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.