Tuesday, July 29, 2008

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.


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.


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."


"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."


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?

Thursday, July 10, 2008

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

Funny RN


nurse funny

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."


"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.

Wednesday, July 09, 2008

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.


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.

Thursday, July 03, 2008

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.