Those Were The Days

I am the queen of embarassing moments. Not only do I fall flat on my ass in front of patients, but I also fart in front of them too. I wish I could say I was cool enough to have done it on purpose. Um, yeah.................no.

Not only did I fart in front of a patient, but I also did it while their entire family was in the room. And by entire family I mean all 436 of them - or so it seemed at the time.

CAST OF CHARACTERS:

Mother - patient who received my wonderful wind

Husband - man who laughed so hard he almost fell off his chair

Son - teenage boy who blushed more than I did

Sister In Law - wearing more bling than any redneck woman ever should. Can I just say that a wifebeater on a woman wearing multiple diamond rings is immensely ironic?

Brother of the Mother - husband to sister in law mentioned above. Wearing a matching wifebeater that said "I'll drink to that!"

4 kids under the age of 8 - self explanatory. Farting is always funny to kids

Grandmother - at least she couldn't hear shit (no pun intended of course) and had no clue what was going on.

Nurse - me



I'd rather fart in the bathtub to make my own personal jacuzzi than to ever, ever, ever do so in front of a patient. It's funny at home - it ain't so funny at work. OK, OK - maybe I was the only one who wasn't laughing.

Asystole

Thank the good Lord above that Christmas is over. It's not that I was really a bah humbug this year or anything. I just HATE to shop. I would prefer to walk into one store, up to one rack and have it all be perfect for all the people on my list. Done in 15 minutes - that's my dream. Unfortunately, the universe does not revolve around me. Sigh...............

I watched a movie the other night where they shocked asystole. Yes, I know. Once again, the production company did not seek the assistance of a technical advisor. When will these people learn? Take your dramatic license - but take it with a bit of VFib, not asystole. It's easy to change that little rhythm on the screen of your monitor (that's not even plugged in) with a programmable chicken heart (what we affectionately call our training unit that changes heart rhythms on the screen for different scenarios).

What's that? Give up, you say? Don't sweat the small stuff? It's only TV? Never! Never, I say! I shall never cease my war against inaccurate defib techniques. I shall battle on for the good of the people, the court systems, and if nothing else - my own sanity.

The next time I see a flat asystole line on the TV and they are shocking it, I think I'll shoot the television.

And To All A Good Night

Tonight I shall entertain myself with hot chocolate and peppermint schnapps as I wait up for Santa. I might be lit to the nines by the time he arrives. Maybe I'll even kiss him under the mistletoe. Anything to take my mind off of the fact that one of our ER nurses apparently felt the need to call in extra staff because she had 3 patients.

Yes - you read that right.

They weren't even critical.

Sometimes you gotta just shake your head and get drunk rather than face the fact that you work with idiots.

Remember numbers 8, 9, and 10? Sigh............

Where's the liquor?

Merry Christmas.

'Tis the Season - part 2

Apparently it is no longer acceptable to try and sneak a peak at your presents a little bit early.

Absolutely Priceless

Shakes Head In Disbelief

Oh Sweet Jesus - I don't even know what to say about this one.


Oh wait! Yes I do!



I want my dollar or my taco!

Just watch - you'll understand

All I Want For Christmas

My Christmas Wish List (otherwise known as Things That Would Make My Life Easier):

• A self contained, non-invasive, urine catch-all that would not require insertion into an orifice of any sort
• A stethoscope that works and cannot be misplaced on any counter, med cart, or back of a toilet
  
• An extra set of hands - preferably not grabbing my ass
• Xray vision. Seriously - wouldn't that be nice? Can you imagine how fast triage would go then? And how interesting it would be?
  
• JCAHO to allow Leather 4 Point Restraints for every meth head parent that comes in with an injured child
• Voice recognition software for real time charting and no need to sit my ass down in front of a computer to type it all out
• An applause-o-meter on the wall of the trauma room for when we get it right
• A pen that works
• Clocks that are actually synchronized throughout the entire hospital. I can clock in on time on the first floor, but be 10 minutes late on the second floor (and it only takes 30 seconds to run up the stairs).
  
• One of those hats that holds a beer on each side with straws coming down to your mouth - I'd fill it full of Diet Coke and never have to leave the ER (especially if I had my self contained urine device mentioned above. Hint Hint Santa!).
• A fully trained, ER competent new hire
• A small, light, yet lethal sledgehammer I can carry in my back pocket and use at will
• A deed to a parking spot at the front of the parking lot
• A doctor with a sense of humor
• To not have to attend another diversity workshop, customer service class, or communication seminar ever, ever again
• A hand held doppler that can sense the pulse as you get closer to the skin and gravitates to the appropriate place like a magnet
• A laser device that automatically takes someone's blood pressure, pulse, respirations, saturation level, temperature, and CBG as they walk, crawl, or are rolled through the door
• Thermoregulating scrubs
• A full 30 minute lunch break
• And a partridge in a pear tree
  

'Tis The Season......

For a Christmas Miracle. There is no other explanation for this.


Mrs. Jones looked in her rear view mirror and saw her 5 year old unbuckle herself from the car seat. "Melinda! Put your seatbelt back on right now!" Melinda started to laugh and climb over the second seat into the third seat of the van. On her way over the seat she kicked her younger sister, Samantha, in the head. Samantha (2 years old) started to cry.

"Melinda! GET BACK IN YOUR SEAT!" Mrs. Jones started to slow the van down and pull towards the edge of the road. Her 13 year old son was in the passenger seat beside her listening to his ipod and bopping his head along with the beat.

Mrs. Jones put on her blinker, continued to slow the van, and waited for a safe place to pull over.

She hit black ice at about 50 mph.

She slid sideways, fighting for control of the vehicle. She heard Melinda scream and saw her body slam up against the side of the van. Then they rolled. Twice.

Mrs. Jones felt the van flipping, heard her children screaming, and saw her daughter fly out the window just before the final thud of the van as it landed on it's top. But it wasn't Melinda that flew out - it was Samantha. The 2 year old.

Total silence.

She looked to the passenger seat and saw her son looking back at her - fear in his eyes. She released her seatbelt and landed with a thump on the roof of the van. She glanced into the back of the van and saw Melinda laying in a fetal position on the roof above (now below) the rear seat. She wasn't crying.

Mrs. Jones said she remembered screaming "OH MY GOD! OH MY GOD!" as she crawled to the back of the van. She saw that Melinda was awake, staring at her. She started to cry as Mrs. Jones got closer. "Mommy, my neck hurts!" she sobbed, but she moved her legs. She moved her legs and reached out for her mom. Mrs. Jones scooped her up and pushed her into her son's arms, as he had unbuckled himself by this time also.

She crawled out the broken side windows to find Samantha. She had to crawl under the empty car seat on the way out. She saw the straps still buckled and couldn't comprehend how Samantha had gotten thrown out of the vehicle. She was sobbing as she slid out the windows, cutting her hands and lower legs on all the broken glass.

"SAMANTHA!" she screamed. She gained her footing and slid and tripped her way back behind the van. Mrs. Jones was terrified of what she would see.

She saw Samantha.

She saw Samantha standing in the snow in the ditch sucking her thumb and crying. She was uninjured.

Apparently she had landed exactly like that as the van flipped over. The only marks around her were the flattened snow from where the van hit and her 2 footprints - which she was still standing in. Mrs. Jones ran to her, scooped her up, and went back to the van.

The motorist behind them picked them up and brought them to the ER. We promptly immobilized and examined Melinda, Samantha, and Mrs. Jones. The son felt fine and didn't want to be seen. A few Xrays and a couple of CT Scans later we had our diagnosis...........

Bumps, bruises, and a few cuts.

Yes - that is it.

An unbuckled child, a child who slips out of a car seat, a van rolling on black ice, and we have no major injuries. NONE.

Tis the Season!

And let us never forget the Reason For The Season - Jesus.

Don't Waste Your Breath

It's been a while, so it's time for another list.

Things you should not waste your breath saying to your ER nurse because he or she will not believe you anyway:

1. The only thing that works for me is Morphine. I'm allergic to every other narcotic known to man.
2. He's had a fever of 106 for 5 days and the tylenol and motrin aren't working to bring it down. I know he's running around the room right now, but he's just faking it. He's really sick and I need some antibiotics for him.
   
3. I've been vomiting for 17 hours straight and can't keep anything down. Huh? What? This? It's an old food stain from McDonalds. Yeah old - even thought the ketchup is still wet. It's like, from the last time I wore this shirt.
   
4. The only thing that works for me is Demerol. I'm allergic to every other narcotic known to man.
5. What? These? No, these aren't needle marks. They're just.......um.....a form of self mutilation involving sharp instruments.
6. The little man in the call light speaks to me.
7. Last time I was here, Dr. Q gave me a prescription for 100 Percocet and I need a refill because my dog ate them all.
8. No my dog is not dead.
9. The only thing that works for me is Dilaudid. I'm allergic to every other narcotic known to man.
   
10. No, I've only had this foul smelling, pus like drainage from my genital region for a day or so.
11. Nope, I can't pee right now.
12. I know I have 28 tattoos, but I'm deathly afraid of needles.
13. I've done everything the telephone nurse told me to do, but I'm still not better.
14. The only thing that works for me is Fentanyl. I'm allergic to every other narcotic known to man.
    
15. Nope, I ain't been drinkin'. Nob at aaawl.
16. I was sittin' there minding my own business, when all of a sudden..................
    

Lovely Little Rattlers

Do you see our little friend over there? Our little friend is angry. He does not like you to bother him. He does not like you to drink 5 beers, kick him with your boot, yell to your buddies "Hey! I found a rattlesnake!" and then pick him up. He does not like that at all.

And he will show you how much he doesn't like it - by sinking his sharp ass fangs into the soft meaty skin of your hand as you reach down to grab him. Not only will he show you, but all the staff in the ER will think you are stupid because A) you are drunk B) you kicked a snake C) you the tried to pick up said snake and D) you are male.

Seriously people........alcohol and snakes are not a good combination. From the basics of common sense clear down to the cellular level of your body - those two things were never meant to go together. Not like Simon and Garfunkel, Peanut butter and jelly, hot chocolate and rum (oh wait - is that just me???). Oh no - snakes and alcohol do not mix.

Mr. SmartAss came to us via EMS after the above altercation, which was of course the snake's fault and not his. "Damn snake bit me! Can you believe that shit? What an asshole!"

"What were you doing when he bit you?" I asked, knowing full well a 21 year old drunk male had to have been doing something on the stupid end of the spectrum to get bit.

"I was just trying to pick him up! He was all pissed and shit from when I kicked him. But I was just trying to get him to rattle! What an asshole."

Yes - because the snake sat there and planned this whole thing out. In fact, Mr. Snake must have been thinking 'I'll just wait until he bends down and reaches his hand out to me and THEN I'll strike. No matter that he just shoved his steel toed boot into my side and kicked me 4 feet down the driveway........I'll just wait for his hand 'cuz that's the good, fleshy, meaty part.'

Uh huh.

Idiot.

Initiate venomous bite protocol. Sigh.

The whole time Mr. SmartAss was with us, he could not stop cussing. Now, I like a good "shit", "fuck", or "asshole" just as much as the next guy - but there is a time and a place people. A time and a place. And the time and the place are NOT when the staff of the ER are trying to treat your increasing swelling, pain, and abnormal lab results.

"You mother fuckers! I'm gonna die! I'm gonna die! Save me!"

"Now Mr. SmartAss - you're not going to die. Let us start an IV on you and give you some Crofab (antivenom yum yums) to help you. I need you to hold still please."

"You bitch! I need medicine now! Give it to me now! You're killing me!" He shouted while waving his arms in the air like a hysterical maniac and spraying spittle with every word.

"Mr. SmartAss, if you don't give me your arm I can't start an IV and then how am I going to give you the medicine?"

"LISTEN BITCH! I DON'T CARE WHAT YOU WANT! I NEED SOME MEDICINE, BITCH! NOW!"

Just about that time, Dr. Q threw open the exam room door and slammed his clipboard on the counter.

"Listen here young man. If you do not cease your piss poor attitude and stop cussing and yelling at my staff we will not be able to treat you and then you just MIGHT DIE! DO YOU UNDERSTAND ME????????!!!!!?????"

Dead silence from Mr. SmartAss.

"GOOD!" Dr. Q yelled. "JULIE, START HIS DAMN IV AND GET THE CROFAB GOING!"

"Dr Q?" I replied.

"YES?"

"You don't have to yell anymore."

"Oh, yeah. Well, yes. Thank you." He turned to the young man and stared him down. "Don't be mean to my nurses Mr SmartAss. They are here to help you and I expect you to cooperate with them."

"Yes sir," he replied.

Sometimes I absolutely adore Dr. Q.

We ended up giving the patient 2 boluses of Crofab before the swelling stopped. We monitored all his labs and prepared him for transport to the University. The plane landed 45 minutes later and we loaded him on it and sent him off. I never heard another cuss word out of his mouth.



SNAKE STORY NUMERO DOS:

If you are traveling cross country with your son and making a video of your trip, do not film a "what not to do" scene involving picking up a rattlesnake by the tale. Seriously people.........if you already know you shouldn't do it, why do you? And why put it on film for future evidence of your idiotic tendencies? You KNOW someone will get ahold of it and use it to make fun of your ass. In fact, all your buddies in your entire fire department will see it during a training session - plastered across the big canvas screen set up at the end of the bay.

SNAKE STORY NUMBER THREE:

If you are going cliff jumping, don't climb up the side of the rock face to dive off the top into the river without first looking where you are putting your hands when you reach a flat spot. Snakes like the sun. Snakes like nice warm rocks. They do not like your hand - especially when it is coming at them like a hawk swooping in from the sky, hungry for a little snake ala carte.

5AM Wake Up Call

It was 5 in the morning when Lucy went in to check on her elderly female patient who had fallen in the middle of the night. EMS brought her in at about 2 AM with complaints of hip and rib pain. Luckily nothing was broken.

Lucy completed her assessment and all the interventions (Xrays, pain meds, lab work) and settled her in to sleep while awaiting the results. She had popped in to check on her patient a few times to make sure all was well, but tried not to wake her each time.

At 5 AM, it all changed.

Lucy tip toed into the room as quiet as a mouse. She slowly lifted the covers off the feet of the patient, taking extra care not to disturb her at all. She needed to do a quick CMS check (for all you non medical readers - how well things are working in your foot like the pulse and blood refill after you push on a toenail) to make sure nothing had changed from previous.

She placed her fingers on the top of the foot to check her pulse when all of a sudden..........


"BOOOOOOOOOOOOOOOOO!" The patient sat straight up and yelled into Lucy's face.

"AHHHHHHHHHHHHHHHHHHH!" We heard Lucy's scream from the desk, along with what sounded like a clipboard hitting a wall and the crash of metal. We all went running in the room and found the patient laughing hysterically while Lucy was pale faced, breathing hard, and standing next to a stainless steel cart that had mysteriously landed on it's side.

"Oh my, sweetie. Oh my!" the elderly lady laughed. "Oh, that was priceless! It's so fun to be my age - you can do stuff like that and everyone thinks it's OK because you're just an old lady. I have the time of my life scaring nursing staff when I'm in the hospital."

Lucy replied, "You scared the crap outta me!"

"Yeah, I know. But at least you don't have to wear a diaper to contain it all."

Speaking of Grannies.............

The EMS tones went off just as I was taking a drink of my Diet Coke. "Damn it," I said. I was 2 hours past lunch and my stomach was screaming at me to put some food in it. I didn't have a chance to eat breakfast that morning as I had overslept. In fact, I woke up 15 minutes before my shift began and it's a 10 minute drive to work. Here's how my 5 minutes of prep time went:

1. Think "OH SHIT!" and increase heart rate to approx 150
2. Throw covers back to get out of bed
3. Tangle legs in covers and fall out of bed face first with my legs still wrapped in the blanket
4. Have pseudo-seizure on the floor trying to untangle myself
5. Take 2 seconds to yell "Mommy's FINE!" to scared 5 year old who thinks mommy is dying
6. Finally get untangled and run to the bathroom
7. Brush teeth in 20 seconds (OK so my dentist will be mad I didn't sing the whole ABC's here for my 2 minutes of brushing but who cares? Is he going to save me from a write up at work? I don't think so!)
8. Pull hair back in a scrunchie
9. Look in mirror and think "I look like hell"
10. Pull on scrubs and pull half of hair out of scrunchie
11. Redo hair in scrunchie - half of it is still falling out anyway. Think "oh who cares" and leave it alone
    
12. Put on deodorant (at least I remembered)
13. Yell at poor 5 year old for getting in my way
14. Search frantically for shoes that are in my hands
15. Grab coat and run out the door
    
16. Slip on ice on the porch and land on my ass
17. Cuss at the world
18. Get in car and start it
19. Drive to work - uneventful thankfully

So as I come running into the report room, Lucy tells me "You look like hell." Tell me something I don't know.

The morning was busy. Not overwhelmingly so, but steady enough to keep us all moving along like cattle to the feed lot at the end of the day. I had just grabbed a burger and soda from the cafeteria and returned to the ER to eat it when the EMS tones went off.

"Medic 1, please respond to BLM road ABC123 for an 84 year old female involved in an ATV rollover. Alert and conscious. Complains of hip and leg pain."

WHAT THE HELL? An 84 year year old on an ATV? In the woods? What the hell was she doing? I couldn't wait to get the whole story on this one.

Thankfully, BLM road ABC123 was 15 minutes out so I had time to eat lunch.

40 minutes later Medic 1 called in with report. "Hey Julie, it's Jimbo on Medic 1. We have an 84 year old female with an obvious open fracture of the right lower leg. Complains of mild right hip pain. Was involved in an ATV rollover which appears to have rolled down an embankment about 75 feet. Vitals stable, leg splinted. Pulses palpable. ETA 5 minutes."

Copy that.

Medic 1 rolled in with our patient exactly 5 minutes later. What timing! Jimbo rolls her into exam room 1 and we transfer her to the stretcher. This lady looks about 50 years old. I cannot believe she is 84. When I ask her to verify her birthdate she confirms it - 84 frickin' years old. I start my head to toe assessment, chatting with her the whole time.

Apparently, she and her family wanted a fun day in the woods so they all grabbed their ATV's and headed for the hills. They all ride frequently and each of them have their own rig. All 15 of them. Granny was the oldest of the bunch - the matriarch of the family. She said she's been riding for years and it's great family fun for them. Her son and his wife, her grandson and his wife, her daughter and her husband, their 3 grown children, and 5 additional grandchildren (grown) all make up the crew. They tend to go on a trek about once a month, depending on work schedules.

This trip, Granny had decided she wanted to take a short cut down an embankment to beat the rest of the crew to the break spot. She said she's done it many times before without any trouble, but this time trouble was chasing her back. Somehow, her tire blew out and over she went. She tried to jump off, but her leg got caught under the rear tire as it rolled. This is when it broke. Then she tumbled the rest of the way, following her ATV as it went down the hill.

Her only major injury was her fractured tib/fib. That is it. A few bumps, bruises, and scrapes - but no other major injury. Let's hear a cheer for calcium supplements! This woman was amazing.

She was obviously in pain, but was so calm the entire time. We got her pain under control with some fentanyl and a little versed kicker for the road.

We had no ortho doc available, so we shipped her out to the nearest Level 2 trauma center. I was really sad to see her go as she was a lot of fun to take care of. I saw her about 6 months later in the grocery store in town. She was still doing physical therapy every couple of weeks, but was already back riding with her family.

"I just don't try any shortcuts anymore. I think I might be getting a little too old for that."

They're Coming Out of the Woodwork

When a teenager gets hurt and ends up in the ER, life as we know it changes. The world stops revolving, time stands still, and it seems like the end is never in sight. Why?

Because 10,000 of their friends show up in the waiting room and your nightmare has begun.

Where do these people come from? They seem to materialize out of thin air. One minute your waiting room has about 5 people in it, and the next time you walk by 20 minutes later it is filled to capacity. Apparently, the word got out. Cell phones are such a great aid to society, don't you think?

I understand that as a teen, your life revolves around your friends. I understand that having a friend hurt seems like the very end of your world (even if it is only a broken wrist from jumping off the top of the truck at the kegger last night). I was a teenager once too - shocking, I know. It wasn't even that long ago (quit snickering Jodee - I can hear you from here).

What I don't understand is why every single person from the high school thinks they need to be in the ER to "support" their friend. We're not going to let you all back to see them. We're not going to let you disrupt our flow. And we're certainly not going to let you have a party in the waiting room - so turn your damn music down and quit sneaking drinks off the flask in your pocket. We do have security here and we're not afraid to use them.

Sigh..........I sound like such an old granny. I know as a teenager I never would have been able to comprehend how my presence and the presence of multitudes of my friends could possibly make it harder for an ER to operate. But it does. I know now. And I am beginning to be irrationally irritated by anyone between the age of 13 and 19 who shows up at the triage desk. I know what's coming next - the entire high school. Followed by 4 hrs of comments such as "She's such a bitch - she won't let us back to see Sally Joe." "I know Susie Q! Gosh! I asked her for water and she told me to go lap it up out of the drainage ditch outside. What a whore."

After we've wasted hours sorting through the kids in the waiting room and finally getting them to leave, we finally find the little old lady in the corner of the lobby who's patiently been waiting for her turn at the triage desk. A little old lady with chest pain who turns out to be having an active MI. "Oh honey, it's OK," she says. "I know those kids were all worried about their friend. I'm not that important." The only people that are accompanying her are her husband and her neighbor.

Caught Red Handed

Yesterday I was at the nurse's station listening to Christmas music. I'm not such a big fan of the classic religious carols, I prefer non traditional music. "Baby It's Cold Outside" by Dean Martin, "All I Want For Christmas is You" by Mariah Carey, etc.

So there I am rocking out to Eartha Kitt's "Santa Baby", singing along and shaking my booty. I was at the medication cart getting some morphine for a patient, and had my back to the main hallway. I THOUGHT no one was there.

Oh how wrong I was.

I was in the middle of sashaying my ass down the med cart like it was a stripper pole when I heard a cough. I froze. I slowly turned around (still crouched halfway down the cart) with the morphine syringe in one hand and the plastic tube I just popped it out of in the other.

There stood the Chief of Staff for the ER and the CEO of the hospital.

"Having fun?" they asked

"Yes," I whispered.

"Keep it up Julie. It's nice to see someone having fun at work."

I heard their laughter as they exited through the double doors. Oh, the predicaments I get myself into.

Assume The Position

Virginia was back. When I saw her walk back from Triage I grabbed my Diet Coke, threw my chart on the counter, and yelled to Lucy "I'm going to lunch!"

It was a good lunch.

When I returned, Lucy was waiting for me in the hallway with her hands on her hips and the glare of death in her eyes.

"You did that on purpose!" she exclaimed.

"Huh? Wha? You talkin' to me?" I stuttered.

"You know exactly what I'm talking about! You did that on purpose! You owe me big time Miss High and Mighty, Shit On Your Coworkers Charge Nurse!"

It was at this point I could no longer contain my laughter, or my Diet Coke. The latter of which came spurting out my nose.

"What happened?" I giggled.

Lucy proceeded to tell me about her fun time with Miss Virginia. Apparently, Miss Virginia's symptoms had returned. She had gone out again with Mr. Bad Man and had forgotten to bring along some protection. Not only did she have another wonderful case of a mucous producing STD, but she had developed a nasty patch of genital warts around her rectum.

She also had gained 80 pounds.

Assessing the area around the rectum is not easy to do when someone is laying on their back. If they happen to be obese, it's not even easy to do if they are laying on their side. Hence, we tend to place them on all fours - hands and knees.

Lucy had Miss Virginia assume the position.







Lucy leaned down and gently opened Miss Virginia's buttocks to assess the area. She was greeted with the longest, loudest, "juiciest" (exact quote) fart she ever had the pleasure to experience.

"My face was RIGHT THERE!" she exclaimed with a horrified look on her face. "I SAW the warts wave in wind as she expelled her air," she said as she waved her arms around above her head in a circular motion.

I started laughing until I was snorting.

"Oh sweet peas on a pod.....giggle.....snort.....Are you......giggle, laugh, snort......serious?"

"YES! And I just didn't know what to say to her," she replied.

Pardon you, might be a good place to start.

I've Been Tagged

I was tagged by My Own Woman to reveal 7 things about myself. I already gave you a list of 17 earth shattering revelations here, but what the heck? If I can't think of something, I'll just make it up. That will leave you wondering, won't it?

OK, here goes.

1. I went to Mexican tonight and had a peach Margarita.

2. I hate snow. The first day is OK - when it's still all white, powdery, and fluffy like a towel. Then day two hits and it's frozen solid and slick as snot, probably a little muddy from the activity of the cars/people/animals/dog crap/etc. Then you fall through as you walk across it and the icy edges slice your skin and knick your artery and you lay on the ground shivering and bleeding to death cause you can no longer walk. Yeah - don't you just loooooove snow?

3. I might be a little off my rocker.

4. I love old wooden boxes. Cigar boxes, storage boxes, decorative boxes. Any of them. As long as they are made out of wood.

5. I love scars. Loooooooooooooooove them. Adore them. Each one tells a story.

6. Stupid people annoy me. I mean seriously, who doesn't know that if your patient's blood pressure is 68/42 you MIGHT want to do something about it?

7. ER on NBC annoys me. But I can't stop watching it. It's my addiction. My heroin. My crack. My 12 year downward spiral into alcoholism. I watch it in secret. I watch it alone. Yes, my name is Julie and I am an ER addict.


Off to tag 7 other people. Hmmmm, I'm not sure I know 7 other people.

Syncopal Synopsis

Lucy's orientation did not start well. I thought for sure she was going to have to find another field to work in. Nursing just was not her cup of tea. Why, you ask? Well, since you inquired so nicely, I will tell you. I just love it when you ask nicely - so polite. Your parents raised you well. You know, I knew this kid one time who .............

Oh, whoops. Sorry. Got distracted there. I hate it when that happens. You start thinking of one story and then some little niblet of a memory starts waving from the sidelines and you follow it for a few moments and then all of a sudden you're at band camp.

Amazing how that happens.

So, anyway......................Lucy's first day was a comical montage of her hitting the floor. Yes, she passed out 3 times. You'd think she'd never done clinicals before. But oooooohhhhh noooooooo. She had. I don't know how she made it through nursing school. Come to think of it, there were some rumors of her paying off the instructors. Something about a big inheritance and her grandpa being the heir to some donut chain. Naw - couldn't be true. Not my little Lucy.

Our first incident began with a laceration. Not a large, gory, profusely bleeding laceration. Just a tiny, little, 4 inch cut from a steak knife. Our patient was sitting on the gurney when I removed his dish towel, observed an arterial spurt, and heard Lucy hit the floor. She took the mayo stand with her. All my sterile 4X4's were now scattered across the exam room floor. I looked at her briefly to make sure she was still breathing, then proceeded to wash out the patient's wound.

"Is she OK?" he asked.

"Yeah, she'll be fine. Don't worry about her," I said as I stepped over her sprawled out body. "Let me just get this irrigation tubing for washing out your wound."

"Um...........OK."

Her second incident came when Mr. Oldfart came in with an active GI bleed. Now granted, GI bleeds make me want to pass out just so I don't have to take care of them, but really - is the smell of rotting intestines mixed with blood really so bad?

HELL YES!

I would much rather smell a rotting dead body any day, than to have my nose anywhere near the tail end of a GI bleed. Lord almighty - the stench is enough to make you want to give yourself a "swirly" in the toilet just to wash out your nasal passages. At least this time she had the courtesy to make it out of the room before she hit the floor. She was weaving a bit on her way out, but I soon heard the other staff laughing and stepping over her so I knew all was well.

Poor little Lucy was absolutely mortified.

"I haven't eaten today. That must be why," she said.

Uh huh. Sure.

"I think my blood sugar may be low."

"Are you a diabetic?"

"No, but that must be why."

(insert eye roll here)

2 hours before the end of our shift, staffing called for an extra nurse in OR to receive for a C Section. I had experience in this area, so I decided I'd go and take Lucy with me to give her a break from the ER. I thought it would be a safe area. I thought seeing a baby would be a good thing.

Wrong.

We gowned up for the OR and took our places near the respiratory therapist who was standing next to the infant warmer. We visited for a few minutes and received a report from the circulator regarding the patient's history. Then the doctors began their incision. And Lucy looked.

Yes, she looked. I know what you're thinking. I thought it too. "No, Lucy! No! Don't look at the blood!"

She did.

And down she went.

Sigh.................

I told her maybe she shouldn't come back the next day. She did.

Last week I watched her step over her new orientee as they sat against the wall - pale faced, sweating, and vomiting into an emesis bag. I raised my eyebrows and glanced at Lucy.

"GI Bleed," she said.

Ah yes. Good times.

How To Tell If I've Had A Busy Day

There is a direct relationship between the number of pens in my hair and how busy I was during my shift.


I tend to "pocket" pens in my hair and forget they are there. It's a handy place to store them. You just take the chance of looking like peacock by the end of your shift if it's a busy one.

Oh - and I see I need another trip to my stylist for a fresh color.

AHA! My Evil Plan Is Working

Someone googled "why can't you shock asystole" and it gave them my blog as a link.

Mission accomplished (well, almost).

Maybe it was the producers from ER? What do think the chances of that are?

I know, I know. Highly unlikely. Since they'll probably continue to shock asystole for the duration of their run on TV. Sigh.....................

Overhead at the Payphone

So I was walking out of work the other night and overheard some guy on the payphone in the lobby.

"Listen Bitch. I need my pipe now. NOW DAMNIT! You have to reach through the cut in the seam of the seat and get it out of the stuffing."

I bet it wasn't Turkey he was stuffing. Or smoking.

Just sayin'....................

Working With the Bottom 1% of the Class

Dr. Dumbshit came in to work a weekend shift as a locum. It took me about 15 minutes to figure out Dr. Dumbshit was an accurate representation of his name.

I know that medicine is not an exact science. Being in the medical field gives me a behind the scenes perspective that the general public does not have. When most people complain about a doctor being an ass, a dumbshit, or a sanctimonious piece of crap - I usually just nod and smile, thinking the whole time, "Yeah, okay. Sure, that's your perception." But oh let me tell you - I would agree 110% with them on this one. I think that he may have opened up every medical journal and textbook in sight and said, "Ah...nah....they're not right. I'll do it the opposite way."

EMS brought us 2 victims from an SUV rollover. The 16 year old girl had been sleeping in the backseat and was partially ejected out the side window. Her upper body was in the rig, and her legs were trapped under it as it came to rest on it's side. Luckily, it landed in a ditch so there was a little "give" room under her legs. She still ended up with an obviously deformed left thigh.

Dr. Dumbshit and I prepared for her arrival in Trauma 2. I put the blue handled Xray pad on the stretcher in anticipation of getting her off the backboard ASAP, and still providing a somehwhat stable environment for transfers to CT scan, etc.

"Why are you doing that? Get that thing off of there!" Dr. Dumbshit yelled. Yes, yelled. Our very first interaction and my first thought was 'he has a lump of coal up his ass that may already be turning into a diamond.'

"Um......I'm preparing the stretcher for our trauma patient. This is standard for when we get them off the backboard."

"They better not be on a backboard. There's no reason for it," he replied.

HELLO? Seriously? This was an unrestrained backseat passenger in a rollover crash who was partially ejected. If they didn't require immobilization then I'd eat my cousin's dirty underwear.

"Trauma Standards of Care indicate they should be immobilized. And they will be, because our EMS crew is excellent in the care they provide."

Just as ended my sentence, Medic 1 rolled in with our IMMOBILIZED and splinted patient. God love 'em.

Dr. Dumbshit stomped his foot and yelled, "WHY IS THIS PATIENT IMMOBILIZED? NOW I HAVE TO SCAN THEM!"

Sweet shit on a stick. Seriously, this man was on the verge of a breakdown. The spittle was flying and the veins were bulging on his forehead. I pulled Lucy to the side and told her to go find Dr. Q quickly. Unfortunately, Dr. Q was busy with the patient's mother who was in the other room.

As our patient was screaming in pain, Dr. Dumbshit decided to start his trauma survey focusing on her leg. Yes, he skipped A, B, C, D, E, F, and G and went right to her leg. He started poking and prodding and attempted to take the spider straps off of her. Medic 1 and I both reached down and refastened the straps immediately.

"Dr. Dumbshit, do you think you might want to start with the primary assessment?"

Damn it all, he was messing up our flow. Trauma's are meant to be run in a very particular order. When you follow that order, things flow smoothly. You don't miss anything that needs addressed first, and you don't focus on something that does not matter at that particular moment.

"Nurse Crazy Pants, I can see that her leg is probably broken, so why don't I just start with that? Hmmmmmmmmm?"

"Well Dr. Dumbshit, maybe you might want to start with Airway, Breathing, and Circulation since I think she might have a pneumo. Her breath sounds are decreased on the left and she's having some difficulty breathing." Then I whispered under my breath "stupid idiot."

"WHAT DID YOU SAY?" he yelled.

"I said 'Sure, I'll get it'" handing Medic 1 a needle for a possible decompression.

"Oh, well, OK. Sure, let's do that. Yeah. Maybe we need a stat Xray too."

"Coming through!" Our blessed radiology tech shouted and pushed into the room with his portable machine.

"Yep, I already put the order through for that Dr. Dumbshit," I replied.

Luckily, the Xray revealed a minor pneumo. A little oxygen and she was good to go. We didn't have to intervene immediately with something more serious. Her IV lines were started by EMS in the field and fluids were infusing, so we didn't have to worry about that at the moment either. Her vitals were somewhat stable and we completed the rest of her trauma assessment. The splint was still on her leg and providing stabilization there. No increase in swelling noted, pulses palpable and strong. Cap refill brisk.

"OK, let's check her back." Dr. Dumbshit said as he threw off her straps faster than I could cross the room and started to roll her.

"STOP!" I yelled.

"Huh? What?" he said.

"Dr. Dumbshit, we need to do a log roll on her. Let me get 3 other people to help."

"Ah no, we can do it ourselves. She'll cooperate - won't ya Betty Lou?"

"No. You will not roll her without doing it right. Stop right now until I get additional staff." I pushed myself between him and the patient.

"All right, whatever Nurse Crazy Pants. Have it your way."

"Thank you," I replied. Stupid Idiot.

"What did you say?" Oops! did I say that part out loud?

"Um, I said um.... I'm stepping in it. You know - the blood on the floor."

"Harumph," he replied.

Dr. Dumbshit and I then had a professional disagreement about what to scan on her. He felt nothing. I felt maybe stem to stern related to her mechanism of injury. I won. Only because he got tired of me not backing down. But seriously, are we giving good trauma care here or are we just trying to protect the patient from unneeded radiation? Which takes precedence? I would think life saving interventions and the complete CT scan would help us there.

Upon her return from CT scan, Dr. Q made his way into the room. A brief update to him on the occurrences of the last 20 minutes enabled him to send Dr. Dumbshit to the fast track area of the ER while Dr. Q assumed care of the trauma patients.

Thank you blessed baby Jesus!

We ended up shipping the patient out to a larger facility to surgically repair her femur fracture. She did very well and after rehab was back to her normal self.

I never saw Dr. Dumbshit again.

Marriage Proposals

Bill comes in frequently to our ER. He likes his whiskey. He likes it a lot. What he doesn't like so much is getting a visit from our local law enforcement when he's above a .234. He doesn't like that at all.

Bill usually arrives with multiple cuts, abrasions, bruises, and occasionally a broken bone or two. He may even have some taser marks in his back. Bill is not so nice to the cops.

But he loooooooooves me. He never remembers me, but he certainly falls in love with me every time he comes to the ER.

"Will you marry meeeeeeeee?" he asks.

"Now Bill, you know I can't do that. What would all my other boyfriends say? They'd be so angry with you."

"Pleeeeeeeeeeeeeeeeeeeze?"

"No Bill."

"How come I've never seen you before? Are you new here?" he asks.

"Bill you see me every couple of months."

"I do?"

"Yup," I reply as I apply the B/P cuff and start cleaning up his cuts.

"Are you sure? I'm certain I've never seen you before. I'd remember those pretty eyes." He always reaches for my........um.......hands at about this time. I do a little 2 step with a samba flair to the side of stretcher and get out of his reach.

"Bill - keep your hands to yourself. I need to get you cleaned up."

"Okay. But will you marry me? Pretty please?"

This is about the time he vomits. Usually on my shoes. Eventually I'll get my timing down on that one too.

Searching Me Out

So I took the time to explore my stats on who is visiting my page and how they got here. Guess what I found?

Google Search Terms:

"my back hurts how do i get a dr to give me vicodin"

"head nurse porn"

"stories hogtied gay"


Doesn't that just say it all folks? I've got drug addicted, porn loving fans who like to get tied up. I LOVE IT!

For Meadow - When the Eagle Won

Bikers tend to love our county. Long, deserted highways stretch for miles and miles. Flat pavement, views of the entire county, wide open spaces - it must be appealing. The summer months bring us more bikers than you could imagine.

Which presents a problem.

Motorcycles and animals do not mix well.

Now I have multiple stories of big bad trauma cases involving motorcycles and deer, cows, or horses, but after the last sad blog entry it's time for some humor. And can I just say that a motorcycle and an eagle make for a hilarious story?

Veronica was on a solo ride across the state. She needed a break from her husband and incessantly whining kids, so she hopped on her Harley and took off. She called them 2 hours after leaving and said "Don't expect me home sooner than next week. Cook your own damn dinner." I liked Veronica immediately when she told me this.

It was a Wednesday afternoon when the EMS tones went out. "Medic 1, please respond to a motorcycle vs. animal crash on Hwy 116 at mile marker 148. Victim alert and responsive. Complains of facial cuts and neck pain."

"Here we go again," I thought. I checked the trauma bay, made sure everything was stocked. I called Lucy to be my second nurse. "But I'm on lunch," she replied.

Because it's so much more important to eat than take care of a patient.

I dragged Lucy's ass into the trauma bay and we waited for the arrival of Medic 1. A couple of minutes later State Trooper Smith walked through the ambulance bay shaking his head and laughing.

"What's up, Smith?" Lucy asked.

"You guys shoulda seen it. Oh my god." Laugh, snort, giggle. "Oh hell man. I was right behind her when it happened. I've never laughed so hard in my life."

"What? What happened??"

Trooper Smith proceeded to tell us the story. Apparently Miss Veronica was enjoying a nice leisurely drive through the country when an eagle decided he wanted a ride too. The eagle flew right in front of Veronica and slammed into her chest, which apparently was not exactly how it wanted to land.

"Oh man, shit was flying everywhere! Feathers, arms - oh hell." More laughter. By now Trooper Smith was crying.

Veronica didn't enjoy having the eagle on her chest so she started trying to pull it off with one hand, while slowing the bike and steering it into the ditch with the other. The eagle became mighty pissed that she would even (gasp) DARE to touch him, so he gave her a piece of his mind. Talons slashing, wings flapping - the fight was on.

Veronica dumped her bike in the ditch and rolled off with the eagle now attached to her head.

Laughing and snorting, Trooper Smith said, "She.....she......was.....giggle...heehee......she was trying to pull..........heehee.......the eagle off.......snort......and......he was clutched onto her........laugh, giggle........head.....and wouldn't let.....giggle......go." He was now bent over with his hands on his knees laughing uncontrollably. I thought we were going to have to give him a sedative.

Lucy and I were laughing along with Smith. It's hard not to when someone is bent over, crying and snorting with laughter. That's one damn funny sight. Especially when they are in a police uniform.

Just about then, EMS rolled up with the patient. As they brought her into the bay, she heard Trooper Smith's laughter.

"Oh great! You told them didn't you?" She shouted.

He was trying his best to compose himself, but every time he looked at her he burst out laughing again.

"Yeah, Yeah. Whatever. I'm sure it was fucking funny watching it happen. It wasn't so funny for me though," she said. Then she started to giggle. "OK, maybe it was."

Veronica filled me in on the rest of the story. She was screaming, and trying to rip the eagle off her head - not realizing she was actually holding the eagle in place as he was trying to fly away. This pissed the eagle off and he started scratching her and flapping his wings harder. Feathers were flying everywhere, the eagle was screeching, blood was flying from her face, and the trooper was yelling at her to let the damn eagle go.

"I finally let him go and he flew off." And this is when Trooper Smith started laughing at her. "He couldn't stop. He tried to pull it together and be professional, but he kept snorting and giggling."

"She had feathers.........stuck on her face," Trooper Smith piped up from the back of the room. More laughter.

The EMS crew had cleaned Veronica up for us. She had multiple cuts on her face, but none were too bad. A few would leave scars, but she was otherwise extremely lucky. Her neck pain turned out to be nothing.

She was more pissed off about the fact that she had to dump her bike in the ditch and it got scratched up. "I just bought that thing 6 months ago. Damn it!"

We gave her a few stitches, bandaged up what we could, and sent her back out with Trooper Smith to her bike.

"I'm not going home now. I have more riding to do."

Please Let Me Go

He lost his wife to cancer 4 months before, his precious Betty Sue to whom he had been married for 40 years. He began drinking the day of her funeral and hadn't stopped. One Sunday evening, he decided he had had enough and wanted to join Betty Sue. So he drove himself in front of a semi truck.

He was still alive.

He was still conscious.

The trauma team was ready, the flow went smooth. Our patient ended up with a left chest tube, lacerated spleen, a tear in his intestines, pelvic fracture, a femur fracture, bilateral forearm fractures, and a minor closed head injury. Before we intubated him for his emergent trip to OR1, he kept screaming "Let me die! Let me die!" He was sobbing and saying he wanted to be with Betty Sue.

His son arrived just before we were planning intubation. "Steve - tell them to let me die! I need to be with your mom. Please! Please!" His son was crying and shaking. "No Dad, I can't. I can't lose you too."

"Please Steve, please let me go," his dad replied.

"Damn it Dad! No! Stay with me! I need you here!" Steve yelled at him.

His Dad turned his head away from him and refused to speak again. He was crying the whole time. As our physician explained to the patient what we were going to do (intubate, OR, etc), he made no indication that he was listening. He just cried.

This man was 60 years old and had the potential of many more years of life. The stress of the situation could have been warping his view of what he wanted. The head injury could be doing it too. He wanted to die, but only to be with his deceased wife. What ethical road do we take here?

The gentleman ended up in ICU for 6 days. The entire time in ICU he was asking the nurses to let him go. Telling them he wanted to die. He had multiple consults with psych/mental health/social workers to no avail. He was still determined that he wanted to die. He refused to speak with his son or any other family members.

On day 7 he was transferred to the Surgical Trauma floor where he promptly coded 35 minutes after arrival. They worked on him for 40 minutes before they called time of death. Many of us have often wondered if he did something to assist his death since he was no longer under 1:1 observation. He was so determined to die.

This was one of the saddest cases I've been involved in. He had sunk so deep into his depression after the death of his wife that he couldn't even reach the edge of rational thought. How do you fight something like that? I think when someone has made a decision to commit suicide in a large manner (driving in front of a semi truck, shooting self in head, etc), there is no turning them back. He was intent on joining Betty Sue, and he eventually did.

Undiscovered Country

Mr. Ben Dover came in with complaints of a delicate nature. I settled him onto the stretcher in Triage and asked how I could help him today. "Well, Miss. I have a problem near my, um, near my.............rectum," he whispered. He was blushing redder than a desert sky at sunset.

"OK, Mr. Dover. What seems to be the problem?"

"Well, it's, um, it's draining some, um, weird stuff."

Weird stuff, huh? Weird like grape juice? Ketchup? What the hell could be weird that comes out of your body?

"Mr. Dover, can I take a look?"

GASP!

"NO YOU MAY NOT!"

"Well, we can't very well treat you if you won't let us see it."

He was mortified that I had even asked to look at his rectum. Mr. Dover was a 28 year old male who had never seen a physician before. I almost think he'd never seen a girl before.

After about 10 minutes of educating the patient on the reason I needed to see the wound and the professionalism with which I would observe it, he finally gave in. I gave him a sheet to cover with and asked him to roll onto his side after undressing from the waist down. Once he was positioned properly, I opened his buttocks and observed the wound.

Sweet Boil on a stove! He had a large wound next to his rectum that was draining very foul smelling pus. Thick yellow/green pus.

"Did you injure yourself here or did this appear on it's own?" I asked.

He didn't answer.

I repeated myself and he said, "I'd prefer to talk to the doctor."

Sure thing. I'm not sure I wanted to know the answer anyway. I notified Dr Q of the patient's arrival and chief complaint. Dr. Q went in to examine him. It turned out that the patient had squatted to take a dump while he was camping in the woods and stabbed himself on a stick. He was too mortified to seek help for it and let it fester for a week or so until he could no longer sit down. Dr. Q did a quick I&D, started him on antibiotics, and sent him on his way.

Another day in the life of the ER.

Mental Health

My bipolar schizophrenic frequent flyer is back. It's been 6 months of stability, so she quit taking her medications. Last week she started coming into the ER 5 or 6 times a day requesting to be seen for problems such as "I need my pill box filled," "I have a sore on my toe," "I need a shower," and "I need something to eat." She refuses mental health services and the system deems she is still competent to make her own decisions.

These types of patients are so hard to deal with. It is not their fault they behave like they do. They don't really have control over it. Yet I still get angry when she has interrupted my care on a much sicker patient for the 4th or 5th time to request something simple. The sad thing is that one day she will come in and truly be in a crisis and nobody will believe her.

She has learned not to come in when I am working now. I don't give her anything she wants. She gets her MSE and then I discharge her immediately. By the end of last week she started calling first and asking if I was working. If I was, she stayed away. I like that little arrangement.

Eventually one of her neighbors will call her daughter and she will come up and start making her take her medicine again. She'll stay on her meds for about 6 months and then we'll start all over.

Our state has cut many of the services for the mentally ill. This means more untreated patients clogging up the medical side of the system for mental health needs. It's a vicious cycle, and it is extremely frustrating to deal with on a daily basis in the ER. I don't have any answers for it, other than increase funding again. I hate politics - I usually don't get involved in political arguments or discussions at all. But this issue is really starting to irritate me. Another contributing factor to ER over crowding.

ER on NBC (and again)

Sigh..........................................


Hmmmmmmmmmmm.


Well, what can I say? This week's episode focused so much around personal storylines, there wasn't really a lot of medical intervention for me to rip apart.

Who didn't see the Congestive Heart Failure looming on the horizon with the baby the instant they mentioned fussy/crying with feedings? Of course it's easy sitting in the recliner at home evaluating what you know will happen related to dramatic license versus having a real patient in the ER that is exhibiting signs of "colic." Most infants would be sent home and told to follow up with their primary PCP, just like Pratt was trying to do. Very interesting.

I actually laughed out loud when Morris started doing "the bicycle" on the stretcher with his arms and legs to prove he didn't have a spinal injury. That was priceless. I haven't had a patient do that yet, but I'm still waiting. Now, ripping of the C-collar? Absolutely. Usually the patient is drunk, high, or both. "Collar? I don't need no stinking collar!"

Sam's little environmental engineer guy is a hottie!

That is all.

Face Up, Flat On My Back

We all have them. Embarrassing moments, that is. I try to remind myself of that every time I think of the following story. I try to tell myself that I am not the only nurse who has made a complete and total ass of herself in front of a patient. There are others.................right? Please tell me I"m right.

Mrs. Fever For 5 Days came into the ER on a Sunday night. She told me during triage that she had been feeling poorly for the last week - fever, cough, rash, body aches, etc. I escorted her back to the Gyne Room as it was the only room free, and laid her on the stretcher (for those of you that don't know, some stretchers have pegs on the end of them that you hook stirrups to so you can do a pelvic exam). Mistake number one.

Her husband came in with her and took a seat in the chair against the back wall of the exam room. I remember he was wearing a gray Tshirt with a black zip up jacket that had a deer embroidered on the front. Now every time I look at a Cabela's catalog I think of this damn story. I wonder if I could claim PTSD?

I turned and grabbed a clipboard off of the counter and walked over to the foot of the stretcher. While obtaining her medical history, I raised my foot and rested it on the end of the stretcher using my thigh as a table for the clipboard. Mistake number two. On this particular day I had chosen to wear a new set of scrubs. A set that was a wee bit big for me. Mistake number three.

Can I just say that when you get a new set of scrubs, hem them up before you wear them to work? Not a week later. Not a day later. BEFORE.

Can you picture what's coming yet? Uh-huh.

After getting all the information from her, I started to turn back towards the counter and take my foot off the stretcher. Remember those pegs on the end of the stretchers that I told you about earlier? Uh....yeah. As I turned, my foot went over the peg, but my scrub pants didn't. The hem was about 2 inches too long and hooked onto the edge of the peg. I felt it catch and hopped back around to face it on one leg, which in turn twisted the fabric around that little sucker. I started to lose my balance - and I was gonna go over hard.

I dropped the clipboard and started waving my arms around frantically, trying to catch my balance. "Oh, oh, oh , oh, oh,.....ahhhh," I said (or screamed - who knows). I did a little improvised samba with my ass trying to stay upright. I could see the patient trying to sit up on the stretcher and reach out to help me.

I finally lost the fight. I toppled like a tower and landed face up, flat on my back with my leg still up in the air - scrubs tangled on that damn peg on the stretcher. My head smacked the floor and I swear to all that is holy that I saw stars and chickens dancing above me. I groaned a little and mentally calculated my potential injuries.

The patient's husband came flying out of the chair as the patient finally got upright on the stretcher. "OH MY GOD! DO YOU NEED A NURSE?" she shouted.

Then I started to giggle.

And snort.

And laugh so damn hard that I almost peed my pants. Only then did they join in too.

Trying to untangled yourself from a stretcher while you are laughing so hard you are crying is no easy task. Your body is shaking so much that you can't get your fingers to work right. Then you just start tugging. Tugging as hard as you can, laughing, snorting, crying. It was not a pretty sight, let me tell you.

I tugged on my pants so hard that I ripped them up the leg's inner seam. They came off that damn peg, but the cooling breeze I was receiving up to my inner thigh was not nearly as refreshing as I thought it would be. This just made me laugh more.

Lucy came in to see what all the commotion was about, took one look at me, and spit the water she had been drinking across the floor. Oh yes, it was a shining moment in my nursing career.

My patient did thank me with a card a week later.

Dear Nurse Julie,

Thank you so much for making a miserable experience so much more enjoyable. I don't think I've ever laughed that hard when I was felt like dying. You truly made a crappy experience tolerable.

Signed,
Mrs. Fever For 5 Days

ER on NBC

You will all be happy to know that I missed Thursday night's episode. I have no scathing critique to offer the masses.

Damn it.

For Jodee

He walked in with 2 nails sticking through his left hand, holding a bag of chips. And he was laughing. "Duuuuuuuude!" he giggled. "Look what I did." Snort, giggle, laugh.

Interesting.

"Sir, please take a seat on the stretcher. Can you hand me the bag of chips?"

"Why? You got the munchies too? HeeHeeHee." He giggled like a little school girl. I couldn't help but laugh. "See? You DO have the munchies!" he said as I chuckled.

"Sir, hand over the chips. I need to see your hand."

"Oh sure. Just save 'em for me - I'm still hungry." He tossed them at me.

I set the chips on the counter and grabbed his hand. The nails were about a quarter of an inch apart, embedded directly through his hand. The head of the nails were on the top side of his hands. "What did you do?" I asked him.

More laughter. A few snorts. "Ah man - it was classic. Nail gun wars! Wheeeeee!"

Seriously? Yes. By this time I was laughing as much as him. He was high as a kite and seriously thought that having 2 nails stuck through his hand was the funniest thing he'd seen in 3 months, 2 weeks, and 17 days (exact quote).

One might wonder what happened 3 months, 2 weeks, and 17 days previous. I didn't even want to ask. Unfortunately I did (morbid curiosity kills me at times). That happened to be the moment he felt he could ride his dirtbike through a couple of trees that were about 30 inches apart. He didn't make it - but his bike did.

It was a very slow afternoon so I sat there and chatted with him while we waited for Xray. He told me he and his buddies had been getting high in his shop he was building, when one of them pulled a nail gun off the top of the compressor and started shooting at people. He abruptly stopped his story, looked at me sideways and said "You ain't gonna tell the cops are ya?" I assured him I wasn't going to release that information and got a high five from him. "You're cool as shit," he said.

Actually, shit is kinda warm so I don't know that it was truly a compliment.

He went on to tell me that everyone started running out of the shop except him. He grabbed another nail gun and started firing back. "Dude! I jumped and rolled over the stacked lumber and fired at him backwards. It was fucking amazing! Just like the movies." Unfortunately, he put his other hand up in front of him to block of the onslaught of nails coming at him. Those nails fell short, but he fired 2 beautiful ones right into the back of his hand. "That there's just funny," he snorted.

Why couldn't all my patients be this entertaining?

He started to tell me about all the other times he has injured himself. They all involved doing something with his buddies, and usually a substance or two. I asked him if he thought maybe not getting high every time would keep him a bit safer. "What good is life if you can't have fun?" he said. "Why would I want to sit on my ass doing nothing when I could be jumping my dirtbike (broken ankle), rolling my truck (broken arm), jumping off my roof (leg impaled on rebar), or wrestling with my friends (broken nose, broken finger)?" He kind of had a point.

Xray came and took him for his pictures. The only injury he had was to one tendon which would limit his mobility in his middle finger. That was the icing on the cake for him. He was laughing so hard he was crying. "You mean I won't be able to bend my birdie down? I'll always be flipping people off? That's fucking cool!"

Dr. Q tried to explain that it wasn't as nifty as the patient thought it was. Dr. Q has no sense of humor.

"Yeah, whatever man," the patient replied. "I gotta go tell my friends!" He jumped off the stretcher, slapped me on the back as he walked out of the room and said, "You rock Nurse Julie. I'm gonna tell all my friends to come see you."

As soon as I got the air back in my lungs I gasped, "Gee, thanks." I threw his bag of chips back at him and he caught them in his other hand and held them high above his head as he sauntered down the hall. "See ya Duuuuude!" he called.

Another Day, Another Dollar

I really get pissed off when I hear nurses complaining about the money they make. "I don't make nearly enough money to put up with this crap." "I didn't go to school to make this shitty wage."

You cannot place a dollar amount on nursing. It is part of your soul, not part of your bank account. If I placed a dollar amount on everything I do as a woman, I'd be a hell of a lot richer than I am right now. My farts would even be worth money. I'm just not saying how much.

The other day, Negative Nelly was standing around the nursing station spewing her poison. "This is bullshit! I need more money to do this job. I should just quit. Do you know how much doctors make? And we spend more time with the patients. And the patients are assholes." I continued to stack charts in the back corner and just rolled my eyes.

"I'm serious! We don't have to put up with this. I could find another job like that," she said as she snapped her finger.

Sigh............... I slowly turned around, physically holding my tongue between my teeth.

"What? You don't agree?" She popped her gum and gestured her index finger at me.

"Nope," I replied as I set the charts in my hands back on the counter. I walked toward her as I wrapped my stethoscope around my neck. "Nope, I don't."

"Hmph" she said.

"I think I make plenty of money," I replied. "I think you make plenty of money. Our job is not all that hard. Yes, there are times when we are crazy busy and we think the world is falling apart. Yes, there are times when someone's life hangs in our hands. But you know what? There are plenty of people out there who work a hell of a lot harder than us. There are people that come home utterly exhausted, full of dirt and grime and bitterness - people who performed hard physical labor for hours straight without so much as a break. There are people who have gone to college for double the amount of time we have, yet make 1/2 our wages. How about the people that spend months away from their loved ones doing some horribly dangerous job and come home to piles of bills and wondering why they ever even work in the first place. There are people who.....................You know what? If you don't like your job and the money you make, then why don't you find another one?"

Where the hell did that come from?

They were all staring at me like I had 2 heads - one of which was spewing pus from it's mouth.

"I'm sorry," I said. "I just think it's so sad that nurses complain about the money we make when there are tons of people who wish they had our job and made the money we do."

Holy Soapbox Batman! I'm climbing down now!

Seriously though, I do get perturbed (that word looks so strange)about that. How many other careers in this world can you have a STARTING wage close to or at $30.00/hr? Not very many. And we're complaining? Sure we have to deal with combative patients, patients covered in feces, or even those that are dying in front of us. How can you put a price tag on that? You can't. Do we need to? If you are in nursing only to make a buck, you are in the wrong field.

ER on NBC once again.

Can I just say that after you shock someone out of Vtach, you should at least pretend to check if they have a pulse with their new rhythm? Oh - and an airway.


That is all.

It Was a Long, Long Night

I worked a 21 hour shift the other day. Short staffing does wonders for my soul. It makes me grouchy, pissy, mentally unstable, and slightly unsafe. But hey - what's an ER without a nurse like that?

I started the day with the worst epistaxis patient I had ever seen in my life (for those not in the know, epistaxis is a nose bleed). This man was seriously HEMORRHAGING out his nose - arterial spurting and everything. Can I just say now that I don't mind blood? Not at all. I can handle blood from any human or animal, any orifice, anytime. But this set off my gag reflex like nothing before. He had blood spurting out of his nose, running out of his mouth, completely covering his shirt and pooling in his lap. It had even coagulated in a big pile of blood clots in his lap.

Lucy was the primary RN on his case. She pulled him back to the ENT room and attempted to place a clamp on his nose while we paged the physician. Um............didn't work. The man was holding his mouth open over an emesis bag and it was slowly filling up with blood. He had 200 cc in the bag in the first five minutes.

Stat IV started with trauma tubing for blood infusion, stat page to MD, CRNA, and RT. We weren't quite sure about maintaining this man's airway.

I looked to my left and saw Lucy standing in the corner with a mask over her face - just staring at the patient. "Lucy!" I said. She jerked like she'd been slapped. "Huh?" she replied.

"I need your help over here."

"Oh, yeah. Yeah. Sorry." She ran over to help and started a second IV. She then became Miss Queen Bossy Pants.

"Send a rainbow to lab, get the difficult airway cart, check his B/P again, CHECK IT AGAIN! GRAB THE SUCTION AND GET ME THE DAMN DOCTOR!" she progressively got louder as she railed at me.

Well, allrighty then - I thought. Lucy's gettin' her big girl pants on. Good for her.

It turns out the patient had recently had surgery for cancer inside his nose. The ENT specialist had completely re-worked his anatomy inside his nose and nothing was where it should have been. Dr. Q came in to see the patient, took one look inside his nose as we suctioned him out, and said "Send him out!" He couldn't even attempt cautery because the anatomy was so different he wasn't sure what he would be cauterizing. We packed the nares with nasal tampons, which held the bleeding off for about 5 minutes. Then the dam burst loose again. He repacked with regular packing which helped enough to get him into the ambulance and sent off down the road with a couple units of blood infusing.

Before Mr. Epistaxis was even out the door, my first chest pain of the day walked in. He was clutching his chest, pale, cool, diaphoretic. "I feel like someone is sitting on my chest," he said. Oh shit. Seriously? I haven't even called report to the receiving hospital for Mr. Epistaxis. Ah well, gotta keep moving.

Mr. Chest Pain is escorted to the cardiac bay and placed on a monitor. Oxygen applied, EKG done, IV started X 2, Nitro given, blood sent to lab, and portable chest Xray performed. 45 minutes later we transferred him out to the Cardiac Center.

I cleaned the Cardiac bay and thought "I'm a bit hungry, think I'll take my lunch now." I turned to walk out the door and was met by a man holding a bloody towel over his hand. "Can you help me with this?" he said. I should have just told him no, that I was going to lunch.

He removed the towel. I blinked. I blinked again. He had no hand. What he did have was a bloody stump with a mangled mash of flesh and bone on top of it. He had gotten in a little altercation with a table saw. The table saw won.

I saw a few more patients with broken bones, fevers, abdominal pain, and another chest pain or two. I went to dinner (my first meal of the day) around 6 PM. Then all hell broke loose.

"Julie, we have someone in triage you need to bring back."

Let's just pause here to say........well, I don't know what but let's just pause a moment. Sometimes you just need a break. Sometimes you should turn around and walk out the back door before you see what's on the other side of the front door.

It started simple enough. I walked out to triage and saw a man sitting in a wheelchair with 2 police officers in attendance. Not an unusual sight, but enough of one to make you go 'hmmmmm....." The man was holding his head and telling me how nauseated he was. The left side of his face was swollen and deformed. His left ear was hugely swollen and bruised and he had bruising behind his ear extending down the side of his head and neck. The bruising was slightly difficult to see through all his tattoos, but it was there none the less.

Mr. HeadInjuryMan was taken to exam 2. Neuro assessment revealed pupils equal and reactive, though slightly sluggish. Oriented X 3 but becoming progressively lethargic. I hooked him up to the monitor, turned around to talk to him and he was not responding. Shit. "Mr. HeadInjury, Mr. HeadInjury..." I called. No response. Airway? Check. Breathing? Check. Pulse? Check. Brisk sternal rub........ "What the fuck are you doing to me???!!!" he yelled. Sigh.......good. He's still in there somewhere.

Dr. Q came to evaluate ("I think I feel a depression here") and ordered a head CT. I called the Paramedic on duty to go with him as I couldn't leave the ER. The officers had disappeared somewhere in the middle of all this. The story I got from the wife is that her son came home drunk and got pissed off at her, but decided to beat up his dad instead. His dad was sleeping in the recliner when Mr. Dandy Son decided Daddy's head needed a little lesson authority. Wonder what Freud would think of that one - son pissed at mom so beats dad's head in.

The whole time Mr. Head Injury is in CT, his wife is on the phone telling the entire town what has happened. She's calling everyone looking for her son, threatening to kill him if she ever sees him again. Then she says "He took all of our medicines with him and I think he might OD on them." Oh reeeeeeaaally? At that exact moment, the EMS tones go off.

"Medic 1, please stand by at East Park per police request. Received report of male who has OD'd on multiple pharmaceuticals and police are trying to find him in the park."

Wonderful.

I needed to pee.

Mr. HeadInjury returns from CT scan with a negative read. Thank the Lord. We hold him in ER until a bed opens up. Neuro checks every 30 minutes, frequent airway checks. He's vomiting all over the place and telling me "If you don't fucking take care of this pain in my head I'm leaving." Um, yeah.....go ahead. I'd like to see you walk out of here.

Here's a little saline for your pain.

OK, not really. I did give him the morphine. Eventually.

While I'm waiting for the ambulance, I get another patient from triage. Miss Alcoholic complaining of abdominal pain. She hasn't eaten for 3 days, has been vomiting the whole time, and has an alcohol level of .350. And she smells just peachy.

After about 20 minutes my phone rings. "ER, this is Julie."

"Julie? It's Jimbo from Medic 1. They found the OD patient and are bringing him in via police escort."

"Why police? Is he stable?"

I hear laughter. Not a good sign. "Oh yeah, he's stable. Have fun." Click.

Hmmmmmmmm............

I walked back into Miss Alcoholic's room to start her IV. She apparently thought I was her best friend as she started to tell me all about her sex life and how big her boyfriend's willy was. Thankfully we were interrupted by screaming in the hall.

"YOU MOTHER FUCKER'S! I'LL KILL YOU ALL. I KNOW WHERE YOU LIVE!"

I stepped out into the hall and saw 6 police officers dragging a 20-something male down the hall. He was kicking at them, spitting at them, trying to bite them. Ah hell..........this was going to be interesting.

"AIEEEEEEEE!!!" A flying female form came screaming out of Exam2 and threw herself into the officers. It was his mother, who was still in the room with his father, who he had beaten up earlier. "I'm going to kill you, you mother fucker!" She screamed at him. "You BItch!" he screamed back.

The officers finally got them disengaged and dragged the mom back into Exam 2 and the son into the Hold Room. More officer materialized out of nowhere and the wrestling match began. They were attempting to get him onto the stretcher, and he apparently didn't want to go there. Arms were flailing, feet were flying............

"What do you need?" one of the officers asked me.

"He's got an airway so I'm OK at the moment," I replied. He just laughed.

Eventually they got him onto the stretcher and we put the 4 point soft restraints on. Mr. Overdose was spitting at me and calling me all kinds of beautiful names like bitch and cunt and whatnot. I just smiled and said "Oh, what a sweetie. You must want to marry me."

"Fuck You" was his reply.

Dr. Q came in to evaluate the patient. "What medications do you take?" he asked.

"Heroine and cocaine"

Nice.

"Allergies?"

"Bitches and cunts"

Super Duper.

We started an IV (which he screamed over and over about how we needed a warrant to do that), hooked him up to the monitor (again - he felt we needed a warrant to do this too), and called Poison Control. He had taken Percocet, Ativan, Klonopin, Heroine, and Cocaine. Nice cocktail there.

The percocet and ativan eventually kicked in. And his airway started to go bye-bye. We inserted a nasal trumpet which helped tremendously. We cathed him for urine, during which he woke up enough to ask us if we were impressed with his male anatomy. "Um.....nope."

"Bitch."

Sometimes I love my job.

After about an hour, he woke up and decided he didn't want the nasal trumpet in anymore. He was trying to blow it out his nostril, but only succeeded in blowing snot and blood across my wall, over the bedside table, across the supplies laid out, and over the sharps container. "What the hell? I'm gonna make you clean that up when we're through here." I said.

"Fine. I'll do it bitch. Let me outta these cuffs."

One of the officers came back in and asked when they could take him to jail. Mr. Overdose spouts off "Take me now. I'll go back to prison. 3 squares a day and I get fucked."

Oh.

My.

I looked at the clock. 2 AM. Sigh...... Can I go home now?

An hour later, Dr Q decided he was stable enough to be transported to jail. He was oddly cooperative when we removed the restraints and put him in the cuffs. His fight was gone.

So was mine. I was exhausted.

I finally went home at 6 AM, fell into bed and slept.

Overall, it was a pretty good night.

ER on NBC

Who watched the episode tonight? Let me rephrase that - who will ADMIT to watching the episode tonight?

Thoughts:

1. DID YOU SEE HOW THEY IMMOBILIZED THAT KID IN THE WRECK? Sorry for shouting, but really - did you see? Straps were all wrong, the kid was twisting around backwards to speak to someone as he was being wheeled in, his body was not aligned AT ALL!

2. That C-collar came off as soon as he hit the stretcher - without an assessment. And they didn't take it off properly either. Then they start rolling his head around everywhere.

OK - I'll pause here to say, "Yes I know it is just a TV show." I know that. Really I do. But can't they at least get things partially right? I know all about dramatic license and blah blah blah.......but don't they know that enough of us watch the show that are actually educated and can pick up things like this? They need a new technical advisor - and I'd just like to say that I'm available for the job.

3. The ultrasound that showed that the teacher girlfriend chick was pregnant.......Um Yeah - he had the ultrasound wand over her epigastric area when the fetal sac showed up on the screen. That's an awful unique pregnancy. My 9 y/o even noticed that one. "That's not where the baby goes Mom." I've got a smart cookie there, eh? She takes after her mom.

4. Reading back over this post already - I completely sound like a whiney bitch.

5. Like a physician would ever conveniently lose a vital piece of evidence related to the comission commision commission (how the hell DO you spell that? They all look wrong) of a crime.

6. Sam looks like shit with brown hair. Bring back the blond. (OK, maybe not shit - but it just looks weird.)

7. Who thinks that Hope dies next week? I looked at the spoilers and couldn't find a statement regarding her, but did you see Morris react to that phone call in the previews?

8. I'm way to involved with even caring about this crappy show. What did I say in my last entry? Something about not admitting you watch these things? I need to follow my own advice.

9. I can't think of anything else to bitch about, so I'll quit now.

10. Oh wait! Will they ever let something good happen to the characters on the show? Huh? Ever????

Now I"m done.




Next time I'll write about one of my real ER visits. Though sometimes they make you shake your head just as much as watching ER on TV.

Qualities Required for an ER Nurse

I'm big into lists all of a sudden. I've been making them all week. I go through spurts of obsessive habits and this week I'm looking to complete a notebook full of lists. Sometimes I wonder if I need to be committed.

I thought I'd enlighten my glorious readers (all 6 of you) on the qualities I think an ER nurse should have. If you want to be successful in the ER, please pay attention.......

1. You must be able to adapt quickly to change. The first 60 minutes of your shift may entail finding out about a policy update, initiating a lidocaine drip on a patient, taking a bead out of a 4 year old's nose, finding out the previous policy update was updated again, assisting in a casting, placing a catheter in a 80 year lady with dementia and unique female anatomy, being floated to ICU, being released from ICU, doing pediatric triage, and then going on a run with EMS because they are short staffed.

2. You must be able to hold your urine for 12 hours straight. See number 1 for reference.

3. You must not be a frequent crier. Tears are OK once in a while, but not on a daily basis. Seriously people......if you are that emotional, find a less stressful job.

4. A sense of humor is a must - a vital requirement. You cannot survive without it. Because sometimes it's just dang funny when a man comes in with a foreign object in his "orifice", or Dr Q slips on the freshly mopped floor and lands with his coffee spilled over his scrubs and the hemoccult card he was carrying flat open on his face.

5. You must be a critical thinker. You must understand WHY you are doing what you're doing. Being genuinely surprised that your patient is hard to arouse after 30 minutes on a Versed drip makes the other nurses look at you funny and wonder where the hell you went to school (www.easynursingdegress.com?). Also, not doing a urine dip on a patient that has just been kicked in the gut by a 1 ton horse because "the doctor didn't order it" is just not acceptable.

6. You must be willing to train other nurses. How will we devlop competent nurses to cover for us on our vacation days if we don't make the effort to train them? Really - it's in your best interest to show SusieQ how to assist in a chest tube insertion, because you may want to go to Florida next month and there is noone to cover your shift on Trauma Call except a new inexperienced RN who was never trained. Next thing you know, your boss says "No!"

7. You must not mind body fluids. Blood, vomit, poop, pee - they're all part of a normal day in the ER. Sometimes you even get to have them splashed all over your clothes and in your face.

8. You must be excellent at organization and time management (refer to number 1 once again).

9. You must be able to recognize the fact that a 45 y/o obese male with a history of smoking who is experiencing chest pain needs to be seen before an 80 y/o female with complaints of "it burns when I pee." Triage is your friend - know it, own it.

10. You must be able to prioritize. It is more important for you to obtain an EKG on your 45 y/o male than it is to obtain a urine sample on your 80 y/o female. Just because the doctor ordered the UA first doesn't mean that is the order in which you perform your interventions.

11. You must be a cold, hard bitch. Oh wait - no....that's just me.

12. You must bitch endlessly about how unreal medical shows are, but secretly watch them at home cuddled up in a blankie with a cup of hot chocolate while yelling "You don't shock asystole asshole!"

13. You must be willing to keep up on your education and be aware of current practice. Stating "Well, Abby did it last night on ER" doesn't go over very well with the Chief of Nursing. See number 12. Another tip - People magazine does not contain any CEU's.

14. You must not screw around with your coworkers. Paramedics, police, firefighters - go for it. But another ER nurse or doc? Not a good decision. First, you're mushy mushy kissy kissy in the hallways, making people want to throw up. Then, when things go south (they always do), it becomes difficult to take care of that patient seeking treatment for syphillis without popping a comment off to Big Bob RN about how you're surprised he's not laying on the stretcher - as much as he fooled around on you.

15. You must be able to handle people yelling, screaming, cussing, and spitting at you without taking it personally. Review number 3.

and last, but certainly not least............

16. You must be able to find rewards in the little things - the smile of a child after they've been sewn up and get to choose a sticker, the reassuring beep of the cardiac monitor after you've resuscitated someone, the way the closet at the end of the hall is soundproof so no one will hear you scream when you are losing your mind.

Random Facts About Me

1. I am not only an Emergency Nurse, but also am a Forensic Nurse and work as a Deputy Medical Examiner in my county doing death investigations.

2. I hate to shop. I wish I could walk into a store and there would be a rack labeled with my name and a sign that says "This will fit you and will look terrific on you."

3. I will never take the top lid when getting a soda at the local quickmart. I pull a lid from the middle of the pile. And if there is only one lid left, I refuse to take it. I make the clerk fill it back up and..............I pull from the middle of the pile.

4. (I've changed my mind on this one so I'll erase it and pretend I inserted something witty here.)

5. I wish I would have traveled around the world before I ever got married. Life is to complicated now to just pick up and leave. I want to go to Europe, Africa, India, Australia, Chile, Brazil...................................the list is endless.

6. I function best in high stress situations. The busier the better. During slow non stress moments I tend to be lazy and forget the simplest of details.

7. I hate panty lines. If you have panty lines you are a fashion don't. Seriously people - check out your ass in the mirror before you leave the house.

8. I would rather smell a decomposing body than a GI Bleed any day.

9. People with poor time management skills should not work in the ER. (OK that's not about me, but really.......it's the truth isn't it?)

10. My first Code resulted in death. My second Code resulted in death. It took 3 times for me to get a live one.

11. Doing CBG's is a huge pet peeve of mine. I hate doing them. It's such an annoyance. The information is valuable, but the obtaining of the information annoys me like a piece of hay in the undies - not comfy at all.

12. I cuss way too much. Once I leave work and hit the car door, my vocabulary reverts to that of a trashy whore.

13. Road Rage is a part of my life. (See number 12)

14. Does anyone really care about random facts about me? I don't even care about random facts about me.

15. I like chocolate. But really - who doesn't? If you say you don't, you are a lying sack of poo.

16. Right now I am listening to Plankton from Sponge Bob as my kids are watching TV. Can I just say that I hate SpongeBob? That show is a boil on the butt of humanity.

17. I'm done now.

Sex, Lies, and Gunshot Wounds

Theresa was carried into our ER in the arms of a big giant teddy bear. He was a few inches over 6 feet, a few pounds over 300, and one of the hairest men I've ever seen. His chest hair morphed into his beard like the joining of 2 great nations. He set Theresa down on the stretcher like she was a precious and fragile sculpture. She smiled up at him and he faded into the corner of the room.

I asked Theresa why she had come to the ER today. She pointed at her left leg, which had a red bandana tied tightly around the thigh. "I shot myself," she replied.

Um..........huh?

"I shot myself. It was an accident. I was being careless."

I initiated my assessment while cutting away her jeans. Vitals - stable. Pulses - intact. Swelling - minimal. Skin - one small open hole in the anterior portion of the thigh just above the knee. Cap Refil - brisk.

"How did you do this?" I asked

"Well, I had my pistol in my hand and I was switching it from one hand to another. All of a sudden - snap! I shot myself in the leg."

I looked at her a little strange.

"What position where you in when you did this?" I inquired.

"I was standing up."

"Hmmm......" I said.

Her wound had an abrasion ring on the lower half and had an upward trajectory. No powder burns were present on her jeans or her skin. This wound did not match her story at all.

She looked at me sheepishly and ducked her head. I completed my assessment and looked at the Teddy Bear in the corner. He was staring at her leg and becoming paler with each passing second. I saw sweat beaded on his forehead.

"Do you need to sit down, sir?"

"Yeah, I think I better," he replied. I noticed tears in his eyes.

I went out to speak with Dr. Q. I gave him a quick history on the patient and my current assessment.

"You think she's lying?" he said.

"I think she's not telling us the whole story," I replied.

Dr. Q went in to see Theresa. I followed closely behind and heard Teddy Bear repeatedly telling Theresa he was sorry. He was crying by this time. He furiously wiped the tears from his face as we walked in the room.

Dr. Q examined her, then ordered an radiology studies of the area. The results came back that the bullet was in many pieces in her leg and did not appear to be near any major vessels. Teddy Bear made a sound like he was gasping underwater when the results came back. I looked over my shoulder at him and his head was in his hands.

"Your husband seems pretty relieved," I told Theresa.

Her head snapped up and she gave me a nervous smile. "Umm..he's not my husband," she replied.


AH-HAAA! I knew something wasn't right.

"Did he do this to you?" I asked

"Not really - it was a joint effort. I was sitting in a chair by the campfire when he walked by. I lifted my foot to kick him in the butt, but I hit the pistol in his holster instead. The gun went off and hit me in the leg."

"Well, why didn't you just tell me that in the first place?" I asked her.

"Because I'm not supposed to be here," she replied. "My husband thinks I'm at the beach with my girlfriends. Instead I'm in the mountains with my boyfriend. I don't know how I'm going to explain this one."

I didn't know how she was going to explain it either. She left on crutches as she had a difficult time bearing weight related to the pain. It was not an injury she was going to be able to hide. I wonder if she ever came up with a plausible excuse.