back to the old grind and some good news

Classes resume tomorrow on Tuesday! Where did the summer go? I had very little chill time, worked my butt off, literally lost 10 lbs, and did very little of my to do list for the time off. My lofty plans of redecorating my dismal apartment are not completed in the slightest, I never even began! All I have to show for my summer is a much cushioned bank account and sore feet who need cushioning.

This is the last semester of my second degree! As of January I will have my BSN and be working as a RN!!! WHOOT!!!! Plans with the husband are going well, he should be redeploying/un-deploying (as I call it) in november-ish! I have found him an apartment near post so he can live in style while we continue to be apart until he ETS's in spring. Long story, I know it seems odd that he would be back in the states and we stay apart but its not just fiesable for me to not work for 4-6 months, or get a job in his state. Soooo he will live in his state and I will live in mine and we shall visit frequently as our scheduals allow. LIGHT AT THE END OF THE TUNNEL: come spring we shall be together, no more separations like this, we can be a real marrige couple again! Once again an example of what our men and woman give up and go through to serve their country and the hardships on the families.

Suburban Emergency's post Scumbag, Sleazeball, and Scumbag got me thinking. Why do so many people in this country have a false sense of entitlement. The negative aspects of our society believe in sueing others for our own mistakes, making money from honest mistakes and if all else fails faking an injury in desperate attempt to sue someone. To me many of these cases are see through, the true motives are crystal clear, especially if there is a history of the like. Our country has created this monster that is obsessed with "criminal rights", I use quotes because a criminal has no rights in my mind, and has forgotten about the victim. We also have this misplaced notion that the government should pay people just for being alive, or for showing up to work. WRONG, you go to work to work, labor to make money. Its a trade of effort for monetary reward, thus no effort or labor means no money! I see so many people who put ridiculous amounts of energy into no working that it would be easier to work. Time and effort to fake injuries, use crutches and braces you don't need to substantiate the lawsuit, to find reasons and obtain notes to excuse yourself from work, or make up lies to the same effect.


I recently figured out why so many people come with the patient to the ER at midnight for a minor complaint: to get a work note so they can call out the next day. I find it odd for a 24 year old female with vaginal bleeding to accompanied by mother, father, 3 sisters, 3 cousins, an aunt and uncle, and 4 friends. At the end of the visit (4 hours later) and a dx of "menses" after having to usher the family out on more than one occasion to discuss private information or do an exam, everyone of the visitors asked for a work note. They were rude, hostile and seemed put-upon to be asked to leave the room for any reason, but all demand work excuses. You all know the kind of people I am talking about, the whole extended family that accompanies a slightly febrile child to the ER at 3am, refuse to stay in the waiting room, sneak back at every ocasion, demand food and beverage and more blankets than a while floor of patients, and yell for the nurse every 5 minutes.

This false sense of entitlement erks me beyond reason!

Quarantined Myself

I got the call yesterday morning that my nephew was born. My poor sister has been having contractions for 2 weeks now. They started off small, bearable, and promising but progressed to nagging, cursed contractions that weren't getting her past 2 cms of dilation. She has been laboring at home, where she can move and be free as opposed to tied to a tocometer in the hospital. Her water broke at 4am and she had baby Trice at 5:30 am via semi-planned cesarean. It was much smoother than her first cesarean and far more "enjoyable". She begged me to come visit when I got off work at 7am, but I had to tell her no.


I had 3 kids the previous night with hand foot and mouth disease. I had never encountered it before though I had studied it in virology class. I was working triage so I called back the family of the child with "mouth sores" to take vitals for the nurse. The family was Hispanic and thank goodness they brought along an interpreter. The child was obviously in distress, crying and shaking. After some coaxing I managed to get the pulse-ox on the child's finger and hold it till I got a reading. Thats when the nurse came in, a man with 30 years of experiance and took over. He looked at me with the look the portrays more than words and said "wash your hands now, wash them good, then get me the disinfectant". I did so, with no idea what was going on other than it must be bad. He finished the vitals and then t0ld me about the disease as we scrubed and sprayed everything in the room. By morning he and I had triaged 2 more kids with the same highly contagious disease. I had to order surgical scrubs from central processing afte the third because I had to forcefully hold the child so that we could get an IV in him, he was so badly dehydrated, the worst of the night. My scrubs are now in a bag in my floor waiting to be washed later today. I thought the bumps on the boy's legs were scratched mosquito bites, never did I imagine that they were caused by a highly contagious virus! My little boy with canker sores from teething and bad mosquito bites turned out to be much more than that!

Last night was the night of antibiotic resistant bacteria. I had 2 MRSA patients and 1 VRE patient. Many times the ER is unaware of our patients MRSA status until we tranport them to the floor. Frequently its not untill I take them upstairs and am asked where my gown is that I find out that they have a nasty organism. Part of me questions will the gown help that much, the other is mad that the ER was not told about this. Either way my scrubs were filthy this morning and unfit for wear.

So the moral of the story, I had to tell my sister that I needed a few days of quarantine before I am comfortable holding the little guy. I also need time to switch back to day time living after 3 weeks of nights. She is sad that I will not be there to see her in the hospital but thankful that I do not want to infect her child. She sent me tons of pictures and I am living vicariously until Saturday.

dear patients,

Dear irate wife of the patient in 209,
On behalf of the nursing staff at station 2 we apologize if we falsely gave the impression that we do not work for a living. We are sorry that you mistook our concerted efforts to stay on top of the charting for our 20 patients as laziness. Just because the nurses are behind the desk in the nursing station typing on the computer does not mean that they are not working. We do not have access to the internet as you so vehemently declared, we only have our nursing charting program and tracking board to "play on". We also apologize for believing you when you said "no, I don't need anything from you" when we asked if we could help you when you stood in the hall or poked your head out of the door. Need I remind you that you continued to close the exam room door after we exited, leaving it open on purpose so that we could see you and respond to your needs more promptly. As a whole we are dumbfounded at your behavior tonight when you screamed at us and called 911 that we were not treating your husband. Again we apologize for not bring him the food or drink that you did not ask for. Sorry, our psychic pager and omniscient ears where broken when you ESPed your needs to us.

Most UNsincerely
The staff





Dear winy ass patient in 403,
Your devoted staff would like to apologize for not giving you the pain medicine that you refused to let us give you. I am sorry that they only way that we can give you medicine is in an IV (the one you wouldn't let us put in), IM (but you don't do shots unless its heroin) a pill (the kind you say you cant swallow, though you are certainly putting away the Cheetos you are swallowing whole), per rectum (which you adamantly refuse). I admit your staff is unable to find an orifice in which to administer the pain relieving substances you want so badly. We are all to dumb to help you, in that you are correct. Sorry you left the ER in more pain you came in with, we will fully document your behavior in an effort to serve you better on your visit tomorrow and the next day and the week after that.

Most UNsincerely
The staff of your local ED






Dear Sickle Cell patient in 203:
When you come in every week in crisis we can not help but to become slightly less sympathetic. Please stop drinking a fifth of vodka every day and dehydrating yourself. When you tell us what works for your pain we sometimes listen, so when we give you something stronger than you asked for please don't lay in the bed and moan and scream and shake with fake pain because you are too dumb and drug seeking to know that we did better than you asked for. When a nurse finally told you that what you got was dilaudid instead of toradol its amazing how your 10/10 pain suddenly dropped to 2/10 in 3 minutes when another nurse reassessed you. If you where honest, or maybe really in pain you would have felt the relieve of the dilaudid, but since you were faking it, your behavior will also be duely noted.

Love your handy drug dispensing machine, the local ER.

enough with the damn vaginal bleeding

Holy effing crap! Can't you women just have your period at home the the rest of the female population!!! Its your period, it comes every 28 days or so, its normal and effing NORMAL! Secondly and not to sound insensitive but have your miscarriage at home too! Miscarriages are common, most women have at least one whether she is aware of it or not. Most miscarriages are not medical emergencies in need of an ER visit. Please, go to your GYN, she knows you better and can determine the cause of your miscarriage far better then the ER. All an ER doc is gonna do is a pelvic to make sure you aren't gonna hemorrhage to death and send you home with some OB pads the size of the titanic and a referal to a gyno. I must have assisted with 6 exams tonight, all of them benign. Its is very rarely that we find an ectopic pregnancy, incomplete evacuation in need of a D&C, or a truly hemorrhaging miscarriage or postpartum hemorrhage. Thirdly if you come in with vaginal bleeding don't get all upset then I wheel in the GYN cart, its shouldn't be unexpected that the doctor is gonna wanna use the "duck lips" and find out why you are bleeding. How did you expect him/her to determine the cause? Fourthly: it really makes me mad when the "bleeding" you were referring to doesn't ever require a pad or only leaves a small smear on your panties, that's not bleeding, you haven't seen bleeding. So in summary Ladies: HAVE YOUR PERIOD AT HOME, NOT IN THE ER!

The past few weeks

As I said in my previous post I have put all my time and energy into working these last few weeks. I have been working 5 12.5 hour shifts a week for the past 3 weeks. The pay checks are amazing and so is the experiance I am quickly gaining. I am amazed and how quickly I have gotten reasonably knowledgeable in the ED. I no longer feel like a bumbling idiot in a trauma and can anticipate the nurses needs and general plan for the patient. Many of my tasks are pretty basic like getting a patient to drink CT contrast while laying on a backboard but I have mad skills at that. The trade off for all of this time at work is that I have no life outside of the hospital. I have also become quite the vampire. I worked a day shift yesterday and I was blinded by this strange glowing bright orb in the sky. I wear sunglasses to leave work at 7am, so the full on brightness of 11am was blinding. I also had trouble going to sleep the other night then I realized why, my room was totally dark. I haven't slept in a dark room in weeks, it was very odd.

Crazy stories:
* chief complaint - "my baby is having seizures, I need an ultrasound now!' This is the second patient I have heard this from, must be more common than I thought. No silly what you feel is called fetal movement. And conveniently its about the time of her pregnancy that you can tell the sex, so no, you can't have an imprompto ultrasound to satisfy your curiosity. The US tech refused to tell her the sex of the baby, just that it was a healthy pregnancy.

* The guy who came in + loc, now very obviously altered and hopped up on something and clearly out of his mind. Totally incoherency, combative and devilishly strong. We intubated him for his safety and ours. He would pass out and barely breath so it wasn't a total social intubation. Unfortunately both of his IV's blew as the nurse tried to push the meds to knock his ass out. Here is the scene- 6 people holding him down (2 very muscular docs, 2 techs of substantial size and strength, and 2 nurses, as well as 2 RT's helping out by getting supplies that the rest of us were to busy to get). With all of this we still struggled to keep him on the bed. I had my body laid over his legs, pressing the pressure points above the knees, holding on to the railing on the other side, trying to brace myself as he levitated my 6ft, 165lb body off the floor with his knees. We had people trying to get IV access on both sides of him and what seemed like 20 people in the room, it was a total mad house! Finally we got him doped up, maxed out on the milk of sleep and sedated at the slightest twitch, we had learned from the previous night.... Best part he was neg for alcohol and the drug screen. What ever he was on was designer and dangerous. His labs were very bad, CKMB >4500, WBC 30K, everything was in the red!

* night before same kind of character came in, very combative, cussing up a storm with a huge head lac. He was drunk at a bar, swinging on a pole in the rain and lost his grip, fell, passed out under a car and bleed like a pig. The cops brought him in for eval and treatment. It was very hard to determine if he was just drunk, had a brain injury or both. He spit on us as we assessed him, cussed at the top of his lungs, upset the other patient quite a bit and fought something fierce. He couldn't put a sentence together, talked nonsense and wouldn't answer questions. We socially tubed him and sent him off to CT. Even with the propofol maxed out and the IV sedation he would still come to and fight the tube, and nearly flipped himself off the board. I again was laid across his legs even though he was in 4 point restraints he was gonna tip over the gurney! We managed to self extubate himself while the lab was drawing blood and coughup blood everywhere. We reintubated him and sent him to the ICU where he later tongued out the tube after aspirating, and signed out AMA! How do you sign out of the ICU? He had a huge concussion and mild swelling in his brain and a BAL of 0.39. I am sure we will be seeing him again with a bad case of pneumonia.

* lots of bugs in the ears. I have never had a bug in my ear so I didn't realize how common it is. EWWW!

*psych patient brought in with delusions that the police were having sex with her cats and teaching the birds to poop on her roof and spy on her. She was fun!

*had a paraplegic with the worst UTI I have ever seen. He had gross pussy exudate all around his foley cath! How does a nursing facility let it get that bad? Places like that make me so mad! GRRR, that is a whole new post in itself.

* I have a new appreciation for express care. I am amazed at the minor stuff that people come to the ED for.
- a mosquito bite
- a cat scratch
- I puked today and I am 4 weeks pregnant, can you do an ultrasound?
- "my feet smell different today"
- I pooped twice today and it hurt a little, can I get something for the pain?
- unexpected bleeding from the penis (real story, he was masturbating and scratched himself with his unbelievably long and gross fingernails)

on the other hand, we do take care of lots of legit patients in 70 minutes or less.

Well time to do laundry and try to be productive before my nap for night shift again tonight.

heart breaking night

Its the conclusion of my 2nd straight 60+ hour week. I have learned to much and gained so much confidence and skill, or at least I thought I had till this morning. We had a 2 month old in full cardiac arrest come in. I can running to see if I could help with the code, not knowing that it was an infant. I stood back while the team worked feverishly to bring the babe back. All I could do was watch and squeeze a silly bag of saline as I watched the scene. I squeezed a damn bag of saline while the rest of the team did CPR, administered drugs, used doppler and sono to look for a pulse and heart beat all in vain. I felt so helpless. I was emotionally fine until the doc called it and the mother let out this guttural scream that tore my heart open. Half the team walked out of the room with tear in our eyes. Its not the loss of the baby that hurts but the pain and sorrow in the mother's voice. Its a sound I never want to hear again. It really did, tear my heart wide open to hear her cry like that. What do you do for her, what to do you say as she crumples in a pile to the floor, praying to god, asking why he took her son, how can this be? All you can do is look her in the eye, with tears in yours and say I'm sorry, it isn't fair, it isn't right and there are no answers. The only conselationis that he is with god now, and thats no comfort now, but in time I hope it will. These are the words of the charge nurse as she kneeled next to the mother, handed her her baby and closed the curtian. I looked around the trauma desk at all the red eyes, smeared eye makeup and knowing glances as we all wordlessly consoled each other and gathered the strength to finnish our jobs and our shifts. Soon there were some laughs, funny quips, but an undeniable black cloud in the ER this morning. We all knew something big was comming it had been way to quiet and uneventful in the ER the last few days. The beginging of our shift was marked with yellow codes spilling into other areas of the ER, a heliocopter landing at shift change and a full house. We ended with a bang as well. Maybe now we can have a few more quite nights.

I know many of you have been through this same experiance, does it get any easier? I don't think so.

huge post coming

I am in the midst of a 120 hour pay period. I have taken all my loneliness and depression of late and poured it into working my ass off. I will post a huge compilation of stories very soon. Lets just say when you work for 5 nights in a row you get very much acquainted with the frequent fliers.

I have discovered the true meaning of tired, and also of "my dogs are barking", and why support hose are necessary.

I do it all for the mulah! And cause I love it!