Triage

Take a Tour of My House.....

2009-12-31T20:44:00.000-08:00

Every year, nurses working in emergency departments around the universe morph into an attitude of mixed emotions. Some are happy, some are sad, some are hilarious, but most are just plain tired, crabby and burned out. Don't believe me? Walk around with me for just a few minutes, and you will have your eyes wide shut!

Back in the corner, or the "psych ward" as we like to call it, is a small hallway with six rooms. These rooms are the farthest away from any exit door, and the farthest bunch away from the triage desk. (You have no idea how important that part is!)The lighting is the same as the rest of the department, but somehow it seems darker back there. This is where the drug overdoses, alcohol intoxications, suicides and the majority of the medically stable mental patients are assigned - and that's just the nurses. (Ok, that part may be a stretch.) The nurses who work in the ward are ones who are always there. They like it. I think they thrive on other peoples demise to make their own life seem less dramatic. Regardless, the patients and the nurses both consider themselves regulars. The holidays prove to be the busiest time for the ward. People trying to off themselves every hour of every day, caught just in time to be drug kicking and screaming into our house - who do they think they are? Nurses are inclined to take active control of the situation with efficient ease and absolutely no conscience whatsoever. Everything can be controlled with a little duck tape and a few chemicals.

Moving to the north of the department, we have the "ICU". This is the part of the department nurses loathe. When we come into the beginning of the shift, we cringe while reading the assignment for these three rooms. They are located near the ambulance bay, and typically receive the most critical patients. Unfortunately, non-critical patients that get triaged to an ICU room, typically become critical for no reason at all. It's probably the ignorance of the healthcare worker. It's typical that the stupidest and least experienced nurses get assigned to the most critical rooms. Yeah, they taught that in charge nurse school.

Moving on around the corner, we have the orthopedic rooms. Anyone who wasn't paying attention while playing a contact sport ends up here. So obviously, lack of intelligence has become a theme for patients and staff! You will see there are broken bones, a little blood and lots of pain medication. That's the cool part. If you have ever seen anyone on narcotics for the first time you would understand. It's hilaroius.

Most of the time, at any given time of the day, there will always be a nurse or three and a few techs hovering around the "trough". This is a tiny, tiny room where all of the food is kept. There is a small table and two plastic lawn chairs, a small college sized refrigerator with an equally small microwave on top, and a set of cupboards. Just enough room to fit one whole body of proportioned size. (Which typically menas one half of a whole nurse over forty. They are big.) Hanging on the walls are three large poster boards filled with miscellaneous papers; managements attempts to educate the staff.

Down the hall and the the left you will see the chest pain/stroke rooms. If you are slobbering out of one side of your mouth and have a glazed look in your eye, this is the place to be. Have you ever seen a santa with chest pain? It will crack you up every time. Nurses sittin gon the side of the bed with their Christmas lists. Yeah, we get busy.

And finally, the last four rooms are hte worst. These rooms are equipped with all of the gyecological equipment known to man. You will find the wierdest looking cold metal objects in these rooms, and probably a male doctor or two happily holding their toys, waiting for the next victim. However, if you can imagine diving through a five hundred pound woman who hasn't taken a shower in a few weeks, complaining of a maloderous discharge and abdominal pain, the doctors may not be so happy. That's what nurses are for. We get all of the equipment ready and leave. After all, the doc is the one who is paid the big bucks, right? If they get to play with the pretty ones, they have to play with not so pretty ones as well.

So there you have it! A tour of my house. Come in a play some time. Just make sure you have a true emergency. Something like a limb torn off or an artery cut. Otherwise we are likely to kick you right back out.

Happy New Year!

Resource...Resource...Resource

2009-12-26T00:02:00.000-08:00

It never ceases to amaze me that some of the stupidest people on earth are some of the most resourceful. A drug addict may be so high that he can't speak, but he can sniff a cop a mile away and figure out how to get away from him. A thirteen year old pregnant girl can't spell her address, but she can forge her mom's signature perfectly to have that baby without getting caught.

This particular night was...amusing.

It was Christmas, and the wind howled through the ER doors every time they opened. Those of us who were approaching middle age and having hot flashes were thankful for the gust of wind and tiny snowflakes bursting through the door with EMS and a stretcher.  Hell, we'd flip a coin to get patients on slow snowy nights like this just to stand by the door and cool off!

The squak box hurled a 30 something male with multiple generalized complaints and more stable vital signs than most of us working that night into room 3. The primary complaint was his tongue. As he so eloquently stated, "My tongue hurts when I smoke."

Ok. Most people would say, "Don't smoke."  But nope. Not Dr. J. he was the most unconcsiously thorough doctor I'd ever had the displeasure of working with. Not only did everyone who was blessed with his presence get a Cat Scan, but a full work up was in order, just in case there was drama to be found. On this night, there was drama.

The man with a sore tongue had three daughters at home, all under the age of seven. Baby mama was somewhere in the house, and according to EMS, she was a little "anxious" when they took her husband to the emergency room. Yet she had no information about his complaint except that it had been going on for three days now and she was sick of listening to him bitch. What a concept.

Now, understand that most patients under the age of forty and in absence of a car accident or unfortunate injury, just need a therapist. So they come looking to our department to find one at two o'clock in the morning. This guy not only needed a therapist, but I would assume some heavy duty brainwashing medication as well.  However, he did have a goal.

While he was waiting the typical five hours to get tested for anything and everything Dr. J could possibly find wrong with him, the patient decided to rifle through the drawers in his room. It was interesting that each time the nurse checked on him he had his hands full of stuff. Most nurses don't care enough to look and see what's in a patients hand. As long as it isn't sharp or bloody it's really of no huge interest.

But this guy was good. Upon discharge, he requested a cab pass to catch a ride home. Yeah, some emergency departments actually pay to get their fellow patients back home when there's no true emergency. It's part of our guilt for saving their life. As he was walking out, something fell out of his pocket. A trail of little packets of KY jelly followed him from the front door to the cab.

When the nurses returned to clean the room, and check the drawers, and all of the things they are supposed to do (although that rarely happens until the next shift), they realized that all the drawers were empty - free of all KY, tongue blades, oversized Q-tips, and oxygen tubing.

Ok, so he went shopping right? Come to find out, that was absolutely the truth.

Baby mama came in (via ambulance, of course) three hours later with oxygen tubing tied around her wrists, oversized Q-tips stuck (and I mean STUCK) up her hoo-ha, and one lonely tongue blade carved to a point and stuck through the lips of her ying-yang. Apparently there wasn't enough KY to finish whatever they had started.

So the story was that they didn't have enough money left over (from buying the kids presents) to get each other anything. They decided to have an "adult" night, and found that the excitement just wasn't there.  Baby mama stated, "My boyfriend said he knew of a place he could get some sex toys..."

Who can make this shit up?!?!?

A Little Salt and Peppa

2009-12-19T08:46:00.000-08:00

One thing about emergency room nursing is the ungodly timing of patients and their problems. At the end of an unruly, incredibly busy day however, there seems to consistently be that one patient that makes all the hassle worth it. This is the story of Sam, the queen of spice:

It's barely seven p.m. and the new shift is sauntering through the department, in no great hurry to be awarded their room assignments for the night. Tara glances up at the clock over the top of her new glasses, crinkles her nose, and swears the second hand has been holding out on her, refusing to tick past the number seven. She scrambles to get the piles of paperwork together for the night shift when the charges nurse comes screeching around the corner, red faced and a crooked smile. "Tara, I really need you to see this guy in room 17. He is doubled over and in so much pain!" That's one thing about charge nurses. They must have taken a class in charge nurse school that disallowed them from recognizing "shift change".

Tara looked at her peer with fired up darts and stated very matter of factly, "Fine." What harm could there possibly be? It's not like she was going to have to do anything to the guy anyway. Her day was almost over, and frankly she couldn't have cared less if the guy was having a baby, she wanted to get out of that forsaken dungeon of an emergency department. However, room 17 was the cursed room of the day. If the patient only knew what he was getting himself into! Three people tried to die there today, none successful. Regardless, she took the triage papers from the charge nurse, and decided to at least do an assessment.

Peering around the corner to the cursed room, Tara almost felt compassion. An old man, in tattered clothes and scruffy hair was sitting on the edge of the bed, hunched over, with tears in his eyes. He looked up at the worn out nurse and the words started pouring like an unattended faucet. He raged on and on about how he was drugged four days ago...and he didn't have a place to sleep that night...and it was cold outside...and something was planted in his belly that was killing him.

"Great" Tara pondered, "another homeless guy that's cold and wants to snuggle."

Sometimes - no, most of the time - ER nursing uses the sixth sense. That's why we're great to have around in arguments. We have been trained to weed through all the crap to get to the ten-words-or-less-complaint. Sometimes the actual complaint is not stated with absolute clarity. Sometimes we have to pick up on phrases like "somethings been planted in my belly and it hurts" to start the decoding process of the actual problem. This is one of those times.

A typical assessment starts with just looking at the person in question. As Tara was flinging the hospital gown at the man who was demanding her full attention, and explaining how he needed to give up all of his clothes to wear only this one flimsy little garment, she noticed that every time he moved, a small wimper escaped his throat, followed by a deep breath. "What exactly hurts, sir?"

"My belly. It hurts all around here." He was holding each butt cheek with a hand and bending over the bed.

"That isn't your belly, Sam. It's your butt."

" I know, I know. But it hurts way up in my belly. I'm telling you somehting was planted in my belly! This is the only way I can move, if I'm holding my cheeks."

Now this is a point where the nurse who is soon hoping to go home makes the decision whether or not it's worth it to stay and enjoy the show. That night Tara decided to stay. What's wrong with getting paid overtime for a little action?

The xray of two christmas shaped salt and pepper shakers strategically placed in Sam's rectum told a much different story than said "abduction". Sam went to surgery and who knows where he landed after that.

Tara drug her tired body home, three hours later, and chuckled as she fell into a deep, tired sleep.

Has it Really Been Four Years??

2009-12-06T01:06:00.000-08:00

I just found this blog that was created so very long ago. I didn't know it still existed - AND I didn't know the other blogs I created still existed. Incredible. So much has happened in four years. I believe at that time I was traveling a bit much for my family life, and working in the ER in my spare time. The result was a nasty, nasty divorce and a brand new wonderful life - although the cynisim remains the same.

I have returned to clinical practice full time for the past two years, so I have many, many stories to tell. Insomnia will be my guide and my assistant through this process, since I write much better when I'm sleep deprived and using memory recall at 3 am.

I could tell you about the dude who swore his dick was going to fall off from an ingrown hair, or the other dude who rolled in face down strapped to a backboard, declaring his innocence and convincing even me he was Jesus. But...for now I think I will wait. Are you even interested?

Now that I have found the flame to my once uninhibited passion of writing, I ask you, do you want to read?

DEATH BY STETSON; ATTEMPTED

2005-11-26T05:09:00.000-08:00

Ok. Read the title, scratch your head, and let your imagination take you where I am certainly going.

A few weeks ago I was working overnight, again on a weekend. This particular Saturday night seemed a bit slow; however content made up for lack of bodies walking through those automatic doors. As a triage nurse, you are the first person to see the patient, determine the 'emergence' of the emergency and place the patient into the appropriate room. For example, a twenty-five year old rosy cheeked frat boy saunters in with alcohol on his breath and glazed over eyes, complaining of severe abdominal pain while making jokes about how nurses used to be in tight little short dress uniforms and rolled up stockings is not something one would consider emergent. Well, not unless he was doubled over and the tears were streaming mid joke. That versus a thirty year old woman accidentally hit by her husband backing out of the driveway (he was talking on the cell phone while backing the car, obviously a very important boy, errr, man) and rolling through the doors with a visible bone or two. Bones are not supposed to be visible, thus creating an 'emergent' emergency. Frat boy will just have to wait 'til the alcohol wears off.

This particular night was relatively interesting. After years of seeing just about everything, this was a first. A man in his mid forties or so was brought in by the police; always a joy. He was hyper, no, more than hyper...my initial guess was methamphetamine. Low and behold I was correct about that part, go figure. The triage process when people are brought in by ambulance or cop is different than the primary tell-me-your-problem triage process. It entails the patient being brought directly back into a room, in this case in handcuffs. From there we go to work trying to find out what happened so we can determine how to treat. Unfortunately there are some docs and nurses that use this time to determine what type of treatment would best fit the type of patient. Yes, even we objective medical professionals are subject to a bit of prejudicial thinking. It comes from day after day of watching perfectly healthy people destroy a body that was perfect upon birth, just for fun.

Methamphetamines usually make people undesirably strong. A small and frail looking 120 pound woman could fight off eight huge security guards with her pinky finger if the situation arose. So then, with the meth guy we were cautious...He didn't look to be in the best of moods anyway. He was having delusions and talking to a lady that none of us could see. It doesn't mean she wasn't there sitting next to him, it means we couldn't see her. He thought we were all out to get him, a normal paranoia with meth. But then something crazy happened. The cuffs came off and he fell silent. We all just stood there, on guard and waiting for him to start bending the side rails of the bed or threatening to snap our little legs in two. He look up at me and with tears in his eyes he said, "It was Stetson."

At first I thought, a delusion, I look like a bottle of Stetson. My thoughts vaguely wandered back to high school, I think that is what my old boyfriend used to wear a ton of. I snapped back to his mumblings and the "not right" feeling came over me. This is when things look ok, and they sound ok, but there is just that little something sitting on your shoulder that forces your senses to understand that something is not right. At this point I start digging, crossing my fingers that he would at least be able to tell me the truth about exactly what happened. Remember, my foremost fear is that someone will keel over and stop breathing, forcing us to intubate and keep them alive. The paperwork is a mess. My primary goal was to figure this out and get him up to psych, after all my 2 a.m. episode of Cops was about to come on.

The blurry eyed man just kept staring at me with his mouth cracked open. Then he slurred, "I wanted to die, then I changed my mind but I had already taken the Stetson..." And the mumbles continued without any sense to them. By this time the necessary steps had been taken to look at a urine drug screen and a blood alcohol level, both not looking very pretty. We will call him "D". "D" looked at me again and decided it was time to leave, grabbed the side rail and started proving his strength by bending it to try and get out. I suppose the thought of just jumping over the rail didn't occur to him. We medicated and in fifteen minutes he was snoring with a pile of blankets and the lights dimmed. Reminded me of a trip to the Marriott with my husband one year.

Come to find out, when all were sober this is what actually happened. "D"s girlfriend broke up with him and he decided he couldn't live without her. They had been doing meth all night and he was cranked. He drove to a part of town where there were train tracks. He had no idea that those tracks had not been used for over fifteen years. After lying on the tracks for hours waiting to die, he got impatient. He was diabetic, and went to the trunk to get his diabetes syringes and medication, with the intention of injecting all of the insulin and ending it that way. Looking through his supplies he realized he had forgotten the insulin, but still had the syringes. Go figure. Frantically searching his car for something lethal to inject, he found a bottle of Stetson in the glove compartment and took it out. (You know where this is going) At this point "D" was frantic. He quickly drew up one syringe full of Stetson and found a large vein in the anticubital space, inserted the needle and shot the cologne into his arm. Once the stinging subsided in his vein the meth took over and he got scared, decided she wasn't worth dying for and called the police threatening suicide and spouting the events of his last few hours.

This is the point when medical personnel make choices. Do we make him comfy or do we allow him to feel like he is truly dying, just for the effect. This is certainly better than my episode of Cops. Hell, it is the episode! As I was leaving to go home that morning I thought about how I would "go out" if I were in his situation and had limited resources. I think I would have not used Stetson. If I'm going I would like to go out in style; who wants to be remembered as the Stetson man? The least he could have done was steal some Armani or Dolce and Cabana and go out in style. But now as I think about it I would have had to change the title of this story and it wouldn't sound as interesting. Thanks "D", for making my a.m. ramblings something of a pleasantry.

"D" lived and vowed never to do Stetson again. The frat boy sobered up and his buddies took him home. The lady with visible bones was transferred to a "more suitable" hospital; we don't do that here.

Blonde Vs. Um...

2005-10-18T18:34:00.000-07:00

In response to Teh Blogfather wanting a picture of a more appropriate nurse (as opposed to a blonde, which there seems to be way too many of - what should that tell you about walking into the ER, Hmmm? Don't Go.)

BRUNETTE, I PROMISE...

There are no clean Brunette nurse pictures because we all are out having too much fun.

The Star Strangled Banner

2005-10-16T09:52:00.000-07:00

The small sip of soda a few hours ago certainly wasn’t enough to sustain Tara’s craving for sustenance. As her stomach gurgled and howled, the inebriated fifty-three year old man chuckled and started singing the Star Spangled Banner. All she could do was cringe and hope that his family would come get him and soon. It was 2 a.m. early Saturday morning and she just didn’t have the compassion that most nurses would normally have for wounded patients. Of course, that would be determined by how one would define the terms “wounded” and “compassion”, but in any case she was ready to kick him in the shins just too really give him something to howl about.

And the rocket’s red glare…the bomb’s bursting in air…

That was it. Tara tightened the strap of the wrist restraint just enough to get an “Ouch lady!” She looked at Mr. Truman and said with an annoyed tone, “I’ll be back in a bit.” As she turned to walk off and ignore the verbal knives thrown at her from behind, she winked at the guard and demanded in a whispered voice, “Just keep him on the gurney for ten minutes!” A bee-line was made first for the little girls room, then the kitchen, or as she liked to call it, the Petri-dish. Her pet name for the break room referred to the never ending amount of bacteria and fungus one had to pilfer through jus to get a “clean” fork, thanks to the day shift of course for never cleaning up their crap. Emergency room employee kitchens were exceptions to the rule of standard good hygiene, a true test of human immune response. As Tara kicked her feet up and turned her focus to a silent television screen, her mind wandered to the social activities of what few friends she had on the outside.

The searing pain felt from a bump in her knee alerted Tara that she had fallen asleep and one of the passive aggressive interns needed her to diagnose and propose treatment for yet another one of his patients. It was old hat for the fresh interns to look to the nurses for help before they attempted to kill someone, hoping they would find a nurse competent and not as equally passive aggressive. “At least they try to save’em before they try to kill’em”, Tara thought sarcastically. But in her mind she knew that she was one of “the chosen”, and as much as she sometimes hated it, it made her feel good to know there was a little faith in her medical capabilities. However, she couldn’t decide if that request,coming from a new intern, was faith or fear of the inability to fluff their chest after choosing act on her treatment plan.

Gave truth to the light…that our flag was still there…

“Oh good God in Heaven” she thought as she ditched the intern to get to her minimally restrained patient. The security guard shot her a glaring look as Tara’s eyes followed the slurred singing. When she pulled back the curtain to the see the singing “banner man”, her first inclination was to puke and just go home. As she stood in horror trying to process the view, the singing stopped and a very foul smelling laughter filled the room while banner man rolled around as much as he could, his hands turning purple from the wrist restraints. There was a woman, equally as drunk and half naked (not the better half, if there would have been one) sitting right on top of him, bobbing up and down like one of those little red fishing bobbers during a nibble.

She decided not to puke, and instead shot a help-me and a how-could-you-let-this-happen glance at the six foot two guard. Together, Tara and the guard named Chuck strategically removed the woman from the room and covered her obese, slithering body, somehow disallowing the public from seeing what should never again be seen by the human race. “Well,” she thought, “at least the singing has stopped.” She turned back to Mr. Truman and covered his ‘working parts’ with a sheet, deciding he needed a brief cooling off period before getting the one inch laceration to the back of his head stitched. “After all,” she justified to herself, “I believe the book says that we have around eight hours from the time of injury to get that thing sown up.” With that she returned to the nurse’s station and grabbed the top record of the stack of twenty, and trudged to the waiting room to call her next victim...

What's your sign?

2005-10-11T18:09:00.000-07:00

It seems that when people start talking "Zodiac" all reasonable thought flies right out the window - especially for men. Yes, we've all heard the old 70's line of "What's your sign, baby?" and a ghastly picture of a toupe`, mustache and a baby blue polyester suit comes to mind. Ick.

What I'm talking about are the lawyers, doctors, nurses - the professionals that actually lose it when reading the back of Cosmo during their birthday month. You know one of those people don't you? Of course! Next time you are shopping for groceries, strategically place your cart behind a 40-something rather unkept mother with her three screaming children (all under the age of five). You will notice a wishful look on her face (probably wishing she would have had her tubes tied after kid #1) and I promise you she will be flipping to the back of a magazine looking for her "most compatible" mystery man. It obviously was not the father of her children or she would be at the salon and he would be shopping with the kids. The woman will be eagerly searching for her birth sign and trying to find something in the words to giver her some hope for the future. Good grief. This woman (or man, with obviously a bit of a feminish side) is a real life professional. The one that figures out how to keep you breathing in the emergency room, or handle your traffic tickets. You don't recognize her because on the weekends she just doesn't care...And make-up does wonders on a weekday!

Aries, Libra, Taurus, Pisces. I could go on but I fear I would start a chant that would never get resolved and I will have it singing in my head depriving me of sleep I need to put you back together after your car accident this evening while you were driving just barely over the legal alcohol limit yet not slurring bad enough to scream in agony. Believe it or not I actually talk in long exaggerated sentences like that. Regardless of your injury I really do not like people and frankly am so caught up in the fact that my horoscope said I was going to be recognized as a successful writer that I'm buzzed and unless you are turning blue I'm going to continue reading the back of my Cosmo magazine.

Hello. My name is Katie and I'm a registered nurse. An emergency room nurse. An Aries/Pisces depending on where the moon is and whether I am on my period or not or whatever that crap is supposed to say. The sign of a Boar according to people in other countries that do not eat them.

This blog is to tell crazy stories of life in my emergency department. Things that will make you throw up, laugh, gasp, chuckle and all with the point of steering you away from my path when you wake up at 3 am and decide you have a toothache (that has been acting up for a few months now) and you're bored, so you get dressed and come visit me in the ER hoping I will give you some sort of relief...or company. Nope. Two aspirin and a coke will do ya' just fine.

Stay tuned to some of my gruesome yet somehow funny adventures. It's never boring.