Wit

Recently I took care of an absolutely ancient woman who was sharper than I am on any given day (no matter how much coffee I drink). She was hilarious, witty, and pretty much the embodiment of everything I want to be as a cantankerous old lady. She also had a daughter present who was up there in years but wasn't mentally aging nearly as well as the old lady.

The daughter spent a large portion of the ER visit asking the staff questions for which she was unable to comprehend the answers to, trying to figure out the desk phone to set up a ride home, getting lost in the ER while trying to find the bathroom directly across the hall, and stopping any wandering resident she saw to warn them about spending too much time in the hospital away from their families. It was clear the patient was trying to rein her in, but as the patient was ancient and not very mobile it wasn't working too well.

At one point the daughter comes out to the desk and is sort of conversing with myself and another nurse. It was a very circuitous and slightly frustrating discussion, but we were trying hard to help the lady out. Suddenly we hear the callbell phone start dinging, and the other nurse picks up the phone at the desk. On the other end, as she told me later, she hears this: "Is my kid bothering you again? Tell her to shut her damn mouth and leave y'all alone! Get her on in here, I need my foot rubbed!"

The patient stayed on the phone until she heard her daughter shuffling back to the room, and then goes "you're welcome!" and hung up the callbell phone.

I love crotchety old people.

Feelings

While discussing general ER happenings with a friend, we got onto the topic of cancer and people being dicks. I'll be completely honest - having cancer is like a get out of jail free card with me. One can pretty much be the meanest person ever but I'll be like, eh, not mad because cancer sucks and I'd be hateful too probably.

But a few weeks ago I had a patient who was just the absolute worst - he had some serious cancer issues going on but signed out AMA from the ER almost immediately. As is his right, but when I asked him to sign the forms, he said "I'm not signing anything for you, you cunt." And walked out.

So when I saw that he was back in the ER the other day and trying to sign out AMA again, I just kinda shook my head. I know cancer sucks - really, it does - but I found I had zero sympathy for the dude. He's gonna die, and probably soon, and I didn't care at all what happened to him.

Does this make me a mean person? Or am I right to not care about someone after they were genuinely horrible to me? I don't know how to feel about it - on the one hand, I get that cancer is awful and I can't expect someone to have the warm fuzzies towards everyone all the time, but on the other hand I can't easily forgive someone calling me awful names and being terrible just because they wanted to. I don't know. I feel guilty for not caring but at the same time I feel indignant because he was an absolute dick to me.

Feelings. I haz them, and they keep me up blogging at 0300. Ugh.

Bougie, but not the useful kind

It has become painfully clear that I am now working at a very upscale fancy-pants clinic, not a real ER. I suspected it from the start, when I was told that our focus is on providing a hotel-like experience and to make sure I kept my patients fluffed and fed and watered no matter what, and that actual nursing takes a backseat to keeping patients happy. I've stayed on because the pay is good and its a pretty easy job, but I'm getting to the point where the pros are so outweighed by the cons that my rage has escalated before I even pull up to the hospital.

I know that I go back and sing the praises of my home hospital probably more than necessary, but it's the truth - despite the little aggravations here and there, it was a top of the line well-oiled trauma/medical ER with smart providers, hardworking staff, and the ability to handle whatever was thrown at it. But my current place? No. Not even close.

The tipping point came the other day. We had an incident which brutally showcased just how fucked this hospital is when it tries to function as, you know, a real hospital instead of the bougie clinic they actually are. The breakdowns were evident from the moment the patient came in the door. Too few staff in triage, a poorly designed waiting room with no code button, security that not only didn't respond promptly but asked why the triage nurse couldn't just handle the extra people by himself, a lack of an easily accessible stretcher to get to the waiting room, doors that don't swing open automatically so it's near impossible to get a patient through without assistance, a surgeon who wanted to finish dictating a bunch of notes before coming to see a legit trauma patient, no ancillary staff to assist with a critical patient, a radiology department that isn't dedicated to the ER, radiology is constantly dealing with inpatients so they send transporters to pick up those patients which takes an obscene amount of time, refusing to clear an inpatient off the CT scan table until transport was present so we could pan scan the sick ER patient emergently, having a trauma cart but having it clearly designed by someone who has never worked in trauma so it doesn't actually have anything useful in it, and then not having ancef stocked in the ER pyxis so it instead takes forty five minutes from pharmacy. Among other things, but I think I make myself clear.

It's just the worst. I don't know how much longer I can work here, even though I like the people and the pay is very nice. I feel like this place keeps polishing their expensive turd so it shines radiantly  for the bigwigs, yet don't even realize it's not a good hospital - it is just a big old shit pile.

Encouragement

I had a very sweet old lady as a patient tonight. Mundane chief complaint, not a big deal, got discharged in a reasonable amount of time. Except that she didn't get discharged right away. I was busy, and in the room next to her was a patient who started his interaction with me by saing "you my nurse? Go get me some motherfucking juice" and ended his interaction screaming down the hallway that I was a bitch for not getting him four blankets instead of the three I did bring. There wasn't much interaction after that because I called security after telling him I would no longer be taking care of him as I refused to cater to his ignorant behavior, and since he was incapable of treating me with respect I would not be coming into his room again. I let the charge nurse know, and she passed along that the patient had burned pretty much every bridge he had there which is why he was given to me in the first place - ah, the joys of being a traveler.

Anyway, that patient got escorted out by security and I went to discharge my sweet old lady. I apologized for the delay in getting her paperwork, and she cut me off mid-sentence to tell me that she appreciated all we did for her and to not worry about a thing. I thanked her and went to move along in the discharge lecture when she stopped me again. "No, honey, I don't think you really heard me," she said. "Thank you, for all that you do. It means the world to people like us. Don't listen to those assholes who don't treat you with respect. I see how hard you're working and you're doing a damn fine job of it. Keep it up."

I really needed to hear that today. It's just an extra bonus that her sailor mouth is worse than mine.

Ridiculous

So, I had a seizure patient come in the other day who told us he was taking his keppra but missed a dose, or maybe he didn't, or he might have taken depakote instead because he had an old prescription, but really he can't remember at all. No big deal. I sent off a rainbow of blood to the lab and the doc ordered a keppra level.

Two hours later it still hadn't resulted, so I called the lab. "Oh, that's a send out," they said. "It's Friday night, so that probably won't get resulted until Sunday or so, but since it's a holiday it'll probably take longer."

Am I just spoiled from working at a fantastic Home Hospital? Even though we were somewhat rural, we had everything - neurosurgery, cath labs, primary stroke certification, and especially fucking keppra levels. I now work in a "state of the art" facility which apparently can't find their ass from a hole in the ground and get basic labs done in a timely manner. Or am I just asking too much, and keppra levels aren't the norm? Oh, and we do deal with neuro stuff, so I feel like being able to do standard neuro-related labwork shouldn't be this damn difficult.