A couple of years ago, I overheard a male colleague of mine triage an elderly lady who tripped or slipped on an escalator, fell, and came in to ER with a couple of nasty abrasions and a laceration to her shin. Trying to be sympathetic and funny my colleague said: "One time an escalator tried to bite my Crocs." (he probably meant that his shoe somehow almost got stuck in the moving parts of an escalator)
The lady, being well into her eighties, and probably not sporting the best hearing, didn't hear him clearly, so she had to clarify: "An escalator bit your crotch?"
I don't know if it's wrong but, for some reason, I could totally picture it happening, which made it 100 times funnier.
Oh, the small joys of triage.
Wednesday 10 July 2013
Saturday 22 June 2013
Coming to ERs near you: Book your next laser hair removal while we treat you for DKA!
Something I heard from a patient recently who was recovering from a bad anaphylactic reaction:
- I was wondering if I could make an appointment for a circumcision?
Um... Sure? And since you are already in the ER how about we schedule you for your next teeth whitening session?
- I was wondering if I could make an appointment for a circumcision?
Um... Sure? And since you are already in the ER how about we schedule you for your next teeth whitening session?
Thursday 6 June 2013
I for an eye
As I was catching up on my charting today, I was interrupted by a visitor looking for a patient.
"Excuse me," she said. "I'm looking for an I-room."
"I'm sorry?" I didn't hear what she said because I was deeply concentrated on quoting verbatim all the scrambled garbage that came out of my drunk patient's mouth a few minutes earlier.
"I'm looking for an I-room? "I" as in "ice cream," she repeated.
It took me a second to realize what exactly she was talking about and, after I did, another two seconds to try and keep a straight face.
"It's Eye Room. Eye as in "eye" [pointing at my left eye that was twitching slightly with the barely suppressed laughter]. It's down the hall to the right."
I spent the next five minutes contemplating on the all the benefits of having an ice cream room in our ER.
"Excuse me," she said. "I'm looking for an I-room."
"I'm sorry?" I didn't hear what she said because I was deeply concentrated on quoting verbatim all the scrambled garbage that came out of my drunk patient's mouth a few minutes earlier.
"I'm looking for an I-room? "I" as in "ice cream," she repeated.
It took me a second to realize what exactly she was talking about and, after I did, another two seconds to try and keep a straight face.
"It's Eye Room. Eye as in "eye" [pointing at my left eye that was twitching slightly with the barely suppressed laughter]. It's down the hall to the right."
I spent the next five minutes contemplating on the all the benefits of having an ice cream room in our ER.
Monday 27 May 2013
Old and awesome are not mutually exclusive
One of my most favorite patient populations to work with is the elderly (or as we lovingly call them - the geris). Mind you, I dread being a nurse for those nasty old people who don't even have an excuse of severe dementia to be a bitch to you and treat you as their personal caregiver and think it's expected of you to make them tea, and brush their dentures for them, and, hey, since you are already in the room, how about rubbing some moisturizing lotion into my flaking legs? When I say I love working with the elderly I mean those old people who remind you of your grandparents and who are so sweet that you want to take them home with you and watch them knit you winter socks while they rock in a chair by the non-existent fireplace (because who am I kidding? I live in a tiny apartment that doesn't only have a fireplace but isn't even big enough to fit a rocking chair in the living room).
I consider it my lucky day when some 85-year-old person that I'm caring for is not only sweet, kind, and lovely but also turns out to have an amazing sense of humor. I still think of this one lady that I had as a patient a few months back. She was close to 90 and I figured she might need some help getting changed into a hospital gown. I explained to her why she needed to change and helped her out of her winter coat. She then stretched the collar of her sweater and took a peak inside. "Are there any boobs left in there?" she said. "Yep. There's a couple."
I fell in love with her right then and there. On the spot. Just like that. Too bad there was a bunch of her family members waiting out in the waiting room. Otherwise, I would've asked her to adopt me just so that I could listen to her talk all day long while I bake her cookies, and rub lotion into her flaking legs, and knit winter scarves for her to make sure she doesn't get sore throat, just so that she wouldn't stop talking.
I consider it my lucky day when some 85-year-old person that I'm caring for is not only sweet, kind, and lovely but also turns out to have an amazing sense of humor. I still think of this one lady that I had as a patient a few months back. She was close to 90 and I figured she might need some help getting changed into a hospital gown. I explained to her why she needed to change and helped her out of her winter coat. She then stretched the collar of her sweater and took a peak inside. "Are there any boobs left in there?" she said. "Yep. There's a couple."
I fell in love with her right then and there. On the spot. Just like that. Too bad there was a bunch of her family members waiting out in the waiting room. Otherwise, I would've asked her to adopt me just so that I could listen to her talk all day long while I bake her cookies, and rub lotion into her flaking legs, and knit winter scarves for her to make sure she doesn't get sore throat, just so that she wouldn't stop talking.
Sunday 19 May 2013
A severe case of incarceritis
Have you ever had a patient come in to the ER
accompanied by a couple of police or court officers? Sometimes they don't even
get a chance to make it to jail, but most of the time they get a chance to
spend at least a few hours in the cell before they get hit by a severe case of
incarceritis. Most of the time it's a life-threatening condition that causes
the patient to experience extreme level of pain and anxiety. What makes it
really worrisome for healthcare professionals is when a patient has a
documented (although, in most cases, untraceable) history of a serious
preexisting health condition. It can be a MI (which stands for myocardial
infarction aka a heart attack), diabetes, CVA (aka stroke), necrotizing
fasciitis, testicular torsion (Google these last two if you need to), or any
other scary-sounding medical problem that makes you shiver and cross yourself
in the hopes that you or your children or your grandchildren or the next seven
generations never be cursed to suffer from.
So when a patient with a history of, let's say, MI presents to the ER complaining of severe epigastric pain accompanied by nausea, shortness of breath, and (according to him) diaphoresis at the onset of symptoms, you, as an emergency nurse, jump into action and unleash a whole slew of all the tests that you can possibly do prior to MD even laying his or her eyes on the patient. Cardiac monitor and a full set of vitals? Done! ECG? Done! Blood work including the troponin level? Done! IV access? Done! Maybe even a 160 mg of baby Aspirin? Done!
And then, finally, a doc comes into the room and assesses the patient, and orders sublingual Nitro spray q5min PRN for pain. And the first thing that comes out of the patient's mouth is that Nitro NEVER helps with this pain and only gives him headaches. And that if you give him Tylenol or Advil for his headache it won't do any good. And that he needs something stronger than that. And than you realize that you didn't even need to go to med school to confidently diagnose this patient with incarceritis.
And an hour later, as you've already predicted, the patient's blood tests all come back normal, and his troponin level is better than your own, and multiple ECGs that you did on him trying to catch any changes all turn out the same, and two Percocets mysteriously and suddenly relieve his pain, and you ask the doc to please re-assess the patient. The patient gets sent back to jail with the official diagnosis of chest pain NYD, and you give yourself a pat on the back and go buy yourself a latte because you knew all along that the patient suffered from acute incarceritis.
So when a patient with a history of, let's say, MI presents to the ER complaining of severe epigastric pain accompanied by nausea, shortness of breath, and (according to him) diaphoresis at the onset of symptoms, you, as an emergency nurse, jump into action and unleash a whole slew of all the tests that you can possibly do prior to MD even laying his or her eyes on the patient. Cardiac monitor and a full set of vitals? Done! ECG? Done! Blood work including the troponin level? Done! IV access? Done! Maybe even a 160 mg of baby Aspirin? Done!
And then, finally, a doc comes into the room and assesses the patient, and orders sublingual Nitro spray q5min PRN for pain. And the first thing that comes out of the patient's mouth is that Nitro NEVER helps with this pain and only gives him headaches. And that if you give him Tylenol or Advil for his headache it won't do any good. And that he needs something stronger than that. And than you realize that you didn't even need to go to med school to confidently diagnose this patient with incarceritis.
And an hour later, as you've already predicted, the patient's blood tests all come back normal, and his troponin level is better than your own, and multiple ECGs that you did on him trying to catch any changes all turn out the same, and two Percocets mysteriously and suddenly relieve his pain, and you ask the doc to please re-assess the patient. The patient gets sent back to jail with the official diagnosis of chest pain NYD, and you give yourself a pat on the back and go buy yourself a latte because you knew all along that the patient suffered from acute incarceritis.
Tuesday 7 May 2013
Happy Nurses Week!
Happy Nurses Week to all the nurses out there! Things we do and see on a daily basis... those are the things other people have nightmares about. In my humble opinion, there should be a Nurses Day at least once a month. And like my local grocery store chain that provides a 20% discount for seniors every third Sunday of the month, there should be half-priced drinks for nurses at pubs every, let's say, third Friday of the month. I think we've earned it.
Wednesday 1 May 2013
The mysterious case of TMKS
I came across this today:
It reminded me of a patient I had a couple of years ago. She was in her mid-40s. She spent the whole night in our ER and had a million-dollar work up for her vague symptoms. All the tests came back normal. When the doc tried to discharge her home, she came up with new symptoms or complained of the old symptoms getting worse. A couple of hours later, she was still in the room, snoozing away on her stretcher. As soon as you went into her room and woke her up, her pain was a 10/10 and she felt too weak to go home. As I put on my Sherlock hat and went through her chart, one sentence jumped out at me. G7 P7. The woman had 7 kids! After she casually mentioned to me that she couldn't be discharged and wanted to be admitted for a few days due to a high level of stress at home, I knew I had solved the case. Diagnosis: TMKS (Too-many-kids Syndrome) also known as LMSYCLLS (Let-me-show-you-what-a-condom-looks-like Syndrome). Unfortunately, the prevalence if this debilitating condition is not as rare in the developed countries as some people might think.
I would like to put a disclaimer here: I do respect a person's right to decide on the number of children he or she is going to have. Sure, go ahead. Procreate. Multiply your sad-looking genes. You want to have three or four kids so that your suburban three-bedroom bungalow is always full of joy and laughter and sunshine? Sure. Oh wait, it's not three or four kids you want? You want seven or eight? Or ten? If God is willing? Oh, OK. I think I just lost all the interest in continuing this conversation with you. Thank you. I'll let you go now so that you can finish cooking your husband's dinner.
I mean, in the end, it's really not up to me to say how many children people should have. But, please, when your herd of little poorly-behaved bastards finally drives you to the brink of insanity, do not abuse the system and use a hospital as an all-inclusive resort. Ask your husband for some money, make and freeze some dinners, get your mother to babysit, and go away for a couple of days.
Tuesday 30 April 2013
Get the most out of your ER visit: tip # 1
There are only a few things in life (and I can't think of any at this moment) that make you feel so much better about yourself than when a patient, whom you're attempting to start an IV on and fail for whatever reason, tells you something like "It's OK. It always takes 5 or 6 tries to get my blood".
I'm usually pretty good at poking people with different gauge needles (I will always remember my first and, so far the only, 16 gauge IV... oh how good it felt to get that sucker in! I mean, it looks like a garden hose, for god's sake! And on the first try too!). I take pride in often starting IVs on our frequent flyers who literally have no veins left. However, we all have our days when we're just not meant to start any of our IVs successfully, even after a couple of tries. It's as if God wakes up every morning and distributes phlebotomy success points amongst all the nurses. ("This one gets 5, this one gets 9, and this one gets only 2 for today's shift... Okay, I think I can go get a coffee now... Oh, crap, forgot this sorry-looking under-caffeinated one! Oh well, no points left to go around. I definitely wouldn't want to be her patient today. [evil laugh] )
So, if you ever were a patient in an ER and wondered how to make your nurse feel better (and please tell me that this thought crossed your mind at least once in your lifetime so it will restore my faith in humanity), just tell her that it's OK he or she missed or blew your vein while starting an IV. It might not sound like a lot but it definitely means a lot. I might even pick a 25 instead of a 22 gauge IV catheter for my next try.
I'm usually pretty good at poking people with different gauge needles (I will always remember my first and, so far the only, 16 gauge IV... oh how good it felt to get that sucker in! I mean, it looks like a garden hose, for god's sake! And on the first try too!). I take pride in often starting IVs on our frequent flyers who literally have no veins left. However, we all have our days when we're just not meant to start any of our IVs successfully, even after a couple of tries. It's as if God wakes up every morning and distributes phlebotomy success points amongst all the nurses. ("This one gets 5, this one gets 9, and this one gets only 2 for today's shift... Okay, I think I can go get a coffee now... Oh, crap, forgot this sorry-looking under-caffeinated one! Oh well, no points left to go around. I definitely wouldn't want to be her patient today. [evil laugh] )
So, if you ever were a patient in an ER and wondered how to make your nurse feel better (and please tell me that this thought crossed your mind at least once in your lifetime so it will restore my faith in humanity), just tell her that it's OK he or she missed or blew your vein while starting an IV. It might not sound like a lot but it definitely means a lot. I might even pick a 25 instead of a 22 gauge IV catheter for my next try.
Tuesday 23 April 2013
Something to think about
There are some things that I see people do in ER that will never fail to amaze me. Here are the two that I was faced with today and that still have me scratching my head in bewilderment:
- How hungry do you need to be to come up to triage desk, take a huge bite out of your disgusting sandwich, and talk to the triage nurse about your "emergency" while chewing right in her face with the crumbs all over your mouth? (And if I felt like entertaining myself I would have asked you what you're eating because I know you'll answer "a sangwich", or maybe even "a sammich")
- Did you just crawl all the way from Sahara while carrying a dead camel on your back, that you are absolutely parched and are sipping on a Coke (because, of course, there was absolutely no water accesible to you on your way to the hospital) while telling me you have diabetes, your blood sugar is 26.3 and you think you might be in DKA?
I'll go have a beer and think about this now. Maybe first I'll check for pieces of your tuna sandwich in my hair that were flying out of your mouth and landing on my head while I wrote your triage note though.
- How hungry do you need to be to come up to triage desk, take a huge bite out of your disgusting sandwich, and talk to the triage nurse about your "emergency" while chewing right in her face with the crumbs all over your mouth? (And if I felt like entertaining myself I would have asked you what you're eating because I know you'll answer "a sangwich", or maybe even "a sammich")
- Did you just crawl all the way from Sahara while carrying a dead camel on your back, that you are absolutely parched and are sipping on a Coke (because, of course, there was absolutely no water accesible to you on your way to the hospital) while telling me you have diabetes, your blood sugar is 26.3 and you think you might be in DKA?
I'll go have a beer and think about this now. Maybe first I'll check for pieces of your tuna sandwich in my hair that were flying out of your mouth and landing on my head while I wrote your triage note though.
Tuesday 16 April 2013
Hi, I'm your nurse. No, you can not touch my breast.
Have you ever wondered why people get away with abusing nurses? I'm talking about all types of abuse here: physical, verbal, emotional, and even sexual abuse. What people say and do to nurses in a hospital, they would never dare, think of, or get away with doing in any other setting to anybody else. Only in a hospital can you get away with and not get arrested for kicking, punching, slapping, biting, or pinching a person. It's one of the very few places where your racial attacks and any other type of verbal abuse will not get your ass in trouble. And if you ever felt like grabbing a nurses' boob or ass - just come to an ER.
You'll say it's a risk you take going into the nursing profession. To which I'll reply - don't you take the same risk becoming a bus driver, school teacher, server, flight attendant, or any other profession that involves working closely with people? Some might argue that hospital and especially ER patients are often in a vulnerable state due to pain, uncertainty, loss, etc and an altered level of consciousness and can not, therefore, be held responsible for their actions. To which I'll reply - does the inebriated state allow a pub patron to throw a pint glass at a bartender? I mean, this is the risk you take going into bartending, right? You know you'll be surrounded by drunk, stupid, bordering on retarded, people on a daily basis. You know that alcohol makes some people aggressive. So after some drunk asshole throws a half-full pint of beer at your head, do you duck just in time to avoid a nasty lac to the forehead and possibly a concussion, wipe the beer off your face, and keep serving Mr. Asshole? After all, Mr. Asshole is intoxicated, right? Well, I don't think you will. You'll call security and/or police and get Mr. Asshole arrested.
Will a bus driver not stop the bus and call the cops after some douche of a passenger spits him in the face? Oh, absolutely he will! Will a flight attendant keep serving you suspicious looking cardboard-tasting sandwiches with a smile on her face after you call her an "ugly b*tch" while at the same time trying to feel her up? I doubt it.
As nurses, we have to deal with all these examples of human assholery and stupidity on a daily basis. It's a rare shift in ER when you don't get abused in one way or another. And we keep on going. We ignore the rude remarks, tell people to either behave or leave, or, in the worst case, call security and have patient Asshole in room 14 restrained and sedated. All the while we keep on taking care of you, giving you pain meds, feeding you tuna sandwiches (even making sure they haven't expired), and giving you clean clothes when you are sober enough to get your ass home (because you either pissed yourself or all your clothes are covered in so much vomit you can't wash it off in the bathroom).
No wonder nurses burn out and have a high potential of turning into jaded b*tches over time. If you treat us like shit don't expect to be treated with compassion and a smile when you come to ER with some ridiculous bullshit complaint. I might smile at you, but not because I empathize with your suffering or feel happy to be your nurse. No. I smile at you because I think you're an idiot (I would openly laugh in your face but then I might get in trouble).
You'll say it's a risk you take going into the nursing profession. To which I'll reply - don't you take the same risk becoming a bus driver, school teacher, server, flight attendant, or any other profession that involves working closely with people? Some might argue that hospital and especially ER patients are often in a vulnerable state due to pain, uncertainty, loss, etc and an altered level of consciousness and can not, therefore, be held responsible for their actions. To which I'll reply - does the inebriated state allow a pub patron to throw a pint glass at a bartender? I mean, this is the risk you take going into bartending, right? You know you'll be surrounded by drunk, stupid, bordering on retarded, people on a daily basis. You know that alcohol makes some people aggressive. So after some drunk asshole throws a half-full pint of beer at your head, do you duck just in time to avoid a nasty lac to the forehead and possibly a concussion, wipe the beer off your face, and keep serving Mr. Asshole? After all, Mr. Asshole is intoxicated, right? Well, I don't think you will. You'll call security and/or police and get Mr. Asshole arrested.
Will a bus driver not stop the bus and call the cops after some douche of a passenger spits him in the face? Oh, absolutely he will! Will a flight attendant keep serving you suspicious looking cardboard-tasting sandwiches with a smile on her face after you call her an "ugly b*tch" while at the same time trying to feel her up? I doubt it.
As nurses, we have to deal with all these examples of human assholery and stupidity on a daily basis. It's a rare shift in ER when you don't get abused in one way or another. And we keep on going. We ignore the rude remarks, tell people to either behave or leave, or, in the worst case, call security and have patient Asshole in room 14 restrained and sedated. All the while we keep on taking care of you, giving you pain meds, feeding you tuna sandwiches (even making sure they haven't expired), and giving you clean clothes when you are sober enough to get your ass home (because you either pissed yourself or all your clothes are covered in so much vomit you can't wash it off in the bathroom).
No wonder nurses burn out and have a high potential of turning into jaded b*tches over time. If you treat us like shit don't expect to be treated with compassion and a smile when you come to ER with some ridiculous bullshit complaint. I might smile at you, but not because I empathize with your suffering or feel happy to be your nurse. No. I smile at you because I think you're an idiot (I would openly laugh in your face but then I might get in trouble).
Friday 12 April 2013
The "Never Ever Do" list
If I'm ever unlucky enough to end up as a patient in an ER, there's one rule I will make sure to follow no matter how much suffering I'm in or what my blood alcohol level is. This one rule is so simple and obvious that I don't understand why everyone just doesn't follow it. Respect your nurse. That's it! Simple as that.
Even if my nurse was the nastiest grumpy b*tch, I would still suck it up and be super nice to her or him. Why do patients always seem to forget that no matter how fast and how much of a pain medication a physician orders for your excruciating pain, it is up to your nurse how soon you will actually get it. And, no matter how nice and thankful you are to your doc, it's not him or her who's going to change your diaper after your explosive diarrhea gets the upper hand. Oh, and you know when your nausea all of the sudden magically goes away (probably because of that medication the nurse advocated to the doc for you to get), and you get hungry? Super-huge-mega hungry because you haven't eaten in a couple of days? It's one thing for a doc to cancel your NPO order but it's another for your nurse to take time to hunt down a sandwich and some apple juice for you. Maybe even make you tea. Two sugars and two milks on the side? Sure, I'll see what I can do.
Yes, if I were a patient I would not suck up to my doc. I'd rather spend whatever energy and presence of mind I had left at the moment to suck it up and be extra nice to my nurse. Here are some of the things I DEFINITELY wouldn't do as a patient:
- talk on my cell phone the entire time a nurse is triaging me;
- have a social conversation with my friend while my nurse is trying to assess me;
- ask my nurse to make me tea, especially when I can see that all hell is breaking loose in the department and my nurse is running around like a chicken with its head cut off (heck, I didn't even know you could get anything other than water in ER until I started working in one);
- let my family members just sit there without moving aside while my nurse needs to maneuver herself and get creative around them while taking my blood (it might be fun to watch but it's MY vein that might have to be poked several times just because the nurse had to crouch in a weird position at an awkward angle);
- go around asking multiple nurses and any other staff including housekeeping the same question over and over again hoping for a different answer after my nurse has already answered it for me;
- ask why the patient who's bleeding profusely from his head gets seen by a doc before me - I arrived half an hour before him with my cold symptoms;
- let my boyfriend spoon me on my stretcher in the hallway;
- tell my nurse I only had one shot of tequila when my fancy dress is covered in vomit and I'm slurring my words.
Like I said, no matter how grouchy or unpleasant my nurse is, I will do my best to be in her or his good books. I would strive to be the patient that gets the "she's nice" line at the end of the nurses' report during shift change. And if my mother absolutely insisted on visiting me while I'm in an ER, I would tell her to pick up a box of chocolates on the way to the hospital. Us, nurses, we love chocolate. Especially at around 5 PM when our feet are on fire and our blood sugar levels are approaching zero. Chocolate = happy nurses = happy patients.
Even if my nurse was the nastiest grumpy b*tch, I would still suck it up and be super nice to her or him. Why do patients always seem to forget that no matter how fast and how much of a pain medication a physician orders for your excruciating pain, it is up to your nurse how soon you will actually get it. And, no matter how nice and thankful you are to your doc, it's not him or her who's going to change your diaper after your explosive diarrhea gets the upper hand. Oh, and you know when your nausea all of the sudden magically goes away (probably because of that medication the nurse advocated to the doc for you to get), and you get hungry? Super-huge-mega hungry because you haven't eaten in a couple of days? It's one thing for a doc to cancel your NPO order but it's another for your nurse to take time to hunt down a sandwich and some apple juice for you. Maybe even make you tea. Two sugars and two milks on the side? Sure, I'll see what I can do.
Yes, if I were a patient I would not suck up to my doc. I'd rather spend whatever energy and presence of mind I had left at the moment to suck it up and be extra nice to my nurse. Here are some of the things I DEFINITELY wouldn't do as a patient:
- talk on my cell phone the entire time a nurse is triaging me;
- have a social conversation with my friend while my nurse is trying to assess me;
- ask my nurse to make me tea, especially when I can see that all hell is breaking loose in the department and my nurse is running around like a chicken with its head cut off (heck, I didn't even know you could get anything other than water in ER until I started working in one);
- let my family members just sit there without moving aside while my nurse needs to maneuver herself and get creative around them while taking my blood (it might be fun to watch but it's MY vein that might have to be poked several times just because the nurse had to crouch in a weird position at an awkward angle);
- go around asking multiple nurses and any other staff including housekeeping the same question over and over again hoping for a different answer after my nurse has already answered it for me;
- ask why the patient who's bleeding profusely from his head gets seen by a doc before me - I arrived half an hour before him with my cold symptoms;
- let my boyfriend spoon me on my stretcher in the hallway;
- tell my nurse I only had one shot of tequila when my fancy dress is covered in vomit and I'm slurring my words.
Like I said, no matter how grouchy or unpleasant my nurse is, I will do my best to be in her or his good books. I would strive to be the patient that gets the "she's nice" line at the end of the nurses' report during shift change. And if my mother absolutely insisted on visiting me while I'm in an ER, I would tell her to pick up a box of chocolates on the way to the hospital. Us, nurses, we love chocolate. Especially at around 5 PM when our feet are on fire and our blood sugar levels are approaching zero. Chocolate = happy nurses = happy patients.
Tuesday 9 April 2013
7/10 pain or Let me finish my burger before you triage me
Just an advice to all those ER patients-to-be:
If you come to my ER and tell me that the pain in your toe that you stubbed on a table leg a week ago (!) is a 7 out of 10, with 10 being the worst pain you've ever had in your life or can possibly imagine, I will not feel too sympathetic to your suffering and will not put you ahead of other people or abandon my other patients to go looking for a doc to get an order for your pain meds. I might tell you to "limp" your way over to a chair to have a seat and wait for your turn. And while you're waiting for a couple of hours, instead of texting on your phone, you might as well observe other patients around you to boost your imagination a little and a get a sense of what a true 7/10 pain might look like. So that you can fake it better next time you come to ER with a paper cut or something. Thanks.
If you come to my ER and tell me that the pain in your toe that you stubbed on a table leg a week ago (!) is a 7 out of 10, with 10 being the worst pain you've ever had in your life or can possibly imagine, I will not feel too sympathetic to your suffering and will not put you ahead of other people or abandon my other patients to go looking for a doc to get an order for your pain meds. I might tell you to "limp" your way over to a chair to have a seat and wait for your turn. And while you're waiting for a couple of hours, instead of texting on your phone, you might as well observe other patients around you to boost your imagination a little and a get a sense of what a true 7/10 pain might look like. So that you can fake it better next time you come to ER with a paper cut or something. Thanks.
Thursday 4 April 2013
Sh*t patients say
I love triage. The pearls that come out of patients' mouths make up for having to deal with all those annoying/rude/stupid/taking too long to take their coat off for blood pressure/malodorous people with a (I wish I knew where it comes from) sense of entitlement. I mean, have you ever tried to arrange a CT through your family doctor to even dare to complain that the results of the scan are taking too long to come back (that's after you had your scan booked for you for the next day)? Were you raised in a cave by a herd of wild goats to think that it's OK to interrupt a nurse triaging a patient to ask for a glass of juice (Would you like fries with that?) or to ask them to open a door for you as you return from your q30min smoke outside? Which country did you just come from to think that waiting an hour in a waiting room at a hospital is a long time? Or is this your first visit to an ER ever? Because, judging by the dirty hospital tape glue that you didn't bother to wash off your arm, I can clearly see that it's at least a second or third... in the last couple of days.
I can keep on going about the things that drive me absolutely bananas at triage. But, instead, I'll focus on the things that make triage my most favorite area in ER to work in. These are just a few examples of some of the profound conversations taking place at triage desk:
Nurse: "On a scale of 1 to 10 how bad is your pain?"
Patient: "10."
Nurse: "So this is the worst pain you've ever had?"
Patient: "No, I've definitely had worse."
Nurse: "So, out of 10, what would you rate your pain at?"
Patient: "10."
Patient: "The last time I was here I had pneumonia. They were gonna intubate me but I left."
Patient: "I had an ectopic pregnancy once but nobody could find it."
Nurse: "So how did you know you had it?"
Patient: "I could feel it was there. But then I hit myself in the stomach with a broom and used other objects and I dislodged it."
Nurse: "???"
Nurse: "From 1 to 10, 10 being the worst pain you can imagine, how bad is your pain?"
Patient: "12."
Nurse: "10 being the worst pain you can imagine."
Patient: "12."
Nurse: "OK."
And my all time favorite:
Nurse: "Do you have chest pain?"
Patient: "No, but I do have pain in my chest."
I can keep on going about the things that drive me absolutely bananas at triage. But, instead, I'll focus on the things that make triage my most favorite area in ER to work in. These are just a few examples of some of the profound conversations taking place at triage desk:
Nurse: "On a scale of 1 to 10 how bad is your pain?"
Patient: "10."
Nurse: "So this is the worst pain you've ever had?"
Patient: "No, I've definitely had worse."
Nurse: "So, out of 10, what would you rate your pain at?"
Patient: "10."
Patient: "The last time I was here I had pneumonia. They were gonna intubate me but I left."
Patient: "I had an ectopic pregnancy once but nobody could find it."
Nurse: "So how did you know you had it?"
Patient: "I could feel it was there. But then I hit myself in the stomach with a broom and used other objects and I dislodged it."
Nurse: "???"
Nurse: "From 1 to 10, 10 being the worst pain you can imagine, how bad is your pain?"
Patient: "12."
Nurse: "10 being the worst pain you can imagine."
Patient: "12."
Nurse: "OK."
And my all time favorite:
Nurse: "Do you have chest pain?"
Patient: "No, but I do have pain in my chest."
Sunday 31 March 2013
To pee, or not to pee
Out of the multitude of tests that we run in ER, urine dip is probably one of the simplest ones. Well, at least I think so. However, some of my patients wouldn't agree.
It seems like everyone who presents to ER gets a urine dip done. Some end up with their pee being sent for C&S as well. I have to ask my patients for a urine sample so often that I have my own little speech that I usually stick to: "Whenever you feel like you can pee, we'll need you to give us a urine sample." [Hands over a container and a biohazard ziplock bag to the patient.] "Just put it in the bag when you're done."
Simple, right? Unscrew the lid. Pee in the container. Put the lid back on. Put the container in the bag. Hand it back to the nurse. Even if I tried, I don't think I would be able to come up with things that people do when asked to provide a urine sample.
An elderly man once returned from the washroom with the biohazard bag in hand. "I've got my urine sample," he says as he hands it over. I spent the next five minutes trying not to spill any of his urine on myself while pouring it into a container. He peed right in the bag. Good thing it had a zip lock on it...
Another time, a young girl handed me her sample only for me to realize that she somehow (and to this day I keep trying not to even try to imagine how) managed to shit in the container, the diameter of which is about 1 1/2 inches, instead of peeing in it (mind you, I didn't give her a hat or anything). I had to tell her to throw that (literally) shit out and go back to the washroom.
I won't even tell you how many times people tried to pass tap water for their urine. These are usually patients that we run urine tox screens on. Right... I've seen enough pee in my nursing career to be able to tell it apart from water, you smart ass. Go try again.
After all these years of asking people to provide urine samples, it makes me think that it might be helpful to come up with some sort of an illustrated step-by-step instruction sheet. No words, just pictures. Multicultural-friendly. Like those Ikea instructions you get with your $15 put-it-together-yourself side tables.
It seems like everyone who presents to ER gets a urine dip done. Some end up with their pee being sent for C&S as well. I have to ask my patients for a urine sample so often that I have my own little speech that I usually stick to: "Whenever you feel like you can pee, we'll need you to give us a urine sample." [Hands over a container and a biohazard ziplock bag to the patient.] "Just put it in the bag when you're done."
Simple, right? Unscrew the lid. Pee in the container. Put the lid back on. Put the container in the bag. Hand it back to the nurse. Even if I tried, I don't think I would be able to come up with things that people do when asked to provide a urine sample.
An elderly man once returned from the washroom with the biohazard bag in hand. "I've got my urine sample," he says as he hands it over. I spent the next five minutes trying not to spill any of his urine on myself while pouring it into a container. He peed right in the bag. Good thing it had a zip lock on it...
Another time, a young girl handed me her sample only for me to realize that she somehow (and to this day I keep trying not to even try to imagine how) managed to shit in the container, the diameter of which is about 1 1/2 inches, instead of peeing in it (mind you, I didn't give her a hat or anything). I had to tell her to throw that (literally) shit out and go back to the washroom.
I won't even tell you how many times people tried to pass tap water for their urine. These are usually patients that we run urine tox screens on. Right... I've seen enough pee in my nursing career to be able to tell it apart from water, you smart ass. Go try again.
After all these years of asking people to provide urine samples, it makes me think that it might be helpful to come up with some sort of an illustrated step-by-step instruction sheet. No words, just pictures. Multicultural-friendly. Like those Ikea instructions you get with your $15 put-it-together-yourself side tables.
Friday 29 March 2013
Triage, or the things you learn about humanity
I had a pleasure of triaging this 22-year old guy last night who stuck a tab of Tylenol in his right ear and (surprise surprise) couldn't get it out. I didn't even bother exploring his reasoning behind what he did. It was well into my night shift. I was tired. I already saw enough stupidity for one night. But I did ask how long has the pill been stuck in his ear canal. "Twelve hours," he said. Then he paused, thought about it for a second and said: "No, more like eleven."
Thanks for clarifying the exact time you did something that no normal person after the age of six would do. Thank you, because it definitely made you look less like an idiot.
Thanks for clarifying the exact time you did something that no normal person after the age of six would do. Thank you, because it definitely made you look less like an idiot.
Wednesday 27 March 2013
12 Hours in Hell, or Why Didn't I Call In Sick This Morning
A shift from hell in my understanding goes something like this:
In 12 hours you look after:
- two intubated patients, one of whom ends up in the ICU and the other transfered to another hospital for an urgent neuro surgery (of course, you are the one who has to go with the patient, RT, MD, and two paramedics bouncing all over the seat at every bump in the back of an ambulance).
- two patients with COPD exacerbation in severe enough respiratory distress to need BiPAP.
- a patient in atrial fibrillation who needs to be cardioverted (while all hell is breaking loose with your other patients).
- a patient waiting for a step down bed for 17 hours because there are no available beds in the hospital, who needs hourly blood glucose checks and Q4H blood work.
- a patient having two seizures even after being loaded with Dilantin.
- a code STEMI patient who gets rushed to the cath lab.
- a violent drunk patient who needs to be put in four-point restraints by security and slammed with vitamins A and H (Ativan and Haldol).
Add to all this the fact that I only got four hours of sleep the night before and you get a true shift from hell. On the bright side though, I finally got a chance to hear firsthand how loud ambulance sirens sound inside the truck. In case you ever wondered, not loud at all. It took me a minute to realize that it was us and not some other ambulance truck behind us. One more thing off my "want to know" list.
In 12 hours you look after:
- two intubated patients, one of whom ends up in the ICU and the other transfered to another hospital for an urgent neuro surgery (of course, you are the one who has to go with the patient, RT, MD, and two paramedics bouncing all over the seat at every bump in the back of an ambulance).
- two patients with COPD exacerbation in severe enough respiratory distress to need BiPAP.
- a patient in atrial fibrillation who needs to be cardioverted (while all hell is breaking loose with your other patients).
- a patient waiting for a step down bed for 17 hours because there are no available beds in the hospital, who needs hourly blood glucose checks and Q4H blood work.
- a patient having two seizures even after being loaded with Dilantin.
- a code STEMI patient who gets rushed to the cath lab.
- a violent drunk patient who needs to be put in four-point restraints by security and slammed with vitamins A and H (Ativan and Haldol).
Add to all this the fact that I only got four hours of sleep the night before and you get a true shift from hell. On the bright side though, I finally got a chance to hear firsthand how loud ambulance sirens sound inside the truck. In case you ever wondered, not loud at all. It took me a minute to realize that it was us and not some other ambulance truck behind us. One more thing off my "want to know" list.
Wednesday 20 March 2013
The tales from down under
One of the joys of my job is chaperoning docs during pelvic exams. Majority of the docs in our department are men, so whenever they have the pleasure of performing a pelvic or rectal exam on a female patient, they ask one of the female nurses to be present during the procedure. Just in case. Doing the job that we do, we all need to cover our behinds.
Just last night when I was the charge nurse (which means I wasn't even assigned to an area in the department) I had to assist with three pelvics. I hate pelvics. First, I find it awkward just standing there doing nothing while the woman on the stretcher with her legs spread wide is looking at me with agony of discomfort and embarrassment in her eyes. Second, the smell that sometimes comes from those vaginas makes me cringe. If you've never smelled a tampon that was "lost" in a vagina for a few days, pray that you'll never get a chance to. Third, depending on the doc doing the pelvic, the experience can reach more than an expected level of awkwardness. I was the lucky witness to the following once:
We're in a middle of a pelvic exam. The doc takes somewhat longer than usual time fumbling around in between the woman's thighs with a speculum and then his fingers. Finally he says: "I haven't said it in ten years, but I can't seem to find your cervix... And I have long fingers."
It took all the willpower I could muster for me not to burst our laughing. The woman on the stretcher just looked at the doc with exasperation and a silent prayer in her eyes for the torture of a stranger man poking around her privates to be over.
I will also forever thank my lucky starts for letting me be present during a pelvic exam where one of the docs would diagnose vaginitis by smelling his fingers after pulling them out of a woman's vagina.
At the end of the day, pelvic exams are sometimes fun. Most of the time though, they are boring and take up a lot of the time that I could've spent on giving people pain meds, drawing their blood, and assessing new patients. But the docs need to cover their asses. It just makes me wonder why is it that no male nurses/docs need to chaperone me when I insert foley catheters into patients' penises?..
Just last night when I was the charge nurse (which means I wasn't even assigned to an area in the department) I had to assist with three pelvics. I hate pelvics. First, I find it awkward just standing there doing nothing while the woman on the stretcher with her legs spread wide is looking at me with agony of discomfort and embarrassment in her eyes. Second, the smell that sometimes comes from those vaginas makes me cringe. If you've never smelled a tampon that was "lost" in a vagina for a few days, pray that you'll never get a chance to. Third, depending on the doc doing the pelvic, the experience can reach more than an expected level of awkwardness. I was the lucky witness to the following once:
We're in a middle of a pelvic exam. The doc takes somewhat longer than usual time fumbling around in between the woman's thighs with a speculum and then his fingers. Finally he says: "I haven't said it in ten years, but I can't seem to find your cervix... And I have long fingers."
It took all the willpower I could muster for me not to burst our laughing. The woman on the stretcher just looked at the doc with exasperation and a silent prayer in her eyes for the torture of a stranger man poking around her privates to be over.
I will also forever thank my lucky starts for letting me be present during a pelvic exam where one of the docs would diagnose vaginitis by smelling his fingers after pulling them out of a woman's vagina.
At the end of the day, pelvic exams are sometimes fun. Most of the time though, they are boring and take up a lot of the time that I could've spent on giving people pain meds, drawing their blood, and assessing new patients. But the docs need to cover their asses. It just makes me wonder why is it that no male nurses/docs need to chaperone me when I insert foley catheters into patients' penises?..
Monday 18 March 2013
Night shift worker blues
Nothing takes the stress and pain of a long Monday shift away like a nice glass of a spicy Caesar. Well, maybe a frosty pint of beer. Or a glass of delicious mellow red wine. To be honest, after a shift from hell, anything containing some amount of EtOH will do. Well, almost anything. I've seen enough patients drunk on hand sanitizer, mouth wash and cooking wine to know that drinking these things makes you smell awful and eventually turns you into a walking (and sometimes, although rarely, talking) bag of flesh reeking of urine/feces/BO/sweat/dirty feet/you name it.
A lot of my friends (mostly the ones that are not nurses and don't do shift work) look at me funny when I tell them that I often have a glass of wine after a night shift. Sure, for most people, drinking at 8 AM is completely unacceptable and probably warrants a visit to AA or a check in into a detox program. Well, not if you work shifts, my friends. When I work nights, having a glass of red at 8 AM for me is the same as you having a drink at 8 PM. I have my wine, take the edge off a long and most often than not busy shift, and then head to bed only to wake up at 5 PM for another night shift... Which brings me to another point of deep frustration: I hate hate hate that there are no bars or pubs open in the morning to cater to shift workers. So many times, my colleagues and I wanted to celebrate the end of the stretch of night shifts by going out for a cold pint of beer after work. But we have to settle for breakfast and coffee. And, since it's not nearly as fun as beer, we've never actually done it. Given how many shift workers are out there it amazes and frustrates me how unaccommodating the world is to us. Don't even get me started on fire alarm testing, balcony repair work, and general water shut down in my building from the hours of 9 to 5. Don't even...
Anyway... One blog post/rant and two Caesars later I feel better. The tension headache is gone. There is only a dull ache in my feet. And my upper back is surprisingly quiet. I think I'll go have dinner now. Yes, it's 9:40 PM. Yes, it's late. But I've just worked a 12 hour shift and just got home an hour ago. I make my own rules about what's acceptable and what's not. I work shifts.
A lot of my friends (mostly the ones that are not nurses and don't do shift work) look at me funny when I tell them that I often have a glass of wine after a night shift. Sure, for most people, drinking at 8 AM is completely unacceptable and probably warrants a visit to AA or a check in into a detox program. Well, not if you work shifts, my friends. When I work nights, having a glass of red at 8 AM for me is the same as you having a drink at 8 PM. I have my wine, take the edge off a long and most often than not busy shift, and then head to bed only to wake up at 5 PM for another night shift... Which brings me to another point of deep frustration: I hate hate hate that there are no bars or pubs open in the morning to cater to shift workers. So many times, my colleagues and I wanted to celebrate the end of the stretch of night shifts by going out for a cold pint of beer after work. But we have to settle for breakfast and coffee. And, since it's not nearly as fun as beer, we've never actually done it. Given how many shift workers are out there it amazes and frustrates me how unaccommodating the world is to us. Don't even get me started on fire alarm testing, balcony repair work, and general water shut down in my building from the hours of 9 to 5. Don't even...
Anyway... One blog post/rant and two Caesars later I feel better. The tension headache is gone. There is only a dull ache in my feet. And my upper back is surprisingly quiet. I think I'll go have dinner now. Yes, it's 9:40 PM. Yes, it's late. But I've just worked a 12 hour shift and just got home an hour ago. I make my own rules about what's acceptable and what's not. I work shifts.
Saturday 16 March 2013
435 pounds of why is this patient here?
My shift today started with me coming in to a 435 lb patient sleeping in a hospital bed that nurses had to borrow from one of the units upstairs. She was simply too big to fit onto one of our gurneys. There was nothing about this patient's presentation to grant a resuscitation bed but given how heavy (both physically and in terms of workload) this patient was, she was assigned a spot in the resuscitation room. Out of all the areas in our ER, resuscitation room has the smallest nurse to patient ratio. It's usually one to two patients per nurse.
This woman has been recently discharged from our hospital after being admitted for a whooping two and a half years. She hasn't spent even two weeks in the nursing home when the staff there decided they could not cope with her care and jumped on an opportunity to send her back to us. Their reason for calling 911 was that the patient had a decreased level of consciousness. She did not. True; she wasn't as active as some other people might be, and spent most of her time in the bed snoozing. True; she had sleep apnea and stopped breathing for a few seconds here and there, but then again, it didn't come as a shock given her weight. But there was absolutely no change in her baseline presentation to grant a visit to ER, let alone being admitted to the hospital.
Couple of hours into my shift (and after a great amount of collaboration between clinical nurse specialists, physicians, social workers, and ER management) it was decided that this patient was going to go back to the nursing home since her medical condition did not change since her discharge a couple of weeks ago.
Never before did I get so much pleasure out of calling a nursing home to inform them that we were sending their patient back. Mind you, I do understand how much it takes to take care of patients like Ms. K. This is one of the reasons I would never work in a nursing home or any other long term care setting. I just don't have what it takes to do that kind of nursing. But it frustrates me to no end when nursing homes literally dump their patients on ERs as soon as they feel overwhelmed and tired of taking care of them. That's not what ERs are there for. We are not there to give long term care RNs, RPNs, and MDs a break.
When two EMS crews arrived with the bariatric stretcher in tow I paged for all the available staff to come to resuscitation bay 3. Did I mention that we don't have ceiling or any other sort of lifts in our ER? It took six nurses and three paramedics to transfer Ms. K onto the EMS stretcher. As soon as they rolled through the sliding doors of the ER and out into the crisp winter morning air I felt lighter. About 400 lb so. I could go back to taking care of patients who actually required emergency care. Well, some of them did. Majority just didn't feel like waiting in line at a walk in clinic.
This woman has been recently discharged from our hospital after being admitted for a whooping two and a half years. She hasn't spent even two weeks in the nursing home when the staff there decided they could not cope with her care and jumped on an opportunity to send her back to us. Their reason for calling 911 was that the patient had a decreased level of consciousness. She did not. True; she wasn't as active as some other people might be, and spent most of her time in the bed snoozing. True; she had sleep apnea and stopped breathing for a few seconds here and there, but then again, it didn't come as a shock given her weight. But there was absolutely no change in her baseline presentation to grant a visit to ER, let alone being admitted to the hospital.
Couple of hours into my shift (and after a great amount of collaboration between clinical nurse specialists, physicians, social workers, and ER management) it was decided that this patient was going to go back to the nursing home since her medical condition did not change since her discharge a couple of weeks ago.
Never before did I get so much pleasure out of calling a nursing home to inform them that we were sending their patient back. Mind you, I do understand how much it takes to take care of patients like Ms. K. This is one of the reasons I would never work in a nursing home or any other long term care setting. I just don't have what it takes to do that kind of nursing. But it frustrates me to no end when nursing homes literally dump their patients on ERs as soon as they feel overwhelmed and tired of taking care of them. That's not what ERs are there for. We are not there to give long term care RNs, RPNs, and MDs a break.
When two EMS crews arrived with the bariatric stretcher in tow I paged for all the available staff to come to resuscitation bay 3. Did I mention that we don't have ceiling or any other sort of lifts in our ER? It took six nurses and three paramedics to transfer Ms. K onto the EMS stretcher. As soon as they rolled through the sliding doors of the ER and out into the crisp winter morning air I felt lighter. About 400 lb so. I could go back to taking care of patients who actually required emergency care. Well, some of them did. Majority just didn't feel like waiting in line at a walk in clinic.
Friday 15 March 2013
By way of introduction
In a few months I will celebrate five years since I went into emergency nursing. I was fresh out of school, full of ambition and passion for the profession. I didn't listen to my classmates and teachers when they told me that I needed experience elsewhere before going to work in an ER. I knew that I wanted to be an emergency nurse and I followed my dream, so to speak. Five years have gone by and even on the worst of the shifts I do not wish I chose to work on any other unit. I love how unpredictable and fast-paced my job is. I enjoy the challenges and feel amazing solving problems that at first seem too overwhelming to wrap my head around. I live for an occasional adrenaline rush of a "true" emergency. I'm friends with my colleagues because we have so much in common. And it makes me feel amazing when I know that I have made a difference.
All these wonderful big words aside, I'm not going to lie - I sometimes hate my job. There are days when I just can't help feeling burnt out and disenchanted with the whole nursing profession. These are the days when I literally limp home at night: tired, bloated, under-slept, yelled- and sworn-at at work by drunk smelly people. Or treated like a waitress or a personal assistant by VIP patients and their family members. Or talked down to and disrespected by MDs. Or having gone above and beyond for my patients only for the physician to receive a thank you card and a $100 bottle of vintage wine in the end. There are so many things that can bring you down and make you seriously consider if the choice you made all those years ago was the right one... And yet I keep setting my alarm for 5 AM and showing up at 7 to get report. My back and my feet are starting to really hate me, but I do.
These are my stories - the good and the bad and most of them something in between. And just to cover my ass, all the names and ages and identifying characteristics will be changed to protect patients' confidentiality. Maybe some of the stories never even happened. And maybe I'm not even a nurse. Who knows?
All these wonderful big words aside, I'm not going to lie - I sometimes hate my job. There are days when I just can't help feeling burnt out and disenchanted with the whole nursing profession. These are the days when I literally limp home at night: tired, bloated, under-slept, yelled- and sworn-at at work by drunk smelly people. Or treated like a waitress or a personal assistant by VIP patients and their family members. Or talked down to and disrespected by MDs. Or having gone above and beyond for my patients only for the physician to receive a thank you card and a $100 bottle of vintage wine in the end. There are so many things that can bring you down and make you seriously consider if the choice you made all those years ago was the right one... And yet I keep setting my alarm for 5 AM and showing up at 7 to get report. My back and my feet are starting to really hate me, but I do.
These are my stories - the good and the bad and most of them something in between. And just to cover my ass, all the names and ages and identifying characteristics will be changed to protect patients' confidentiality. Maybe some of the stories never even happened. And maybe I'm not even a nurse. Who knows?
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