Worst Come, First Served

Just because you are coughing and sneezing louder than an elephant with a stuffed up nose does not make you priority number one. The guy who just came in with the thumper on his chest wins that prize.

The louder you vomit, sneeze, cry, moan, scream, whimper, and call out does not matter to me if I am in the middle of a Stroke Alert. Since I saw you out of the corner of my eye eating doritos and your girlfriend stroking your head, I decided that I don't like you. You're a level 3, which means you're probably going to get IV fluids and Zofran, but in the common sense world of people who don't think they are entitled, you would have stayed home, sipped on gingerale and when dinner time rolled around your mommy would have made you some chicken soup.

Just because you went to the charge nurse and complained doesn't mean that I'm impressed. What do you think this is? A restaurant? The DMV where you take a number and your turn is called? You going ape shit at the DMV is something I would like to see. The police dragging your sorry ass out of there in cuffs would make a great perp walk. But you wouldn't do that at the DMV, would you? Just because you're in the ER doesn't mean you can act like a fool and we're suppose to take it. So sit down, hurry up and wait, or better yet, make like a banana and peel.

When I saw the BLS ambulance coming in the door with 4 small children on it with you walking aside with your cell phone in hand and a Louis Vuitton bag on your arm I laughed when the charge nurse sent you all straight out to triage. Cold symptoms, indeed! Just because you called the free taxi, er ambulance, doesn't give you and your gaggle a free pass to a bed in the Pedi area.

Since I've got the summer cold from hell right now, my sympathies may be distorted. There's nothing I'd like more than to get me some good cough medicine and take a nice long nap. Not going to happen since I have to be up tomorrow at 5:15 sharp to get ready to go in and take care of more cough, colds, vomit and drama.

So, excuse me while I sneeze really loud and attempt to garner some sympathy from my dogs.

Ordinary Shift

Yesterday was a good day for overtime. I show up for an eight hour shift with my hair actually looking half way decent. Coming in at 11A gives me time to gussy up for the day, something that I never do when going in at 7A.

I start off floating, which is fun because I'm not really responsible for a group of patients, I just get to go around and triage ambulances and put out fires.

I just so happened to be standing by the ambulance triage when the EMT says to me, "Oh, hey, how are you doing? Remember that lady with the shoes the other day? Well, guess what? The shoes were in her room when we dropped her off." I commented that I didn't receive an apology call from that heinous daughter. Eye roll, sigh, gasp.

After a while, I get put in the halls which isn't too bad, except for the fact it's difficult to take vital signs because we have one, I said one rolling dinemap for all four halls, total 32 patients. Not to mention that maneuvering the COW is a challenge.

I'm typing up this guy who brings in a huge wad of MRI's and X-ray's and he tells me that he has run out of his pain meds since he lost his job and can't pay for the pain clinic, anymore. I'm thinking to myself does he think it's free to come here? I'm sure he was going to one of the pay as you go all cash pain clinics, of which we have 35 of them in my county. After the medical screening, he's told he has to make a co-pay for treatment or leave. I just love it when that happens. Drug addict number 15 of the day out the door without his precious Oxy.

Drug addicts aside, I get the cutest man who fell at his ALF and has a big boo-boo on the back of his head. He's alert but a little forgetful. After we patch him up, I tell him I'm sending him back home to which he tells me I'd better call his wife, she might not want him home. I guess he forgot he lives in the ALF. Seems that she put his 84 year old butt in the ALF because she's having an affair with a guy who is about 48. His wife is 60 he tells me and he thinks she only wants his money. Apparently he has a a huge house with a Mercedes in the drive. I feel bad for him, he was so sweet.

The lady in Hall 3 comes in with a headache x 3 days. She's got a shocking amount of unruly curly red hair, that seems to be all over the place. While typing her up, she tells me that she had fallen in the shower and thinks the bump on the back of her head might be the problem. So, I proceed to take a look when I notice bugs crawling through her frizzy mane. Geezus, bitch, do you know you have head lice?? Oh, she tells me, yeah, I have to wash it everyday and they just won't go away. Gawd, I just got the chills thinking about it, again.

All in all, not a bad day for an extra shift. Makes me think this job is okay, for now.

Douches Part Deux

There are so many douche bags to talk about and so little time.

So the other day another LOL comes in from Shaky Graves Nursing Home with Altered Mental Status. She looks to be about 90 pounds soaking wet and drier than a popcorn fart. Her lips are crusted with junk, her tongue looks like a prune and when I insert the foley I get about one drop of urine.

Following the ambulance in is her crazy douche bag daughter from hell. Oh, excuse me, she's an RN from New York and she just flew in to town. Well, fuck me dead, bitch. Like I care.

So, she's hovering like a helicopter over Mother and up my ass asking for a toothbrush, soap and water for a bath, ice chips, some Motrin and a Xanax. I tell her let's wait for her to be seen by the doctor, first. She huffs and puffs a little and in walks one of my favorite docs, a little petite thing with 5 kids who looks like she's 15. RN from New York tells her in a rude way to step out because we're in the middle of fluffing and buffing. She said this only like a New Yorker can. To which my favorite doc looks at her, puts her hand out and introduces herself. Nothing like a little southern charm. HaHa, you should have seen New York's face.

Anyhoo, we get to hanging some fluids, do all the usual stuff and this freak wouldn't stop with the constant demands. It was like she was tweaking on sugar or something and I felt like I was going to start twitching any minute. She intimidates enough that we get her some Xanax and a Motrin. One sip of water and she's coughing up a lung. I suggest we hold off because I fear she is aspirating. Nope! She says she'll take full responsibility for it and insists it be given. After discussion with Sweetness Doc, we decide we need to up our Press Ganey scores and give the meds. I crushed them, got some yummy pudding and let New York RN administer. (All documented as such in a very professional way, of course).

About 2 hours later she was on a vent. I wish I could have said told you so, but I'm not that way. I smiled and comforted like the dumb nurse that I am from the south.

Moving on, a dude with HTN whose wife was pregnant. He asks me if I can get her a stretcher to lay down on. Uh, sure. Just let me kick a sick patient off one so we can help you out a little. Douche.

19 year old female shows up as a psych hold after threatening to kill her brother with a knife. We go into the bathroom to take her clothes off and get a drug screen when she pulls up her leg, shows me her kitty cat and tells me it's warm and silky. Okay, sister we're out of here. With urine in hand, she's walking back to her stretcher, but unbeknownst to me, she had opened her gown in the back so her ass was fully exposed to all of the medic students who had just arrived for orientation. Fun times I tell ya. PsychoDouche.

Two 18 year-old frat boys come in with a couple of gigantic Red Bulls in hand and tell me that the car they were driving suddenly backed into a concrete pole and the windshield shattered. Okay, he had a little tiny .01cm sized lac on his eyelid and he was also extremely fucked up on something, I suspected Oxy and Xanax. They deny that, however. Doc Crotchety couldn't wake him up enough to get a straight story, but they did tell him that they thought the car ran into an overhanging branch causing the windshield to break all over them. Hmm, overhanging branch or concrete pole? They do like alike. Spoiled frat boy double douches.

Hip Hooray! A whole two days off. I think I'll give my precious little puppies a bath and watch Lee sing Hallelujah again on the DVR.

Extreme Douchery

I'm seriously starting to hate this my job. It's to the point where I'm thinking about going back to the unit.

I don't know how other ER's operate, but mine seems to suck balls lately. With the extreme douchebaggery of management, and the out of control douches who come in for bullshit and bring their psycho-bitch wives, girlfriends, daughters and sisters with them, I've just about had it.

We have this one charge who I've not mentioned who is the most mealy-mouthed freak of a ho I've had for a charge in a long time. She used to be a first grade teacher if that tells you anything. She only uses her inside voice to talk so you can never hear a fucking thing she says. She loves to give you stupid crap, like putting men in all your GYN rooms, then while you're in the room getting one triaged (immediate bedding, 'nuff said), she's paging your ass to go to another room for some bullshit or other. I try, but I can only wipe one butt at a time. Not good enough I suppose because you get a a look from her like you're somehow incompetent that you can't triage three people at once and have them all lined and medicated in five minutes.

Fuck her.

Anyway, I get this LOL from a nursing home who fell the day before and hit her head. She's non-verbal by history, and has a big blue egg on her forehead. I type her up and get her labs when her neurotic hysterical daughter comes in looking like her ass is on fire. Seriously, bitch! Like, take a chill pill. I proceeded to tell her the plan, only to be interrupted by her telling me things like "NO, I don't think she needs to be cathed, that's invasive," to "Where is that doctor?? She's been here 10 minutes!!" Gawd, what a C-word this one was. This hag was in her 50's, but when she talked to me she would roll her eyes and sigh. I'm not sure what she wanted and what it was that I wasn't doing for her. But, I'll tell you, just because she wanted me to come in and check Mothers diaper to see if it needs changing, doesn't mean I'm dropping what I'm doing with the dude who just came in from a house fire to attend to her every whim. It's all about triage for me and Mother was a level 5 at this point.

Fuck her, too.

I had called a transport ambulance to send Mother back to Serenity Hills and was just awaiting their arrival. Oh no, not good enough. I get more eye-rolling, more sighing (I think she's an old valley girl from the 80's, I haven't seen that much sighing and eye rolling since my daughter was a teen)-more hysteria because a skin tear was bleeding, complaints that she has seen ambulance after ambulance come and go and it's been an hour and why haven't they picked Mother up. Seriously, I want your mother out of here like yesterday, trust me you heinous piece of crap. The final straw is Valley Woman comes up behind me while I'm talking to somebody else and butts right in with a sigh and a shrill shriek that Mother's shoes are missing. I turn to look at her, I say nothing, I just look. She stands there, sighing, rolling her eyes, shrieking on and on about the missing shoes. Finally, I say I don't recall any shoes. She says, "I called Serenity Hills and they said she had shoes!!" Snort, eye roll, sigh. So I say , "Well, did you look in the room?" Well, that did it. She lost it. Total meltdown right there. With a super eye roll, a huge sigh and snort she tells me "WOULD I BE ASKING YOU ABOUT THE SHOES IF I HADN'T LOOKED?" Got to admit she has a point, but seriously, does she think I'm hiding the shoes? Lying about the shoes?

Yeah, I stole the shoes, that's it! Sigh. Eye roll....

Happy Nurses Day

I got my ass handed to me on Nurses Day.

Management was cooking up flapjacks so me and a few others including a student or two headed on over. My unit director was cooking while some manager in a nurses hat and white uniform was handing out plates. Bitch, please! You mean you really saved your nursing school hat from 1966? Is that how you see nursing, still? Probably, but I digress.

So there was a two pancake limit which didn't deter us. The students had already eaten so they lined up and then handed us their dollar size pancakes. We proceeded on over to the next line and were greeted by this:


SAUSAGE POLICY: NO MORE THAN TWO SAUSAGES PER PERSON. NO EXCEPTIONS. SEE YOUR MANAGER FOR ANY QUESTIONS.


Good thing I got that great breakfast, huh? The shit storm was about to hit. Between the crazy drug seekers in Xanax withdrawal and the really sick people, the place was beginning to sound like a jet engine idling for take-off.

Add to the mix a crazy nurse who forgets to take her ADHD meds and starts getting really loud with the chaos, Crazy Town was heating up and she was the Mayor.

I had in my room one squirrely benzo withdrawal lady, one drunk guy who was talking non-stop, one sweet lady with a dickhead husband who kept telling her to shut her mouth, and the sick lady who came in with bleeding from a left femoral cath site.

Bleeding Fem lady looked like Caspar. She had been tubed in the field for Altered Mental Status and the presence of copious amounts of blood in her bed. Upon arrival, she did not have a pulse. She also had no line. I was alone, except for two nursing students, a paramedic student, the doctor with his scribe and The Mayor of Crazy Town who showed up to flirt with a few of the paramedics.

I throw the doc a central line kit and some gloves, I instruct one of the students to start CPR and I crack the code cart. The Mayor is running her mouth, bouncing all over the place and accomplishing nothing. Oh, and in the midst of the all this debauchery, she finds time to stand at the foot of the bed and send a text.

I kick her out of the room with a few expletives to express my displeasure, screw the fact I'm the only licensed nurse in the room. I'd rather have glued my eyelids shut with peanut butter than deal with her dumb ass.

Boom! I hear a crash and look through the curtain to see that my drunk dude has fallen on the floor and is curled up in a ball with some blood coming from his head. I call out to our illustrious Mr. Testosterone charge nurse who is busy surfing the internet and tell him I have a man on the ground. Bummer for him he has to get up off his fully-sized bowling ball butt. Xanax withdrawal is also practically hanging by her telemetry wires, nothing I can do at the moment, I turn my attention back to my code. I compliment the nursing student on her awesome CPR. She's a very serious girl, she barely looks my way.

It was too late for trauma blood, she was dead. I'm even more screwed now, because I know I'll spend the next 90 minutes give or take on the phone calling all the appropriate agencies. Not to mention, the screaming I get from her private doctors, none of whom will sign the death certificate. In the meantime, the sweet lady leaves and I'm still getting my beds filled with sick people.

I finish up the paper work in record time, console the family, hug the daughter, tag and bag and send her off to the morgue.

It's only three, I have four more hours of this. I'll spare you, needless to say an eerie calmness came over me and I tuned out all the loud noises. Maybe I was just hungry. I think I'll head over here:

Code Blue

He was called in over the radio as a full code. A 45 year old found down in the yard by his wife.

He was a big guy with a full head of dark brown air. Wearing shorts and dockers, his tee-shirt long cut off, pieces of it peeking out from underneath his shoulders. His face was pleasant, now blue and flaccid. I couldn't look at it. We coded him longer than usual, with no return of rhythm or pulse. No medical history given, he was just a guy on a beautiful Saturday working in his yard.

The wife finally arrived with two of her girlfriends in tow. The utter angst on her face was enough for me to take her to his bedside and hold her while she cried. No, he takes no medications, no he doesn't smoke or drink, he's had no complaints at all about his health.

They had been working in the yard and she had slipped into the house for some water, only gone a few minutes. The overwhelming sadness I was witnessing felt surreal. I've seen hundreds of these codes in my career. How I can stand back and be an observer to such human emotion is a mystery. It doesn't seem normal to be so removed, clinically distant, an observer of another human being losing his life.

I wondered about this. Are medical professionals the ultimate actors? Do we learn to quell our emotions so well that we are affected in our personal lives?

No, but sometimes I question my sanity.

Instant Karma

I appeared to working the loony toons room, which is not to be confused with the critical room, but that day it was one and the same.

In bed A we have a 27 year old female who came in by ambulance, rather, free taxi with a 6 week history of RUQ abdominal pain. No N/V/D or fever. She seemed fairly honest about her history, says she's bipolar but doesn't take any meds because they make her crazy. Her solution is to just smoke the gonja. She talked about it the entire time she was with me, where she gets it from, who grows it, she was in love with it.

In bed B we have a 50 year old female with chest pain with no psych history who is sitting with her husband. After spending some time with A bed, I go over to check some vitals on B bed. Her husband is hunkered down in the corner with the curtain pulled tightly and is trying to tell me something. I lean down to hear what he has to say and he whispers "I'm her parole officer." Shut up!! Seriously, he showed me his ID.

Poor bed A. I felt sorry for a nanosecond.

When she was being discharged, her niceness turned totally into a bipolar, head-spinning, shrieking foul-mouthed shrew creature all because all her tests were normal and she was leaving with no narcotics.

Funny I would hear a Lennon song on the drive home.

"Instant Karma's gonna get you gonna knock you right on your head."