Over my past few shifts in Mid-Size Non-Trauma Center, I have noticed a few common questions and requests from patients that I would like to address:
1. "Can I have something to eat/drink?" - This is a perfectly reasonable question if you've been in the ED for a few hours, and haven't been allowed anything pending test results or some such. It's going to SERIOUSLY PISS ME OFF if it's the first thing out of your mouth when you walk into the ED. Here's why: if you've WALKED into the ED, you got yourself to the hospital. On your way, you passed LOTS of places to get a drink of water/juice, or a snack. If you're sick enough to be here, your snack should really NOT be your primary concern.
On the other hand, i make plenty of exceptions for: people brought in by ambulance, especially for fainting- maybe hunger or dehydration MADE them faint, so I'll do my best; Pregnant women- snacking helps with morning sickness, i get it; The Elderly- sometimes they have been brought in without much input on their part, and havent eaten in AGES.
2. "When will the doctor be here?"- Another question that sounds perfectly reasonable, except when whined repeatedly by someone who came in for narcotics over FOUR HOURS. The doctor (nominated for sainthood) had checked on him EVERY TWENTY MINUTES, but he still felt it was unreasonable that the doctor "wouldn't really help"- the doc exhausted like, 7 DIFFERENT pain management techniques INCLUDING a lidocaine patch, toradol (allergic, but not to codeine with tylenol, or to vicodin), pain management referral, etc. I was sorry that he was in pain, but...we cannot just keep giving him narcotics for his complaint of "the last doctor pushed REALLY HARD on my abdomen and it hurts". Seriously, try a heat pack. The doctor even went in and explained "i think you have a problem with narcotic addiction, and I would like to refer you to somewhere for help". The patient spat at him and left.
3."Can't you just look it up?"- with regard to medications the patient is taking. The emergency departments of the world do not, as a rule, have access to magic 8 balls, or necromancy to divine patient records from world war 2, other states, other hospital systems, or other planets. While this DOES put the burden on patients to know what they've taken, what they're allergic to, and if they still have an appendix, until we get a centralized national system patients are just going to have to try to help us out. Again, free passes are given for people too sick to remember anything, 90 year olds taking 40 meds with memory problems, or anyone unconscious.
Thursday, April 29, 2010
Wednesday, April 28, 2010
Death 2, Alpine, 0
Today was another fine day in Mid-Size Non Trauma Center's ED. Coffee in had, I stepped bravely into the department following a TERRIBLE night, waking up every hour with a recurring nightmare that I had overslept and gotten thrown out of clinical for tardiness. Auspicious start to the day, I must add.
Upon arrival my coffee and I were shoved into the doctor's dictation closet, because JHACO/TJC were expected to do an inspection of Stroke Center Procedures, and Coffee In Public Areas is not permitted when inspectors are present. Seriously, I think that medical and nursing professionals without ready access to coffee are a FAR bigger danger to their patients than coffee cups on the nurses stations. I mean, we're talking about alertness here, people!
Death's first victory was an elderly woman, past 80, who came in with mild stomach pain and more serious back and flank pain, presenting with an inability to get up off the couch. COPD? No. CHF? No. Diabetes? WRONG AGAIN!!!
AAA. Yes, an abdominal aortic aneurysm (never seen one before!) of 7cm, already popped. According to the (VERY excited) doc, she was currently stable because a clot had formed over the popped bit, rendering her sort-of hemodynamically stable-ish. No problem. We know JUST what to do with her- a quick-as-HELL trip up to the OR! Or...not. See, she was a Jehovah's Witness, and they cannot accept blood products, which obviously sort of limits the operating rooms that are willing to take a shot at an operation that ALREADY has a greater than 50% death rate. Half an hour of frantic phone calls later and one of the Large Impressive City Hospitals agreed to try a "bloodless" surgery on her. We managed to keep her alive out the door, and she actually survived the surgery, much to our surprise. Unfortunately, she suffocated 10 minutes later from a hemoglobin of .8- she literally had NO blood cells left, and was circulating saline. Even though I don't necessarily understand her beliefs, I have to admire how she and her family stuck to their beliefs in the face of death.
Death number 2 was much less exotic- a code that really had died at home, with paramedics working him on scene for HALF AN HOUR without ever getting a rhythm back. His family refused to let the paramedics pronounce him, and insisted on a hospital transport. I'm not really sure how that works, legally, but they were still coding him when he arrived, and were getting a VERY nice waveform on the monitor, complete with femoral pulses with compressions. On the other hand, his skin was mottled and grey-green. While part of me grieves for the family, and can understand that "letting" the paramedics call time of death would make it all "real", the rest of me wonders how they could have thought that he was anything other than dead. Live people don't look like this man did. I've seen living people, dead people, and dying people- even the woman with NO BLOOD LEFT, for all her pallor, still was unmistakably alive. This man was, just as unmistakably, quite dead.
I just hope that someday soon I will actually see a SUCCESSFUL code. Death, next time I'M cheating.
Upon arrival my coffee and I were shoved into the doctor's dictation closet, because JHACO/TJC were expected to do an inspection of Stroke Center Procedures, and Coffee In Public Areas is not permitted when inspectors are present. Seriously, I think that medical and nursing professionals without ready access to coffee are a FAR bigger danger to their patients than coffee cups on the nurses stations. I mean, we're talking about alertness here, people!
Death's first victory was an elderly woman, past 80, who came in with mild stomach pain and more serious back and flank pain, presenting with an inability to get up off the couch. COPD? No. CHF? No. Diabetes? WRONG AGAIN!!!
AAA. Yes, an abdominal aortic aneurysm (never seen one before!) of 7cm, already popped. According to the (VERY excited) doc, she was currently stable because a clot had formed over the popped bit, rendering her sort-of hemodynamically stable-ish. No problem. We know JUST what to do with her- a quick-as-HELL trip up to the OR! Or...not. See, she was a Jehovah's Witness, and they cannot accept blood products, which obviously sort of limits the operating rooms that are willing to take a shot at an operation that ALREADY has a greater than 50% death rate. Half an hour of frantic phone calls later and one of the Large Impressive City Hospitals agreed to try a "bloodless" surgery on her. We managed to keep her alive out the door, and she actually survived the surgery, much to our surprise. Unfortunately, she suffocated 10 minutes later from a hemoglobin of .8- she literally had NO blood cells left, and was circulating saline. Even though I don't necessarily understand her beliefs, I have to admire how she and her family stuck to their beliefs in the face of death.
Death number 2 was much less exotic- a code that really had died at home, with paramedics working him on scene for HALF AN HOUR without ever getting a rhythm back. His family refused to let the paramedics pronounce him, and insisted on a hospital transport. I'm not really sure how that works, legally, but they were still coding him when he arrived, and were getting a VERY nice waveform on the monitor, complete with femoral pulses with compressions. On the other hand, his skin was mottled and grey-green. While part of me grieves for the family, and can understand that "letting" the paramedics call time of death would make it all "real", the rest of me wonders how they could have thought that he was anything other than dead. Live people don't look like this man did. I've seen living people, dead people, and dying people- even the woman with NO BLOOD LEFT, for all her pallor, still was unmistakably alive. This man was, just as unmistakably, quite dead.
I just hope that someday soon I will actually see a SUCCESSFUL code. Death, next time I'M cheating.
Sunday, April 25, 2010
That's Just Unsanitary!
Friday was another 12 hour shift in Midsize Non-Trauma Center's ED, and while there were only two people I would actually be able to label "True Emergencies" all shift, there were some VERY interesting cases in other ways, which was impressive given that when I walked in at 645, there were NO PATIENTS IN THE DEPARTMENT. I curled up on one of the swivelly chairs and DIDNT SAY ANYTHING for fear of jinxing it, but as predicted, the "quiet" (oh no! i typed it!) only lasted about half an hour.
The first truly bizarre/awful case of the day was a 500 some-odd pound man, brought in for, ironically "failure to thrive". This MUST only be a social designation, since in neonates "failure to thrive" means they're LITTLE...not this particular gentleman's problem. His problem was bilateral cellulitis of the lower legs. REALLY GROSS cellulitis of the lower legs. They were wrapped in biohazard bags by the medics, who promptly ran outside and started shaking their clothes off on arrival...which is NEVER a good sign. Apparently this gentleman had ROACHES LIVING IN HIS SKIN FOLDS.
The truly odd thing about this large man was that he was COMPLETELY LUCID, and convinced that we were "making a big deal out of nothing!". He was caked in dirt, apparently from "pulling himself across the floor" which he didn't seem to think was a problem in and of itself, and was FURIOUS that he'd been taken out of his house. It took us (me, my partner and three Real Nurses) almost an hour to get him all cleaned up. He was really quite polite, and seemed lucid, albiet with a HUGE blind spot about how bad his house and hygeine really were. He was admitted to med-surg, for placement in assisted living, and may lose both his legs to gangrene.
I learned that the smell of gangrene actually does not upset me nearly as much as I had originally thought. Good to know! On the other hand, I have also learned that I will be itching for the rest of any day when a patient has bugs.
Its tough to know how to feel about a patient like this- on one hand, you KNOW they cannot take care of themselves, because...well...he was dragging himself across the FLOOR in a filthy house! But on the other hand, now we're taking away all his perceived independence. Tough call.
The first truly bizarre/awful case of the day was a 500 some-odd pound man, brought in for, ironically "failure to thrive". This MUST only be a social designation, since in neonates "failure to thrive" means they're LITTLE...not this particular gentleman's problem. His problem was bilateral cellulitis of the lower legs. REALLY GROSS cellulitis of the lower legs. They were wrapped in biohazard bags by the medics, who promptly ran outside and started shaking their clothes off on arrival...which is NEVER a good sign. Apparently this gentleman had ROACHES LIVING IN HIS SKIN FOLDS.
The truly odd thing about this large man was that he was COMPLETELY LUCID, and convinced that we were "making a big deal out of nothing!". He was caked in dirt, apparently from "pulling himself across the floor" which he didn't seem to think was a problem in and of itself, and was FURIOUS that he'd been taken out of his house. It took us (me, my partner and three Real Nurses) almost an hour to get him all cleaned up. He was really quite polite, and seemed lucid, albiet with a HUGE blind spot about how bad his house and hygeine really were. He was admitted to med-surg, for placement in assisted living, and may lose both his legs to gangrene.
I learned that the smell of gangrene actually does not upset me nearly as much as I had originally thought. Good to know! On the other hand, I have also learned that I will be itching for the rest of any day when a patient has bugs.
Its tough to know how to feel about a patient like this- on one hand, you KNOW they cannot take care of themselves, because...well...he was dragging himself across the FLOOR in a filthy house! But on the other hand, now we're taking away all his perceived independence. Tough call.
Thursday, April 22, 2010
Finals
In senior year at Very Catholic University, finals are EARLY. Today i had both my Ob-Gyn test (the FINAL for OB/Peds is TUESDAY) and my FINAL in Leadership/Management. This is because MOST people have their leadership clinicals next week...unlike me, and I'll be FINISHED for the WHOLE SEMESTER on the 30th of April. Yeah. Next week. Then all I have is Home Health / Community Health this summer.
So I'll be (NCLEX willing) A NURSE at the end of July. Yes, JULY. THREE MONTHS AWAY.
I'm sort of scared now.
So I'll be (NCLEX willing) A NURSE at the end of July. Yes, JULY. THREE MONTHS AWAY.
I'm sort of scared now.
Wednesday, April 21, 2010
Cootie Shot
So I've now spent 3 fridays at Mid-Size Suburban Hospital's ER/ED, and there are two patients, very much alike, who have me wondering one simple thing:
Is it REALLY that hard to avoid getting Syphilis?
I mean, although it's an EXCELLENT learning opportunity for ME to give large IM injections of painful antibiotics into the butts of young men, it CANT be a good sign that this many of them are presenting with "testicular pain", burning on urination, or REALLY REALLY OBVIOUS SYPHILIS CHANCRES. One of these young men (23 or so) BROUGHT HIS MOTHER WITH HIM. That must have been one interesting conversation...and makes me really wonder- if he's that big a mamma's boy, why didn't she teach him how to avoid these things?
The OTHER unfortunate young man had his syph shots and promptly went into anyphylactic shock. The intern LOUDLY says, at the nurses station, "well that's ONE way to teach someone about the dangers of STDS!"
So really, people, WEAR A CONDOM. Because as much as I appreciate the practice, your butt is going to be sore for a week.
Is it REALLY that hard to avoid getting Syphilis?
I mean, although it's an EXCELLENT learning opportunity for ME to give large IM injections of painful antibiotics into the butts of young men, it CANT be a good sign that this many of them are presenting with "testicular pain", burning on urination, or REALLY REALLY OBVIOUS SYPHILIS CHANCRES. One of these young men (23 or so) BROUGHT HIS MOTHER WITH HIM. That must have been one interesting conversation...and makes me really wonder- if he's that big a mamma's boy, why didn't she teach him how to avoid these things?
The OTHER unfortunate young man had his syph shots and promptly went into anyphylactic shock. The intern LOUDLY says, at the nurses station, "well that's ONE way to teach someone about the dangers of STDS!"
So really, people, WEAR A CONDOM. Because as much as I appreciate the practice, your butt is going to be sore for a week.
Tuesday, April 20, 2010
The Month From Hell
More accurately, the week from hell. First, for most of this month my blog keeps trying to send me to another website when i try to view it, and i'm HOPING that it has been fixed so i can start posting again.
Just THIS week, i have been through the following: During my Leadership Clinical in the ER i had to pick up a miscarried placenta from the FLOOR (it done fell out) while comforting the poor woman it fell out of, find a jar with formaldehyde to put it in, then got yelled at by the woman's nurse who WENT MISSING FOR AN HOUR while this was going on, but was upset that the charge nurse had had ME take care of it, since it was "her patient". Sorry, wasn't going to leave the placenta on the bathroom floor. Seemed unsanitary.
Then, THREE WEEKS after my observation day in the NICU, a nurse said i told her i did something REDICULOUSLY stupid, which i didn't do. Like, never get my nursing license and possibly get sued stupid. And i didn't do it. So yeah...i'm still panicked that i'll get thrown under the bus for this, even though it was just a miscommunication where the nurse thought i said i did it, and i was ASKING if one would do it, and i hope my instructor irons this all out. Of course, at THIS point, i dont REMEMBER what exactly i said, because IT WAS THREE WEEKS AGO.
THEN, now that i'm completely emotionally a DISASTER AREA, i decided to get my hair trimmed, so i could pamper myself a bit, and feel better. Besides, my hair hasn't been cut in 4 months.
She ruined it. It was a simple, slightly layered shoulder-blade-length cut, and now she cut MOST of the hair short, but left a FEW long pieces...basically the OPPOSITE of what i asked for. My hair has a SHELF. I'm now in tears AGAIN, and have to wait to drive home to my parents to have my MOM'S lady try to fix it, which will probably involve trying to make it look like Ginnifer Goodwin's in "He's Just Not That Into You", because it's too short to do anything else.
I think i need a hug...and for this to be fixed. I'm afraid they wont let me be a nurse...AND i have bad hair!
Just THIS week, i have been through the following: During my Leadership Clinical in the ER i had to pick up a miscarried placenta from the FLOOR (it done fell out) while comforting the poor woman it fell out of, find a jar with formaldehyde to put it in, then got yelled at by the woman's nurse who WENT MISSING FOR AN HOUR while this was going on, but was upset that the charge nurse had had ME take care of it, since it was "her patient". Sorry, wasn't going to leave the placenta on the bathroom floor. Seemed unsanitary.
Then, THREE WEEKS after my observation day in the NICU, a nurse said i told her i did something REDICULOUSLY stupid, which i didn't do. Like, never get my nursing license and possibly get sued stupid. And i didn't do it. So yeah...i'm still panicked that i'll get thrown under the bus for this, even though it was just a miscommunication where the nurse thought i said i did it, and i was ASKING if one would do it, and i hope my instructor irons this all out. Of course, at THIS point, i dont REMEMBER what exactly i said, because IT WAS THREE WEEKS AGO.
THEN, now that i'm completely emotionally a DISASTER AREA, i decided to get my hair trimmed, so i could pamper myself a bit, and feel better. Besides, my hair hasn't been cut in 4 months.
She ruined it. It was a simple, slightly layered shoulder-blade-length cut, and now she cut MOST of the hair short, but left a FEW long pieces...basically the OPPOSITE of what i asked for. My hair has a SHELF. I'm now in tears AGAIN, and have to wait to drive home to my parents to have my MOM'S lady try to fix it, which will probably involve trying to make it look like Ginnifer Goodwin's in "He's Just Not That Into You", because it's too short to do anything else.
I think i need a hug...and for this to be fixed. I'm afraid they wont let me be a nurse...AND i have bad hair!
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