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.

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.

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).

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.

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.

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."