Friday, October 10, 2014

A Dialogue in the ER

"Alrighty, you've been discharged and we can't let you sleep here all night long. Sorry, but you've got to go," I say.

She responds, "where is the nearest bus stop?" I answer that it's about a quarter mile away, north up the street, and kindly hold the door open for her. "Can you push me there in a wheelchair so I don't have to walk?" she asks.

"Um, no."

"Fine bitch," she responds, "then I need a coffee with cream and sugar, and a sandwich bag."

***

Security is next to enter the scene.

***
"Imma mess you up, I know where you live! I'm gonna give you Ebola!" she shouts as security escorts her out on foot. The sound of her screeching fades as the doors slide shut, and I wearily sign up my name to the next patient coming into my group. Abdominal pain, the chief complaint says. And in the triage note I see their first request is for some juice.

***
End scene.




Thursday, October 2, 2014

I'm back, with even more rage!

So, sorry about that time I stopped blogging for forever. I'm back and have stories saved up and shall bring all the hilarity. But before hilarity comes rage.

I'm pretty full of that rage right now, both from stupid stuff and from a confrontation with a nurse yesterday that reduced me to tears and made me feel like I was a new grad with no confidence all over again. But more on that later. First, the stupid stuff rage.

I had to buy new scrubs for this job, and whilst scrub shopping I was slowly building my rage level because of how ridiculous scrub attire is now. You never see scrubs for men with fancy little decorations on them or brightly colored trim or attractive flared darts to make the boobs look nice. And when men wear scrubs, they are viewed as a professional wearing a uniform to get a job done. Women, on the other hand, are bombarded with scrubs with sexy cat logos or boob darts or ruching and slim cut lines to enhance the body and appearance of scrubs. So when a woman wears a pair of scrubs, they aren't wearing a standard uniform anymore but instead are wearing a stylish outfit which just happens to be workwear.

And this this pisses me off. I searched for hours for a plain pair of scrubs. No frills, just a soft-wash pair of pants with simple pockets and a top with two reasonably sized front pockets and without a bunch of decorative stuff. I'm not even joking when I say I was in the dressing room for hours. The sign on the door said 7 items only, but I just looked at the lady with a side eye and defiantly carried in my 25 items.

I finally find a pair to my liking, with all the requirements and in a nice boxy shape so I don't look inappropriate. Imagine the rage I felt when I look at the tag to check the price and saw this:


THE ACTUAL FUCK?! This is a catalog model trying to be a lingerie model. I AM A NURSE. I AM A PROFESSIONAL. Not this shit. I try my hardest to be a good nurse and a professional worker in a well respected career. And this is the type of company I have to buy from. Even when I find a pair of scrubs that fit and don't make me look like I'm trying to slut it up at work, I end up supporting a company who perpetuates the stereotype that nurses are just there to look good and bring water and fawn over the real professionals who are doing the actual work. It's a bunch of bullshit, and I'm sick of it.

Saturday, September 6, 2014

Heyooooooo!

Long time no see! I promise, I didn't just drop off the face of the earth. I was busy doing things that didn't involve lots of work. Basically I miss being in college and getting summers off so I decided to live it up for a couple of months and enjoy the sun.

Here's a quick rundown of things since July:

-I finished my contract in Denver, and already miss those friends like crazy. Denver was amazing, and I can definitely see myself living there in the future.

-I flew home to the east coast and immediately went on our annual family Lake Vacation (20th year running!). It was a week of good times, delicious drinks, hilarity, and an ungodly amount of combining all three of those together while floating on a raft in the lake water under the sun.

-My boyfriend flew up to visit. He met the entire family and almost all of my friends. No one drove him off with torches and pitchforks, so that's a good sign.

-I worked back at home hospital for 2 weeks. It was amazing. I had an unprecedented string of fantastic shifts where it was busy but not overwhelming, calmed down nicely at reasonable hours, and I got to work with all of my favorite nurses and doctors. That place will always be home to me.

-I went to the Gettysburg Bluegrass Festival with family and friends. Campfires, bluegrass, jams at 0200, GORGEOUS weather, and amazing bands. It was just all the best.

-A trip to Punta Cana with my cousin. 5 days, all inclusive, amazing weather, and the BEST TAN EVER. Seriously. I had to buy new makeup when I came back because the old stuff was too pale.

-Another road trip to Texas. Yeah, I'm back. And this time, it's for a significantly longer period of time. I'm still travel nursing, but I have an actual place to call home here. It's weird. So weird. But good.


I start orientation later this month at a hospital in town, and I'm looking forward to it. I will hopefully have some ridiculous stories once things get rolling, which I shall dutifully share with you all.

Thanks for sticking with me through the slowest of summer blogging!

Saturday, August 2, 2014

Summa summa summatime

Hi folks!

I figured it was about time for my annual "I'm having too much fun on summer vacation to post anything" update, since I've spent the past three weeks variously at the lake, in my old hometown, with my parents, and my boyfriend flew in to visit and meet the horde that is my entire family/friend group. I've got another few weeks of vacation, picking up per diem time at Home Hospital and generally being a lazy bum. Then I'm back to the Southwest for more travel assignments! I'll keep you all posted when I know exactly where, but in the meantime...



You're welcome.

Thursday, July 3, 2014

Constipation

I'm not sure if this is practicing good medicine or not, but coworkers and I were sitting around the other night discussing the various alternatives to patient care (read: ways to avoid actually completing the order) when a doctor orders an enema on a young and otherwise healthy patient. Really, we'll do anything to get out an enema administration. They're not fun. Trust me.

In this conversation, I mentioned the best constipation remedy I've ever heard of - it was a comment from Hood Nurse, and I still laugh about it and wish I could tell my patients this:

If you are young, healthy, and just suffer from an unfortunate lack of fiber in your diet and subsequently think "should I go to the ER because I haven't pooped in four days?" then the answer is no. Go home, drink one cup of black coffee, eat one taco bell taco or burrito with hot sauce, and then go for a jog around the block. If you don't run the risk of shitting your pants before making it back to your house, then you may come to the ER and we will give you a bottle of mag citrate.

Pretty sure that's not an exact science though, so take it with a grain of salt. And don't sue me if it doesn't work, because this is the internet and contrary to popular opinion not everything on here is true.

Wednesday, July 2, 2014

Blame

There's this one doc I work with who is super slow at seeing patients and discharging them, but is otherwise a great provider. She's smart and thorough and a really nice person. The patients like her because she takes the time to explain everything to them, and is also very good about telling them exactly what to expect during their stay - things like "I'm worried you may have something wrong with your belly, so we're going to do bloodwork and I'll be ordering a CT with contrast. The contrast can't be given until your kidney function is confirmed as good, so it won't be done until your blood tests are back which will take around an hour. The CT will then probably take around 2 hours to be done and resulted, and since it's a busy day it will probably take me a little bit longer to get back in to you with the results. But Shrtstormtrooper here will keep me updated on how you're doing and if you're in too much pain, so make sure you communicate with her. Any questions? Can I get you a blanket?"

I mean, it took forever for me to just write that, let alone have her explain that to a patient. But I don't really mind the delay because communication really does (sometimes, if the patient is logical) prevent pissed-off people. Also, alliteration.

However, we use Meditech at this here hospital, and it's a piece of shit. This doc hates is so much that she frequently just bursts out in a string of curses whenever trying to do something mundane like chart or order something or review a test. Since she is not the quickest to begin with, this EMR just turns a slower pace into something exponentially more lumbering and painful.

So the other day, we had a patient who was somehow connected to the bigwigs at the hospital. He came in for a pretty minor reason, but the department was slamming busy and the primary nurse hadn't gotten back in after the initial assessment. The guy comes out to the nursing station, and sees this doc standing there. He's like "what's taking so long? I just got asked my address at least four times by two different people!"

Doc jumps on the opportunity that no one else is ballsy enough to take. She says "It's Meditech! It's a terrible, outdated system which doesn't allow anyone to communicate with each other and we have to ask the same questions a million times! I'm still trying to document from patients I had hours ago, and that's why I haven't been in to see you yet. You should definitely take this to the board and let them know that Meditech is awful and directly affects patient care. I'm not kidding..."

I am 99% sure the guy took it to heart, and I can only hope that somewhere, somehow, an HCA exec is getting ripped a new one for supporting such a terrible EMR.

Wednesday, June 25, 2014

Denver fun times

One of my favorite things about travel nursing is getting to experience cities in depth, not just from visiting the touristy places for a couple of days.

I haven't put up a lot of photos from this assignment, so let me remedy that for you now...

My first Denver beer.

Maxwell Falls

These mountains. I love them.
An early-assignment hike for which I was woefully unprepared. And also didn't finish, because OMGZ elevation is a bastard.

Stranahans Whiskey is so delish.

M-A-R-S MARS, bitches! Red Rocks! But seriously. It was SO AMAZING!

Baseball, of course.



Don't worry. I don't know that guy on the deck. But this view. I can't even.

So I've made some good friends, and I've had a lot of fun times. I didn't realize quite how soon I'll be done here - just a few more weeks and I'm out. I'll miss it here. I think I'd be singing a different tune when winter comes, but right now it's summer and it's gorgeous and I love this state.

The adventure will continue elsewhere, though!

Tuesday, June 17, 2014

Throwback

There is this doc I work with who is super badass. He's no nonsense, only-the-necessary-workup type, funny, compassionate, and intelligent. I seriously enjoy working with him because he's the best mix of all of the above, and gets shit done in a timely manner to boot. Basically, an ER nurses' dreamboat of a doc. I mean that not in a Tiger Beat weird way, but in a professional "I enjoy coming to work and seeing this doc on the schedule" kind of way because I know the patients will be well taken care of and I also won't hate my life during the shift.

He does, however, have one downside.

Every single shift sees him wearing these awful, hideous, terrible ACIDWASHED JEAN material scrubs. It's so painful. Is this the 90's? These scrubs are the equivalent of me putting a VHS tape into the VCR and the machine eating the tape. Or of hearing the devastating news that *NSYNC has broken up fo' eva. Possibly as bad as having a Lisa Frank folder that didn't fit into your trapper keeper.

All I'm saying is that this doc somehow stopped dressing himself in the 90's. And a very small part of me is amused by it, but the vast majority of me is like NOOOOOOOOOOOOOO, the horror! I wish I could help. I think, however, that he is too far gone to save.

Wednesday, June 11, 2014

Food

I've gotta hand it to the tech and nursing staff at this Denver hospital. They have these docs trained so well it's almost like watching an educational video. I'm seriously impressed.

When the 11am doc comes in she brings a tray of cookies. When the 5pm doc shows up he brings a veggie tray and a two liter. When the 9pm doc arrives he brings a bag of chips and m&m's. When the 6am doc rolls in she brings a dozen bagels.

Every. Single. Day.

I'm not exaggerating. Every single day, when the docs show up for shift they bring food. I didn't go grocery shopping this week because I'm lazy and couldn't make myself get out of bed early, but I didn't starve at work. I also didn't eat healthy but you win some and you lose some. The important matter is that I was never hungry, because the nursing staff has laid down the law and demanded food and their edicts have been followed ever since.

I've never worked anywhere else that had the providers trained this expertly. I've really enjoyed working at this hospital, and will be sad to leave when my contract is over. It's full of great people and the city is fantastic. But if for no other reason, I'll miss my daily 6am work bagel.

Friday, May 30, 2014

Science

In the ER world, gravity + beer is a very bad thing. It inevitably starts with the famous "here, hold my beer" statement and is quickly followed by a brutal demolition of both ego and intact anatomy. I'm pretty sure Newton even started formulating his equations after witnessing some drunk guy holding an apple while on a horse go, "Hey guys! Watch this!"

These unfortunate people are most always surrounded by a group of people who either gasp in horror or point fingers and laugh. Sometimes, the act of Spectacular Fail is even recorded on video for posterity. Which helps me out in the ER, when my patient comes in with a broken arm and has a perfect rebuttal for the question of "Oh my God! HOW did you DO that?!"

Fortunately, there is no shortage of beer in this world and no shortage of stupid people willing to hand over said beer to try something dumb.

Take, for example, this girl:


Close analysis of the picture reveals a few things: a hill in the background, a bike, a bike wheel at an odd angle against a piling, and a bike rider with a face accelerating towards the dock at 9.8m/s^2. Fortunately, she's wearing an alcohol helmet and flip flops. Because safety first, you guys.

I can only imagine the shame that was felt by this girl after this accident. Wait. I don't have to imagine it...

Because I'm that girl.

Science. Helping drunk people make a fool of themselves since the Neolithic Era.



Sunday, May 25, 2014

I'm done on this topic, for real. Until next time.

You see? YOU SEE?! I've posted many, many times about this. So have all the researchers. I'll post it again though.

VACCINES DON'T CAUSE AUTISM.

(Link: I Fucking Love Science: Huge Meta-Study of Vaccines Reveals No Link to Autism)


Friday, May 23, 2014

Night shift

I swear...night shift gets no love. Last week I worked a shift where we were severely understaffed - I'm talking there were TWO nurses from 3a-7a. This ER has been getting busier and busier, so of course this was a slamming night. Want to know about unsafe patient ratios? Try sixteen patients for two nurses. 8:1 ratio. That translates to 7.5 minutes of care time per patient per hour. Which is awful. Pretty much I went from triage to triage, threw in an occasional IV, and did a couple of EKGs in that time. And charted. Sort of. And because this place has no triage nurse, we can't leave people in the waiting room like a normal ER.

By the time 7a rolled around, we were drowning. I was sitting at the desk charting the three new triages and one EKG I had done in the last 10 minutes, and the dayshift charge grabbed the staffing clipboard to fill out the assignments for the day. "Oh man," she sighed, "we're so shortstaffed today! There isn't a float to cover lunches, this sucks!"

The other night nurse and I just looked at each other. Or we would have, except she was taking up her own tele admit since we didn't have any techs.

I would be pissed, but it won't do me any good. We'll continue to be dangerously short staffed on nights, because administration needs to cut costs and nights are where it comes from. We'll continue to get burnt out on nights because we do the same amount of work with a fraction of the staff. I'll continue to blog about it because I'm just a traveler who gets pulled aside to ask why I took an hour to discharge a fast-track patient instead of congratulated for making the five minute EKG time even though I did an entire nSTEMI workup myself.

On the plus side, free pizza almost every night. And free diabeetus...

Wednesday, May 14, 2014

Burnout

I love ER nursing. I really do. I love the rush I get from successfully managing really sick patients. I love the ridiculous things overheard from patients. I love being able to help someone not by giving all the meds or hanging blood or placing an IV, but by holding their hand because it's 6am and they're sad to be missing Easter dinner later today. I love the camaraderie of all the staff placing guesses on the BAL of the local college student who just came in. I love when the ER doctor I've only just met a month ago asks if I'd be willing to housesit for her, because she thinks I'm a competent and responsible person and "would trust me with the house, since I definitely trust you with patients."

There is a lot to love in the ER.

But when someone asked me the other day how I was enjoying travel nursing, I found myself not talking about all the things listed above, but how much I hated the politics of medicine and how awful satisfaction-based care reimbursement is and how resentful I am of the people who come in and get everything they want because they're entitled and know how to work the system.

I found myself saying, "I love the ER, but I kinda hate people now." And that makes me sad. I started this career as a nice person, one who loves people and helping them and was full of naivete and compassion. In return, the direction medicine has taken is slowly overtaking the compassion in me. It's still there, but it's buried beneath cynicism and bitterness.

When I get a patient who says to me, "I hurt and the only thing which works for me is dilaudid," instead of thinking she probably hurts really bad and has been through this before I immediately jump to how much of a drug seeker she must be and how it's bullshit to even be in the ER right now. When a 22 year old comes in on the ambulance for a mild asthma exacerbation, texting and wearing a brand new hat, then asks for a cab voucher home, I don't think that perhaps he is homeless and wearing the only things of value he has in the world; instead I think that he's just a typical arrogant entitled drain on society who will get that voucher because the hospital can't say no without getting a bad review. When a patient lashes out at me and calls me horrible names, instead of thinking that he is in the most stressful time of his life and have reached the crisis point where he can't cope with the stress anymore, I immediately write him off as a horrible person and provide appropriate nursing care but extend only the bare minimum of servility to him. The things about these patients may be true, but the fact that I immediately jump to them instead of giving the patients the benefit of the doubt, if only for a moment, says a lot about me.

I never wanted to be that cynical nurse from the nursing school horror stories. But here I am, waving that flag like it's going out of style. I'm sad to have found myself in this position, because I truly do love nursing and the ER. I'm hoping the system will someway somehow start to be fixed, because seriously. This can't continue.

Friday, May 2, 2014

Friends

The best part about travel nursing is the number of new friends I've made across the country. The hardest part about travel nursing? Making new friends.

You see, I went to a smallish rural high school where the people I graduated with are the same ones who pushed me down on the playground in kindergarten or who I puked on in gym class in third grade (just kidding - I actually puked in a potted plant, not gym class). All the friends I had in high school were people I had known my whole life. It was easy to be friends with them, and there were enough of them around that if you didn't like someone you just didn't hang out. When I got to college I was placed in a dorm with three hundred other people - a couple of us found ourselves living together the next year, and friendships were born. It's not hard to be friends with people when you have TV marathons at 4am and create hard copy calendars for pooping schedules and hold prank wars involving firecrackers in an underwear drawer or a Harry Potter doll set into jello. It's also not hard to make enemies when you have to fight a roommate over burnt out light bulbs or who forgot to wash a fork, but that's besides the point...

My actual point, which I've gotten kinda far from, is that in high school and college it's pretty easy to make friends. If one is super introverted it's a bit harder, but the opportunities are still there - in both schools there is a built-in group of people who one might have things in common with. Travel nursing removes that built-in group and forces me to step outside that comfort zone.

There is always the risk of rejection when meeting new people, because one doesn't have the benefit of being in a situation where you'll see them again and again for months or years and can mutually take the time to decide if a friendship should happen. Many times they don't want to invest in someone who they know will only be around for a short time. Sometimes you even hang out and discover that no, you actually don't like that person or vice versa. But you just have to put yourself out there on day one and hope that others will respond in kind.

I did just that in Austin - at one of my first post shift breakfasts I wrote my phone number on a bunch of pieces of the receipt and handed it out, saying "Guys. I don't have any friends here. I want to have friends. Call me if you're doing anything fun, okay? Here's my business card..." And it took a few weeks, but they did. And I made life long friends. So when I got to Denver and was seated in orientation next to a girl who works in a different department, we exchanged phone numbers after discovering that we didn't know anyone around. Tonight we met up for dinner, and have plans to grab drinks in another week or two. And there you have it. My first friend in Denver.

Thursday, May 1, 2014

Calendar

I had a real post all set to go. But then the interwebz happened. And when you wake up,



You're welcome.

PS, actual post to follow in a day or so, after I've stopped laughing at this.

PSS - Yes, I know the size is off on the header picture up top there. Blogger has defeated me, and I give up for the night. In other news, I'm technologically illiterate. I've become one of those old farts that I always laughed at - like when your sweet uncle fumbles with the iPhone because it only has ONE BUTTON OMGZ but it's not funny anymore because now I'm that person. Le sigh.