Healing the Walking Wounded on Boxing Day

In order to get New Year’s off, I had to compromise and agree to work the week of Christmas. I was preparing for the worst on Christmas eve and day. Instead I was pleasantly surprised. Working on Christmas was actually quite lovely. The department was calm, the staff was happy and the patients who did come were incredibly thankful and nice. However, the next day, Boxing Day – well that was a different story. Boxing Day can be thought of as the American equivalent of Black Friday – a perfect storm of drastically reduced prices and injuries. Weather permitting (or not), shoppers line up as early as 0100 to score a great bargain, and I suspect to get a little bit of a break from the family togetherness of Christmas.

I was assigned to work in fast track and well, that was a complete bloodbath. Battle weary men and women limped in one by one, and then ten by ten with their swollen and sprained ankles while clutching their loot for dear life. A potentially major kerfluffle broke out when three patients confused their shopping bags and started to walk away with each others’ merchandise. A little old lady called a younger woman a shameless floozy after having discovered that the younger woman had managed to buy the last 52” Sony Bravia television available. Even some of the staff took extended breaks to scour the malls for some deals. Most came back shell shocked – one came back after having spent $3500 on some serious electronics and clothes. Minor lacerations were the theme of the evening when people started to dig into their merchandise with a great deal of fan fare and sharp objects. After tensor wrapping sprained ankles, setting up countless suture trays and administering an endless amount of tetanus vaccinations, I did my part for the economy and scoured the aisles for offers I could not refuse. But not before having taken a substantial shower and a long sleep.

Happy holidays and a very happy new year to everyone :)

More Evidence That Rap Music Promotes Violence

Emerging Dazed and Confused from the Land of Night Shifters

“Dude! I thought you were like dead or married or something! Where have you been?”

Thus I was greeted by one of my more colourful friends when I ventured out in the afternoon for lunch after working 7 nights in 9 days. How do I feel after this (mostly) self inflicted torture? Let’s just say, off. Usually I like to work nights but this time it has been particularly vile because I have been denied my nap during breaks. Due to ongoing construction, the ER nursing lounge is inaccessible, which means that the lousy nap chairs from yester-year are also inaccessible. Without a nap I’m a terrible nurse. I can’t get IVs in, I can’t collect blood samples, the thought of having to catheterize a little old broken hip lady induces terrible sobs of anguish and people asking me ‘how much longer until I see the doctor?’ makes me seethe with uncontrollable, mouth foaming, profanity hurling, stretcher kicking rage. In a moment of shocking desperation, I think I actually fell asleep while trying to get a history from a psych patient. Perhaps Santa will reward us lowly nurses with a decent lounge and some spare stretchers or couches? Unbloody likely.

In any case, I learned that after waking up entirely disoriented and slightly scared at having seen sunlight for the first time in a week, it is best not to acclimatize to the day time world by trolling in a mall full of herds of bewilderbeasts frantically looking for presents. At least lunch was delicious and fun!

Life Lessons Learned and the the Abundance of Pooh

In yet another teaching shift, I got assigned to a new grad nurse who was quick on her feet and even quicker in her thinking. She told me that she was really looking forward to learning about the indications for using different kinds of antibiotics. However, she got a lesson in pooh (really, aren’t all lessons about pooh?). She learned that it is far better to collect blood and urine samples before giving a massive tap water enema to a little old bunged up lady who is just confused enough to crap all over the room and then stand in the middle of the carnage with a smile on her face. Some lessons can only be learned through experience no matter how far in advance a warning is given.

One of Those Days

17 year old female, c/c – “got my cherry popped at my doctor’s office with a q-tip and some metal. Can you fix it?
Have a seat.

37 year old man, c/c – “Some ho did something to my junk she didn’t get paid to do”
Have a seat.

17 year old male, c/c – “I’m really high, I got the munchies and I heard the nurses here are really hot”
Have a seat.

26 year old female, c/c – “I think I was pregnant a year ago. Can you tell me if I actually was?”
Have a seat.

34 year old male, c/c – “My fern tried to strangle me when I slept and now I’m going to kill my brother all of you and the fucking fern”
Security.

44 year old male from home via EMS – Allergies x1 year.
The current wait time is 9 hours – give or take. Have a seat.

Unkempt male of undetermined age – “Where my Percocet bitches!!?!”
Security.

29 year old male, c/c – “I haven’t had a shit in 3 days and I want…”
Patient was interrupted by his own very loud and putrid flatulence.
“Never mind, I feel better now”.
What the hell??

19 year old male – “Do you guys prescribe medical marijuana?”
“No”
“Uh… well… I have cancer”.
“You should be ashamed of yourself”.

I helped to save many lives, and left a lasting impression on many more.

Dos and Don’ts of a Staff Party

It’s that time of the year when the crisp winter air is filled with festive joy, store windows are decorated with Christmas scenes, there’s an extra sparkle in children’s eyes and all steadily employed people are filled with varying degrees of dread, apathy, anxiety and yes, even excitement about the annual Christmas party. Socializing with one’s coworkers while not scrub clad can be somewhat daunting because when removed from the hospital setting, there aren’t any psychotic, belligerent, needy, disrespectful, bitchy, douchbagy, moronic and/or idiotic patients/staff to deal with. As such, engaging in small-talk can be awkward, if not outright impossible. Parties are also a social minefield because as unbelievable as it sounds, a vast majority of the staff have lives outside of work. Sometimes, those lives include dating each other, breaking up, working together uncomfortably for a while before a new normal is established.*Lastly, staff parties are an extremely weird combination of coworkers, bosses, alcohol, food and 80s dance music which can make effective and fun socializing all that much more difficult.

Since staff parties are a better dressed, tressed and fed extension of work, it’s important to remember to maintain a certain amount of decorum and reserve. With this in mind, here is my list of dos and don’ts of a staff party loosely based on this year’s party mishaps.

Do try to be civil to each other no matter how much you wish your foe was under a bus.

Don’t tell your foe that you were ardently hoping for them to be under a bus.

Do enjoy the catered food and open bar.

Don’t enjoy the open bar to the point of which you start to loudly vomit in the ladies room and end up being dragged home by another staff member while your boyfriend stays behind to pay the manager off for the damages incurred.

Do compliment your ex on his/her educational/professional achievements.

Don’t berate them for their weight changes, poor sartorial decisions and even poorer choices in mates.

Do make an effort to introduce your partner/date/family member to the rest of the staff so they don’t feel left out.

Don’t let your companion be in a foul mood at one of your past transgressions, especially if their revenge plot is to out how you want to take over someone else’ job and forever taint you as a treacherous corporate climbing snake.

Do show of your fancy footwork when kickass 80s anthems are blasted, especially if you’re the chief of medical staff.

Don’t dirty dance with the nursing manager and end up with your tie lost and your shirt buttons undone, especially if you’re the chief of medical staff.

This is by no means a comprehensive list but merely guidelines that one should try to follow in order to have a successful staff party experience! Please share your dos and don’ts and keep the hilarity going!

*HR neither condones nor endorses this behaviour.

Tweedle Dee, Tweedle Dumb and Tweedle Dumbass

It’s befitting that I got to take care of the following three gentlemen after getting TNCC* certified. Three home-boyz found themselves in a slight altercation involving a ‘fine ass bitch’ who turned them all down. Home-boy #1 took out his gun and shot home-boy #2 near the tibia. Home-boy #2 was not impressed so he shot home-boy #1 in the upper thigh. Feeling a little left out and getting pissed off at home-boy #2 for shooting home-boy #1, home-boy #3 took out his gun but wasn’t quite schooled in how to use it properly and so, ended up shooting himself in the foot. All three of them limped in cursing and bloody and accusing each other of ‘startin’ shit and messin’ wid da fine bitch’ who supposedly belonged to one of them only. At home-boy #1’s insistence, I caved in and called the woman who they were fighting over only to have her curtly tell me to euthanize them all. Needless to say, the ‘po-po’ were also involved.

*TNCC - Trauma Nursing Core Course

Miss Maha if You're Nasty

A little old lady with a hip fracture after being catheterized: What does RN stand for?

Me: Registered nurse, ma'am.

LOL: Should be real nasty for what you just did to me.

Items Misplaced

Looking for a clean scrub top before a night shift and this is what I find instead. Had to wear a t-shirt that night :)

Lights

On my way to work, I pass by an old Tudor style house. Its backyard can be seen from the train tracks and each evening regardless of the weather, there were festive lights casting a lovely glow to the entire house. Every time I had a night shift during the summer, I would pass by that house and I would see a giant barbecue, a myriad of guests, all sorts of flowers in stunning colours and of course all those lights. Being somewhat of a recluse, I always wondered who would have the energy to entertain so many guests so frequently. In winter, the backyard lights cast a beautiful amber glow on the snow and it made me want to befriend that person over a great cup of hot chocolate. There was something about that house that instantly made me feel happier. I know I have dreamed about that house many times.

Last week, was a little different. I was on the train daydreaming and staring out the window but the lights weren’t on. In fact, had I not known about the house previously, I would have never thought to look for it. Thinking that electricity bills finally got the better of the owner, I let my thoughts wander aimlessly once more until I reached my stop. By then, I had forgotten all about the house and started to worry more about my imminent future – namely what kind of department would I be walking into.

As usual, I purchased my latte and walked over to my assigned area to get asked, “Ready for report?”

“Sure”, I replied.

“For now, you only have one patient. She’s a 66 year old woman presenting with diffuse CP, SOBOE x2 days and mild 1+ pitting edema in the ankles with no relief from nitro. Positive trops, no significant ECG changes from previous visits, she’s a bit more comfortable with morphine. Cardiology is consulting on her now so you get to wait for their orders. She really doesn’t want to stay here because she’s convinced she won’t make it out of here so you get to deal with that. Family will be here in a little while. Any questions?”

“No, I’m fine. I’ll get the rest from the chart. Good night”.

“Night”.

I hung around the nursing station for a while savoring my latte while I looked over her labs. Eventually the patient was admitted and I finally got a chance to talk to her. From the minute I walked into her room, I felt as if I had known her all my life. She reminded me of so many people in family that I haven’t spoken to in months just because life gets in the way. Listening to her speak was effortless. I was simply spell bound by her eloquence, charm and her ability to describe the texture of a life that I could not possibly know. I lost track of time as she told me about how she managed to escape Afghanistan in the early 80s, made her way to Pakistan and eventually into California before coming to Canada and resuming her career as a teacher. She paid a heavy price for leaving – she lost three of her four children, her parents and many of her friends. Once she managed to buy a house and provide for her daughter, she started to feel as if she spent her days struggling against the relentless waves of guilt at having survived while having to watch too many of her loved ones fail and pay with their lives. She thought about killing herself – overdosing, throwing herself on the train tracks, jumping from a building – anything that would get the job done but ultimately she could not sacrifice her daughter’s well being to appease her own dark desire for escape. She sought help for her depression and eventually started to befriend others in her community and reestablish roots in Canada. Her daughter grew up, fell in love, married the man of her dreams and had two children who were lavished with love by everyone in the family. She said that for as long as she could, she always wanted her family and friends near her because at any moment, all of the newfound beauty in her world could be snatched away. She did not want to stay in the hospital and have her troponins and ‘lytes measured on a tele floor because she had a house whose backyard needed a new string of lights so she could once more take in the sights and sounds of her loved ones enjoying a delicious meal under their glow.

And that’s when it dawned on me that she owned the house that captured my imagination for so long. I wanted so badly to tell her what seeing her house everyday meant to me – how just for an instant, I was able to let go of my worries completely and just admire the beauty and warmth of her house and its spirit. But as it happens, I was slammed with two new patients back to back who needed a whole lot of work done. When they were discharged, the influx of patients did not stop and she eventually got transferred to the tele floor by another nurse.

I got to work early the next night so that I could visit her, say goodbye and wish her well in her recovery. She coded that afternoon. I doubt I will ever see the same house on my way to work again.

A Family Business

When asking a patient what he does for a living:

Patient: I’m a dealer yo. My mom’s a dealer. My dad’s a dealer. My sister’s a dealer. My brother’s a dealer. Yo guy, even my motherfucking dog is a dealer.
Me: Foshizzle bro.

*fist bump*

Un-effin-believable

EMS brought a patient over to triage who called and demanded that he be taken to the hospital to get her H1N1 shot. She was livid that we did not have it. Furious does not even begin to describe how I felt towards her. Similarly, I don't have a sufficient vocabulary to express the amount of loathing I felt towards her for tying up an ambulance for an hour.

Keeping Kosher

Elderly Jewish patient with a sense of humor who tested positive for H1N1: Is it Kosher for me to suffer from the swine flu?

Me: Sir, almost seven years of schooling and the meager experience that I have as a nurse in this department has not prepared me to answer your question in a satisfactory manner. Would you like some orange juice?

More Photography Fun!

I was threatened - err kindly asked - by my sis' bf to post some of his work. I'm impressed by the detail!

Adventures in Fall Photography

These lovely pictures were taken by my awesomely talented sister (ie: little bear) in various places on my way to work. She was using her bf's camera (who is also uber talented but I don't have his work so it can't be posted - yet). I love fall!

Had Edgar Allan Poe Been an Emerg Nurse…

The Drunkard

Once upon a midnight dreary, while my back ached, weak and weary,
Over many a quaint and curious patient at the triage door.
While I nodded, nearly napping, suddenly there came a tapping,
As of someone rudely rapping, rapping at my triage door.
"'Tis no drunkard," I muttered, "tapping at my triage door--
A well man and nothing more."

Ah, distinctly I remember the bloody night before November,
And each and every staff member had brought a patient to the floor.
Eagerly I wished the morrow, vainly I had sought to borrow,
From my books of assessments thorough –to avoid the cookies from days of yore
And drink my latte from so long before.

But the stinkin’ sad uncertain shuffling of a drunkard’s gait that’s struggling
Thrilled me – filled me with supreme annoyance, never felt before.
So that now to still the beating of my heart, I stood repeating
“Tis no drunkard entreating entrance at my triage door –
Some late UTI-er entreating entrance at my triage door;
This is it, give toradol galore”.

Towards the patient I finally headed, hope for sleep completely shredded,
“What,” barked I, “please don’t have a complaint I’ll deplore,
But the fact is I was napping and so intently you were tapping,
And so rudely you came slurring, ranting at my triage door”.
And without regard or thinking, he barfed upon my triage door,
Chunky vomit and lots more.

Then, of course, the air grew denser, thanks to the obscene Spencer,
A man now pickled, whose foot-falls dragged in the department’s floor.
“Wretch,” I cried, “why did God bring thee – by the devil he hath sent thee
Respite – respite and valium please for thy abnormal CIWA score
Why, oh why this loud decree of your drunken presence on my door?!”
Screamed the drunkard, “I barfed some more”.

"Spencer!" said I, "this stench is evil!--Spencer this is the needle’s bevel,
Whether taxi sent, or whether ill-fate tossed thee here ashore,
Desolate, yet all undaunted, in this department un-enchanted,
In this hallway by Horror haunted--tell me truly, I implore--
Is there--is there calm from gravol?--tell me--tell me, I implore!"
Quoth the drunkard, "I need lots more."

"Spencer!" said I, “more upheavals? - Spencer still, if man or devil!
By the score of twenty and eleven – by the valium we both adore –
Tell this nurse with sorrow laden, who to call? Perhaps thy maiden?
Please, oh please, I beg thee, use the bucket on the floor.”
Quoth the drunkard, "Nevermore."

"Be that word our sign of parting, man or fiend!" I shrieked, upstarting.
"Get thee out of the department and save my night from being abhorred!
Leave no chunks of vomit as a token for my tolerance thou hast broken!
Leave here with this train token! – Quit the bed and leave the main floor!
Take thy stench as you depart, and take thy form from out the door!”
The drunkard started to loudly snore.

And the drunkard, unremitting, still is snoring, still is snoring
On the pallid stretcher mere inches from the door;
And his socks have all the seeming of a mould that is steaming
And the lamp-light o’er him streaming throws his shadow on the floor;
And my break retreating into shadows that was planned for four,
Shall be taken – nevermore!


Have a spooooky halloween!

Rethinking Professions

Recently, I was working fast track and I brought in a patient who needed a script for ramipril and atenolol because she forgot her meds in another province. Being surprised that a) the script refill wasn’t for narcotics or benzos and b) she was prepared to wait for a while with a copy of the Massey Lectures, I tried to get her seen quickly but since we were expecting EMS to bring a patient with a CTAS of 1*, I just ended up chatting with her for a while. We started to talk about job security and how nursing seems like a very safe profession since there are always sick people who need attention (tell that to the half baked suits that think firing nurses is the best step towards achieving fiscal goals). I told her that I was considering applying for a part time/casual position at one of the local clinics so I can get rid of my student loans a bit faster. She disagreed with my choice and told me that I ought to consider becoming an escort! After recovering from nearly obstructing my airway with my latte, I had to tell her that as much as I would like to cease worrying about money, I can honestly say that nowhere in my psyche have I ever considered escorting (is that the proper verb?) as a potential means to achieving that end. Apparently I have the ‘right personality and look’ – I suppose telling Mr. Drunky McDrunkington that he’s wearing a hospital gown because he pissed his pants numerous times while wearing my ‘I’m too bloated and tired to care wtf I look like scrubs’ is the escorting look du jour. Since I’m in a rather forgiving and jovial mood (I got New Year’s off!), I’ll just pretend that she was trying to complement me in her own bizarre way but when all is said and done, I’m rather offended and the entire discussion just left me with a sour feeling in the pit of my stomach.


*CTAS (Canadian Triage and Acuity Scale) 1 is an honest to goodness emergency - if you're ever in an ER and hear people scrambling about saying CTAS 1, it means that a patient who's about to start knock knock knockin' on heaven's door is going to be coming in shortly and you will have to wait until said pateint is either stabilized or is transferred to the Eternal Care Unit.

Letting it All Out – While Retaining Everything

Old MD Girl’s post about how one should maintain their composure and appear zen-like while interacting with patients at all times is inspiring this particular rant. I got a memo stating that admin is starting mandatory once a month round table discussions aimed at airing out the nursing staff’s frustrations or concerns. There’s some crap written about how those discussions can have the potential to positively benefit the entire staff because concerns can be dealt with as they come along. There’s also some other crap about how reflecting on our practice with staff at varying skill levels can improve our overall practice. My personal (ill-articulated) thought - suck it! I do not want to give up my precious break to sit awkwardly in front of some suits to talk about how much I hate the smell of C. diff in the morning. Nor do I want to talk about how irrationally angry I get when my latte doesn’t have the right proportion of espresso and milk because I’m nagging the barista to hurry up so I can make it to a meeting to talk about my ‘feelings’. I can understand the need for debriefing sessions after a particularly memorable or horrendous event but being forced to go every month to these ‘vent out your feelings sessions’ when I do just fine venting over great food with my friends is simply cruel. Not only that, the entire concept seems redundant to me because up until now, I thought monthly staff meetings and providing proof of competent practice to the provincial licensing body were for the very same purpose. No matter how stressed I am, I can guaran-damn-tee that I would find peace and quiet much more relaxing than having to restrain myself with politically correct language in front of power suited chumps.

Tasteful Fixtures

I want this in my bathroom for Halloween! Also tempted to put it up discreetly in the ER’s shower room and await the inevitable meeting with admin about the utter lack of professionalism that would follow!

Found via Gizmodo

Status Dramaticus

From my highly un-researched, completely anecdotal experience, ER nurses are generally thought of as ‘tough as nails’, ‘bitches’, ‘know-it-alls’ but rarely are we acknowledged as overly emotional cry babies who can’t keep their shit together. However, I have the great fortune (note sarcasm) of working alongside such a nurse. Every call bell, every new patient brought to her when it’s ‘busy’ and every patient/doctor/nurse/lab tech/porter who’s being a jerk to her brings her close to tears and for some reason, I up having to clean up the resultant mess because she’s too busy wailing (complete with snot and tears) in the bathroom. When I’m off work, I love shooting the proverbial shit with her, but when we are working together, I feel myself cringe because I know I will be running off my feet no matter how organized I keep my area. Not being a completely insensitive dunce, I tried to ask her if anything has been bothering her lately but her excuse for her outbursts is that she is just a very emotionally expressive person and that she feels that it’s better to let everything out rather than keeping frustration bottled up. Fair enough. Except when she’s busy sobbing, someone else has to pick up the slack that she creates. Lately that lucky person has been me and I’m getting just a little annoyed. I get it – nursing can be tough. There are always setbacks and jerks that must be dealt with but there has to be a point in which one has to put on their game face and start paddling through shit creek. Breaking down into a blubbering sobbing mess at every hiccup doesn’t help in anything except erode others’ confidence in a nurse’s ability to function well under pressure – and it’s not very professional either.

Whiny Cry Babies or Warning – Rant Ahead

I don’t know what’s in the local water supply but lately I’ve been inundated with patients who are a) obstructed in the small bowel and b) prone to throwing screaming fits of agony when I have to put in an IV and get blood work done. I would imagine that having your doody machine tied up in knots or bunged up to the point of needing surgical intervention would hurt a hell of a lot more than a puny needle collecting minuscule amounts of blood. All friggin’ day I get to hear bitching and screaming about how 25 gauge needles are instruments of superb and exquisite torture. And that was before GI and Gen Surg wanted 18F NG tubes shoved into tiny nares. Also, why, WHY would someone eat a giant pork souvlaki meal after having a confirmed obstruction and being told in no uncertain terms that eating is strictly off limits? Guess who gets to provide barf buckets to those degenerates? Honestly, some days, people really suck! Rant over. Now to head off to bed and dream of something better than small bowel obstructions.

File this Under WTF??

Towards the end of my shift, I got a patient triaged under medical device problem. Turns out his PICC line was blocked. No biggie – I got the doc to order some heparin so I could get his treatment started as soon as possible. I got into his room and was greeted by a bunch of ex-football player, frat boy, keggers every night kind of guys. The patient had a PICC line because he developed a post-op infection in his shoulder and needed q6h antibiotics for a while. I asked him when the line became blocked and that’s when things started to make a lot less sense. Apparently a blocked PICC line wasn’t his only problem. Turns out his buddies decided to see what would happen if they shot a few tablespoons of beer and finely ground nachos into his PICC line to see if he would get drunk faster! As I tried to ungracefully pick my jaw up off the floor, they started to high five each other. The dressing was filthy and smelled like rancid beer. I changed the dressing with 4 guys telling me to “shoot some crack in his line miss”. Had I not been exhausted I would have stuck around a bit longer to see what the doc and interventional radiology would do but I figured this moron wasn’t worth the trouble. However, here’s the real kicker – the patient is a masters student in immunology! Stupid cuts across all socio-economic boundaries.

Revenge is a Dish Best Served in 57 Minutes

I am firmly convinced that HR departments (at least the one in my hospital) are run by sadistic, soulless evil minions of Satan. After doing four full night shifts in a row, I went to the department to pick up some income tax forms. Now herein lies the dilemma – my shift usually ends at 0700. The HR department opens at 0800. I went down to the department at 0740 to see if some kind soul would just type in a seven letter password, click print and hand me the piece of paper so I could go home, flop onto my couch and dream that I’m a fabulously wealthy traveler. Instead I walked into a room full of people who at first completely ignored me and then proceeded to berate me for being there. I very politely asked if they could kindly print me the form so I could make my train and get some rest before I would have to come back for yet another night. One particular man told me that I would have to come back in precisely 19 minutes to get the form. For a moment I thought he was joking. He was not. I asked him again, this time practically begging. He told me that since the department is not officially open for another 19 minutes, he cannot print me the form I needed, despite the fact that he was logged onto his computer. Clearly, I was going to lose the battle so I retreated to Starbucks cursing under my breath.

In exactly 19 minutes I was defeated but slightly more caffeinated and crabbily asked for my form. And then that malicious troll tells me “2 more minutes”. This was far too much for my over-caffeinated sleep deprived and emotionally labile brain. I started to wildly point at the massive digital clock in front of the department that said 0800 and demanded that my form be print. He then pointed to his clunky analogue wrist watch and said, “not according to my watch”. Standing there for 2 minutes, I watched him calmly sip his coffee and smear icing over his keyboard and thought to myself that I would exact payment from him a hundred fold if I ever got the opportunity. He finally opened the application, asked for my employee number and last name and gave me my form. Feeling livid yet helpless I asked him why he couldn’t have just done that for me 20 minutes ago. “You’re not special enough to break rules for” was his curt reply.

I stormed out of the department, got home an hour later than I normally would have and ate a giant bowl of rice to try to silence the fury within. After a hot shower and a long nap, my encounter with the evil HR troll became nothing more than an irritating memory.

However, on rare occasions, karma works in my favour. On my next set of shifts, the very same troll was in the waiting room and triaged to fast track for flank pain. He looked visibly uncomfortable while I looked positively overjoyed. When I went out to the waiting room to introduce myself and to bring him inside the department, he didn’t initially recognize me. But boy oh boy did that change fast! Normally I use a 20 gauge angiocath – he got a 16 gauge (it’s a much fatter IV needle). He then started to look at me as if he recognized me (and wronged me) but wisely kept quiet. Perhaps he was cursing his dumb luck and was hoping that I wouldn’t remember him. Fat chance buddy. Fat chance. He was ordered 4-6 mg morphine q4h prn. I normally push morphine but for him, I made a cute little mini-bag and let it drip slowly. I kept an eye on him but in 3 hours he asked for another dose. The satisfaction I felt in telling him that he would have to wait exactly 57 minutes for his next dose while watching his face contort in agony and horror was beyond anything I can articulate. After 57 minutes had passed, I took my sweet time in setting up another mini bag. A better person than me would have let the entire thing go. A better person would not have had this to blog about.

So let this be a lesson to evil HR people who don’t take mercy on night shifting staff – vengeance will be sought and you won’t enjoy it one bit!

A Chief Complaint with no Easy Fix

Chief complaint - back pain. In fast track it’s a fairly common, slightly irritating (if the person is a known drug seeker) but mostly benign chief complaint. Not last night. I picked up a chart from triage and read that the patient was a 27 year old woman presenting with back pain. On first look she appeared to be quite well – there weren’t any exaggerated displays of agony, her gait was steady and unremarkable and she denied any parasthesias.

“So what is it that we can do for you?” I eventually asked.

“I need a referral to a plastic surgeon for breast reduction surgery because my back hurts. And if I can get it done this week, it’ll give me enough recovery time to wear a strapless gown on my wedding”.

Shocked and mildly amused at having to ‘work up’ this patient, I just had to ask why she chose 0400 to come into an ER to ask for a plastic surgeon for an obvious non-emergency.

“Umm hello, wedding” she told me in a tone that suggested that I was not only an idiot for asking something so obvious, but that I should lose my license for failing to grasp a fundamental truth about the importance of being able to fashionably wear a strapless gown on one’s wedding day.
In the end, things took their expected course. She was sent away because we could not provide the care she was seeking. She was visibly upset at not being referred to a plastic surgeon right away (they like to sleep at 0400) and left with well vocalized thoughts of malice for us all.

Notwithstanding the behemoth that is the wedding industrial complex or the frenzied feelings of insecurity about one’s looks in a world where one’s every movement can be photographed (from every imaginable and unflattering angle) and be posted on facebook within minutes, I still think trekking it out on a cold night to go to an ER in a hospital whose specialty is oncology and cardiology to ask for a plastic surgeon is bordering on downright irrational.

Despite the fact that she was a complete bitch to me, a part of me sympathizes with her. I know I’ve spent an entire day getting my hair and nails done for a casual get together and bought an insanely expensive item of clothing to try to silence my own inner critic. She too is trying to achieve her vision of perfection but I do hope she wakes up out of her wedding induced fog and pursues breast reduction surgery to enhance the quality of her life as opposed to quality of her photographs.

Grunge Work and an Unlikely Source of Help

One of the staff docs that I work with is a fairly reserved guy whose demeanor can be mistaken for snobby or stand-offish. He’s not mean per se, but he gets irritable fairly easily. He’ll never throw a hissy fit at any of the staff, but rather just mutter quietly to himself when doody hits the fan. He’s not exactly friendly, but nor is he unfriendly – he’s just quiet. He always lends a hand where needed by whoever without being asked. And he’s scary smart. Sometimes, I like to pretend that I’m documenting furiously when in fact I’m listening to him teach the med students and residents because he explains concepts so clearly that even in my most twitchy sleep deprived state, I manage to learn and retain the new knowledge. Having said that, he would not be the first person I’d ask for help for something trivial – I just don’t feel very comfortable around him. However, he completely surprised me during my last shift.

I had a fairly heavy patient who was hypoxic and was well on his way towards delirium. The patient was a HUGE guy and he needed a boost up in bed. As crazy as I can get, even I knew that if I even tried to lift him myself, my back would seek vengeance on me for years to come. So I did what any nurse does – put the side rail up and trolled the department for an extra pair of hands. That’s when the doc asked me, “what do you need?” Stuttering, fumbling and with some fairly elaborate gestures, I manage to tell him that I need to boost hypoxia/delirium guy up in his stretcher and get him comfy. The doc starts to head towards the patient’s room and tells me that he’ll give me a hand with the boost. Confused, yet relieved, I started to follow him. When we reached into the patient’s room, the patient had spilled his water and jell-o all over the linens, which meant that now I had to change his gown and linens as well as boost him up in bed. When I turned around, the doc had left the room. Just as I was about to silently wish a pox on his house and mentally assemble a shopping list of materials I would need to construct a voodoo doll in his likeness, he walked in with fresh linens, some more water and jell-o as well as the patient’s next dose of antibiotics (which were properly mixed AND labeled). Not only did he help me with all the grunge work, he sat down with the patient for the next 20 minutes trying to reorient him back to reality while I arranged follow up appointments for another patient.

I never did get a chance to thank him for his help since that quiet period was sadly the eye of the patient influx storm. Not that he’ll be reading this blog post (or at least I really hope not), but I was thoroughly and pleasantly surprised at how he was willing to lend a hand with the less glamorous aspect of patient care instead of sitting on the sidelines and telling the charge nurse that the patient needed to be tended to. Dude totally gets team work. I still won’t be asking him for too much help though.

Killing me with Kindness

There are those patients who are rude, demanding, entitled and prone to screaming temper tantrums. Those patients are fun to (figuratively) bitch slap back into place and/or throw out of the department. They are also fun to blog about because they showcase the scummy depths of immaturity to which people can sink when their demands are not immediately met.

Then there are those patients/families that on first impression seem to show genuine understanding about wait times and how busy the department can become and for a while, they leave you alone. And then the call bell starts ringing. You go into the room with high hopes of all being well. Turns out the patient wants an extra blanket. “Sure, no problem” you say as you bring one fresh from the blanket warmer. “Those rooms are chilly” you think. “Anything else while I’m here”, you ask. “No dear, that’s all, thank you”. You get back to doing whatever it is you were doing, and then the call bell rings again. You go back into the room and this time, they’re asking you to readjust the telemetry wires because they’re uncomfortable. You do your thing, give the patient a winning smile, do a quick little assessment and then leave. Then the charge nurse brings a new patient that will take up some time and sure enough, the call bell goes off again. “Please dear, can you tell me how much longer will it be before I see the doctor?” The department is swamped (as usual) and you tell them once again it’ll be a while but in the meantime, they’re being carefully monitored. “While you’re here, can you get me another blanket? Also my IV is feeling uncomfortable. Can you bring me something to read? I’m really hungry as well – do you have any dinner trays? How long could it possibly take for the doctor to see me? All I want is a quick little x-ray and some medications” And then you think, “I’m so fucked – this is going to go on for the entire shift”. You also realize that you should have set limits waaaaayyyy long ago when they first comfortably ambulated inside their room.
When you actually can’t answer their bells, they get extremely upset and use all available tricks up their sleeves to make you feel like you’re scum for not holding their hands through their terrifying ordeal when in reality you’ve got 5 other patients and ever increasing amount of orders that you have to carry out so your entire team doesn’t chew you out for slowing down patient flow. Finally you have to put your foot down and tell them to use the call bell for emergencies only – holding the urinal in place while I have to be the third party listening to a detailed cell phone conversation about how the new son-in-law is a complete schmuck does NOT qualify as an emergency.

The entire encounter reaches a disheartening conclusion when the patients and families want to speak to the charge nurse about how their reasonable requests were ignored throughout the length of their stay despite the fact that a nurse was in their room almost every 45 minutes. “At least I documented really well” you think as you trek it to Starbucks for yet another latte after having downed an Advil. Some days, defeat is inevitable.

Zonked Out

Completely unorganized? Check.

Abnormal sleeping patterns? Check.

Lapses in short term memory? Check.

Occasionally slurred speech? Check.

Extreme irritability at neighbours who are rebuilding their deck? Check.

Are these symptoms of a stroke? I really hope not! However, I feel like that for the past two weeks, I’ve been completely and utterly ‘out of it’. I can’t seem to sleep at a normal time, can’t get up before 1400-1500 in the afternoon, feel tired and groggy and can’t pay attention to what happened several hours ago, let alone several days ago. Friends are telling me that I’m anxious about my upcoming performance appraisal, but I’m going to disagree. My completely untested theory is that since I force myself to be hyper-alert and vigilant at work, my mental status takes a 180 turn and I completely zonk out when I’m at home. I think the pinnacle of zoning out happened when I watched 6 hours straight of True Blood with my sister and then promptly fell asleep. As soon as I snap myself out of this funk, I’ll write a proper blog post.

On another note, I’ve officially been a REGISTERED nurse for exactly a year today. How freaky is that? Some days I still feel like a nursing student (albeit with a slightly less emaciated bank account) who’s been wrongfully handed responsibility! And check this out - http://www.rncentral.com/nursing-library/careplans/life_in_er_50_best_blogs . All I’ve got to say is thanks so much for paying attention to my little corner of cyberspace :)

Organic Bitterroot Juice is not an Approved Treatment for HHNS

I don’t think any nursing text book will actually publish this but I think the biggest challenge to a new nurse is how to deal with stupidity in all of its jaw-dropping manifestations while keeping a straight face. The latest round of battles were fought with the family, specifically, the wife of a portly elderly man in rip roaring HHNS who decided that his poorly controlled diabetes could be ‘cured’ with organic foods and bitterroot juice. As expected, he stopped taking his oral anti-glycemics along with his BP meds. From the second I started to do my assessments and place lines in him while trying to make sure I heard the correct dosages from the doc, the wife kept badgering me with conspiracy theories about how ‘the suits’ are trying to create dependence on pharmaceuticals to maintain and increase profits. She also insisted on knowing whether or not the fluids and meds were organic. Judging from her ‘humph’, ‘sterile’ wasn’t a good enough answer for her. At one point, she started to sob hysterically about how we were polluting her beloved’s body with ‘chemicals of the apocalypse’. I wanted to stab her with a 10G filled with Ativan.

Now before I get flamed for hating on organic foods, let me explain something. I’m a HUGE proponent of nutrition as part of an overall healthy lifestyle. Eating wholesome foods (including some organic foods) on a consistent basis is going to be a lot better for one’s health than eating over-processed and fatty foods. However, when a medical condition starts to spiral out of control, some heavy duty medications are needed to help the person. Drinking organic bitterroot juice is not going to ‘fight the free sugar in the body’ when a patient is barely alert.

When I finally got a chance to ask the wife why she brought him to the ER if she didn’t believe in western medicine, she sheepishly replied, “His daughter is an internal medicine resident here and she said she’d call the police and have me thrown in jail if I didn’t bring him over”. I tried to explain to her about the importance of controlling his blood sugar and hypertension in conjunction with proper nutrition but she just accused me of not being as enlightened as her. My forehead hurt a lot from consistently being in high impact contact with the walls for the rest of the day.

Abusing STAT

There’s a new resident on the GI service who LOVES to write STAT for everything.

Lytes, BUN, Cr, Glucose – STAT

ECG – STAT

Trial clear fluids – STAT

Stool samples for C&S – STAT (But…but… she hasn’t made a doody yet!)

AM blood work – STAT (umm – that’s in 7 hours from now. I’m confused.)

Even when he’s asking for some mundane piece of equipment (ex: 10 cc NS flush), he will add STAT to his command. Granted that his ubiquitous and unnecessary use of the word stat makes me chuckle without fail, but I really want to tell him that he’s in the ER – everything is stat! However, I’ll hold off for a bit just to see what other not so stat orders get the stat treatment from him.

If You Can’t Take the Heat…

Today was a hot, humid and hazy nightmare of a day. It absolutely sucked. I had to forgo my regularly scheduled hot caffeinated beverage for an iced variety, which turned warm within a matter of minutes. Walking to and from the train station promptly transformed me from a bleary eyed nurse to an uncouth sweat drenched bewildered monstrosity. Moisturizer melted. Hair simultaneously frizzed and fell flat. Skin sizzled. It was literally too hot to live – which is just what one of my dingbat patients stated as his chief complaint. He said he had been feeling suicidal lately so he decided to check himself in before he hurt himself. Fair enough. However, my fierce assessment skills revealed his diabolical plan. The air conditioner in his apartment broke down so he figured that he would express suicidal ideation, get placed in a mandatory psychiatric hold in air conditioned quarters for the next several days, while not having to cook, clean and most importantly, not go to work. At first, I was quite impressed with his thought process, but when the caffeine kicked in, I was left feeling like I was punked. What an effin waste of resources. I passed along my newly acquired information to his doc, however, my shift ended before I could witness the (likely) anti-climactic conclusion to the patient’s drama of poorly concocted lies and deceit. Hopefully, he gets placed on the psychiatric hold in a unit that has faulty air conditioning.

Why I’m in Love with Vincent Lam

I was recently re-arranging my bookshelf when I found my copy of Vincent Lam’s Bloodletting and Miraculous Cures. I immediately started to leaf through it and I once again realized how much some of his stories resonated with me. Lam’s stories revolve around the lives and changing perceptions of a group of medical students as they go through school, residency and eventually become full-fledged doctors. In Eli, a story that I found to be one of the most compelling in the collection, a doctor’s encounter with a prisoner brought in by the police is simmering with moral and ethical dilemmas that develop at a lightening pace. In yet another story featuring the same doctor, this time in a SARS isolation ward during the height of the epidemic, Lam delicately but authoritatively draws out what it means to the characters to be a doctor. In the last story of the collection, Lam describes a typical night shift which I found to be a wonderful ending to the collection as it highlights how confident yet weary he has become.

I’ve heard that every time a book is read, it is read by a different person. When I first read this book, I was stunned and fascinated by how the characters managed to hold dichotomous world views. On the one hand they were doctors – a profession defined by healing – on the other hand, at times they were deeply ambivalent, if not downright hostile towards their patients. I was also frustrated because I felt that the stories did not offer enough exploration or closure. Rather, I felt like I was being given selected glimpses into the characters’ lives. Lam based the stories on his experiences as an ER physician; now that I too work in an ER and only catch glimpses into patients’ lives, who sometimes present with situations that manage to deeply unnerve me, I am much more at ease with what Lam has left unwritten. I am greatly looking forward to his next book and in the meantime, I strongly recommend that Bloodletting and Miraculous Cures be in your reading list.

Disclaimer – I haven’t been paid by the publishers or the author to write this post (although the extra income would be greatly welcome).

Generalized Mean-Spirited Disorder

After finishing a shift on a Saturday morning, I somehow managed to make my way over to the train station and await my subterranean chariot home when a youngish man in his early 20s walked onto the platform and loudly announced, “Guys, I’m sorry to bug you but I desperately need $9.25 to pay for my train home. I got smashed last night, I acted like an ass and my ride left me here. All I want to do is go home so please please spare me some change”. Some people got uncomfortable and left, some just ignored him and a few gave him some coins. I got the feeling that this guy was genuinely just looking to get home. True, he could have called a cab home, but if he lived really far away, that would be an expensive endeavour. Likewise, he was asking for a very specific sum instead of ‘some spare change’. Myself and another passenger gave him a toonie* each before he walked to the other end of the platform where he asked other people. That’s when I saw two guys throw some coins at him and told him to pick them up if he wanted the change. He bent down to pick up the change while the two guys laughed and swore at him. I was disgusted by that entire exchange. It was incredibly unnecessary, needlessly cruel and unbelievably mean-spirited. What was the point of belittling a stranger in distress? My granny once told me that one should judge a person’s character on actions that they don’t think are being seen. If that’s the case, those guys are vile. I really hope that what goes around really does come around and the stranded guy got home.

*Two dollar coin in Canada. The name is dumb but endearing. The coin has a picture of a polar bear on one side and Queen Elizabeth on the other side. I like the polar bear side better.

I'm Tired

For the past two weeks I’ve been consistently getting my ass kicked every minute of every hour of every shift I’ve worked. Usually I’m fairly organized and timely but last week was just a god-awful mess. After the first two shifts, I couldn’t even bring my C game to work, let alone my A game! Lately the department has been getting inundated one major after another. Everything from stabbings, substance misuse, old people falling and breaking various bones, people with fairly complex medical histories circling the drain and of course drunks. It’s never a normal night without a couple of drunks. I’m lucky to work in a department that’s extremely well staffed for the most part but for I’ve worked almost 11 hours without a break for several shifts and stayed overtime for two of them.

A particularly memorable shift included a patient who kept desatting down to 75% on a non-rebreather mask – sure he had lung CA but 75% is still not a number I like to see. The woman next door to him went into a v-fib arrest only to be replaced by a tachycardic/hypotensive MVA who needed surgery ASAP. Of course all the surgeons were already swamped so she got transferred to the hospital next door. The cherry on the crap sundae that was my shift was an ashen looking LOM with a Hb of 47 who experienced a horrible transfusion reaction. I came back after only getting 4 hours of sleep to get a psychotic patient who needed elephantine doses of haldol. He just had to develop extra-pyramidal symptoms right when I see the monitor showing full blown tombstones on another one of my patients. I almost missed the drunk-tank. Almost.

By the time I finally made it home, all I wanted to do was to crawl into a little blanket covered hole and die. But no – I couldn’t sleep the entire day and my neck hurt! If the next set of shifts is as crazy as the last set, I may have to start self-medicating – or seriously consider switching over to retail :P

Heart Health in Action

After explaining atherosclerosis, cardiovascular fitness, weight management and the importance of maintaining a diet low in cholesterol to my old country non-English speaking relatives, my sister and I scurried out of the door like rabid dogs as soon as we heard the siren song of the ice-cream truck and returned with ginourmous cones of ice-cream that probably had 2 days worth of calories. Our display of unrestrained gluttony was met with sharp disapproval as ice-cream melted onto the carpet. We’re soooo smooth.

When Your Timing Sucks

Lately I’ve been getting patients who suddenly remember all of their outstanding medical concerns AFTER they’ve been seen and discharged! Last night, three of my patients started causing a ruckus over needing various scripts* to tide them over until they were able to see their family doctor. I fail to understand why they would not ask the doctor about their medication concerns when the doctor is actually seeing them rather than sauntering up to the nursing station 30 minutes after being discharged and then casually asking for scripts from the ward clerk or the nurse. I do not enjoy having to needlessly argue with a patient especially when I’m juggling a full area because the patient thought, ‘hell I’m here, might as well take care of ALL of my inane errands’. I’m also pretty sure that our docs don’t like being confronted with an eager pen holding patient who they thought was long gone asking for a script. I realize that sometimes patients forget to mention things to the doc because the entire department seems to be rushing, but it’s called an EMERGENCY department, not the WALK-IN clinic.

*Not narcotics – those are a completely different issue!

Highly Personal Shit

Location – ER waiting room
Time – 0327

Me: Hi there, how can I help you?
Patient: Yeah, yeah, I’m going through some highly personal SHIT.
Me: Meaning?
Patient: Yeah I need some Percocet and Ativan for my highly personal shit.
Me: Have a seat.

Best triaging I’ve ever done while getting an unofficial orientation to the area!

High School Hospital

I was one of those people who didn’t enjoy high school. I didn’t hate it either, but I saw it as a stepping stone towards something greater. I certainly didn’t enjoy the petty backstabbing, clique forming, ass kissing groups that smiled at your face while their lackeys stabbed you in the back. Leaving high school was great because I was finally free of the aforementioned people. But they were quickly replaced by another set. In university, they wanted to rip off your academic accomplishments. In the workplace, they want to strip you of your professional accomplishments. But no matter what stage of life they’re in, they all have one thing in common – they’re all a bunch of vindictive bitches who know how to ‘work the system’. They can be mean, and they’re often stupid, but they get in touch with the higher ups (some of whom couldn’t give two shits about what’s actually going on in their units so long as the right paperwork is done) and so, they can make your work life HELL! Mean cliques can be especially dangerous when they’re led by stupid people.

Sadly, two of my very good friends (and highly competent nurses) are in trouble because of such slithering snakes holding nursing licenses. Without giving too much information away, the first friend got called into her manager’s office because he has allegedly been providing consistently unsafe patient care. Never mind that none of his patients have ever complained against him or have suffered any adverse outcomes but because the manager is chummy-chummy with the snake, all of his charts are going through review. I’m sure he’s going to come out of this unscathed but it’s extremely unfortunate that so much time and effort is being wasted on trying to look for something that doesn’t exist. The icing on the cake - when I was orienting, this nurse told me "basically it doesn't matter what kind of insulin you give - they're all the same!"

The second friend was also called into her manager’s office for violating “patient confidentiality”. Over dinner. During her days off. What did she have the misfortune of uttering out loud? “Some days I hate work [name of hospital] because I’m sick of dealing with demanding people who have their heads stuck up their asses”. Ummm, isn’t irritation with oblivious demanding masses almost a prerequisite for working with the public? Some manager-ish person who was sitting nearby and heard her called her into her office to discuss the “image of the workplace she’s projecting when she’s not working”. We quietly talked about how certain TYPES of patients (did NOT mention specific names/cases) drive us mental and how we deal with their crap. Apparently we’re not supposed to talk to our friends or our close support systems – we have to talk to hospital employed specialists. I would much rather rant and bitch to my closest friends get it done with and then go on with my bloody day rather than speak to a stranger! What I still fail to understand is HOW patient confidentiality was compromised considering no specifics were mentioned – no names, no specific cases, no ages, no locations. Because of some gremlin trying to cozy up to higher management, my friend is stuck dealing with idiotic management on several levels.

Right now I’m furious on behalf of my friends and any nurse who has had to deal with obnoxious backstabbing bullshit because it can easily happen to any of us. My naivety led me to believe that a nurse’s first priority would be to provide the best possible care to patients, not to keep a bunch of vindictive people with the mentality and intelligence of high school punks happy.

Public Transit Hissy Fit

After any shift (especially night shifts), I throw on a jacket over my scrubs* and hurry home to my shower, kitchen and lavender-vanilla scented bed (I love Downy). While I’m rushing home, I like to decompress by getting lost in my own world while surrounding myself with a giant bubble of silence. So imagine my irritation on a sunny morning I’m completely zonked out of my mind, I’m approached by a seemingly normal looking guy who looks directly at me and then loudly asks, “Excuse me miss, are you a nurse or a doctor?” Having just gone through a break-less shift liberally peppered with loud obnoxious alarms and patients screeching every two minutes, I ignored him and started to pray that he was addressing the other scrub-clad people on the train. Nope. He was talking to me. Once again, he very loudly asked me,

“Are you a doctor? A nurse?”

This time, I took a perfunctory look around the train to a) make sure that there wasn’t some dire catastrophe about to unfold and b) catch another scrubbie’s gaze and maybe get rescued from the asshattery of the buffoon standing in front me. Once again, my hopes were crushed.
I reasoned that he’d eventually tire himself out and since he did not look to be in any distress (clearly his ABCs were intact), I could go on ignoring him for another couple of minutes before getting home. Yet again, his unrelenting questioning did not cease.

“Miss, I need to ask you a few questions! Are you a nurse or a doctor? Where do you work miss? I NEED to ask you some questions!”

This was pushing it too far! I can normally get away with my standard “No speakie English” line and have public transit folk leave me alone but this guy was clearly not going to buy that. As the train hurtled towards my stop, his questioning became louder and more persistent. He then inched towards me (in the off chance that I did not hear him the first several times) and very loudly repeated himself again, this time trying to reassure himself that I was a nurse. Unable to contain my rage at having my decompression time and post shift latte sipping interrupted so rudely and without any justifiable reason, I snapped. Oh boy did I ever snap. While he was firing off the next round of questions, I screamed,

“Just leave me the f**k alone! I don’t wanna f***ing talk you jackass!”

Normally, I would have tried to cover my crimson face in a newspaper and quickly get off at the next stop to avoid strangers’ stares, but that morning, I felt a wormy self-righteousness in screaming back at this guy and keeping my seat. He was of course stunned and quickly sinked back into his seat. I’m sure I did not do the image of nursing any favours with my little outburst, but did it ever feel good. When I told my coworkers about this, some of them were high-fiving me for telling him off while others were aghast at how I handled at the situation. The latter group felt that I should have politely but firmly told him to seek medical attention from his family doctor or at a hospital.

So what should I have done? Should I accept the congratulatory high-fives or should I have handled the situation with more grace and dignity while keeping my ‘nurse’ face on?

*Changing out of them is not always an option because I would much rather catch the train on time than hang around work for another hour especially on weekend mornings. I am not safe to drive after a night shift.

Even if it is a Quiet Night...

…The wierdos still come out in packs.

Exhibit 1
30 something year old woman comes in presenting with palpitations and diaphoresis. When I get her into her room, she tells me that she thinks someone at a party tried to get her to OD on cocaine at a party two nights ago. I then asked what brought her in to the ER on this particular night. I almost wish I hadn’t because then I wouldn’t have to hear her say that she kept on taking crystal meth at home to prevent withdrawal. *headdesk*

Exhibit 2
50 something year old man presents with midsternal chest pain radiating to his axilla. He got the standard chest pain workup and then asked for the “Jewish Bible, the Christian Bible, the Quran and the Ramayana and Mahabaratha”. Unable to provide him with those texts in the middle of the night, I asked him why he needed them so urgently. He replied that since he’s been a “lying, cheating, whoring, filthy sonovabitch who’s screwed chicks from every religion, nationality and race”, he might as well repent to all the gods before he “kicks the crapper” since no one can tell for sure who “reigns supreme beyond the clouds”. I ran a drug screen on him. Came back positive for marijuana and benzos. Nonetheless, I believe that his request implied some measure of remorse for his past actions, selfish though his motives may have been.

Exhibit 3
40 something year old woman comes in with halitosis that would make a decaying zombie shrink back in disgust comes in for, surprise surprise, dental pain! I put on an N-95 and ask her to open her mouth. Two of her molars are missing. The void left by her missing teeth was filled with puce yellow pus. She said her pain just started “a couple of hours ago”. Right. She tried prayer and crystals to heal herself when her teeth first fell out. I must have hidden my frustration quite well because she gave me a shiny crystal for being a “sweetie pie”. The crystal hangs in the nursing lounge with a set of sharp white teeth attached to it!

It was a quiet night because for almost 3 hours I had no patients – I saw 6 patients in total that night. Good times indeed!

Happy Birthday Canada

Happy Canada Day! Enjoy the wonderful weather, a break in the middle of the week, a good bbq, some Ceasars and fireworks :D

Don't Mess with the Choos

Gentlemen, if you get into an argument with your girlfriend and things get out of hand, do NOT deface her Jimmy Choos with permanent marker. She will smash your laptop and then use a jagged piece of the wreckage to try to cut you. She will succeed, it will not pretty and you will not be happy.

The Five Stages of Grief

A wonderful teaching and learning tool. Enjoy!

Health Teaching Gems

In a recent shift, I met a young man who had a few questions about the transmission and pathology behind influenza. Since it was a quiet lull in my day, I relished the opportunity to flex my teaching muscles and started by asking him to describe what he knew so I could proceed from there. He knew that he should wash his hands and cover his mouth when sneezing or coughing but he did not know how that prevented flu’s spread. The conversation eventually led to me explaining how the virus essentially hijacks cellular machinery to assemble millions of copies that burst out of the cell thereby destroying it. He became slightly confused and in order to clarify the concept, I asked him to imagine an overcrowded place in which people are pushing to get out. Lost deep in thought, he stared at the wall behind me before his eyes lit up and he triumphantly announced, “the virus bursts out of the cell like hookers from a cake!” Flabbergasted at such a crude, yet visually effective analogy, I had no choice but to enthusiastically agree!

Diagnosis Wenckebach

Bad Idea

The economy is bad. We’re hearing doom and gloom reports all over the news. People are losing their jobs and youth employment is steadily decreasing. Nonetheless, if you’re a 20 year old man-boy, you should not let your friends pay you $10 per shot to let them shoot your leg with a BB gun. Even if you made $300 from this fine entrepreneurial endeavour, the resulting cellulitis, abscess drainages and time needed to adequately heal is worth far more than the cash acquired (which was quickly exchanged for beer and cigarettes). Also, if you want even a measure of feigned compassion from me, you cannot tell me to hurry my ‘sweet ass over with some food’. That makes me want to replace your morphine with bleach and your antibiotics with C. diff diarrhea samples.

Meow

Sometime during the last of Christmas holidays, I took care of a patient who was an elderly homeless man. He came in complaining of recurrent dizziness and frostbite to his toes. When I went to greet him, he seemed very worried and held onto his coat as tightly as he could. I tried to reassure him that his belongings would be safe in his room and that there is security throughout the ER keeping an eye on everything. And then his coat meowed. For a second I thought I had finally lost my damn mind but his coat meowed again. The man finally opened it and inside was a tiny little mangy black kitten that I wanted to cat-nap immediately. The man said that although he was feeling very sick (and he looked it), he didn’t want to leave Tiger out on the street in case he never finds him again. Apparently Tiger was separated from its mom and siblings and the poor thing looked like it was scared to death. The man said that prior to finding Tiger, he was contemplating suicide and if he couldn’t keep Tiger, then he’d leave. Now I had to tell him the man that animals are not allowed in the ER but we didn’t want to separate the two. Long story short, we found a box, lined it with a warm blanket, put some tuna and milk in denture cups and let Tiger be watched at the main security desk. The man got admitted and the staff pitched in to get Tiger seen by a vet and get neutered. Owner and cat left a few weeks later in good spirits. I write about this now because the man came back to the ER a few days ago and was completely unrecognizable. He wanted to thank us for taking care of Tiger and setting him up with the right community resources because he’s no longer homeless. Moral of the story – pets are wonderful for your health. Now to go feed my giant roving cotton ball of a cat.

Sick Days

For the past several days, the weather was gorgeous (low 20s), the skies were clear, gardens were blooming everywhere, people were out strolling about in the parks and me? I was stuck inside my room febrile and nauseated while countless trees were killed to contain the buckets of snot my nasal passages were perpetually seeping out. And whose fault is this? It’s the fault of the irresponsible, incompetent, rude and completely asinine family of my sweet lom who came to the ER with lots and lots of wheezing. One of them had a cold and kept spraying the room with his snotty secretions. He also refused to wear a mask because “I’m not fucking staying here”. Yet another delightful family member marched right up to the nursing station and demanded that I page the doctor right away – when her request was flat out denied, she coughed her smoker’s cough without covering her face or at least turning away almost in my face. She also got quite offended when I decided to don a N-95 in thier presence. I finally got fed up with all of them and told them to leave. As a parting gift, some of them left snotty tissues around the patient’s bed and the nursing station when there are PLENTY of garbage cans around. Three days later, I too am sick. If there’s any sort of karmic justice at work, I really hope that those pricks contracted C. diff and lose their driver’s license.

Creepy – with a Capital CREEP!

Two hours into my shift, I got a patient with chest pain and he got the standard initial workup – ECG, bloodwork, line, oxygen, monitor etc. Three hours after that, I got a lady with similar symptoms and she got the same treatment. She was placed in the room next to the guy. The rooms are divided by glass walls and are covered with curtains. The curtains were FULLY drawn between the two rooms because undrawn curtains are my pet peeves. Patients are already forced to expose themselves to the staff – they shouldn’t have to be exposed to other patients as well. While the woman went to the washroom, I figured, I’d quickly down some juice to prevent a hypoglycemic episode while assessing my patient. When she returned to her room, I started hooking the woman up to the monitor and what do I see out of the corner of my eye? The man peeking out from the uncovered part of the glass partition and staring openly at the woman. I quickly closed the curtain and finished hooking the woman up to the monitor. I then talked to the charge nurse about moving him to another room. He was moved and then he started peeking into other women’s rooms with a very visible erection (one woman was being catheterized)! A 30 something woman got so freaked out by him staring at her that she tried to throw a bag of NS at him. It (unfortunately) missed. Security was promptly called after that little incident and was made to stay in his room. What a f%$*ing CREEP!

How Much?

In economics, the term ‘free’ is used to describe something that is available in nearly unlimited quantities with zero opportunity cost to society. (For the non-economics folks here, opportunity costs measures the value foregone as the result of deciding to produce one good over the other). Free in this sense does not mean that an individual (or group of individuals) can consume a good in unlimited quantities without deflecting a part of the cost to society as a whole. However, that’s exactly how a lot of folks are treating ER. In Canada, health care is ‘free’. That means that if an individual goes to a clinic or (for the purposes of this blog) the ER, they should be able to get a superfluous treatment that they deem necessary for themselves right? After all, it’s free, so what does it matter to the referring physician? And let’s say that the individual’s request was fulfilled and they went home happy with their productive visit, they have an exciting anecdote to share with their family and friends, right? Because in Canada, the discharge papers don’t include a bill. But here’s the thing –I think sending people with an itemized list of the expenses that they accumulate while visiting an ER versus the cost of visiting a family doctor might make the average person think twice before coming into an ER to seek treatment for non-urgent problems.* Maybe I’m being overly naïve here, but a population wide reminder of how much ER abuse costs the system (and raises taxes) can influence a shift in health care consumer behavior to make more socially conscious choices. Of course, this means that Canada really should start making it a little easier for foreign trained health care professionals to enter the Canadian system instead of letting them drive cabs (and other upstream interventions) but that’s another blog post entirely.

*Some stellar examples include, a cold sore, a cold, a well healing bruised hand, having TWO beers and feeling ‘wrong’, calling 911 for an ambulance and then talking on your cell phone the entire time while in the department, stubbing one’s foot against a parked car, bunions that suddenly got worse after wearing a new pair of shoes two sizes too small for the past several hours and on and on…

Med Error?

Talking to a patient who was particularly hard of hearing today for almost 12 hours has not been good for my voice. However, it was all worth it just for this conversation:

Patient: What pill is this?
Me: This is your Losec.
Patient: Low sex? I’m already old and feeble! Why the hell would I need a pill for that?
Me:* LO-SEC! NOT Low sex! This is for your heartburn!
Patient: Good! I don’t need a pill for low sex!

Good times! I could never have a conversation like this in the corporate world.

*While trying desperately to suppress loud and boisterous laughter

My First Time

“I think I’m joy-gasming”

Overheard when the charge nurse for the day walks into a completely empty department. No one in triage, no one in trauma, no one in resuscitation and no one in fast track. I doubt this will ever happen again. I think the night crew should have gotten a raise just for that night. This has nothing to do with the fact that I was part of that night shift.

Services that are Pissing me off!*

1) Gyne
I was working the gyne area and almost each and every one of my patients got referred to them. The new batch of gyne residents SUCK! They’re rude, they NEVER answer their pages unless you threaten them with bodily harm and they leave their patients hanging for hours. When they finally get down to the ER, they held up all 5 of my assessment rooms while the pile of charts at triage kept building up. One lady in particular was kept waiting for 17 hours – did I mention that she was an IDDM and was kept NPO for no reason?? The ER staff doc got so pissed at the whole sham that he just referred her to outpatient services and wrote her a script for some percs.

2) Internal Medicine
The senior is a mean BEEYOTCH! She’s mean to the patients, she’s meant to the nurses, and she’s mean to other doctors. On top of that, she took a chart from the nursing station, took it apart and left the pieces on the FLOOR on the other side of the department. I wasted half of my shift looking for that damn chart. When I called her about the chart, she yelled at me for wasting her time and then hung up on me. I was forced to be just as mean to her underlings and make them stay within my range of vision with the chart.

3) General Surgery
They NEVER pass along their patients to another service or discharge them when they’re finished with their assessments. I end up making a thousand calls just to figure out what the eff they want to do with the patient. Meanwhile the patients and their families hover over my head glaring and bitching at me.

*I'm waiting for the new batch of residents and students to take over so the staff with the nasty attitudes can get out of my hair.

Fall Down Go Boom

Our ER has been a heavy duty construction zone lately.

“Of course we can (BAM) provide a somewhat (THUD) quiet place (OWWWW) for your easily startled formerly (SMASH) shell shocked grandfather”

BUT there is a reason – we’re upgrading our layout, adding new beds and also getting a boat load of some kickass computers and flat screen televisions (to umm keep a track of patients). However, I’m firmly convinced that the ghosts of technologically averse administrators past are haunting us. As a beautiful Sony flat screen panel was being brought into the newly refurbished nursing station, one of the men let go of his end and cracks the screen in 3 jagged pieces. He was a code STEMI. The construction worker is doing well. I rejoice for him and his family. The flat screen panel could not be resuscitated. I mourn for the loss of a beautiful piece of technology.

G8P1A4, Age 25

Yep that’s right – 7 pregnancies, 1 live birth 2 miscarriages and 4 induced abortions all before the tender age of 25. Oh and lots of drinking. Lots. She comes in with vague complaints and abdo pain. She had her last menstrual period almost 4 weeks prior to her coming in and her beta was almost 10,000. She was genuinely surprised to find out that she’s pregnant – again. The father was her friend from elsewhere and they both got piss ass drunk when the blessed event happened. Her 22 month old daughter was accompanied by another friend and was passed along to grandma because “mommy always wanted grandkids”. I don’t think mommy wanted grandkids to raise – she probably just wanted to spoil them like a grandmother would want to. Instead, mommy is now stuck working god-awful hours just to make sure that the innocent little toddler is well taken care of because obviously the daughter has shit for brains. I think the staff doc said it the best; “How can one person be so stupid?” and I agree with her completely. After all of those pregnancies and referrals to birth control clinics, you think she might have learned to take better care of herself? Nope. Not at all. She just smiled sheepishly and said, she didn’t think she’d get pregnant this time. Because 8th time is the charm. I fulfilled my nursing responsibility and talked to her extensively about birth control but it was a total fucking waste of my time because apparently she knew all this. “I don’t like to put unnatural things in my body”. Technically speaking, vodka and cigarettes aren’t natural either. And the biggest irony of this entire miserable story – she lives a block away from one of the most respected and accepting birth control clinics in the city if not the province. Somehow I doubt ‘the system’ let her down. Some people are beyond the help of the system.

A Small but Perceptible Shift in my Position on the Totem Pole

Apparently the powers that be feel that I’ve got enough experience in the non-critical areas to orient new staff. So that’s just what I did. For two weeks straight.

I must say that I really enjoy teaching. It’s an opportunity to not only help another person get their bearings in a new setting but it helps me learn from their experiences as well. Unfortunately, a particular new hire does not feel the same way. I tried to go through several protocols including chest pain with cardiac features and hip fractures but she talked over me the entire time. I heard all about her kids, her husband’s habit of not filling up the gas tank, her mother-in-law’s crazy tarot card obsession, her sister’s multiple affairs and her favourite shampoo’s magical hair softening effects. When I finally got a chance to speak, I redirected her to a patient who was brought to us with a possible hip fracture. I told her to do the initial work up which we would discuss afterwards. She talked and talked and talked and then talked some more with the hip pain guy without checking for distal pulses, checking for shortening or rotation, drawing blood, doing an ECG or even putting in a freaking catheter. When she came out of the room, she tells me the guy’s entire life story but nothing clinically relevant. She didn’t even ask him about HOW he fell! What really kills me is that she’s been a nurse for 4 years! FOUR years! Had I known that she wouldn’t even do basic assessments, I wouldn’t have left the patient to her because I had to give up my break to catch up on the work she created for me. While she sauntered off to break, she had the audacity to comment to another nurse that *I* was slowing HER down. It was a miracle that I didn’t end up strangling her!

However, the day was saved when I had to orient two new grads – they were brilliant. Smart, great critical thinkers and asked lots of intelligent questions. Even though I was still swamped with a bunch of unworked-up patients, I genuinely enjoyed teaching them as much as I could. Unlike nurse with 4 years experience, they did a great job with their assessments and were able to very intelligently explain their rationales.

As I write this post, I received an email saying that I’m teaching for the next set of my shifts as well. Here’s hoping I get the later and not the former. Otherwise, I might stuff her mouth with a chart. But that would not be very professional of me, considering that now I have to uphold an image of someone with a mild bit of nursing experience.

Bad Dream, Worse Behaviour

Some nights I have a dream in which my boss and peers come up to me in the middle of a busy shift and tell me that I’ve actually failed my licensing exam and as such, I’m not actually a nurse. Then I see professors from some time long ago saying that my degrees have been revoked. Of course, my nursing license also gets revoked. All of this happens in front of a doctor who starts to lecture me on ER wait times being prolonged because of something I’ve done. It’s never a good sign when I dream this dream while on break AND when the doctor in question is on shift as well. Of course it doesn’t help that this doctor makes me incredibly nervous and I can’t figure out why. Rationally I know full well that I have the requisite knowledge to work as nurse. I am also completely cognizant of the fact that I have a long way to go before I reach the ‘expert’ level of nursing. And yet, there remains something about this doctor that makes me feel very very edgy (close to the point of full blown mind numbing anxiety) when he’s on the same shift as me. His presence makes me feel as if anything I say would sound foolish and anything I do would be wrong. I become consumed by the thought that I was hired over the other candidates from my class only because I might have stumbled across the right answer to some mundane question. And so, much to my own chagrin, I say nothing. I silently sit paralyzed with self-doubt and wait until he goes onto see the next patient before I can breathe a sigh of relief. He has never done ANYTHING that would warrant such a response from me, but I feel threatened by him regardless. Perhaps it’s his height (almost 6’7) though unlikely, or perhaps I think I see an expression of restrained surprise so subtle as to be nearly imperceptible when I speak intelligently about something. Or maybe, I still feel I have nothing substantial to offer next to the highly skilled and experienced nurses and doctors and this doctor just happens to work on the shifts in which I feel exceptionally shitty and under-qualified. I know I have to deal with this, and quickly, but I don’t even know where to start.