Hey! Watch This!

We've all heard those famous words "Hey! Watch this!". We know we shouldn't turn our heads and look. We know that if we do, we will only see something that should be featured on late night cable shows - something that makes us cock our head to the side, converge our eyebrows, and say "What the hell?" Shows that make us literally gasp in horror (or amazement) at what humans do. Humans are not the smartest creatures on the planet. Emergency nursing taught me that in my very first day.

Friday night, two ........ um .......... wonderful (and I say that not in jest, but in awe at the entertainment that they provided) men arrived in our ER. Jim walked in with bloody towels wrapped around both of his hands. Jay, following behind, was an exact replica, even down to the attire he was wearing. But that is a completely different story. What is it about drunk men on a Friday night in rural USA? Do they all grab clothes out of the same closet? "Hey JimBob - Can I borrow your red wifebeater?" "Sure BillyJay - but the blue one might go better with your eyes."

"Hey Miss!" Jim yelled, waving his bloody mitts in the air. "Hey Miss! Can we get some help here?"

"Hey, me too!" Jay, not to be outdone, yelled across the hallway, pushing himself in front of Jim.

"Shut up Jay! More of my fingers are missing than yours, you pussy."

Fingers? Missing? Oh, this was going to be good.

"Jim - you're a prick," Jay replied. "I outta kick your ass."

"Oh yeah? I'd like to see you try it. You can't even make a fist. Whacha gonna do? Punch me with your thumb?"

Jay started toward JIm, hands (what was left of them) in the air. The towels fell off and blood ran down his arms and spilled onto the floor. "Shit," I thought "I'm gonna have to clean that up."

"SIT DOWN!" I calmly shouted. They simultaneously dropped their butts down onto the stretchers in the room. "What did you guys do to yourselves?" I asked. Now, I've talked about this before. Asking people what happened or what they did to themselves often takes you to areas of human intelligence you never knew existed. It's like walking around a corner in some little town you are exploring and coming upon a man walking a Great Dane dressed in a tutu. You're just not quite sure if what you are experiencing is real.

Jay and Jim started talking at the same time, arguing like little kids. "It's your fault!" "Nuh-uh! It's your fault!" "I thought it was a stupid idea!" "You did it too!" "Nuh-uh!"

"SHUT UP! You guys sound like a couple of 5 year olds," I said as I grabbed Lucy and had her help me examine the wounds. Both men hung their heads low, but continued to whisper insults at each other. Rolling my eyes, I threw Lucy a few extra packs of 4X4's. Upon examination, I noted that Jay had lost the 1st through 4th fingers on his right hand, and half of the 1st and second fingers on his left hand. Jim had lost half the height of his 1st through 4th fingers on his right and left hands.

During our exam, Jim said something to Jay about his mother and I thought maybe some type of relationship with her brother. I'm not 100% certain what he said, since Jay jumped up off the stretcher and started towards the other side of the room, pushing me out of the way as he went. Luckily, the clatter of the metal mayo stand hitting the floor was enough to make him think twice. He called Jim a few choice names, sat back down on the stretcher, and then politely said, "Sorry Miss. I didn't mean to curse."

"All right boys. I'm going to have to separate you," I said.

"NO!" They both yelled. "I gotta stay with my Jim," Jay said. "He's my best friend."

"Oh man," Jim replied. "I love ya man." Then he started to cry.

"I love you too man!" Jay said. "I'm sorry man. I'm sorry!" Tears were flowing from both of them.

(And they say women are complicated and emotional.)

We finally got the story out of them. Jay had apparently thought it would be a great idea to use a lawn mower to trim a hedge. What's so bad about that, you ask? Well, let me tell you. Picture the scene: family BBQ, drunk men, kids running around screaming, Jay and Jim discussing how the hedge needs trimmed. Jay's wife yells something about how he can't even mow the grass, how the hell is he going to trim the hedge? The lightbulb goes off above Jay's head. Jay talks Jim into helping him.

"Hey! Watch this babe!" Jay yells.

His wife hears the engine of the lawnmower start. She slowly turns and watches as the men position themselves on either side of the mower. "I wouldn't do............." she starts to say.

They reach under the mower to pick it up. Yes! They picked the lawn mower up with their hands sticking under the machine. Under the machine that has rapidly rotating, extremely sharp metal blades. Metal blades that cut things - things like grass, sticks, FINGERS!

They were successful for about 2 seconds. Two seconds and 2 inches (sounds like some other things we're familiar with, huh ladies?) before fingers started flying.

"Why the hell were you picking it up like that?" I asked.

"Well," Jay replied, "I thought if we each got a side of the lawnmower and picked it up, we could just carry it down the hedge while it trimmed the top off."

I stood in stunned silence. Lucy snorted in the background.

"Seriously?"

"Yeah, I know. Stupid huh? When my wife mentioned the lawnmower I just thought, 'Hey, let's use it to trim the hedge.' I suppose it's a good thing we've had a few beers, huh? Helps with the pain."

"Helps with something....." I replied.

The ortho docs were called, came to see the patients, and closed and repaired what they could in the OR. No fingers were salvageable for replacement. The men were admitted under ortho services for IV antibiotics and observation.

It took less than 2 hours for a drawing of a lawnmower with fingers flying out of it to be posted at the nurses station. The caption read 'Hey! Watch This!'

Oddities of the Universe Unite!

It always amazes me how just being a nurse attracts the weirdest situations. Sometimes you are standing in line at McDonald's wearing your scrubs (wondering how on earth that little, tiny french fry on the floor became such a mass of squished goo), when the lady in line behind you starts telling you about her copious vaginal bleeding and how many clots she's expelling, while all the other customers are trying not to vomit and silently throwing their ketchup away.

I've even experienced many of these interesting scenarios just driving down the road. You never know what will be on the other side of that corner. If Mel is with you, you can be assured that something crazy or completely hysterical will happen. She attracts the oddities of the universe like flies on the sticky strip of life. I really think she should start working in the Emergency Department. She'd fit right in with the rest of us who are one taco short of a combo plate.

Last year at about this time, Mel and I decided to take a drive to Boise to escape the duldrums of a deep, depressing winter. Can I just take a moment here to say I hate snow? I seriously hate snow. It starts off white and sparkling and amazing. In 4 hours it is crap - and when it starts melting off at the 7th month, it turns into liquid shit. By the 3rd day of snow, I'm ready to pull my ass up to the top of the local skyscraper (all 2 stories of it) and start screaming obscenities nonstop. Kind of like the gentlemen we admitted to the psych hold room last week.

Mel picked me up in the boonies where I live. When we hit the end of the road at the highway, Ms. Eagle Eye Mel looked to the left and spotted an upside down truck in the snow about 1/4 of a mile up the road. A white truck - in white snow. I was oblivious to the situation since I was seizure dancing in the front of her van, rocking out to Third Day, swinging my hair and screaming "Turn it up bab-eeeee!" I think she might have even punched me to get me to pay attention the fifth time she asked me, "Is that a wreck over there?" I finally stopped my seizure dancing and followed the line of sight from the tip of her finger to the corner.

My control freak personality emerged. "Get over there!" I yelled.

Jumping out of the car, we ran to the truck. The cab was pretty much intact, but the bed had been ripped away from the frame. A local cowboy was bent down at the passenger window with his cute little wrangler butt sticking up in the air, trying to help the passenger crawl out of the vehicle. They were having a little difficulty getting her seatbelt undone (but I was enjoying the view), so I started ordering Mel around (bossy little wench that I am), "Go get coats, blankets, whatever you can find". By this time, a few more vehicles had stopped and Mel "borrowed" the needed items.

I turned my attention back to the passenger. I knelt down beside the cowboy and stuck my head in the window. I ran through the whole "Does your neck hurt? Did you lose consciousness? Any pain in your back? Yada, yada, yada," conversation. She kept denying everything. "I'm fine. I'm fine," she kept saying. Mr. Cowboy Man finally got her seatbelt undone and starts pulling her out the window.

"Wait!" she yells. "I can't feel my left leg"

"Ah Crap, Immobilize! Immobilize!" I think. Until the lady so very calmly says to us........................................................




"Actually, I don't have a left leg."


She was an amputee. After the shock wore off, I couldn't help but giggle. I looked at Mel and thought, "This is all your fault."

Mel's Journey

Please watch the progress of my friend Mel as she does a medical mission in Cambodia. She is an amazing nurse who will be going to Cambodia for 2 weeks at the end of April.

You can find her blog here

Addicted

I have an unusual thirst for blood. Now before you go off trying to come up with the correct medical terminology related to this disorder, let me clarify.

I Love Fights!

I went to the UFC fight in Vegas a couple of weeks ago and found out that I am an insenstive, bloodthirsty, whore of a human. My husband has decided that there is something so seriously wrong with me, he may need to commit me to the State Hospital. I believe he's thinking of hiding the children.

The pomp and circumstance surrounding these fights made me roll my eyes. "Yeah, whatever," I thought. "Just show me some blood." The stadium was full of screaming fans, the music was pounding, the floor was vibrating and I was drooling thinking about the amazing injuries I would see.

Yet, with each fight I became more disgusted. "Where's the blood? Where are the injuries?" I kept thinking. I was so disappointed. "Can't he just break the other guy's leg or something?" I wondered out loud. Four pairs of very disturbed eyes turned towards me. "WHAT?" I snapped.

Then it came. Someone finally broke open a torrent of blood. An amazing right to the eye was all it took. That man could HIT! The red was on the mat and I felt the excitement rise. Finally there was blood! I stood up in my seat as I screamed "Oh Thank God! Finally! Someone's hurt." My husband replied with "There is something very, very wrong with you."

It's Emergency Nurse Porn. Blood, broken bones, open chest wounds - they're all we need to feel the rush of adrenaline, the pounding of our hearts, and the excitement of what's to come. What I wouldn't give to be on the medical staff of a fight team.

The really sad thing is that I don't even know the fighter's names. I have no idea who they are, how many fights they've won, how long their reach is.........................nothing. My dear friend Heidi - the one who tricked me into watching the fights on pay-per-view the first time and got me addicted to the heroin that is UFC - just shook her head in dismay. Her disappointment in my knowledge of the fighters was palpable.

"I don't care who they are. I just want to see them hurt somebody," I told her.

"You have no respect for their talent!" she cried. "That's Rampage Jackson out there! And look - Tito Ortiz just walked by!"

"Tito who? Will he hurt someone?"

"You need help," she said.

Shout Outs

It's time to give a shout out to a few people I love to read. Obviously, the ones in my Links column are all wonderful, stupendous, amazing bloggers (am I kissing ass enough for you here?), but there are a few out there that deserve special recognition.

One of the funniest blogs I've read in a long time can be found at Tales from a Bohemian Road Nurse. I love people with a wicked sense of humor and I do believe she takes the cake this week. And that's a damn hard piece of cake to take away from me. It's full of rich dark chocolate, dripping with yummy frosting - yet when you take a bite, it can leave a funny taste in your mouth.

If you are a parent, or hell, if you've even walked by a kid in your life, (that's excessive use of comma's isn't it?) then you will enjoy Busymom. Her posts make me feel like I'm not the only want who wants to run naked down the road, screaming and pulling my hair out by the roots - just because I am a mom.

For the girly-girls (or just anyone who enjoys shopping and talking about girl crap - and by crap I mean stuff, not poop), check out Savvy Chick. She has all kinds of cool crap (stuff, not poop) on her blog. She's helped me save some money too by listing good deals she finds. Other times, I've looked at her lists and thought "How the H-E-Double Toothpicks am I going to afford that? But oh! I want one."

Another enjoyable little diddy can be found at The Sarcastic Journalist. Her posts make me giggle, sometimes guffaw. This one combines Valentines Day, kids playing in pee, pizza, and a gossip rag. How can one go wrong with that?

Enjoy the reads people!

Big Daddy and the Chainsaw

Big Daddy came into the ED late Friday evening. He had definitely earned his nickname as he was 6 ft 5 inches and 300 lbs of hulking muscle. Big Daddy came in with a bloody towel wrapped around his left arm, and a tiny little blonde around his right. He left a pack of buddies in the ED waiting room as he walked up to the triage window.

"Can I help you?" I asked.

"Yeah - I cut my arm with the chainsaw I was using," he replied.

"Oh Big Daddy, you're so brave" cooed the little blonde.

I cast a sideways glance at Lucy who was trying very hard not to spit Diet Coke all over her computer screen.

I escorted Big Daddy and his companion back to ED1. My curiosity got the better of me and I asked "What were you doing with the chainsaw?" I've let my curiosity lead me before and I've found out many things that I would be better off not knowing. Like the man with the Q-tips in his penis because the demons lived there, or the woman who sawed off her hand with a steak knife because God and Satan were arguing over her soul. I also asked a man why he shot up with coffee once and he told me he thought he could get a better high. You'd think I would have learned my lesson about following my curiosity. Nope.

"I was dancing with it," he calmly stated.

I dropped the blood pressure cuff and said "you were what???"

"Oh Big Daddy, you're so very very brave" tiny little blonde piped in.

"I was dancing with the chainsaw. I wanted to show Tina here how graceful I was. When I went to do an arc above my head, my left hand slipped off the handle and the chainsaw slid down the side of my arm."

This was not what I expected. A story laced with alcohol and trying to build a new bookshelf for his pretty wife, or camping in the woods and cutting down firewood, or even showing off his new engine to the neighbor next door - those were the stories I was expecting. I think it showed on my face.

"What? You never heard of chainsaw dancing before?" he asked.

"Nope - never heard a single word about it," I replied

"Well, it's actually not called chainsaw dancing. I was dancing with props trying to tell a story. The chainsaw was just part of the story I was dancing for Tina. It symbolized my emergence into manhood."

I took a second look at the man in front of me - long hair held back with a bandanna, decked out in leathers, arms sleeved in tattoos, looking the very image of a hard core biker. I stared at him for a moment as I tried to put the images together in my head. I thought of his buddies out in the waiting room and I said the only thing I could..............

"Yes Big Daddy, you are very brave."

New Job Offer

I've been offered the position of ED Nurse Manager. Do I want to take it? Do I want to leave the every day stress induced high of the ED? It's a scary prospect, that's for sure.

What's the good?

• higher pay
• ability to shape and change policies/procedures
• ability to run a team
• normal hours
• limited weekends
• ability to fine tune my leadership skills

What's the bad?

• I'm one of "them"
• No longer in the trenches

Now another good thing is that I can still jump in and help during codes, traumas, high census moments, etc. I think that will keep my mind working and my blood pumping. I love the high of working in the ED. I love the moments of insane disorganized chaos. I thrive on those moments. But, I also want to see my family more and have some sort of rhythm to my life.

Working as the ED Clinical Coordinator was perfect. Half time on the floor, half time in the office. Those positions are being transitioned into Nurse Managers now. Decisions, decisions.

Listen Here, Sally Joe....

Teamwork is a great thing. It's a wonderful thing. And it can be spoiled by one individual who thinks he (or she - who's limiting to one gender?) is the all knowing supreme nurse in the sky. It's even more amazing when they are fresh out of nursing school.

Now, I don't believe in eating our young in nursing. I believe in training them up right - so they can take good care of us when we come to the ER having overdosed on painkillers and lithium. We need them properly prepared and ready for that life changing event. There's just one thing I hate about newbies. One thing that will drive me insane and push me to the verge of swallowing that handful of pills.

Know-It-All-Newbies. AHHHHHHHHHHHHHHHHH! Everyone run and hide!

We had a trauma roll in the back door. One vehicle rollover with ejection of passenger. Multiple injuries, unstable vital signs, AirLIfe on their way. I'm the primary RN and working with Dr. Q to keep things running smoothly. And they are - running smoothly, that is. Then in walks Know-It-All-Newbie who proceeds to say to me "Listen here Sally Joe," (excuse me?) "I know you need some assistance in here, so I've come in to help." He graced me with a smug smile and his fists on his hips. Nose in the air like Mighty Mouse. Can you just picture my eyes rolling?

"OK Know-It-All-Newbie, you wanna help? Go on over and clean up all the crap on the floor around the stretcher. My trauma bay is messy."

"I'm a nurse!" he replies, shocked. "I am here to help take care of this patient."

"Yeah? Well you can help take care of the patient by picking up the bloody crap around the stretcher."

"That's not why I came in here."

"Well goodie for you. Now either get over there and pick up the garbage, or get the hell out. 2 choices. Easy peasy lemon squeezy."

His face turned red and his fists tightened on his hips. "I have had recent trauma training and I know what to do! I just took TNCC and I know how to treat this patient!"

"Oh! Oh! You've had recent trauma training! Well, pardon me. I didn't know. I definitely could use you then," I reply. He smiles...........until I say "I could use you to pick up the crap around the stretcher."

Dr. Q told me I need a vacation. I just asked him for a prescription of valium. He laughed and told me no. Stingy little doctor.

The Dead Ones

You really shouldn't deliver dead people to the ER. There's not a whole heck of a lot we can do for them. Above all, you should not deliver dead people to the ER when a brand new attending and a brand new nurse are on duty. This is not a good combination.

Billy Bob's family pulled up into the ER bay - well, came screaching in sideways with smoke coming from their brakes would be a more accurate description. Billy Bob's brother jumped out of the truck. "OH MY GOD MY BROTHER IS DEAD!" he screams as he runs into the waiting area. "He's dead, he's dead, he's dead! HELP HIM!" he yells at Dr. S, grabbing him by the front of his scrubs.

"Ummmm............. OK", Dr. S replies. (This is where you can see me rolling my eyes and heading off to lunch. I'm a cold hearted bitch sometimes)

You know how stories grow as they get passed on to new people? They grow and develop a completely different storyline than what actually happened? I'm not so sure that's not what happened here. This story took on a life of it's own (no pun intended of course).

So Newbie Nurse runs out to the ambulance bay with Dr. S. Dr. S proceeds to open the back door of the Mercedes and comes face to face with Stone Cold Stiffy. Stiff as a board (coincidentally, not light as a feather), sitting upright in the back seat. Hands curled under his cheek as if he's daydreaming.

Dr. S touches him. No response. "Uh, Dr. S, I think he's dead," Newbie says. (ya think? He's stiff.)

Dr. S checks his carotid and says in a surprised voice "He doesn't have a pulse." (figured that one out all by yourself, did ya?)

Dr. S makes his first big mistake - "Bring him on in to the trauma bay" he says.

"Seriously?" Newbie replies.

"Yes, seriously. Bring him in."

"Shouldn't we just call the police or the funeral home or......?"

"Absolutely not" Dr. S replies. "We'll bring him in and hook him up."

"H....h....hook....h...him....up-p?" Newbie stutters. "But he's dead"

"He's not dead until I say he's dead" Dr. S replies

OK, now do we believe this? Not sure - but it makes for a great story. Dr. S is a bit of .......... well, that's better left unsaid. Newbie, bless her heart, obeys him. She's sweet and unsullied - naive to the ways of ER nurses. "Um...OK" she says. Um..........OK my ass. My reply would have been somewhere along the lines of the following:

"You wanna bring the dead guy in Dr S, feel free. I'm not wasting anyones time hooking up some obviously cold, stiff, and dead guy to the cardiac monitor to prove he's dead. He's dead. He aint' moving (insert poke to guys head here). Call the cops or the funeral director. Hell, call the national guard. I don't care. I'm going back in to take care of the guy who's on the verge of crumping in room 3. When you feel the need to grace the ER that is full of sick patients with your presence, just let me know. But I'm not BRINGING IN THE DEAD GUY!"

"Um, OK" sounds so much nicer, doesn't it?

Anyway, they bring Mr. Stiffie into the trauma bay, proceed to hook him up (by the way, he's in complete rigor so he is still in a sitting position) and discover that he is in (everyone gasp here) asystole. Duhn duhn duhn.

Quick! Shock him! (SNORT - this isn't Lifetime Movie Network people. Here at ERTV we don't shock asystole - we give 'em a thump on the chest and they'll magically convert to sinus rhythm!)

Dr. S heads out to have a family conference and Newbie covers Mr. Stiffie with a sheet and calls the morgue. Charts are started, dictation is completed. Resources are wasted.

Did this really happen?




The only truth I know is I saw a sheet shaped an awfully lot like someone with their knees in the air being wheeled to the morgue as I returned from lunch. You learn not to ask questions.

ER Rap

I am in love with this video. Please follow the link and pick the media you'd like to view it on.

The (un)Reality of TV

Forgive me, for I have sinned. I watch medical dramas. Yes, I do. I watch them and I giggle, then I snort, then I guffaw, then I shout at the TV "THAT'S NOT HOW YOU DO IT YOU IDIOT!". Meanwhile my husband rolls his eyes and walks out of the room. We have a cool relationship like that. He rolls his eyes and leaves whenever I yell at the TV. We've bonded.

Let's do a low down on this fall's TV shows (medical drama or not)

1. One Tree Hill

Do the powers that be seriously think that we will believe CPR compressions are performed on the abdomen? And did you know we're supposed to check a carotid pulse after every 3 compressions? Wow - these must be the new 2005 guidelines everyone is up in arms about. What is even more amazing is that Lucas (yeah - that's the character's name. Not George Lucas, he probably would have gotten it right) was supposedly "not breathing" yet a simple oxygen mask stimulated his respirations and created enough of a BiPap pressure to keep him alive. Wow! The studies that we could do on this.

Don't even get me started on Hailey. Seriously - hit by a car, thrown into the air, pregnant, and unresponsive. Cut to the doctor telling her husband that she has several fractures in her leg and she won't wake up. Oh - and he can't worry about the baby right now, he has to save the mother's life (yeah, OK so I agree there - don't tell anyone). Cut to the next scene where Hailey is in a hospital bed with no oxygen, IV, or monitors in place. She also has a cast on her right lower leg with it suspended in a sling - but no traction pulleys are in place on the bed. It's a miracle! She also wakes up with a clear voice, not the scratchy one we usually hear from someone who hasn't spoken in ages. Hmmmm.............. Oh, and of course all is well with the baby.

2. Grey's Anatomy

Residents who purposefully endanger the lives of a patient so they can get to the top of an organ donor list are not graciously allowed back into their programs because they "meant well". Residents that are pissy whiney babies don't go far in medical school without a serious "come to Jesus" meeting. Oh - and IV tubing that ends nowhere doesn't help the patient much. Just a few thoughts there people. Give me time. Give me time.

3. ER

If there is an IV bottle hanging beside the patient, make sure 1) the bottle is dripping, and 2) the patient has an IV site. Easy peasy? Please, for the love of all that is holy, please correctly identify heart rhythms. Afib is not the same as a 2nd degree block. It's really not. Finally, not every ER nurse has an affair with an attending. Some, but not all.

4. Soap Operas (all of them)

People on ventilators need an ET tube coming out of their mouth, and noone uses those black accordion "shwish shwish" ventilators. Not even rural hospitals.

5. Any other show on television or major motion picture

Everybody all together now: "You do not shock asystole, You do not shock asystole". Good job class.

Gold stars all around!

R-E-S-P-E-C-T, Find Out What It Means To Me

There are many things I try to be nonjudgmental about. I try not to think you're a big whiney baby when you come to the ER to have a sliver removed from your foot. I try not to think you need to be committed when you come to the ER to have a q-tip (or some other foreign object) removed from your nether regions. I try really hard not to think you need to step off the edge of a cliff if you come in screaming that you're dying when in reality all you need to do is fart.

I try. I usually fail.

I guarantee that I will treat everyone with respect, no matter what. I will treat you the same, but I will think you are a lunatic in my head.

If you tell me that your child has kept you up for 5 nights in a row, you haven't had an ounce of sleep, and you need some medicine to put your child to sleep so you can get a moment's peace - I won't believe you. And I'll probably think you're a bad parent. I will still treat you with respect.

If you tell me that the Vicodin you've been taking for 3 months isn't working and now you want to try something else, and "why no ma'am, I haven't been to any other doctors for this" - I won't believe you. I will find the 5 pharmacies and 13 doctors you've been getting drugs from. I will still treat you with respect.

If you tell me the president is an alien who comes into your head everynight and tells you to place foreign objects in your orifices - I won't believe you, and I will call for a mental health evaluation. I will still treat you with respect.

If you are a doctor who is yelling and screaming at me, spittle flying out of your mouth, face turning red, telling me I'm a bad nurse - I won't believe you, and I probably won't like you. I will still treat you with respect.

I will treat you with respect, and I will expect the same. I am a nurse, yes. I work in the ER, yes. But I am still a human and deserve to receive the same respect that I give. You don't have to like me. You don't have to think I'm a sane, rational, compassionate person. I probably don't think any of those things about you. Yet, I will treat you with respect.

Can we not all expect the same from each other?

The Difference Between Life, Death, and Drug Seekers

When you come into the ER yelling, moaning, and twisting in agony because you have a sprained ankle - I will hate you. Why will I hate you? I will hate you because the man in the next stretcher is dying of an excruciatingly painful form of cancer, yet he is silent. He is silent, and dignified, and asking for pain medicine "when you can get to it dear. It's really not a big hurry. I've been dealing with this for 6 months now." You, on the other hand, are screaming at me to "hurry up and get my fucking morphine bitch! I've been waiting for 20 minutes now! I'm in pain, ya hear me? I'm in fucking pain!". Yes, that is why I will hate you.

The difference between life pain and death pain has amazed me more than once. The man who threw his back out hauling cement blocks is begging for relief, while the woman who is here on hospice respite and is probably going to die in the next 2 or 3 hours is calmly waiting for her turn on the IV morphine train. The woman with a knife in her leg is screaming like she is dying, but the man who is actually dying next door - he just wants his family close so he can say goodbye.

I don't understand it. I'm not sure I want to. I just want people to respect the fact that someone having a bigger crisis than them may be in the bed next to them. And I may be needed more over there. I probably won't respond quickly to you if you scream at me to get your pain medicine. I will be busy with the man next door who is passing from this world. His problem supercedes yours. Your pain may last longer - but you'll still be alive at the end of it. He won't.

Now I'm not saying that all people in pain are whiners. I'm not saying that if you come in complaining of pain I will roll my eyes, take a deep breath, and say, "Whatever - come on back." I will believe you are in pain. I will treat your pain as able. I will be respectful to you as a human being. The moment you start screaming and cussing at me - you've lost me and my respect. The moment you disrupt every other patient in the ER by demanding your "fucking morphine" you will have lost me.

Pain is subjective. Reactions to pain can be controlled. Most of the time.

Hog Tied

He arrived at the back door in a large white vehicle with flashing blue and reds on top. It was a bad sign. It's always a bad sign.

Mr. Law Enforcemen Officer (Mr. LEO) proceeds to drag out Mr. Violent Man. Mr. Violent Man is shouting and screaming - in Spanish. I don't speak spanish. Dr. Q doesn't speak spanish. No one on duty speaks spanish. This is not going to be good.

"Did you check him for weapons?" I ask.

"He's clear", Mr. LEO replies. I then notice that Mr. Violent Man is hogtied. Hogtied with white rope. Why is this important? I'm not really sure - but I remember the white rope and how it was frayed on the edges. Mr. LEO and 5 of his closest similarly dressed friends assist Mr. Violent Man into the ER.

"Puta! Puta! Puta!" He screams at me.

"No hablo espanol" I reply.

"Fucking Bitch" he says in perfectly accented English. Oh yes, it's going to be a grand day.

A translator finally arrives. She looks lost a minute into the conversation. She proceeds to tell us that Mr. Violent Man is not making any sense and can't follow a conversation. She asks why he's here. When one of the police officers say "He was threatening his co-workers with a chainsaw", her face drains of color. We have to bribe her with candy and offers of free medical care to get her to stay.

Mr. Violent Man takes 8 mg of Haldol and 10 mg of Versed to calm down enough to get him to quit yelling and lay obediently on the stretcher. He soon starts singing the Mexican national anthem to us, horribly off key. But he is happy - happy and calm. After all, that's what matters now, isn't it?

Dr. Q finally gets close enough to examine the patient. Why is it that the nurses are the first line of defense? Dr. Q just smiles and pushes us forward in front of him. "To the hold room!" he shouts, like a king commanding his army. Mr. LEO and his 5 buddies immediately obey.

"Hey! Wait!" I yell. "Don't forget the patient."

Reluctantly they turn around. After we remove his restraints, they escort him to the hold room. I can hear the words "Viva la Mexico!" resounding down the halls.

It's Time For .............

Change of Shift!

In Honor of Halloween

It was a dark and stormy night in the ER. The lights were flickering and the bedpans were rattling. The reverberating boom of thunder accompanied the swish of the ER doors each time they opened to admit the next victim. Dr. Q was limping down the hallway, moaning with each step. "Kill me now," he moaned. "Kill me now."

Screams filled the hallway. Horrid gut wrenching screams of terror. Nurses were running in and out of the rooms, wiping sweat from their brows, yelling for more supplies. The lights flickered and went out. One, two, three, four seconds passed before the generator clicked on.

"Dr Q! Dr Q! Come quick!" Lucy yelled down the hall.

Dr Q slowly turned around, fear plastered across his face. His thoughts sent out on the air like an electric current "Oh please, no. Not again. No. No. No!"

"Dr Q! NOW!" Lucy screamed.

He limped back down the hall, breathing heavily. Taking in the air like he would never have the chance to breathe again. Tears came down his face, sweat soaking the back of his scrubs. He pushed open the doors to ER 3.

"PUSH!" Lucy said. "PUSH NOW!"

Dr Q made it to the stretcher just in time to grab the squirming pink infant as he made his way into the world. He promptly cut the cord, handed the baby to Lucy, delivered the placenta, and walked back out the door.

"I hate delivering babies," he whispered as he headed toward the Dr's Lounge.

The Hot Dog Incident

The day started out calm enough - no overfills, triage going well, wait time less than 30 minutes. We were living high on the hog of ER medicine. Then Lucy said the dreaded word...............the word we all fear.

"Boy, it sure is QUIET today"

Time stood still as we all swung around to look at her. In slow motion, you could see Dr Q running toward her, arm flung out attempting to cover her mouth with his hand. "Oh noooooooooooooooooooooooo!" he cried as he tripped over the cord for the fluid warmer. "Not the Q word!"

Instantly, the ER doors flew open and a multiple victim ATV wreck self-presented to the ER. A dark cloud descended over the ER as we glared at Lucy. "This is YOUR fault" Dr. Q said, struggling to get his legs untangled from the warmer cord. "You did this to us." After 20 seconds of what appeared to be some new African tribal dance, he freed himself and accompanied us out to triage.

The four victims were sorted and triaged when an elderly couple walked in with c/o chest pain. "You both have chest pain?" I asked. "Yes" they replied in unison. "Well, what brought it on?" Red faced and stuttering, the old man said "well, you see..... we were, um........well, we were kinda...." "Oh for Christ's sake Harold - just say it" his wife replied. "We were having sex miss and we both started feeling a little short of breath and having a bit of chest pain. We didn't think it was bad enough to call an ambulance so we just drove ourselves up." I looked at Harold who was looking a little bit gray all of a sudden. Our lovers were escorted back to the cardiac rooms.

Lucy came running up to me at that point screaming "Some dude in the lobby cut his hand off with a chainsaw - there's blood everywhere!" All our beds were full at this point. Oh, what to do - what to do? Rooms were swapped, people moved around, and another doc called.

Approximately 6 hours later, Lucy calls and asks for lunch relief. "Yeah, right" I reply. Seriously? Lunch? Dream on, I thought. I immediately filed her request in the back of my mind and continued to help my current patient. This one had wrecked his bike when he tried to jump a barbed wire fence. In what had to have been only 4 maybe 5 seconds later (if I allow time for Dr Q's clumsiness), Dr Q approached me and said "Lucy's crying in front of a patient." "WHAT?" I said, immediately stepping out into the hall to find her.

Lucy was a bit flustered. By a bit I mean weeping uncontrollably, snot draining from her nose, throwing pens across the room flustered. I pulled her out of the room and into the nurse's lounge. "What the hell is going on?" I asked.

Between snorts and sobs she says "I ..... just ....wanted.......lunch.......and ........I got this.........snort, snuffle, cough......... hotdog............an hour ago..............and it's ....... shriveled........and..........cough, hack, sob...........cold!" I just stared at her, my mouth hanging open. She continued. "And.......I'm not going .............to ...........eat the damn thing............NOW!" she screamed. With the speed of a professional baseball player (which in all honestly, I never though Lucy had any talent in that arena at all), she threw the hot dog on the floor and stomped out of the room. "I'm leaving and I'm going to eat lunch!"

The poor hot dog was shriveled, I'll give her that. It was also now broke into an open massive wound of meatflesh. It had left a trail of grease across the floor as it bounced on it's merry way. I stared at this poor hotdog in disbelief. I was in shock - this poor hotdog was mutilated, destroyed, dead.

Dr. Q threw the door open - "What are you doing? I need you out here!" he screamed.

"Staring at a hotdog" I replied.

He wrinkled his brow in confusion. "Umm............" he started to reply.

"Lucy's hotdog is on the floor" I said.

"Ummm........OK" he said. "Let's go back out to the ER now. Slowly. Just come with me," he urged.

As he was pulling me out, my eyes shifted to the hotdog. "Lucy went to lunch" I said.

Leaving on a Jet Plane

Little Miss Betty called for an ambulance at 2 AM. The tones from the radio at the desk startled us all out of our dazed slumber. "EMS, please respond to 123 N. Main for an 82 year old female complaining of high blood pressure and a bloody nose."

"Bloody nose? She's calling an ambulance because she has a bloody nose? Is she bored?" Lucy asks.

"She better be gushing blood and about ready to pass out" whispers cranky Dr Q, who happens to have a sore throat and a fever.

"Oh, go take some Nyquil Dr. Q" We all say in unison.

Ten minutes later the ambulance rolls into the bay. I stand at the back door propping it open and shivering as the wind blows up my scrub pants. Holy moses on a teacup it's cold. The back doors of Medic 93 pop open and the paramedics unload Little Miss Betty.

Now, Little Miss Betty has made many visits to our fine Emergency Department. I've received her from the ambulance for complaints of chest pain (her bra rubbed her raw under her left breast), a broken leg (it was just a scratch), abdominal pain (she needed to fart), and burns (she spilled coffee on her toe). They tried not to transport her but Little Miss Betty insisted that she must be seen. "It's an EMERGENCY!" she'd cry.

We settled LMB on the stretcher and hooked her up to the cardiac monitor. Her blood pressure was 158/68, heart rate of 72 in Normal Sinus Rhythm, and a respiratory rate of 38. There was approximately 1 teaspoon (or less) of blood on the front of her nightgown. Dr. Q came in the room, took one look at LMB, and tried to walk out the door. Lucy did a quick double step and grabbed him by the back of his scrubs. "Let me introduce you to Little Miss Betty, Dr. Q. She's here with complaints of a nose bleed and high blood pressure". I must say, every day my pride in Lucy increases. She's learning so well.

Dr. Q proceeds to examine LMB. He asks her the standard questions regarding the events of the day and night, past medical history, current medications, and allergies. LMB is being very unclear on her answers - rambling, making up names of medications that don't exist, changing her story, etc. Finally Dr. Q has had enough.

"Okay Betty, what really happened today?"

"Well," she pauses, sniffles a bit, and wipes her nose with a crumpled up paper towel. "If you really want to know.................."

"Yes, I do" he replies. "Tell me now" (Dr Q needs to work on his bedside manner when he's sick. He really gets a bit cranky).

"Well, I applied for a loan today and I was denied. Can you believe that? They denied me, a little old lady, they denied me money!" She dissolved into sobs.

"What did you need a loan for Betty?"

" A plane," she replied.

Silence. We all looked at each other with a quizzical eye.

"A plane?" Dr Q asked.

"Yes you moron. A plane! I need a plane to fly to Georgia to buy a new house. I'm leaving this place. I'm leaving you all and I'm never coming back. But.... But I....." she pauses to sniffle and choke on her tears, " I can't get a looooooooaaaaaaaaaaan". She once again dissolves into chest heaving sobs.

Lucy whips out ten dollars from the back pocket of her scrubs. "Let's start a collection" she whispers to me. Five hands appear over her shoulder with twenty dollars in each.

It's a start.

I Want To Be A Drug Seeker. I do, I really do.

Vicodin, Percocet, Demerol, Morphine, Dilaudid ~ it's all good. Take a little back pain, add one narcotic and flavor with a splash of muscle relaxer. Oh yeah, heaven has just arrived.

So, I should have listened to Jon when he said "Don't go to softball practice. You'll only make it worse." But seriously - what do men know?

I did not listen to him. I know I should have (they say hindsight is 20/20), but I did not. I went to softball practice (with the hospital softball team, mind you) with my back already hurt and I woke up the next morning unable to stand up straight. Yes ~ he was ......................... do I dare say it? ................................. He was RIGHT (insert audible gasp here)!

I walked into work Saturday morning walking like I had a corncob up my ass ( a direct quote from one lovely lady I work with). The instant I saw Dr. Z, I begged for a prescription. "Please, give me Vicodin. Anything containing a narcotic. Just knock me the hell out and call it good."

Then I realized...................I am a drug seeker. Yes, I am that crazy, irritable, give-me-the-damn-drugs-now-before-I-kick-your-ass patient. I could name my drug (Vicodin). I could name my strength (5/500). And..................I could name my directions (1-2 every 4 hours as needed for pain). "Really doc - I'll only take 2 at a time. Oh and throw in a little flexeril while you're at it".

So I've decided to go with it. Why not join the ranks of the drug seeking public and just ask for a little narcotic every time I see the doc. That stuff is gooooo-ooood! I love that nice little high you get right before your head rolls to the side, your tongue drops out of your mouth, and the drool starts to flow down your chin. It's a nice little place to be. Spinning room, tingling toes, and a smile in your brain - it's heaven in a little white tablet. God is good. He gave us all this special little gift.

Vicodin? Check.
Percocet? Check.
Morphine? um...................... "Now, Julie. I don't think you're hurt that bad."

"Yes. Yes I am doc. I'm totally hurt that bad. Really. See? I can't walk."

"Julie - we just ran a Code together. I saw you walk."

"No you didn't," I challenge.

"Um. Yes I did."

"Damn you and your morphine hording self! Damn you to hell!"



I think I better go to bed and have myself a little Vicodin cocktail. My back hurts.

What Happens When You Don't Get Along

Emergency Departments are full of hard-headed, stubborn, control freaks. And that's just the nurses (bet you thought I was going to say doctors, didn't you?). To be an effective ER nurse, you have to be able to make quick decisions on your feet, fight for your patients, argue with the doctors when you know you're right, and separate the real emergencies from the fake ones.You have to have a strong, confident personality.

Put 5 or 6 of us in a room together and there's going to be someone there that doesn't like someone else. And when all of you have very strong, dominant personalities ~ watch out Betty! It's gonna get a little rough.

Nurse Jane: I'm gonna run and pee real quick, watch my patient's would ya?

Nurse Mary: I ain't watchin' your patients. I've got 2 leg lacerations and a chest pain.

Nurse Jane: Damn it! I have to pee! I only have 1 ankle injury and a foreign body in the nose. Can't you take 5 seconds of your precious time and check on them while I'm emptying my bladder?

Nurse Mary: Grab a bedpan and piss in that. I am BUSY!

Nurse Jane: Where's good help when you need it?

Nurse Mary: Call rent-a-nurse. Maybe they'll help you.

Now granted, not all interactions happen this way. But there's always the possibility of butting heads in the ER. The good thing is, by the next day (or hour) it doesn't matter. It's been dropped like a fistful of needles and we're all in love again.

Dr. X: This patient needs a cardiac panel, an EKG, a CXR, a cath UA, both arms splinted, both legs sewn up, and a partridge in a pear tree ~ STAT!

Nurse Julie: Uh.....yeah. I'll get right on that.

Dr. X: I want it done and I want it done 5 minutes ago!

Nurse Julie: Uh huh. I heard ya. See me running? (As she walks slowly away)

Dr. X: (face red, shaking both fists in the air, spitting as he yells) Damn it! You must obey me! I am the doctor! I give the orders!

Nurse Julie: (looking over her left shoulder, flinging her middle finger up to push her hair over her ear) the labs and the EKG were done before you got here, the lacerations were repaired by the resident, the arms were splinted 2 minutes ago, and I hung the partridge with a noose in the pear tree and now he's dead. Any questions?

Dr. X: Well......why didn't you tell me that in the first place?

I love being surrounded by strong personalities. It amazes me the things we can get done when we work together ~ and the things we can prevent with our own stubborness. As long as we take care of the patient first and foremost, everything works out in the end.

Nurse Mary: Dr. X, I think this patient is going to crump.

Dr. X: Oh Nurse Mary - you're overreacting again. He's fine. He's just breathing a little fast and he says his back hurts.

Nurse Mary: No, Dr. X. He doesn't look right. He is going to crump and we need to get ready to intubate him now. I think he's got a triple A (AAA = abdominal aortic aneurysm).

Dr. X: Now Mary...........

Nurse Mary: DR. X! I THINK HE'S GOING TO CRUMP ON US! TRUST ME!

Dr. X: OK Mary, let's go and check it out.

Intuition can save a patient's life and nurses and doctors all have it (or they should if they're any good). It's a good thing we're stubborn and hard-headed or we'd never trust ourselves or each other!