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 :)