Another Day, Another Carnie

We've had a string of carnies (you know, as in folks traveling with the carnival) coming into our ER because there's a fair in town.  Wow.

None of them are your average patient.  One was totally wasted with track marks everywhere (ok, that's normal).  But, he was there because his best friend stabbed him in the back.  His plan was to go stab his buddy to get even.  He said it was "carnie code."  

Last night was a dude whose feet were so swollen, dry, and cracked he could barely walk on them.  And, nine days before coming in, he had fallen down some steel stairs and "scraped" his shin.  

Yeah, that was some scrape.  I pulled up his pants leg to find a four inch diameter hole in his shin.  Yep, the bone was just sittin' there.  All out for God and the world to see.  He said it had been like this for nine days!  Didn't want to go to the hospital because he makes commission off of what his carnie booth (known as a "joint" in the carnie world) brings in.

The best part is, I learned a hell of a lot more than I'd ever want to know about the ins and outs of the carnie world.  Interesting stuff!

Never Again. . .

. . . will I take a sore throat for granted.  That's what she came in for today.

Four days ago, this chick in her early 20's comes in for sore throat, worried it's Strep.  We check.  It's not.  But her tonsils are swollen pretty good.  Script for antibiotics with instructions to follow up with primary doc.

Never follows up with primary doc.  Never fills prescription.  Why?  Can't afford it.  It's four dollars!  Yet, she certainly has no problem indulging her pack-a-day smoking habit.

Comes back yesterday because of continuing concern for swelling.  Yep, everything's ok.  Follow up with doc.  Take antibiotics.  Again, never follows up.  Never fills script.  Still smoking.

Comes back last night.  Same thing.  Same thing.  Same thing.

Comes back again later the same night.  Says her throat is really sore.  After a little while, the girl states that she "feels like she's drowning."  Her throat is swelling up.  Can't talk to us.  You can hear the voice changes when she does try to talk.  Everything else is hand written communication.  Sats are 95% on arrival.  Soon, they're 93.  Then 90.  Shit.

Steroids and anti-inflammatories given.  Doc says, "time to intubate and transfer."  Pt says no.  Can't afford transfer.  Husband (who I'm pretty sure is in his fifties) says too bad.  Do it.  Pt says no.  I want to go home now.  I feel better.  Doc says, "Ok.  Go home.  You're going to die.  See ya on the other side."  Pt says, via pen and paper, "ok, let's do it."

Pt intubated.  Husband is drama.  Pt saved.  Pt transferred.  Everything went great.  The doc, who is my favorite doc we have, says it was a pretty difficult intubation, even though he got it fast and on the first try.

Another life saved.  Strong work, team.

Yep, I've Heard That Before. . .

. . . and it drives me crazy.

Check out this post to see what I'm talking about:

My *favorite* thing to hear

Please Just Go Away. . .

. . . other people need this bed.  Sick people.  People who aren't perfectly fine!

I understand you came in because you were scared.  You started taking a new medication and started breaking out in a rash.  I get it.  Then you called your primary doc and he told you to come in.  I get that too.

But the ER doctor has examined you.  I've assessed you.  The triage nurse has assessed you.  You have a few red spots on your belly.  Yes, they are really itchy. . . but they aren't life threatening.  No swelling of tongue, lips, or throat.  You, yourself, are telling me that you feel fine. . . just itchy.  And you're already on hydroxizine because your doc thought you might get a rash.

So, when I discharge you with instructions from the doc to stop taking your new medication and to continue the hydroxizine, please don't argue with me.  Have peace of mind that you have been looked at by three trained professionals and nobody thinks you are in any danger.

Please don't go out to the lobby, call your primary doc, and have him call to interrogate us for sending you home. . . especially when he hasn't even seen what you look like to assess you!

Does Day Shift Have Any Idea?

I often wonder if the day shift folks have any idea what goes on at night.  Personally, I believe that they think it's slow.  That nobody comes in at night.  That we all just sit around catching up on our continuing education, shooting the shit, and messing around.

Nothing could be further from the truth.  I feel like, more often than not, we clear everything out by discharging patients and transferring people upstairs about fifteen to thirty minutes before they get here.

Then, they show up and see four people on the board.  I'm pretty sure they have no idea and wouldn't believe me if I explained it to them. . .

I Don't Know What It Was

I don't know what it was about last night, but it sucked the soul out of every nurse, doctor, tech, and clerk who worked last night.

To be honest, it wasn't even that busy.  We didn't have anybody that was super sick.  We didn't have drug seekers or drama queens.  No ETOHers.  No psych patients.  It was a fairly reasonable night.  For some reason, it sapped everything out of me and all the other staff tonight.

I actually feel kinda bad.  I usually try to leave the day shift folks with the best situation possible.  I will even stay to make sure stuff is done that they don't have to do.  But, this was not the day for that.  I left my relief in sort of a mess.  I felt bad, but obviously not bad enough to stay any later. . .

Tonight's Winner

Chief complaint of the night.  17 year old male.

"Possible rock in nose"

Man, I love my job.