My Dilemma

Several years ago I worked with a tech in the ED.  I'll call her Molly.  Molly was lazy, only liked working with certain people, and if she was asked to do anything she needed company.

At one point she was the tech working in my section.  I asked her to start a Foley Catheter in a room while I took care of an ambulance in another room.  Molly immediately turned around and asked her friend, the RN, to help her. This RN was already mad at me for starting an IV for me (she just wanted to sit in her section and literally do nothing).

The combination of Molly and this RN was enough to tarnish my name.  The RN stepped out of the room and started yelling that I was lazy and I needed to get off my ass and stop eating tacos so I could do my own job (at this point this RN had only started an IV and helped Molly do her job, literally nothing else).  The Charge nurse that night for the next several months harassed me about me doing my own work. Never allowed me to speak, etc, etc.

I lost all respect for Molly (and that RN, but that's another story).

Fast forward, Molly was terminated from my department for attendance problems (considering her work ethic, this was no loss in my mind).

Fast forward again to yesterday. It was a horribly busy day, we got slammed by multiple sick patients within a few minutes of each other (including a cardiac arrest).  This backed up the rest of the ED for several hours.  Molly checked in as a patient where people were waiting up to 3 hours just to get into a room.  

15 people ahead of Molly, she was the only one who came up to me and asked how much longer until she was seen.  Once again, not exactly the best thing to do when there are no rooms and the triage nurse has little respect for you as a person.

Molly was eventually seen and discharged.

Over the last several weeks the schools in the area have been sending us nursing students.  Guess who was sent our way today?  That's right, Molly.

She spent the first 4 hours of her shift with someone else.  I'm stewing in my section, avoiding her as much as possible but still keeping it professional (that's what I do). I vent to some people about the person, the situation and my complete lack of respect for her as a professional.

After those first 4 hours she is then transferred to me to I so I can precept her.  I'm not thrilled about the situation. 

I'm glad I could keep it cordial but she was no different at with my interactions tonight than she was when she tarnished my reputation several years ago. She was still the entitled, lazy tech who is now in nursing school. 

I still have no respect for her as a person. I hope she never works at my facility because I guarantee I will have no respect for her as a nurse.  

Is this a bad thing?

Uh, Hell No!

I feel violated.

I received a female patient today from the local jail who was vomiting and a heart rate in the 40s (should be at least 60, maybe 50s for someone who exercises regularly and I think the only exercise this patient did was taking a spoon to her mouth).  Officers are in the room telling her to be patient while we do our job.

I can tell this patient is going to be time consuming because as she was going to vomit she would purposely vomit on the floor.  How do I know this you ask?  She was given two different emesis basins and instead of using them she leaned over the bed on vomited on the floor (classy).

Considering the circumstances I needed to start an IV to help her get fluids, etc.  I get my other patients situated so I can spend time in her room knowing it will be time consuming.  By the time I return the guards are gone and she informs me she can leave whenever because she is no longer in the custody of the police.

She claimed she wasn't interested in leaving and she wanted treatment.  I proceed to tie a tourniquet and stretch her arm out to look for a vein.

Here's where the violation starts.  The picture below is how to search for a vein (if you have a table to assist in keeping the arm straight).  In the ED this is seldom available so we use our bodies (at least I do) to help keep the arm outstretched while searching.

Veins are spongy and will bounce back to normal, arteries have pulses, that's how you differentiate.

The way she is positioned she is able to use her fingertips to touch the inside of my arm (gentle brushing, obviously flirting type), then reached up and touched my chest.  I tell her to stop and to act appropriate during the process if she wanted me to continue.

She stops, I move to look for a vein in the other arm.  Since I am now on her left arm I need to stretch out her arm and lay it in my lap (I start IVs with my right arm, searching for veins with the left).  At this point she took complete advantage of the situation.  She started feeling up my leg working her way up my leg.  Fortunately for me my wallet was in the pocket; she got distracted and tried to remove take the wallet instead.  

As quickly as possible I removed the tourniquet and stand up.  As I was standing up she reached up to my chest again and grabbed the trauma shears out of my pocket, asking if she could keep it.  I yank it out of her hands, remove all sharp objects from her reach and tell her that she is not welcome in the ED if she won't act appropriately.  I reminded her she was no longer in police custody so she could walk out whenever and left the room.

My coworkers (being the great friends they are) immediately pointed out she was in jail and just wanted to touch a man again.  Thanks guys.  She had only been incarcerated less than 36 hours by this point.  I've gone longer than that without seeing my wife (though she will probably claim I do the same thing if I've gone that long without seeing her).

This patient ended up walking out of the room and shat herself in the lobby in front of everyone, then demanded a change of clothes before she would leave.  Paper scrubs were happily provided to get rid of her.

Again, I feel so violated. 

On a side note, I told my coworkers this story and they got confused with the word shat.  It is the past tense of shit, in case you didn't know.  My patient shat on the floor because he was drunk and missed the bedside commode (yes, this was also my patient while dealing with the one above, fun night).

Family Oriented

In the ER we take care of people from every profession (obviously, we can't turn anyone away).  Most professions are typical (factory worker, truck driver, teller, food service, etc).  Occasionally we get the more "exotic" professionals.

Tonight was one of those nights.

Making conversation I asked where she worked.  She then divulged a lot of information that was rather interesting.  She used to work at "Gentlemen's Club A" before they lost their liquor license (selling alcoholic drinks to minors).  She then got a job at "Gentlemen's Club B".

Gentlemen's Club A is going to be reopening soon (at least that's what their sign says, I drive past it regularly) so I asked if she was going to return to Club A.  She informed me she would not because Club B was more family oriented.

So, that's not the reason I would ever expect out of an exotic dancer describing her place of employment.  "Hi Son, for your 12th birthday lets go to this family joint I heard about. You'll love it!"  Not exactly what I have in mind.

Her explanation isn't much better.  Club A is more cutthroat there between the workers.  They are likely to kick you while you're down (I pointed out the obvious, all the employees are competing for money).  Apparently Club B is more like a family (wrong choice of words, for all we know this area they could be family) and they are more friendly.

Interesting.  Anyone up for a family outing to Club B?

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?

What's going on?

Over the last couple of years I've had more than a few coworkers get fired.  Most of them deserved it (in my opinion), they would take a lunch break lasting an hour when it should only be 30 minutes or disappear for long periods of time.  One of them was so verbally abusive to any female "subordinate" he would make them cry.

One trend that is surprisingly shocking (to me) is the amount of my coworkers that have been fired for drug use/mismanagement.

As nurses we have to document when we take narcotics out of the Omnicell.  If the patients refuse the medication or the doctor orders a partial dose we have a second nurse sign off showing the narcotic was disposed of appropriately.

In the last 2.5 years there have been 5 nurses terminated for drug problems.  The first one I got called at home and asked if I had seen her dispose of the narcotic.  Turns out one of the patients noticed she was getting tylenol instead of percocet and reported the problem to the provider.  That led to the first nurse being terminated.

The next 2 took place about a year later.  One of them was spastic and would disappear for long periods of time.  Technically she resigned from her position and was going to work somewhere else in the hospital but she was so bad at abandoning her patients she was told not to worry about finishing her 2 weeks and she could leave then.  She was pulled over a few weeks later and admitted to the police she had been using drugs (LSD, PCP and Mary Jane).

Shortly after her the second never showed up to his shift.  There was a huge snowstorm coming in (we ended up getting 4 feet of snow in a 24 hour period).  We ended up calling the police near where he lived.  They reported he was safely in jail.  Confused we asked what was going on.  Apparently he was arrested for possession of drugs with the intent to sell to minors (he was in a school zone or something like that).  That one caught us all by surprise.

Another was busted under the influence while at work during this time frame as well.

Most recently two of my friends were dismissed for the same thing.  They were withdrawing narcotics with "verbal orders" on patients that they weren't even taking care of.  These two were more shocking to me because they were both friends of mine (the rest were like those annoying coworkers who you deal with because you need to make it through your shift without harming anyone).

WTF were they thinking?  Not only did they lose their jobs but they may have even lost their nursing license.  I worked my ass off for my license, why would I risk losing my livelihood and potentially my entire family over something so stupid and easily remedied?  Obviously their situations at home were different than mine but still.  Of all these people only one that I know of has bounced back but she is still not sure if the boss that fired her is going to press charges.  If so she will be in the same boat as the other 4.

I pray for them that they may be able to overcome whatever problem they have at home.  I wish them all the best in their ventures.  As for me, no way I'm going to throw my nursing license away for something so mundane.

Fish

On my 8th birthday (around that time) I got a goldfish.  I was so excited for my very own pet.  They even got me a bowl.

Yeah, like this except no gravel and no grass, just Goldie, water and the bowl

I wanted to prove to my parents I could take care of this fish all on my own, that I was responsible and they wouldn't have to help me.  As soon as they let me I ran upstairs and filled the fishbowl with water.  Goldie was happily swimming away, I fed it some food (all part of my birthday present, wow such a wonderful gift!)

The party finished, everyone went home and I went upstairs to check on the fish.  Bedtime was approaching and I wanted to make sure it was OK.

It wasn't moving.  I was devastated.  I pulled it from the fish tank and put fresh tap water in the tank hoping it wasn't too late.  Apparently in my haste to give it fresh water I turned on the hot water (my sister pointed that out a few decades later), sealing it's fate.

Sobbing I took the fish to the front yard and buried it.  I don't know how long I cried that night, mourning the loss of Goldie (I actually don't think I named it, that's what I'm calling it now).

See the gas can? That's where Goldie is buried.

After almost 30 years I still remember the fish funeral in the front yard digging the grave with my hands, the only light I had was from the porch.  I'm pretty sure my parents were behind me, I don't recall.  Very traumatizing for a young mind.

Fast forward to today.  My 8 year old daughter and 7 year old son both wanted fish.  My wife claims the water from the fish tank will help the humidity levels in their rooms (which is great, the boy has some serious allergies).  I'm thinking it should be cheap to get things ready, only need a bowl, a tank, and some water.

We go to Petsmart, start looking for tanks and fish and I learn that one goldfish needs 10 gallons of water to grow.  Crap, the cost of the fish just increased exponentially.  I also learn that the water needs to be conditioned for a few days to make the water safe for fish.  

Wow, everything I thought I knew about caring for fish (water, food and you're good) went right out the window.  Suddenly I realize that the hot water on my fish probably didn't do it in but the fact that I used untreated tap water (and I definitely had a bowl that was too small for that fish).

I wanted to give my kids a better chance at keeping their fish alive than I had so we grab the water treatment and everything we need to keep them healthy.

We buy the fish, 5 neon tetras for the boy and 6 guppies for the girl.  We were told the transition for the fish is extremely stressful and some may die in the process.  My kids seem prepped for this and as far as I could tell the expectations that they may lose a few fish were understood.

Two days into their new environment and all seems great.  We get home the afternoon of day two and we see one of the guppies struggling.  We bring my daughter upstairs and tell her what is going to happen.  She seems to understand.  The tetras were doing fine, all 5 of them.

We leave and run some errands, come back just before bedtime.  We go upstairs to feed the fish so we can start our bedtime routine and notice the guppy is belly up.  My daughter loses it.  All I can think about is my experience almost 30 years ago.

You teared up, you know you did.

We go check on the tetras, we need to feed them anyway.  One is dead and one is missing.  Crap, 3 dead fish after only a few hours away.  My son, handling it better than the girl, also starts crying.  

One hour before bed and we have 3 dead fish, 2 sobbing kids, and 2 parents doing the best we can to help soothe them, and one happy German shepherd (oblivious to the turmoil, just glad we're together as a family).

My kids went to sleep in much better moods than when we got home.  If this is how they are when they lose fish they've owned for 2 days, I hope I can prep them when it's time to bury our cats or dog.

What would you do?

Hypothetically speaking what would you do with your toe if it was amputated in the ED?

Personally I think I would not only get the tattoo shown above but I would probably try and pickle it and put it in a jar.  Or even better (and probably a little less crazy of a conversation point) bury it in the flower garden and make a nice headstone dedicated to the piggy who went to market.