Life is not always perfect

As 2010 ends, I can't help reflect. One moment it was January 2009, and then I blinked.
Life and death is part of every day life, which is emphasized in this profession. I couldn't count how many people I have seen take their last breath, how many febrile seizing children have been handed to me, nor the countless heartbroken families that have been told that their loved one is critical. however, with the death and sorrow that comes into the emergency room, life, relief, and joy walk out those doors. I can count the number of births, 2 girls and 1 boy. I have seen the relief on families faces when the have realized their family is going be okay. At the end of this year, I am thankful that I work were I do. I am bless to work with great doctors, nurses, paramedics, techs, and secretaries, who are always their for each other and our patients.

What not to do or say in the ER

1. As a 1st year resident on a student visa, yell at the nurse when you have no idea what the heck you are talking about. Result will be the nurses taking up a collection for your one way ticket back home and handing it to you in front of your attending, who by the way loves us.

2. Don't say while you are attempting to place an ET Tube, "Damn my tube is huge and her mouth is too small." Result will be the perverted nurse laughing her butt off and everyone in the room catching the giggles.

3. Don't play a practical joke on the charge nurse because it makes you fair game. Result will be your coffee cup dermabonded to the desk.

All kidding aside...

Do remember when you are having a bad day that we are in it together, we have your back as you have ours. If you are new to the ER setting, most of us working in the department have worked together so long that we are family. We have are times that we love to hate each other, but in the end we are there for each other.

There comes a time....

There comes a time when a person must take responsibility for themselves. If they do not then their care takers need to buck up and make responsible choices.

I have a 39 year old male that lived with his mother his entire life. His mother was ill and had him placed in a nursing home 2 months earlier. However, the nursing home had set up independent living for him complete with 24 hour aid to help care for him. Sounds great, but here is the catch.

When he presented to me, he came into the ER on a SWAT teams flat bed truck, he was soaked head to toe with urine, fecal matter, and unknown debris. He had fired his aid 2 days earlier and had no one to care for him, which he was completely bedridden. All of his medical conditions and his current condition was completely due to one modifiable condition. His weight. He came in weighing 894lbs. according to his medical records he has had and average yearly weight gain of 150lbs over the last 4 years. In talking to him, I felt sorry for him. In front of me laid a man that was able to walk, bathe, or even find his penis to urinate all because he was overweight. Earlier this year, he had a trach placed because the weight was causing breathing problems. I wondered how he could have gotten to this point and if he had any medical condition, which caused him to gain weight. There was none, he was overweight by choice. In talking to him, he believed that if he broke the Genesis book record for the heaviest man, then he would become famous and never have to work. So, I would say he had a mental disorder there!!!

Now here is where responsibility for ones self should kick in. Once he started developing medical problems, he should have gone on a diet. Once he was unable to do anything for himself, he should have rethought his idea of being the worlds heaviest man.

Responsibility as the care taker (his mother). If your son is so overweight you have to wipe his butt at the age of 39. Then put him on a diet. Seeing that his mother had to take total care of him, why did she keep feeding him everything that he wanted? He reported that breakfast normal consist of 1lb bacon, 6 sausages, pancakes and a dozen eggs... does anyone see the problem here I wanted to say to his family. Now back to the live in aid. He fired he because she made the diet that the doctor had ordered. He instructed her to leave the phone by the bed, his wallet by the bed and the front door unlocked. Over the few days that he was without help, he ordered and average of 40 pizzas a day, side order of wings, and bread sticks. He was worried about food and did not care about his toileting needs. The only reason that 911 was called was because the one night he had ordered Chinese, well the delivery guy call 911 due to the condition of the patient and truly believed that someone was dead in the house due to the smell.

What gets better is that he refused medical care when EMS arrived. Police had to be called and adult protective services had to file and emergency order of custody. Then the fun part came. How to get this guy out of his home and to the hospital. It is just sad, but people need a wake up call. After all was said and done, he still insists that he needs to keep to 10,000 calories a day to reach his weight goal.

As a side note, is it really right for tax payer to foot the bill for his selfinflicted medical conditions? He is on SSID, all of his meds are paid for, foodstamps supply him with a portion of his food, medical bills are paid, and he had HUD housing. To me there comes a time that we need to just cut the umblical cord. If he wants this life and he is doing it on purpose, let him. Just let him foot his own bill!

ER work note

Patient of the day award goes to this guy. I could not resist putting works into animation. I am just too under paid to pay for it to have real charters or a scene setting:)

http://www.xtranormal.com/watch/6792243/

Talking in Tongues

Starting an hep-lock, the guy started saying something, yet I couldn't hear him. So, asked him to repeat himself. His wife jumped in and said he was praying. Now, I couldn't understand what the heck he was saying. Instead of just letting it lay, I asked what language is he specking. You think I would have learned by now not to ask people anything anymore. His wife became highly upset, yelled that she wanted another nurse and the supervisor. Well, I am the supervisor, and explained that, but she wanted someone else who could recognize the holy spirit talking through them. Apparently, he was speaking in tongues and I was the antichrist.

Nurse asked me, "where is the prostate in a women?" No shit are you serious I asked, it just slipped, but come on!!!

Post 100 My day

For a couple of weeks I have been debating of what to post as my 100th post. Then I realized that it really did not matter because I was not posting at all while I was debating on what to post.
So, what the hell, I am just going to post about my day because my day was laughable when I look back on it.

Events:
1. Get to work and realize scrubs are on inside out.
2. grab husbands coffee instead of mine, not a good thing
3. Broke my Rosary, yes I carry one, I am superstition and everything goes bad when I do not have it. The doctors had bought it for me from Rome and they too believe that the day will go to hell if it is not in my pocket. ( It has become a running joke in the ER)No, I don't preach and never have it out, but it was my security blanket that I kept tucked away for comfort)
4. Had a resident stick me when we were holding down a child for stitches (thankful it was a clean needle)
5. vomited on and took 30 minutes to find scrubs
6. gun shot to the chest ended with me being sprayed with 500ml of blood when chest tube was placed. (dang undies even got socked, ended up running around all day with no undies, which was found quite funny to my co-workers)
7.ran over by a linen cart with my diet cherry limeade in my hands, which ended up in yet another change of scrubs.
8. peed on by a drunk, yup you guessed it, another change of scrubs.
9. finally, had a another code. problem is, I had changed scrubs so many times that I only could find an XL top the last time. I wear XS bottoms and S or M top. Well, just a warning to all women at there, if you have to do a code in a top that is too big, you boobs will be exposed during compressions and you really don't have the time to put them back up.

What I learned today,
1. Get a new Rosary!!!!
2. Be thankful that I have great co-workers, even if all were guys today. My partner in crime 1st tucked the girls back in by pulling scrub top back up, then took off his under shirt for me to swim in under the XL top! Now that is a buddy for life.
3.Bring at-least 4 sets of extra scrubs to stash in locker.
4. I really do know way too many 4 letter words!

even though the day just would not go right, I still enjoy my job an love my co-workers. Looking back on it, I really should have stayed in bed, but the chain of events that unfolded were hilarious even if I was the butt of the joke though out the day.

Deleted Comments

I went to delete portions of a few comments because they had email address in them. I thought that maybe these people did not want me to post their emails for the world to see. Unfortunately I ended up deleting their entire posts, and a way for me to contact them. I your comments were one of the ones I deleted. I am sorry, it was completely an accident. and now I do not have your emails to contact you by.

Nursing Bloopers

ER Doctors and nurses are human, and working together day in and out we get comfortable with each other,and end up doing something stupid at some point. So here are my op 3 bloopers of the year.

1. While sitting down, reached for IV cart that was behind me. Problem was that a male nurse was standing behind me and I ended up grabbing his family jewels. Funny part was that I didn't register what I had grabbed and squeezed trying to figure out what I was holding. (He seemed happy, but I was mortified and still have not lived it down)

2. One of my coworkers has lost a ton of weight, yet has not bought any new scrubs. During a code, she was doing compressions and her scrub bottoms slipped right down and exposed her Minnie mouse bottoms. (Her new nick name is Minnie).

3. Bored one night, which does not happen often, stretcher surfing somehow got started. Well there is a ramp outside of the EMS doors. Long story shorten. Doc, who was winning, ended up flying down the hall, unable to make the turn and out the door he went and down the ramp into a dumpster he landed. Lucky he was not hurt, but we now call him Oscar (You know, from sesame street)

Code 3 Sunburn

Radio report:
29 year old male...... sunburn related itching

What the ED status was:
42 rooms filled, 20 in waiting room, 3 EMS reports coming in

As the poor EMS rolled in, we saw:
Wife rubbing lotion on Pt's back in tears saying he is going to die with out pain meds. PT on his belly screaming and yelling that it itches soooooooooooo bad!


My response:
Walked over, saw a very minor sunburn that was covered in about 2 large bottles of coco butter and globs. Asked the PT if he had any other injuries,

"nope just itching like crazy, it's going to kill me."

Are you allergic to anything, like maybe coco butter?

"Nope use it all the time, but right now it isn't helping! Are you going to give me Xanax or Valium now? That is the only thing that helps my itching!"

Can you walk?

"Yup"

Okay, you can go though those double doors to your left and check in at triage.

Pt's wife then screams are me,"we want straight back that is why we called 911!

4 hours later, triage calls me because a PT wants to file a complaint

Guess who... sunburn guy

his complaint was that he was treated for sunburn and discharged with out pain meds. Wife wanted him admitted and placed on a Dilaudid drip. Conversation just went downhill from there. At one point I could not help but to ask more questions for entertainment!

Funnies of the day

Patient calls in and tells me that he can't get the toilet paper out of his wound. Once again, I had to ask.... Why is there toilet paper in your wound, Well doc had done an I&D and packed it, the packing looked like skinny worms, so he pulled it out and stuff it with toilet paper....

child presents with c/o fever, during triage she doesn't have a fever and everything else came back normal, mom asks if we can admit her baby for a few hours.... once again I ask why, apparently mom had a lunch date....

another call, women wanted to know if she could eat nutella with a nut allergy if she pretreated herself with her epi pen.... I so wanted to say sure, not a problem. see ya in 30 minutes.

However, my favorite call of the day was a little boy calling to see if I could xray his dogs leg. The dog was limping and he was worried that it had hurt his leg. What is funnier was that the little boy was my son!!! and yes we xray the leg and ended up with a sucker-for-kids er doc, splinting a dogs broken leg till we could take him to the vet. Thankful I did not have to pay the $100 co-pay my insurance charges:)

Carrot cake

I get immune to the sounds of the emergency room. Call lights, alarms, shouts, vomiting, babies crying, and so on. However, for some reason they stuck out today. It all started when my code pager went off. I took off from triage and sprinted towards the back. it went something like this:

pager alarming, beeping from the badge scanner to get through locked doors, pages over head for code team stat to room 6, pyxis door buzzing as it opens, ran past a crying baby, women complaining about wait time, man asking for blanket, and what sticks out the most is in room 9 I overheard the doc agreeing with the alzheimer's patient that carrot cake was the best. Not really sure why I thought this was so funny or even worth blogging about. To me it just demonstrates how many different things are going on at the same time in the er, and most of them have nothing to do with each other.

How to get told to F%$k off 3 times in 10 minutes or less and still feel so appreciated

Case #1
Patient: "I need a note to excuse me from community service"
Me: Why?
Patient: "Because they want me to work out side and I sunburn easy"
Me: "Sorry we do not write notes to excuse people from community service, you need to go to your primary care doctor or walk in clinic"
Patient: "That is BullS*!t, F%^k you"

Case #2
Patient: After walking in "How long is the wait?"
Me: "It depends on your acuity level, we will triage you and see what is going on"
Patient: "I have had this mole for a year now and I think it might be cancer, you need to take me right back before I die"
Me: "Ma"am, you are not going to die right now because of that mole, we will get you back as soon as possible, but with the increase in patients, we must take back those who need immediate medaicl intervention right now" (as my tech was wheeling back a patient with pulse ox of 78%)"
Patient: "You insenative B!@#h, F%$k off!"

Patients family member: "I need in to room 2"
Me: "I can let you back, but you can't take food back, I can hold it up here for you"
Patient family member: "But it for the patient"
Me: "Sorry, but you father can't eat right now, he is getting ready for surgery, after surgery he can eat and we will provide him a heart health tray because the hospital don't allow outside food"
Patients family member: "this place is insane! everyone else would let me take it back, you are just being a snobby c@#t, go F#$k yourself" She then threw her Wendy's bag across the counter with one of the containers of chili exploding all over me. She was escorted out and I enjoyed the other bowl of chili:)

What really touched me was when a 98 year old man came up to me with some flowers from the gift shop. I asked him which room he would like. He said no, I do not need to get back there. I made a wrong turn a while ago when I went up to visit a friend and it seemed like you were having a bad day, so on my way done I thought a few petals would brighten it up. I almost teared up, it really was not a bad day, just a few patients behaving badly. I tried to explain that sometimes people just get upset due to the stress of being sick or hurt. He just nodded his head and told me that I was someones wife, mother, sister, and daughter and that no one should ever treat another that way. He gave me the flowers and thanked me for being a nurse. After he left I had to take a break, this little old man's sweetness made me tear up. It is not often that people see us that work in the ER as humans with feelings.

What to do????

I have a chance to change jobs and I really do not know what to do. I am scared and excited all at once and I feel like I am going to pop out of my skin. I was offered a flight nurse position with better benefits, less work, and more money. In order to attain the position I have a medical test with drip rates, ekg's, and 5 mega codes. On the other hand, I am loyal to my ER, I have been there since 2003 and have a love hate relationship with the typical er stuff we see. I know grass is not greener on the other side, but do I pass up this opportunity and stay because it is what I know? Or do I take a leap and go flying around? I love my er, but I also love helicopters and and I can nurse in both! So there is my choices just don't know what to do.

To the back of the rack you go!!!!

Top 3 ways of the day to get your chart moved to the back of the rack.

1. Come in to the ER reporting that you missed your appointment at the methadone clinic and need it now. Then make an butt out of your self because the doctor has not come into the room after you being there for 4 minutes. After all you are dying!!! They other guy is already dead on the other side of the curtain, which is why according to you we are wasting our time doing compressions when you are alive and need your methadone. Oh and by the way, telling us you missed your appointment because they made it too late and you needed to score prior going to your appointment, will not gain any sympathy!

2. Check into the er for dental pain and once you get to your room you demand (not request) that we fax a letter to the court stating that you are in the er and can't make it to court. All of this after your call your nurse a B@%!#h. Guess what, after obtaining you court time, I will personally insure that you are discharged 10 minutes prior to you court time, which is 5 hours from now, and will fax the letter to the court stating what you requested. It will go something like this, "Dear sir/ Ma'am, Mrs. Crack head was in so and so ER from this time to this time." Seeing that the court house is across the street, you will have ample time to attend your hearing and be detained as your lawyer has told will happen.

3. Check into the er with complaint of cramping and abdominal pain at 10 weeks pregnant. After we find out you are not pregnant and you tell your nurse that you really just wanted a preg test and that your best friend told you to lie to get back faster.

The Bucket

After working in the emergency department for as long as I have, you think I would know what questions not to ask. However, I am a curious person and can;t resist asking the unaskable. For example, I have learned not to ask what is is your pocket, what is under your coat, what position where you in, and so on. You think that I would no better to ask what is in the bucket??? Nope, not I. I just have to know! Well a client came in with fracture arm after falling at the creek. He came in in swim shorts and muck boots.... that should have been my first clue. His attire included a 5 gallon bucket with the lid on tight that had small pin holes in top... That should have been my second clue, but no. My curiosity and the egging on from less bold co-workers lead me to ask the loaded question! What's in the bucket???? My first thought that it was bait, but when I picked up the bucket to move it it was heavy and no swishing of fluid. so I really had no clue and had developed increasing curiosity by the minute. The patient told me to go ahead and open it. Nope I have learned that lesson, which is an entirely different but related story. Anyway, he opened it for me and I nealy died. In the bucket was 17 diamond back rattlers!!! Just rattling away when he lifted the lid. Why did he have them, he was collecting them or research when he fell and broke his arm. Why did he bring them into the ER? He did not want them to die in his car. What would I have done if they were my snakes????? Had one hell of a barbecue, but definitely would not have caught, touched, and been anywhere near them while they were alive!!! Will I learn my lesson and stop asking always loaded, "what do you have there question?" nope, but will never open any container on my own!

Freaky Friday

Questions of the day.....

29 year old female presented with pelvic pain. After finding out that she had a small vaginal tear, her husband requested that we exam him. Why? Because as he pointed out (pun intended) his penis was way too small to cause any type of tear. He wanted us to measure and prove that his wife was cheating on him... He even offered to get it hard for us to measure.

Life

I ran away awhile from life. Or at least I tried, with no success I would add. I needed time to reflect on life, my life in particular. I had too many children die on me this year. Nothing that we did could save them and one begged to just let her go, she was tired of the fight. As a nurse that works in the ED, we have pretty thick skins, yet sometimes things get to us. I felt mentally and emotionally exhausted.I think I had to just mourn a bit for those that I never knew, but took care of in their last moments. Sometimes people forget that we are human because we have to maintain our composure when hell breaks out, but many of us do care and carry a piece of our patients around with us. I ended up just shutting down emotionally, not depressed, but on autopilot. However, auto pilot does not seem to work too well for me. I love nursing. Having myself shut off to the emotional aspect of my work lead to me not enjoying it. Yes, death is sad, children death is heart wrenching, yet there is more to being a nurse then just the sad aspects. So now I a back to posting silly patients, sad stories, and stupid things that I do.

Drug Reps and Food

As a nurse, there is little time to eat when you are getting you butt kicked in the emergency room. It is a blessing when the drug reps come in with their bags of food. However, I find it funny as all heck when a drug rep comes in peddling their cholesterol medication while giving us baby back ribs, tators, coleslaw, and apple pie. What ever happened to a heart healthy diet??? either way, as a nurse, food is food and we are all very thankful

Cyanosis vs Eye Shadow

Women presented with c/o SOB that has a history of COPD. Attempting to triage her was difficult due to the blue eyeshadow that was in a giant circle around her mouth and on her lips. However, she was insistent that it was related to her SOB. Pulse ox was 99% on room air and lungs were clear.

So what do we do as we choke on our giggles.....
We rush her back because it is the policy to take everyone back. Shoot a chest xray than proceed to do a cardiac work up because she now has chest pain with a cardiac history.

We did everything we could to give her an out. We asked if she had been eating anything blue... nope she says. We ask if she could have gotten make up on her pillow, which would have transferred to her face while she slept.... nope, nope, she states, I am blue because I am dying and you are doing nothing to save me. Family is surrounding her and must not have a brain between them because they see the same as we do. Blue glittery make up painted around the woman's face. Finally, I give up and grab a wash cloth and wipe. Who knew it would wash right off???? She was ticked because she reported the cool water gave her a chill and would make her sicker, and all hubby could say was, "holy crap the blue comes off!!" Without thinking, I point to the women's open purse and say, it should it is the same color as the eye Shadow sitting on top of her meds that she made me pull out." Needless to say, she was discharged after a psych eval.

As a patient... A bit manic depressive.. humor me

As a patient, I become more and more frustrated. Every time things start going right and everything is in the right socket, something happens. I hate having EDS, yet up till now I knew that no matter what I would be okay. I knew what to expect. I knew what risks, side effects, and symptoms to expect. However, It feels like the wind was knocked out of me a few days ago. All of my joints have given me trouble and I was under the impression that there would be no more surprises, I was wrong. Apparently, the three bones in a person ear make up a joint. With any joint in a person that has sever EDS, it can become hypermobile and lead to hearing loss. Over the past year, I have hid from my decreasing hearing and increasing buzzing sound in my left ear. Finally, family and friends sat me down and made me go my hearing checked out. I am 90% deaf in the ear and my right ear is starting to act up. I have always seen a silver lining to whatever was thrown at me, yet this one has come out of left field and I do not see a positive. Every other problem a brace, pin, or joint replacement has fixed. Yet with this, a hearing aid could work, but not for long. Not even sure my insurance will cover them. What will happen to me in the end? This actually scares me, and much does not rattle me. Up till now, I have not let EDS interfere with my personal or professional goals, but how is this not going to effect my life? I have 10 weeks left for my BSN and was excepted in APN. How in the hell will I be able to be an APN, or even a nurse with out hearing? I love nursing and patient care. It sounds selfish, but I just turned 34 in march and do not see any part of this disease as fair!Yes, I know life is not fair, but I feel that there as to be some kind of balance. I know this posting is a bit manic depressive, I am just frustrated and scared. My plan is to spend the next few days curled up in bed, head under the covers with a ton of chocolate then I guess I will just have to deal with it and get on with living life.

Its my sisters husbands baby, but his brother is the one I am saying it is the babies daddy!!!

This is an unbelievable conversation I had at triage today, still shaking my head at it.
Me: What brought you into the ER
Her: I need a pregnancy test
Me: Okay... What brought you to the ER that is an emergency?
Her: I need a pregnancy test because I have plans
Me: When was your LMP? Are you cramping? Bleeding?
Her: Think it was 6 weeks ago, but I had sex... (wait for it).... a few weeks ago with my sisters new husband and his brother wants to take me out tonight.
Me: Okay, and????
Her: He is a jerk, but if I am pregnant, I can go out with him, have sex and when the baby comes no one would say anything if it looks like my sister's husband. So, I really need that test before he calls me back!!!

By the way, this 17 year was pregnant. Should make an interesting thanksgiving holiday.

Don't get between two angry love birds

98 year old women presented via EMS c/o should pain after altercation with local police.... Yes, a 98 year old women. What's better is that 99 year old man presented with laceration to his forehead after altercation with local police.

Apparently, husband and wife were having an argument, neighbors call police due to the increasing volume of the argument. When police arrived, wife had thrown lamp at husband, which landed square on his forehead. Police attempted to arrest wife and husband went to defend his wife and pulled a shotgun out. So, police let go of wife and grabbed husband. That's when wife pulled her own shotgun out and when she was taken down the shotgun went off, which dislocated her shoulder....

Guess Again!!! No vacation for you...

48 year old women presents to the ER after a syncope episode at her youngest child's graduation party. The patient and husband have been planning for years to take off and travel the world once there children are out of the home and in college. Both are telling us their plans of where they are going, when, and promising to send a post card. Their one concern is the syncope. Husband is worried that wife might just be worn down and needing the vacation. While wife is worried that she has come down with something that will postpone their plans. After her tests the doc went in to give the grim news. Your plans will be postponed, but congrats, you are pregnant. The look on their faces told the story, they were in shock, they did not want any more kids, and they did not believe us. We ended up retesting with blood, urine, and an ultrasound to prove it to them. To them their world has ended and they will not be a trip around the world this year.

The Great Snake Hunt

This really has nothing to do with the ER, but I just think it is funnier than hell.

I live on top of a small mountain and am surrounded by woods. I choose to live a far away from people because I just don't like cities, crowds, or noise when I am not working. However, by living this way, my children have had many opportunities to send me on an adventure, or two. Today was the day for the snake hunt.

It started as simple as telling my son to grab some hay for the animals. Next thing I know he comes running back with tales of a 8 foot snake sunbathing on the hay stake. Of course, my first question was is it a rattler? Nope he tells me, so I ask is it a king snake? Once again the answer is nope. So, up comes my younger son with the camera with the suggestion that we go look and take a picture to identify it. As always, I am outnumbered and off we go. Younger son with camera and me with a 40 caliber. (I am not fond of snakes). My husband comes over and he sees about an inch of the tail hanging out of the hay. My suggestion is to just shoot the hell out of the hay stack, but no, hubby and sons want to save the poor snake from mommy and move it. So, down comes one bale of hay and the snake digs dipper into the stack. Then down comes another and then another. By this time we have identified it as a red milk snake, which is why they even entertained the idea of catching it. Yet, I don't like snakes and am not fond of the mess my children and yes, my hubby, were making out of the neatly stacked hay to catch it. During this entire time, which was over an hour, I sat down on one of the barrels to watch them make fools of their-selves. Might I add that I was at least 20 feet away from were the snake was hiding. Anyway, my older son turns around to me and starts taking pictures. Then my hubby, who one job is to keep the snake away from me starts laughing. I look down and the snake that they had been hunting was coiled up just watching them about 4 inches behind my boots between me and the barrel I was sitting on. Apparently, the snake was finding humor in the mess that they were making and just relaxing and watching.
So this is what I do on my days off from the ER, and unfortunately this was not the first wild animal or snake hunt I have been on and I have the feeling it will not be my last. I hope that you find it as amusing as my husband and boys did.

Brazilian wax

Women came in with c/o labia pain. Prior to exam, the women bashfully explained that she had always wanted to have a brazilian wax, but was too shy to go to the salon. So here she is in the ER showing the ER nurse and ER doc the results of having her husband wax her. Her poor husband look sick, He did not mean to hurt her, yet there was blood everywhere. He had misunderstood her directions on not to put wax on the "lips." he had gotten a small portion on her labia and when he held the skin tight and pulled, he caused a avulsion labia. I am not sure who I felt more sorry for, the wife with the injury or the husband who felt horrible.

Moral of the story... if you want to wax down there go to someone who can do it and don't talk your poor hubby into it.

New Nurse

I swear that our new nurse has Ideophobia related to her ergasiophobia because if she used her brain than she would have to work.

Posting

Sorry, have not posted in a while. I just took on the new trauma coordinator position and in finials at school. I will be back to posting soon.

Dumbass

Okay, I am very proud of you for placing that ET-Tube, hell it only took 20 minutes and you made me don full gowns. However, when your nurse tells you that she has a bad feeling about this patient, then you might want to believe her. When the nurse tell you that she is not going to hang dip until a BP is obtained, you need to pay attention because something is going bad! When the nurse tells you that rhythm has changed, know what the hell she is talking about. When the nurse tells you to check for the pulse while she is grabbing a Doppler, something has gone very bad. When you hear the nurse say, "ahh Shit here we go," as she pops the cart and tells someone to start compressions, things are beyond bad! While the nurse is pushing epi, don't ask what the hell I am doing. I am doing my job and was while you were not paying attention and bragging to the other residents about how well your intubation went. So, don't act so surprised when you were told that the women was coding dumb ass! As a side note, the variance that you wrote up on me that stated:

1. nurse failed to follow medication orders (Diprivan). Need BP prior to hanging
2. Nurse push medications with out medication order (epi). Basic ACLS
3. nurse ordered medical test without order (EKG and post tube placement XR).Protocal
4. nurse was verbally abusive (referred to me as a dumb ass). you were being a dumb ass!

My boss found it quite amusing and forwarded it to your attending,who is the same attending that brings me coffee every morning. I am sure that you will if you have not already be called a dumb ass more than once today:)

Today's Funnies

Radio Reports:

68 year old male C/O HA, coming in code 3, pt is V-Tach on monitor, heart rate 98

103 female from XXXX nursing home, last known well time 8 hours ago, found pulse-less, full code in progress....Once presented in the ER, pt was a DNR

Nursing opps:

Over heard nurse tell a pt "Just drop them, bend over, and let me give it to ya," apparently, pt had high levels of ETOH and after 20 minutes of being hit on the nurse just got frustrated with wasting her time.

New nurse attempted to insert rectal tube prior to inserting.... we stopped her

Ranting a bit

You know that it is time to take a few days and relax when you have a very bad run of patients and all you want to do is complain. Here is a small sample of the last few weeks:

1 child shoot in the head while the mother was committing a crime.

1 child brought in at 3 weeks old with SIDS, 6 hours to get the mother to the point that I could take the child and turn over to coroner.

Pys patient asking me for her purse because people are out to kill her, when asked why the purse she tell me to get her gun!.Ended up taking a 22 ca hand gun fully loaded, 1 in chamber, and cocked back out of purse. After clearing the gun and handing it off, she stated that she was going to kill me.

After some narcan someone ended up with projectile vomit in face and down scrub top.

At the end of a 20 hour shift, ended up spending 2 hour attempting to keep a airway open of a very obsess women, with no neck to be found, that had just had a total neck done. Her neck was so large and swollen that we could not get her tubed and was unable to place a cric. I guess when a person weighs over 700lbs they are going to be hard, but hell, I do not have to go to the gym today after that fight.

And the is a number of other just bad cases that make a nurse just want to throw up their arms and walk out.

So why do we do what we do???? Could question.

I work in the ED because for every bad case there are 10 that I can help, just need to take a break sometimes. Planning on sitting on a friends front porch, sweet tea, deer chili, and watching all of our kids play in the fields. Will go back to reality on Monday

Tragic

Tonight one mother is waiting while her little boy receives a heart transplant that he has been waiting for his entire life. 100 miles away another mother watches over her child that is in the intensive care unit after a lung transplant. 2 other mothers are holding their children after their liver transplants while other mothers around the state are thankful for having another day with their child after their transplants. Tonight 14 children have received organs because of one tragic event.

a mother took her child while she committed a crime. The victim fought back and fired at the mother's car. The victim did not know there was a 14 month old in the car and the bullet went into one side of the child's head and out the other. We did everything that we could do to help and it was determined that the child was brain dead. The loss of this child is a tragic event. Some believe that some children would be better off dead, yet every child deserves a chance no matter what type of parents they have. In this case, this child did not have a chance. However, the loss of this soul has saved 14 other souls. Sometimes thing do not make any sense in the ED, this is one of them. Thankfully, something good has come of this tragic event. There might not be any family to mourn the loss of this soul, but everyone in our department feels the loss and mourns for her.

Busy

Busy week, for some reason we are hold patients in the ED and still excepting transfers. This is just crazy. There are not enough nurses to cover all of the beds on the floors, so we hold them. Yet, no one seems to be concerned that we in the er, don't have the nurses to handle the same amount of er patients, plus hold floor patients. Crap, I have patients stacked in the halls and 4o deep in the waiting room. i really do not know how long we can keep at this before everything breaks down further.

Anyway, completing some papers for school and getting butt kicked at work. thought i would at least post today. Sorry if not interesting:)

Grab Ass: Only some will relate

Okay, only some of my followers will understand what I am talking about and hopefully all will find the humor.

My hips are acting up, in and out they slip. Not really all the way out, but I feel the ligaments slip over and joint come out just a bit, than ligament slips back over and they go back in. This combined with the cold and the arthritis it is very uncomfortable.

anyway, my ortho saw how I was walking when he came to admit another patient in the er. When he asked e were it hurt, he just was not getting the picture. So, I took his hands and placed them where it hurt. Now for those that suffer hip pain, the pain is normally not on the outside of the hips, but right where the butt meets the top of your leg. That is where mine is. After 15 years of him fixing me, I am use to him and he is very professional, but his med student, not familiar with the history turn the brightest shade of red and even ask my dear doc if I was hitting on him... My doc shared that little bit of info later with me and we laughed so hard that I about peed my pants. So for those with pain in what could be sensitive areas, please be aware that some new doctors will not understand you grabbing their hands and having them grab your ass.

For the record..... pain is right were the finger tips are in the above picture... lol

Urine Sample

Patient comes in confused, but has stayed confused for longer than expected. We attempt to get a urine sample from he, but are unable.

Picture this...
all nursing and doctor staff sitting around desk and talking, patient comes out of room. I attempt to get him back in room. There is a large column that block the view from the doctors desk, yet they hear me say, "no, no, put that back in your pants." At that time patient is whipping out his dick and proving his urine sample all over the chair that I was just sitting in, which of course bounces back up onto desk and into my fresh coffee. He than zips up and everyone is gaping at him. I am trying to get him back into room while everyone is just looking at him and me like he is crazy, which he was. It took me saying, "hey, how about a little help here prior to the male doctors and male nurses snapped out of it and came to my aid or the pissing patient.

First diet, than quit smoking and than someone pees in my coffee

Revenge: ER Style

I have ranted and rave about having EDS and the pain in the butt, or should I say the pain in the joints it is. Well my EDS help get a little sweet revenge on a new ER Doc today. With the help of a few other Docs:)

A few weeks ago, a new Doctor started. I have no clue where he is from, but I am positive the nurses held a party after he left.He some how believes that nurses only live to follow his commands. He does not understand that we as nurses follow protocols, which allows for nurses to order tests, give certain medications, and yes, even perform a full code with out the help of a doctor. (Not that we want to, but we can if we have to).

After making the last few weeks hell, the doctor's and us(nurses) developed a plan to teach this doc some manners. He has the habit of not looking when talking to the nurses and roughly handing the charts to us. Sort of slapping the charts in our hands, or down next to us. We have told him many times not to do that, but he just doesn't care.

This is where my EDS comes into play. Just for the record, it was not my idea, I just went along with it. I can dislocate most of my joints on demand, and at times the doctors have relocated me after having a few good laughs when I can't relocate myself.

Here is the set-up:
1. take ring braces off fingers and wait till new doc is not looking and slaps a chart down next to me.

2. Hyper-extend/ dislocate fingers and yell

3. When old doc, who is in on it, looks down holds hand and pretends to exam dislocated fingers, pop the shoulder out

4. Old doc calls over new doc, and asks him why he slapped my hand with the chart.

5. Wait till new doc looks at hand and grabs hand to exam to yell that he is pulling shoulder out.

6. New doc than sees shoulder is out, give him a few minutes of thinking he abused some poor nurse.... than pop shoulder back in, flex fingers back, and tell him to stop slapping charts down at the nurses.

It is comical to watch the emotions that crossed his face, but he has not slapped a chart in the hands or next to any nurse since then.

only draw back was that my ortho got called in for another patient and the doctors let the gag slip out of the bag to my ortho, who in turn gave me a lecture (another) on the hazards of voluntarily dislocations. Some how the doctors never let it slip that it was THEIR idea.

Withdrawls

My name is Mel-Lee and I am an nicotineholic. That is how everyone that I know who are non smokers make me feel. What jerks! Right now, I feel as if I am going to DIE. WTF!!!! I am on Chantix, which is supposed to help with withdrawals symptoms, yet it is blocking all of my nicotine receptors so that even when I smoke, I STILL DO NOT GET THE NICOTINE. Going through withdrawals, night sweats, chills, and feeling like my insides are going to be ripped out. It is like being on antabuse and drinking with the severe sickness. Okay, there is my bitch of the day.

Soliciting the pity vote

Okay, I have been nominated for Doc D's nursing blog award, which is a great feeling because people do actually read my crazy rants. However, I am only second in the running, that is second to LAST.

So, come go on over to the Doc, and vote

Check out some of the other blogger, they are truly funny and while you are there read through some of our dear Doctor D's posts at Ask An MD They are very honest, which is at times hard to come by this day and age

Warning: What not to do in a Snow and Ice Strom

Well, I live in the south/ mid west, if that makes any sense. Anyway, we do not get many snow storms. Our average snow fall a year is less than an inch. We get plenty of Ice storms, but it is too cold for people to really go out and do dumb things. So, bring on the snow and all the idiots come out. This past week we had 4 to 8 inches of snow dependant on area. People did not know what to do!!!

1st pet peeve:
I had 5 of my 9 nurses call out of work.... for the week, not just the day! I figure if I live 40 miles from work and had double the amount of snow than those who live two blocks away that they should be able to make it if I did.... Not the case

2nd pet peeve:
If a person is spinning on a ice road, why do you decide to keep going once you hit the ditch??? Watch 2 of these geniuses from the shallow gene pool do just that.

WTF are these patient thinking????

We have all seen what happens when a person sticks their tongue to a frozen poll, yet I took care of at least ten patients that did that one thing. What is amazing is that nine of them were over the age of 30!

I have an idea, why not have billy-bob hook a metal drum lid to the back of the tractor and go down the hill??? What happens is the lid picks up speed and rear ends the tractor resulting in 2 broken arms.

Let's take the 4-wheeler and try to cross the creek. Hell it is covered in snow...so it must be frozen.... Nope, billy-bob was lucky, the creek was only a foot deep.


Let's bury our friend in the snow like they do on the beach with sand, I know it is in the middle of a snow storm, but it will be a a great picture.... with all the snow falling, they lost poor Billy-bob and search dogs had to locate him under 4 feet of snow, which they had piled on top of him.... No worries, a touch of hypothermia doesn't kill everyone.

My personal favorite....
Women with deformity to left ankle screaming that she wants pictures so she can sue the landlord for not clearing her driveway.... We took picture, but included the 4 inch stilettos that the women was wearing in them... Must be Billy-Bob's Sister

The nursing home dump.

99 year old male, agonal breathing, heart rate we are watching drop from 150 to asystole. Why are we not doing anything, because he is a full DNR. No Chest compressions, No airway management, No medications, No cardioversion, and No antibiotics. Are hands are tied and their is not a dang thing we can do. So, why do we have him in the ED?


Ah, it is a nursing home dump! Nursing home sent him over because of his agonal breathing and did not tell the EMS what his DNR until until after he was loaded in the rig. He arrived at the ED and we watched him die with in 5 minutes. Not coding him was the right thing to do, but still I am a fixer and that is why I work in the ED, standing there not being able to do a thing is hard for me.

Now,Back to the nursing homes... I figured I would make a short list of reason why a patient should not be sent to ED.

1. They have died (sorry, once dead there is not a dang thing we can do)

2. They are about to die and have a full DNR (Still we can not do anything)

3. If patient is normally confused; such as, dementia, don't send to ED for confusion. (I will send them right back)

4. patient has cloudy urine and fever, but just started treatment for UTI less than 24 hours ago (Can't do a thing on that but discharge back with instructions to continue home meds)

My favorite

5. Transfer to the ED due to short staffing is not a way to make friends with ED staff


As a side note, just because a person is in a nursing home, it does not mean that they are not human. I will call you and question why a person is in the condition they are when a simple bath and turning could have prevented their pain.

Going to Haiti

With everything going on in the world, there is always the need for volunteers. I am part of a disaster response team and every year I have the opportunity to help someone. It is just a way that I can help others like I was once help.

With this said. I am nervous and frustrated at this time. I am to go to Haiti and was set to go two days after the earthquake. However, due to the united nations taking over, nurses are right now not allowed to come in due to safety reasons. So, my questions are, why not? I was supposed to go with the troops, and work within their wire. To me, this would mean that I am very protected. Now, the UN wishes for us to work else where, yet they are delaying our deployment for up to 8 weeks. Haiti needs nurse now and we are left with our hands tied. I really can't stand red tape!

So why am I nervous? I have been in manydisasters, yet something about this just leads me to believe it will be the worst that I have ever seen.

Forget about that nuero consult!!!

Log roll patient, part of skull hit floor and baseball size piece of brain landed on foot. Yup, nuero is not going to do nothing with this! Forget about the burr holes we had requested earlier, you know us in the ER, we make our own.

When nuero called to ask why we cancelled, he thought I was joking when I said that they are on the floor. Nope, I was not teasing. Most on the floor and a few bits on my shoxs.

And no,Dr.sleepy, I am not being a smart-ass, just logical and stating the facts to you so you do not drag yourself out of bed for nothing. Next time, I will consult you on ever chronic HA at 3am to rule out a tumor if you keep being a snotty little boy

Make a Nurse Smile

People have asked me why do you work in the ED. Some days I really do not know why, after being belittled, yelled out, and dealing with some of the most persistent drug seekers. However, those above are only a sample of who I take care of in the ED, and some patients just make you smile all day.

1. Little old ladies, who have reached the age that they just do not care what comes out of their month. They can say some of the most insightful and interesting things that I have ever heard. Example: One day, a very special 87 year old women, , who was slightly affected by dementia, stated to the doctor, "She is cute why don't you just date the nurse, marry her, and have a bunch of kids, if you get laid, you will be a happier man and less grumpy!"

2. Children are also the funniest little patients that a nurse could have. There is a age where children are just brutally honest, yet they only understand what they have been told and what they see. One such child, 5 year old male, told a nurse that if she was not a home wrecker than she would not be fat with a bastard child. Apparently, the mother of the child had said why too much in front of her child. Her ex-husband's new wife was pregnant.

These are just few of the patients, there are hundreds that just know the right way to make a nurse smile.

Just a small touch!!!

It is amazing how a sternum rubs can bring a person back to life when they are on the brink of death!!! Had three unresponsive, 2 from the jail, who just would not respond at all to gentle shaking, nor talking to them. One appeared not to be breathing (holding breath). One little rub and they are good as new!!!



My question is, do people really think we are that stupid? What is the sense in playing possum????

Picture says it all.. Cardiac Rhythms

I wonder if they can put this in the textbooks...:)

Feral Child

I have experienced many things in the emergency room, yet everyday something amazes me and I learn something new. We had a feral child in our department and when the doctor told me that I should take over care because the child was feral and the newer nurse was not handling it well, my response was that it was that all children are feral at times. I did not know she was dead serious!

What is a feral child????
A feral child (feral, wild, or undomesticated) is a human child who has lived isolated from human contact from a very young age, and has no (or little) experience of human care, loving or social behavior, and, crucially, of human language.

This child that I was taking care of had been found in a dog cage at her others home. When she was found she was a little over 4 years old. When I encountered her, she was 9 years old. Now there are many sources out there that can explain the importance of human contact, care, love and human language that the child do not experience and the outward causes.

This child had not experience much in her first four years of life, and did not have any lauguage skills, was impulsive, and a true wild child. Any simulation she was bouncing off the walls, just because she still was curious about everything. I watch her in a blink of an eye jump on the bed then onto the overhead pelvic light and swing across the room before any of us could stop her. The foster mother, who must have a heart of gold, caught her. The doctor and I just attempted to distract her with the drawers full of supplies. This gave us time to get her discharged!!!

Exam room after discharge:

Over head light broken and sharps container ripped from wall: called maintenance
every single package of gauze wrap, ace wrap, bandages, and everything else that was in the drawers completely opened and around the room. ky jelly and saline flushes all of the floor. Basically the room was trashed.

What caused her to go completely nits was that the foster mom grabbed the wrong bottle of meds, not her fault, so the child's med level went low. Child needed up draft, we all know what updrafts do to children.

Why did we give the child everything in the draws???
We can't blame the child for her actions, we did not want to physically restrain her and put her through more mental anguish, so we distracted her knowing it would leave on hell of a mess.

Now the techs did not quite understand our laughter at the room and refused to help us clean it up. I just think that they did not understand. I did not want to force them to help, I could have. So the doctor and I cleaned the jelly up, washed the walls, had maintenance come and help with the ceiling. It was quite a learning experience for me.

I have to say, this doc an I seem to get into many a interesting cases. I have learned a lot from her and it is nice that when things come up like this, she stays at my side through the crazy parts and the clean up. She has no problem helping me clean fecal matter off a person or being my medication bitch (her words, not mine).

Rules of the ER

Okay, my last post was a bit depressing, so decided to post something on the lighter side. This list was sent to me by one of my fire buddies.

1) If it requires the ambulance team AND entire truck of firefighters
to transport you and safely place you on a hospital stretcher.....it is
time to go on a diet.

2) When you present to the Triage nurse, do NOT tell him/her that your
doctor called ahead. If you survey our waiting area, probably 50% of
the people waiting said the same thing.....and the other 50% use the
ER as their regular doctor.

3) When asked how much you weigh, please do not give the 'deer in the
headlights' look and tell us you don't know. It's a simple question,
simple answer.

4) Just because you have a phone and know how to call 911, we are NOT
impressed by your arrival on an ambulance stretcher. You had BETTER be
sick.

5) If you came escorted via EMS for multiple complaints that started
more than one week ago and your entire family followed the ambulance to
the hospital, you will be labeled a pussy and treated like one. Enjoy
the waiting area with your family.

6) One complaint/ailment per visit, please.

7) Just because you came in an ambulance doesn't mean you're going home
in one. You better start making arrangements now. I am NOT figuring
out how to get you home. Cab vouchers are NOT an option.

If you have one of these four, go to your own doctor in the morning:
A migraine; the Flu; a stomach virus; or a stuffy nose.

9) Do NOT ask us how long it will be. We don't know. I don't know
what is coming through my door 30 seconds from now.....and so I sure as
HELL don't know when you're getting a room.

10) We have priorities. We understand that you have been waiting for
2 hours in the waiting room. If you don't want to wait, make an
appointment with a doctor. The little old lady that just walked in
looking OK to you, is probably having a massive heart attack. THAT
is why she goes first!

11) If your mother is a patient and we ask her a question.....let her
answer it.

12) If your child has a fever, you had DAMN well better give it
Tylenol BEFORE coming in.

13) If you are well enough to complain about the wait.....you are well
enough to go home.

14) Do not utter the words "it is in my chart." I don't have your
chart! And I don't have time to call and get it! Just tell me.

15) We know how many times you've been to an ER. We can usually tell
if you are faking it during the first 5 seconds of talking to you. Do
not lie to us.

16) If you have diabetes and do not control it, you are committing
slow suicide.

17) If you are a female between the ages of 16 and 42 and your last
period was 28-35 days ago.....PLEASE don't waste our time if you are
here for abdominal pain and vaginal bleeding. Guess what???!!!
You got your period again!!!

18) Do NOT bring your entire posse with you. One person at the
bedside is all you need. It is really difficult to get around seven
people in the event that you are actually really sick.

19) Every time I ask you a question, I learn more about what is wrong
with you. I don't care if I asked you what day it is 4 different times!
Just answer the questions.

20) If you want something, be nice. I will go out of my way to piss
off rude people.

21) Our definition of "sick" is not your definition of "sick." If a
member of the ER staff says that someone is sick, it means that they are
in the process of DYING!!! They have had a massive stroke....are
bleeding out....are having a heart attack....or have been shot!

22) We do not consider a kidney stone "sick." Painful, yes.....but
sick, no.

23) At any given time, one nurse has up to 4 patients. One doctor has
up to 15. There is a law (similar to Murphy's Law) in the ER: If you
have 4 patients, one of them will be sick (see above definition)....one
of them will be whining constantly....one of them will be homeless....and
one of them will be a delightful patient. DON'T be the whiner!
Please.

24) If you see someone pushing a big cart down the hall at full speed
and you hear bells/alarms going off.....do NOT ask for a cup of coffee.
Someone is dying, you inconsiderate asshole. Sit down....shut
up....and let us work.

25) If you can bitch about the blood pressure cuff being too tight, or
the IV hurting, you are not in that much pain!

26) Physicians and nurses are NOT waiters. We are NOT customer
service representatives. This is NOT McDonald's, and you very well
may NOT have it your way. Our job is to save your life. If you
want a pillow, two blankets, and the lights dimmed......GO TO THE
RAMADA!!!!!

27) If you have any sort of stomach pain and you ask for something to
eat, you are NOT sick.

28) Do NOT talk shit about the other members of staff I work with.
That doctor that you hate? -- I work with him every day, and I know that he
knows what he is doing. I trust him a LOT more than I trust you. I
am NOT here to be your friend, and neither is he. I will tell him
what you said, and we will laugh about it. If you want a buddy.....go
somewhere else.

29) If you are homeless.....DON'T ask for a bus token or a cab voucher
to get home, it just confuses the staff.

30) PLEASE don't tell us how to do our job. Do we come to your place
of business and tell you how to do your job?

31) Please don't bring in a "show and tell." If you have to fish it
out of the toilet, it's really not necessary to bring it in. We will
take your word for it. If you did fish something out of the
toilet.....you may NOT use my pen.

Tragic

Tommy-ray 09/23/93 - 09/22/96
Andrew 03/28/95 - 09/22/96


Women called today, asked if I had her son who had been killed in a fatality a few hours earlier. I looked to see if we had his body. He never made it to us. Mother was frantic, she was notified via police, yet does not remember where they said he was. She could not comprehend her loss. I took her number and told her that I would find her son for her. What I found was four bodies. Four families had lost their children this morning. Four sets of mothers, fathers, sisters, and brothers who will always remember 1/17/2010 as the day their brother were killed. These young men had never come through my ED door's, yet I could not just pass the mother off as not my problem. She was lost, confused, and searching for her son. Once I found his remains, I set up transport for her and the other families so that the bodies could be seen at the funeral home of their choice. There are times that working in our profession that I wish we could just wall off all of the bad things that happen. Life and death can be ugly and most times it is. Very rarely do I see someone die in peace. It might be because I work in the ED and not on floor or in hospice.
Today was hard, hearing the mothers voice just brought back memories which I tend to suppress most days.I heard how I felt almost 14 years ago. What I most of sound to like to the ED nurse who took my call.
All of this death today was caused by drunk driving. I do not understand why it is so hard for people to understand that nothing ever good comes from drinking and driving. Today, those families will always remember. They will feel a sense of loss and grieve on this day every year, along with holidays, birthdays, and odd days here and there. Just as I do.

Please don't

I only say these things because it has happened!

1. If you find bright red fluid in the diaper, check to see what the color of the juice is that is in the kids sippy cup!!!

2. Gum stuck in the child's hair is not an emergency!!!

3. because your friend's child was potty trained at 12 month, which I doubt. Don't worry if you 15 month old is not.

4. I really do not care how long your labor was. I had 4 children all natural without pain medication and do not want to compare stories.

5. Please do not ask me if I think you kid is cute. There are ugly babies out there! If your child is one of them, instead of answering you, I will simply say what a cute outfit.

6. If you are in the ER for etoh and drug abuse and there are 4 of your kids in the waiting room, please do not ask me the best way to get pregnant..... My sugestion is fertilation.

Blown

Just love going to the eye doctor. Afterwards I walk around for hours looking like I have one heck of a nero problem. Along with a headache because I went to my boys basketball game under the bright lights.

My Blooper

Woke up this morning, jumped in shower, coffee while I dressed. Proceeded to drive the 45min through country road to the city. Walked into work, clocked in, made assignments. While making assignments, I noticed that we had 1 too many nurses. Hmm... I thought, It will be a fight to decide who wants to go home because everyone does. 30 minutes later I realized it was my day off!

1. In my dummy defense, I have worked the last 11 days.
2. It would have been nice if someone gave me a heads up when I walked through the doors! Instead they found it funny.

3. Really need to work on life not being so automatic.


What is sad is that this was not the 1st time I have done this. I do it about once a year. Last time, I did not realize it was my day off till the end of the shift. I had 5 days on, 1 day off and another 7 days on. Somehow I was off a day on when day off was. With us always being short nurses, everyone thought I was called in.

Frustrated

Okay, just a little frustrated. 9 months ago, I started planning for this trip to Mexico for a month of volunteer medical corps. My husband just vetoed all plans!!! I understand he loves me and is worried that something could happen, but hell I could be walking the dog and trip over a log and something could happen. So, those who read my blog, any ideas on how to convince he that I am a big girl?????

Triage adventures

Between family, school and work, have not been able to post the last few days.



I normally do not work triage, but every once in a while I need a break from the code and trauma rooms. Triage is always frustrating and at times funny as hell.

1. Woman is brought in by family, C/O heart stopped last night for 4 hrs, my response was did you feel it stop? Do you have a defibrillator? What made you think it stopped? Her response, my doctor is crazy and said I had a perfect heart, but I use to work on the cardiac floor and I know something is wrong!!! I did compressions till it restarted.

2. Woman came in tweaking, C/O told to come here so that I could be admitted for surgery. My response, do you have direct admit orders? Who is the Doctor admitting you? Her response doctor said the only way that he would pull the two teeth that I have is if I get sick and am admitted, but I need meth patches while I am here... I really had no response after that (At Least not one I could verbalize)

3. Young woman came in, C/O bumps on clitoris. My response, when did they start? are they anywhere else. Her response, started after I felt bad for this guy and only charged him $10.00 to lick me, next time I'm gonna charge him $25.00......

4. 15 year old male came it with mother, C/O nonstop itching in genitals. Mother reports that she has found him in his room a just scratching and scratch, he told her it was itching and that is why his pants where down and that he only was using the lotion to help the itch...... Okay, give me a break here, mom needs to get a clue that her baby is no longer a baby.

I will never figure this out..

1. How a patient can walk into the emergency room, walk to their bed, undress, and get into bed. Then they hit their call light to be pulled up in bed because they are uncomfortable. Will never figure it out. Just wish some of these patient were a bit lighter!!!

2. How a patient can call 911 to go to the emergency room, then when they get there they say "nope, don't need a doctor, just needed a ride down town."

3. How a patient can have 10/10 abd pain, n/v, than proceed to ask for a cheese burger and coke form the cafeteria. My answer is, nope, don't want to reload you for projectile vomiting that you complained of.

4. How someone can really justify calling a nurse any number of names, and in some case threaten to assault them prior to the nurse giving them their pain shot. A little common sense would say that nurse get to pick what gauge needle she uses.

Child Abuse

The question that I pose to all of you is.... Can you really tell the difference between child abuse and a genetic disease? Do we that work in the ED think outside of the box when we see injuries that could be caused from abuse? Do we just become cynical and assume all suspicious injuries that we see are related to child abuse?

This might not be an entertaining or funny post, but after the news I received today, I believe that it is worth a mention.

Case: 9 year old male covered head to toe in bruises, sclera on left eye was red, shoulder dislocated.

mother reports that child just bruises easy, that child was swinging on monkey gym and fell screaming that his arm hurt.

Both mother and child wore what appeared to be older hand me down clothes. Mother might have completed 5th grade, but very doubtful that she went any higher. The child did not have any medical insurance, not even medicaid. When reviewing the chart, the child had been to our ED many times for dislocations, bloody noses, rectal bleeding, and sprains. This child had scars that looked like he had never had medical treatment, so some of his wounds turned to scars were wide and gaping.
So what would you think???? Looks like abuse, sounds like abuse, it is abuse... right????

Lucky, I work with some great doctors!!! The resident was assuming abuse and had the police on line. One of our ED doctors told him to hold on. Dr. Great came to me and asked about what I experienced with EDS as a child, and what type of injuries that my younger son had encountered. You see,Dr. Great thought there was something off about the abuse allegation because of the mother and son interaction. No, this doctor is not familiar with the disease process of EDS, but he had thought that it sounded some what similar to the injuries that my son and I suffer from.... So he asked, then he looked up the disease.

Some of the common injuries that come with Ehlers-Danlos syndrome (EDS), include dislocations, easy bruising, vessels in eyes are very fragile, the lining of the intestines can easily tear, which leads to rectal bleeding. Minor injuries heal poorly and leave wide gaping scars.

So, after the doctor found all of this out, he came up to me with a very odd request... Can I pull your skin, he asked. At first, my response was pardon me? He then proceeded to tell me what he was thinking and prior to him going into the room he wanted to see and feel how the skin reacted when pulled. Those with certain variants of EDS have very elastic skin. Anyway, long story longer.... Doctor Dx the child with EDS and sent him to a specialist for a biopsy to confirm the genetic disease. Today Dr. Great called me and told me that the child that everyone thought was abused indeed had EDS that was confirmed by the test. Social services have been set up to help this mother find the resources to help this child.


So what is my point???
1. Look at the whole story prior to calling it abuse.
2. Most cases are abuse, but for that 1 in 1,000, 1 in 10,000, or even 1 in 100,000 it is a disease.
3. If you do not understand or know something, go look it up or ask, no matter if that person is lower on the totem pole than you. Everyone knows a little something that another does not.

Ok, Done with my rant

Cold, Cold, Cold...

We normally do not get below 20*F, nor do we get snow!!! This year we have had snow twice and they are calling for -5*F, no that is not a typo -5*F!!! With the decrease in temperatures we are having an increase in homeless coming in looking to get warm. I normally talk with them prior to them checking in to see if they are cold or seeking treatment. Yes, I am a sap. I do not have the heart to kick them out of the waiting room. I just do not feel like having a bunch of bumsicles coming in with hypothermia and frost bite because I kicked them out of the waiting room.

23 weeks...

23 weeks and 23 visits. I can't wait till this pregnant female hits 24 weeks because than we can just divert her to L&D.

Week 1.... I missed my period and think I might me pregnant, can you test me? no, well I have abdominal pain.... Instant pregnancy test

Week 2 ... I get nausea in the morning, can i have a pain shot? No, well have abd pain..... instant treatment

Week 10... Can you do a ultrasound so I can tell the sex? No, I have abd pain and think I am spotting... instant ultrasound

Week 16.... I have abd pain can you tell me the sex of the baby now that I am further along?..... ultrasound.... it's a boy

Week 23.... How long before I can just give birth, so tired of being pregnant.... 40weeks!!!! I have abd pain, knee pain, nausea, sore throat, on and on... can I have a pain shot?

Now this can go on and on.... I could tell you every visit from week 1 to week 23, what a waste of medical resources....

My One Weakness

Well, I hate to admit my one and true weakness, but the cat was let out of the bag today. A person can puke, poop, pee,and bleed on me. However, mucus just gets to me. Most of the time I can hold the gag in or think pleasant thought. I have worked in my ER for over six years, with the same staff and same doctors and they never had an inkling to my aversion and my gag reflex when it comes to mucus. Well today, I was helping another nurse with one of her patients. This patient had a foul, rank, and obscene Odor to her. It was not fecal or urine, No clue what it was but it was bad! I turned away from her for one minute and when I turned back she had runny, snotty, foul mucus all over her face. The mucus combined with her unique smell just sent me over the edge. I made an attempt at a graceful departure towards the bathroom, but only made it as far as a trauma room. With my head over a biohazard can while I looked done at bloody towels and pads from our recent trauma I dry heaved till I thought I was going to pass out. When I finally thought I had composed myself, I made my way to the nearest bathroom. When I encounter the patient in the hall, but this time she reached out to grab my arm with her slimy hand. That is when I just couldn't hold it in anymore. I made a dash towards the bathroom and lost all of my cookies. Unfortunately, I had not locked the door.... Next thing I know one of my favorite doctors was in the bathroom with me holding a syringe filled with zofran. Between gagging I was trying to tell him that I was not nausea just disgusted and that last time I got a shot I passed out (Don't like needles:) Long story longer... he gave me the shot, I passed out, when I woke up I had half ER staff surrounding me on a gurney. (ER nurses worst nightmare!!!) At first they thought I had morning sickness, nope took about 15 minutes to convince them I was not pregnant, not sick, did not need 100 or so tests to dx my illness. I just got disgusted and gagged. Once they all figured it out, They spent the day making sniffing, snotting, and every noise possible that might make me gag..... The feeling of the ER love!!! Think it is going to be a while before they let up on me.

New Year's Resolutions

Every year, I hear about people making their New Year Resolutions. However, they are mostly things that people do not want to do. I on the other hand use this time to check a few things off of my bucket list. Why do I have a bucket list many ask me. Well I have Ehlers-Danlos syndrome (EDS), plus I am human. I know that I am not immortal and will die... eventually. Also, with the EDS, I have so much metal and plastic in my body that my children tease me and tell me that they will just take me to the recycling plant when I die, which should cover my funeral expenses... Any way, I do not want to live my life afraid of being in pain or broken. Truth is, I am always in pain and about once a month, I am dislocated or have broken something. So why should I live my life discouraged and crippled?

First.... Last years bucket list

1. Get out of a wheel chair and relearn to walk.... Was in wheel chair for 4 months, Was out on 2/10/2009.... Done (The rehab and learning how to walk again was tricky, but I got it done!

2.Walk in the Walk For life 10k..... done on 4/2/2009

3. Hike 50 trails..... Trail number 50 completed 11/1/2009

4. Cliff jump 100ft.... Done, many times over the fourth of July weekend, what a blast, only cost me a dislocated shoulder

Now this year, money and joints permitting....

1. Tandem Skydive.... the jump and fall should be a piece of cake, the landing might be a little tricky.

2. Hike another 50 trails.... advance from medium to hard

3. Learn to play tennis.... with my physical limitations, friend has suggest playing doubles with me in front... we see how it goes, but I want to play in one competition match.

4. Go to Alaska and watch the whales, not so sure on cost, but going to give it one heck of a try!!!

4. See if I can give my orthopedic a heart attack when he asks about my bucket list (smile)... last year he threatened to disown me


Happy New Year to all of you, and I hope you have atleast one thing that you want to do on your list. Life is short!!!

New Years Day as a SANE

First, let me say a few things...

If you are sexually assaulted it is not your fault, even if you are drunk, stoned, or doing something that you really should not be doing. Someone that assaults another is a predator. On New years Eve I worked a 8 hour shift in the ER, which I did 4 RAPE kits. After work I did another 3 Kits prior to calling it a night and handing off the next 3 exams to another nurse. On the New Years day, I did another 2 kits in the ER and 4 more kits as a SANE. What all of these have in common is that the person was drunk and/or stoned, passed out and alone. They woke up with someone on top of them raping them. Yes, I get paid VERY well to do the kits as a SANE, but please put me out of a job.

Now, with that said.....

Use some common sense if you plan on getting so drunk or stoned that you don't remember who you are.

1. Use a buddy system, If a bunch of you are going out drinking, have one person there who is going to remain sober. This person can help steer you away from dangers situations.

2. Always carry a condom. Believe it or not, a predator will put one on most of the time if there is one available. No judge or jury will ever say you had consensual sex with someone if you are the one who had the condom. They will just think you where using your brain. Also, the condom is a great collection device for DNA, most the time the predator leaves it behind.

3. If your are assaulted, don't shower, wash, brush your teeth, eat, change clothes, no matter how much you want to. If you have to urinate and can't wait, go ahead, but don't wipe. I am a forensic nurse, I collect the DNA, if you wash and shower, I will have a harder time finding evidence. This is the evidence that links the victim to the predator. With out evidence, it is a he said, she said situation that could go either way.

Remember, my job is to collect the evidence. I don't judge what you do, have done, or planning to do. I need to know the truth. I am your advocate in the court room and out of it. If you hide the truth from me, I can't come to your defense because all of my testimony will be based on false information.