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.
Monday, 27 May 2013
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).
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