Wednesday, October 31, 2007

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.

Thursday, October 25, 2007

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."


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.


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.


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"



"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."


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."



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.

Thursday, October 04, 2007


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


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 ( 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.

Wednesday, October 03, 2007

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'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.