Thursday, November 26, 2009

I Think I Know This Patient

but then again, I think we all know this patient.

Definitely worth three minutes of your lives.

Unless you happen to be an all-too-typical ER patient.  Then you will find this offensive.

Monday, November 23, 2009

The One That Got Away

This one was from several years ago, and I may have mentioned it already in a post, but it invaded my dreams last night, so what better dream therapy than to bore you all with it.

I was an ER tech at the time, so I don't know all of the details, (as an aside, it is interesting to see life from both sides of the ER bubble.  I thought that I was so involved in patient care as a tech, and now that I am an RN, I realize that I really didn't know anything about what truly goes on in the ER.  I'm sure it would be a similar jump to go from nurse to doctor.) but I remember this guy was a really nice guy.  He was probably about 50 years old with a great sense of humor and he and his brother were joking back and forth every time I went in the room to do anything.  He had come in for sudden onset of debilitating leg pain.

A few hours later, I was working in another area of the ER, so a different tech was to take him down to radiology for an imaging study.  Somehow along the way, he coded and was rushed back to the ER.  One code was already in progress (I was tied up in that one - another devastating and unexpected code), but whoever was free went to help save this guy.  In all, they tried for an hour and a half but had to call the code.

As I think back on it, I have to think that the most logical explanation for this guy's code was a PE, but that seems too simple and I had the impression that the nurses and docs were confused and had no explanation.  And the poor brother was devastated.  One minute he goes in to the ER with his brother to get some pain pills for a leg injury, and the next minute, he is signing the mortician's paperwork.  And as if he needed the case compounded, nobody on staff was assigned to be with him and explain what was happening, so he stood outside the door to the room watching CPR go on and on and on, not knowing what to expect or how to take what he saw.

As you will hear from anybody who has been involved in codes, they are very stressful for the team working to save someone's life, and often, in some kind of attempt to maintain sanity, and cope with the situation, a few jokes will get cracked.  Such was the case here, and because nobody ws with the brother and he couldn't hear what was happening, he just assumed that nobody cared about his brother and perhaps even that they were making fun of him.

All in all, it was a very sad night and a hard one for the entire staff.  By the time all was said and done, three codes had been run simultaneously, with the only survivor being the 88 year old with dementia and a laundry list of health problems, while the two younger, generally healthy patients both getting the wrong kind of discharge.  What I will always take away from that night, however, was the vision of the brother of the patient I described and the 16 year old daughter of the other patient, both of whom were standing outside the door in shock, trying to find a way to cope with what they were seeing.  I did what I could to try to comfort the daughter and explain what was happening, but I was young and new at this and didn't know what to do.

When they teach you the ABCDEFGHI mnemonic in your TNCC and ENPC classes, please don't gloss over the F is for Family part.

Friday, November 20, 2009

Today's "Reason For Your Visit"

When a patient checks in at our ER, they are asked to fill out a half-sheet of paper with name, phone, SSN, birth date, and "reason for your visit".

Whenever I work triage, I write down the interesting ones and have been building up a list.  Some are funny, some embarrassing, and some just tickle my warped sense of humor.  I try to give the benefit of the doubt.  I know that these people are hurting and just want to be seen, but it still makes me shake my head to see some of the things that patients can come up with.

Thus, my regular (as in whenever I feel like it) series, "Reason For Your Visit."  Please keep in mind that spelling, punctuation, and capitalization are copied directly from the original paper.

So let's get to today's Reason For Your Visit:

hurt ankle rolled ankle

Unfortunately, I got the triage done before the whole poem could be written.  I later found it laying on the floor, scribbled on the back of a tongue depressor:

Inside, outside, upside down
I walk a lot to get around.
Oh, no! twisted, bent, and pulled
My foot moved how it never should!
hurt ankle rolled ankle, ouchie ow!
Let's get to the ER now!
Nurse, oh nurse, you little elf,
Dilaudid won't inject itself!
Get me back or I'mma holla,
Fix me now on your tax dolla!
Thank you, thank you. Happy clam
I really like green percs and ham!

How to Get Seen Faster

ERP has a post up about how not to get seen faster over on his blog.  Read that (hint: how it should be done), then consider this:

A month ago, I was told to leave my four other patients to triage a boisterous lobby patient.  "Just check her out and see how she is doing," the manager told me, as she escorted her into an empty room in the ER.  I dutifully triaged her and went through the litany of ridiculous questions forced upon us by Jay, Co.(TM), and at the end of that marathon of pointless questions, I pulled out the thermometer to get her temp.  As I was so doing, the doc walked in, asked her why she thought she would get seen any sooner by making a fuss in the lobby and told her that she was going to wait her turn, then walked out.  As soon as she found out that she was to go back to the lobby, she started screaming and kicked over out vital signs stand and broke it.

Her reward: getting chased into the parking lot by the nurse manager as she stormed out, and getting escorted back to an ER room so that the doctor (who she yelled at for being "unfriendly") could see her, because as we all know, we can't have an unsatisfied customer.

And the 5000 dollar paperweight on the floor?  Written up as a loss.  To this day it still hasn't been replaced.

And that, among many similar stories, is why I quit that job and am about to start at a better hospital.

And that, among many other reasons, is why I have been very sparse in my blogging of late.  Thanks for sticking with me.  I haven't given up the ghost yet.