New Nurse Insanity: The Adolescent Years

Humor

2012-01-26T04:58:00.003-05:00

The absolute best thing about working ER is knowing that as foul and potty-mouthed and inappropriate as I can be, there is always another person willing to take a joke even farther.

I told a filthy Helen Keller joke tonight, and promptly blushed when a coworker told me one even crasser. And then we laughed, and picked our brains for even more dirty jokes.

I've had a doc make comments to me which would get him immediately fired from any other job...but because this is night shift in the ER and we're all raunchy people, I just came back with a comment to top his.

Jokes are made about people which I can't even repeat here for fear of being struck down by lightning. No patient is safe.

There is constant harassment between my two favorite techs and I...in front of patients. If there isn't a comment made about one being old, one being fat, and me being too young to work legally, then it isn't a good night. Most of the time, we can even rope the patients into doing the insulting as well.

Things like this make me love my job, in spite of all the bullshit politics, management idiocy, rude and entitled patients, shit-cleaning (literally), and lazy staff. Really, I love my job because I can laugh and because these people are my second family.

Pharm

2012-01-19T17:28:00.002-05:00

So Etomidate is out, thanks to a nationwide shortage. We're out of Ativan IV, and we have critically low supplies of Versed and Valium IV. What could possibly go wrong in this scenario?

Let's hope no one seizes or needs RSI in the near future.

*update*

Oh yes, we're also out of Zofran IV and Compazine IV. Woooo.

Long night

2012-01-19T08:05:00.003-05:00

It was a crazy night. At 07:59, I'm still trying to get out of there.

Cardiothoracic surgeon walks by and spots me, wearing the same harried look as 13.5 hours prior.

"Oh my God, you're still here? This must have been a bad night after I left," he says.

Yes, I agree. It was. "And by the way, I'm sorry about that cluster of a transfer Doc B dumped on you."

His reply? "Ah, it wasn't your fault. You can't help the fact that numb nuts over at Hospital B probably can't even tie his shoelaces without someone holding his hand, and he still probably gets it wrong. We must rise above our distress though, and carry on*."

*Dare I say it? Did I make a surgeon friend? This one is normally grouchy. Maybe I'm just not used to the grouch being directed elsewhere; this is quite a new position for me.

Interwebs fun

2012-01-07T02:22:00.002-05:00

Ever wondered what I do when I can't sleep? Well let's take a peek inside my train of thought...

01:59 - Watching Craig Ferguson clips, because he's quite the cheeky Scotsman and he makes me giggle.

02:12 - Still watching Craig. Still funny, as is ESPNUK.

02:14-I watch a clip of Craig discussing his mild dislike of crabs.

Kristen Bell mentions giant spider crabs. No way their leg span is that large. I get curious and go to wikipedia.

02:15 - HOLY SHIT! These crabs are huge!! Oh god I hope I never ever run into one of these things, I'll need a change of pants. I can't even bear to look at the picture any more.

02:15:46 - Youtube. Spider crabs.

New job responsibilities

2012-01-05T07:21:00.002-05:00

So you remember that time way back in June when I wrote about how I was asked to be trained as relief charge nurse? I ultimately told management no, because I didn't feel I was ready and I didn't want to deal with all the stuff that comes along with management type positions.

Fast forward to December, when situations again conspired to instigate the need for a relief charge nurse. The manager comes to me again to request I do relief, and in a moment of weakness I agree to it. I had a week of orientation - which really just equals three shifts - with a full-time charge nurse and then they gave me two weeks of "supervised charge," meaning I was alone in charge but one of the full-times took a patient group in the same station as me.

I'm currently in week three of supervised charge. What happened to just two weeks, you ask? I knew that I don't know much yet, but I discovered just how inadequate 2.5 years of nursing experience really is when I'm the one being asked all the questions. Boss Man subsequently gave me another two weeks.

It's been quite eye opening, to say the least. One of the unit secretaries, who has been working at the hospital almost 30 years and knows everything about everyone there, said to me last night while it was hellishly busy, "you're finding out just who doesn't know their stuff and who doesn't care to know it when you're in charge, aren't you?" And it's true. We're working with a huge amount of new grads who don't know much yet* and also with some nurses who are straight up lazy**.

I kind of imagined how much the charges had to deal with, but I never did understand the full scope of it - people calling in looking for advice, doctors calling in pissed about the number of patients getting referred to them after another doc shuts down his practice, needing to know the protocol for a rare procedure which only gets implemented four or five times a year, nurses calling to ask drug questions, deciding which ambulances go to which rooms, juggling the influx of ambulances while still bringing people back from the four hour backup in the waiting room, deciding which chest pains are legit and which chest pain complaints are bullshit and directly related to that four hour backup, personally handling patient complaints, sucking up to some complaining patients and telling other complaining patients to piss off in nice words, denying cab voucher requests, granting cab voucher requests, needling the staff to keep moving quickly to make patient throughput speed up, stepping in when staff isn't moving quickly enough, babysitting new staff during procedures they aren't familiar with, getting an obscure piece of equipment when the doc needs it, making sure xray is called to come do a portable on that newly intubated patient, knowing the story of a patient so you can tell the surgeon what's going on even when you've never laid eyes on that patient, being able to answer questions from bed coordinator when you've got no idea what the answer really is, needing to be at your desk constantly to review the tracking board and assign ambulances, needing to be walking around constantly to make sure staff is doing everything, being the contact point between the ER doc and the primary nurse in a room, being the last resort when a nurse can't get a pediatric IV, addressing a nurse doing a generally shitty job of patient care at the request of a doc, performing daily quality control tests on various devices, general upkeep of the department, tracking down a lost cardiac monitor, delegating tasks, cleaning beds when environmental is nowhere to be found, answering the phone when the secretary is somewhere else...and a thousand other things I haven't yet realized are my responsibility.

I'm overwhelmed, to say the least. I haven't once left work on time. I've cried more than once. I feel inadequate on a regular basis. Yet somehow the department hasn't imploded. A couple of docs have congratulated me on doing a swell job. No one seems too upset that I've agreed to do this. No one has laughed at me...much. I guess I'm doing alright, then. I've got one week left of scheduled charge, and then after this it's just on an as needed basis. We'll see how things go.

Sorry to talk your ears off, and sorry for the light posting recently.

-------
* I feel a little guilty calling some of the new grads out when I myself was a new grad starting straight into the ER. I, however, had the benefit of being one of two new nurses amongst a sea of experienced nurses and I never felt alone. Now, there are so many newbies and so few experienced nurses (as evidenced by them asking me to do charge) that we've had nights where the new outnumber the old by a horrifically high ratio - whole stations are staffed by nurses with less than four months of experience. A scary scenario indeed.

**A side effect of being charge is docs coming to me and telling me things I never would have heard otherwise. We had a real sick patient the other night who was unfortunately being cared for by the laziest of nurses. The usually level-headed doc was infuriated with the substandard care and pulled me into the dictation room where he went off. I've never heard this side of him - "she's a fucking lazy, shitty nurse and I can't believe she's taking care of this patient. Do you see it? She's a fucking awful nurse, and this patient might die because of her. You need to make sure she doesn't kill him." Um, thanks for your high opinion of me? Am I really ready to see this side of you, and actually act on it?

Reactions

2011-12-25T23:37:00.003-05:00

We were all sitting around in the nursing station the other night, talking about anything and everything since there was almost a negative-number patient census. A topic that came up was how we react to crazy or unexpected situations which is interesting since this is occurs nearly every single day. One nurse mentioned a wild GI bleeder that came in recently, and how when they rolled the patient to clean her up she somehow managed to blow out the biggest GI bloody shart of all time, right onto the walls/face/body/hair/shoes/papercharting of and around the nurse doing the wiping.

Two of the nurses in the room just burst out laughing. I mean, what else can you do? The nurse on the receiving end was amazingly stoic. After hearing the story, I decided that I would probably just let slip the first expletive that came to mind, no matter who heard it.

At this point the sweet low-key secretary, who had been overhearing the conversation, pipes in with this: "Would you say S-H-I-T?"

I don't know why this was so funny, but it was. Especially considering she is so nice she can't even say the word shit out loud. Amusingly enough, I hadn't even thought of this word. I was leaning in another sailormouthed direction the whole time.

Knowledge and experience

2011-12-19T00:49:00.004-05:00

You know, I recently had a series of rather interesting things happen in my work life, which has resulted in me taking a part-time charge nurse position in the ER (um, holy crap!) and various factions of the trauma surgeon department thinking I know what I'm doing 99% of the time.

In reality, I am quite overwhelmed. I don't know how I went from shiny new nurse to okay nurse to preceptor to prn charge. I really feel like most of the time I'm just winging it and I've got everyone fooled. In fact, I remember writing about that exact thought not so long ago. Funny thing is I really haven't come far since that particular moment, at least in my own opinion.

To sum it up nicely, this is exactly how I feel:

Changes

2011-12-09T03:48:00.002-05:00

Just call me Shrtstormtrooper, (relief) Charge Nurse. Sweet mother.

Story to follow soon, including both the exciting parts and the anxiety-causing parts.

Pie

2011-11-29T11:32:00.001-05:00

I must apologize for the lack of posting. I ate an entire pumpkin pie by myself this weekend (and copious amounts of corn and stuffing and ham) and now I am having trouble reaching my keyboard. Posting shall resume when my waistband has returned to normal.

Spirit

2011-11-23T13:51:00.002-05:00

And while we're on xkcd...

I feel oddly sad after reading this webcomic about an appliance with no feelings.

Unless it DOES have feelings?!

[http://xkcd.com/695/]

Pain scale

2011-11-23T10:22:00.002-05:00

xkcd is the greatest ever.

[http://xkcd.com/883/]

Pain relief

2011-11-21T11:46:00.003-05:00

While discharging a sweet old lady and her husband who had been involved in a very minor fender bender, I'm explaining that they can both take their usual OTC pain reliever for any muscle aches. "Motrin, Aleve, or Tylenol, whichever normally works best for you is what you should go with," I tell them.

Sweet old man pipes up, "I usually go for heroin, is that okay this time?"

I was unsure if he was kidding, until he starts laughing and assured me he would use Aleve.

On second thought...I'm still not sure he was kidding.

Krokodil

2011-11-17T10:22:00.006-05:00

Whilst reading up on other blogs I saw New Nurse, in the Hood mentioned reading an article about Krokodil, a codeine based drug similar to meth in it's preparation that is apparently all the rage in Russia. I read the article and when it mentioned that plenty of youtube videos are floating around of the horrendous effects of course my morbid self went hunting.

Holy shit. That is all I can say. (if you needed the warning...yes, this is graphic.)

**Since I don't speakez the Russian, apparently this video is showing a user who injected a different med than krokodil - though the end results are similar. Either way, kids...drugs are bad, mmkay? (thanks, anon)

Holy shit. I cannot understand this level of addiction. I just can't.

The art of diversion

2011-11-17T00:43:00.005-05:00

Recently I started working full 12 hour shifts in triage, which is still new and exciting and butt-clenchingly scary most of the time. It's a whole different world than working in the core. In the core I get 3, 4, maybe 5 patients and when my rooms are full I don't get any more, unless it's a hall patient in which every one helps on. I always have lots of other people around me, and if I find myself in the weeds I can always call charge and either get extra help or block a room for a bit to catch up.

Not so in triage. They keep coming in the door and you keep quick assessing and you make the decision to sit them in the waiting room or bring them back with a fire under your ass. It's hard! I'm terrified of missing something, or not assessing a patient well enough - which is scary enough seeing as I have to triage without ever laying a hand on them. In all fairness though, I expected triage to be difficult.

What I did not anticipate was the stalling skills required for families of Very Sick Patients.

Take the other night. We get a real sick patient, in her 30s, who ended up arresting. Right after everyone starts working on her, the husband strolls in the front door and asks for his wife - you see, when she left the house she was awake and talking, albeit sickly looking. He had no reason to suspect anything had changed.

I was not prepared for this. What do you say to someone whom you know is losing their other half but you can't tell him yet? I know she's dead, but I have to stall until the nursing sup can come and collect him. How do you deflect the request to go back and see her? I don't know. It's hard. I really don't know how to handle this yet, but I guess it will come with time. This is very humbling though. Just when I was starting to feel like I might be okay at nursing, I get bumped to a new level and discover that my deep dark suspicions were right - I've got a really long ways to go.

Is that a banana...

2011-11-14T08:05:00.003-05:00

I tend to be on the juvenile and/or inappropriate side of humor most of the time...I think it's amusing, but people usually just get offended.

After hitting up the cafeteria, I returned upstairs with a bagel in my hands and can of soda in my pocket. Our very own Dr. One Liner (TM Nurse K) happened to be working, and he looks over at me and asks "what is that in your pocket?" I glance down, look back to him and reply that I'm just happy to see him.

He laughed. And snorted while laughing. Then hugged and thanked me for my eighth grade humor packaged in unsuspecting classy lady form.

Ba-ZING! Even a nonfunny person is funny twice a day. Or something like that.

Pacing

2011-11-12T01:55:00.005-05:00

Quote of the night (while setting up for the external pacing of a patient)

Badass nurse: Whaddya want to start at, doc?

Cardiologist: Eh, let's start at 5 mAs.

Badass nurse: Hell doc, I poop harder than 5 milliamps!

We started at 0...because ACLS trumps badassness in most circumstances. But it was still funny.

While bored stiff in triage...

2011-11-07T07:45:00.003-05:00

It really isn't a funny situation to be in, but let me tell you. There are A LOT of penis-related jokes to be found in the ER after someone presents with a priapism. I know, because I may or may not have made half of them.

That is straight up truth.

Hu

2011-11-04T19:12:00.003-04:00

I have to say, however you feel about Dow as a company...this is probably the best commercial of all time. I remember seeing it years ago, and it's still excellent.

For the win.

Conversations that go nowhere

2011-11-01T07:51:00.003-04:00

While sitting in triage, a hood looking young gentleman comes to the window looking for his friend. I scroll through the tracking board for the name he gives me, and after informing him there is no one by that name in the system he gets all belligerent. "He ain't the patient, it be his friend that be checked in!" he tells me. I ask the name of this new friend, and he tells me Jigga.

"Jigga what?" I ask.

He tactfully informs me "just Jigga, bitch!"

"I need a last name, sir. Jigga Who?" I'm dying inside of pure joy.

Recognize, girl.

How nice

2011-10-30T06:56:00.004-04:00

The craziest thing happened to me tonight! I had a patient going to the OR, and the surgeon was in the room talking to the patient and whatnot. I'm scrambling to get a few last minute things the doc wants, and get the chart printed to hand off to the OR nurses. As I'm standing at the printer, I hear wheels bumping along and when I look up I see my patient go by on the stretcher...being pushed by the surgeon!

Now, we all know most docs will walk out of a patient room, wander the hallways, find a nurse, and then ask that nurse to go get the patient a blanket instead of handing them one from the blanket warmer directly next to the patient's room. But not tonight! The surgeon packed the last few personal items in the patients bookbag, paperclipped (most of) the chart, and started driving the patient to the OR. By. Himself.

Maybe surgeons elsewhere are more useful at mundane tasks, but I had to scrape my jaw off the floor. And then chase him down to hand over the last of the chart. But seriously, what a nice moment. I hope this is a new trend!

Miracles

2011-10-29T04:11:00.003-04:00

I clearly suffer from insomnia, seeing as it's 4:11 am and I'm blogging instead of sleeping. Anyway I figured I'd had enough of Jackass 3.5, went to turn my tv off so I could attempt slumber, and behold! A miracle!

My tv remote ALSO WORKS THE ELECTRIC FIREPLACE!

Maybe I'm just a bit wonky from sleep delirium, but I think it's the greatest thing ever. Volume up? Yes please, and add in some flame while you're at it.

I've no excuse.

2011-10-27T02:54:00.004-04:00

Well friends, it's been a while since I've updated. Life has been busy. It's not you, it's me. I swear. I've been hopping with a wedding (not mine), work, procrastinating by looking up plane tickets to anywhere but here, and well, stuff. It doesn't look like a lot when I write it out, but whatevs. I live the rockin life, yo.

So I was driving back from visiting family today, when a snippet of conversation from work popped into my head, and an uproariously witty blog post then blossomed forth in my mind. I couldn't write it down because I was driving, obviously. I repeated the outline a few times so I wouldn't forget it. As soon as I got home, I turned on the ol macbook and also made the mistake of turning on the TV. Alas, my plans were foiled. Mythbusters happened to be on, and then Craig Ferguson, and then Mythbusters again and then I realized...I forgot the blog post.

For the life of me I cannot remember it. I've got the funny conversation bit, but that's it. Everything else...blank. Nada. Nothing.

Curse you amusing TV!

Ah well. Hopefully I'll wake up in the middle of my slumber and write it down or something. I know you all are on the edge of your chairs waiting. You be careful though. Those chair edges are quite perilous at times.

Decisions

2011-10-06T09:38:00.002-04:00

Tonight was my first unsupervised bit-o-shift out in that tragic wasteland known as Triage. Hot mess, let me tell you. This kiddo comes in looking all bleh and crappy and feverish and, dare I say it, lethargic. I chart the required stuff, the tech gets a round of vitals, and I send the kid back to a room nursing a 104 temp. The big-workup PA on that morning takes issue with the fact that I used the word "lethargic" in my triage note, because "if you use the word lethargic then I have to do a septic workup and admit the kid."

No, asshole, you don't. I wrote that the kid looked lethargic because the kid looked lethargic. End of story. YOU don't have to do squat. If your assessment shows the kid looking fine, then all's well and good. But when this kid came to the door, he looked lethargic and that's what I'm gonna write.

I'll refrain from mentioning that you are notorious in the department for doing a big huge workup on every single patient, so regardless of what I write down you're going to order everything anyway.

I'll also refrain from nitpicking your treatment decision for the previous patient I triaged. Youngish girl, had a headache x2 days. Neglected to tell me that her headache started approximately 3 hours after getting a new weave. You discharged this headache with a fourpack of vicodin to go and a scrip for TWENTY MORE VICODIN. Twenty four fucking vicodin for a tight weave.

Do you really want to question my decision making skills? Really?

Bacon

2011-10-04T17:50:00.005-04:00

Listen up people. Bacon is the best. End of story.

I love bacon so much, I partook in the drinking of a beer that a local brewery had run through a bacon filter. You heard. Bacon filter. It was delicious. My favorite incarnation of a Bloody Mary includes a bacon strip instead of celery stick. When I eat a BLT, it's more like eating a BBBBLT. Only bacon can be included as a salad topping in bit form. You don't see Hot Dog bits, steak bits (although this would be tasty), burger bits, or spam bits.

To prove that bacon is the best, consider the following:

Mmmm bacon.

***
and also, who else misses Bill Nye the Science Guy on tv? I do.

How to convert

2011-10-03T09:55:00.001-04:00

This youngish guy comes to the ER complaining of palpitations, and he turns out to be in Afib with a rate of 140-160. We toss the usual meds at him, none of which work. Cardiology is consulted, and they recommend giving him flecainide before sitting on him for 6-8 hours. I go in, explain to the dude what I'm giving and why, and then give him some pillows and blankets and tell him to settle in.

Six hours later, he still hasn't converted from Afib. The doc talks to him, and decides to cardiovert. Why we didn't do this way earlier is beyond me, but whatever. I get him set up, put the sticky pads on, bring in the EKG machine, and make sure the conscious sedation consent is signed by all parties.

Just before starting the sedation, the guy calls me over. He whispers, "Can I use the bathroom? I'm kinda nervous and I really, really need to go." I offer a urinal, and he gives me the sideways eye which translates to I don't need the urinal, I need to go blow the bathroom up. Doc doesn't want him walking without the cardiac monitor, so I set up a bedside commode. We're all loitering in the nursing station, waiting for him to be done, when I look up at the monitor and notice...hey...yep. Sinus rhythm.

How amusing. We do just about everything to get this guy to convert, and all it really took was him dropping a deuce. Oh, the miracles of medicine.

Literature

2011-09-23T22:21:00.004-04:00

You know what's neat? While sitting in a Trauma M&M, the surgeon started talking about a case he recently published. Without going into details, it was a very rare scenario made even rarer by the method of treatment, and this surgeon was the first in the world to do it (or at least write about it). Within the first few minutes, I started to recognize the scenario.

And then I realized it was my patient! I'm the one that took care of this patient through the ER!

Granted, my name isn't anywhere on this patient. Rightfully so since I did about zero percent of the hard surgical work. But still...my ER patient. My interesting patient. My dude who is now part of medical literature.

What's up vicarious living, baby.

Humor

2011-09-21T17:38:00.003-04:00

It was a slamming night, and one of the other nurses was real busy so I offered to discharge her chest pain patient after his second set of enzymes came back negative. A few minutes later the doc hands me the discharge papers and I go to get the guy out of here. I wish I had taken care of him the whole night, because he was a riot and his family was just as funny. I joked with them for a few minutes while taking out the IV and all that stuff then sent them on their way.

After getting back to take him out of the system, I noticed an extra bit of dc paperwork I had forgotten. I called the number listed on file and started telling him about the instructions for retesting of blood. "Sir, you'll need to come back to outpatient in 2 days, and have your kidney function tested since you take metformin and had a CT with contrast done today. In the meantime, please hold your metformin for 2 days."

His response? "But what if my hand gets cramped?"

Over my head completely until he started giggling.

Priorities, seriously

2011-09-17T08:27:00.004-04:00

So I got called into the Boss Man's office this morning, because the floor wrote me up and he wanted to address the issue.

At this point, my feet hurt, I haven't peed yet tonight, I didn't get to eat anything, I have blood on my scrub pants (which I just now noticed), I have poop on my scrub pants (which I just now saw but have been suspiciously smelling for the past two hours), I haven't finished charting on that last arterial bleeder that came in, and my coffee from 7pm is still sitting full on the counter next to my computer. It's been a rough night.

During the night, we moved a patient out of a trauma room and into one of the smaller rooms. The patient who was moved had some fairly big issues going on, but nothing that was going to kill her in the next 6 hours. The patient we cleared the room for, however, was very much going to die if we didn't act. He would probably have died in the next 25 minutes if we didn't get moving. So we got moving, did our ER thing, and eventually sent him off the OR. At the very same time, a cardiac arrest AND and an MVC came in - so our ER staff was split between three very critical patients. The patient who was moved next door was then quickly taken upstairs, as she had a bed assigned already and we needed the space in the ER.

I got written up because, in all the madness, I missed a skin tear on this patient. One skin tear, out of many. And actually, it wasn't my patient to begin with, so really I never did anything for this patient except wave goodbye as she was on the way up to the floor. Although I didn't even really wave goodbye, because I was slightly preoccupied with running the Level 1 Rapid infuser with mass quantities of blood products.

There really isn't a point to this story, except that I'm royally annoyed.

Dear floor nurse: I'm sorry I didn't dress a skin tear. I was busy. You know, actually doing something to save a life. Not that a skin tear isn't important...but...no, wait. It's not that important. Not in the grand scheme of the ER.

Fortunately, the nursing sup was in the ER the whole night, and backed me up regarding the madness. No thanks to Boss Man.

Sunset

2011-09-15T16:38:00.002-04:00

Tatooine is real! Real, I tell you!

Mishaps

2011-09-11T21:37:00.002-04:00

I really am a shit magnet. Today was my first day at my new part time job, doing prn critical care transports. About half of the transports are for the really really sick people, like new intubated traumas, or the burn patients or pediatric stuff. But the other half is glorified babysitting of a patient who just happens to have a cardiac infusion running.

Like my dude today. He had a cardiac drip going, but was pain free, alert and oriented, ambulatory, totally independent, and funny as all get out. Needless to say, I did not anticipate any troubles for my first run. Which is dumb. As I am the aforementioned shit magnet, every single thing that could have gone wrong did.

I get to the office to meet the crew, and they had no idea they were supposed to be doing a run (dispatch's fault, not theirs.) We leave 30 minutes late. We get a flat tire on the way. Once at the hospital, our medpump decides to stop working halfway through programming the new drip in. The outgoing hospital forgot to sign paperwork. We had to borrow a pump from their hospital, which took 30 minutes as the nursing sup had to get involved and make us sign in blood that we will return it. The patient realized he forgot his cell phone in the bedside drawer as we were getting into the ambulance. His IV, which was patent on our arrival and patent upon leaving and patent halfway through the ride back decides to become no longer patent sometime between halfway home and arrival at new hospital. Nurse upstairs throws a hissy fit about said IV, even though time of un-patency was perhaps 10-15 minutes. I apologize (even though it wasn't my fault) and she is having none of it. I had planned on a 3 hour transport...It ended up being 7 hours.

Whew. Sometime, I wish I got the easy stuff. But then again, I guess I'd be bored if everything always went well for me.

At least the Skins won today. Hooray football season!!

Spelunking

2011-09-08T17:12:00.002-04:00

Fun Young Doc: Hey Shrtstormtrooper! You're a big fan of hiking, right?
Me: Yeah, I do love it.
FYD: How about caving, have you ever done that?
Me: No I've never been caving. I'd like to sometime, though. What makes you wonder?
FYD: I'm so glad you asked! Come on, let's go butt caving in this patient and see how much poop we can get out of this FOS dude!

Suckered right into it. I couldn't even come up with an excuse.

Badasses

2011-09-05T23:36:00.001-04:00

Usually when someone meets me and they find out I'm an ER nurse, they're all like "man, that is so badass. You must see all kinds of crazy stuff!" And then they pester me for stories until I tell them the real gross one of the time the patient vomited charcoal all over my legs and it stained the skin beneath my scrubs and got into my socks, or the time I was hit in the neck with a trach loogie from across the room. That usually squelches the need for gross stories, and it makes me giggle to see them turn a little greenish.

But really, the ER that is portrayed on TV is a super high octane, go-go-go nothing but excitement all the time environment. In reality, it's not all that badass. For every freaky random lawn decoration leg impalement I take care of, we see a hundred toothaches. For every time someone goes into a v-tach arrest in the department and gets shocked back to the land of the living, I argue with fifty drug seekers. For every gunshot resuscitation, I give five enemas. For every EKG that prints out tombstones and sends the patient directly to the cath lab, I start IVs on thirty vague belly pain patients. For every statistic I just gave you, I made 100 percent of them up.

Eh, I digress.

Seriously though, the ER is a lot of fun. I do get to see crazy stuff and it's astounding how unbelievable some of the stories are. Just be prepared, all you people who meet ER nurses, that if you ask us to tell you a story...you might just end up hearing about that really exciting time we did something crazy like stick our finger up someones butt to insert a flexi-seal. Aka butt foley.

In summation, we're not always badass. But this guy is. He surgically removed his own appendix. While at a research base. In ANTARTICA. Read all about it, in the aptly named badassoftheweek.com.

***
Since we're speaking of badasses...I'm currently watching Return of the Jedi on TV. Boba Fett is introduced as the most badass guy ever in Empire Strikes Back. Even though he only has a couple of lines, it's generally understood that he is indeed a bad motherfucker. And then poof. ROTJ. He dies like a little bitch in a big giant sand monster pit. What a puss.

Personal Information

2011-08-27T01:10:00.003-04:00

Alright folks, let's get personal. I mean real personal. Like I usually only talk about work stuff or nerdy stuff...but this it going to get deep.

Ready?

I'm a nervous pee-er. Really.

And, storytime. I recently picked up another part time job, and had to do the standard pre-employment drug screen. Knowing that I'm a nervous pee-er I drank approximately eight gallons of water and one cup of coffee prior to leaving my apartment. I was going to waltz in there and pee like a racehorse. Like Secretariat! I was going to be the champion of all pee-ers.

I proudly handed my paperwork to the lady at the window, and she led me to the room of peeing. I signed in all the right places, and boldly took the proffered specimen cup. She gave me the complicated instructions of "pee and don't flush." I nodded assent and walked into the bathroom with the confidence of England circa 1588. Mind you, the door must remain slightly open and the lady must check the crapper afterwards to ensure no shenanigans.

When I sat down, it all went to hell in a handbasket. As soon as my cheeks touched that throne of porcelain, I knew...I had to poo. Not even like a semi-need to poo. It was an "if I attempt to pee AT ALL I'm going to christen this toilet instamediately."

This breaks all drug-screen codes of honor, all protocols of yellow gold, all processes of elimination.

I was...in deep shit. What to do?! Say I couldn't pee, to avoid the humiliation of dropping the kids off at the pool and everyone knowing? Try to poo with the stealth of a ninja and pray for the elusive Ghost Poo? Let it rip and revel in the glory? Or poo and pretend like I had no idea how it got there? It was an agonizing, prolonged decision. The lady knocked on the door at one point to make sure I was still alive. Sadly, I had been trying to will myself to disappear away, but it hadn't happened.

So I bore down and made the decision. I went for the "poo and pretend like it never happened" option. If I act like there is no poo in the crapper, can the lady really call me out on it? Truth is, I was never going to manage a pee without the poo, and this screen was necessary. So I committed.

AND IT WAS A MIRACLE! The heavens opened up and smiled upon me, God took pity on my plight, and I was blessed. Blessed with the Ghost Poo! Like it never happened! Ah, life is good. I then proceeded to pee and finished that drug screen like the champion I know I am.

However, I can't help but wonder...does my good fortune mean that someone, somewhere, will attempt a discreet poo and be struck with the Newton's Third Law Poo instead? Will they drop a bomb so loud that everyone knows it happened? I can only speculate. And if it does happen...to you, stranger, I am sorry.

***
And while we are on the subject of peeing, I give you this:

Anticipation

2011-08-25T07:11:00.002-04:00

As I walk into the trauma nursing station at 7pm, the doc looks over and groans. "Ugh, you're up here again? You're such a shit magnet."

Thanks, doc. Although...he was right. It was a hot mess of a night.

Unfortunate

2011-08-20T13:52:00.002-04:00

It's bad to drive when you're so sloshed you can't stand up straight.

It's really bad to hit a parked car when you're so sloshed you can't stand up straight.

It's extra bad when that parked car you've just hit (while sloshed and unable to stand up straight) belongs to the cop that just got out a minute ago to ticket someone else.

It's even worse when you don't just hit that parked cop car, but go all out and total it while flipping your car.

Oh, but it's the worst when that cop happens to be the city police chief.

And when said police chief asks you in the ER if you think your alcohol intake has affected your driving tonight, and you respond, "oh no chief, I've driven way worse than this before."

Yes, you're fucked.

Change up, part deux

2011-08-17T17:23:00.002-04:00

New Nurse Insanity: The Adolescent Years

Hmmm. We'll give this new blog title a whirl, and see if I like it. Feel free to keep up suggestions!

A short lesson in texting

2011-08-16T14:07:00.004-04:00

Our ER sends out mass texts when there is a need for staffing. As with any texting, there is a limit to the number of characters that can be sent at one time. I woke up the other day to this message:

Hi everyone! Will have needs for tonight, 3p-7p and 7p-7a. Please call! D is in charge and requests your ass

I can only hope they meant to complete the message with "isstance."

Change up

2011-08-10T04:05:00.003-04:00

New Nurse, in the hood isn't quite a new nurse anymore. She's looking for a blog name change...which got me thinking. I'm not quite a "new" nurse anymore either. I'm definitely not yet an experienced nurse, but I guess I'm past the newbie stage.

So I'll join the blog name changeapalooza. Any suggestions?

Awkward

2011-08-07T07:35:00.002-04:00

I tell ya, there is really nothing like wearing a brand spanking new set of scrubs to work, and having your first patient be an ortho requiring much splinting. Forty minutes and a lot of plaster later, and I'm covered from head to toe in splashies.

Including my boob.

Yeah, I accidentally leaned too close and an armful of plaster smacked right into the 'ol funbag. Good times. Especially since I had to walk around the next 11 hours looking like I just had a toss in the hay with Dr. Gypsum. I'd tell you that everyone respected me and politely ignored the mildly awkward situation, but that would be a total lie...

Busyness

2011-08-04T08:55:00.004-04:00

Look, I know you're really busy, sitting there with your iPad. That email is really taking up a lot of time and I understand that you've had a lot of patients tonight. It's that witching hour too, so I know you're kinda sleepy and 0430 isn't a good time for thought processes. That's probably why you wanted to discharge this dude right away. And believe me - I tried. I went in there all gung ho with my discharge papers and to-go pack of meds.

But when a patient, who happens to be of the right age...and with the right medical history...and is an extensive smoker...and hasn't seen a doc in six years happens to tell me that he is having new onset crushing chest pain with radiation to the left arm...I don't give a shit if you're fake busy and don't want to do any more work ups tonight. I'm going to ignore the grumbling I can hear under your breath regarding my seeming inability to be firm with a discharge. I don't care if you give me the evil eye when I smile and hand you the EKG. I really couldn't be bothered if you're annoyed that I made you get back up out of your chair to go see this patient again.

Because that EKG I handed you had some tig ol bitty tombstones on it, and that patient did not pass go and did not collect $200. He went straight to the cath lab.

And that is why I don't care what you think about me.

Shock

2011-08-03T17:37:00.002-04:00

I've seen and heard some awful things in my twoish years in the ER. Child abuse, nursing home patients all but abandoned by their family, a little kid crying over their dead parents after a horrific accident, the mishap that ends up being murder...I've seen a lot. Most of it doesn't surprise me; but every now and then something happens that really makes me wonder how humanity is going to survive. Are we really this cruel on a daily basis?

We've had a recent string of unbelievably bad car accidents, where people come in so jacked up it's hard to believe they're actually alive. The other night, another MVA rolls in and we get four or five patients from it. All but one were minimally hurt - scrapes, a broken wrist, that kind of stuff. The last one...he won't ever be the same person. If he survives the long recovery process, that is.

Suffice to say, the accident was life changing for the one patient and a nuisance to the rest of them. I'm one of the nurses taking care of the real bad patient, and I'm standing at the charge desk for a second to sign for the blood products that we're massively transfusing while this guy is trying to die. One of the other patients was getting a portable XR, so the family had been kicked out of the room for just a second - and they are in the next room to the bad patient. The curtain is closed, but they can hear what is happening. They can see the dozens of people involved. I then overhear one of them griping about the accident: "I can't believe that guy was so stupid. He wrecked that motorcycle, and my girlfriend had to slam on the brakes and someone hit her from behind. That fucker wrecked and now her head hurts. I hope that gravel tasted real good; he deserves it."

No. No, no, no. I wished I could have violated HIPAA in every way and dragged this ass into the room. I wanted to shake him, and point at the kid dying and say really?! This guy wrecked his motorcycle because someone ran a stop sign and hit him. This kid is dying. If he survives, he will never walk again. Your girlfriend has a sore lump on her head and this patient is forever changed. No one deserves this. Ever. I wanted to yell at him, snark at him, hit him, or something.

But I didn't. I got my blood products, and went back into the room, and continued trying to help save this patient's life. Because that is what this patient really deserved.

Are we really that cruel? Yes. people are.

Ninja what.

2011-08-01T00:10:00.002-04:00

OH. MY. GOD.

I have discovered the utter amazement that is American Ninja Warrior on TV.

This could be epic.

Methods

2011-07-27T13:37:00.002-04:00

From out in the hallway, I hear this. *AAAAGHGGHHHRRRGHGG!* I had to double take when I went in the room.

Me: Dude! What are you doing?! You know your ankle is broken! Stop shaking your leg! Ortho is here, they're just looking at your xrays and they'll be in here in two minutes to splint it.

Patient: I know, but it just hurts so bad. I'm trying to shake it back into place so it doesn't hurt anymore!

Me: No. Just, no. Don't do that.

Srsly. This happened.

Poo(h)

2011-07-13T08:03:00.005-04:00

There are some moments where I think to myself, "self? Why are you a nurse? Why didn't you decide to be a doctor instead?"

Last night was one of those moments where I wished I was doing anything but what I was actually doing. I wished I was a doctor. Mostly because I was, quite literally, elbow deep in shit. Full barrier gown, extra long gloves (doubled up. safety first.), and TB mask. And shit. Up to my elbow.

That's my patient right there...the one covered from head to toe in liquid diarrhea with bits'o'corn for added flair. I'm partway through cleaning up the nuclear disaster, and the doc sticks her head in the room and goes, "oh by the way...can you send a stool culture? KTHANXBYE!"

First of all bitches, I sent that culture like ages ago. And started a line, and drew labs, and cleaned up poo, and started a liter of saline, and gave some zofran because the patient was vomiting too, and cleaned up more poo, and put twelve thousand absorby pads under her, and I did it all before you walked in the room because it's hella busy tonight and this lady is going to poop her brains out by the time someone gets around to seeing her. So it's done already.

I really, really, really wished at that point in time to be the doctor instead of me...how nice it would have been to just poke my head in the door and spew off some orders to the nurse. But no. I was elbow deep. In shit.

Sigh. I need this vacation of mine to hurry up.

***
And speaking of poo...

Words

2011-07-11T15:58:00.004-04:00

Patient: Can you hand me that urinal? I've gotta go, it's all that damn lazyticks you gave me.

Well, sure. At least you didn't ask me for it "instamediately," as did my patient last week. As in, "My baby had fever, so I didn't give her nothing but brang her here instamediately so yous all could."

Sigh. I need a vacation.

End of an Era - STS-135 Atlantis

2011-07-08T08:18:00.004-04:00

I would, without hesitation, sell my future firstborn child for the ability to be on Atlantis today. Just saying.

Watch it now!

Futility

2011-06-29T09:19:00.006-04:00

I can't figure it out.

Most major building projects leave some evidence (besides the new building, of course) around. In the apartment complex where I reside the evidence is a large grassy knoll in the corner of the property where all the extra dirt went. That large grassy knoll, which is really just a pile of dirt covered with scrubby weeds, started out as just a huge deformed pile of dirt. Last year a single bulldozer came and smoothed out the pile into a nicer pile and covered it with grass seed and hay, which promptly scattered itself across the next 100 square miles as it was a very windy day. I thought all was done.

Then, about 6 months later, another bulldozer showed up and spent a morning smoothing the dirt again. It left after a few hours of smoothing, and nothing ever came of that activity nor was there any noticeable difference in the grassy knoll's appearance.

Until today.

At 0745, I was awakened by another bulldozer. Smoothing the pile. For the third time. I can't figure it out. What the fuck are they doing?!

And after all of this, I cannot for the life of me understand why they are taking this much care over the appearance of the grassy knoll while at the same time leaving this little piss-ant pile of sad dirt a mere 100 feet away.

And also,

2011-06-15T06:21:00.002-04:00

No one can resist my Schweddy Balls.

teeheehee.

Dilemma

2011-06-15T03:56:00.006-04:00

So I've been a nurse for 2.5 years. A real, off orientation nurse for about 2 years. I'm not great at nursing. I like to think I'm a good nurse, and on my way to eventually becoming a great one, but I'm nowhere close. As in there is a megagram of shit I don't know. And I know that I know this, which sometimes makes it a little awkward when a coworker is all like damn girl, you rocked that code, well done. Because knowing how much I don't know, I sometimes feel like I'm just a mediocre nurse who got lucky that day and really has everyone fooled.

Here is where the situation gets a bit sticky. On night shift we're essentially being bent over and told to hold our ankles, because management has run out not one - not two - not three - four fantastic nurses to neighboring ERs because of how crappy we are treated in many respects. These nurses were all career ER people - people who if I ever wreck my car or accidentally fall into a wood chipper, I pray that they are working. Now they are being driven out in mass numbers. This is where the dilemma lays: the fourth nurse is a Charge Nurse. So since we will be down to only two FT charges, there is a need for some people to be trained as relief charge*.

And here is why I'm in a bit of a pickle**.

The manager has asked me to train as relief charge.

Right?!

I told him I'd think about it, but really all I can hear in my head is someone screaming INEXPERIENCE! NEWBIE! YOU'LL ACCIDENTALLY IMPLODE THE DEPARTMENT! I truly am flattered by the offer, and the teeny part of me who wants to advance in my career is like oh hell yeah I'll do this, but the much more rational part absolutely knows that I really am too inexperienced to do charge. I'm know I'm not viewed as a complete moron by the current charges, because some of them have mentioned this before. Really though, I feel like I need more years of experience before I can competently keep the department from burning down.

The pickle is that I don't want to piss off management by just saying no since they can and have made life hell for these other nurses, but I also am not willing to take something I am nowhere near ready for.

Help. Advice?
----------
* Part of the fuckery that happened to the nurses is this: A (recently)current relief charge nurse noticed one of the new nurses engaging in some very stupid decision making, with the actual life of a patient at risk. Relief charge went to the nurse and mentioned her concerns, and stated that the new nurse maybe needed to change her ways. New nurse, instead of being like "this is embarrassing but oh yeah I almost just killed someone, maybe I should listen," instead went to the manager and wrote up the relief charge. Manager went to relief charge and chewed her out, and then took away the position of relief charge because she "needs to learn to be nicer." Srsly.

** I was kinda scared to google search the term "pickle." Maybe I'm just a paranoid with the sense of humor of a fifth grader, because all that showed up on the first page was...you guessed it...pickles.

Fair enough

2011-06-11T20:22:00.002-04:00

There is a standard set of questions for ailments that I use to drag more information out of a patient, until I can tailor the questions more specifically. What were you doing when the chest pain started? How long has it been going on? Is it constant or intermittent? It is sharp or burning or pressure? Stuff like that.

Lots of patients experience their complaint for hours/days/weeks/years. One question I find particularly useful for them is "what changed about your complaint today to make you come in right now?" Usually it's because they're coming in at 0300 on a Tuesday for finger pain x8 months and just need a work note, but sometimes that question evokes a surprisingly legit response.

The best I've ever heard:
Me: So you've been having this diarrhea for almost a week now, what changed about today to make you come to the ER?
Leaky Patient: Well, I accidentally shit myself today. I figured it was an okay reason to be seen.

Touche, sir.

So you're telling me there's a chance

2011-06-09T09:13:00.003-04:00

Yes, it's moderately flattering to have you, my 25 year old male patient, ask me out for a beer right after I'm done giving you your discharge papers. Even though the odds of me saying yes are slightly worse than the 3720:1 of navigating an asteroid field, you've still got a small chance.

That small chance, however, immediately goes to zero if you ask me out for a beer in between massive dry heaves since you're in the ER after nearly killing yourself in a drunken stupid decision.

Dr. Death

2011-06-03T10:35:00.003-04:00

Democrats silent, vague on Weiner photo.

heehee. I'm five years old.

In other news, Dr. Jack Kevorkian died today. I was old enough to know what was happening but young and dumb enough to not understand a bit of it back in the height of his assisting of suicides. Now that I'm older, somewhat less dumb, and working in a field which allows me to truly understand the suffering of terminally ill patients, I've got a lot more respect for the whole situation.

I guess it's sad to see him go - if only because he was a figurehead for the debate in the End of Life issue and "dying with dignity" and the politics of it all. I don't necessarily agree with his methods; Kevorkian was theatrical and inflammatory against the media. I do, however, agree with his view: those who are terminally ill, of sound mind and wishing to end their life have every right to do so. It's their life, let it be their death.

I've watched so many patients die in my short ER career. There is one that stands out in my memory: a woman who I took care of for a mild complaint, in which she ended up being diagnosed with cancer in a weird place. Months later the same patient comes to the ER after seizing, aspirating, and nearly coding. I didn't even recognize her; the cancer had destroyed her in a very short time. But she died quickly, and relatively peacefully. Her family understood what was happening and didn't try to drag her back with CPR and drugs and futile treatment. They let her die with dignity, which she herself told me she wanted way back during that initial diagnosis. But there are many who aren't so lucky.

If someone's future only holds death and pneumonia, bedsores and tube feedings, being bedridden and in an ICU, renal failure and dialysis, and mental status changes until you don't recognize your family...I think I can understand why these people would want to choose their own manner of dying.

Imma get off my soapbox now. Put the pitchfork down, please.

Rambo

2011-05-24T07:45:00.005-04:00

Ugh, you know what is the worst? Intoxicated vomiting patients who do so while laying on their backs. I'm the only soul in sight at the nursing station, and I see this dude start to do that heave ho chest thing and make a gurgley sound and so I walk in and grab the yankauer to suction that shit right up. Of course, the patient decides that the moment I am two inches from his face with the suction, he is going to yak all over himself...and straight back into his airway. I do the only thing I can with a non-C-spine cleared patient: ignore the c-collar and grab the sheet to roll the dude onto his side. While still trying to prepare suction on the forthcoming flood.

And promptly have the full components of a foot long BMT sub vomited onto my leg. At least, I think it was a BMT. It might have been meatball sub. Or even Sweet Onion Chicken Teriyaki. There were definitely onions in it. Oh, and I think there were brain particles, or maybe they were just bits of his common sense but whatever it was, it sure as hell didn't stay down. I yell for help and the cavalry arrives just in time to see him finish the vomitfest. Thanks, guys. And fortunately his C-spine was negative, so we can all just forget that I manhandled someone in a collar.

Anyway, when dayshift came in we were relegating them with tales of this fool, and discussion turned to other gross things, and how gross trachs are, and how we'd rather have a drunken vomiting moron any day over a septic nasty trach. We tell stories of our grossest trachs ever, and one of the docs overhears and mentions how the absolute worst is when there are like nine people in the room, and the tracher just machine guns his sputum right down the line of people with his coughs...UuuuHuYOU! UuuuHuYOU! UuuuHyYOU! and YOU! and YOU!...you're okay...and YOU!

"It's like the Rambo of Lung Butter," he says. Mmmm mmm good.

I hope you're eating breakfast while reading this, suckers!

Ohshitosine

2011-05-11T08:30:00.002-04:00

I gave my favorite med of all time this morning! It's the most satisfying thing in the world. I just love adenosine.

Love it.

Equally enjoyable is taking care of two back to back STEMI patients. Like I've had a recent run of only drug seekers, chronic abdomen/leg/back/head paineurs, I ran out my inhaler a week ago patients, my left toe feels funny x3 years, I haven't had a period in two months and there is NO WAY I could be preggo birth control is dumb girls, and other stupid mundane shit. Until today, when all I did for the last three hours of the shift was make someones heart stop temporarily, try to keep someones heart from stopping x2, and sending someone really sick to the OR. I felt like an actual ER nurse. Good times.

Dear 16-year-old me

2011-05-07T21:35:00.002-04:00

Dear 16-year-old me. There's going to be a new set of Star Wars movies. Don't watch them. They ruin everything.

And wear sunscreen. Check for moles. Don't go tanning. Be aware of your skin.

Skin cancer can kill.

Big Sexy

2011-05-06T03:33:00.002-04:00

Quite a few male nurses work in our department, so much so that we rarely give it any thought. But every now and then, the gender differences are glaring.

Two weeks ago, a patient was put under conscious sedation for a procedure, and we couldn't get her to go to sleep. She kept talking, and looking around, and talking, and oogling. Finally, we had to banish the cause: the male nurse. He leaves the room, and the patient tries to sit up and go after him. We lay her flat again, and she heaves this big giant sigh, and goes, "but he's soooo sexy!"

Fast forward to tonight. My little old lady is putting up a surprisingly fierce fight against the po contrast. She doesn't want to drink it, and vehemently swears against the NG tube. While we know she is slightly demented, she knows what's going on right now and where she is, so forcing the tube would pretty much be assault. I'm trying to coax her into these little bitty sips, and she's refusing - for a half hour. Finally the same male nurse walks into the room after taking pity on me, and sweetly asks her to drink it. She eyes him up for a minute, and then grabs the cup and sucks down the entire dose of contrast. He smirks at me and walks back out.

I look at the lady and thank her for drinking it, and then ask her how Male Nurse convinced her. She looked at me like I'm an idiot, and shouts, "well, he's Big Sexy, of course."

Right. I should have guessed. Best part is, the entire nursing station overheard this exchange. So obviously, we will be calling him Big Sexy for the rest of his career...until little old ladies no longer swoon in his presence.

Status

2011-05-05T07:54:00.000-04:00

Oh okay. Just checking.

hasthelargehadroncolliderdestroyedtheworldyet.com

A short list of dislikes

2011-05-01T08:23:00.002-04:00

Things I can't stand:

Having to come home from a banging vacation
Immediately going back to work for three nights
Getting my ass handed to me all three nights
Boyfriends who beat the shit out of their girlfriends*
Patients who come in on a backboard after a day of drinking and immediately tell me they need to take a dump
My recent inability to hold my bladder for herculean amounts of time. It's not convenient having to pee in the middle of important things
Doing CPR on a 400 lb person with a 30pack of Bud Lite in their stomach, because it sure as hell isn't going to stay there
Having to wait until July 15 for the next Harry Potter movie
Drug seekers
Patients who continue to do dumb things even after a recent injury
People who don't wear helmets whilst riding on fast things
Lazy patient care techs who disappear as soon as the septic gomer rolls in with EMS
Being too busy to take a meal break
Knowing I internally complain too much when in reality I love my job

Seriously, I have a lot of dislikes...but I love love love my job far more than I can truly say.

*If, however, I happen to see your ass walking on the side of the road after you're out of jail...I swear I will run you over.

Movies

2011-04-16T16:16:00.004-04:00

Oh, my friends. What a glorious year this will be for movies! I bought HP and the Deathly Hallows Part 1 yesterday, and it's even better than I remembered. July 15 will bring with it Part 2, which will be so epic I can't even put my excitement into words.

I am holding out hope for a brand new trailer in the next couple of weeks, but in the meantime let's review all that will be looked forward to in the interim...

X-Men: First Class. Charles, Erik, and the beginnings of it all. "The cost of freedom is always high..." And James McAvoy as Xavier? Squee. I will see it June 3.

Thor. Most likely going to be cheesy but I will enjoy every second of it, especially watching Anthony Hopkins be all badass. And apparently Thor can sneeze and grow a beard. Obviously I will see this May 6.

Green Lantern. Ryan Reynolds in spandex. Enough said. June 17.

Cowboys and Aliens. Daniel Craig being badass, Harrison Ford being badass, Olivia Wilde being badass...and the aliens? Most definitely badass too. I'll try to be badass on July 29.

Hesher. I'm still not quite sure what this is about, but I want to see it and I want to see Joseph Gordon-Levitt be awesome on May 13.

There, that should tide you over for now.

Full circle

2011-04-14T10:42:00.003-04:00

Hey remember that patient a few weeks ago who kept telling me he was going to die? The one who was totally lucid but whose body had fallen apart something fierce, and was working towards hospice care? Ah, I suppose you don't since I didn't blog about it, but let's pretend that I had.

I took care of a sweet lady the other day, who was in for belly pain. Just before she was shipped off to the OR, the rest of her family came back to say their good lucks. One of her brothers came up to me and said "I just want to thank you for everything you've done for my family."

I was a little perplexed, since this was a fairly straightforward case and the dude seemed about to burst into tears. "It's my pleasure," I responded, "and that's what we're here for. I'm glad I got to take care of your sister."

Then he leaked a few tears and asked if I remembered Mr. Guy, his father, from a few weeks back. Ohhhhhh. Yes. I remember. "He passed away two days after you saw him, with hospice care and surrounded by family. He kept telling us he was going to die, and he was right. And he was happy..."

Brother cried for a minute, and then kept on. "He kept saying how nice you were and that you took such good care of him even when he told you he was dying. Our whole family says thank you."

I looked back at the rest of the family, and damn if every one of them weren't crying too. Of course I teared up, and didn't know what else to do so I just gave Brother a standard side hug - which he promptly turned into a giant wet slobbery teary bear hug. I don't usually stand for that kind of stuff...really, do I want your snot all over me when you're crying, and you're a complete stranger dude, and sometimes I feel awkward with displays of snuggly emotions...but today, I think it's okay.

Mr Guy, I'm glad you went peacefully. And I hope you're enjoying that gin and tonic now.

Pause

2011-04-10T07:55:00.003-04:00

Posting has been light lately, which I apologize for. Mostly it's been because I've been too exhausted to write after getting my ass kicked at work every night for the past few weeks...multi traumas, crazy septic workups, three hour codes, random guy who has the big one during triage, demented patients who crawl out of bed while their sitter is in the room and DFO...you name it, I've had it. Just saying. I almost pine for the days of the nostalgic drug seeking tooth paineur. Almost.

I've got a few more shifts, and then I'm on vacay. Perhaps I'll post; perhaps I'll just kick back with a margarita and think about posting.

Either way, I'm going to bed right this minute.

So take a seat Steve...oops, I see you brought your own!

2011-04-05T05:26:00.000-04:00

Oh, this is too epic to pass up.

"I'll give you a brief history of pain..." Why this amuses me so much I don't know, but it's glorious.

She's fine

2011-03-30T18:03:00.002-04:00

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

2011-03-28T05:07:00.002-04:00

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.

2011-03-27T03:26:00.002-04:00

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

2011-03-20T19:07:00.003-04:00

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

2011-03-18T18:02:00.004-04:00

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

2011-03-16T02:00:00.003-04:00

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

2011-03-14T07:36:00.005-04:00

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

2011-03-11T00:04:00.000-05:00

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

2011-03-09T03:53:00.003-05:00

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

2011-03-06T19:56:00.001-05:00

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?

2011-03-03T22:49:00.001-05:00

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

Vote for Lando Calrissian! w/ BILLY DEE WILLIAMS - watch more funny videos

Honor

2011-02-28T17:04:00.002-05:00

"We have lost a living link to an important era in our nation's history" - Eric Shinseki, Veteran Affairs Secretary.

Thank you, Frank Buckles, for your service.

Technicalities

2011-02-28T07:44:00.003-05:00

A little bit of backstory: We have quite a few foreign exchange nurses working in our hospital. Most are either Pacific Islander or Indian, and a few from other scattered places. All speak English well, usually in addition to two or three other languages. Having just taken a Spanish for Nursing class, and still feeling Spanishly Dumb, I really, really wish I was bilingual. I've got the greatest respect for those who can hold multiple languages in their head and not have it leak out of their ears. That being said, there are occasionally some language snafus which we all get a giggle out of.

Such as tonight.

One of the exchange nurses went into the patient room to check a pulse ox. He was placing the pulse ox finger thingy on the patient, while explaining what he was doing. "I'm just going to check your pulse ox, to see if you're SOB."

The patient looks at him all bewildered like, and goes, "I mean I'm having a little trouble breathing, but I'm not a son of a bitch!"

The poor nurse came back out and was just as bewildered as the patient...until we all busted out laughing and explained the idiom that is "You SOB!!"

Lesson learned. And after the lesson was over, the nurse did smile too. Because let's face it...that junk is funny. Political correctness be damned.

Overkill, overdose

2011-02-25T00:05:00.003-05:00

We do med reconciliation in the ER on every single patient. I ask them what prescription meds and/or OTC meds they take, they tell me, and I enter them in the computer. Sometimes they give me a list, sometimes they hand me a bag with 6 or 7 med bottles. With nursing home patients you know you're going to spend 15 minutes searching through the chart and then entering 23 meds, but at least they are on two or three pages and usually in alphabetical order.

And then sometimes you get a patient that defies all expectations.

Like the patient whom EMS dropped off with a suitcase of meds.

A suitcase. There were ONE HUNDRED AND NINETEEN pill bottles in the case. I know, because I counted them. And read them. And entered them in the computer. Every single one.

Face palm.

America...the States

2011-02-17T13:45:00.002-05:00

I really enjoy when people forget that an actor might have had a role in TV long before one popular show. Thusly, please enjoy Hugh Laurie and his magical musical skillz.

I am not a Belieber.

2011-02-13T21:09:00.004-05:00

Hey Justin Beiber. I'm watching you right now on the Grammys. How are you popular?! You're twelve and singing baby baby baby baby baby baby baby oh yeah baby baby baby. I could have sworn I had never listened to you before, but then I remembered that you were on the TV in the background at a New Year's Eve party I went to once, and then I also remembered thinking "man, this kid is awful."

I can't take this.

Jeff Lang, please come back to America so I can hear actual live music.

This little piggy

2011-02-12T08:32:00.003-05:00

The first 15 minutes of a shift will make or break you. It will decide what kind of night you're going to have; whether it will be a pleasantly steady and mind-stimulating set of patients, or a bat out of hell don't sit down for 9 hours insanely busy crammed influx of the entire population, or a just face the music you'll-probably-have-actual-shit-on-you at some point kind of night.

Tonight, my friends, was a have actual shit-on-me kind of night. And I knew it would be bad from the start.

I walked onto the floor and the previous nurse had just dispo'ed all of my rooms. Empty group + 4 hour wait time = bend over and take it now. I'm trying to help clean out the trauma room of the stuff enviro won't touch, like saline bags and extra blood tubes and suture kits. There was a large tray, obviously from central, of all sorts of clamps and scissors and such. We send those back down to be sterilized, but always they have to be looked over to make sure nothing of the sharp and pointy variety is forgotten. It's a no needle left behind policy.

So I'm pulling a few spare pieces of gauze off the tray, and eyeing it up to make sure there are no sharps, when I spot...a...what the feck? Is that? Is THAT wha---?

Holy shit on a stick, batman.

It was a severed finger. Just hanging out. Next to the kelly clamp. A severed finger. In all its number one glory.

I don't know what the hell happened in that room before I got there, but I'm glad I wasn't present for it. Ugh. Can you imagine if I sent that down to central processing?! I can only dream of the conniption fit that would be thrown.

So my friends, in case you are wondering, this is not a good way to start the shift. Finding spare body parts will guarantee an actual shit-on-you kind of night.

And it was...

The issue is pronunciation

2011-02-08T21:56:00.004-05:00

So this city won't name stuff after a Mayor from years ago. Why? His name was Harry Baals.

They're afraid people will snicker.

They're right.

'The issue is pronunciation. The former mayor pronounced his last name "balls."'

I'm thirteen years old.

I also have nothing of interest to add regarding nursing. Womp womp.

I find your lack of faith disturbing.

2011-02-06T08:36:00.002-05:00

Star Wars. Super Bowl Commercial.

For the win.

Stoicism

2011-01-31T08:09:00.003-05:00

I am a rock. I am a brick wall. I have the blank stare to end all stares. I am impervious to small children and unicorns. I have a soft heart encrusted in a layer of steel and beer. I am a rock.

Let me set the stage...

8 months ago...
Frequent flyer: I don't know how I'll get home...sob story...I know how to work the system...sob story.
Other nurse: Well, I guess you can have a cab voucher.

7.75 months ago...
Frequent flyer: I don't know how I'll get home! Sob story. Whine. I have no money...Sob story.
Other nurse: Well, I guess you can have a cab voucher.

7.25 months ago...
Frequent flyer: I have no money, I'm so pathetic...Sob story. How will I ever get home?
Other nurse: Well, I guess you can have a cab voucher.

6.5 months ago...
Frequent flyer: How will I get home? I have a meeting with my social worker today, I think she can help me with bus tickets.
Other nurse: Well, I guess you can have a cab voucher.

6 months ago...

And so on.

Until tonight. We've been telling this girl for FOR.EV.ER. that she can't have a voucher, no way, yet she will always try and wheedle and whine and complain and look pathetic until someone caves, and if you don't cave she'll demand to speak to the charge nurse. Usually the charge nurse will put her foot down, but often enough someone will give her one and she keeps coming back with that in mind. Not today, bucko...

Tonight...
Frequent flyer: It's so cold outside! I have to watch my friends' kids in a few hours, and I don't have any way to get home! Can't you just give me a cab voucher?
Me: Um, no. You've been pulling that crap forever now, and I'm not giving you one.
FF: But I have to watch my friends' kids!
Me: Aaaaaaannnd?
FF: Well, how am I going to get there?
Me: How were you planning on getting there in the first place?
FF: I was going to walk.
Me: And it's too far to walk from here. So when you called the ambulance, how were you planning on getting home?
FF: Well, they gave me a voucher last time.
Me: Aaaaaaannnd?
FF: So I thought they would tonight too.
Me: So you called the ambulance for a complaint which you've had for years, and are feeling no different than usual, with the full knowledge that you have no cab money and no way to get home?
FF: I guess...but I really need a cab voucher!
Me...blank stare...Well, that's unfortunate. You're welcome to sit in the waiting room and make phone calls from your cell until you find a ride. No voucher for you.

Blah blah, sob story some more, I need the charge nurse, charge nurse backs me up 100%, peace out frequent flyer!

No cab voucher.

Just for tonight, the ER wins.

I am a rock.

The cost of night shift

2011-01-29T08:38:00.005-05:00

Lots of people don't like working night shifts. It fecks* with your sleep pattern, makes you nocturnal, you miss out on brunch specials at the local diner because you're comatose in bed, and sometimes people mistake your pasty skin to mean you're a vampire.

But I love it. I love the night shift staff, I love the ability to sleep in until 11am and get away with it on any given day, I love the fact that EMS people bring us coffee at 0300 because they can.

There are, however, some things that make me wonder if I'm a little bit jacked in the head from working all these nights. Like this morning. I came home after a 4 day string of night shifts, and was seriously jonesing for some waffles. I'm bone tired and really want to go to bed...but those waffles need to come first.

There I was, standing at the counter with my waffle maker trying to stay awake. When they're done, I sit and begin to chow. A forkful is on the way to my mouth, when I notice a small piece of color on it - color that normally does not belong on a waffle. It's the same color as my scrubs. I eye it up. I could have reached my finger into the mess of syrup to pick that bad boy off. I could have set that bite aside and gotten the next one. I could...I could...but I didn't.

I am way too tired to get that piece of thread.

So I ate it.

Come to think of it, I'm not even sure it was thread. It might have been a small scrub-colored bug for all I know. Actually I hope it was a bug, because who knows what is on my scrubs after 12 hours in the ER. I barely slowed the fork down on the way to my mouth though so really it was a moot point. I don't think I could have stopped that trajectory even if I wanted to.

But whatevs. I don't even care. I was hungry. And now I'm full, and ten minutes from a carb coma, and I'm going to bed.

I love night shift.

***
Feck. My new favorite almost-cuss word.

"The future doesn't belong to the fainthearted..."

2011-01-27T17:45:00.008-05:00

It's all part of taking a chance and expanding man's horizons. The future doesn't belong to the fainthearted; it belongs to the brave...

...The Challenger crew was pulling us into the future, and we'll continue to follow them...We will never forget them, nor the last time we saw them, this morning, as they prepared for their journey and waved goodbye and 'slipped the surly bonds of Earth' to 'touched the face of God.' -Regan

I think that says everything.

Bits

2011-01-24T22:00:00.004-05:00

I've been in a bit of a narrative funk recently; I just don't seem to have anything interesting to say. So with that in mind...here are some bits of not-that-interesting things for your consumption.

***
I'm taking a Spanish for Nurses class, and the professor warned us that she will be teaching us phrases that she doesn't usually teach to her high school classes. Because they're too immature. I didn't have the heart to tell her that my sense of humor is equivalent to that of an immature high school boy.

So we were supposed to put together some phrases for practice. I immediately went for 'voltéese, agáchese, y relájese.' Along similar lines, please refer to the pain scale discussed by ERP.

***
It's been noted that I'm a sucker for comic book action movies. Apparently not only does my sense of humor mimic a 16 year old boy, but so do my movie preferences. Thusly I went to see The Fighter recently, and while it was fabulous...I was also intrigued by the preview for Thor. It's going to be typical superhero cheesy, probably along the lines of X-Men 3, but still. Dude is hot. And shirtless. Sign me up.

***
It's also been noted that I'm out of shape. I've managed to avoid all forms of physical fitness recently, but somehow have gotten sucked into multiple events that will require not dying during extreme activities.

First, I'll be undertaking the Polar Bear Plunge in a few weeks. 40 degree water, 30 degree air temperature, me in a bathing suit. I don't see how this can go well.

And next, I've signed up for the Warrior Dash. 3.11 miles, extreme obstacle courses, hundreds of participants. I'm not so worried about the obstacles. Fiery log I have to jump over? Whatev. Climb a cargo net? Pfft. Run 3.11 miles? I'm going to have a heart attack. I haven't run that far since high school.

But let's be real. I'm just doing it for the Viking hat and free beer.

***
I love Beards. I love football. I love when the two meet with an epic clash. As Rosenthal puts it, "That thing is the seventh wonder of the world."

***
As as aside, I hate the Steelers. Kaley is right, I've got no self respect after putting this picture on here. If I knew how to photoshop, I'd change that jersey right up. But alas, no dice. And the beard is still amazing...

***
Fin.

Things that are not funny

2011-01-19T07:58:00.004-05:00

Okay, I don't know what's wrong with me. I can hold my bladder for like eighteen hours and dozens of patients and a giant coffee and two diet cokes and most likely some cheez-its too even though they are my weakness but not related to the bladder in any way, but double-you tee eff is up with me INSTANTLY having to pee the minute I get into my car to go home?!

I don't have to drive far. Probably only four or five miles. And come hell or high water I won't pee at work, but damned if I'm not sitting at the stoplight 400 feet from the ER employee parking lot, crossing my legs and almost in tears.

It never fails. It's like I have a sixth sense. An ass-sense, if you will. My buttcheeks touch my car seat and it's like ba-blam! Contain the fountain of gold. Or perhaps that is my #1 sense, and all the other normal ones are two through six. Who knows.

All I know is that it's not funny, and it's not at all amusing to have to walk past my neighbor at 0730 looking like I'm attempting the new Olympic sport of Stair Climbing Whilst Not Moving Your Legs.

Not helping.

2011-01-15T07:59:00.003-05:00

Shrtstormtrooper: What medications do you take every day?

Patient: Um, it's prescribed by my doctor. It's a little white pill.

Shrtstormtrooper: Do you remember the name of it?

Patient: Yeah, it's round and small.

Sigh.

Reassurance

2011-01-12T08:03:00.000-05:00

I love working in the ER. I really do. The chaos, loud noises, knowledge base required and crazy scenarios are what I most enjoy. Sometimes, though, I feel like I don't quite get the opportunity to interact with patients on a basic level. Sure, I can give them pain meds and talk while I'm assessing their mangled leg and reassure family members before we do a conscious sedation to reset that mangled leg...but in all the craziness it just isn't possible to give as much time to each patient as I would like to.

So the other night, when it was shockingly slow - only four patients in the ED for more than an hour - my attention wandered to the patient belonging to another nurse. I had overheard the staff talking earlier; apparently this patient was related to one of the more prominent administrative peeps in the hospital, and they just didn't know how else to help her. This patient also had severe, advanced early-onset Alzheimer's. The patient was waiting for a social work consult in the morning - but even though she had been reminded of that many times, the patient had no idea she was waiting for that social work consult. She also happened to have been PC'ed by the doc, so security was sitting with her.

Since it was the wee hours of the night, and dementia robs people of the ability to critically think or analyze a situation logically or even remember what situation they are thinking about in the first place, she was starting to get very anxious. She started pacing back and forth, going from bed to chair to doorway and back. Security kept getting gruff with her, telling her to sit down and stay on the bed.

Now this lady had been in the ER for 8 hours already...I'd be pacing too. She kept getting more anxious, and security kept getting shorter with her. Her primary nurse happens to be someone I like personally but detest as a nurse - she is lazy, preoccupied, and would rather go take a smoke break than talk to her patients. The primary had also been complaining about this dementia patient, since her agitation was preventing a long and relaxed lunch break. So when the lady wandered to the doorway for the umpteenth time, I walked up to her.

"I have to get out of here! It's so late, and my husband just died and I don't know what to do..." She rambled and paced, so I offered to take her for a walk.

And we did.

We circled the pod hallway at least ten times. How else to comfort someone whose husband has actually been dead for a decade, yet who is experiencing the grief as if it were new? After a dozen laps, I asked if she wanted to do another. "No, I think I want to go lay down," she said.

And she did.

She went to sleep for the next three hours, until change of shift. She woke up when dayshift staff came out, and so I went back up to her to let her know about the social worker coming in soon. She climbed out of bed and gave me a hug, and started crying. "Thank you, and please tell my husband that I'll be home soon," she said. "And also, you smell very nice."

I am glad for this slow night, for the chance to be able to be there for someone. I didn't need nursing school to do what I did. It required no critical thinking, no med knowledge, and no IV skills. I didn't titrate a drip, or do an EKG, or keep an eye on the cardiac monitor. But I think it made a difference to that lady, just having someone who was there for her, to hold her hand. And that felt real great. I felt more like a nurse in that short time than I have in the past few weeks. Even though, in six hours, she will forget I ever existed.

And let's be real...it's always nice to be told you smell good.

Obi-Wan never told you who ate your cookies

2011-01-10T02:56:00.010-05:00

So I'm a terrible cook. I can potentially set the smoke alarm off by making pancakes. Make a three course meal? Chyeah right. Recently though I've been trying my hand at baking.

The verdict? Let's find out.

First, I make the dough. No wait, first I pour a glass of wine or two. Ah, yes, now we can get started.

I make the dough. I have some confidence about this thing. Right now, I feel like I could take on the whole kitchen by myself. Hey, the raw dough tastes normal! As normal as raw dough should, I guess.

Next I roll the dough out. Since I'm lacking a rolling pin, the wine bottle from earlier this week will suffice. I hope. Hmm. The dough is a little flaky. Not like Mom's cookies usually start...But whatever. I've got some awesome cookie cutters, and I'm already invested in this project. The dough gets cut and placed on cookie sheets. Minus the parchment paper, because that I forgot to buy. It's not my fault! Well okay, it is.

Minutes later, they're done! And...they look a little pale. I hope they're tasty. Imma tell you the rest of the story, but first I've got to scoop them up with my Darth Vader spatula.

And the final product! Okay so they taste subpar, but let's be real. These cookies are badass.

Now I know how I got so big. It's eating food of this kind.

***
The possibility of me successfully learning how to cook is approximately 3,720 to 1.

Act I, Scene infinity

2011-01-09T20:55:00.004-05:00

03:52 am. Enter patient, lobby right. Patient carrying two large suitcases, one in each hand. Strong smell of etoh.

Shrtstormtrooper: So what brings you in tonight?

Patient: My arm hurts.

Shrtstormtrooper: Uh huh. You have a cast on. When did you break it?

Patient: Earlier this week, and they did surgery to fix it.

Shrtstormtrooper: Well, your arm is going to be sore for a while. It takes time to heal.

Patient: Yeah, but it's been almost a week and it still hurts. And it hurts a lot more when I carry my stuff around, like this.

Facepalm.

End scene.

Rest in Peace, DHC

2011-01-01T22:01:00.004-05:00

Discovery Health Channel passed away on January 1, 2011. It was eleven.

The child of Discovery Communications Inc, DHC lived a thrilling yet short life showcasing the medical realities of our world and those who live in it. From birthing babies to the critical hours of emergency medicine to the autopsies of those who didn't survive, DHC showed it all.

During its brief but poignant life, DHC won a daytime Emmy and the viewership of millions.

Towards the end of its life, DHC was burdened with the knowledge that with its passing, a gaping hole would be left in the viewing options of those who work, live, and care about the medical field. Even with this heavy heart, DHC stayed strong until the end.

You will be missed, Discovery Health Channel.

Condolences may be stated on your own blogs.

***
And also, screw you Oprah. You are the spawn of Satan.

Angry

2010-12-27T00:53:00.006-05:00

You know what really, really chaps my ass? When you come to the ER at 9:30 pm, for a chronic pain issue which has "just been nagging at me for a while now," on the 911 cabulance, for the sixth time this month, IN THE MIDDLE OF A FRICKIN BLIZZARD, and you get pissed at me when I tell you the hospital can't provide you a way home.

But they gave me a cab voucher last time! Well in case you hadn't noticed, there are nine inches of icy white stuff on the ground. No cab runs in that.

But I only live half a mile from the hospital! Trust me, if I could throw you that far I would do it gladly.

But can't someone drive me home? Yes. Let me call the national guard, just for you. Or maybe I should abandon the rest of my patients and drive you there myself. Yes, that seems like a winning idea.

But can't I be admitted? For bullshit back pain? I'd like to see you try.

But I have to work in the morning! And....? I'm at work right now, so obviously I found a way to make it happen.

But what am I supposed to do...this is YOUR fault for not being able to get me home, I want to speak to your charge nurse and I'm going to write a letter to the CEO telling them how you're mistreating me and how you shouldn't be a nurse because you don't care about people.

One charge nurse coming right up, buddy. And security, and a goodbye wave from me while I document the hell out of this. Feel free to sit in the waiting room for 9 hours. And no, I won't get you a blanket or ginger ale. Because you know what? You're right. I don't care about your complaints. You are angry at me for not bending over backwards to make the impossible happen. But really, you shouldn't even be here. You have a non emergent complaint, and you wasted valuable resources by requiring that EMS pick you up.

And the saddest part? When you're angry because the charge nurse hasn't come to you soon enough, and when you're angry that EMS didn't give you enough blankets for the ride, and when you're angry that I'm not in your room every three minutes to give you the dilaudid you demanded...I'm angry too.

I'm angry that EMS was dropping you off and weren't closer to the cardiac arrest call they needed to bring in. I'm angry that you're wailing for the charge nurse when she is comforting the wife of the sweet man that dropped dead of the big one tonight. I'm angry that you suck down pain meds like they are candy, while nothing will fix the pain of the newly widowed woman's holiday season gone to hell. I'm angry that you think you can manipulate me by threatening, pleading, and insulting. I'm angry that I wasted time arguing with you when I could have been doing something, anything for the arrest patient's family.

And deep down, that makes me cringe. Because you're right - I don't care about you and your BS complaints. And maybe that is the saddest of all. Instead of feeling compassion for you, I feel nothing but anger.

Harmony

2010-12-22T23:14:00.002-05:00

I had this big epic blog post all planned out about how badass I am, how cold Colorado is going to be, why I suck at holiday shopping, and how I was going to tie it all together with some witty snarks and a moral to wrap up the day.

And then I see Nurse K is back online.

So perhaps I'll try again tomorrow, and in the meantime you all can go forth and read up on why she is the shiznit.

Copy fail.

2010-12-11T17:52:00.007-05:00

Iron and Wine's new EP is out, and it's pretty fantastic. But you know what, Sam Beam? Step offa Jeff Lang's toes! Music win, appearance fail.

Jeff Lang circa before I&W:

Sam Beam:

Same difference

2010-12-11T07:46:00.001-05:00

Shrtstormtrooper: Do you take any blood thinners?

Sir: Yes, I take Cootiemen.

Shrtstormtrooper: I see.

Pure evil

2010-12-09T17:38:00.003-05:00

Karma is a bitch, and my dentist is an evil evil man.

As I've made clear, I am not a fan of those who deal in teeth. I hate the dentist. I hate having my teeth worked on. I hate the little scrapey things and the suction and the noises and the feel of metal. Ugh. I really, really don't like it.

So there is a lot of anxiety every six months when I go for my cleaning. I sit on my hands so I don't accidentally punch someone. I make the squinty eyed face during all the scraping and mumble mrrruuuuggghh when they ask me questions. In general, I try to move as little as possible in hopes it will be over quicker.

And then today.

Dr. Dentist, who is actually a decent person, bounces into his chair and pokes around my mouth for a few minutes. He looks over at the xray, and gets real quiet. He calls over the hygenist. And then goes, "will you look at the size of that cavity?! Surgery, for sure..."

And then looks at me. I must have looked like he killed my puppy. I felt crushed, devastated. The end of the world. My vision was going dark. I could feel the tears rising.

Aaaaand then he laughs. Giggles, and goes "just kidding! All is well, see you in six months!"

I might have almost had an anxiety attack.

Looking back, this must be karma's way of getting back at me for all the cracks I've made about patients, and all the inappropriate things I've blogged about. It has to be.

But regardless, my dentist is an evil man.

Elvis has left the building

2010-12-08T12:11:00.002-05:00

Elvis is dead, but he doesn't want you to be too. Read up on how an anesthesiologist dressed as The King resuscitated a fellow runner.

There are just too many jokes to be had with this one, so I'll refrain. I just hope she sends him a note saying thank you...thank you very much.

Well, I tried.

Unproductive

2010-12-03T15:23:00.001-05:00

Seeing as I've resigned myself to having a completely unproductive day today, I have spent some time wandering the interwebs of youtube.

And here is what I found.

And it is good.

Maybe tomorrow I'll be productive...

Cleanup on Aisle 2

2010-12-02T07:39:00.002-05:00

Standard protocol in our ER is for emergent patients like those with chest pains, SOBers, or those bleeding profusely to be brought back from triage by the nurse for RN to RN report. Non emergent patients can be brought back by a tech, and just a quick handoff report is given to the receiving primary RN.

So a non emergent patient was rolled back today, and the tech found the primary RN and lets her know that there is a rectal prolapse patient in the room. The other tech overhears and asks what a rectal prolapse is. Without missing a beat the triage tech goes, "Oh, her asshole fell out."

My last mental image before falling asleep this morning is going to be of environmental sweeping up an asshole into the garbage bin from off the floor. How fantastic.

I meant to say...

2010-11-30T07:44:00.002-05:00

Overheard tonight in the ER:

Fun Young Doc: Okay, it starts off all loose and floppy, so Shrtstormtrooper here will hold it, and then we'll wrap it and it will get real hard.

I died a little inside. We were splinting the broken wrist of an 11 year old boy. Who just got his first lesson in reproductive planning.