Friday, December 28, 2007

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,

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.


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.


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.

Monday, December 24, 2007

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.

Sunday, December 23, 2007

Friday, December 21, 2007

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.

Monday, December 17, 2007

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 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.


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?"


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.


"Dr Q?" I replied.


"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.


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.


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."

Monday, December 10, 2007

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.

Saturday, December 08, 2007

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.