The Mother Letters

Someone linked me to this great project called The Mother Letter Project

I think I might write a letter and submit it. Mine will be to a mother who wants to bring her child to the emergency room.

How honest shall I be?

Running Commentary of a Random Day

My first patient of the day was a STEMI (heart attack). Busy beaver this AM. 37 years old. Yes, you heard me right. 37. No risk factors. NONE. No family history, not a smoker or drinker, eats well, exercises daily. Therefore, I shall use this as my excuse to never exercise, eat like shit, and drink to my heart's content.


THEN:

A gallbladder and 2 ear infections.

Do you ever find it weird that we refer to patients by their diagnosis and not their name? Even though I do it online for privacy reasons, we still do it in real life.

"Hey Lucy - can you medicate my gallbladder in Exam 2 please?"


NEXT:

Migraine (my own).

Trauma Chart Reviews for an hour.


TIME FOR LUNCH.

Another chest pain after lunch, another Migraine, a Peeing blood, and abdominal pain, and a r/o labor.

Then I got transferred to OB with my r/o labor and finished my shift there.

Rural Medicine is great.

You're Kidding Me, Right?

You have to be. You absolutely have to be, because no one in their God given right mind would think that you insert a chest tube into someone's SPLEEN - FOR SHITS SAKE!

Phew...... got that one off my chest. Chest. Huh, funny. That's where that damn tube belonged.

Dr Morris even said it! "5th intercostal space, mid-axillary line." That means 5 rib spaces down from your collar bone and along an invisible line that comes straight down from your armpit.

Um, yeah. Maybe the technical advisers should have listened to the dialog (that doesn't look right - shouldn't it be dialogue? Nope guess not. Spell check says I'm stupid as hell apparently. So anyway........). As Morris is telling Chaz where the tube belongs, he meanders south about 5 inches and puts it in his abdomen. Loser. It's not like they couldn't have faked him putting it in the right spot - they didn't need to pretend the abdomen was the lungs. Sheesh.

Oh! And! (How do you like that rule breaking sentence structure?) When the "blood" was pouring out of the chest tube area - it looked like red tinted water coming straight out of a faucet on high pressure. Whatever. Special effects on a tight budget all of a sudden? Blood does not spray out continuously like a water faucet. I know they can do this right as we've seen it before. Apparently, the special effects peeps have either forgotten the basics of blood spurting or have become so incredibly lazy they figure the general public will believe blood sprays out just like when you're running yourself a nice, cozy, hot bath with bubbles. Maybe they should supply us all with a glass of Chardonnay and a good book to read too.

Now let's talk about the MRI incident. Can I just call a bullshit on that one? Granted, it was funny as hell to see a patient screaming for morphine get their due, but honestly.... the MRI techs would have NEVER let that happen since in the REAL WORLD the techs do the scans and not the doctors/interns/med students.

Moving on to Sam and Gates. Sam gets an A+ for wanting to secure their patient's airway first. A-B-C's. Learn 'em. Know 'em. Follow 'em. Dr. Gates obviously is dyslexic since he follows algorithms backwards. "Naw, we don't need to worry about no stinkin' airway - let's scan his head first! Off to the scanner troops! Move out!" Oopsy-daisy...... airway needed.

And I will give a nickel to anyone who can tell me how exactly a 1% Non-Rebreather is supposed to work. Anyone? Anyone? Bueller? Mrs Bitchtastic, superheadchief of the ER, apparently has invented a new way of providing oxygen to a patient. For all my non medical peeps out there, a NRB (non-rebreather) is usually run on 10 to 15 Liters of oxygen. Therefore you will receive an order to "place the patient on an NRB at 15L." Ah well - dramatic license and all, eh?

Whatever will I do when this show is over? Thursday nights will be so dull and boring. No one yelling at the TV in my house. No one cussing about portrayals of medical care on TV. Maybe I'll just have to get drunk.

Paging Dr Greene.....Paging Dr Greene - STAT!

So, my prediction for the return of Dr Greene shall be as follows (and y'all know mine will be a hell of a lot more entertaining than anything they have planned anyway):


Dr Greene will come back as an evil twin of the original Dr Greene, who will carry out his evil plans to become a serial killer by offing ER patients via injections of a mysteriously blue colored substance or smothering them by holding the tip of his finger over the end of the ET tube. And then good Dr Carter will come back to save the day, all the while screwing some hot nurse in the janitor's closet. But then (oh no! dun dun dun.....) Dr Carter will be trapped in the dungeon of the hospital by Evil Dr Greene who will inject him with some new bio terrorism substance that will turn Dr Carter into a Stepford Wife. The Carter Stepford wife will then become the Evil Dr Greene's new partner between the sheets.

Suddenly - Sam will show up and kick the shit out of both of them before jumping out of the 5th story window and becoming a patient herself. But alas, the Evil Dr Greene will be able to sneak into her hospital room and will pull out the mysterious blue syringe. Just as he starts to inject the substance Neela will run in, throw her arms around Dr. Greene and say "I knew we could do it my love. I knew we could!!!"

Ack! It's all so shocking!

ER on NBC - Abby Leaves

Abby is gone.


What more can I say?


Sad. It's pathetic that I feel a deep sense of loss when my favorite character leaves. It's a TV show damn it! A TV show!

I loved it when she told off the new Mrs. Mean. I think I was partially aroused.

As far as medical care given, I was so distracted by the thought that this would be the last time I would see Abby that I forgive them for any and all mistakes they made.

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

Wine. I need vino.

Let Us Discuss............... Universal Health Care

There is a discussion going on in a Mom's forum I belong to regarding Universal Health Care (UHC). I am being called an asshole and repugnant because I don't believe in UHC. Let's discuss this issue because I honestly want to know why people think it should be a Constitutional Right to have health care.

Here are my points:

I believe we should have universal EMERGENCY coverage for truly emergent situations. I believe we should have coverage for children for preventative care (well child checks, etc) and illness/injury. I do not believe that we should have total coverage for general health care for all adults. I do not believe that this is a RIGHT.

I have seen government run programs (Can anyone say Oregon Health Plan?) that are so completely mismanaged and are more of a hinder to health care than anything else. They have created a healthcare environment that promotes ER visits for non emergent reasons. And even though the patients have to sign a waiver to agree to pay if OHP does not pick up the bill, this doesn't happen. Our ER budget this year showed a tremendous loss of revenue related to this issue (as does every ER in the nation - ER's are pretty much always loss leaders in relation to this). Remember people - we cannot refuse to see anyone no matter what the reason. Now after a medical screening exam we can tell them their situation is non emergent and recommend follow up with a primary physician. Most won't follow up anyway, and we've just wasted 1 to 2 hours of ER flow time because of this. Therefore we have delayed care for someone else who is truly emergent and we have the need for additional staffing to tell people they don't need to be in the ER. And people wonder why medical costs are so high.

Next, I have seen time and time again, people that do NOT follow their physician's recommendations for care of their condition (think diabetes, congestive heart failure, etc.). Should we still help them when they are in a crisis? Absolutely. But we should not pay for their medical visits at a clinic if they are not willing to be cooperative with their medical care. Yes I know there are case by case situations where this may not apply (quacky docs, new therapies, etc), but I'm referring to an in general population.

I do not believe that our current system works, but I also do not believe that UHC is the answer either. Someone told me that Germany has a program where everyone is guaranteed emergency treatment and they have the option to buy into higher level plans if they so desire (does anyone know if this is true?). I think this sounds like a great option. As long as they are NOT government run.

I do believe everyone deserves good medical care - absolutely. I just do not believe that the government should foot the bill.

Let us discuss..................

ER on NBC 2nd Show, Last season

So I'm a few days late on this one. Sue me. No not really - I don't have anything that you'd want anyway. You can go ahead and take my debt on if you'd like to though (A double mortgage and some over extended credit cards because apparently Santa believes in over buying for my kids).

My man was bustin' my balls tonight because I hadn't posted anything about the last episode of ER. Like I have to obey him. Pashaw. There's no ring on this finger. But alas, I cannot disappoint my 3 other readers.

One of the only things that still sticks out in my mind is the asthma kid that was stuck in the room with the cooky ass Ricen man. When arrogant entitled med student hoochie mama was taking care of him, he HAD NO OXYGEN ON! When Dr Sexy John Stamos told her to turn it up to 15L she said something like "I did" but the patient had no oxygen in place. Then presto! Next scene, oxygen mask on. I love the magic of TV. You can get anything you want by just blinking your eyes and requesting a scene change.

Now onto Mrs. Angry New ER Manager. Obviously she's lost someone in her family. Is there a connection to Pratt? I couldn't find anything online in the spoilers, but something smells funny in the kitchen. And Morris - yeehaw! Good for you for letting loose. Of course, I don't know that it's a great way to endear yourself to your new boss, but hey - whatever works for you.

So tomorrow night Abby leaves. WTF? Can't she stay until the end of the season? She rocks. Well, maybe not so much lately with the nights of alcohol fueled sex with coworkers and irrational arguments with spouse, but she used to rock. A med student told me once that I reminded him of Abby - I'm not so sure that's a compliment anymore. Of course, she was still a nurse then so it was during her time of uber coolness.

Well off to work for the next 2 days then riding 4 wheelers all day Saturday. Maybe I'll be a patient in my own ER. It'd be just like TV! I could be improperly immobilized, not have my oxygen on, an IV that goes nowhere, and a partridge in a pear tree.

A Lesson Learned

I've been a nurse long enough that you'd think I could fish out the drug seekers vs those truly in need of narcotic intoxication within seconds. I know, I know - you'd think I could. I'd certainly think it.

Apparently, we both would be wrong.

48 y/o disheveled, dirty, matted hair, no teeth, 5 tattoos, holey clothes wearing man presents to the ER with a yelled complaint of "I need Vicodin! Badly!" He also happens to be holding his shoulder.

"Were you injured sir?" I ask.

"Yes," he replies. "I fell over the guardrail last Thursday when I was walking along the highway by the rest area. My shoulder has been killing me ever since."

Pulses present and equal, grips equal, no numbness or tingling, cap refill brisk - flashing neon sign saying "Drug Seeker!" flashing across his forehead. Well at least in my mind it was.

Triaged to wait a bit.

35 y/o woman dressed in a business suit with perfect personal grooming habits and a polite demeanor presents with the complaint "I think I have another kidney stone." She's slightly bent over and holding her left side. She dry heaves into an emesis bag I give her and her b/p and heart rate are elevated.

"I'm sorry but I just couldn't wait to see my primary physician on Monday. I've been dealing with the pain for 2 days now and I just couldn't take it anymore. I'm really sorry to even have to come in."

I admit it, I was sucked in by her politeness. It's such a foreign concept in the ER. Seriously - someone throws us a polite bone and we jump all over it like starving dogs.

"We'll get ya back just as soon as we can." I told her.

Apparently, I am an idiot. Yes, I am admitting it now.

The gentleman had dislocated his shoulder and it had been out of place for 3 days. 3 DAYS! No shit he had pain, eh? Our lovely lady friend was found to be a doc shopper and drug seeker from multiple hospitals over the ENTIRE STATE. She'd learned the game, and she'd learned it well.

I learned a huge lesson that day. It wasn't such a pleasant look in the mirror for me.

And So It Begins (Or Ends)......

Yes my lovely readers, it is that time of year again. The time when we can all give a big sigh of relief and relax into our comfy over stuffed recliners with a big glass of cold beer and a bag of chips. The time when we can prop our legs up and have blissful silence since the screaming kids are finally asleep in bed. The time when we can pick up our remotes and turn on the TV and say..........

"What the HELL were they thinking?!?!"

Yes, my friends. It is time for ER on NBC.

Last night was the season premiere for the FINAL season. This is it. We'll never have a season premiere for ER again. I feel like we should bow our heads for a moment of silence.




Uh, nope. Can't keep my mouth shut that long.

First and foremost - why the HELL do they have to keep killing off characters in these huge dramatic ways? Tell me! Helicopter crashes, ambulance explosions.........pashaw. Can't someone just die of a nice simple heart failure or something? I mean really. And then, to top it off, they kill one of the best characters on the show. One of the few that actually spoke their mind. Oh yes - I know, I know. Those of us that speak up tend to get killed off. Sigh......

Numero Dos: That was quite an interesting way to get an airway on Pratt. Using the IV drip chamber and spike? Creative. Anyone actually ever seen this done? Anyone actually ever heard of it? Though I have to give huge props for the writers putting in the tidbit about the other supplies not being located where they were supposed to be. Now that's true to life people! True - to - life. Apparently when some people get a job in an ER, they forget how to put shit away since their mommies aren't following them around anymore.

Number 3: Does cyanide make people high? That little girl was acting like she was doped up on morphine and having one hell of a trip. My experience with this is that the patient actually doesn't feel good. At all. Sometimes they're not even awake. Sometimes they be sleeping at my buddies house called The Morgue. Oh, props again for the bitchy mom though. Spot on.

Numero quatro: When the hell are the guest spots? We need them already. Paging Dr. Green.

Number 5: Isn't it nice that they knew exactly the place to go in with the needle into fake-hero-man's leg without a quick bedside ultrasound to define the area? And the make up artists really need to look further at pictures of infected legs - that one just looked a little bruised and slightly red. Certainly not something that my doc would have ran and got a needle for right away. It was also quite convenient how they skipped over "Airway" to drain the leg first, and THEN said "Prepare for intubation." Yep, cuz we all know that draining a wound is so much more important than having an established functioning airway on a possibly septic patient. A-B-C's people! A-B-C's.



Damn, I love this show. I do.


And yes, I shed a tear or two for Pratt last night. Let's keep that one our little secret, shall we?

On Vacation

Relaxing in the sun, spending time with friends, and going to see Kid Rock at the Puyallup Fair.


Will return when I find my brain again.


Until then....................

Finer Than Frog Hair, Thank Ya

Well shit. I got tagged. Damn it. But since The T Dude said such nice things about me, I am now obligated to play along. I know how excited you all are to read more useless facts about me, but hey - I'm a damn cool chick so read it all anyway.

Da Rulez:

1. Link the person that tagged you. (That would be This Dude)
2. Mention the rules on your blog.
3. Tell about 6 unspectacular quirks of yours.
4. Tag 6 following blogger's by linking them.
5. Leave a comment on each of the tagged blogger's blogs letting them know they've been tagged.

The six things:

Can I just say that trying to come up with 6 things I haven't already told y'all in my previous list posts is harder than shit dried on a popsicle stick? Seriously people. And then to make them unspectacular? Hmmmm. I love a good challenge.

1) The absolute very first thing I do after I wake up or have sex is pee (How's that for a number 1? Huh? Huh?).

2) I love stars. Love them. I'm talking about the sharp pointy things, not the ones that grace the pages of People magazine every week. Those stars are no longer fascinating to me. Same old, same old - blah, everyday. Kiki Chochonos slept with Harvey Bigdong and his wife Sally Oblivious just found out and is taking it all like a trooper since she still accompanies the kids and their Nanny to the park everyday. Pfffffllllltttt. Whatever.

3) I don't have much compassion for whiny, sniveling, oh-woe-is-me type of people. They drive me absolutely bat shit crazy. Coping skills - get some.

4) I sighted in my rifle yesterday getting ready for hunting season in the Wild West. Yeehaw. "Thar's baaaaare in dem dare hills!"

5) I got a new phone last week. A Nokia 5310 and I lubs it. It's my new best friend. Hell, if it had a "special" attachment, I wouldn't need a man (I know the phone is not a quirk, but the fact that it's my new best friend might qualify. Or possibly the fact that it could be my life partner with a few add ons).

6) I hate shit like this, and yet I cannot stop myself from doing them. Tags, quizzes, questionnaires, etc. I MUST give the world my opinion. Sad, I know.

The Tags

Well now you're really making me think. Shiznit. Whoever will I tag?

1) Tricia Rennea because I adore her girly artwork. Plus she cracks my ass up whenever we talk on the interwebz.

2) Orthette because I had one hell of a time with her on the 50 yard line in Biloxi, Mississippi when we were both there helping out after Hurricane Katrina (and no - not THAT kind of time. Keep your mind out of the gutter people).

3) Crzegrl because she linked me once and I got a shitload of hits from her. Plus - I adore her blog and love to read it.

4) Trauma Queen because he is the funniest Across-The-Pond blogger I have read.

5) Mel because she rocks my socks and her spiritual journey is one to be watched and admired. Obviously, I do poorly following in her footsteps.

6) I'm already running scared from those I've listed. They'll be chasing after me ready to kick my big ole' hiney for tagging them. So I'm calling this one finished.


Sigh........................... off to laundry now.

Props for the Homies

THIS is some funny ass shit. I snorted at least thrice reading this novela.

Necking and such

I got to stick my finger in a hole in some guy's neck today. How cool is my job?

Don't Touch That Thing!

For all my male peeps out there - remember when your mommy told you "not to play with that thing or you'll go blind!!!"? Remember? I bet you do. Guess what?

It really happens.

Seriously. It does.

I was taking care of a guy one day who came in for abdominal pain. He also happened to be blind. He asked me what I looked like and so I tried to describe myself to him.....

"5ft 10 inches, 115 pounds, blond hair to my ass ,and big boobies."

HeeHee - OK only one of those is right. You figure it out.

Anyway, he obviously had not been blind all his life because he could picture whatever I was describing to him. Nodding his head and smiling, he would always say "Ah yes, I remember."

"How long have you been blind?" I asked.

"Since I was 25," he replied.

"What happened?"

"Well, I didn't listen to my mama," he said.

"What? How so?" I asked.

He laughed as he said, "She told me never to play with myself or I'd go blind."

"Seriously?" I giggled in reply.

"Well sort of - I was having sex with my girlfriend and at the moment of, uh, impact, I went blind."

"Holy shit!" I said.

"Yeah, they said I had a hemorrhage that affected my optic nerves and I actually did lose my vision."

I stared at him dumbfounded. I didn't know whether I should laugh or offer sympathy.

He pulled the covers up over his chest and patted his belly. "Yeeeeeeep," he said. "I shoulda listened to my mama."

He turned his head toward me with a crooked grin. "But it was so much damn fun NOT listening to her."

I was still laughing as I walked out the door.

Ethical Conundrum

We saved a life the other day and I was extremely pissed off about it. We were manipulated and abused and just all around beat up. It was one of the rare times when I thought "We should have just let your ass die."

Laxative, Please

Oh my hell. Kill me now. Seriously. Dr. Constipation was in our ER the other day and I officially decided that taking a really long ice pick and stabbing it into my eyeballs over and over would be a really good thing.

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

Dr. Constipation makes my life hell. He holds onto his patients and just will not let them go until you shove a big ole' enema up his ass and make him squirt them out the door. What should be a less than one hour ER visit ends up taking 6 or 7 hours. Why you ask? WHY? Well, let me tell you.

Apparently Dr. C feels that ordering ONE FREAKING TEST AT A TIME is a GREAT way to practice medicine. Yes. Uh huh. You heard me right.

Fuck.

52 year old presents with sudden onset right upper quadrant abdominal pain. She is very obese and had fried chicken, bisquits and gravy, and chocolate cake for dinner. She meets the 4 F's for probable gallbladder attack:

Female? Check
Fat? Check
Forty? Check
Food - greasy? Check

Most docs would order a CBC, Chem Panel, Amylase, Abdominal Series, and a possible ultrasound right off the get go. Dr. Constipation? OH NO! Never could he imagine ordering more than one thing at a time.

"Julie, start with a CBC."

"That's it? Don't you want a Chem panel and an Amylase at least?"

"No I don't Miss Thang. We'll start with a CBC and maybe we won't need to do anything else and we can save this patient multiple tests," he says in that wonderful I-am-a-doctor-and-you-are-a-stupid-little-underling condescending way.

"I'd like to know how a little old CBC is going to tell you everything about your patient. So what if the WBC's come back elevated? You'll still do another test to find out why. I know your kind you SOB."

OK so I didn't really say that. But I thought it damn it! I thought it.

"Sigh........OK Dr. C."

Guess what? The WBC's were elevated.

"OK nurse Julie. Let's get a chem panel now," he says.

I wanted to scream.

"Can I draw an amylase with it? And maybe get radiology involved?"

"No Nurse Julie. She probably won't need those things."

FUCK FUCK FUCK FUCK FUCK FUCK FUCK!

"Dr. C. Look. I know you want to avoid unnecessary tests for this patient. I know you are trying to look out for their best interests. But we know she is most likely having an issue with her gallbladder. If we keeping adding test on top of test she will have to be poked mulitple times and we've actually added to her suffering rather than preventing it. We know we're going to need radiology and we know we're going to need a surgical consult. Can we PLEASE just do that all now rather than delaying and doing one thing at a time?" I actually did say that. Yes, pat me on the back now.

"Nope, just get the chem panel please."

AHHHHHHHHHHHHHHHHHH!

So 4 hours and multiple doses of morphine later the decision is made for a surgical consult. Guess what? Yep. Exactly. To OR for a cholecystectomy.

So not only did we delay treatment, we caused suffering by prolonging her pain when it could have been dealt with earlier through surgical intervention. We also potentially could have caused more pain with multiple needle sticks for all the lab tests. Luckily, I am a sneaky little nurse who drew all my tubes the first time and had lab hold them for the additional tests I knew would be forthcoming.

I battled with Dr Constipation for the rest of my shift. The next day there was an enema bucket hanging from the nurses station ceiling with a big note on it saying "Rx for Dr Constipation."

Hmmmm....... wonder how that got there?

I Suppose I Should Be Offended........ But I Ain't

I find these incredibly funny. I suppose that says something about my inner workings eh?

The Things You Find Out When You Stop By For A Second

I stopped by the nurses station today when I was walking through the hospital to go to physical therapy. I saw Mark sitting at the computer and knew immediately I should turn around and walk the other way. He is always, ALWAYS the bearer of bad news.

"Hey! You hear about your guy from yesterday?" He asked.

Oh shit.

"Um, what guy?" I replied.

"Mr. Gross Leg Abcess Man. We flew him out last night."

"What the hell for?" I asked.

"He coded in the OR."

WTF?

"Seriously? He was just in for a leg debridement. He was only 32. He had no medical history."

"I know," he said. "He went into cardiac arrest."

Sweet shit on a stick. Ya think the meth had anything to do with it? Snort.

Linky Loo for Yoouuuuuuu

Oh my hell. Snort. Oh God. Help me please. Ha-Ha. Shit.

I went HERE

and found a link to HERE

and now I'm pissing myself laughing.

Back In The Saddle Again

Today was my first day actually providing patient care in the ER since my back injury. I only worked 8 hours (normally do 12) but man, oh man did I feel it. I wasn't necessarily in pain but my back felt like I'd spent the last 8 hours workin' the street corner in 5 inch stilettos fighting off the other hookers trying to take my space.

Phew.

Ibuprofen is my best friend.

My day started with an Air Life transfer for a cardiac patient. Acute MI. He was sleeping when I got report on him. Pain? "Not to bad Julie. It's about a zero or 1 on that pain scale thingy." Well perfect. IV meds infusing and he was good to go.

Then Miss SOB (shortness of breath, not son-of-a-female dog here people. Sheesh! Do you really think I'm that mean? OK well I am. And she was a bitch. But alas - I shall not SINK to the lower depths of bitter ER nursedom and call her names. Oh, OK I will. Cuz she was a bitch) walks in.

"I can't breathe," she tells me as I can hear her wheezing from the double sliding doors.

'No shit,' I think.

I take her back to the cardiac bay and hook her up to every wire we have. Well look at that! A fib with rapid ventricular response. Basically her heart was just a tickin' away - and not being very regular about it. I pushed a little Cardizem bolus through her IV and started a drip (IV infusion for my non medical peeps). Then I got to admit her to the floor and it took all of 30 minutes from request for a bed to actually reporting off. I love it when the ER gods of the universe decide to support my ass for a change.

The Air Life crew arrived during all of this and wanted report on Mr No Pain Chest Pain. Reported off to them and when they walked out the door only then did I realize they didn't bring me my chocolate. BASTARDS! They always bring chocolate. WTH?

"Where the hell's my chocolate?" I shouted after them.

"Budget cuts!" I heard as the pneumatic doors swooshed closed.

Well, shit.

What's the state of health care coming to when the Air Life crew can't bring us chocolate anymore? Someone needs to write their congressman or something.

My next patient was Mr. Gross Leg Abcess. He had multiple pustule scabbed "things" on his lower legs with one in particular that looked like Mt St Helens waiting to blow. Holy bulging pusbag batman! Hot, red, swollen - I could practically see the pus pulsating with every heartbeat.

I love wounds like that.

Dr. J and I opened that puppy up and got lots of nice green and yellow tinged pus out of it. Yummy.

Apparently when your right leg is 3.5 inches larger in circumference than your left leg, it kinda hurts. Who'da thunk? Aaaaannnnnddddd........ when you have a history of meth use, it takes a lot of Fentanyl to make your pain go away.

A lot like "make Julie stop breathing" doses. Holy crap.

Anyway, Gross Leg Abcess Man got admitted to med/surg for Vanco infusions and I&D of his abcess.

The rest of my day was filled with sprained ankles, runny noses (allergies in the summer? Shocking! I know. Tell me about it.), and lacerations. I didn't get a single trauma all day. I'm kinda pissed about that. It's funny how you miss things like that when you are off work for a while.

The best thing about today? I got called in so it was all time and a half. Yeehaw.

The fingers are falling! The fingers are falling!

Fingers and huge ass diesel truck doors do not make good partners. They do not dance well together. They do not make nice googly eyes at each other.

Oh no.

Truck doors do not like fingers at all. Oh no they do not. In fact truck doors don't like fingers so much that they think it's mighty fun to cut the little suckers right off. And they laugh when the tips go plop in the dirt.

So do I.

Sometimes I think I'm not a very compassionate nurse. I might need some hospital mandated classes on that.

So Sally Sue comes in with 3 finger tips soaking in hydrogen peroxide in a plastic cup. First and foremost to all my readers: DO NOT STORE AMPUTATED FINGERTIPS IN HYDROGEN PEROXIDE!! Umkay? This is how you should handle your amputated parts.

Anyhoooo......... Sally Sue tried her best to do the right thing with her parts. She meant well so I did not lecture (hard to believe? Pashaw!). She had a great dressing over her hand so I promptly set about packaging the fingers in a dry, sterile, cool environment. Once the parts were comfy I focused my attention on her hand.

I unwrapped the gauze and saw 3 cute little stubby fingers dripping blood. A quick Xray, followed by a few digital blocks (numbing the fingers so you can get in there and really look at them/clean them/play with them/whatever you want you crazy freaks), and I had my way with her fingers.

They were full of dirt and debris. Truck doors are dirty. Ranch trucks are even dirtier. Hay, cow shit, horse shit, dirt, you name it - it's all in the seals of the doors. I did a little cleaning, the doc did a little reattaching, and off to the ortho doc 2 hours away she went. Hopefully they will be able to completely reattach her fingers for her.

She was on vacation from Florida at a dude ranch here in Ory-gone. Hell of a way to spend your paid time off eh?

Props to the Nursies

Please take a minute and peek at Mel's Blog

She just returned from a medical mission to Haiti. She's got a few pictures up and is working on a slideshow it looks like. Can't wait to see them all.

Holy Humperdink Batman!

It has been such a loooooooooong time since I've posted. It actually feels like days instead of months though. So much has happened. Shall I sum it up for you? Here we go:

1. Manager position dissolved
2. Got put back on the staff rotation
3. Got drunk
   
4. Separated from husband
5. Divorced husband
6. Got drunk
   
7. Hurt back (again - wtf?)
8. Took a much needed break from anything
9. Got drunk
   
10. Went on an awesome amazing beautiful 100+ mile 4 wheeler ride with friends
11. Got drunk
12. Went rafting down the Rogue River
13. Got drunk

Are we detecting a pattern here? LOL.

OK Seriously now...... I've been in physical therapy since May 23rd for a re-injury to my back. It involved 4 nurses, one 450 pound intubated patient, and no lifting equipment. Um.... yeah. Hurt. I should be released back to full duty again soon though. Thank God! I'm so damn tired of chart reviews and updating policies I could vomit. I hate light duty. Seriously. It is like a huge infected ass pimple that makes it difficult to sit down on because it's just so fricking irritating.

The good news?

TRAUMA SEASON IS HERE!!!! Yeeeeeeehaw!!!!!

I love trauma season. May through November is my favorite time of year to work in the ER. Car wrecks, motorcycle crashes, horse wrecks, cow tramplings, gunshot wounds, stabbings, beat up with frying pans, falling off ladders, exploding fireworks............sigh............ I love 'em. Love 'em all.

Had our first snake bite of the season the other day too. Classic presentation - young male, drunk, saying "Hey! There's a snake! Let's catch it!" - followed by a sloppy grab and an envenomated bite. So what did our cute little chubby fellow win? A trip to the ICU and a 10 minute lecture from a craggy old physician.

Craggy - is that a word? I don't think so. Doesn't look right.

Anyway - I'm back! I know you are all falling over yourselves in excitement. I can see it. Just make sure you sustain some good injuries because I'm bored and need something to do.

Seriously.

Update

I may be on a bit of a break for a while. Personal issues. But I shall return!

Performing Arts

I came walking out of the break room the other day when I heard Bob say (in a very sing song voice mind you) "Turn around......" I couldn't help myself. I had to do it. I had to complete the song.

"Bright eyes. Every now and then I fall apart.......and I need you now tonight......and I need you more than ever.......and if you'll only hold me tight......we'll be holding on forever......" I sang back at him as I walked down the hall.

The entire staff joined in.

"And we'll only be makin' it right ........cause we'll never be wrong.... together we can take it to the end of the line. Your love is like a shadow on me all of the time.....I don't know what to do and I'm always in the dark...we're living in a powder keg and givin' off sparks................."

By now we were virtually shouting.

"I really need you tonight! Forever's gonna start tonight.....forever's gonna start tonight."

We were all laughing hysterically by the end of the song. I felt like I was in a really bad musical episode of ER. Frightening.

Addiction

Guess who came back yesterday? Mrs .420. She called the ambulance for "pain everywhere." Paramedic Pete responded and rolled her through my ER doors at about 10 in the morning.

"Paula, have you been drinking again? 'Cuz you know I can't give you any pain medicine if you've been drinking," I told her.

"No I haven't Julie. I've been puking all morning. I promise I haven't drank anything. My belly hurts so bad - can I just have something for the pain?" she asked.

We transferred her to the ER stretcher and I quickly disrobed her and changed her to a gown. Her abdomen was twice the size as it was during her previous visit. Oh Lord.

"I just don't feel right," she said.

"I bet," I replied.

I finished a rapid assessment, started and IV, drew some labs, got a quick catheter urine sample, and notified my doc of her arrival.

30 minutes later we saw that her liver was shutting down. Her liver enzymes had quadrupled since her last visit, and I noticed she was a bit yellow when I got her out of the exam room and into radiology. Let me just say here that lighting makes all the difference on a skin assessment.

2 hours later we got her admitted to the floor. Dr. Q set her up on the alcohol withdrawal protocol and I reported off to the accepting nurse.

I went back to the ER and started talking about addiction with another nurse. It seems so foreign to me that something could have so much power over you as a human that it can make you crave it while simultaneously destroying your life. I see it every day and yet I don't really think about it all that often.

But here was a lady in her early 50's who could have been anything in the world when she was younger. She could have been a teacher, a lawyer, a politician, a nurse, a mom - anything.

Yet her biggest accomplishment in life was to become a die hard alcoholic and drug user.

So sad.

ED nurse stat!

Dr. J and I were standing at the nurses station when someone came running down the hall shouting "I need an ED nurse!"

I grabbed my soda, took a drink and started flipping through a magazine as the radiology tech flew by me.

Dr. J looked at me and smiled. "Is that a new treatment?" he asked. "Do they have to be dressed in a french maid's uniform?"

"Hmmm?" I asked, looking down at a half naked picture of Hugh Jackman in my People magazine.

"You know," he said as he started twirling around pretending like he was dusting the light fixtures along the top edge of the hallway, "ED nurse - erectile dysfunction nurse? They could dress in costume, come in to the patient room and poof! Patient cured."

"You're an ass," I said as I laughed.

"Yeah, but think of the research!" he replied.

Sometimes you just have to shake your head working in a place like this.

Linky Love

Ambulance Driver needs your help.

Passing on the link so he can get the info he needs. He's looking for gun bloggers and medical personnel who work with gunshot victims.

Have They Checked The Clocks?

Slow day today. I had a whopping total of 3 patients. What the hay? Something ain't right here.

My day consisted of the following patients:

• a nosebleed
• a migraine
• a fall down go boom

I felt like the day would never end. Every time I looked at the clock it was only ten AM - and it stayed 10AM until I finally went home at 5PM. Ever have one of those days? It just refused to move any faster. I did get a lot of QI analysis done on the trauma charts. Yeehaw. I know how much you all care.

Oh! I did get in a debate about pain control with one of our docs. Thaaaaaat was an interesting conversation. Hoooboy. Seems we have differing opinions there, such as I think people who hurt should get pain medicine and he doesn't.

Anyway, back home now wasting time on line.

Miscalculations

I lost a bet this morning. I thought she'd be about a .238.

She was a .420.


At 8 o'clock in the morning.



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

Hope

Sherri and I hopped in the van and hit the backroads around Biloxi, Mississippi with a cooler full of tetanus vaccine, a box full of syringes, and multiple dressing supplies. We were 2 weeks out from Hurricane Katrina and the devastation still amazed me. Every road revealed something ripped apart and given to the winds as if it were an offering to the gods.

I will never forget the people we met that day. They were resilient, hopeful, hardworking people of the South - and I fell in love repeatedly with their spirit. I had spent the previous week working in a shelter where the majority of people were angry, mean spirited, and had the largest sense of entitlement I had ever seen. It was quite refreshing to get out and meet some of the people who loved their homeland - even through the devastation. They had hope and did not fear working hard to get back what they had lost.

We dressed the arm wounds of a lady who had literally hung onto a rope in a tree for eight hours while the water swirled around her. She talked of seeing snakes swimming at her feet and watching the remnants of peoples lives float by her. She was sifting through the wreckage that used to be her single wide trailer and trying to pick out anything left. She had a handful of photos that had been trapped under some debris. That was it.

We found an elderly lady sitting in her home laughing as she went through the boxes at her feet. We could see the water marks on the walls of her living room - black mold and dirt approx 4 feet high. Her couch was in her kitchen and her car was halfway through her living room wall - filled with plant debris. But she was still laughing at the memories in her box.


We wrapped a leg wound on a man who was cutting apart the tree that had fallen on his house. His kids were running around the front yard playing tag with each other while his wife sifted through their belongings scattered over the driveway. He talked about coming back home after they had evacuated and the first thing he saw was the foundation to his neighbor's house. No house - just the foundation. He still didn't know where his neighbor was. They had been best friends for the last 10 years.

We rounded a corner in Ocean Springs and came upon a lady whistling and hanging out her laundry. I remember how unbelievably white the sheets were on the line. She offered us some ice cold sweet tea and some cookies. Her house had flooded but she refused any help from us. "I got it all taken care of hon," she said. She sent us on our way with a pitcher of tea and a box of snacks. "Y'all do some good out there now, OK?" she shouted as we drove away.

We dressed wounds, gave shots, helped people move furniture, and spent hours helping sort through debris. But I gained more from the people there than I could ever have given them. They showed me that great sorrow and huge tragedies birth hope.

The Birthing of the Bowels

I think I'm on a poop roll. Everything I do lately seems to be centered around someone taking a crap. There is a black cloud of shiznit hovering over my head. Sigh..............................

I walked into Exam 2 to help Lucy "roll someone over" yesterday. She's learned how to manipulate me - and manipulate me well. "It'll only take a second," she whimpers.

I walked into a wall of odiferous haze. Oh..........my.............god.

It smelled like the bowels of hell. Literally.

Mr. Intoxicated had crapped himself. For the first time in 8 days. Lucy looked at me from the back of the stretcher and winked. I flipped her off. We set to work and got him cleaned up, changed to a fresh gown, and settled back in.

"I have to crap!!!!!!!!!!!" he screamed.

Oh Lord.

We quickly assisted him up to a bedside commode where he proceeded to give us a play by play of his bowel movement. We apparently had ringside seats.

"OH OH OH! It's coming! It's coming!!! I can feel it starting to come out."

Grunt.

"Oh, wait. It stopped. I think I'll push harder." Grunt, Grunt, Strain.

"Here it comes! I think I've got it!"

Long pause.

"Nope. I was wrong. Lordy, I can feel it hangin' there."

Lucy was holding her hands over her mouth trying not to laugh. I just stood staring at the guy with my mouth hanging open.

"Seriously?????" I mouthed to Lucy.

She snorted.

"Oh!!! Here it is! Here it is!" PLOP. The bowel movement finally arrived.

I felt like I should have clapped.

We proceeded to admit him to the floor for detox and some abnormal labs. I volunteered to take him up - not the smartest move of my day by any means. The floor nurse and I transferred him from the stretcher to the bed where he decided he had to crap again. Instead of waiting for us to get the bedside commode, he just let loose - and loose is a definite understatement. The dramatic ejection of the poop plug in the ER had broken the dam. The river was overflowing the banks! My lower legs were suddenly (and shockingly) covered in his diarrhea.

Sometimes I wonder why I go to work every day.

The "Butt" of the Joke

I think I was a little to verbal at work about my frustration with coworkers taking a poo in our bathrooms. I am now the target of containers of mysterious brown substances being left on the ER desk when I am working. One even had a note asking me if I could identify what they ate for lunch the day before.

I wrote back on the bottom, "halibut fish and chips, coleslaw, and a pepsi" and set it back on the counter.

Thirty minutes later there was another post it note on the bottom that read, "OH MY GOD! You're right!"

Personal Hygiene

One of the male nurses I work with keeps me laughing constantly. He always has a comeback that will make me practically pee my pants from giggling so hard. I thought he could never be beaten.

Until Flirty Flora came in.

It took her only one full sentence to leave him stunned and speechless, unable to grasp even the edges of a smart assed reply.

He grabbed her chart from the triage nurse and saw the chief complaint of "fall with abdominal pain." He headed to Exam2 and walked in and introduced himself.

"Hello Flirty Flora. My name is JoeBob. I'm one of the ER nurses and I'll be taking care of you today."

Flirty Flora, who is in her 60's by the way, batted her eyelashes, looked up at him and uttered the now famous words we have posted in our nurses lounge.............

"Oh good. I just cleaned and powdered my twat."

Google Away

Apparently, it's all the rage to surf the net drunk

I made the google list for that one. HeeHee.


I AM that inspiring. Snort.

And Away We Go

A few months ago I had the privilege of manning the back of Medic 1 on a transfer to a higher level facility. We were 2 Paramedics short and they needed someone to provide care on the transfer. The patient was a stable GI bleed who needed the services of a surgeon. Ours was out of town on a hunting retreat in Africa.

I received report from one of my coworkers. 58 y/o female, bright red blood from rectum, vitals stable, mild abdominal pain. Alert and responsive. She threw me a cooler with 2 units of PRBC's (packed red blood cells) in it "just in case".

EMT Bob helps me pop her up into the back of the ambulance and away we go. I get her hooked up to the monitor, check her IV site, take vitals, do a quick assessment. Nothing has changed from previous report.

We get 60 miles out of town and her IV site blows. Not a big deal, right? An IV start is an everyday activity for me. Multiple starts per day.

But never in the back of an ambulance going over a highway that has multiple potholes from the nasty ass winter we had where the snow and gravel tore up the road.

I have two words................. NEW RESPECT.

It takes a certain finesse to start an IV in the back of the short bus. It was one hell of a bumpy ride. Trying to maintain your balance with a needle in your hand aimed at a vein while the rig is swaying back and forth and jumping over potholes is no easy feat. To think our Paramedics do this without thinking twice.

I did get it on the first try. I left a large amount of the patients blood all over the EMS stretcher and on their floor, but damn it - I got it. Yeehaw! EMT Bob even congratulated me. "You're the first nurse I've seen who got it on the first try back there."

The patient looked at me and smiled. She then promptly rolled her eyes in the back of her head and went out on me. What the hell?

Airway intact, breathing OK, B/P in the toilet, pulses weak, tachycardic. Shit.

"Um........Bob?"

Yeah - he can't help. He's driving.

Fluid bolus. Start second IV (amazing how a little stress made me completely forget about the bounciness of the ambulance. Bounciness? Is that even a word?). Initiate blood transfusion.

Pt condition improves.

Nurse breathes.

OK seriously - this condition in the ER would not have made me blink twice. But I also know I have backup at the drop of a hat. Being in the back of Medic 1 in the middle of nowhere halfway to the next hospital (120 miles of desert to cross with no towns in between) adds a new perspective to the problem. No one there to help. Closest help an hour away.

I loved every minute of it.

Must do it again.

Agree To The T

I could not have said it better:

Open letter to ER Patients


Courtesy of ER Tech Dude



I do believe that health education for the public should include how to behave in the emergency department waiting room and how to tell the truth to your medical caregivers. 'nuff said.

Obviously the 50 Previous Attempts Don't Matter

Interesting case from my state:

Woman jumps from balcony in hospital and kills self

Powell jumped from a balcony in the hospital’s main lobby Monday after she broke free from two escorts who were taking her to a secure mental health facility, said Robin Henderson, director of behavioral services at the hospital. ~Bend Bulletin Newspaper~

This is going to bring about all kinds of interesting policy changes there I bet. Which irritates me. I'm all for patient safety, but sometimes you just cannot prevent something bad happening. Especially when the patient has attempted suicide 50 - yes FIFTY times before.

Cindy Powell’s sisters both say her 50 suicide attempts weren’t what they seemed. ~Bend Bulletin Newspaper~

She succeeded this time.

Someone who attempts suicide multiple times and finally plunges off a balcony is not just "looking for help" in my humble opinion.

I took care of a gentleman early in my career that had attempted suicide 4 times - and they were all major attempts. Not just a little pill popping here and there, but serious attempts.

1. tried to slash his own neck - nicked one major vessel and was found immediately by his wife
2. gunshot to the abdomen. Missed anything major. Found immediately by his wife
3. attempted to stab self in heart. Missed. Dug around with the knife in his chest for a little while. Nicked some major vessels but found immediately by his wife
4. gunshot to the head when wife finally left him. Used a .22. Wrong angle, bounced off skull and played around under the skin of his head

Now, wouldn't you think that if you had lived through those things, someone upstairs really wants you alive for some purpose? He didn't. He still wanted to die. I never found out what happened to him as I moved from the area, but I'm almost 100% certain he is probably dead.

When you want to go, you want to go.

Everything's Coming Up Roses

Why does everyone feel the need to come to the ER to shit? And I'm not talking patients here. I'm talking other staff.

Apparently, people like to haul their butts all the way down to the ER to take a dump in our bathrooms. Lab personnel, Xray personnel, even the dang business office people! Do they think they can hide their stink in the ER? Do they think it will blend in with the other smells of the unit? OK, they're right there, but seriously people................shit on your own unit.

I'm almost at the point where I can identify coworkers by the smell of their poo.

Challenges of Obesity

I ate lunch with 2 of the EMS crew and one of our ER docs today. The conversation turned to alcohol levels, drug seekers, and morbidly obese patients - sometimes all in one.

Obesity is an epidemic in our country. We all know that. What some people don't realize is how much of a strain it puts on the medical professionals who have to treat them. The EMS crew were discussing a story about how difficult it was to get a 550 lb patient out of her house last week. They had to call the fire department for lifting help as they could not even move her. They talked about a 700+ lb lady we have in our community who they are just waiting to get a call on. They have a plan involving planks from the hardware store and tarps.

Now before I get any nasty comments, they were not making fun of her. They seriously had to plan for how they would be able to transport this patient to receive appropriate medical care at a hospital. The challenge is if they are able to get her to the hospital, what will we put her on? Our stretchers do not accomodate her weight, neither do our hospital beds.

Obesity leads to multiple medical problems, many of which you all already know so I won't repeat or lecture. How do we solve this? Can we? I don't think we can. But we must prepare for heavier and heavier patients as we see more of them every day. We must prepare not only for the physical demands of caring for them, but also the mental demands. We must figure out how to develop a plan of care for every other disease process that accompanies the obesity, and then we must plan how to complete the plan of care without interacting with treatments for the other diseases/conditions. It's a never ending cycle. One with a pretty scary ending.

Just the Pills Please Miss

I can't always remember what I've already posted on this blog and I'm too damn lazy to scroll back through everything I've written, so this may be a repeat story. I don't really know............or care.

Bob came in holding his right ribs complaining that he had fallen off the back of a truck 15 minutes prior. He stated his pain level was 10/10. I took him back to an exam room immediately and started my assessment. I had him undress and put a gown on. That's when I got a good view of his injured area.

I shook my head.

"Bob, what really happened?" I asked.

"Huh? What? I told you," he replied.

"Bob, I know you're not telling me the truth. What do you want?"

Bob hung his head and said "I just want some Vicodin."

"Well, you're not gonna get it. Anything else we can do for you?"

"Nah, I'll just go home."

Bob's injured area was a small abrasion approx 2 X 3 inches which was mostly scabbed over. He had picked portions of the scab off to make it bleed. He thought he could pass that off as an acute injury.

Not on this nurse.

I had 3 more interactions with Bob over the next 2 weeks. He finally got to the point where if he saw me as his ER nurse, he turned and walked out the door. Eventually he moved across the state. Wonder if I had anything to do with that or not?

My naughty habits

I love dirty jokes. The raunchier the better. Sexist, chauvinistic, pigheaded, dirty jokes make me laugh until I cry, and the ER is a terrific place to hear them. I get 'em from coworkers, doctors, and even the patients. I must have a sign on my head that says "naughty girl" or something. People feel free to have verbal diarrhea around me and I adore it.

I ain't right in the head.

I was introduced to the whole naughty joke genre by my grandmother when I was around 11 or 12. She told me a joke involving a mouse, a pussy, and a tattoo. I was hooked. I made her tell me all the ones she knew. I have a cool grandma like that. Aren't you jealous? Now she starts happy hour at noon and has an even larger repertoire. I love her.

If you are a patient in my ER, please bring a dirty joke along.

Bring It On!

I made the mistake of opening my big fat mouth and being a smart ass to Dr. Q. Shocking, isn't it? I know. I found him slamming things down at the nurse's station, mumbling to himself about fighting with insurance companies and being disrespected by the patients.

"Hey Dr Q - you wanna take this outside?" I said with my fists held up in front of my chest.

He rips off his lab jacket, grabs my arm, and says "Hell yes! Let's go!"

"I NEED BACKUP!" I screamed as he pulled me out the double doors and into the grassy area beside the ambulance bay.

Fresh snow on the ground. 10 fresh inches of the white shit.

My comrades got there just as he lobbed the first snowball straight at my face. I ducked, and Lucy took it in the eyes.

The fight was on!

15 minutes later exhausted, dripping wet, and crying with laughter we all tromped back into the ER. The rest of our shift was a breeze, even though we had 2 trauma's, a code, and 10 or so drug seekers. It's easy to deal with stuff like that when you have a little stress relief snowball fight.

Drumroll Please..........

Cathy stood in the hallway with the adult diaper in her hand. She was telling her RN that something wasn't right with the patient's stool.

"Just smell it," she said. "It's not right."

"I'm not going to smell it!" Lucy replied. "What the hell?"

"I'm telling you - something's not right! Wait, let me......" Cathy brought the diaper up to her face and licked it.

"OH MY GOD!!!!!!!" We heard Lucy yell.

Laughter surrounded her as we all knew Cathy had put chocolate pudding on the diaper. Lucy about shit herself watching Cathy lick that diaper.

Medical people are a quirky lot. We have to relieve tension with laughter and joking or we would never survive our shift, let alone our career. I am lucky enough to work with people who enjoy a good joke, whether receiving or giving.

We have a Paramedic who is insanely in love with his rig. I'm talking on the verge of a psychological disorder. Ripe for the picking in other words, and boy did I do the picking.

I took a picture of his rig and made about 20 For Sale posters with his work extension on it. I hung them all over the hospital and got everyone to call him asking about buying his rig. All for the low, low price of $5,000.

His vehicle was worth well over $50,000.

Approximately one hour into the shift I see Paramedic Pete charging through the doors of the ER. For some reason I felt the need to run.

"WHAT THE HELL WERE YOU THINKING?!!!???" he yelled.

Poor sport.

"THAT'S NOT EVEN FUNNY JULIE! NOT ONE BIT FUNNY!" he yelled again. By this time his face was red, spittle was flying out of his mouth, and he was shaking his fist in the air.

Oh my.

I couldn't help it - I started laughing. He just looked so damn funny. That calmed him down a bit and he started snickering.

"Damn you, leave my car alone," he smiled as he walked away.

Five days later, I was drenched with a basin full of water as I was walking out of the trauma bay, stripping off my yellow gown. I stood there sputtering and trying to breathe through the 2 cups of water that I inhaled right as it hit.

I heard laughter all around me.

"I told you to leave my car alone," I heard Pete say through his laughter.

"I .....cough cough......think I ......sputter, cough, snort......need......cough......intubated," I gasped.

Dr Q walked by just at that time, slapped me on the back and said "Nah - if you can talk, you can breathe."

Too Drunk to F*@k

Apparently we had a new record in our ER on Friday night.

.631


I know - I didn't believe it either. I thought the nurse was totally shitting me. An alcohol level of .631? "Whatever," I replied.

They ran the test 3 times just to be sure. They ran controls on the machine. It was correct.

I cannot even imagine living a life where you are still able to live and breathe at a .631. That means this man has built up a tolerance over the years to be able to be completely pickled and probably walks around at a .3 on a normal day. Scary, isn't it?

Then I stumbled upon this little gem surfing the net today. Holy crap. This is what our kids will face on the road as alcoholism becomes more rampant and people build a tolerance level that is insane.

Sigh..........

Back Again?

I was a patient in my own ER last night, and can I just say right now that that ain't right. You should never have to be treated by those you work with. There is no need for your coworkers to know your STD history.

Just kidding.

I only hurt my back.

Nursing is notorious for back injuries. Why? Well, because. We clean your ass, move your ass, and lift your ass - which makes for some back breaking work. And apparently, it's not a good thing to lunge to the left to catch a patient who is falling. Not just any patient, but a mom who has just delivered a baby, has a weak leg from an epidural, and weighs about 250 lbs.

But seriously.............who's really going to let her fall? No nurse that I know of, yet that is what I was told to do next time. "Let the patient fall," they said.

Sure thing.

(Insert eye roll here. Add one huge sigh and a shaking of the head)

So Dr. Q saw me in the ER. He walked into the room, shook his head, and handed me a prescription for Vicodin. He loves me.

Diagnosis? Back pain with Radiculopathy. The worst part is the burning sensation in my hip and down my leg. He said it should go away with rest and steroids. He gave me the vicodin just because he knows he needs to keep me in a good mood. He knows me like that.

The Things We Talk About

I washed maggots out of a wound one day. Real, live, squiggling maggots. Apparently, Mr. Hygiene was performing his own wound cleansing via maggot therapy. Unfortunately, he wasn't doing it on purpose.

I was telling the story to Lucy one day over lunch. We were sitting in the break room discussing the grossest things we had come across when I starting telling her about the pulsating mass of maggots. Sally came in behind us as I was elaborating on the little critters.

"It was just vomit inducing Lucy," I said, taking a bite of my lunch. "They were squirming all around and I could hear them from across the room. They were swimming in a pool of juicy body fluid - it was disgusting."

Suddenly I heard Sally retch and run for the sink. Lucy twirled her chair around while I swung my head to the right, fork poised midway to my mouth. Sally looked up and me and instantly vomited in the sink.

"What?" I shrugged at Lucy. She started laughing as she pointed to my lunch.

I was eating rice and gravy.

Dear Penis

They called me back to the recovery room around 11:30 AM. I had traveled across state lines to be with my friend Kiki while she underwent a cystoscopy and a lithotripsy. Basically they wanted to blast a kidney stone and sneak a peak at her pisser while she was under. Good times. Good times.

I walked back through the recovery room hallways and rounded the corner to find Kiki wrapped head to toe in blankets. She looked like a mummy. A mummy who had imbibed in a little too much preserving fluids, if you know what I mean. Higher than a kite on a windy day.

"Hey Julie - I got a song for ya," she says.

Oh Lord.

Giggle Giggle.

"Hey - have you heard that penis song?" she asks.

Now let me preface this by saying that the stretchers in the recovery room are separated by curtains only. No auditory privacy. None. Zip. Zero. She then performs her first concert for the entire room.

"Deeeeeeeeeear Penis.............I don't think I liiiiiiiike you anymoooore................" she sings like a wino on the end of a 3 day binge. I hear snickers coming from the other side of the curtain.

"Oh! Wait Wait!" she says. "I'm gonna call Eric and sing it to him." I can't get to the stretcher fast enough - she has him on speed dial.

"Deeeeeeeeeeeeeeeeear Eric - I don't think I liiiiiiiike you anymooooooore," she sings into the cell phone as he picks up. I just shake my head. I hear someone snorting beside us.

I wish I had been smart enough to whip out my cell phone and video her. Alas, I missed it.

I'll give you the next best thing - Rodney Carrington singing his own Dear Penis song:

I love this little guy. He just represents so much that can be left unsaid.

Ode to the Name

This post over at Musings of a Highly Trained Monkey stirred the recesses of my spiderweb covered brain and handed forth a few memories of crazy names I've come across. I often wonder if parents are seriously as stupid as they look or if they plan to slowly and deliberately torture their children as they go through school. Are they handing down retribution to their children for when they were made fun of in school?

"Well, I had to toughen up pretty quick when I peed on the teeter totter and all the kids called me Peeter-Potter until 12th grade. I'll show them! I'll name my kid.........."

Diarrhea.

I shit you not. No pun intended of course.

Pronounced Dee-Ar-ee-a

I stood there with the chart in my hand for a good 2 minutes. I stared at it not believing what I was seeing. I ran through every pronunciation in my head and I still could not wrap my tongue around it.

I hesitated. Fumbled a bit.

"Ummm.......de.....duh......um....."

"Oh! That's us! It's dee-ar-ee-a."

"Um, okay. Come on back."

As I settled them at the triage desk I asked what they were here for. Yes, you guessed it...........

Diarrhea had Diarrhea.

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

Chicken Nuggets

We had a patient a few years ago that I'll call Mr. ChickenNugget. Oh, Mr. ChickenNugget was a joy to take care of. He came staggering in to the ER lobby clutching his belly and shouting "I BEEN STABBED! I BEEN STABBED!" The triage nurse escorted him back to her room and did a quick assessment.

She pulled open the lower half of his shirt and saw a small amount of blood smeared around his belly button. There appeared to be a tiny puncture wound in the middle of the blood. Initial vitals were absolutely normal.

"What were you stabbed with, Mr. ChickenNugget?" she asked.

"A Screwdriver! He got me with a screwdriver!"

Apparently, Mr. ChickenNugget was approached by "just some dude" in the Safeway parking lot when he was viciously (and for no apparent reason of course) stabbed with a phillips head screwdriver. He walked the 2 blocks to the hospital himself.

Triage Teresa brought him back to Exam Room 1 and gave me report. I went in to do my assessment on Mr. ChickenNugget, pulling the bedside ultrasound unit behind me. I figured Dr. Q would want to do a quick FAST scan.

I told Mr. ChickenNugget to take his clothes off and I would give him a gown. I turned around and reached into the cupboard next to the sink and grabbed the gown, an IV start kit, and some lab tubes. I turned back around with the gown in hand and immediately started laughing. I hate to admit it, but yes.............I laughed at my patient.

He had a tattoo over each nipple. On the right it said "SWEET" and on the left it said "SOUR". I shit you not.

How can you not laugh at that?

Mr. ChickenNugget followed my line of sight to his own chest and started laughing too.

"That's what happens when you get drunk and go to a tattoo parlor with your buddies," he said.

I immediately placed that on my What Not To Do In Life list.

So it turned out that he had not even been stabbed. There was a small abrasion on his abdomen but no depth to the wound. Mr. ChickenNugget had been scratched by a screwdriver.

I still think about him any time we have a stabbing come in.

ER on NBC

Last Thursday's episode kept me so entertained that I fell asleep..............15 minutes into it. Sorry T-Dude. Once again I have no wonderful insight (heehee) on the episode. I can't even remember the first 15 minutes that I did watch.

Maybe next time I'll down some caffeine, take a couple of NoDoz (do they even still make those?), eat a bunch of sugar, and then plant my ass in front of the TV on the floor and not in the big, fluffy, overstuffed Lazy-Boy recliner. That was my downfall. A comfy chair, a cozy blanket, and a glass of whine, oops I mean wine. I was asleep as fast as a woman who likes to "shop around" gets called a whore in Southern Mississippi.

Once Again For Your Viewing Pleasure

I know this has made the internet rounds a few times, but I laugh every single time I read it. A friend sent it to me via email, but I also saw it again today posted over at Nursing Voices. Hope you enjoy!

Come to think of it, this may produce a few more entries from me as I remember stories that go along with some of these. People are amazing creatures.


Subject: You know you are a nurse when

1) the front of your scrubs reads "Nurses... here to save your ass, not kiss it!"

2) you occasionally park in the space with the "physicians only" sign... and knock it over.

3) you believe some patients are alive only because it's illegal to kill them.

4) you recognize that you can't cure stupid.

5) you own at least three pens with the names of prescription medications on them.

6) you believe there's a special place for the inventor of the call light.

7) you believe that saying "it can't get any worse" causes it to get worse just to show you it can.

8) you wash your hands BEFORE you go to the bathroom.

9) you believe that any job where you can drive to work in your pajamas is a cool one.

10) you consider a tongue depressor an eating utensil.

11) eating microwave popcorn out of a clean bedpan is perfectly natural.

12) you've been exposed to so many x-rays that you consider it a form of birth control.

13) you've ever heard a patient with a nose ring, a brow ring, and twelve earrings say "I'm afraid of shots."

14) you've ever placed a bet on someone's blood alcohol level.

15) you've told a confused patient that your name is that of a coworker and to call if they need help.

16) your bladder can expand to the size of a Winnebago's water tank.

17) you have seen more penises than any prostitute could dream of.

18) you believe that not all patients are annoying... some are unconscious.

19) your family and friends refuse to watch medical sitcoms with you because you spend the whole time correcting everyone and pointing out upside down x-rays.

20) you don't get excited about blood, unless it's your own.

21) you've sworn to have "do not resuscitate" tattooed on your chest. Soon.

22) discussing dismemberment over a gourmet meal is perfectly normal to you.

23) your idea of fine dining is anywhere you can sit down to eat.

24) your idea of a good time is a cardiac arrest at shift change.

25) you believe in the aerial spraying of Prozac.

26) you believe that "shallow gene pool" should be a recognized diagnosis.

27) you believe that the government should require permits to reproduce.

28) you believe that unspeakable evils will befall anyone who utters the phrase: "Wow, it's really quiet, isn't it?

29) you have ever wanted to write a book entitled "Suicide: getting it right the first time."

30) you have ever had a patient look you straight in the eye ad say "I have no idea how that got stuck in/on/up there."

31) you've had to leave a patient's room before you begin to laugh uncontrollably.

The Elderly and UTI's

I walked into the room at 11 PM and was met with the sight of a 78 year old naked lady laying spread eagle on the stretcher.

Oh my.

"Mrs. Smith, you're naked," I said.

"Oh my," she giggled. "Am I?"

I giggled back. "Yes, you are. Let's cover you back up." I put her gown back on and pulled the blankets back up over her body.

She laughed. "OK dear, let's do that."

I rounded on her 30 minutes later. She was naked again.

"Mrs. Smith. You're naked again!" I couldn't help but laugh. She had a huge smile on her face, her arms were thrown back over her head, and she was giggling again. Like a little school girl.

"Oh my........giggle, giggle.........did I do that again? HeeHee."

"Let's pull these covers back up," I said as I put her gown on her and replaced her blankets once again.

"Thank you dear!"

I went to check on my chest pain patient next door. I returned to see Mrs. Smith in another 30 minutes.

Naked again.

Laughing hysterically.

"Mrs. Smith! What are you doing?" I laughed.

"What dearie?" she replied.

"You are naked again!"

"Oh my.........snicker, giggle......again? Oh my.....heehee. I don't know why I keep doing that. Giggle."

She was so pleasantly confused she then pulled out her catheter. She stared at it and started laughing. "What's this thing?"

I couldn't help myself. I was laughing so hard I had tears coming down my face. She thought everything she did was the most hilarious thing she'd ever seen, which in turn made me want to spend all my time in her room. She was extremely entertaining.

She finally settled down for the night and fell asleep...........naked.

One Flew Over the Cuckoo's Nest

I was sitting at the desk in ER the other day (why do a lot of my stories begin like this? Does this say something about where I spend most of my time?), when I heard a chirp.

"What the hell?" I said.

Chirp, chirp. Chirp, chirp.

I suddenly remembered my previous conversation with the EMS guys and figured they were playing a little game with me.

"I know it's those assholes with a bird call. I'm not even turning around," I said to myself. "I'll just sit here and continue charting and then walk away."

So I did.

The chirping got louder. Angrier. More frantic.

I giggled.

"They're not going to get me. Not this time."

I have a long standing relationship with my EMS crew. We love jokes. The more embarrassing, the better. The more we can make the other look like an ass, the better. I love those guys! We have so much fun.

So hence, I ignored them.

Chirp! Chirp Chirp! CHIRP CHIRP CHIRP CHIRP CHIRP!!!!!

Snicker.

I started whistling back.

Whistle Whistle.

Chirp Chirp.

"Suckers," I thought.

Suddenly my pharmacist came around the edge of the desk. "Hey Julie, did you know there's a bird in your ER?" she said.

"No, that's just the EMS guys trying to be stupid. They have some bird call or something they're playing with."

"No it's a bird," she replied.

"No it's not. Really. They're getting me back from the other day."

"No Julie. It's a bird. It's right there............"

I looked up to see her pointing down the hallway. I stood up, leaned over the desk, and saw the damn bird - sitting right in the middle of the hallway.

Chirp Chirp! Chirp Chirp! He cocked his head as he talked to me.

Sigh................... Yes, apparently I am that stupid.

4 nurses, 6 slammed doors, and 18 cuss words later we had the bird in our hands and escorted him back outside for his return home.

15 minutes later the EMS crew was standing in the double doors pointing and laughing at me.

All in a day's work.

I Know What's Important

You never know how valuable soda is until you are doing medical disaster work after a Hurricane and you are trading favors for Diet Coke.

Not those kind of favors! Get your mind out of the gutter. At least for a little while.

When I went to Mississippi with a group of nurses after Hurricane Katrina, we found that it's the little things you miss. The little things like Diet Coke. One of our nurses finagled a case of DC from some volunteer firefighters (I don't even WANT to know how) and we protected it like a meth head protects his last hit from his girlfriend's cousin's sister.

We had it wrapped up in our bedrolls, hidden from prying eyes. Whenever we felt the need to imbibe, we attacked the gym like Navy Seals on a mission to save the only person who knows the code to stop the nuclear bomb from exploding. One lookout, one distractor, one to grab the soda, one to hide it on a sideways pass, and one to just stand there and look good.

When we flew out and landed at the airport in Minneapolis, I think I downed 3 Diet Cokes within the first 10 minutes on solid ground.

It's the little things in life that matter.

Oh The Joys of Rural Living

Mr. Estupido did the smart thing and rode his bicycle to the bar to drink his 8 Rum and Cokes and 6 Bud Lights. He hopped his ass on that bike and pedaled fast and furious down the road to fulfill his nightly ritual.

That was about the only smart thing he did.

Around 11 PM he decided it was time to go home. He staggered out to the bike rack (as a side note - how many bars do you know of that have a bike rack? Hmmm? I'm not talking in the big city here - it's redneckville 100%), swung his leg over the middle bar, and promptly fell over. He had a nice long gash above his right eye and a few scratches on his right arm. He tried again.

And fell again.

You'd think that the people watching from inside the bar would help him. Nope. It's much funner to point and laugh (I have to admit I'd probably be laughing too).

On the third try he got it right.

He then pulled out of the drive and headed down the sidewalk towards home, blood running down his face.

About 3/4 of a mile down the road, he thought he saw something in the ditch by the golf course. His curiosity (that word just looks wrong) got the best of him and he went to investigate. Now I have told you all before what happens when you let your curiosity take control. It's a bad, bad, bad thing. Why can't we just say no? I know, I know. It's impossible. Sigh..................

Anyway, Mr. Estupido steers his bicycle toward the ditch. He squints his eyes to try and see more clearly, but the blood from his cut is clouding his vision. He tries to wipe it away with his arm, but only succeeds in making more of a mess. Wait, wait! He knows there is something there, he can see it moving! What is it? What is.........



OH SHIT!





He hits a deer.





On a bicycle.





Yes............... he did.




My first thought when I heard the EMS tones go off for a "bicycle vs. deer" was "you have got to be fucking kidding me." They weren't.

He ended up with a broken arm, 2 more cuts on his face (plus the original one), and an alcohol level of .320

The deer ran off. Unhurt we would suppose.

We Make Funnies

I spent half of today reviewing the ER log from 2007 for retrospective trauma entries. Basically I was looking for cases that should have been entered into the trauma system that for some reason were not. Usually related to under triage by the nurse and/or physician. I actually really enjoy reviewing these cases because it is absolutely hysterical what you find. Between admitting clerks who have no medical terminology background and physicians who apparently were on the tail end of a 48 hour stretch when they dictated - it makes for a fun filled 6 hours of reading.

When the admitting clerks register a patient, they must fill in a chief complaint on the admitting form. This usually is what the patient specifically says they are there for, such as abdominal pain, can't breath, chest pain, etc. Apparently, we need to do a little more training with some of our clerks, or be a little more aware of typos.

For example (exact spellings included):

• Hell and hit head (I'd hit my head if I was in hell too - over and over and over and......)
  
• here for a cathader (is that related to Darth Vader?)
  
• cut all his finers (ummm..................where are your finers?)
  
• turned both ankles (turned them where? Left? Right? Into the police?)
  
• bitten twice by unknown (wouldn't you have recognized it after the first time it bit you? Or at least ran from it when it went at you a second time?)
  
• history of vowel obstruction (good thing they weren't consonated too)
• slash of gasoline (vs a dash or a pinch? Or maybe a guitar player from a rock band?)
  
• left thigh from a dirt bike (what - did he grow a left thigh from the dirt bike? Borrow it from the dirt bike? Left his thigh on the dirt bike?)
• kedney pain (apparently a new type of pain related to shoes?)
  
• pains from having appendicitis out (this is just funny)
  
• Fell likes passing gas (Sweet shit on a stick. Did he fall because he likes passing gas? Did we just need to know he likes flatulence? Does he feel like passing gas? Because apparently it's now OK to come to the ER whenever you feel the need to fart)
  
• painful hemoridds (maybe they wouldn't be painful if he'd have just passed the gas)
  
• toothpain and a bad smell (well maybe a shower would help)
• ripatory dress (as compared to a non ripe............ shirt?)
• sinkable episode (was this a near drowning?)
  
• sour throat (If they watched what they put in their mouth, they wouldn't have such a bad taste in there)
• dieraha (ummm...............hmmmmm......yeah)
• crappy cogn (it took me a long time to figure out this was a croupy cough and not something to do with poop)

It's days like today that make me love my job.