One hungry escalator

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.

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 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.

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.

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. 

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.

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.