Tuesday, March 31, 2009
*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.
Thursday, March 26, 2009
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!
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.
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.
Wednesday, March 25, 2009
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!
Sunday, March 22, 2009
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!
Saturday, March 14, 2009
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”.
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.
Wednesday, March 4, 2009
Monday, March 2, 2009
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.
*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.