Insults

I've been insulted with the most colorful of language at work through the years, and it seems that patients are somehow globally involved in a network of one-upsmanship where I think I've heard the most creative insult possible and then somehow even that gets topped.

With that in mind, I really appreciate my patient the other night bringing it back to basics.

I got called a bitch, albeit indirectly, as she was talking to someone via speakerphone the entire time I was attempting to do a workup on this early twenties frequent flyer. When I immediately dropped all my supplies on the bedside table and removed my gloves in preparation to leave, she then addresses me directly with an "I don't like your attitude, bitch."

I shrugged and left the room, with a bye wave on my way out. I took back all the pain medication I  had with me, too, which royally pissed her off. I guess she thought I was going to give her norco after verbal abuse? The logic seems suspect to me, but at any rate she was helpfully escorted off the property about an hour later after attempting to pull the "I can talk shit to your face and make threatening gestures but still expect everything done for me" bit on two different nurses.

Gotta say though, after all the years of increasingly elaborate insults, it's quite refreshing to get back to my roots as a simple, straightforward bitch.

Pinkeye

I recently offered to take an admitted patient upstairs for a coworker of mine, and oh my god it was the best decision I've ever made at this hospital.

My coworker asked me to help roll this patient, who was a zillion years old, so he could put a new bandage on the pressure sore on her buttcheek prior to her leaving the department. I turned this tiny old lady onto her side, and he bent over to get a better angle at bandage placement. And then it happened: the greatest moment ever witnessed.

You know those air puff machines at the ophthalmologist? The ones that shoot a jet of air directly onto your eyeball in the name of science? Imagine that exact thing happening except instead of a fancy expensive machine blowing a gentle puff of air, it's a century old colon forcing out a stale fart hard enough to ruffle his hair.

I nearly peed my pants from laughing hysterically and had to leave the room where somehow the entire ER staff was in the hallway and wondering why I was falling apart. In retelling the story, I'm making myself laugh even harder and could barely function for more than two seconds without the whole vicious laugh cycle starting over. My coworker finally comes out of the room, and had to deal with concerned staff members asking him all night how his eyes were doing and if he needed a script to help with pinkeye. I spent the rest of the shift in perpetual laughter, and had to go wipe off all my eye makeup because I had cry-laughed it down my face.

Oh, man. I think this might actually be the funniest moment from my near-decade of nursing. I can't even keep my shit together just writing this post, and I'm so glad the universe decided to do me a solid and let me have this little joy.

Sass

Oh man sassy old ladies are the BEST. We had this broad last night who got tripped up by her dog and took the express route to the tile floor. Fortunately she was the rare very old lady who was magically not on blood thinners, totally alert and oriented, and also hilarious.

While the doctor was suturing her gaping eyebrow laceration back together, she hit on many topics:

"I'm so glad you're sewing me up so my brains don't ooze out of that. I've only got a few years left to hold on to them anyway, can't be careless now!"

"You don't have a ring on. Can you sew your phone number into that for me?"

"If I slip you a twenty, can you maybe just tighten up that thread a bit and make me look young and surprised?"

"Just imagine the bloody mess the other lady was when I was done with her!"

Annual "I haven't blogged in months, but I'm still alive!" post

Oh hai guys! Lookit that, it's been yet another multi-month stretch where I haven't blogged. Sorry about that. Every year, I somehow get surprised by the fact that over the dark cold months of November-February I withdraw into myself (and my couch) and then suddenly rediscover joy and socialization and friends once the sun comes out and warms everything up for more than two consecutive days. It's like haven't gone through this before...except I have, every year, for the past fifteen years. One day, I'll buy one of those happy lights or just take a vacation to Mexico in January.

ANYWAY. Blog. Here we go!

***

I had a patient a while back who died.

She was one of those patients who, by all rights, should have died before she got to the hospital. I triaged her in from the ambulance after she had a sudden syncopal episode while driving and thought, since she was also diaphoretic and complaining of chest pain, that she was having a massive heart attack.  I was wrong - I got an EKG on her before doing literally anything else, but it was normal. So I proceeded to get her undressed, on the monitor, get vitals, and start a line. I did all this within five minutes. Her pressure was in the 80's, and all of a sudden she told me her lower back had just started to hurt.

Fuuuuuuuuck. After announcing to the ER MDs that I thought she might have a ruptured AAA, one of them went into the room and promptly confirmed my suspicion via bedside sono.

I did everything right for this lady - from ER arrival to OR arrival was around 80 minutes. It would have been sooner, but the cardiovascular team was already operating and had to close before they could take my patient. We were short staffed, and somehow by myself I still managed to get this elderly patient undressed and triaged, on the monitor, obtain an EKG, start two big IVs, send down all the labs including a type and cross (which at our facility is a step that takes an extra minute or two), get a doctor in quickly, find the sono machine, order blood products, keep this sweet and totally oriented patient and her family from panicking, move her to the critical care side of the ER, give report to vascular when they did arrive, keep the patient alive, AND chart all that shit. I did a fanfuckingtastic job, all by myself. This was one of those situations where everything went perfectly, and I felt like a complete badass for correctly diagnosing a critically ill patient and giving her the best possible shot at making it though alive.

She died the minute they moved her onto the operating table.

It was emotionally devastating, and I was fortunate enough to find the family and spend some time with them to express my sadness and cry with them. I've thought about this patient for months, but always was comforted by the fact I really did give her an amazing chance at surviving - and that the family saw how much work I did to help her.

***

I found out this week that the patient's case was reviewed by the hospital for a possible delay in care, and I'm furious. It just goes to show that even when everything is stacked against me and I still manage my patient perfectly, instead of a congratulations for a job well done I get told it's still not enough.