If you come to the ER weighing 82 pounds at the age of 48, skin the color of freshly bloomed daffodils, vomiting blood, have a heart rate of 140, a blood pressure of 138/79, and have tremors so bad that you can't hold a cup without dropping it - I will not believe you when you tell me you do not drink alcohol on a regular basis. I will prove you wrong when the labs come back and your ETOH level is .280.
Don't go there.
Truth - it's a good thing.
Sunday, January 25, 2009
Foul Language
I got a comment on another post basically saying that I cuss too much. So I read back through my posts from the beginning and I will have to say she was right. The question remains though - will I change?
Probably not. I work in an environment where cussing is a native language. I don't know a single one of my co-worker who has not uttered a foul word, even the "good girls." We are faced with people cussing us out almost on a daily basis because we won't give in to their demands for pain pills, work excuses, or other things. We get cussed out by people who have no medical training telling us that we are doing our job wrong. We get called bitches, fuckers, and the Queen of the mean - c.u.n.t. Why? Because we care.
We come to work ready to save lives, dress wounds, set broken bones, run our butts off all for the sake of getting called names when one person is unhappy because their morphine shot had to wait until we were done with CPR in the next room.
Are these valid excuses? Not really. But I tell you one thing. You will never catch me cussing at a patient or their family members. Never. I may cuss all day long on my little blog-a-roo here, but I will be respectful and professional with you if you are seeing me as a patient. I will probably continue my use of shit and such here, but I suppose that will expose you (my 12 readers) to the world I work in every day that I put those scrubs on my butt.
Welcome to the ER....... it's the place to be.
Probably not. I work in an environment where cussing is a native language. I don't know a single one of my co-worker who has not uttered a foul word, even the "good girls." We are faced with people cussing us out almost on a daily basis because we won't give in to their demands for pain pills, work excuses, or other things. We get cussed out by people who have no medical training telling us that we are doing our job wrong. We get called bitches, fuckers, and the Queen of the mean - c.u.n.t. Why? Because we care.
We come to work ready to save lives, dress wounds, set broken bones, run our butts off all for the sake of getting called names when one person is unhappy because their morphine shot had to wait until we were done with CPR in the next room.
Are these valid excuses? Not really. But I tell you one thing. You will never catch me cussing at a patient or their family members. Never. I may cuss all day long on my little blog-a-roo here, but I will be respectful and professional with you if you are seeing me as a patient. I will probably continue my use of shit and such here, but I suppose that will expose you (my 12 readers) to the world I work in every day that I put those scrubs on my butt.
Welcome to the ER....... it's the place to be.
Monday, January 19, 2009
Linkylooloo
This post over at Emergiblog got me all fascinated and such. She makes some great points about ideas for health care for our new President.
I love it when someone can speak my mind better than I can.
Loved this one also. It is an amazing play by play of a trauma death.
And THIS video over at Mel's blog made me tear up. It's an amazing testament to the strength of women and their friendships.
I love it when someone can speak my mind better than I can.
Loved this one also. It is an amazing play by play of a trauma death.
And THIS video over at Mel's blog made me tear up. It's an amazing testament to the strength of women and their friendships.
Yeah, Sorry.
I suck.
At Blogging anyway.
The past 2 months have been extremely difficult at work. Actually the last 4 or 5 months have been. Too many changes, too many cooks stirring the soup. Getting emotionally punched in the face every few days by someone you used to be very close with but who now feels the urge to "take you down" takes it's toll. A new job is sounding better and better.
Enough of my useless prattle. Onward and upward they say! I just don't say it with them today.
16 year old drug into the ER by her parents. She is visibily shaking in Triage. I can see her heart pounding through her chest. Heart rate about 160, respiratory rate about 40. Glassy eyed, scared shitless.
"Emily says she took something but she won't tell us what," Mom says.
After an extensive workup we found............................. nothing. Nothing popped positive on the drug screen. No weird labs. Just crazy vital signs. Was she just nervous? Did she take something else that we can't test for? Salvia came to mind.
"Can I have some ice cream on my toes for my trip to Maine?" Emily asked.
Um....................... huh?
"I need some tiles for my eyes on Canada."
What the hell? She is as confused as Grandma Mabel - who thinks it's 1812 and that she's a man fighting in the war.
Little Emily gets admitted for a few nights stay at our overpriced hotel. I came back a few days later to check on her and they finally figured out what she took.
Hold on - are you ready?
Dramamine.
Yep, you heard me right. Who knew? I've never had anyone come in that took Dramamine to try to get high. Holy crap. These kids will take anything. Do they not understand that almost anything can kill you if you take enough of it? I think they finally figured out that she took about 7 or 8 tablets.
***********************************************************
I've been taking practice tests for my CEN (certified emergency nurse) exam. Apparently they were designed to make you feel like the dumbest nurse on earth. The other night our crew sat down and did them all together, reading the questions out loud and discussing them. We argued with the book many times on the correct answer. Is that a sign that we might not be right in the head?
"Oh bullshit! That is not the first thing you would do for that patient."
"What a load of crap. Who wrote these questions?"
"Close the book and let's go get chocolate!"
Yeah, I like the last one.
***********************************************************
I've found my nursing soul mate. One of our night shift nurses moved to day shift and I'm finding that we work wonderfully together. I can read her like a book. We argue like sisters about practically everything, but when it comes down to the knitty gritty, we don't even have to speak. We get it all done for the code/trauma with little fussing and only relevant communication. We can briskly shout commands to each other without getting offended, which is the absolute frosting on the cake. I lubs her and she's my favorite team member now.
OK, I'll try to jump back on the blogging bandwagon, but I can't make any promises. My internet time lately has been limited to hours on Facebook and shaking my head at some of the responses on AllNurses.com. We'll see how it goes.
At Blogging anyway.
The past 2 months have been extremely difficult at work. Actually the last 4 or 5 months have been. Too many changes, too many cooks stirring the soup. Getting emotionally punched in the face every few days by someone you used to be very close with but who now feels the urge to "take you down" takes it's toll. A new job is sounding better and better.
Enough of my useless prattle. Onward and upward they say! I just don't say it with them today.
16 year old drug into the ER by her parents. She is visibily shaking in Triage. I can see her heart pounding through her chest. Heart rate about 160, respiratory rate about 40. Glassy eyed, scared shitless.
"Emily says she took something but she won't tell us what," Mom says.
After an extensive workup we found............................. nothing. Nothing popped positive on the drug screen. No weird labs. Just crazy vital signs. Was she just nervous? Did she take something else that we can't test for? Salvia came to mind.
"Can I have some ice cream on my toes for my trip to Maine?" Emily asked.
Um....................... huh?
"I need some tiles for my eyes on Canada."
What the hell? She is as confused as Grandma Mabel - who thinks it's 1812 and that she's a man fighting in the war.
Little Emily gets admitted for a few nights stay at our overpriced hotel. I came back a few days later to check on her and they finally figured out what she took.
Hold on - are you ready?
Dramamine.
Yep, you heard me right. Who knew? I've never had anyone come in that took Dramamine to try to get high. Holy crap. These kids will take anything. Do they not understand that almost anything can kill you if you take enough of it? I think they finally figured out that she took about 7 or 8 tablets.
***********************************************************
I've been taking practice tests for my CEN (certified emergency nurse) exam. Apparently they were designed to make you feel like the dumbest nurse on earth. The other night our crew sat down and did them all together, reading the questions out loud and discussing them. We argued with the book many times on the correct answer. Is that a sign that we might not be right in the head?
"Oh bullshit! That is not the first thing you would do for that patient."
"What a load of crap. Who wrote these questions?"
"Close the book and let's go get chocolate!"
Yeah, I like the last one.
***********************************************************
I've found my nursing soul mate. One of our night shift nurses moved to day shift and I'm finding that we work wonderfully together. I can read her like a book. We argue like sisters about practically everything, but when it comes down to the knitty gritty, we don't even have to speak. We get it all done for the code/trauma with little fussing and only relevant communication. We can briskly shout commands to each other without getting offended, which is the absolute frosting on the cake. I lubs her and she's my favorite team member now.
OK, I'll try to jump back on the blogging bandwagon, but I can't make any promises. My internet time lately has been limited to hours on Facebook and shaking my head at some of the responses on AllNurses.com. We'll see how it goes.
Friday, November 21, 2008
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?
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?
Sunday, November 09, 2008
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.
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.
Friday, November 07, 2008
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.
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.
Wednesday, November 05, 2008
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!
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!
Monday, October 20, 2008
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.
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.
Sunday, October 19, 2008
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..................
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..................
Wednesday, October 15, 2008
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.
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.
Monday, September 29, 2008
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.
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.
Friday, September 26, 2008
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?
"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?
Tuesday, September 09, 2008
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....................
Will return when I find my brain again.
Until then....................
Thursday, August 21, 2008
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.
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.
Wednesday, August 13, 2008
Monday, August 11, 2008
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.
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.
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.
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?
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?
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