Saturday, November 29, 2008

Dumbest. Code. Ever.

During my morning break, I staggered my way over with an unsteady gait to Starbucks. Lots of other employees were doing the same so naturally there were a lot of people around. There is a gift shop, a drug store and the info desk right in front of the Starbucks so many patients and families are also in the area. For some reason I noticed a lom with an oxygen tank and mask making his way through the gift shop. Apparently there was some resident who was meandering about as well when the lom started gasping for air and turning blue. The heroic resident quickly called a code and in the commotion I made my way over to see what the big fuss was all about. Turns out the tubing got disconnected from the tank when the lom tried to reach for a magazine from an awkward corner. So I reconnect the tubing with the lom returning to a normal colour and unlaboured respirations. This is when I see the code team (which consists of half the ER staff) rushing towards us in a giant kurfluffle looking to save lives and look good in front of the myriad of highly attractive women in the vicinity! One of my coworkers got completely confused when he saw me and asked what was going on. When I explained the situation to him, his worried expression transformed swiftly into one of profound disdain and disappointment followed by the words, “what the fuck man?” as he storms back to the ER. The code blue turned out to be a code bust leaving the resident exceptionally embarrassed.

Friday, November 14, 2008

From Kensington Palace

Sometimes there are some real pieces of work that walk in through the ER doors. Two nights ago my preceptor asked me if I wanted to try to triage a few minors just to get some experience. I was more than happy to get out of observation so I followed along. All was going well until a 40-something year old guy walks in. Actually, barges in is more like it. He immediately declares that he needs an x-ray of his belly. When I asked him why he thought he needed an abdo x-ray he looks me dead in the eye and states, “I’m pregnant – can’t you see that?” Ummm… no! I tell him that he can’t be pregnant (because he’s lacking the requisite parts) but he will be seen (and not shortly either). This sets him off even more and he starts screaming, “I’m pregnant! I’m pregnant! I need to see what my baby looks like!” Of course at the moment I heard the entire waiting room turn around to witness the freak show unfolding. He carries on screaming about his unborn child while my preceptor calls for security. The sight of security calmed him down enough for me to ask him name. He said it was Diana Spencer, better known as Princess Di. This just sets me off and I start to giggle (very professional, I know) while my preceptor takes care of the paper work.

Eventually he gets brought in and placed in the psych room. I also go back to observation but when I walk by the psych room he stops me and asks me for a pen. I saw him writing furiously so I figured why not and gave him my cruddy pen. About 20 minutes later, I walk by the room and I see his face covered in pen marks and he managed to wrap his head with medical tape! I asked the security guard about where he got the tape from and he told me that Princess Di was crawling around on the floor writing in “pregnancy pain” when he found a roll of tape under a chair and proceeded to tape his head! I wish I could have violated patient confidentiality and taken a picture because I’ve never seen anything quite so bizarre! The wrapping looked like a mummy’s bandages! Several minutes later Princess Di has to go to the bathroom. The security guard obliges and waits outside the door. When it was taking too long, the guard went into the bathroom and found him seran wrapping his chest and abdomen. I snuck away once again from observation just to be a part of the show! The on-call doc walks by, stops dead in his tracks and says, “Diana, I just saw you yesterday! What the hell is your problem now? You better not say you’re pregnant again!” Princess Di looks sheepishly at him and tell him that he wrapped himself for the x-ray so the baby will be protected. Oh good lord this man was insane (probably literally)! The doc just grabs the chart out of the nursing station, discharges him and tells him to get out! Princess Di threatens to report the shabby care he received to M15 and the Queen of England because she is his “mother”. Riiiight.

About an hour later, he walks into the waiting room and towards the triage desk again but this time the triage nurse tells him that the ER is closed – there’s too many people! He gets confused and bewildered and stumbles out of there. He didn’t come back for the rest of my shift but I’ve been told to keep an eye out for him because he’s almost frequent flyer number 1!

20+20 = 40

I had a patient come in for a prescription refill early on in my shift. He needed 40 mg OD, PO Lasix for a month, meaning he needed 30 tablets. Nothing unusual about that – we get a lot of people who need prescription refills and I’m more than happy to get the refillers seen quickly, especially when they DON’T need narc refills. So this guy gets his prescription filled and leaves. 45 minutes later he bursts into my area and starts yelling at me telling me that the “idiot doc got me the wrong dose”. Surprised and flustered (because this particular doc is a border-line perfectionist) I ask him to let me see the container. I read the label which says something along the lines of 60 20mg tabs. I point this out to him and he incredulously looks at me and says, “It says 20mg not 40! Are you illiterate?” I start to lose my patience and ask him, “what’s 20+20?” He replies, “40!! What is your f@#&%k point??” My f@#&%k point is that if you took TWO 20 mg tablets for a month, it would be the same dose you mathematically illiterate idiot! It took me a good 20 minutes to explain this concept to him. Did I mention that pre-temper tantrum he said that he’s a teacher? I fear for the future.

Thursday, November 13, 2008

Conscious Sedation Chats

Happened while prepping a pt for conscious sedation for an I&D

Doc: Okay dear just relax and think of pleasant thoughts.
Pt: Man I’m thinking I look like Halle Barry! Life is gooooood!
Doc: What’s a halle berry?
Pt: DAYUM doc you one OLD DOOD!
Me and 2 other nurses: Giggle snort chuckle!
Doc: Just push in the stupid fentanyl!
Me: Sure thing – giggle snort chuckle!
Doc: Glares at everyone in the room

Monday, November 10, 2008


27 y/o woman comes in with ++nasal congestion and watery eyes.
States symptoms started yesterday and generally experiences similar symptoms with onset of cold weather which resolve in several days.
Denies fevers/chills.

Productive cough with yellow sputum.
No pain on inspiration.
Lungs clear bilaterally.

COLD!!!! WTF people??? You wake up and think "hmm... sunday morning, now is a good time to go to the neighbourhood ER?? GET A LIFE!!!

Thursday, November 6, 2008

Diagnosis – Degenerate

17 year old girl comes in with her douche bag of a boyfriend complaining of abdominal pain, distension and vaginal discharge with whitish tissue. When asked when she had her last period, she says 2 months ago. When asked if she has unprotected sex she says ‘all the fucking time’. When asked if she thought she could be pregnant she gets a deer-in-the-headlights look and says, ‘but he doesn’t cum in me!’ The boyfriend emphatically supports this. Then he asks, ‘but couldn’t her gut be hurtin’ cuz I fucked her too hard in the ass?’ Ew. No you degenerate assbag it’s because she’s pregnant and miscarrying. Some people seriously should have IQ testing done before attempting to reproduce.

Baptism by fire

Several shifts ago, I walked in feeling good, feeling confident and generally feeling fine about the night. I put away my coat, got out my ID and stethoscope, greeted my coworkers and started walking on over to the assignment board. And that’s when I experienced a moment of asystole and then rapid tachycardia. My name wasn’t paired up with a preceptor. ‘Surely this must be a mistake – the ward clerk made a mistake. This HAS to be a mistake’, I thought in a panic. Unfortunately it was not a mistake. The charge nurse strolled over and told me that the unit was extremely short staffed and she thought I could take on the assignment by myself. Apparently 4 nurses called in sick. Damn flu season.

So I try to pull myself up by my bootstraps and head over to the fast track area (seems to be where I’m usually placed). I have 8 patients and a very worried day shift nurse waiting for me. Report sounds something like this;

‘Curtain 1 is a 33 year old guy came in with coffee ground vomiting. He’s got 2 boluses of fluid and needs a pantoloc infusion started along with another PIV. He’s due for another CBC in two hours and he’s waiting for a GI consult. Keep a close eye on him. Curtain 2 is HIV/HIT positive and came in for query pneumonia. Her sats are now in the low 80s. She’s gonna need help and lots of it. Oh she’s also isolation for ESBL precautions. Watch out – she’s kind of a bitch and may try to hit you or rip of your mask. Curtain 3 is a homeless lady, EtOH abuse, left elbow cellulitis and waiting for an ortho consult to rule out septic arthritis. Her morphine tolerance can rival that of a large baby elephant so keep on signing out as much as you need but keep an eye out for respiratory depression but you knew that hahaha! Curtain 4 is another homeless EtOH abuser and is VERY tremulous. He needs hourly IV diazepam. He’s to be discharged when he stops shaking. Curtain 5 is a lol who’s waiting for a bed in medicine. The resident wrote a shit load of orders for her. My advice would be to start her cipro, ancef and avelox and let the floor worry about everything else. Keep an eye out on her I&Os cuz the resident is really anal about it. Jerk. Curtain 6 is a perforated appendicitis but GI can’t take her right now because they’ve got 3 urgent cases lined up ahead of her. She’s got admission orders so start her antibiotics quickly. Oh and she’ll probably be spiking a fever soon. Do hourly vitals on her cuz she just doesn’t look right. Good luck hon – make sure you ask for help. Good night’.

When that report was finished I wanted to hide in the bathroom and cry. Turns out that between patient transfers to the floor, I went to the bathroom and experienced what could be my first ever panic attack. I was definitely tachy, diaphoretic and vomited. Had I been older, I would have thought I was having an MI. Not a good patient load to start of with when I'm still a newbie. I don’t know how I managed to survive that night – all I remember is that my priority was sticking on high flow oxygen to bitchy HIV lady, getting pantoloc to coffee grounds guy, antibiotics for old lady and perforated api woman while begging admitting to find beds for the ones who were waiting. When I finally got a bed for my perforated api lady, I realized that I forgot to give her Tylenol for her fever. Since Tylenol was not in her admission orders, the medical directive becomes void on the floor. The floor nurse made sure she bitched at me. Funny thing is that I had Tylenol in my pocket and was willing to sign on the chart for it but she wouldn’t let me. Her problem.

Not that I want a night like that again, but looking back on it I got a month’s worth of learning in 12 hours. Sure I needed a stiff drink after that but since it was morning time when I was finished I just crawled up in my bed and tried to forget that any of the night actually happened. My boss is telling me that she wants to test run another independent shift in a few days so I suppose I better I get my butt into gear and get ready. I don’t wanna!

A good man

My faith in humanity has been restored once more. Before a night shift, I always end up getting a vanilla bean latte but last night my heart broke when the (incredibly cute) barista told me that the espresso machine was broken. Hovering somewhere between depression and panic at not being able to meet my nightly caffeine requirements, I wondered what else I could drink that would sustain me for at least half the shift. And that’s when he made me a ‘fake latte’ – he mixed in just the right amount of vanilla flavour and milk in the caramelo and handed it over to me! Unnamed barista, thank you for making a yummy and functional drink that allowed me to see a boat load of patients without losing my mind for half the shift. I’m officially in love with you!

Unfortunately named

Dr. Hung for swallowing assessment.

My apologies to Dr. Hung but he provided hours of entertainment for us weary night-shifters! And yes, I'm very immature at 0300.

Monday, November 3, 2008

Pearls of wisdom from violent drunk/psychotic dood

“Hail Satan motherfuckers!”
“Your mom sucks cock”
“Your mom sucked my cock you faggot” (to security guard)
“I’ll light your dick/vagina on fire bitch” (that one is actually pretty good no?)
“Jesus is dead bitches – I killed his ass” (no comment)
“I feel like shit assface” (after throwing up three times)

I’m always surrounded by classy gentlemen. This guy was screaming like a maniac on the top of his lungs AFTER 10 ml of Haldol. It took six big burly security guards to restrain him and even then he almost turned over the stretcher. Being forced to listen to that jackass made me realize how glad I was to be working with nice, normal non-psychotic women with pregnancy concerns.

Sunday, November 2, 2008

Hydration is key

Guy comes in on Halloween night with a serum alcohol level of 87, tested positive for amphetamines, benzos and cocaine is staying as a B&B patient. In the morning one of the residents calls a bunch of nurses over and points out party-guy gnawing on his IV tubing while making asinine tranquilized animal-like noises. When he finally wakes up several hours later, he states he feels like he was eating or drinking something salty. The guy managed to gnaw through his tubing and drink the normal saline. At least he was hydrated.

Warning – angry rant ahead

Today was a great day in terms of learning complicated nursing stuff like trauma. That’s right – I got to work my first trauma! Actually the only thing I did was push in amiodarone and atropine. After that I retreated back to documenting.

Now to put the anger into perspective – prior to receiving trauma-man, I got a patient with query hip fracture and ++ nausea complete with her insanely bitchy daughter in tow. The daughter hovered around the nursing station like a vulture ready to descend down on her pray and hack them mercilessly with mind-numbingly idiotic demands. Such demands included, “my mother should be allowed to eat” (before an unnecessary abdominal CT? get a life), “take her to the bathroom right now” (I don’t get paid enough to be your personal bitch) and last but certainly not least, “these sheets are much too rough for her skin so go get her something softer” (Do I look like the manger of the fucking Hilton? Go fuck yourself and then head over to a department store if you’re that concerned).

During her concerted efforts of putting the retard back into retarded, we got a call from EMS saying they were bringing trauma-man to us with an ETA of 5 minutes. Naturally, we all rush into the trauma room and get it prepped. I was getting the IV pumps and the cold lactated ringers prepped when I spotted the vulture. I ignored her and along with the trauma team ran over to the EMS crew to get report and start documenting like my life depended on it. When I was back in the trauma room and drawing up atropine (which has a half life of about nothing), this fuck-tard of a woman BARGES in and demands that either myself or my preceptor take her mother to the bathroom RIGHT NOW! This was the moment that I lost it at this woman. I was blinded by a ball of white fury so I don’t remember much but apparently I screamed at her and told her to get out and stay out if she doesn’t want to be thrown out by security. She walked away in a huff and then threatened to sue me.

You know what I have to say to you lady? FUCK YOU! How far up your ass is your head stuck that you can’t understand that a guy suddenly lacking vital signs with 50 people hanging every single drug known to mankind is less important than your mother’s voiding needs, who by the way is perfectly capable of walking! You asked for Vaseline earlier? I’ll get you a boat load of Vaseline and try to pry your head out of that entitled ass of yours. And then give it a swift kick for the good of the country. Your parents have failed as human beings by not putting you in a reed basket in the middle of a Florida swamp filled with ‘gators upon your birth. If I have to be sued by you, I’d love to see your uppity ass trying to defend your mommy-dearest having to hold it in while the rest of the team tried to SAVE A LIFE.

Idiot people just grate my nerves more and more everyday.

Saturday, November 1, 2008


Two nurses talking to each other about a dance lesson poster in the staff lounge;
Nurse 1: Did you hear about those dance lessons?
Nurse 2: Yeah I did but my husband won’t go cuz he’s a crappy dancer.
Nurse 1: My husband sucks at dancing as well – the only dancing he’s good at is between the sheets and even then I have to fake the shakes.
Nurse 2: 0_o - You need a new husband.