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?"