*See disclaimer at bottom of page

Monday, April 22, 2013


Worked 4/20.

Waaaaaaay more OD patients than average were brought in.


Sunday, April 21, 2013

Sure, I'm Not Busy At All (sarcasm)

*This story comes from one of the docs I work with*

One of the hospitals he used to work at had a big ER bay with nothing but curtains separating the beds.

Well, it just so happened that three patients who were right next to each other all coded at the same time.  The doc is standing in the middle of the three running all the codes.  Obviously, there are nurses surrounding all three beds performing CPR, pushing meds, etc.

An older lady from somewhere else in the ER pulls back the curtain and sticks her face in, staring right at the doc running the code and says, "Excuse me!  Can't somebody get me a pillow?!?!"

The doc just pulled the curtain back over her face without so much as taking his eyes of his coding patients.

Well done, doc.  Well done.

Go Home Now. . .

*Lady comes in via EMS.  EMS guys have a look of sheer irritation on their faces.  The paramedic pulls me aside and tells me that they don't know what the hell her problem is.  She called EMS out for one thing, told the guys another story when they got there and kept changing her story during the ride.  No pain, stable vitals, no injury, patient is perfectly calm, alert and oriented, and doesn't seem like a psych patient to them. . . just a pain in the ass.
NurseHubba: Ok, Ma'am.  What brings you in tonight?
Not Sure What To Name Her: My legs!  Look at them!
NurseHubba: Ma'am, I don't see anything with your legs.  Did you fall?  Hurt yourself in any way?  What's going on?
Not Sure What To Name Her: MY. LEGS.
NurseHubba: You're going to have to tell me exactly what the problem is.  I don't see anything wrong with your legs.
*She sits up and points to three tiiiiiiiny, tiny, tiny little bumps.  Two on one leg and one on the other.
Not Sure What To Name Her: Can't you see those?!?!
NurseHubba: Ma'am, those look like mosquito bites.
Not Sure What To Name Her: Well, they're not! 
NurseHubba: Ok, tell me about them.
Not Sure What To Name Her: I was sitting outside on my porch since the weather's been getting nice.  I was wearing these same shorts.  Suddenly, I noticed that my legs were a little itchy.  I went to scratch and found that there were these little bumps in the same spots my legs were itching!
NurseHubba: You know mosquito season is starting, right?  Those really seem like mosquito bites to me.
Not Sure What To Name Her: Nothing bit me!  I didn't feel anything bite me!
NurseHubba: Do you normally feel mosquitos bite you?
Not Sure What To Name Her: Of course not!  Don't be ridiculous!
NurseHubba: Ok.  The doctor will be in to see you shortly.
Not Sure What To Name Her: Oh, something else too!  I felt like I might, possibly go into A.fib later.  
NurseHubba: Do you have a history of A.fib?
Not Sure What To Name Her: No.

Triage That Rash A Level ONE Next Time!!!

Or don't.  Probably don't.  Definitely don't.

At our hospital, we use the ESI triage system, where a 1 is the most critical patient (CPR currently in progress) and a 5 is the least critical (somebody sneezed earlier).

Well, there was a young lady there with her six year old son who had a small, seven inch by 3 inch red area on his left forearm.  It was itchy, and red.  The kid had been playing outside at a friend's house, out in the monstrous expanse of property that people tend to have out here.  The kid has had poison oak before, and it looked just like this and felt just like this.  This rash had been progressively getting worse over the last week or so with continuous scratching.   No, the kid had not been to a dermatologist or his primary doc.

The night this mom decided to bring her son in for the poison oak spot was a particularly rough one.  Rooms were all full.  The on-call nurse had been called.  We had CNAs sent down from the floor to help vitalize, transport, and take care of other CNA-y tasks in order to free up the nurses to do meds, assessments, and work codes.

Out of the 8 nurses there (including the charge nurse and triage nurse), three were in a trauma room with a traumatic arrest, two were in another room (on the opposite side of the ER) working a cardiac arrest, and one (me) was in yet another room working a damn STEMI.  The triage nurse was up front, triaging patients in the waiting room.  With two doctors, we had one in each of the arrests, while one occasionally popped his head into the STEMI since he was close.  This left one nurse to attempt to take care of the other seventeen rooms by himself while the rest of us were in critical situations.

Well, this night happened to be one where the majority of people in the ER were using it for something that they actually needed to be in the ER for.  That meant that most of the other seventeen rooms were needing monitoring, meds, etc.

Ok, so here comes the lady with the poison oak kid.  She marches out of her room (I can see out of the glass doors of the room I'm in) and asks in a quiet and respectful tone screams her lungs out at the poor nurse trying to keep an eye on seventeen rooms.
The Not-So-Patient Patient: This is fucking bullshit!  I've been here for three damn hours!  When is the doctor going to see my son!?!?
Nurse BusyAsHell (in a calm, but stern voice): Ma'am, there are multiple patients in this ER that are dying on the table as we speak.  The doctors and other nurses are in the middle of saving them and bringing them back to life.  You guys are going to have to wait a while.
The Not-So-Patient Patient:  But we've been here three hours!!!
Nurse BusyAsHell: Ma'am, we don't see patients based on how long they've been here, but on how critically ill they are.  That means your son is going to have to wait a long time.  The good news is that he's not the sickest person here.
The Not-So-Patient Patient: Well, if there isn't a doctor in my room in the next thirty minutes, I'm walking right out of here!
Nurse BusyAsHell: Well, that's just not gonna happen, so have a nice night.
*Lady grabs son by the arm and stomps out of ER cussing and yelling.

Thursday, April 18, 2013

Buckle Up For Safety. . .

. . . buckle up for fun!  Oh, and, you know. . . your life.

Over the past several weeks, our ER has seen an influx of MVC (motor vehicle collision) folks coming in.

First of all, people do some seriously stupid shit.  So, I guess my first piece of advice is don't do stupid shit. . . you know, like driving 90 on a 30mph winding road.

My second piece of advice is don't be the asshole who tailgates.  I see a lot of people who get rear ended by somebody because they didn't have enough stopping distance when something happened suddenly up ahead.  You know who comes to the ER with injuries from that?  It isn't the guy who was following too close.  It was the person who was being tailgated.  So, don't be an asshole.

My final piece of advice for this little post is WEAR YOUR DAMN SEATBELT!!!  With this influx of MVC folks, I've noticed something.  I'm sure it's different everywhere, but thus far, I have seen this:
100% of the people coming in who were wearing a seatbelt have survived whatever crash they were in.
100% of the people coming in who were not wearing a seatbelt have died in one of our trauma rooms.
Now, I recognize that there are more variables out there than whether or not somebody is wearing his or her seatbelt, but I've gotta tell you, this is an important one.

So, to recap:
#1: Don't be stupid
#2: Don't be an asshole
#3: Wear your seatbelt 
Thank you.  That is all.

Wednesday, April 17, 2013

You Don't Have That Right

When you come to the ER, you have a right to be seen.  For better or worse, it's the law.

That doesn't mean that the ER is free health care.  It isn't Burger King.  It's not your way, right away.

Also, coming to the ER does not give you the right to be an asshole.

I know you don't feel good and that you aren't exactly in the best mood.  But, please, don't start bitching at me every time I come into the room to do something.  Don't tell me how unhappy you are or how this is bullshit or how you haven't eaten in 10 hours (you've only been here 3 hours, so what were you doing the rest of the day?) or how the ER stretchers are uncomfortable or how much you hate the doctors, nurses, techs, etc.  If you do want to vent, that's fine.  Get it out of your system once, then let's move on with our time together. But, if you are going to bitch and moan every time I come into the room, I am not going to want to come into the room anymore.  I am going to avoid you like the plague.  I will delay coming to see you for as looooong as I possibly can.

So, if you think being a dickhead will make us really step up our game and provide you that exceptional care you're craving, then you're wrong. . . It makes us hate you.  It makes our sympathy level plummet.

It makes me want to punch you in your throat.  That was specifically covered in nursing school under the "what not to do" column, but keep it up douche-nozzle. . .  Just keep it up. . .

I Should Stop Answering The Phone

*Call from a 30 year old woman. . . yes, an adult*
NurseHubba: Emergency room, this is NurseHubba.
Mothra (high-pitched wail): Aaaaaaaaaah, it went in!  It went in!
NurseHubba: Ma'am, what is going on?  What's wrong?
Mothra: It went in my ear!  It's gonna eat my braaaaaaaain!
NurseHubba (sighing): What did, ma'am?
Mothra: The buuuuuuuuuuuuuuuug!
NurseHubba: . . . .
Mothra: Wait.  I think it flew out. . . . Yeah, it's gone.
NurseHubba: Good.  So, you're all set, then?  
Mothra: Do I need to come to the ER?
*I gave the whole speech about medical advice over the phone, etc while trying to dissuade her from coming.

Fifteen minutes later, I see on the tracker that, in the waiting room, there is a 30 year old female who might have a bug in her ear. . .


Friday, April 12, 2013

Another WHY Moment. . .

*Triaging a patient who was brought in by EMS, who gave me a good report.  But, I like to hear things from the patient's perspective*
NurseHubba: So, what brought you in today?
Not Humpty Dumpty: I fell.
NurseHubba: Ok.  What kind of surface did you fall on?  From ground level? What part of your body did you land on? (All these asked as separate questions, of course)
Not Humpty Dumpty: Carpet. Ground Level.  I landed on my butt.
NurseHubba: Any pain?
Not Humpty Dumpty: No
NurseHubba: Weakness or dizziness before you fell? 
Not Humpty Dumpty: No.  I'm just old.  My legs went out from me.  I'm supposed to use my walker, but I wasn't
NurseHubba: Ok, so what made you call EMS?
Not Humpty Dumpty: I fell
NurseHubba: But you're not hurt, right?
Not Humpty Dumpty: No, it happens sometimes.
NurseHubba: Do you usually call EMS?
Not Humpty Dumpty: No
NurseHubba: So, Why'd you call EMS?
Not Humpty Dumpty: I fell
NurseHubba: But you're not having any problems at all
Not Humpty Dumpty: Nope
NurseHubba: So, if you're not having any problems, why'd you call EMS?
Not Humpty Dumpty: I fell

*Neither the doctor or I ever found out just exactly why he called EMS and came in.  The guy got up and walked around, then got released.*

Thursday, April 11, 2013

And Theeeeeeeennnnn?

*Walks in to patient room who came in EMS after hearing ludicrous tale from triage nurse about patient's chief complaint*
NurseHubba: So, what brings you in today?
Energizer Rabbit Of Complaints: My blood sugar's really high.
NurseHubba: Okay, what was your blo --
Energizer Rabbit: And my stomach hurts
   . . . And I'm nauseous
   . . . And I have a headache
   . . . And I'm having chest pain
   . . . And I'm short of breath
   . . . And my shoulder hurts
   . . . And I'm experiencing symptoms of appendicitis
   . . . And I think I have a kidney stone
   . . . And I think I have a urinary tract infection
   . . . And a yeast infection
   . . . And I'm having some rectal bleeding
   . . . And my back hurts
   . . . And I'm pretty sure I'm dehydrated 
So, I guess the better question to ask her is, "what doesn't bring you in?"

Tuesday, April 9, 2013

Am I Really?

Sorry you and your child had to wait three hours to be seen

Sorry your child vomited once at 8am this morning and was sent home from school (It's now 11pm)

Sorry your child had a 99.2 "fever"

Sorry there were people lined up in the hallway and stacked in the waiting room with silly little things like chest pain, GI bleeds, respiratory failure, and appendicitis

Sorry the docs and nurses had to make sure those people were going to live

Sorry your child was placed behind them in the priority list

Sorry we needed to stop people from bleeding out

Sorry we couldn't place you on top of the "to be seen" pile

Wait. . . No. . . I'm not sorry about any of those things

Wait. . . So, WHY Are You Here?

From my co-worker, Nurse FunnyBone (this is around 11pm):

*Chief Complaint: Left Shoulder Injury*

*Oh, and New Doc ordered a complete cardiac workup on this one*
Nurse FunnyBone: Ok, ma'am.  I have some Toradol for your pain.
Evolving Complaint Lady (without looking away from television, and with perfectly flat affect):  Toradol?  *Grrrooooooaaaaaaan*. . . . Oh, my mouth hurts sooooooo baaaaaad.  It's unbearable.
Nurse FunnyBone: Mouth pain?  What kind of pain?  Teeth?  Gums?  
Evolving Complaint Lady (still staring at TV): I don't know, but it's easily 10+ out of 10 pain.
Nurse FunnyBone: Ok. . . Well, I'll let the doc know. . .
*New Doc finds nothing wrong with her mouth, but FunnyBone and I were both surprised she didn't order a CTA and maybe even a central line.
Nurse FunnyBone: Ma'am, I have some Tylenol for your mouth pain.
No sandwich!  You STOP that!
Evolving Complaint Lady (again, without looking away from TV): Tylenol?  Well, can I at least have a sandwich?  I haven't eaten since noon.
Nurse FunnyBone: No, ma'am.  We don't have food down here.  Besides, wouldn't chewing aggravate your mouth pain?
Evolving Complaint Lady: Meh.
*To her credit, New Doc didn't cave and give any narcotic prescriptions either.  She's really good about that.  Lady was definitely not happy about that, though!

Sunday, April 7, 2013

Every Day With This Crap

*Phone rings during a stupid crazy day*
NurseHubba: ER, this is NurseHubba.
Not The Sharpest Knife In The Drawer Dude:  Ummm. . . hi.
NurseHubba: How can I help you, sir?
Not The Sharpest: Yeah, my friend is sick.
NurseHubba: Okaaaay. . .
Not The Sharpest: Well, I don't know what to do.
NurseHubba: Okay, what's going on?
Not The Sharpest: He's sick.  I don't know what to do.
NurseHubba: Okay, sir.  I don't know what you mean by that.  How is he sick, exactly?
Not The Sharpest: He's, ummm, like,  throwing up and stuff. . .
NurseHubba: And stuff?
Not The Sharpest: Yeah. . . like, ummm. . . you know. . . like, diarrhea. . .
NurseHubba: Ok, look. . . I can't give medical advice over the phone, but if he feels like he needs to come to the EMERGENCY room, then he's welcome to come on by. 
Not The Sharpest: Oh, ok.  Cool.  It's free, right?
NurseHubba: Wait. . . what?!?! 
Not The Sharpest: It's free, right?  We don't have to pay for the ER.
NurseHubba (ugh): No, sir.  It's not free.
Not The Sharpest: Oh. . . Well, is it expensive?

Why Bother?

Why do people bother to go to see the doctor?

It's not like most of them actually listen to what the docs and nurses tell them.  Some do.  That's great.  But this post isn't about them.

So many people come in to the ER or to their primary care provider (PCP) for problems, but don't seem to give a crap enough to do what we tell them to.

Case in point:
18 year old female with abdominal pain, nausea, vomiting in the ER.  Turns out the girl has a UTI.  We give her discharge instructions, along with a prescription for some antibiotics and set her up with our low cost clinic for follow up care by the PCP.

One month later, same girl shows back up with the exact same symptoms.  I happen to be her nurse again.
NurseHubba: Oh, no!  Sorry to see you back again (sympathetic tone, not irritated).  
Repeat Offender: Yeah, I didn't get better after last time you people (you people was said in a derogatory tone) saw me.
NurseHubba: The antibiotics didn't help?
Repeat Offender: Nope.
NurseHubba: Well, did you follow up with the clinic to get something else?
Repeat Offender: No.
NurseHubba: Did you take the whole bottle of antibiotics like we talked about?
Repeat Offender: No.  I didn't get them.  I can't afford to buy antibiotics! 
Let me make sure this is clear for everyone.  It was a $4 prescription.  She smokes.  She reeks of it.  She's playing with an iPhone.  Foregoing one pack of cigarettes for her prescription would have been relatively easy.  Hell, she could have panhandled outside the pharmacy to get enough for the script.  She can afford an iPhone and cigarettes, but not her prescription.  Then she bitches at us for not taking care of her properly.

People always want a magic pill for their problems.  In this case, we were able to get her one, but she still didn't take it.


Friday, April 5, 2013

Discharge Instruction Of The Day

Young lady came in today because she had a pretty violent seizure at the local grocery store.  

She has no history of seizures or any other medical problems, but she does like smoking pot.  

She bought some synthetic marijuana from "some guy," smoked it, went to the store, and had a seizure.

She was ok and was discharged with the had-written instructions from Dr. Discharge:
"Stop smoking synthetic marijuana."
That was a fun discharge to do. . .

Can You Please Hurry?

*4:30am:  Thirty minutes after arrival for chest pain.  EKG unremarkable.  Initial Troponin slightly elevated.  Still waiting on other cardiac enzymes and blood tests.*

Impatient Wife: Ummm. . . excuse me?!?! 
Nurse V: Yes, ma'am?  How can I help you? 
Impatient Wife: I'm not impatient, but when are we going to get to go home?
*Nurse V explains [again] what the plan is, including the meaning of additional tests we are waiting for.
NOT Impatient Wife: Oh. . . well, we both have to be at work at 7am.  Do you think you could hurry it up?
Seriously, lady?  You brought your husband, who has multiple risk factors for ACS, in for chest pain and you just can't wait to get him out of there?  You came in screaming about him having a heart attack and crying.

How about if you just leave and let us take care of your husband, since you don't really seem to care now that the dramatic entrance is over?

Thursday, April 4, 2013

Why Can't You Fix Her?

*Family of a 99 year old woman with slightly more altered mental status than usual is bedside*

Dr. Discharge: Well, all her labs look good.  Urine is clean.  She has a history of Alzheimer's that's been getting worse over the years.  I can't find anything acute going on.  We're going to go ahead and send her back to the nursing home now.

*The nursing home, for once, didn't think she needed to come in but the family insisted*

Family: What about her confusion? 
Dr. Discharge: She's been confused for years and, I hate to break it to you, but she's only going to continue to get worse. 
Family: What about her shaky hands? 
Dr. Discharge: She's had Parkinson's for years. . . 
Family: What about her high blood pressure? 
Dr. Discharge: She's had that for years too and is on medication. 
Family: But it's too high!
Dr. Discharge: It's 140/90.  It's a little elevated, but the doc at the home can take care of a med adjustment.
Family: What about --
Dr. Discharge (giving me the look that he's about to lose patience): Look, there isn't anything going on that hasn't been going on for years.  There's no emergency.  There's no acute illness.  This is an EMERGENCY room.  We can't fix or test for every little thing that is going on.  Unfortunately, there's no magic pill or procedure that's going to fix everything she's got going on.  She's ninety-nine.  She's got to see her primary doc at the home.
*Dr. Discharge walks out*
Family (Great, now their attention is on me): Well, where did he go to medical school?!?!  He's the worst doctor I've ever seen!

Some people have no idea. . .

Wednesday, April 3, 2013

Thank You, Dr. WhiteCoat

I read this post on Dr. WhiteCoat's blog.

He links to a couple of videos that he and his colleagues were watching a lot at the time.  Well, one of those videos stood out to me.  The first time I watched it, I thought, "What the hell?"

But, for some reason, I had to watch it again. . . and again. . . and again.

I then shared it with my colleagues.  On slow nights, goofy videos help pass the time.  

WARNING:  Strong and offensive language.  Watch it and suck it up.  Or don't and don't bitch at me.

Soon, I hope, you'll be quoting along as we are.  The lines from the video have become a staple of our night shift conversations.

Whether The Weather Is Nice

It's interesting to me how much the weather impacts people's "emergencies."

You'd think that an emergency is an emergency, and that, no matter what the weather is, it needs to be treated.  I'm not talking about snow storms, tornadoes, or hurricanes here.  I'm talking about temperature.  People will actually stay home if it is "too cold."

I say "too cold" rather than too cold because I live in a part of the country where it doesn't really get that cold.  If it's below fifty or sixty out, people don't want to come.  Well, ok, fine.  I'm not complaining because that usually means we get patients in who actually need emergency services.

But it's funny that the same person who won't come in because it's cold out will come in on a nice day with the sniffles and tell me how they just had to come because it's an emergency to them.

I've got news for those folks.  If the temperature influences whether or not you come in to the emergency room, it isn't an emergency!

Monday, April 1, 2013

Bond. . . James Bond

*With a dude complaining of chest pain (in English accent) who is definitely schizophrenic and possibly manic*

This was not my patient
NurseHubba: Sir, your name is not James Bond.  Please tell me your real name.

Not James Bond: Bond. . . James Bond.

NurseHubba: Sir, stop that.  Remember that conversation with the cops you had just now?  This is real life.  What's your name?

Not James Bond: Eric Jones (pt gave real name, but obviously, this isn't it)

NurseHubba: Thank you.  Mr. Jones, what brings you in today?

Not James Bond: I'm 91 years old and I'm having chest pains.

*Dammit.  I need to get him back on track!*

NurseHubba: Ok, you're having chest pains.  But you are not 91 years old.

Not James Bond: No. . . no, I'm not.

Finally got him triaged, settled in, and evaluated.  Not sure if he ever really was having chest pains, but he was in his 50s. . . not 90s.  Ended up discharged by the awesome Dr. Discharge.  Also, we had to continuously corral him back into his room.  Every time we had to go help another patient and we'd disappear from his view, he'd start yelling, "NurseHubba!  NurseHubba!  I can't see you, NurseHubba!"

It took about a 20 minute stand off with police in the lobby to get this guy calmed down enough to come to the back.  The guy originally came in with an empty bottle of wine and a hand held work light that he was waving at people like a metal detector wand.  Also, he tried to pull the fire alarm and steal an O2 tank and a fire extinguisher.

Did I mention that the only thing he was wearing was a knee length skirt?

I love my job.  Never know what the hell is gonna walk through that door. . .