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.
Monday, October 20, 2008
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?
Thursday, July 10, 2008
I Suppose I Should Be Offended........ But I Ain't
I find these incredibly funny. I suppose that says something about my inner workings eh?
The Things You Find Out When You Stop By For A Second
I stopped by the nurses station today when I was walking through the hospital to go to physical therapy. I saw Mark sitting at the computer and knew immediately I should turn around and walk the other way. He is always, ALWAYS the bearer of bad news.
"Hey! You hear about your guy from yesterday?" He asked.
Oh shit.
"Um, what guy?" I replied.
"Mr. Gross Leg Abcess Man. We flew him out last night."
"What the hell for?" I asked.
"He coded in the OR."
WTF?
"Seriously? He was just in for a leg debridement. He was only 32. He had no medical history."
"I know," he said. "He went into cardiac arrest."
Sweet shit on a stick. Ya think the meth had anything to do with it? Snort.
"Hey! You hear about your guy from yesterday?" He asked.
Oh shit.
"Um, what guy?" I replied.
"Mr. Gross Leg Abcess Man. We flew him out last night."
"What the hell for?" I asked.
"He coded in the OR."
WTF?
"Seriously? He was just in for a leg debridement. He was only 32. He had no medical history."
"I know," he said. "He went into cardiac arrest."
Sweet shit on a stick. Ya think the meth had anything to do with it? Snort.
Wednesday, July 09, 2008
Linky Loo for Yoouuuuuuu
Back In The Saddle Again
Today was my first day actually providing patient care in the ER since my back injury. I only worked 8 hours (normally do 12) but man, oh man did I feel it. I wasn't necessarily in pain but my back felt like I'd spent the last 8 hours workin' the street corner in 5 inch stilettos fighting off the other hookers trying to take my space.
Phew.
Ibuprofen is my best friend.
My day started with an Air Life transfer for a cardiac patient. Acute MI. He was sleeping when I got report on him. Pain? "Not to bad Julie. It's about a zero or 1 on that pain scale thingy." Well perfect. IV meds infusing and he was good to go.
Then Miss SOB (shortness of breath, not son-of-a-female dog here people. Sheesh! Do you really think I'm that mean? OK well I am. And she was a bitch. But alas - I shall not SINK to the lower depths of bitter ER nursedom and call her names. Oh, OK I will. Cuz she was a bitch) walks in.
"I can't breathe," she tells me as I can hear her wheezing from the double sliding doors.
'No shit,' I think.
I take her back to the cardiac bay and hook her up to every wire we have. Well look at that! A fib with rapid ventricular response. Basically her heart was just a tickin' away - and not being very regular about it. I pushed a little Cardizem bolus through her IV and started a drip (IV infusion for my non medical peeps). Then I got to admit her to the floor and it took all of 30 minutes from request for a bed to actually reporting off. I love it when the ER gods of the universe decide to support my ass for a change.
The Air Life crew arrived during all of this and wanted report on Mr No Pain Chest Pain. Reported off to them and when they walked out the door only then did I realize they didn't bring me my chocolate. BASTARDS! They always bring chocolate. WTH?
"Where the hell's my chocolate?" I shouted after them.
"Budget cuts!" I heard as the pneumatic doors swooshed closed.
Well, shit.
What's the state of health care coming to when the Air Life crew can't bring us chocolate anymore? Someone needs to write their congressman or something.
My next patient was Mr. Gross Leg Abcess. He had multiple pustule scabbed "things" on his lower legs with one in particular that looked like Mt St Helens waiting to blow. Holy bulging pusbag batman! Hot, red, swollen - I could practically see the pus pulsating with every heartbeat.
I love wounds like that.
Dr. J and I opened that puppy up and got lots of nice green and yellow tinged pus out of it. Yummy.
Apparently when your right leg is 3.5 inches larger in circumference than your left leg, it kinda hurts. Who'da thunk? Aaaaannnnnddddd........ when you have a history of meth use, it takes a lot of Fentanyl to make your pain go away.
A lot like "make Julie stop breathing" doses. Holy crap.
Anyway, Gross Leg Abcess Man got admitted to med/surg for Vanco infusions and I&D of his abcess.
The rest of my day was filled with sprained ankles, runny noses (allergies in the summer? Shocking! I know. Tell me about it.), and lacerations. I didn't get a single trauma all day. I'm kinda pissed about that. It's funny how you miss things like that when you are off work for a while.
The best thing about today? I got called in so it was all time and a half. Yeehaw.
Phew.
Ibuprofen is my best friend.
My day started with an Air Life transfer for a cardiac patient. Acute MI. He was sleeping when I got report on him. Pain? "Not to bad Julie. It's about a zero or 1 on that pain scale thingy." Well perfect. IV meds infusing and he was good to go.
Then Miss SOB (shortness of breath, not son-of-a-female dog here people. Sheesh! Do you really think I'm that mean? OK well I am. And she was a bitch. But alas - I shall not SINK to the lower depths of bitter ER nursedom and call her names. Oh, OK I will. Cuz she was a bitch) walks in.
"I can't breathe," she tells me as I can hear her wheezing from the double sliding doors.
'No shit,' I think.
I take her back to the cardiac bay and hook her up to every wire we have. Well look at that! A fib with rapid ventricular response. Basically her heart was just a tickin' away - and not being very regular about it. I pushed a little Cardizem bolus through her IV and started a drip (IV infusion for my non medical peeps). Then I got to admit her to the floor and it took all of 30 minutes from request for a bed to actually reporting off. I love it when the ER gods of the universe decide to support my ass for a change.
The Air Life crew arrived during all of this and wanted report on Mr No Pain Chest Pain. Reported off to them and when they walked out the door only then did I realize they didn't bring me my chocolate. BASTARDS! They always bring chocolate. WTH?
"Where the hell's my chocolate?" I shouted after them.
"Budget cuts!" I heard as the pneumatic doors swooshed closed.
Well, shit.
What's the state of health care coming to when the Air Life crew can't bring us chocolate anymore? Someone needs to write their congressman or something.
My next patient was Mr. Gross Leg Abcess. He had multiple pustule scabbed "things" on his lower legs with one in particular that looked like Mt St Helens waiting to blow. Holy bulging pusbag batman! Hot, red, swollen - I could practically see the pus pulsating with every heartbeat.
I love wounds like that.
Dr. J and I opened that puppy up and got lots of nice green and yellow tinged pus out of it. Yummy.
Apparently when your right leg is 3.5 inches larger in circumference than your left leg, it kinda hurts. Who'da thunk? Aaaaannnnnddddd........ when you have a history of meth use, it takes a lot of Fentanyl to make your pain go away.
A lot like "make Julie stop breathing" doses. Holy crap.
Anyway, Gross Leg Abcess Man got admitted to med/surg for Vanco infusions and I&D of his abcess.
The rest of my day was filled with sprained ankles, runny noses (allergies in the summer? Shocking! I know. Tell me about it.), and lacerations. I didn't get a single trauma all day. I'm kinda pissed about that. It's funny how you miss things like that when you are off work for a while.
The best thing about today? I got called in so it was all time and a half. Yeehaw.
Thursday, July 03, 2008
The fingers are falling! The fingers are falling!
Fingers and huge ass diesel truck doors do not make good partners. They do not dance well together. They do not make nice googly eyes at each other.
Oh no.
Truck doors do not like fingers at all. Oh no they do not. In fact truck doors don't like fingers so much that they think it's mighty fun to cut the little suckers right off. And they laugh when the tips go plop in the dirt.
So do I.
Sometimes I think I'm not a very compassionate nurse. I might need some hospital mandated classes on that.
So Sally Sue comes in with 3 finger tips soaking in hydrogen peroxide in a plastic cup. First and foremost to all my readers: DO NOT STORE AMPUTATED FINGERTIPS IN HYDROGEN PEROXIDE!! Umkay? This is how you should handle your amputated parts.
Anyhoooo......... Sally Sue tried her best to do the right thing with her parts. She meant well so I did not lecture (hard to believe? Pashaw!). She had a great dressing over her hand so I promptly set about packaging the fingers in a dry, sterile, cool environment. Once the parts were comfy I focused my attention on her hand.
I unwrapped the gauze and saw 3 cute little stubby fingers dripping blood. A quick Xray, followed by a few digital blocks (numbing the fingers so you can get in there and really look at them/clean them/play with them/whatever you want you crazy freaks), and I had my way with her fingers.
They were full of dirt and debris. Truck doors are dirty. Ranch trucks are even dirtier. Hay, cow shit, horse shit, dirt, you name it - it's all in the seals of the doors. I did a little cleaning, the doc did a little reattaching, and off to the ortho doc 2 hours away she went. Hopefully they will be able to completely reattach her fingers for her.
She was on vacation from Florida at a dude ranch here in Ory-gone. Hell of a way to spend your paid time off eh?
Oh no.
Truck doors do not like fingers at all. Oh no they do not. In fact truck doors don't like fingers so much that they think it's mighty fun to cut the little suckers right off. And they laugh when the tips go plop in the dirt.
So do I.
Sometimes I think I'm not a very compassionate nurse. I might need some hospital mandated classes on that.
So Sally Sue comes in with 3 finger tips soaking in hydrogen peroxide in a plastic cup. First and foremost to all my readers: DO NOT STORE AMPUTATED FINGERTIPS IN HYDROGEN PEROXIDE!! Umkay? This is how you should handle your amputated parts.
Anyhoooo......... Sally Sue tried her best to do the right thing with her parts. She meant well so I did not lecture (hard to believe? Pashaw!). She had a great dressing over her hand so I promptly set about packaging the fingers in a dry, sterile, cool environment. Once the parts were comfy I focused my attention on her hand.
I unwrapped the gauze and saw 3 cute little stubby fingers dripping blood. A quick Xray, followed by a few digital blocks (numbing the fingers so you can get in there and really look at them/clean them/play with them/whatever you want you crazy freaks), and I had my way with her fingers.
They were full of dirt and debris. Truck doors are dirty. Ranch trucks are even dirtier. Hay, cow shit, horse shit, dirt, you name it - it's all in the seals of the doors. I did a little cleaning, the doc did a little reattaching, and off to the ortho doc 2 hours away she went. Hopefully they will be able to completely reattach her fingers for her.
She was on vacation from Florida at a dude ranch here in Ory-gone. Hell of a way to spend your paid time off eh?
Props to the Nursies
Please take a minute and peek at Mel's Blog
She just returned from a medical mission to Haiti. She's got a few pictures up and is working on a slideshow it looks like. Can't wait to see them all.
She just returned from a medical mission to Haiti. She's got a few pictures up and is working on a slideshow it looks like. Can't wait to see them all.
Holy Humperdink Batman!
It has been such a loooooooooong time since I've posted. It actually feels like days instead of months though. So much has happened. Shall I sum it up for you? Here we go:
OK Seriously now...... I've been in physical therapy since May 23rd for a re-injury to my back. It involved 4 nurses, one 450 pound intubated patient, and no lifting equipment. Um.... yeah. Hurt. I should be released back to full duty again soon though. Thank God! I'm so damn tired of chart reviews and updating policies I could vomit. I hate light duty. Seriously. It is like a huge infected ass pimple that makes it difficult to sit down on because it's just so fricking irritating.
The good news?
TRAUMA SEASON IS HERE!!!! Yeeeeeeehaw!!!!!
I love trauma season. May through November is my favorite time of year to work in the ER. Car wrecks, motorcycle crashes, horse wrecks, cow tramplings, gunshot wounds, stabbings, beat up with frying pans, falling off ladders, exploding fireworks............sigh............ I love 'em. Love 'em all.
Had our first snake bite of the season the other day too. Classic presentation - young male, drunk, saying "Hey! There's a snake! Let's catch it!" - followed by a sloppy grab and an envenomated bite. So what did our cute little chubby fellow win? A trip to the ICU and a 10 minute lecture from a craggy old physician.
Craggy - is that a word? I don't think so. Doesn't look right.
Anyway - I'm back! I know you are all falling over yourselves in excitement. I can see it. Just make sure you sustain some good injuries because I'm bored and need something to do.
Seriously.
- Manager position dissolved
- Got put back on the staff rotation
- Got drunk
- Separated from husband
- Divorced husband
- Got drunk
- Hurt back (again - wtf?)
- Took a much needed break from anything
- Got drunk
- Went on an awesome amazing beautiful 100+ mile 4 wheeler ride with friends
- Got drunk
- Went rafting down the Rogue River
- Got drunk
OK Seriously now...... I've been in physical therapy since May 23rd for a re-injury to my back. It involved 4 nurses, one 450 pound intubated patient, and no lifting equipment. Um.... yeah. Hurt. I should be released back to full duty again soon though. Thank God! I'm so damn tired of chart reviews and updating policies I could vomit. I hate light duty. Seriously. It is like a huge infected ass pimple that makes it difficult to sit down on because it's just so fricking irritating.
The good news?
TRAUMA SEASON IS HERE!!!! Yeeeeeeehaw!!!!!
I love trauma season. May through November is my favorite time of year to work in the ER. Car wrecks, motorcycle crashes, horse wrecks, cow tramplings, gunshot wounds, stabbings, beat up with frying pans, falling off ladders, exploding fireworks............sigh............ I love 'em. Love 'em all.
Had our first snake bite of the season the other day too. Classic presentation - young male, drunk, saying "Hey! There's a snake! Let's catch it!" - followed by a sloppy grab and an envenomated bite. So what did our cute little chubby fellow win? A trip to the ICU and a 10 minute lecture from a craggy old physician.
Craggy - is that a word? I don't think so. Doesn't look right.
Anyway - I'm back! I know you are all falling over yourselves in excitement. I can see it. Just make sure you sustain some good injuries because I'm bored and need something to do.
Seriously.
Tuesday, April 08, 2008
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