Best. Shift. Ever.

Yesterday I was still trying to recover from my previous night shifts. I couldn’t sleep the night after until 0500 and I was woken up by construction at 1000. After eating a nutritious breakfast consisting of rice and lentils followed by a gargantuan cup of coffee, I parked myself in front of the television so I could let re-runs of Oprah lull me into a thoughtless daze and promptly started weaving in and out of sleep. This continued until 1400 when I finally drifted off into a deep sleep. At 1420, I was once again woken up by an obnoxious noise – the telephone this time. I begrudgingly reached over and answered gruffly only to hear the obviously forced saccharine voice of the ward clerk asking if I could pick up a night shift. Figuring that I probably will spend the entire day zonked out worse than the guy who OD’d on clonazepam, I might as well go in and earn some (time and a half + night differential) cash. Turns out it was a pretty good decision – I was on a float assignment, I had relatively well behaved patients, a doc who was thorough but quick and because I didn’t take a break, I could leave early (or as administration knows – the last break). I got a chance to catch up with nurses that I normally don’t work with and helped play a pre-April fool’s day prank our staff doc!*

*It involved making fake patient ID and putting it up in the gyne area and a fake chart with PMHx including G20P17, untreated STIs and an extensive psych and drug seeking history. It was great watching him run around the department looking for the ‘patient’. Heh heh heh.

Love Letters

Dear Nursing Administrator,

I just wanted to say how horrible one of your nurses was to me. I think her name was Myra or Moira or some ethnic sounding name that didn’t make sense to me. First she told me that she didn’t believe I was having 10/10 pain. I was obviously in pain and then she made me wait so long before I could see the doctor who ORDERED that awful nurse to give me dilaudid. She only gave me 2 stinking advil. Then she totally told me that I couldn’t have another sandwich because I already had one. But I waited in that stupid hallway hungry and she didn’t care. Finally she told me to leave when the doctor cleared me – she wouldn’t let me talk to the doctor. Ms. Administrator, you’ve made a horrible mistake by hiring that bitchy and stupid nurse. I’ll never come to your ER again until I’m ready to sue you all!

Sincerely,

Bitchy Drug Seeker


Dear Bitchy Drug Seeker,

We take all patient complaints very seriously and as a result, myself and several other nurses on the chart auditing committee reviewed your records. Upon review, we have found several discrepancies between the events that you have claimed in your letter and our documents. First of all, the physician who saw you ordered 800mg Ibuprofen which were given to you by the nurse in question. Secondly, unless a patient is staying with us for an extended amount of time, we usually do not provide meals. You were in the ER for 4 hours and 27 minutes according to your records and as a result, you were not entitled to a meal. Lastly, the physician has documented that she saw you before you were discharged and extensively discussed detox options with you. You explicitly stated to the physician that you were not interested in pursuing the matter any further. The nurse in question then gave you a copy of your blood work and chart to take to your family physician. I regret any misunderstandings that might have occurred regarding your visit and if you have any further questions, please contact our patient relations department.

Sincerely,

Nursing Administrator


I was told afterwards that this particular drug seeker is a very frequent flier but was serving some time for (take a wild guess here) for drug possession and trafficking when I got hired. But she’s back now to raise hell all over again. Gotta love my job.

Cheapskates and Freeloaders

Lately it seems that each shift features several patients who want me to provide them with amenities on top of their ‘emergency’ care. I’m not talking about the homeless/otherwise disenfranchised population, but regular joe-schmoes trying to scam me out of something or the other. For example, I was in the middle of taking out a saline lock from a 20-something year old guy when he demands a sandwich and juice. He was holding a Starbucks coffee cup in the other hand and was sitting beside a half eaten subway sandwich next to him. Sandwich and juice denied.

The next set of offenders was a middle aged couple who kept asking for juice and jello every 20 minutes. They had to be not so politely reminded that we have a limited supply of food in the middle of the night and they’re clearly not the only patients in the department. On top of that the husband was NPO because he's waiting for the OR so there is no way in hell he'd be getting something to eat on my watch.

However, my all time favourites are the ones who ask for public transit or taxi vouchers when they have their wallets with them. I had one patient from a very well to do part of town ask me for a taxi voucher because he didn’t want to call his wife in the middle of the night to pick him up. He also did not want to use his credit card or an ATM not belonging to his bank because he did not trust cabbies and did not want to pay the $1.50 fee to get home at 0330. Again, I had to not so gently remind him that since he took the taxi to the hospital, he can use our taxi phone and take the taxi back home and stop near his bank. He of course threatened to sue me (maybe the taxi voucher savings could have been set aside for his future legal endeavours?) before storming out dramatically.

I want to put up another sign saying something along the lines of the ER not being a pediatrician’s office in which one will get a proverbial lollipop during or after your visit if it’s not deemed necessary. Courtesy people, courtesy!

Paging Dr. Shit Disturber

“There’s no reason for you to be in this room. Get dressed and go wait in the waiting room until the surgery team has time to see you”.

Those are the curt words I hear from the staff doc to an elderly man with a low hemoglobin who says he has been experiencing increasing bright red blood per rectum since his colonoscopy two weeks ago. The patient is staring at the doctor dumbstruck and calls him an obnoxious jerk before he starts to make his way to the waiting room.

I too was dumbstruck because I’ve never seen a patient (who’s not triaged to the fast track area) kicked out of the room at the whim of a doc in a bad mood. The staff doc walked away before I got a chance to ask what happened. Before kicking the patient out of the room, the staff doc declined to tell the patient that we were waiting for his PT/INR and that he was referred to surgery. Understandably the patient thought that he was being denied adequate care. He went to the waiting room and told the triage nurse that he would not leave until he had been properly assessed by a physician. The triage nurse was thoroughly confused and irritated by the situation because she can’t be keeping an eye on a patient who has already been assigned to an area inside the department.

When the charge nurse confronted the doctor about the situation, he became irate with us all and started yelling about how he needs free rooms for patient assessments and that a patient waiting for a consultation can’t be keeping a room occupied. That might have been a valid argument had we been short on rooms and the waiting room was full. However, it was a very quiet night – 13 rooms were free, the waiting room only had 4 people waiting to be triaged and all were candidates for fast track. Furthermore, patients waiting for consultations (especially surgery) are kept in a room so the nurse can continuously assess them, especially those with low hemoglobin counts and are bleeding!

The patient was brought back inside the department and I decided that he should go back to his room. When the staff doc saw the patient back in his room at the nurses’ insistence, his temper further flared and he started to curse under his breath while he randomly started to bring in patients who weren’t even registered in the system creating a gigantic mess for the entire department. Basically he was acting like a little bitch!

The patient was eventually discharged but not before the entire staff (including the surgeons) told him to file a complaint with patient relations.

Later on during the night, he forgot to order a head CT for a patient. When I brought that little error to his attention, he bitched at ME for not entering it into the system. I had to not so gently remind him that it is the PHYSICIAN’S responsibility to order CTs – the computer system won’t let me do it because I don’t have the appropriate privileges! Ass!

I’ve foolishly agreed to work a lot more shifts than is probably healthy so I’m really hoping that he’s not the staff doc - I might just end up strangling him Homer Simpson style and further exacerbate the Canadian physician shortage!

Welcome to the Department of Redundancy Department

I’m still considered to be a new nurse who doesn’t have a lot of experience under her scrubs but everyday (no matter how angry or tired I come back from work), I know I’ve learned something new that will help me in another future shift. But one thing that really irks me is when I’m giving report and I get inundated with the same question over and over again because the oncoming nurse refuses to listen to what I’m saying. During the last set of shifts, I was giving report to one such nurse about a patient who recently travelled to India and came back with symptoms highly suggestive of malaria. That and she was jaundiced with RUQ discomfort. I sent off blood work and asked for LFTs to be included along with a malaria smear. I included all of this information in the report I gave to this particular nurse. The resultant conversation went something like this;

Me: “So I asked the lab to include a malaria smear – I know it’s not our medical directive but she’s coming from an endemic area, she’s having biphasic fevers, she’s jaundiced and she’s having some RUQ discomfort. All this is in the triage notes, but just let the doc know that I did it”.

Clueless nurse: “But asking for malaria smears is not part of our medical directive. I’m not telling him that I did it without an order and anyways why would you do that?”

Me: “I’m not asking you to tell him that YOU did it. I’m asking you to tell him that *I* did it”.

Clueless nurse: “But sending for smears isn’t part of our directive. You need an order to that”.

Me: “I’ve seen a lot of malaria, I’ve had malaria, so I have a pretty good sense of what malaria looks like. That’s why I asked for the smears to be included. Worst case scenario, they’ll be negative and we would have spent a miniscule amount of money on them”.

Clueless nurse: “I’m not getting into trouble for you. You did something against the rules. I’m not telling him anything. Anyways I don’t even know what smears are”.

Me: “uhhhh….”

Clueless nurse: “yeah, it’s your fault!”

Me: “What the…? What are we talking about?”

Clueless nurse: “You’re not supposed to do anything without orders if it’s not part of our medical directive. You’re the one who broke the rules and you’re the one who’s getting into trouble for it”.

Me: “Umm… okay. Uhh have a good shift?”

Clueless nurse: “I’m not getting into trouble for you. I just don’t get why you’d do that anyways”.

When I came back for my next shift, lo and behold, the lady was diagnosed with malaria and I got major cut eye from Ms. Clueless.

Hand Hygiene and the People Who Refuse to Practice It

I was one of those weird kids who actually liked to bathe and was almost obsessed with washing my hands before eating or after using the bathroom. Because I think I’m perfect (kidding!), I just assumed that everyone else follows the same standard of hygiene that I do. However, the more time I spend in the ER observing people, the more I realize that a vast majority of people are either completely ignorant or completely filthy. I helped plenty of people to the washroom and they hand to be reminded to wash their hands after they had a (probable) C. diff filled BM. And then there were those charming folk that just flat out refused. The same people got highly offended when I refused to touch them without a pair of gloves on. I even tried the whole health teaching approach with a woman my age – she looked at me like I was telling her that I would be using leeches to treat her. When she was done staring at me with her mouth agape, she retorted by saying, “well I didn’t get any pee on my hand so what’s the point of washing and ruining my manicure?” Hearing that made me die a little on the inside. Yet another patient had to be told that if he didn’t wash his hands after wiping himself, he would literally be eating his own shit at dinner time. I shouldn’t be having to have that talk with a 40 something year old self professed business man. With hand hygiene eschewing patients running around the hospital, it’s no wonder that hospitals are such dirty places!

Sweet Merciful Relief

Anything retained that should be expelled is an awful feeling – this includes urinary retention. I always feel really bad for elderly people coming in with obvious pain because they haven’t been able to pee for a while. I had just such a gentleman assignment to me. He was 79, could barely speak a word of English and kept clutching his bladder and pointing to his crotch saying, “no pee pee last night”. Oh dear. I got a 16F in him so fast he didn’t realize his pants were off! He drained almost a liter of urine in less than 5 minutes. The relief was literally palpable. By the time the doc got to see him, there was nothing much to do except set up an appointment with a Turkish speaking urologist and write him a script for prophylactic antibiotics. That’s one of the things I love about working in the ER – discharging a happy customer in a (relatively) short amount of time. That and getting a catheter to drain urine without a fuss!

Nepotism, douche-bagery and the million dollar workup for the undeserving

What happens when a woman with a sore throat, weakness in her legs and an ex-resident douche-bag boyfriend signs in at triage? She gets waited on hand and foot by the staff doctor, gets a stat MRI and supposedly a free pass for idiotic requests such as, “Go get us some herbal tea”*, “I’m getting a little bored – can you bring me a magazine or a book?” and “I just want to talk about how nervous I’m feeling”.
By the time I was finished my shift, I was furious with not only her and her boyfriend, but the staff doc as well. This woman is perfectly healthy previously but develops a sore throat and feels weak. The most remarkable note in her history is using multivitamins! Before the triage nurse knew that she was the ex-resident’s girlfriend, she got placed in the fast track area. However, when the boyfriend showed up, he got her to a bed in my area and then my shift went to shit. The woman’s boyfriend was a resident in the ER before I started working there so he weaseled his way into getting her a stat MRI! The sheer injustice of the entire situation was infuriating considering one of my other patients was waiting 6 weeks for an MRI and came in with excruciating pain while waiting for a diagnosis. Rather than being profoundly thankful for getting the best freaking care possible, she and her boyfriend kept pestering me and the charge nurse for retarded requests such as the aforementioned herbal tea and generally acting like jerks. What kills me is that even though I understand the staff doc’s rationale for getting her an MRI, he would have never bothered going into such a detailed history with her had her boyfriend not been a friend of his. He also could have gotten my other patient an MRI but didn’t. It’s a good thing that the other patient was far too zonked out with pain meds to realize that he too could have gotten a stat MRI had he known the right people. Of course the woman’s MRI showed nothing and she got sent home with some antibiotics. Medical nepotism at its finest.

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*The ex-resident boyfriend rudely demanded that I get him and his girlfriend tea when I was in the middle of preparing a mountain of medications for my very sick admission. Rather than silently seethe with rage, I decided to let it all out and said something along the lines of “Go to the pantry and make it yourself. You only worked here for 5 months so you should know I’m not your fucking waitress”. The only downside of this exchange was that the cardiologist that I have a huge crush on heard the entire exchange and in his gorgeous Clive Owen-ish voice said, “I suppose I won’t be leaving orders for 1-2 cups of herbal tea q2h prn anytime soon”. I blushed a deep crimson, dropped my meds, stumbled picking them up and scurried out of the room. Envy my smooth man-eater skillz.