She's fine

Charge nurse got a call from a nursing home last night about a patient transfer. "She's had some shortness of breath for an hour, and when we checked her pulse ox on 2L was 60%. We're sending her to you by 911. Her vitals are decent; BP 166/89, HR 103, RR 16, temp 100.9, and pulse ox 60%."

Charge nurse remarks that her O2 must have come up from 60% if her vitals are okay now.

"Oh no," says nursing home nurse. "They're still 60%, that's why we're sending her."

Face palm. Again.

Lady had raging pneumonia, sepsis, UTI, and probably things we don't know about, like malaria and/or river blindness. And oh yeah, that RR of 16? Try 46 instead.

Definitions

Inevitable: the itch that appears on your scalp deep into the hairline immediately after painting all ten fingernails.

Ridiculous: how I looked trying to scratch that itch with my forearm, shoulder, and wall corner.

Resigned: how I felt after messing up my nails at 5:10 am and realizing I should have been in bed anyway.

Oh hello, brick wall.

0200
"My daughter was here yesterday for bronchitis/pneumonia/ear infection/ebola and you gave her antibiotics. I gave her another dose today but they aren't working because now she has a fever. At least she feels hot. I don't know what it is."

Did you give her motrin or tylenol?

"Was I supposed to?"

Well, yes, those are medications to keep her fever down, and since she has a fever...yes. You are supposed to give them. I went through all that yesterday when I gave you discharge papers.

"Well how will you know how high her fever is if I give them at home? And why isn't that antibiotic working yet? It's been over 12 hours! And can I have a work note?"

Face, palm, repeat.

Essentials

I've really got it good. When I show up to work, I can adjust the heat up if the nursing station is freezing. I get myself a cup of ice and water when I'm thirsty. My patients always see me wash my hands when I first walk in a room, and again when I leave. If they need Diltiazem, I pull it from the mini fridge after I've used my computer access password on the accudose. If a patient is coding, we need to defibrillate so I don't think twice about zapping them - and I can watch the instant results on the cardiac monitor.

If my patient is incontinent, I grab a pack of heated wipes and a full supply of new clean diapers. If my patient has CHF, I use the desk phone to call respiratory so bipap can be set up. I take the elevator downstairs at 0200 when the cafeteria opens, so I can get myself a fresh salad. I even take full advantage of the free iced tea machine.

When I need a stat medication, pharmacy tubes it up. When my patients are cold, I grab them a heated blanket. When my drunk and violent patient is going batshit crazy, I take comfort in knowing they're on the security cameras when they're escorted out.

When there is a bit of traffic on the highway to work, I get annoyed. Damn! A twelve minute drive has turned into seventeen minutes. The horrors! We staff find things to complain about all the time - computer downtime, the three hour wait out in triage, the fact that it's too busy to finish that cup of starbucks...

In short, I have everything I need to adequately take care of my patients and I still manage to whine about what I see as "hardships."

But really, my hardships are nothing. Senen General Hospital in tsunami-hit Japan is currently flooded - the basement, home to the electrical room and the boilers, is still full of water and the entire first floor medicine supplies have been ruined. Their nurses and staff members are homeless too. Yet they show up to work for 24 hour shifts in a hospital that has no power, no running water. No heat, no light, no wall oxygen. No medicine refrigerators, no heated blankets, and no med pumps.

And still their hospital operates.

I have nothing to complain about in my job, do I?

Spring fever

Oh hello, Springtime. Nice to see you again.


And also, hey Annual Springtime Sunburn. While it's been real, I think we've seen enough of each other today. Let's just plan to meet again next year, okay?

***
It's spring fever. That is what the name of it is. And when you've got it, you want - oh, you don't quite know what it is you do want, but it just fairly makes your heart ache, you want it so!
-Twain

Stupid laughs

This is funny.



In other news, I have the humor of a twelve year old boy.

I'd like to sink into the floor, please

You know what's embarrassing? Getting words mixed up when talking to someone.

You know what's even more embarrassing? Getting words mixed up when talking to someone important.

You know what's mortifying? Getting words mixed up when you're overheading someone important on the Emergency Dept Intercom system.

Yup. I did that tonight.

"Can I have a consult to the doc for a Priority 1 radio, please?"

True story.

Intelligence

So the other day I'm sitting in a staff meeting, and I'm supposed to be learning all sorts of new ways to increase patient satisfaction through new processes...when really all I can hear is this:



Anywho, one of the complaints we get occasionally is that patients don't know what they're waiting for. Sometimes a legit complaint...but usually not. "Yeah," snarks Fun Doc, "it's because they're idiots." I laughed, but then I wanted to cry. He's right. A good percentage of our patients are really, really dumb.

Before you flame this post for my blatant disrespect of patients and their rights and their feelings and my hatred of unicorns and rainbows...consider the following:

Recently I had one such patient. I do my routine assessment, and afterward I'm talking with one of the techs just outside the room. I watch the doc walk into the room, with the scribe. He's in there for 10 minutes. The doc leaves, and I walk back in. "Alright," I say, "I saw Doc was just in here, and he let you know that we're going to be drawing some blood and getting an xray, so I'm going to start with the bloodwork now."

The patient blankly looks at me and goes, "What doc? There hasn't been any doctor in here yet."

I'm like, guy that left 90 seconds ago? Stethoscope? Asked you lots of questions? Introduced himself as Dr. Doc, with a nametag stating he was Dr. Doc? Had a minion scribe furiously typing away? Anyone...anyone. Bueller?

The patient looked at me like I was crazy. And steadfastly maintained that there had been no doctor anywhere in sight. I could only shake my head.

So flame on, people. I rest my case.

Lessons

There are lots of different personalities that work in the ER. Loud, relaxed, abrasive, and low-key. Usually we all get along pretty well, but occasionally there are spats. The student I had shadowing me the other day discovered that first hand.

I had a pretty sick patient, who we decided needed intubation. I prepped all the RSI stuff, the doc explained everything to the patient and family, and respiratory got the vent set up. We intubated, and I started the sedation drip. The patient was down for maybe five minutes, and then when the initial drugs wore off but the drip hadn't kicked in yet, the patient started fidgeting. I was talking to the patient, reassuring, and she was nodding yes or no. I assured her that the sedation would kick in shortly, as I titrated the meds up a little.

Respiratory, however, apparently didn't like this. "The patient is going to pull the vent out! She isn't sedated! What is Doc thinking?! This patient isn't ventilating, she's going to crash!"

I'm all like chill, it will only be a few minutes, the patient will be fine. Nope, Doc walks in the room and Respiratory lights into him. Like all out verbal spat with him - you didn't adequately sedate this patient! This patient is going to die! Doomsday! Accusations!

Seriously, talk about overreaction. I look at the student, who is making herself as tiny as possible in the corner, student looks at the patient, and Doc looks at me like for realz, is this actually happening? Since I'm well aware he doesn't like this RT at all and this RT hates pretty much everyone who works at the hospital and all the patients that come in, it was rather apparent that this spat was on the verge of becoming an epic hissy fit. I stepped into the middle of the room and sort of put my hands out - "Okay, people, let's not forget that this patient can hear us and is probably wondering what the hell we're bitching about. And there are a bazillion people outside this curtain who can also hear this. So let's grow up and not fight inside this room, kapish?"

Both the doc and RT gave me about two seconds of silence, and then lit back into each other for a good five minutes - albeit in a relatively quiet volume - regarding care of the patient, vent management, proper sedation, and generalized insults. I snuggled back into the corner, handed the student a bowl of popcorn, and told her to enjoy the show.

Until the doc rounds on me, and blurts out "and you, you stay outta this!" And then blows out of the room all huffy.

Respiratory, now that the patient is properly sedated - as she would have been, with or without this argument - blows out in a huff too. And the poor student is left with her jaw on the floor. "You guys fought! He yelled at you and you didn't even do anything wrong! Is it always like this here? It's so rude of Respiratory to say those things, and Doc was so rude to talk to you like that. How can you stand it?" The poor student was astounded.

A useful lesson, though. Not all staff get along. Not everyone can have an adult conversation over a disagreement. Sometimes nursing staff is in the middle of it all, and we just have to remember to focus on the patient. The best part though? When Doc blows back into the room three minutes later and apologizes for getting snappy with me when his beef was with Respiratory, and for getting sucked into a pointless argument.

I think the student had a good experience. I always hope the students get to see some crazy sick patients, wild stories, and generally interesting cases; it's even better when they get to learn how staff can fight, resolve the issue, and move on.

****
Eh, I need an editor. Sorry this post is so fecking long! Obviously the literary world is not my calling...good thing I have a day job.

Dreams

It must be nice to remember dreams. I mostly just remember flashes of them, like a landscape picture, or an emotion or even just a word. There is only one dream that I remember vividly, and it's a fecking creepy recurring dream. I've looked it up multiple times, and apparently it's one of the most common recurring dreams out there. Supposedly it means I've lost control of something in my life, like I can't control my appearance or I can't make my voice heard or even can't stand up to an intimidating person; I beg to differ - if I was as weak noodled as this dream suggests, I'd be a seriously messed up person. Besides, I like to think that I'm fairly low maintenance, secure in myself, and generally harboring a secret badass that comes out when intimidating people are around. But, I digress.

The dream? My teeth falling out. I'll suddenly get the feeling that a tooth is loose, and when I reach up to touch it, it falls out into my hand. I look at it, and the inside is all crumbly like brown sugar. The rest of my teeth start to feel wiggly, and I try not to touch them but one by one they crumble and fall out in pieces. It's not painful, just the weirdest sensation. I usually wake up once all my teeth are gone, but I never remember anything else about the dream - like where I am, or what lead up to the tooth disaster.

I'm telling you, it's the weirdest feeling. But it's pretty harmless overall, and since plenty of other people have it too I guess I'm not too much of a freak. It's the other dreams that worry me...

Like when I wake up with a certain word in my head. I have no idea where it came from, or why I'm dreaming about it...but it must have been a vivid and odd dream to stick in my head like that. I'm just really worried when it's a word related to work. I can only imagine how freaktastic my work dreams must be.

For example, I woke up today with the word Octreotide bouncing around. Just that one word. No other scenes, or feelings, or context. Octreotide. In case you're wondering what it is, we use Octreotide in patients who come in c/o belly pain and vomiting and then say "oh hey by the way I'm a raging alcoholic" and then lean over the bed and go BBBLLLEEEAARRRRHHHHGGGHHH and promptly vomit up astounding amounts of blood from their ruptured esophageal varices. I've never actually taken care of one of these patients however, so I don't exactly know what this scene would look like.

Apparently my dream imagination can make it up pretty well though. I can only marvel at the blood and gore spattered scene it must have been. I mean seriously, it must have been like Saw XI up in my brain for me to wake up with a solution to blood in my mind.

Octreotide. At least my sleep self knows what to do in that situation.

Let's just hope I never wake up with the words "Christmas Elves" bouncing around.

Lando Calrissian. What's he smuggling this time?

I'm Lando Calrissian, and I approve this message.

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