Hood Nurse: Thoughtful Answers

I'm in triage the other night when a nice younger gal checks in for some kind of strep/allergy/viral illness hybrid- not life threatening but definitely super unpleasant. I get her vitals and history and ask her the dreaded pain scale questions.
She thinks for a while, then rates her throat pain a 9 and her headache a 7. Then, she stops herself, thinks for another little while, and says,"wait, I guess like, people who get shot come here, and probably their pain really is a ten. So I guess mine isn't anything like that, so that number should be like, way lower. Sorry."
I could have hugged her. Instead I just smiled and told her I always thought that scale was really stupid anyway, and walked her back to a room in fast track. At this point in my ER journey, this sort of perspective is almost just as refreshing as taking care of someone with an actual emergency.

Hood Nurse: A Little Perspective

Verbal abuse in the ER is hardly notable, even at the much nicer job I'm at now.  I'm pretty sure there's actually a mad libs version that would fit 90% of these encounters. Feel free to play along-  get me some (noun) you little white/tattooed (noun).  I told you to (verb) you (adjective) bitch! This is my life. Not every day. I've mastered the blank stare, usually followed by "okay!" with a smile as I call security.  Sometimes, though, the rationale for the verbal abuse is so minuscule and unexpected that it manages to make me a little angry.
Such was the case the other day, when my request for a UDS on my definitely chronic homelessness/maybe acute on chronic psych patient was met with "get me some juice", and I had the audacity to reply, "sure, can you grab me a urine sample while I'm getting that?"  Yeah. So as a general rule I don't get juice for people who refer to me as a stupid bitch, regardless of how much screaming you follow it up with. SAH-CUR-ITY.
When security's stern talk about honey, vinegar, etc. was not well received, they sent the social worker in to try to clear her for discharge, who finally brought her some juice to get her to stop screaming. Crazy lady then gave me a talk about how I should be more professional and proceeded to obtain a nice cocaine metabolite filled urine sample for us.  Afterwards she made sure to tell me that I was a "scared  little white girl" for calling the po-pos on her. I was DONE.
I'm sitting charting all this foolishness being irritated as hell over and above my baseline pregnant bitchiness when the social worker came to talk to me.  What she said could not have been a more perfect antidote to my angst and frustration.  "Yeah, hood nurse, she's completely batshit crazy.  Don't take it personally.  She's absolutely out of control and awful, so there's no point on even trying to reason with her. She's not this way because of anything you're doing, or anything anyone is doing- she simply lacks the capacity to be any other way.  She's not capable of being calm, or reasonable, or nice.   And what a horrible life that must be."
Really thinking this out nearly brought me to tears. I actually did cry when I thanked her for saying this a few days later. Maybe it resonates with me more now, being crazy hormonal and more emotional than I've ever been and having the sensation that my feelings are not coming from within myself, nor do they seem at all in character with who I feel I am as a person.  I'm sure this pales in comparison to people suffering from mental illness. I can't imagine feeling things so strongly and beyond my control every day, for life, and struggling constantly to strike the right balance of medications with innumerable awful side effects to just be able to function in society.  Even worse, the people that suffer from hallucinations and delusions and who live, what for most of us, would be a bizarre nightmare- only they never wake up from it. It's no wonder so many of these people turn to drugs or alcohol.
I hope it doesn't come across that I'm excusing or justifying bad behavior.  Aggression should be dealt firmly across the board, because when it isn't, dangerous things happen.  It's just in situations like this, it's really easy for anger to be the first emotion to surface, even when it's not the one that will get us anywhere.  It's advice I'd always give to the new nurses I mentored, but that I still find hard to take myself sometimes- you can't argue with crazy.  Beyond that though, and what I'm trying to be mindful of from here on out, is that not only can we not reason on that wavelength, but we should be very, very, very grateful that we can't.  I hope I play those words back in my head every time I feel my temper rising, and my face flushing.  "What a horrible life that must be."  Indeed.

Oxygen is a privelege, not a right. Right?

I had a moment of slight alarm when I put the Sp02 monitor on my patient the other day and it read 89%. "Do you have any history of COPD, sir?" I asked. "Or maybe any other breathing problems?"

He looked at me with a blank face, so I quickly pulled a nasal cannula off the wall and started to apply it. The nurse who was precepting me was like, hey, he probably doesn't need that. I was all "yeah okay, I guess oxygen isn't all that important but whatevs" and kept putting the NC on. The guy denied feeling short of breath, tired, or anything. So I go to turn on the O2 at 2 L, and again my preceptor is telling me that he probably doesn't need it. In my head I'm thinking she's a crazy person because we all need oxygen, right?

Then she gets one of those lightbulb moment faces, and asks if this is my first job at altitude. I answer yes, and she looks all satisfied.

Three minutes later, I'm educated on the fact that apparently everyone here in Denver lives in the 89-100% range, instead of the more common 95-100% non-COPD range for everywhere else. The more you know, I guess?

I dunno. I still put the oxygen on, because I just felt more comfortable doing that. No one's gonna die from hypoxia if I have any say about it, dammit.

Black cloud

I've had pretty good luck in my past few assignments in not being a total shit-magnet, but I've got a feeling that this one's gonna be different. It harkens back to Ye Olde Days of Home Hospital. I've already told you about the dude who dropped a deuce on the floor on day 1 off orientation, but did I also tell you about the guy I put in restraints literally the FIRST FIVE MINUTES of day one? No? Well, I'm gonna tell you now.

My first shift off orientation was a bit dodgy since I didn't have computer access yet. Being a Meditech user, the awesome high tech piece of shit this system is thought I was still in Texas even though multiple requests had been made to change my access. No luck. So I'm stuck without.

Because of that, the charge nurse put me as the float for the first two hours so I could just task and not worry about charting. I ask a coworker if there's anything I can do, and she gives me a gown and requests for me to go change a heroin/meth/pcp guy out of his street clothes. I mosey into the room with security, and the guy is sleeping on the stretcher.

"Hey man, we need to get you outta those clothes and into a gown. Hospital policy." The guy cracks one eye open, mutters a Fuck You, and goes back to sleep. I give security a look, and then shake the guy's shoulder again. "No seriously, you need to change. Get into this gown and then I'll leave you alone." He opens both eyes, and I'm not even kidding - straight up exorcist screams, throws a shoe across the room like Hillary Clinton was standing there, and lofts his blanket at the security guard. This next step was great, and points for creativity. He rips the tubing out of the saline bag hanging from the hook above him, and then power-wash style squeezes the bag and sprays every person in a ten foot radius. At this point the security guard calls for restraints and everyone piles on to apply them. I ensure they go on in a medically safe way, and then walk back out to the nursing station where I hand the gown back to the nurse and shrug my shoulders. She's like yea, I kinda expected that to happen so don't even bother apologizing...

Good to know I'm not only a shit magnet but also a sucker.

Give a warm welcome to Hood Nurse, y'all.

Look everyone! A blog friend! Please extend a golf clap to Hood Nurse, who will be guest blogging here occasionally until she decides to maybe or maybe not start up her own site again. I'm stoked she'll be contributing, since now errbody gonna get ALL THE CAT VIDEOZ the interwebs has to offer. And also insightful/hilarious/ragey commentary on the world of ER nursing. You're welcome.

See the post below for her first guest spot!

Hood Nurse: Stop The F-ing Madness

Hey guys, prodigal blogger Hood Nurse here, starting my new co-blogging/ hopefully not blog ruining gig with my dear friend Shrtstormtrooper.  Hopefully after this she won't be like... hey, I was just kidding about you contributing, but here's a cat video you might like... 

Anyway.  Nothing to shake the rust off quite like getting really angry about stuff, so here goes.  

I was just hanging out, chipping vinyl siding off of old furniture and listening to Pandora radio at 3 AM like any normal person when an add came on for my old hospital.  Advertising their super awesome sparkly unicorn new and improved online check-in system, where you can check in on their website and make an appointment in the ER so you can wait at home and get seen faster for your "emergency".  UM.  Let me just stop you right there.   

The hospital in question is, in fact, a real ER, like that actually takes care of dying patients, and not a free-standing "ER" that should allow for checking in online for your tummy ache/UTI/stubbed toe/prescription refill/minor discomfort that you absolutely can't tolerate long enough to see your doctor because you can't deal with any form of pain or distress. Those of us that work at these places understand the distinction.  The general public does not.  I WONDER WHY. 

To put it kindly, whoever is coming up with these marketing campaigns deserves to have the shit beat out of them with a pillowcase full of soap, prison style.  I'm sorry.  I just refuse to believe that things like this benefit any legit hospital.  Free standing boutique "emergency rooms" are now a thing, like it or not- they're glorified urgent care centers that hopefully hire people qualified to take care of your outpatient emergent needs, who will subsequently charge you and your insurance company all the dollar bills for your treatment and even more dollar bills if you need to get transferred to a legitimate hospital to continue your treatment inpatient. I know this, because I worked at one as a second job for a bit.  I'm of the opinion that these places don't really have any business calling themselves emergency rooms if they don't have the means to provide inpatient care, but I could write a whole other post about how sketchy these places are just by their nature.  

The point is, despite what they call it, they are urgent care.  We are the ER.  We have absolutely NO BUSINESS acting like an urgent care center. We have no business trying to compete with apples when we're MF-ing oranges. Most of the well-to-do folks who you might be able to trick into patronizing your legit ER for their urgent care needs might, in the best case scenario, catch you on a slow day and be impressed with you.  Worst case scenario, they'll get there, realize that they're in an actual emergency room where people who aren't legitimately ill have to- OMGZ God forbid- wait- and they'll get epically butthurt and send you a Press Ganey nastygram or complain directly to the hospital bigwigs, who will in turn crap all over you for providing a subpar patient experience.  

What I'd like to say to said bigwigs, but am yet unable to until that Nigerian prince follows through on his promise to send me great riches, is HELL NAW.  You can't have it both ways, bitches. You can't go to conferences and brag about how you work for the big name hospital with a super amazing A-number-one trauma/stroke/STEMI program, and then expect the same doctors and nurses tasked giving the absolute best emergency care and saving lives to give more than .000001 fucks about how long the person with private pay insurance and an Audi has been waiting to be seen for their hangnail.  NO. If you want people getting seen for their trifling complaints to be happy, either build a free-standing fake ER across the street and send the sick people that might stumble in exclusively to your affiliated real hospital, or stop setting unrealistic expectations and then blaming your staff when people are disappointed.  

I don't want to come across like I have a problem treating minor complaints, or that I think I'm above handing out band-aids and Z packs.  It takes all kinds to make the ER world go 'round.  BUT- by nature of the ER world, those patient may end up waiting for quite a while.  It's doing them quite a disservice to teach them to expect otherwise. 

I hate Meditech, part 2.

I remember, once upon a time like a month ago, saying to myself that Meditech is the absolute worst possible excuse for a charting system ever and I would never ever ever ever EVAR allow myself to work in an HCA facility again. After that statement, I was feeling pretty pleased with my level of conviction and gave myself a little pat on the back for making strong pro-sanity career choices.

Fast forward a week, and I'm interviewing for the position here in Denver. I've already expressed to the trio of interviewers how much I want to come to the city, and as that was the only position offered I had already internally decided to take it. Towards the end of the interview, they mention that they're an HCA facility. Mentally cussing everything in existence, I ask which system they use. "Oh, we use Meditech."

Well, fuck.

Maybe it won't be that bad, I tell myself. I liked the hospital in Texas, so maybe I'll be okay and like this one too despite the system. Maybe I'm just remembering it worse than it really was. Maybe, I say to me, I'm just spoiled and it's not really all that bad.

Folks, I've been here almost two weeks now. I can emphatically say that it IS THAT BAD, and Meditech has been confirmed through a repeat study by me that it is the worst ever. Maybe I'm just whining, but dammit it's so terrible.

This is 2014. FFS, why are we using the Atari of electronic systems?! Dedicated to the highest possible care of patients, my ass.

Eye bleach

Some things you just can't unsee. For example, the dude who was taking a stroll through the ER lobby and decided yup, that tile right next to the bathroom door is perhaps the best possible place ever for someone to drop trou and take a shit. And I'm not talking about a little squeaker turd, or even a tiny little shart. I'm talking about how this dude most definitely hadn't pooped in at least six months. Until that moment. On the lobby floor. Remember those Tamagotchi toys where the poo just piled up until you finally had to deal with it? Just like that, except not adorably pocket sized.

And the worst part? He had gone into the bathroom two minutes previous AND CAME OUT WITH TOILET PAPER! This was a premeditated shit! A grown ass man. Shit on the floor like a two year old. At least he threw the TP away, so he's just a floor shitter instead of a litterbug floor shitter.

There are no words, just as there is no enough eye bleach in the world strong enough to make me unsee that.

So far...

Thoughts on Denver so far:

It's a lot colder than Texas. It snowed here on Wednesday, and I was so unprepared for it. I walked outside in my sanuks and was like, oh, well, okay. Six inches of snow. Guess I should go put some boots on. But everything was still packed in my car and I couldn't get to my shoes, so instead I just went back into my hotel room and watched a terrible movie.

It warms up really quickly here. About four hours after I was unprepared for snow and admitted defeat, I went back outside and all the snow was melted. Seriously, six inches just gone. And it was almost warm enough for a tee shirt. I've been told that's what to expect in the springtime here.

The hospital is small. There's a 28 bed ER, but it feels waaaay smaller than that. They saw 97 patients the other day and were like "good job on a crazy day, folks!" From what I'm used to, that's nothing.

But they have a terrible, terrible layout and a pretty bad triage & communication system so it actually somehow feels busier than it is. There's two little sections of three beds each that you have to walk THROUGH the nursing station to get to. So when XR comes to get that patient, they push the stretcher right between all the residents and clerks and extra chairs. It's the most ridiculous layout I've ever seen. And instead of having one big supply room, they have four small ones. FOUR. Why? Because a kindergartner designed this place. There are three pyxis machines, and each one has different meds. Because of course. But the worst part? Instead of carrying phones that ring and the patient can be aware that you're talking to someone else, we all wear these headsets that make me feel like I'm working at McDonald's. So when someone starts talking, I have to divert half my attention to the earpiece while still trying to talk to patients or staff. And it's either too quiet or blasting my eardrum. No happy medium. If I can get away with stealing one of these headsets at the end of my contract, I'm going to light it on fire in the parking lot.

The people are pretty nice. They're polite and helpful, but seem distant and not all that willing to take in a stranger. I don't see myself getting to know a lot of these people, at least not anytime soon. There's also the downside of this being a smaller ER so I don't have a lot of staff to meet anyway. I'm hopeful this could change - I do seem to remember hating my Texas assignment for the first month, and then loving it. There is one coworker who is friends with a good friend from Texas, so I'm hoping I can maybe get in with them.

Denver itself is really nice though. I have a friend who lives in Boulder, and he was in town today so I met up with him and got the chance to walk around downtown a bit. There are a ton of places to eat and drink, and I'm optimistic about the exploring I'm going to do. I also looked up an observatory near where I live, and they have public open house nights. And mountains! I can see them from my bedroom window. My god they're gorgeous. I missed them so much. Actually, I missed any sort of topography. It's so different from flat brown Texas, and I love it.

That being said, I miss Texas. Mostly I miss the people there, specifically one certain person who I have yet to come up with a catchy nickname for on this blog. But he's there, and so are friends, and I am super glad I came to Denver in the name of adventure but I'm looking forward to going back in a couple of months.

I'll have some fun stories from the ER soon, because damn have there been such ridiculous things already. For reals. Consider this my cliffhanger ending!