Can we not all expect the same from each other?

The Difference Between Life, Death, and Drug Seekers

When you come into the ER yelling, moaning, and twisting in agony because you have a sprained ankle - I will hate you. Why will I hate you? I will hate you because the man in the next stretcher is dying of an excruciatingly painful form of cancer, yet he is silent. He is silent, and dignified, and asking for pain medicine "when you can get to it dear. It's really not a big hurry. I've been dealing with this for 6 months now." You, on the other hand, are screaming at me to "hurry up and get my fucking morphine bitch! I've been waiting for 20 minutes now! I'm in pain, ya hear me? I'm in fucking pain!". Yes, that is why I will hate you.

The difference between life pain and death pain has amazed me more than once. The man who threw his back out hauling cement blocks is begging for relief, while the woman who is here on hospice respite and is probably going to die in the next 2 or 3 hours is calmly waiting for her turn on the IV morphine train. The woman with a knife in her leg is screaming like she is dying, but the man who is actually dying next door - he just wants his family close so he can say goodbye.

I don't understand it. I'm not sure I want to. I just want people to respect the fact that someone having a bigger crisis than them may be in the bed next to them. And I may be needed more over there. I probably won't respond quickly to you if you scream at me to get your pain medicine. I will be busy with the man next door who is passing from this world. His problem supercedes yours. Your pain may last longer - but you'll still be alive at the end of it. He won't.

Now I'm not saying that all people in pain are whiners. I'm not saying that if you come in complaining of pain I will roll my eyes, take a deep breath, and say, "Whatever - come on back." I will believe you are in pain. I will treat your pain as able. I will be respectful to you as a human being. The moment you start screaming and cussing at me - you've lost me and my respect. The moment you disrupt every other patient in the ER by demanding your "fucking morphine" you will have lost me.

Pain is subjective. Reactions to pain can be controlled. Most of the time.

Tuesday, November 21, 2006

Hog Tied

He arrived at the back door in a large white vehicle with flashing blue and reds on top. It was a bad sign. It's always a bad sign.

Mr. Law Enforcemen Officer (Mr. LEO) proceeds to drag out Mr. Violent Man. Mr. Violent Man is shouting and screaming - in Spanish. I don't speak spanish. Dr. Q doesn't speak spanish. No one on duty speaks spanish. This is not going to be good.

"Did you check him for weapons?" I ask.

"He's clear", Mr. LEO replies. I then notice that Mr. Violent Man is hogtied. Hogtied with white rope. Why is this important? I'm not really sure - but I remember the white rope and how it was frayed on the edges. Mr. LEO and 5 of his closest similarly dressed friends assist Mr. Violent Man into the ER.

"Puta! Puta! Puta!" He screams at me.

"No hablo espanol" I reply.

"Fucking Bitch" he says in perfectly accented English. Oh yes, it's going to be a grand day.

A translator finally arrives. She looks lost a minute into the conversation. She proceeds to tell us that Mr. Violent Man is not making any sense and can't follow a conversation. She asks why he's here. When one of the police officers say "He was threatening his co-workers with a chainsaw", her face drains of color. We have to bribe her with candy and offers of free medical care to get her to stay.

Mr. Violent Man takes 8 mg of Haldol and 10 mg of Versed to calm down enough to get him to quit yelling and lay obediently on the stretcher. He soon starts singing the Mexican national anthem to us, horribly off key. But he is happy - happy and calm. After all, that's what matters now, isn't it?

Dr. Q finally gets close enough to examine the patient. Why is it that the nurses are the first line of defense? Dr. Q just smiles and pushes us forward in front of him. "To the hold room!" he shouts, like a king commanding his army. Mr. LEO and his 5 buddies immediately obey.

"Hey! Wait!" I yell. "Don't forget the patient."

Reluctantly they turn around. After we remove his restraints, they escort him to the hold room. I can hear the words "Viva la Mexico!" resounding down the halls.

Friday, October 13, 2006

In Honor of Halloween

It was a dark and stormy night in the ER. The lights were flickering and the bedpans were rattling. The reverberating boom of thunder accompanied the swish of the ER doors each time they opened to admit the next victim. Dr. Q was limping down the hallway, moaning with each step. "Kill me now," he moaned. "Kill me now."

Screams filled the hallway. Horrid gut wrenching screams of terror. Nurses were running in and out of the rooms, wiping sweat from their brows, yelling for more supplies. The lights flickered and went out. One, two, three, four seconds passed before the generator clicked on.

"Dr Q! Dr Q! Come quick!" Lucy yelled down the hall.

Dr Q slowly turned around, fear plastered across his face. His thoughts sent out on the air like an electric current "Oh please, no. Not again. No. No. No!"

"Dr Q! NOW!" Lucy screamed.

He limped back down the hall, breathing heavily. Taking in the air like he would never have the chance to breathe again. Tears came down his face, sweat soaking the back of his scrubs. He pushed open the doors to ER 3.

"PUSH!" Lucy said. "PUSH NOW!"

Dr Q made it to the stretcher just in time to grab the squirming pink infant as he made his way into the world. He promptly cut the cord, handed the baby to Lucy, delivered the placenta, and walked back out the door.

"I hate delivering babies," he whispered as he headed toward the Dr's Lounge.

Monday, September 25, 2006

The Hot Dog Incident

The day started out calm enough - no overfills, triage going well, wait time less than 30 minutes. We were living high on the hog of ER medicine. Then Lucy said the dreaded word...............the word we all fear.

"Boy, it sure is QUIET today"

Time stood still as we all swung around to look at her. In slow motion, you could see Dr Q running toward her, arm flung out attempting to cover her mouth with his hand. "Oh noooooooooooooooooooooooo!" he cried as he tripped over the cord for the fluid warmer. "Not the Q word!"

Instantly, the ER doors flew open and a multiple victim ATV wreck self-presented to the ER. A dark cloud descended over the ER as we glared at Lucy. "This is YOUR fault" Dr. Q said, struggling to get his legs untangled from the warmer cord. "You did this to us." After 20 seconds of what appeared to be some new African tribal dance, he freed himself and accompanied us out to triage.

The four victims were sorted and triaged when an elderly couple walked in with c/o chest pain. "You both have chest pain?" I asked. "Yes" they replied in unison. "Well, what brought it on?" Red faced and stuttering, the old man said "well, you see..... we were, um........well, we were kinda...." "Oh for Christ's sake Harold - just say it" his wife replied. "We were having sex miss and we both started feeling a little short of breath and having a bit of chest pain. We didn't think it was bad enough to call an ambulance so we just drove ourselves up." I looked at Harold who was looking a little bit gray all of a sudden. Our lovers were escorted back to the cardiac rooms.

Lucy came running up to me at that point screaming "Some dude in the lobby cut his hand off with a chainsaw - there's blood everywhere!" All our beds were full at this point. Oh, what to do - what to do? Rooms were swapped, people moved around, and another doc called.

Approximately 6 hours later, Lucy calls and asks for lunch relief. "Yeah, right" I reply. Seriously? Lunch? Dream on, I thought. I immediately filed her request in the back of my mind and continued to help my current patient. This one had wrecked his bike when he tried to jump a barbed wire fence. In what had to have been only 4 maybe 5 seconds later (if I allow time for Dr Q's clumsiness), Dr Q approached me and said "Lucy's crying in front of a patient." "WHAT?" I said, immediately stepping out into the hall to find her.

Lucy was a bit flustered. By a bit I mean weeping uncontrollably, snot draining from her nose, throwing pens across the room flustered. I pulled her out of the room and into the nurse's lounge. "What the hell is going on?" I asked.

Between snorts and sobs she says "I ..... just ....wanted.......lunch.......and ........I got this.........snort, snuffle, cough......... hour ago..............and it's ....... shriveled........and..........cough, hack, sob...........cold!" I just stared at her, my mouth hanging open. She continued. "And.......I'm not going the damn thing............NOW!" she screamed. With the speed of a professional baseball player (which in all honestly, I never though Lucy had any talent in that arena at all), she threw the hot dog on the floor and stomped out of the room. "I'm leaving and I'm going to eat lunch!"

The poor hot dog was shriveled, I'll give her that. It was also now broke into an open massive wound of meatflesh. It had left a trail of grease across the floor as it bounced on it's merry way. I stared at this poor hotdog in disbelief. I was in shock - this poor hotdog was mutilated, destroyed, dead.

Dr. Q threw the door open - "What are you doing? I need you out here!" he screamed.

"Staring at a hotdog" I replied.

He wrinkled his brow in confusion. "Umm............" he started to reply.

"Lucy's hotdog is on the floor" I said.

"Ummm........OK" he said. "Let's go back out to the ER now. Slowly. Just come with me," he urged.

As he was pulling me out, my eyes shifted to the hotdog. "Lucy went to lunch" I said.

Friday, August 18, 2006

Leaving on a Jet Plane

Little Miss Betty called for an ambulance at 2 AM. The tones from the radio at the desk startled us all out of our dazed slumber. "EMS, please respond to 123 N. Main for an 82 year old female complaining of high blood pressure and a bloody nose."

"Bloody nose? She's calling an ambulance because she has a bloody nose? Is she bored?" Lucy asks.

"She better be gushing blood and about ready to pass out" whispers cranky Dr Q, who happens to have a sore throat and a fever.

"Oh, go take some Nyquil Dr. Q" We all say in unison.

Ten minutes later the ambulance rolls into the bay. I stand at the back door propping it open and shivering as the wind blows up my scrub pants. Holy moses on a teacup it's cold. The back doors of Medic 93 pop open and the paramedics unload Little Miss Betty.

Now, Little Miss Betty has made many visits to our fine Emergency Department. I've received her from the ambulance for complaints of chest pain (her bra rubbed her raw under her left breast), a broken leg (it was just a scratch), abdominal pain (she needed to fart), and burns (she spilled coffee on her toe). They tried not to transport her but Little Miss Betty insisted that she must be seen. "It's an EMERGENCY!" she'd cry.

We settled LMB on the stretcher and hooked her up to the cardiac monitor. Her blood pressure was 158/68, heart rate of 72 in Normal Sinus Rhythm, and a respiratory rate of 38. There was approximately 1 teaspoon (or less) of blood on the front of her nightgown. Dr. Q came in the room, took one look at LMB, and tried to walk out the door. Lucy did a quick double step and grabbed him by the back of his scrubs. "Let me introduce you to Little Miss Betty, Dr. Q. She's here with complaints of a nose bleed and high blood pressure". I must say, every day my pride in Lucy increases. She's learning so well.

Dr. Q proceeds to examine LMB. He asks her the standard questions regarding the events of the day and night, past medical history, current medications, and allergies. LMB is being very unclear on her answers - rambling, making up names of medications that don't exist, changing her story, etc. Finally Dr. Q has had enough.

"Okay Betty, what really happened today?"

"Well," she pauses, sniffles a bit, and wipes her nose with a crumpled up paper towel. "If you really want to know.................."

"Yes, I do" he replies. "Tell me now" (Dr Q needs to work on his bedside manner when he's sick. He really gets a bit cranky).

"Well, I applied for a loan today and I was denied. Can you believe that? They denied me, a little old lady, they denied me money!" She dissolved into sobs.

"What did you need a loan for Betty?"

" A plane," she replied.

Silence. We all looked at each other with a quizzical eye.

"A plane?" Dr Q asked.

"Yes you moron. A plane! I need a plane to fly to Georgia to buy a new house. I'm leaving this place. I'm leaving you all and I'm never coming back. But.... But I....." she pauses to sniffle and choke on her tears, " I can't get a looooooooaaaaaaaaaaan". She once again dissolves into chest heaving sobs.

Lucy whips out ten dollars from the back pocket of her scrubs. "Let's start a collection" she whispers to me. Five hands appear over her shoulder with twenty dollars in each.

It's a start.

Thursday, June 15, 2006

I Want To Be A Drug Seeker. I do, I really do.

Vicodin, Percocet, Demerol, Morphine, Dilaudid ~ it's all good. Take a little back pain, add one narcotic and flavor with a splash of muscle relaxer. Oh yeah, heaven has just arrived.

So, I should have listened to Jon when he said "Don't go to softball practice. You'll only make it worse." But seriously - what do men know?

I did not listen to him. I know I should have (they say hindsight is 20/20), but I did not. I went to softball practice (with the hospital softball team, mind you) with my back already hurt and I woke up the next morning unable to stand up straight. Yes ~ he was ......................... do I dare say it? ................................. He was RIGHT (insert audible gasp here)!

I walked into work Saturday morning walking like I had a corncob up my ass ( a direct quote from one lovely lady I work with). The instant I saw Dr. Z, I begged for a prescription. "Please, give me Vicodin. Anything containing a narcotic. Just knock me the hell out and call it good."

Then I realized...................I am a drug seeker. Yes, I am that crazy, irritable, give-me-the-damn-drugs-now-before-I-kick-your-ass patient. I could name my drug (Vicodin). I could name my strength (5/500). And..................I could name my directions (1-2 every 4 hours as needed for pain). "Really doc - I'll only take 2 at a time. Oh and throw in a little flexeril while you're at it".

So I've decided to go with it. Why not join the ranks of the drug seeking public and just ask for a little narcotic every time I see the doc. That stuff is gooooo-ooood! I love that nice little high you get right before your head rolls to the side, your tongue drops out of your mouth, and the drool starts to flow down your chin. It's a nice little place to be. Spinning room, tingling toes, and a smile in your brain - it's heaven in a little white tablet. God is good. He gave us all this special little gift.

Vicodin? Check.
Percocet? Check.
Morphine? um...................... "Now, Julie. I don't think you're hurt that bad."

"Yes. Yes I am doc. I'm totally hurt that bad. Really. See? I can't walk."

"Julie - we just ran a Code together. I saw you walk."

"No you didn't," I challenge.

"Um. Yes I did."

"Damn you and your morphine hording self! Damn you to hell!"

I think I better go to bed and have myself a little Vicodin cocktail. My back hurts.

Monday, April 17, 2006

What Happens When You Don't Get Along

Emergency Departments are full of hard-headed, stubborn, control freaks. And that's just the nurses (bet you thought I was going to say doctors, didn't you?). To be an effective ER nurse, you have to be able to make quick decisions on your feet, fight for your patients, argue with the doctors when you know you're right, and separate the real emergencies from the fake ones.You have to have a strong, confident personality.

Put 5 or 6 of us in a room together and there's going to be someone there that doesn't like someone else. And when all of you have very strong, dominant personalities ~ watch out Betty! It's gonna get a little rough.

Nurse Jane: I'm gonna run and pee real quick, watch my patient's would ya?

Nurse Mary: I ain't watchin' your patients. I've got 2 leg lacerations and a chest pain.

Nurse Jane: Damn it! I have to pee! I only have 1 ankle injury and a foreign body in the nose. Can't you take 5 seconds of your precious time and check on them while I'm emptying my bladder?

Nurse Mary: Grab a bedpan and piss in that. I am BUSY!

Nurse Jane: Where's good help when you need it?

Nurse Mary: Call rent-a-nurse. Maybe they'll help you.

Now granted, not all interactions happen this way. But there's always the possibility of butting heads in the ER. The good thing is, by the next day (or hour) it doesn't matter. It's been dropped like a fistful of needles and we're all in love again.

Dr. X: This patient needs a cardiac panel, an EKG, a CXR, a cath UA, both arms splinted, both legs sewn up, and a partridge in a pear tree ~ STAT!

Nurse Julie: Uh.....yeah. I'll get right on that.

Dr. X: I want it done and I want it done 5 minutes ago!

Nurse Julie: Uh huh. I heard ya. See me running? (As she walks slowly away)

Dr. X: (face red, shaking both fists in the air, spitting as he yells) Damn it! You must obey me! I am the doctor! I give the orders!

Nurse Julie: (looking over her left shoulder, flinging her middle finger up to push her hair over her ear) the labs and the EKG were done before you got here, the lacerations were repaired by the resident, the arms were splinted 2 minutes ago, and I hung the partridge with a noose in the pear tree and now he's dead. Any questions?

Dr. X: Well......why didn't you tell me that in the first place?

I love being surrounded by strong personalities. It amazes me the things we can get done when we work together ~ and the things we can prevent with our own stubborness. As long as we take care of the patient first and foremost, everything works out in the end.

Nurse Mary: Dr. X, I think this patient is going to crump.

Dr. X: Oh Nurse Mary - you're overreacting again. He's fine. He's just breathing a little fast and he says his back hurts.

Nurse Mary: No, Dr. X. He doesn't look right. He is going to crump and we need to get ready to intubate him now. I think he's got a triple A (AAA = abdominal aortic aneurysm).

Dr. X: Now Mary...........


Dr. X: OK Mary, let's go and check it out.

Intuition can save a patient's life and nurses and doctors all have it (or they should if they're any good). It's a good thing we're stubborn and hard-headed or we'd never trust ourselves or each other!

Tuesday, March 07, 2006

Rollin' Rollin' Rollin'

A montage of rollovers. That's what a Saturday night feels like. Play a little music in the background, clips of vehicles rolling, people being pulled out of the rig, and then cut to the ER with bloody people on backboards. It's all about immobilization baby.

Rollover #1 - single vehicle. Fell asleep at the wheel - over corrected when faced with the feeling of wheel on gravel. Guaranteed to get you at least a few hours stay in the ER with an Xray or two. And if you're drunk, you might get a pissed off police officer as your visitor of the day.

Rollover #2 - single vehicle. Excessive speed - took the corner too fast. When you come to a stand still on your roof after the 8th roll you may or may not be conscious. You may or may not be alive. You may or may not have a pissed off police officer standing outside your rig (were you drunk?).

Rollover #3 - single vehicle. Swerved to miss a deer - hit the ditch and rolled 1 or 2 times. Your head took out your driver's side window and you now have dicing abrasions on the left side of your face. Your ear is hanging by a thin strip of skin. You probably got knocked out and are coming to with the face of a pissed off police officer in your field of vision. He's holding your open bottle of Jack Daniels that made it through the wreck just fine, thank you.

Rollover #4- Multiple vehicle. Swerved to avoid another vehicle who also swerved to avoid you. They roll. You hit a third vehicle and roll off into the ditch. The third vehicle spins sideways and hits a fourth vehicle which rolls off into the ditch on the opposite side of the road. Two patients with neck fractures, two patients with broken femurs, and you - telling the police officer you only had "twee beers haccifer - honest"

Rollover #5 - Multiple vehicle. Swerved to hit another vehicle. You rolled when your tire ran up over the edge of their front bumper. You came to a rest on the passenger side of your vehicle. You are fine. The driver of the other car has a broken arm, a probable neck injury, and a large laceration on the left side of their face. He was a police officer - in his patrol car. You are still holding your beer.

It's amazing that when the drivers get into the ER they only had one drink (5 hours earlier mind you), they really weren't going that fast (at 80mph), and it's always someone else's fault. They are bloodied, strapped to a backboard, reeking of alcohol (and let me tell you - the smell of blood and alcohol together is not a pleasant floral aroma - oh no), and insisting "if that other guy wouldn't have been in his own lane, I wouldn't have hit him so it's his fucking fault!"

Now don't get me wrong - they can be quite entertaining. Especially the ones that believe they are in the world of "ER" on TV. We had one especially polite lady scream out "Where the fuck is Luca? Where's my Luca? I want Dr. Luca damn it!" When Dr. Q walked into the room she hollers "You're not Luca. Get the fuck out! Now!" She then turns to me and says "Who are you?"

"They call me Abby," I reply with a smile and a wink.

Thursday, January 26, 2006

Gut Feelings

Not every chest pain is a heart attack, and not every heart attack has chest pain. This is a truth known to ER nurses in all areas of the globe. So how do you know when it's serious - before you've done any interventions at all?

ER nurses develop a talent for gut feelings. We can tell when someone walks in the door if they will triage to a Level 2 or a Level 5 - just by the way they hold themselves. We can also tell if they are a narcotic seeker. Do not ask me how we develop this talent. We just do. The secret is closely guarded - one you will never find out unless you become one of us (insert evil laugh here)!

The other day Mr. Jones walked in - slightly bent over, a little pale, saying "My back hurts". I immediately pulled him through triage to the protests of 8 other people in the waiting room. "Hey! I was here first!" and "I have an ingrown toenail right here! I am before him nurse. I've been waiting 3 hours already!" rang out across the room. Some people truly believe that their infected hair follicle is more important than a gunshot wound, heart attack or a trauma. I had a person tell me once "I don't care if she's having a heart attack. I have an ear infection and I was here first." Well OK - let me take care of your life threatening ear infection instead of this person ready to walk through deaths door any moment. Yeah - you need the doctor much more than he does.

I rushed Mr. Jones to a room and hooked him up to the cardiac monitor. Tombstones - right there in front of me. No chest pain, no shortness of breath, no diaphoresis - just tombstones on that monitor. Immediately called the MD and another nurse into the room. This man is having a heart attack. Right in front of us - only he doesn't know it. IV's in, oxygen on, meds given, drips started - it all happens so fast.

How did I know this was not a normal complaint of back pain? It's that gut feeling. Something about them is registering in my brain - an unspoken, unseen force. It takes a while to develop it, but every good ER nurse does at some point.

You cannot survive in the ER without it.

Saturday, January 14, 2006


She walked into the ER requesting to see a doc for her "Virginia". Naturally, we look down beside her expecting to see a cute little girl in ringlets with ribbons in her hair named Virginia. Oh no - we see nothing.

"Your Virginia? Is she meeting you here?" Lucy asks.

"No - my Virginia is with me. I need a doc to look at her."

We obviously need a psych consult on this one with her imaginary friend. There's always something about imaginary friends - maybe I should get one.

"Ma'am I don't see Virginia," Lucy says.

"Well of course you don't silly. I'm not naked yet"

Hold on there Nelly! Why do we need to see her naked to find Virginia? Is she hiding under her clothes? Little did I know how right I was.

Lucy takes Ms. Imaginary Friend back to room 1, gets a history on her, and has her change into a gown. "So, what's the problem with Virginia?" Lucy asks.

"Well, she's been really itchy lately and really irritated," the lady replies. Suddenly a foul odor sweeps the room as the lady removes her clothes.

"Um...." (cough cough) "Has Virginia gotten into anything she shouldn't?" asks Lucy.

"Well.............she met up with a man who might have had something bad" the lady says. This is when the lightbulb in Lucy's head goes on - and she attempts to back out of the room slowly. "Virginia? Do you mean your vagina?"

"Yeah! Of course I do. She's got something wrong with her!"

Lucy comes back out to the nurse's station looking a little green. "She was talking about her vagina y'all." A stench follows Lucy out of the room. Three heads turn together toward Room 1. What could make someone stink so bad? What could cause the hair on the back of your neck to stand on end because it's the only thing holding you up so you don't faint? What could permeate through the air at a rate of 10 feet per second?

An STD. Yes, Ms. Imaginary Friend had met up with Mr. Bad Man and come back with a very stinky case of (insert STD here, they all pretty much work). Upon further questioning, she had had the symptoms for about 4 months but never had time to get to a clinic. It's 5PM on a Sunday and she decides Virginia needs a doc. Oh - how Virginia needed a doctor.

A couple of antibiotic shots and a take home prescription later, Ms. Imaginary Friend thanked us for fixing Virginia and said "I'll see y'all later!"

Oh - I hope not. At least not until Virginia feels a little bit better.

Friday, January 06, 2006

Fight! Fight!

When a very tall, very broad man OD's and is extremely lethargic - NEVER trust him. He is not the nice sleepy little thing on the stretcher that he appears to be. Oh no. He is not. He is an evil monster waiting to burst off that thing with the speed and strength of a demon. And one very pissed off demon at that.

Mr. Joe arrived at the ER stating he took his entire bottle of anti-anxiety medication. 60 pills in all. Mr. Joe was very sleepy. Mr. Joe laid down on the stretcher, closed his eyes, and went to sleep. Mr. Joe was full of shit.

Approximately 30 minutes later, after we stuck a tube in his nose, filled his stomach full of charcoal, and poked him twice with 2 large IV needles - Mr. Joe was pissed. He yanked out both his IV's (which proceeded to empty his body of what I swear was half of his blood volume) and his NG in 2 seconds flat. He came flying off the stretcher, bare ass in full view, and screamed "you ain't gonna kill me you mother fukka's!" and tried to punch the doctor.

The "Dr Strong" call immediately went out and 8 staff members descended on this poor unsuspecting soul. Mr Joe tried to escape through the door with blood running down his arms and charcoal coming out his nose. He did not want 8 very pissed off staff members touching him. He just wanted to go home, take the rest of his pills and blissfully go to heaven. Yes - we know this because he shouted it across the ER. The demented lady in the other curtain shouted out "Take me with you!"

"10 Mg Versed IM NOW" shouted Dr. Q while Mr. Joe was sinking his teeth into the paramedic's arm. Lucy and I threw ourselves across Mr. Joe's legs as the men got him back onto the stretcher. It took all 8 staff members to keep Mr. Joe on the stretcher. He was still bucking against us and actually lifted Lucy and I up off of the stretcher with his legs. Dr. Q was starting to get a little excited - "50 mg of ATivan IM now!" "Um, Dr. Q," I said between being kicked and spit on, "I think that's a bit much." "Oh yes, yes you're right. How about 5 mg IM?" Yeah - that's better.

Poor Lucy - her eyes were as wide as saucers. "Such a young inexperienced thing-she must be scared," I was thinking - until I saw that Mr. Joe had a handful of her hair and was creating quite a bald patch on the back of her head. "GRAB HIS HAND!" I yelled to one of the other nurses. "GIVE THIS MAN SOMETHING TO PUT HIM TO SLEEP," yelled another. "Screw You!" shouted Mr. Joe.

Finally, the Versed and the Ativan kicked in. Mr. Joe's eyes rolled back in his head, a slow smile spread across his face, and his respiratory drive stopped. Now don't worry - we gave it back to him. A little baggin' and one ET tube later he had oxygen again. Sweat pouring down our faces, the staff looked at each other and started laughing. We got him positioned properly on the stretcher, pulled up the side rails and headed out to the ICU. As we were rolling out the door, the echo came from the next curtain "Take me with you!"

Monday, January 02, 2006

So? It's A Slow Day.

Bored ER nurses are a dangerous lot. If you didn't think we were psychotic when you first met us, you certainly would if you saw us on a slow day. When there is nothing coming in through those doors, you have to entertain yourself in some way- and offering money to every staff member that walks by to go throw themselves in front of the first moving car they see is entertainment of the highest sort.

There are some warning signs that the ER has had a slow day. If you ever see a CPR Annie sitting in a waiting room chair with a foley coming out of her mouth, a rectal tube in each ear, and a speculum in her right hand - you'll know what's happened. Especially if you see chicken heart Bob, the ACLS dummy, next to her holding the exam light with a condom cath on his head. Don't you know they were just married and had a little wedding night mishap? So they've come to the ER requesting a foreign body removal.

Another warning sign is the sudden miraculous movement of a corpse. A body bag on top of a stretcher in the hallway is a very dangerous thing to walk by. You must watch out for suddenly groping hands or the shriek of the dead. It's pee-your-pants-laugh-inducing when someone jumps 3 feet in the air as a scream comes forth from the stretcher, even better when the corpse suddenly sits up and fights against the body bag. You get 10 extra points if the visitor runs frantically down the hall yelling "He's alive! He's alive!"

Be very, very careful (I cannot stress this enough) in an empty room. It's amazing how nurses can fit under stretchers and grab ankles when you least expect it - though I must put a little warning in here to wear gloves, because you just never know when someone will pee their pants. Go ahead, ask me how I know. And let me just say here that doctors have absolutely NO sense of humor.

So as we sit and pray for trauma, chest pain, or an always fun out of control schizophrenic, please keep in mind that visiting your local ER on a slow day could provide some very cheap entertainment. Just watch out for those body bags!

Sunday, January 01, 2006

Horses and Mug Shots

The man hit the horse at 60 mph and his face was instantly split in two (the man, not the horse - the horse lost his face completely, along with his head). He was brought into the ER where he immediately met our trauma team. We were standing at the ready taking bets on whether or not he would be able to maintain his own airway. Leah and I lost 20 bucks that night.

The team surrounded him, the sound of the wall suction filling the room. Controlled chaos reigned. Dr Q leaned down to ask the gentlemen about his health history and was immediately assaulted with projectile bloody vomit. A slight pause occurred as we all turned our heads in unison to follow the bloody trail from the doctor's chest, over his head, and up onto the wall.
We were all impressed when it hit the ceiling in the corner of the room behind Dr Q. It was truly an amazing accomplishment. A few of us started to bring our hands together to clap when we remembered where we were and reached for a syringe instead.

His intubation proved to be a tricky maneuver. One that induced multiple cuss words from staff and a few thrown instruments. But noone was hit, which is a good thing when a bloody ET tube comes your way. You just do a quick tango to the side and worry about cleaning it up later.

Once the patient was stablized, I got on the phone to the trauma center to arrange a transfer for OMFS services. The rest of the team were debating the laws of geometry and physics while discussing the angles and distance of projectile for the bloody vomit. Dr. Q was in the corner dictating and Leah was on the phone with Air Life. Housekeeping kept trying to come in and clean up the vomit because their shift was ending in 10 minutes.

Once Air Life landed and whisked our patient away, we called housekeeping to tell them they could come in now - only to find out they had clocked off shift. So Leah and I spent the next 40 minutes cleaning up bloody vomit and thrown instruments.

A week later, Leah ran into the patient's girlfriend at the sherriff's office (Leah swears she was there to pay a parking ticket, but who pays a parking ticket at the sheriff's office and why does it take 4 hours?). After the initial "don't I know you from somewhere?" and "thank you so much for helping him that night", Leah got down to the bottom of why the girlfriend was there;

"Well, the surgeon needed a picture for his facial reconstruction surgery and his mug shot from last month is the most recent one"

Yes - she actually took the mug shot to the surgeon. We still hear about that when we call with a trauma transfer. "Are you gonna send their mug shot too?"