Sunday, November 24, 2013

Just how attached ARE you to your scrotum?

That's what I wanted to ask the pissy little medic today.

Now, lemme start by saying that I love medics and respect them.  Respect?  Goes both ways.  And, in some situations, in more than 2 directions.

So, here's what happened...

I just happened to be caught up, so went in to help another nurse who was getting an ambulance patient.  Cute little old lady.  I was "doing bedside" (getting patient undressed, into a hospital gown, getting vital signs, hooking up the patient to monitoring equipment) while the primary nurse took report from the medics. One of the medics was still in the room with me and the patient, re-organizing their stretcher and equipment.  The other stepped outside the room to give report.  I closed the door behind him and started to disrobe the patient.  Just as I'd taken off her top and her floppy little old lady boobs were exposed to the world, he -- without knocking -- opened the door wide, left it open and walked into the room.

I said, "could you please close the door?"

His response, the one that practically begged me to slice his dangly bits off with my trauma shears?  "I will, calm down."


"Calm down"?

Me: "Oh, I'm calm.  But, my patient is naked.  Close the door."

He did.

I finished as quickly as I could with getting the patient settled in and then bee-lined for the ambulance bay to set junior straight.

When I got to the bay, he was talking to his partner, so I waited for him to finish, because I'm considerate like that.  Then?  Feeling my anger mount as I opened my mouth, I said,

"Two things:

First?  The absolutely fastest way to piss off someone who didn't start out pissed off is to say 'calm down'.

Second?  If that was YOUR grandma in there --"

(he cut me off with something that sounded like Charlie Brown adults taking)

"No!  Listen.  If that was YOUR grandma in there and you saw someone treat her with such indignity you'd be pissed."

"Look, I was just trying to...look, my bad, ok --"

(he started to say a "but", but I cut him off)

"Right.  Your bad.  That's what I was getting at."

And I walked away.

There was no justification for his complete lack of consideration for this patient.  I hope he gets that THAT was the issue.

I cannot abide when healthcare workers begin to treat their patients as cargo.  That's a person, jackhole!  Perhaps, you could find it within yourself to remember that and to treat her as such.

/rant over.

Thursday, November 21, 2013

Thin skinned need not apply

Here's why I love when people come to work in ER and they get it.
New nurse, just came off orientation, very smart, hard-working, really good nurse. She also happens to be fucking gorgeous with big boobs, a tiny waste and just generally very pretty. She was assigned next to another gal that is also new-ish, also a very solid nurse, and she is nearly 6' tall and genuinely looks like a runway model.
Problem was, we *actually* had a tech on the floor today, but he was basically camped out by the two hot girls being their little bitch while myself and another middle aged nurse floundered with no help of any kind except from each other when we could.
Finally, when I'd literally discharged 3 people in 15 minutes and then got 2 back to back ambulances, one of them a 4 yr old with an obvious fracture that was going to need -- at minimum procedural sedation for closed reduction and EMS hadn't put in an IV and it was almost 6 o'clock and he was over flirting with Nurse Hotty #1 and Nurse Hotty #2...
I'd had it.
HAD it.
I said, really loudly, directed at HIM, not them, "I guess I'm gonna have to lose a bunch of weight and get a boob job if I need some help in here, huh?"
Nurse Hotty #1, the big boobed one, thought it was a jab at her. She immediately just said, "Chill out. I'll give you the name of my surgeon."
I laughed my ass off. I LOVED that she jumped right back when she thought I was dissin' her. Of course, I wasn't. So, I also loved it that she understood and agreed when I explained that I was directing it at him and not at her.
I even told her, later, that I totally didn't realize they were fake, I had just meant I needed bigger ones than I have if I wanted to get the tech's attention. She said, "Oh, no, totally fake. My husband got them for me. Aren't they great!?"
She totally deflated my pissy mood. It was awesome.

Tuesday, November 12, 2013

The least of these...

Back in the day, when I was a tech in Albuquerque at a busy, downtown ER, our hallways were literally lined with stretchers holding homeless drunk guys every night.  Particularly in winter.

It was a constant source of frustration for the staff at the ER to spend so much time and energy, essentially, being a homeless shelter.  Especially because, as a rule, they tend to be very unpleasant, demanding, uncooperative and a risk to themselves and staff when they belligerently insist on trying to get up and leave while still very drunk and unsteady on their feet.

I became locally somewhat famous among the homeless population because of my fervor for a particular adherence to the letter of the law where vital signs were concerned.  In ER, every patient has to have vital signs done at least every 2 hours.  So, I would dutifully and cheerfully wake every single homeless guy every two hours to check their vital signs and assure that they could be roused.  Just doing my job.  But, knowing that they weren't going to get a good nights' sleep if they came to my ER, they would elect to be "found" closer to other facilities.

Over the years and in various cities in several states I have taken care of homeless drunk folks (not all homeless are drunks, btw, but the drunks are the portion of the homeless population who make most use of ERs).  I still make sure that they are made aware that the ER is for medical care and not a soft, warm bed for the night (or day as I primarily do days shifts now).  There are generally beds available at local shelters, you just have to show up by a particular time and not be drunk.  But, also, a certain amount of diligence is necessary because long term alcohol abuse puts one at risk for quite a few legit medical emergencies and some of them (bleeding into the brain for instance) can easily be mistaken for intoxication.

I was reminded of this years ago when I had a patient, I'll call him ICY, who -- as I was told in report -- had been witnessed to have fallen and bystanders called 911.  He was well known to EMS staff as a homeless alcoholic.  As I was taking report, ICY was walking from his stretcher to the bathroom.  His gait was a bit wobbly, but he made it.  I waited for him outside the bathroom and made sure he got safely back to his stretcher, got him undressed and gowned, got him a warm blanket -- for which he thanked me profusely and was generally just very sweet -- checked his vital signs and then sent him off to CT.

About 30 minutes later, I went in to recheck on ICY.  I couldn't get him to wake up.  At all.  I checked his pupils.  Not good.  One was about 3mm the other was probably 6mm.  He was breathing, but irregularly.  I put him on the monitor, rechecked his vital signs and discovered that his heart rate was slow, his blood pressure had a larger than normal difference between the top (systolic) and the bottom (diastolic).  Cushing's Triad.  Definitely NOT good.  He had pressure on his brain.  Just as I was about to go get the doc and let them know of this change, the radiologist had apparently called the ER doc to notify about the GIANT brain bleed that ICY had.

We pretty quickly intubated him and I got in a couple of big IVs and we gave him a powerful medicine to help reduce the swelling.  The neurosurgeon showed up  not long before I transferred ICY to the intensive care unit.  After looking at the CT, ICY's history and doing a physical exam, the neurosurgeon said to me, "This guy is going to die."  Yeah.  I thought so too.

Flash forward about a year.  I had left to go on a couple of travel assignments but was now back in the area where ICY lived.  Lo and behold, who is brought into my ER by EMS because he was found "down and out" by some kindly citizen who helpfully called 911?  Yes!  He was not only alive, but was now rocking a giant, old incision on his scalp that still had staples in it.  In the time I was gone, he survived his brain bleed after having had a hole bored into his skull.  He was sent to a rehab facility (no alcohol rehab, physical rehab) after discharge from the hospital, but then from rehab returned to his previously homeless state.  Rather than follow up at the local clinic or even return to the ER for re-evaluation after his ordeal, he just kept drinking and sleeping out of doors.  Predictably, he got an infection in his skull.  Yes.  The actual skull.  He ended up back in ICU having IV antibiotics and having part of his skull removed.  Now he'd been released again and still had his staples.  I finally convinced one of the ER docs that the better part of valor was to remove the staples.  I gave ICY a blanket and some food and, as per his usual, he was very sweet and grateful.

ICY has become one of those homeless alcoholics who could essentially give the ER as their permanent address.  He is known by name by all of the staff.  Most feel he is just another homeless drunk guy and are frustrated every time he returns.

Somehow, the lump of stone that resides just the other side of my sternum melts whenever I take care of him.  I always take great care to really look him over and make sure he's ok and then I get him a warm blanket and some food.  And, he is always very grateful and sweet.

And he makes me remember why I love being a nurse.