If you're a bird, I'm 1967

Dementia is not a fun disease. It's actually really tragic. Someone dies in a car crash, well, that's quick. They are alive and then they're not. It's unbelievably hard for the family, but at least it's a finite event and there is a sense of closure.

Watching someone's mind slowly slip away into nothing is not at all finite. It's a heartbreakingly slow process. First that family member calls you the wrong name. Then they can't remember if toothpaste is for their teeth or for their bagel. Then they forget to take their blood pressure medicine and have a stroke, and then they forget to turn the oven off and then they forget who they are. And the family gets to watch the whole process. Sort of like in The Notebook, except they don't get to leave the nursing home to dance with Ryan Gosling and instead of curling up at the end to peacefully pass away with their life long love, they are dragged into the hospital where we poke and prod and change their diaper and then maybe, hopefully, there is a dignified end to their life.

Like I said, dementia sucks.

But sometimes, there are little nuggets of humor. When you're staring at a shell of a former person, you take what you can get. It's not always appropriate humor, but it keeps us sane.

Take Jeremiah. That's not his real name, obviously, but it fits since he was just about as old as the biblical dude. Pops comes into the ER for altered mental status...change in mental status in someone with a baseline change in mental status? Not something I'm going to turn the dial to 11 for. But for whatever reason, we were slow, and everyone - including my favorite doctor - immediately piles into the room to get report from EMS. The Doc is going through the exam, nurses are doing their things, and I can barely keep from peeing myself.

Doc: What year is it?
J: 1967.
Doc: Where are you right now?
J: I worked for the seafood business for 30 years!
Doc: What's your name?
J: Jeremiah, you idiot. I already told you that.
Doc: Why are you here today?
J: I worked for the seafood business for 30 years!
Doc: Okay, look at this light. No, don't go towards it, just look at it. Good. Well, you hang tight and we'll get some labwork, okay?
J: I worked for the seafood business for...1967!

I kinda feel bad for laughing, but whatever. That junk was funny.

Meds: Milkbone BID

Not really sure how I would obtain this H&P...

Hurt dog limps into New Mexico ER

But really, it's impressive. And kinda sad that this dog is probably smarter than a good percentage of our people patients.

Hi, I'm a moron.

There are an unbelievable number of idiots that come into the ER. I'm not sure of the exact percentage, but a sadly high ratio have already spawned and have now blessed the world with potential little idiots. And it's tragic. Because kids aren't born douchebags, they get made that way by their parents.

A fine example would be Tweedle Dipshit, who graced us with her presence at 0430 the other day. Her two year old, Tweedle Jr., was the absolute cutest kid ever. All ears and grin, he was dragged into the ER because he had a 104' fever. Tweedle tells me, "Well, he felt really hot but I didn't feel like taking his temperature and I knew yall'd do it here. I didn't give him no tylenol either, because I just wanted to get here quicker and that kinda stuff takes too much time."

I can only manage a blank stare for three seconds, max, before I want to hurt something. So I turn to look at this kid, who immediately wants to give me a high five. I open my mouth to start asking questions when mom, and I shit you not, holds up a finger in the universal "give me a second" gesture and pulls out her cell phone, dials her friend, and proceeds to start talking about how long the ER wait was and how the nurses haven't done anything yet for her kid. Even though the kid got tylenol in triage.

Wolverine has a beserker rage that just takes over him. If you've seen the movies, he just snaps and snikts and slices some people up while everyone around him is like WTF just happened?! Sometimes I joke that I have this rage inside me too - which helped me fend off a creepy potential rapist, a story for another day - but after this day I'm not so sure. If I really had a beserker rage, Tweedle wouldn't be alive right now.

Instead of flinging metal claws out of my hands and destroying her, I silently vowed to somehow get revenge. So I glared at her for my max of three seconds, then loudly started asking questions over her talking. She looked at me like I had three heads, rolled her eyes, and gets off the phone. Whatever.

I tell her to pull the britches off her kid because I'm taking him temperature again. She asks "why would you need to do that?" It's like this woman is here solely to infuriate me. Because, I tell her, you brought your kid in for a temperature, which means I sort of need to know what his temperature is. Sigh. As I pull his diaper open, the smell of freshly laid turd assaults us. Tweedle looks at me. I look at her. She asks for a diaper and wipes.

I'm at boiling point. What parent brings their diaper wearing two year old somewhere at the wee hours of the morning and doesn't bring a diaper bag? Scratch boiling, I'm at silently raging homicidal by now. The worst part is that I have to get the kid a diaper, because I can't let an innocent kiddo marinate in his own poo. It's not his fault his mother is on the same evolutionary level as a sea cucumber.

After all this, all the rant inducing behavior and brain degradation, she manages to push me over the edge with one simple request. "You get me a soda? I want Ginger Ale. And crackers, t-"

Imma let you finish, lady.

Well, no I'm not. I walked out. She yells "HEY! Get me a soda!" towards my swiftly walking away self. I give her a half turn, and point in the direction of the waiting room. "Vending machines. Help yourself."

Listen, I'm bound by the law which means I can't stab, kick, punch, shoot, or otherwise maim her. I also can't be too much of a jerk to her because then she'll call my supervisor and I don't feel like dealing with that. But Karma's a bitch, and revenge is best served as a crunchy snack that I made you pay for. It's not much, but I'll take what I can get.

Boring

Well blogfriends, I must apologize for boring you recently with my lack of anything interesting. I promise I'll have something worthwhile to say soon, once I get over this crippling laziness. I promise!


see more Lolcats and funny pictures

For now, you get this.

Lessons

Lessons of a $618,616 death. A man dying of kidney cancer and his family's struggle to fight it for 7 years. Help? Hurt? Worth it? It's long, but is it ever worth it. For reals, it's worth a read.

No really, wait for it...

Shrtstormtrooper: So what brings you in to us tonight?
Patient: I think I have an exploding head. Can I have vicodin?

Ah, Exploding Head Syndrome. Thanks, MSNBC, for widely publicizing this. I can already see the triage notes forming...

Wait for it...

What I enjoy most about the ER is that we can fix people in one visit. True, many people abuse the system and we have to sort through the junk to find a satisfying end to some cases, but there are plenty of other cases where the person comes in not right and we can fix them up in a short time.

Like fixing a broken bone, for example. Your tibia is in two pieces, which is one piece more than it should be. You hurt. It's not fun. But then we give you pain meds and do a conscious sedation, you murmur a few choice words, then wake up and wonder why we're all giggling and hey! your leg doesn't hurt anymore. So far in my career, these sorts of things have been my favorite.

Until today.

I can now say with certainty that my new favorite is treating SVT with adenosine. It's just so...rewarding! There's nothing like it!

I mean seriously, it's one of those things where the new patient complaints of his heart racing, you hook the nice guy to the monitor, your eyes get really big, every alarm in the place goes off, and six people come trooping into the room immediately. He's racing away at 220 bpm, you put the pacer pads on to ward off bad spirits (or to shock the hell out of him later), call for a doctor, start big honking IVs, send someone for the adenosine, draw it up, and warn the guy it's going to be a bit of a weird feeling.

Then you slam it in. Eyes go from the IV to the monitor.

And ba-BAM! Flatline. You wait. And wait. And oh dear God is it EVER going to start up agai-whew. There is it. Success, in 15 seconds flat.


I love my job.

Toyota

I'm typing this from my new Toyota Keyboaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa

***
Wish I could take credit for this, but it belongs to Joe Peacock. Read his stuff.

...and a purpose for living

Recently, the last US Veteran of WWI turned 109. While speaking to the Senate, Cpl. Frank Buckles of Charles Town, WV talked a little about the responsibility he feels and how he has been able to make it to his age. "The important thing is the desire to live, and a purpose for living," Cpl. Buckles said.

If everyone had the same view, I wonder what our country would look like?

Thoughts

If a tree is four-point restrained in the forest, and no one is around to see it...is it really in four point restraints?

Snow snorkeling

So my mom sent this picture to me, and I can only imagine the facepalming that went on when this patient came to the ER for hypothermia...

Fishing

I really, really love Deadliest Catch on Discovery. Captain Phil is one of my favorites. He passed away yesterday.



You'll be missed, Phil.

Decisions

Listen up, buddy. You're the one who decided 0400 in a blizzard was a dandy time to call an ambulance. You're the one who told EMS you have flank pain and have a history of kidney stones. You're the one who told us that you actually ran out of your dilaudid prescription for chronic kidney pain.

You, my friend, are the one who kindly wailed in pain so loudly registration couldn't get anything more than your name and social. You are the one who insisted you have awful awful stones and need something now for the pain. You're the one who told us you have an allergy to toradol and morphine and IV contrast dye.

You're the one who decided to lie about your frequent visits to the ER and try to convince us this is your first time here. You, bucko, are the one who then yelled at us. Not a normal, mundane "you all are awful horrible people and suck at life and have no sympathy and I wish Bad Things upon you" sort of yelling. No, sir, you took it up a level.

You are the one who decided to, and I quote, "beat the shit out of every one of you if you don't give me dilaudid now!"

We are the ones who decided to bodily throw you out of the ER and into the custody of the police.

Vicks Vapor Rub can kiss my big black ass

I've been pretty congested lately. I only wish I had Colt 45D to clear me up, so I wasn't coughing up all kind of s**t and generally feeling sick as a damn dog.



Colt 45D. It ain't just for black folks anymore.

Broke

Patient: I can't afford that prescription, you need to give it to me here.

Shrtstormtrooper: It's on the $4 plan at Walmart.

Patient: But I spent all my money on blow!


I'd say that's a case of poor planning...