Rambling

Fair warning, I'm bored and just rambling here.

The other day I was the lead nurse on a trauma that will forever be ingrained in my mind. Though HIPAA laws prevent me from giving details I can provide some information.

A motorcycle was speeding around a corner and hit an SUV going the opposite direction. Though he was wearing a helmet, that did not do much to save him. He succumbed to the extensive injuries while under my care.

Everything that happened during the trauma, injured, procedures, and his eventual passing, didn't really affect me or my other coworkers as far as I know (having spoken to them after, we all seem to be OK). There was only one thing that bothered me, his legs and feet below the knees. 

The extent of the injured allowed both feet to lay flat and pointing in the same direction. He didn't fit in the body bag because of his stature.  Those same injuries allowed me to fold his legs/feet into the body bag. That was what bothered me the most.

I had a chance to talk with my boss, she wanted to make sure I was mentally doing OK or if I needed to talk with anyone.  Honestly I'm fine, minus that one thing.  

Trip

I'll be going to Corpus Christi later this month. I grew up visiting family there almost every weekend until I was in high school and after that it was usually once a month.

The area of Corpus Christi I knew was not the safest in the world. After dark you didn't keep your head above the window line in the off chance there were stray bullets.

It wasn't until I was in high school that I realized Corpus Christi was a tourist town.  I had no clue and I was honestly baffled why people wanted to go there.

Now that I have an opportunity to go back, I'm checking out a few tourist things including the Selena statue and a turtle sanctuary.

Though I'll be extremely tired by the end of the trip, I think it'll be a good visit.

Well, that's all that's truly on my mind. Watching some cheesy 70s horror movies while typing. Entertaining.

Trump Card (and other stuff)

Up front, this isn't a political post.

Several situations at work today, I'll start with the amusing (in the dark kinda way):

First story:

*Paramedic report to their station*
Paramedic: We're not taking him in, he's dead dead.
Doctor's scribe in ER overhears report: Is there a difference between dead and dead dead?
Me: Of course there is. One is Mostly dead, they still might be alive. The other is all dead, nothing left in them
*Scribe stares blankly at me*
Me: Guess you've never seen the Princess Bride....

Second story:

I introduced myself to my almost 80 year old patient. After a couple of attempts she still couldn't figure out my name.
Me: I'm Ernesto, I'm your nurse
Pt: What's your name?
Me: Ernesto
Pt: How do you pronounce it?
Me: Ernest

It reminded me of a time when my coworker couldn't remember my name for over a year and she called me Lorenzo (and I answered cause I knew she was talking to me).

Final story:

A coworker created a problem that I spent almost an hour fixing. Long story my patient called out using the call bell and she answered. They requested pain medication, she called and told me but I was not on the floor. They called a second time and she cut them off. A third time and she didn't even let them talk before hanging up on them. I was back on the floor at this time and my patient called out to inform us they were leaving to another hospital.

I walk in the room to talk to them and they were gone.  I found them in the hall and the patient's IVs were still in.  I politely asked them to come to the room for me to remove them before they left the hospital.

They refused stating I could not touch the patient without permission or consent and they were not giving me their consent.  They obviously thought they had the upper hand in the situation. 

I agreed with them that I could not touch the patient without consent. I then explained that I could not allow them to leave the premises with the IVs in because that would be negligent on my part. I then dropped my trump card: if they left with the IVs in the patient's arm I would have to call the police to have them check on the patient and make sure they got removed.

They agreed to return to the room.

Now that the story is done I just want to thank my lovely coworker for doing her job so professionally. Her courtesy was so helpful in this situation....yes this statement is dripping with sarcasm.

Processing events

The last four days I've worked have been rough.  My shift ended on Friday with a guy arriving to the ED in cardiac arrest. Saturday was a double shooting that kept me late. Sunday overall wasn't too bad other than working with a slowpoke in triage (I would triage 2-3 people to her one) but she did triage all the screaming pediatric patients.

Today things finally got to me (to an extent). Though I helped care for more, I only had three official patients over eight hours. 

First patient was a stroke and due to administering TPA that patient was 1:1 for almost two hours. I was able to sneak a lunch break in after I got her to the ICU (her symptoms had resolved within the first 15 minutes of TPA).

After finishing my lunch break I get paged for an unresponsive patient. He was dropped off by his "girlfriend" and was told his name was Gary. After a little Vitamin Narcan he became responsive and we discovered his name was Larry (close enough, right?). He was discharged.

Here's where it got rough. Triage was backed up and one of their nurses went to lunch. I went out to help, the other RN out front said it was my call.  I felt I should stick around and triage a few people.

While out there a woman asked for help getting her husband out of the car, he was having a heart attack (we hear this frequently so they can be seen quicker). Rolling my eyes I grabbed gloves and a wheelchair to help the man out of the car. He reported palpitations and being sweaty earlier. 

Checked him in and took him to the back for triage. Before I could start the official triage he started posturing and became unresponsive.

Fuck. I thought he was just trying to get back sooner.  Called a code blue, got him on a stretcher and to our trauma bay.  After 45 minutes we decided to call it, he was not coming back.

Talking with the other triage nurse we both came to the realization that if I had not felt inclined to help, this person would have literally died in the lobby in front of everybody because the other triage nurse was already tied up and didn't get back to the triage bay until after he had coded.

I'm grateful I was able to follow my impression today. I'm thankful for a good team that worked well during the 45 minute code. Even though communication wasn't 100% the extra hands were great and everything was completed as it should have been done. 

Triage Hell

Spent the last 12 hours in Triage. Definitely one of the worst days I've had out there. 

I clock in at 11a and we're holding 10 admitted patients because there are no beds upstairs, 3 transfer patients, rapidly transfusing blood on another, with several overdoses. We have a really high acuity going on (unusual that we have this many at one time).

We get word of an OD needs help out of a car.  We drag his strung out ass into a wheelchair with the help of security. As we take him to a room, security disappears.  The patient becomes combative and we end up calling a code gray (violent patient). Everyone shows up who is supposed to respond (security, maintenance, basically everyone available), and NOBODY helps. They stand outside the room listening to the patient ramble on about being raped by the person living in his head (I think that's called masturbation) and how he's travelling at the speed of light.  Homey is tripping on something.

As we deal with all this in the back, people continue to come in to the department, obviously we can't exactly close.  I end up with 23 people in the lobby with a 5 hour wait time just to get to a room.

One person waiting tries talking to me about how he doesn't understand how this hospital can handle an emergency when we can't even get patient's in the back to be seen.  This is the same fucker that eloped with his wife because they had been there 4 hours (she had an ulcer on her ass with an abscess starting to tunnel to another location, and it appeared necrotic) without an answer. 

I told him they had to wait because of the large number of traumas/overdoses/unresponsive patients. He didn't seem to happy but it shut him up.

After triaging a few other people, I marked 2 for the rapid medical side of the department.  One of the RNs working that unit called me to ask if we could bring them back.  Mind you, I'm still 20 deep and trying to get protocol orders completed and still triage the rest. She had 4 patients, one of whom was being admitted and the others nearing the end of their treatment.

I asked her to come out and grab the 2 extra patients.  She starts bitching about patient abandonment and how she is the ONLY one in that section (not true) and how she is leaving the provider without help (maybe true, but they don't need us to wipe their ass while working).  Instead of calling her out on her bullshit I decide to ignore her and hang up the phone.  A couple of minutes later she comes out and is still bitching about all the work she had to drop so she could get more patients for herself.  Again, instead of calling her out on her bullshit I ignore her (and so does the other triage nurse).

Basically she needs to get off her high horse and take one for the team. It's not like we have a lot of options.

The other triage nurse gets a call from home and her grandma is sick and she has to leave.  I'm then left alone for over 30 minutes trying to get everyone triaged (yes, still 20 deep, people still coming in).

I'm then told by the charge nurse to take a lunch break whenever because people are going to keep coming in.  I'm not the kind of guy to leave my coworker alone to triage 8 people in 30 minutes.  I opt to not take a lunch break unless someone comes to cover for me and help triage (never happened).

Towards the end of the night it FINALLY starts to slow down.  I'm finally in the single digits for people needing to be roomed/triaged.  Rooms are becoming more available. Someone checks in and reports leg pain. She is making such a big scene that her boyfriend goes up to the registration desk and asks for the patient to go back twice in 5 minutes.  I opt to triage another person in front of her (had been waiting for almost half an hour for the triage and palpitations come before leg pain anyway). She's making such a big stink about her pain that everyone in the waiting room was happy to see her go back to a room (turns out she was just drug seeking and she was escorted out by security. I'm SO shocked by this outcome).

Overall there were a lot of variables I couldn't control in the ED. I thank my coworkers for helping us all get through this without any real incidents.  Over the course of the 12 hours I had more people leave without being seen than I have in the 5 years I've worked in the department.  I don't blame them (other than they probably didn't need to be seen if they left).

At one point someone asked if I hated my job.  Honestly, even through all this shit today, I still like my job.

I don't think so

I have a 15 year old female patient who claims she can't see after getting hit in the face with a cell phone.  She obviously has a swollen black eye to one side but no trauma to the other side.  She refuses to even try to open her eye (unless she thinks you're not looking where she'll not only open both eyes but she is able to text from her phone without any problem until you walk in the room where she'll then pretend she can't read/write anymore on her phone).

At one point she needed to walk to the bathroom, once again "walking blindly" with her younger sister helping her out.  She calls my name and grabs my elbow (how could she see where that was?) so I can help "guide" her to the bathroom (where she then proceeds to take care of everything herself, presumably, because no way in hell I'm hanging out in there).

By the end of the night it's time to determine whether or not her eye will need stitches.  Because of all the dried blood near the site of injury (because when you're bleeding you just let it run down your face, no need to try and control it) we have to soak (damp cloth) and scrub (gauze and elbow grease). Because of the pain she is in (honestly I believe she hurt, just milked it for everything) she said she needed to hold my hand.  At this point she reaches out and grabs my hand (miraculously able to see exactly where my hand was even though her eyes were still "swollen shut").  Keep in mind her girlfriend (whose perfume smelled a lot like wacky tobacky), mother and sister are in the room with her cousin cleaning the room next door (who also couldn't figure out how to unlock a push lock door, that's something special).

Seriously, she just needed to push the handle down to unlock it and she couldn't figure it out.  Please don't breed...

I don't think so.  I literally pulled my hand away from her and pointed out her family and friends who could hold her hand during this "traumatizing moment" (ok, I didn't actually say traumatizing moment, just told her about her family in the room who could hold her hand).

Several co-workers said I should have just let her hold my hand so she could get a contact buzz from the situation (I think there was enough buzz in that room just going second hand. Here's hoping I don't get drug tested any time soon).

So, what would you do in this scenario?

Witch Hunt

Our hospital "upgraded" our specimen collection system to something called Beaker.  Now instead of the lab collecting the specimens sent to them in the computer the nurses and techs do that.  It was a big readjustment for all of us, including myself.

Over the last several weeks they have received unlabeled specimens from our emergency department more frequently.  It's becoming aggravating to my boss to have to deal with the lab and something that should easily be taken care of from our end, just an extra minute of documentation on the computer before leaving the room and you're good.

Because of the number of calls the boss is getting on unlabeled specimens (specimens are usually blood and urine though can include many other things) it feels as though he is on a witch hunt now.

Earlier this week he sent me an email informing me not to send unlabeled specimens to the lab.  He included the patient ID for me to look into the chart.

My response was simple.  If the specimen was unlabeled, how does he know which patient it came from? Or even how did he know it came from me?

As you can see (I think) I also pointed out that the patient in question had results from the urine that was supposedly unlabeled and sent to them along with a collection from myself.

Being the boss man of course I'm going to make it sound a little more professional than that.  His response, it was recollected.

I'm not the only one he has done this to.  Two other people in my department got emails from Big Boss Man with similar accusations.  Their response was similar to mine.  How does he know which patient the unlabeled specimen came from and how does he know which person to blame for sending it to the lab without the proper label?

It honestly sounds like he wants to correct the problem (rightfully so) but it also sounds like a giant witch hunt to me.  Maybe he thinks if he sends enough of these accusations out the problem will correct itself.  Regardless of how he handles it I'm in the clear as far as I can tell.

Rhetorical Questions

I was accused of not taking care of my own patients tonight. I asked her to start an IV for me on one patient (me and another nurse tried and failed) and I asked the tech to start a Foley catheter who in turn asked her for help with it.

I then hear her scream "Well fuck, why am I taking care of his fucking patients?  The only thing I haven't done for him is his assessment."

We've been working together tonight in the same section by this point for 2.5 hours and that's all I've asked her to do. Start an IV we had already missed. The tech asked for help doing her job. I didn't ask her to do it.

Anyway, I can tell she's fuming so I watch my patients remotely from the other end of the ED and I can hear her say to the charge nurse "If he would stop eating his fucking tacos maybe he could take care of his fucking patients and I wouldn't have to."

A little while later I go to the charge nurse to explain what had happened from my point of view.  He cuts me off and asks me if my patients are taken care of, if I'm caught up. I say yes and try again to explain and he cuts me off and says make sure my shit is done.  I explain again I'm caught up minus some documentation.

Whatever.  I only asked her to do one thing. Heaven forbid she get off her high horse and help.

Here's what I got out of tonight: Don't ever ask her for help, heaven forbid I set her off on a racist tirade attacking me personally, and don't ask this tech for help cause she'll throw me under the bus.

Neither one of them can look me in the eye after this, both avoid me (and I them).  So why is this still bothering me?  Chances of me being written up are nonexistent.  It's over with, I'm at home and don't go back to work until Tuesday.  Why am I still up?  Why am I frustrated over this situation?

I should pull an Elsa and let it go.

Smoke Breaks

I consider myself a team player.  I'll jump in and help you if I see you're drowning as long as I am available.  I don't expect you to reciprocate, especially if I'm already familiar with your work ethic (most of my coworkers become extremely frustrated if I ask for help, even if all they have to do is discharge a patient and send them home).

There are some things that are beyond frustrating that have happened lately while trying to help.  The one that pushed me over the edge was a smoke break.

Here's the situation.  I'm working the the "urgent care" section of the ED (Rapid Medical Evaluation in my hospital, sometimes known as Minor Care).  One of my coworkers in the acute side of the ED receives an ambulance (respiratory distress) and has 2 other patients, one of whom they are trying to determine if he has a heart attack.

The Charge Nurse asks me to leave my area and help my coworker.  I get there and she is taking care of the respiratory distress. I'm asked to watch her other two patients. The rule out heart attack needs a second IV started along with a heparin drip (blood thinner) and a nitro drip (vasodilator, makes blood flow easier).  No problem.  I get that going in less than 10 minutes (including all the documentation and explanations to the patient).

Because I am who I am, I take over the care of her other patient as well.  I make sure they are situated, comfortable, and I explain what is going on with their care.  Time passes (about 30 minutes from when I get there) and she steps out of the room she has been frantically working in.  I give her updates on her other patients.  They are settled, just waiting for admission orders (heart attack) and discharge orders (the other patient).  I'm told to stick around for a while until the respiratory distress is more stable. No problem.

More time passes, the doctors involved with the heart attack patient continue to ask me for updates and I continue to help.  I discharge the other patient.  The next time I see her she is grabbing her cigarettes and leaving on a smoke break.  I ask her who is going to watch her patients (remember, this is not my assignment, I'm supposed in the "minor care", just keeping her afloat so she doesn't come back to a nightmare of orders).  She rambles off that someone else is going to watch her people and runs off.

Seriously?  I've been watching her people for 45 minutes at this point and she suddenly have enough time for a smoke break? I still haven't given her report on her other patients so she can officially resume care of them.  I am still answering questions from the doctors for her cardiac patient yet she has enough time for a "breathing treatment"? Unbelievable.

The worst part of this situation is reporting this incident.  It's beyond ridiculous that she did this. Unfortunately the charge nurse is in no position to help because he was a substitute.  Even so, our current boss doesn't know how to confront people (instead of writing people up for playing Pokemon in the ER he sent yet another reminder we aren't supposed to have cell phones, easily narrowed to 2 people on the overnight shift).

So what about confronting the person who went to smoke? Can't bring it up to her because in her mind her people were covered so she did nothing wrong.

Honestly by the time I'm writing this I'm mostly over the situation.  Obviously it still bothers me a bit but for the most part I'm over it.  There's nothing I can do and at this point it's far from everyone else's mind.

Life goes on.

They asked me to stay late that night to help relieve lunches.  I agreed to remain long enough to transport the patients that were admitted but did not want to do any lunches, especially my smoking friend.

Politics and the ER

Politics is a very touchy subject. It can make or break friendships and relationships.  It's not uncommon for people in the workplace to have different political views.

Same goes for the Emergency Department.  While working there we develop a camaraderie that plays into helping the patients, especially traumas, overdoses, heart attacks, etc.  Bringing politics into the workplace can be especially tricky.  I can't take credit for these words but I want to share them.  I can't state this any better.

A plea to all my FB friends in healthcare: As the political season continues to heat up, can we please, please, please at least try and keep politics out of our professional lives? I know what my views are on things, and understand that not everyone feels the same way that I do. That being said, I also appreciate that people's individual political views are as much a part of what makes them unique individuals as their love of their career, their love of family, their hair and eye color, and all their other facets do. I may not agree with you, but that does not make you less of a person in my eyes. For me, what is more important than who you think should be running for a political office is that when the chips are down and someone else's life hangs in the balance, you will have my back and I will have yours. Very few people go into any of the healthcare professions for fame, money, or because they believe that some people are more special than others. The reality is that for most of us, caring for others is a core value that shapes who we are, and why we do what we do every day. No matter what happens in November, this will not change. The other thing that will not change is that we will still have to work together, supporting each other as we work to save lives and help our fellow humans through some of the worst moments of their lives. We are all on this roller coaster ride of life together, and in the end ALL lives matter, which is why we do what we do. Please let's not allow ourselves to forget that in the coming months.

At the end of the day, do you have my back to help save a life, even if we don't agree politically?