They're not ALWAYS crazy.

Skinny little 72-year-old man, sent in by his nursing home for "aggressive behavior/altered mental status." Apparently he had been throwing food and dishes at breakfast and was cursing at the other residents and staff. He cursed at and didn't recognize his daughter when she came to visit, either.

It took two of us to get him into bed, and three of us to get vital signs--he was fighting and kicking and biting and cursing. The daughter was very distraught--"He's never been like this! He's a sweet guy!" No history of Alzheimer's, no psych history, just some cardiac issues and arthritis.

I immediately thought he was hypoxic, but his color was good, and his oxygen saturation (when we could get it!) was 96% on room air. That was good, because there was no way he would keep a mask on. I was finishing up my triage when I realized in all the hubub, I hadn't gotten a blood glucose level. The patient wasn't diabetic, but we get a glucose level on all patients who are altered.

It was 26 mg/dL. Normal is 70-120 or so. (I was shocked that he was even AWAKE, let alone fighting and kicking!) So five of us held him down, started a line, and gave him 2 amps of 50% dextrose solution. After the first one, he calmed down. After the second, he sat up in bed and said, "Hello ladies! What's all the fuss?" Completely back to normal. We got him started on a little D5W and gave him something to eat.

What I'm wondering is how his blood sugar got that way. Perhaps he took someone else's oral antidiabetic medication by accident?

In the Park

So, because the weather is lovely, I decided the other day to go for a run in the actual park, instead of in the gym, on the track or on a treadmill.

I'm plodding along, realizing that cement is probably not great for my gimpy hip, enjoying nature, listening to my iPod, and watching all the other people doing the same thing. Up ahead of me is a nice, slightly pear-shaped, older mom-looking type, also plodding along. Since I'm doing a walk/run training program, we keep passing each other.

At one point, she jogs past me as I'm walking, and she says something. I pull a headphone out of my ear and ask her to repeat it: "Are you a lawyer?" I reply in the negative, and smile, and she jogs on.

I'm completely mystified by this. Is there something about my running style that says "lawyer"? Do only lawyers jog in the park in the middle of a weekday? Did I accidentally flash some secret lawyer hand sign or something? She was behind me...do I have a lawyer butt? What IS a lawyer butt? And then it hits me.

I'm wearing DR's MC5 t-shirt. Back in the late 60s, their shows were almost like counterculture rallies--they were often introduced with, "Brothers and sisters, brothers and sisters, I present a TRUE TESTIMONIAL! Are you ready to TESTIFY?!?" (And then the MC5 would kick out the jams, motherfuckers!!! But I digress.)

So, the front of the shirt says "MC5: A True Testimonial," and the back says "Are You Ready to Testify?"

Mystery solved! so I jogged up to her and said, between gasps for breath, "It's not a courtroom testify--it's more like a gospel 'glory hallelujah' testify!" complete with me shaking my hands in the air. "But in a rock-and-roll way!" I added, after she gave me an "uh-oh, I've provoked some crazy god-bothering religious nut" look. She smiled in an "OK crazy person!" way, and I gave up and jogged on.

Great. She's the one who brought it up!! And I'M the one who looks like a nut in the park. I better watch out for squirrels.

Oh--and just so you know what I'm talking about:

Mental Health Day

Aaaaaahhhh.....

It's nice to be off today. It sucks when you dread going to work. So I took the day off.

So there.

And now I will drink a beer.

sniff, sniff...is something burning?

Oh, that's just me. Burning out.

In the past month, I haven't taken care of an actual patient. Nope. I've been doing triage, ambulance triage, and I've been in charge. Twelve hours a day. Oh wait, I lied. I DID take care of a patient once...a few weeks ago...when I relieved a nurse in a patient area for an hour. So in the last month, I've done one hour of patient care.

Contrary to what some think, I enjoy taking care of people who are sick. I like assessing them and discussing their care with the doctor and making them more comfortable, and possibly, helping them to get well. I like being able to intervene to stop their diseases from getting worse or killing them. I like educating them about how to keep themselves well.

I also like triage and ambulance triage, but in moderation. These are two very hard jobs.

In triage, you decide who is sick NOW and who can wait, and sometimes it is not as straightforward as it seems. You have to look at someone, and figure out...hmmm...is this cold pneumonia? Can this person be seen in fast track and sent right home? Is this baby likely to go south in the next half hour or so? You also see TONS of not-sick people who believe they are dying, and who will harass you at every possible interval: "Why he went back and not me? I was here first! I vomited! ONE TIME! Why you call this an emergency room! This is an emergency!" OR "Nurse, my daughter cut her lip and was bleeding! I KNOW it seems to have stopped, and I KNOW you called plastics to come look at it, but I don't understand WHY she can't go inside and lie down! She is OBVIOUSLY in severe discomfort!" (and the child is romping around the ER, cute as a button, coloring in a coloring book.)

It makes you lose faith in humanity.

When you do ambulance triage, you greet every ambulance that comes in, quickly assess the patient and listen to EMS's information, decide if the patient needs a cardiac bed or not, get the patient to the bed, finish your assessment, and then go type it up, put the patient in the tracking system, distribute the printed triage to the doctors (alerting them to any serious emergencies), and report on the patient to the nurse. There is a LOT of literal running around. Sometimes you get backed up on busy days. And if it happens to be a day when the director of emergency medicine is there, woe is you! This person, who is the doctor version of a clipboard nurse, decides that "Bedside triage is BEST!" and just orders EMTs to stuff patients in any available bed. Without telling you or the charge nurse what he is doing. So you have to scuttle around, trying to figure out who hasn't been triaged yet, trying to find the EMTs or paramedics for each patient (god forbid they should stay by the bedside until you get there), and move patients around to beds that are appropriate for them. And you PRAY you didn't miss some little old lady whose EMTs left because someone else signed their paperwork. Oh, and on busy days, the other nurses HATE you because you are bringing in an endless stream of patients to them. Joy.

I won't even go into being a charge nurse. It's just all of the above, plus dealing with the clipboard nurses and doctors from upstairs, and settling staff disputes, and more.

Sometimes triage and ambulance triage are a nice break. You don't have to commit to anyone and you get to see a lot of interesting things. When you do triage, you get to sit in a chair. But do either of those things every day you come to work for a month? Some nurses like it. I don't. I'm getting stale and burned out. My nursing skills are suffering. My time management skills are suffering. And I don't like to complain to the charge nurse when I don't like my assignment, because it puts a burden on her to move things around. So I'm going to the ED's director of nursing and gently pointing out that the ICU has lots of vacancies for nurses who enjoy patient care, and if I don't start taking care of more patients down here, then I'll start doing it up there.

WHEN are people going to realize

that while the business of medicine does sometimes make money, medicine cannot be run like a traditional business?

I can't possibly say it better than Dr. Whitecoat at WhiteCoat Rants. On his blog, he posts a link to an editorial by Kevin, MD, a response to Kevin's article, and Dr. WhiteCoat's own response to that response. Please go read all three. My blood is boiling.

Listen, all you MBAs and businesspeople who think that you've got a handle on how the "business of medicine" is going wrong: People are not egg timers. Diseases are not just broken cogs and gears to be fixed and then everything is good as new. You sometimes can't predict results of things--you may not be able to manage time or money in any predictable way when you're dealing with actual human beings on both sides (producer and consumer) of the equation.

Most things in business don't apply to medicine. Let's look at an example near and dear to my heart: Guitars.

I buy a guitar for $500. Is that the end of the story? No. I have to buy strings and picks if I intend to actually PLAY the thing, as opposed to just looking at it. I also have to get it "set up," or adjusted for optimum playing enjoyment.

If I take my guitar to any competent luthier (or "guitar fixer-upper"), I will undoubtedly see a sign that informs me that it costs $50 or whatever to just hand over my guitar so the luthier can tell me what's wrong with it. Even if I don't choose to have the guy DO ANYTHING, I still have to pay the $50. It's called a bench fee. If I don't pay the fee, I can't get my guitar back.

Apply that to medicine. If I have a medical problem, I can go to a doctor in the emergency room (or "people fixer-upper"). I don't have to pay anything to see that doctor, and if he fixes me up? I don't really have to pay him! Even if I don't have insurance! He's supposed to take care of me ANYWAY, because the law says so!

Yeah. That's really the same thing.

The HORROR

Can you imagine turning on the light in your kitchen at night and seeing THIS?!?



To heck with calling the exterminator--I would just move out...immediately.

Photo credit

I should have had a V-8.

A slightly agitated senior citizen comes in with the triage complaint "My blood pressure is high."

Me: Hello, Ma'am, I'm GuitarGirl RN, the triage nurse. What's happening today?
Senior Citizen: My neighbor took my blood pressure and it was high! 178/110! He said I should come right in because I could be having a stroke or something!
Me: Ok, do you have a history of high blood pressure?
SC: My doctor told me I do.
Me: Ok, do you take your medications every day?
SC: I don't have any more. My Medicaid ran out and I have to get more Medicaid. Can someone just give me a few pills?
Me: It's very important to see your doctor regularly and take your medications for your high blood pressure.
SC: I don't even need medication every day! I use something else.
Me: What do you take for your blood pressure now?
SC: V-8 vegetable juice. I have a glass every morning and night.
Me: Ma'am, vegetable juice is very nutritious, but it won't lower your blood pressure all by itself.
SC: (getting agitated) Yes it does! It's low sodium!
Me: It's great that you drink low-sodium juice, but you need to see your doctor and take any medications prescribed every day.
SC: IT LOWERS YOUR BLOOD PRESSURE!! IT SAYS SO ON THE LABEL!!! You think I'm stupid! I know all about this! HIGH BLOOD PRESSURE IS DANGEROUS!!
Me: Uh...
SC: WHAT IS MY PRESSURE NOW?!?
Me: 186/92. You seem a little upset. Perhaps you should stay and see the doctor; we can give you some medication, and then a prescription for later.
SC: I DON'T HAVE MY MEDICAID! THAT'S WHAT I'M TELLING YOU!!!
Me: I hear what you are saying. Please wait to see the doctor; we will try to help you the best we can, OK?
SC: YOU DON'T KNOW ANYTHING! I'M GOING HOME AND HAVING A GLASS OF JUICE!
Me: Well, all right then.

I Love Bunnies

A little-known fact about me. I love rabbits. Especially rabbits in a tub. Thanks, Cute Overload!

I didn't invent it!

Remember my post some weeks back, you know, the one where I got a lot of vitriolic troll-mail because I called someone a "methadonian"?

Well, I'd LOVE to take credit for coining the phrase, but I can't. Here it is, in the Urban Dictionary, and was apparently entered back in 2005. Sigh. AND, I found one reference that states "methadonian" has been in the vernacular (at least in England, and possibly on the Geraldo Rivera show) as far back as the 1970's. And someone did his thesis on the term.

Just because I'm bored, I Googled "methadonian" and up popped about 625 responses. Including one from a person who calls himself that, and has a website (actually, it's more like a humungous run-on sentence) about how he'd like you to donate money so he can go to Israel and get off the methadone (which was prescribed to him for depression). Or something.

There seem to be plenty of Methadone-user-community sites up. In fact, in many, they call each other Methadonians. (Is that like women calling each other "bitch" or African-Americans calling each other the "n" word?) One big site is a Yahoo "health group" (yikes) called Dolophinea Cafe, where patrons are encouraged to "come in and Make some noise..or just snore quietly and take your dose."

And here I was thinking I was inventive. Ah well.

Simple Arithmetic

Hey Cranky Old Nurse!

PLEASE stop freaking picking on me. Come on, don't make the old adage, "Nurses eat their young" be true!

Actually, it's not just one cranky old nurse--it's two. And, to be completely honest, they don't pick on just me, or just new or younger nurses. They pick on EVERYONE. And before I get all jumped on, there are a ton of older/more experienced nurses who are great, who have fantastic senses of humor, and who do their jobs and don't make people want to toss them off the top of the hospital.

These two are like Heckle and Jekyll (but not as funny). They sit there and caw at everyone, and also talk about people loudly behind their backs.

HEY HECKLE! Quit yer bitchin! We all are working very hard. I didn't give you that extra patient because I'm "inexperienced as a charge nurse." You happen to have the only open bed. It's a kid with a hand laceration. He's fine, nothing to do. Just wait for the Motrin and tetanus shot order. Please don't argue about it with me in front of everyone. Oh, and if I'm 15 minutes late to relieve you for your 30-minute afternoon break (because your compatriot was late getting back from hers), don't insist that you're having a "blood-sugar moment" and commandeer TWO residents to bring you outside onto the ambulance bay "for some air." And then not come back for 45 minutes.

HEY JECKYLL! I know that you are old. I know that we have to rotate who does ambulance triage every day, so sometimes you will get picked. But SHIT WOMAN! It should NOT take you A HALF AN HOUR to triage a patient and get him or her into our tracking system. Oh wait! You refuse to do the last step of actually clicking the little button that puts the patient into the appropriate bed in our list on the computer. Right, that's the charge nurse's job. And when I tell you to put a patient into a specific bed, don't switch them all around without telling me so I look like an ass when a doc is looking for a patient and I keep sending her to the wrong bed. Also? Last time I checked, your JOB as ambulance triage included taking the patient's vitals yourself. NOT taking up a tech for yourself and sending her all over the ED to take your vital signs, and then bitching that she's not doing it fast enough. I know you're OLD and that OLD people are not good at computers--get over it. My mother is 73 years old and has a freaking post-grad degree in NURSING INFORMATICS and is better with computers than me. Oh, and speaking of my mother? When you recognized my last name, I realized that you had been taught by my mom when you were in nursing school. I mentioned you to my mom and she shrugged and said, "Huh. I'm surprised she's still a nurse."

BOTH OF YOU: I don't WANT TO BE IN CHARGE. Believe me. OUR BOSS wants me to be in charge because she thinks I'll be good at it. Thank GOD I don't ever have to do it for more than a few hours at a time.

PLEASE don't quote "policy" at me when I'm trying to make a patient more comfortable after she's been assaulted. And DO NOT question her victimhood just outside the curtain. SHE CAN HEAR YOU, you insensitive fuckers!

And when our boss puts someone new in charge, someone who has had similar experience in a different field, someone who would actually be BETTER AT IT THAN YOU, someone who actually WANTS to be in charge, do NOT: 1) stand around belittling him; 2) call the nursing supervisor to complain; 3) call the nurse manager at home at 7:30 am on a Sunday to complain; or 4) complain so much that she has to call someone in from home to be in charge, because even though you don't want the current person in charge, YOU WON'T STEP UP EITHER.

Annoying freaks.

Sprinkles

And no, I'm not referring to the kind you get on donuts or ice cream.

How is it possible that adults--health care providing adults--health care providing adult WOMEN are incapable of cleaning up after themselves?

If I have to go into our staff bathroom one more time and find the seat COVERED with piss, I'm going to...to...I don't know WHAT but I'm going to do SOMETHING.

This is a bathroom in our staff lounge. You cannot get into the lounge without knowing the code to the door-lock. This is not some bathroom that the public uses. It's clean and relatively fresh-smelling. There are nice lotions to use on your hands. There are disposable toothbrushes. The people who use this ladies' room are nurses, nurse techs, doctors, and our CLEANING STAFF.

Oh my freaking god. How do you squat there, piss, wipe, then pull up your pants, flush, and just waltz out as if nothing is wrong? How do you not NOTICE that you've inundated the toilet seat with your loin lemonade? Oh yeah, and SOMETIMES, it's PINK LEMONADE. (Uh huh, ew, right?)

Look, if you can't BEAR to sit on the toilet seat, then fine! But until you grow a penis and a sense of aim, you need to clean up after yourfreakin self, you disgusting piglet.

And now for something completely different

Why was I not born Jimmy Page?

Oh my god, Robert Plant is freaking awesome. And John Paul Jones, with that crazy electric mandolin. And does ANYONE play drums like good ol' Bonzo? I can't even stand it. Sometimes I really miss being part of a band that is so instinctively and musically together like that.

Whenever DR is watching VH-1 Classics and some Led Zeppelin thing is on, whether it's the new Song Remains the Same or other live stuff, I have no choice but to watch and pay attention. These guys are truly masters and true musicians in every sense of the word. Ugh, it sounds SO good, I just want to...roll around in it a little.

It makes my little heart hurt and go pitty pat. (And no, I'm not talking about chest pain.)

Dear Trolls,

Just because YOU THINK that people can hear exactly what it is YOU are thinking about them does not mean that it is true for you OR for other people.

That's called thought broadcasting and it is a symptom of schizophrenia.

When I think things about people, I know they cannot hear my thoughts. In the adult world, it is possible to think things about people and not act on them. It is possible to treat people in a way that does not reflect your personal thoughts or beliefs. This is called being professional.

And then you get to go home and blog about what you've seen.

Oh, and Trolls? It's a good thing you can't hear my thoughts. You would be very unhappy.

xoxoxo

GuitarGirl, RN

Atropine, anyone? Anyone?

The above was an actual quote from the other night.

The whole day was not terrible. It could have been better, but it definitely could have been worse.

And then at about 11:15 pm, just before I was supposed to go home, the entire ER exploded. Ok, not LITERALLY. But we got five or six ambulances at once, two notifications, and one patient was about to be intubated. AND one of our nurses who is about 5 months pregnant had to go upstairs to L&D because she was having very strong contractions. I was running around trying to help out as best I could.

I was asking one of my coworkers if I could help her with anything, when one of the upstairs residents came over, and nonchalantly said, "Do you have any atropine around, or something?"

I stared at him and said, "For who? Is someone coding in here?"

He lazily scratched his head and said, "Uh, we just brought a stroke code down from upstairs for a CT scan, and I think she's bradying down."

"What?!" I grabbed a couple of amps of atropine and ran over to the CT scan room. Four people were standing around this little old lady who was schlumped over in a stretcher, breathing like people do who have had a stroke and have slack facial muscles (think curtains blowing in the wind). Someone is mumbling, "I think she doesn't have a pulse. She might have died in the elevator..." No green band on her wrist, so she's a full code. Heart rate on the portable monitor is 27. Looks like sinus rhythm, but the monitor she's on is some ancient piece of crap and who knows if that's reliable.

"Uh, has anyone checked a PULSE?!?" I grab a wrist and put the other hand on her femoral artery. The CT tech, a transporter, some lady in a white coat, and the doc who grabbed me outside are standing there staring at me. Tiny, thready pulse. "Is she on oxygen? Get a non-rebreather! These nasal cannula are doing nothing! Doc, do you want this atropine in? Doc? How's about point-five of atropine? HELLO?!?" They all stare at me. "IS there a CODE CART IN HERE?!?" They roll over some freaking ANCIENT monophasic monster. It had so much dust on it it was furry. It was yellow--like those old waterproof Sony Walkmans. I could not even figure out how to turn it on.

"Atropine anyone? Anyone?" Oh, fuck this, I think, and give her the 0.5 mgs of atropine. (Point five if you're alive! Yay ACLS class!) They are all surrounding me like I'm an astronaut on Mars and they're aliens. Pulse comes up to 56. OK, not great but not bad.

"How's her airway? Anyone check for a gag reflex? do we need to intubate her? Has she had the scan yet? Is this suspected hemorrhagic stroke?" As I'm saying this, I'm putting a finger in her mouth to see if she gags and she bites me. OK, at least she's protecting her airway.

Then two of the ER residents come running in, one with the intubation box. The nurse I was with when the doc grabbed me figured something was up and notified our residents. I told them what was going on and they assessed the situation and agreed with me that she didn't need to be intubated, but needed to be scanned as soon as possible.

I turned to the woman in the white coat and said, "Are you this patient's nurse?" No, she was from STAFF ED. Just helpin' out! I asked her to please endorse to the covering nurse that I had given 0.5 mg of atropine.

And then I went home. Gack.

I Died.

Here's my obituary! Thanks, Ambulance Driver!

'What will your obituary say?' at QuizGalaxy.com

It's Brutally Fresh!

Objects left in a bag in the detox/psych room after its drunken inhabitant took a swing at me, slammed an EMT's hand in the door, and stormed out, yelling that he was going to call his wife, a cop:




1 large black-and-white poster of Biggie Smalls









1 leather Crocodile Dundee-style hat



1 medium size blue jelly dong (with lifelike veins!) (sorry, no picture...)

and, most interesting:

1 DVD entitled "Afro Samurai," featuring the voice talents of who else but Samuel L. Jackson. Apparently it's a an epic tale of a black samurai's hunt for Justice (a person, not the concept) who murdered his father! According to the cover copy "Afro Samurai blends traditional Japanese culture, funky technology and hip hop to create a brutally fresh entertainment experience."
I almost didn't turn this in to security with the rest of the stuff. Ah well, guess I'll just have to Netflix it!

Perhaps not allergic ENOUGH?

500 lb frequent flyer. In with shortness of breath, chest pain, headache (probably from popping nitro like jellybeans). Her EKG was normal. She stated that she felt the pain while out shopping. Bought a "sexy nightgown" for $29--on sale from $49! ("You know it's a sexy nightgown when it costed fifty dollars!" says she.) Her breasts were bigger than my head. She offered me some candy and insisted on showing me her nightgown. She offered to get into it, since none of our gowns fit her, but said she was worried about "all the men coming around to get a look" at her in her lingerie. Ooof. Ya gotta admire someone with a positive body image.

Of course, she was a tremendously hard stick. I tried three or four times, got some blood, but no dice on the IV. We dragged out the ultrasound. No deal. Finally, one of the attendings got the IV in using a combo of the ultrasound PLUS an arterial line catheter. It was the only thing long enough to get through all the fat and down to an actual vein.

I sat down with her to go over her huge list of allergies: Latex, toradol, percocet, tylenol, demerol, aspirin . . . and gravy.

"What happens when you have gravy?" I ask.

"It makes me fat."

You can't make this stuff up.

High Press Ganey?

Not for long!

Our ER got a free lunch brought to us the other day. (Woo hoo cold cut sandwiches and potato salad. They sure broke the bank on that one.) Oh, and we got tote bags, too.

This massive outpouring of support was because we actually managed to get our Press-Ganey ratings up to 75 percent good/outstanding. How we did that, I don't know. That rating was from December.

However, it won't last! Those scores will plummet right back down due to the high volumes of people we've been seeing. We've nearly doubled our usual number of visits almost every day for the last few weeks. As a result, people have been waiting for seven to eight hours out in the waiting room to be seen. We're often holding up to six ICU patients at a time for days (and never mind the telemetry holds!). They even tried to float one of us up to the PACU (post-anesthesia care unit) where they were keeping ICU admits. Fortunately our charge nurse flat-out told the nursing supervisor no, since we still had 20 patients yet to be seen in the ER and another 20 outside in the waiting room who had been there for at least four hours.

ERnursey has hit the nail on the head. The last few weeks have been a taste of what it would be like in a pandemic or mass casualty, and boy are we screwed.

I want to poke my eyes out

when people say the word "vomick."

What the fuck? Vomick? After listening to people tell me all about thems vomick and hims vomick and alla y'all's vomick I want to string myself up from a very tall tree.

Oh, did he vomick right after eating his McDonald's? I see. Oh, and he's unable to keep anything down, yet you just gave him some noxious bright-blue sugar drink that ends in "ade"? And now he just vomick it all over another kid in the waiting room? Even after I told you to stop giving him anything to eat or drink for now? Ah.

A close second to "vomick" is "thowd up."

It's like "pops."

Well, at least he's creative!

The methadonian who had been snoring away for four hours finally awoke and was discharged--after stating that he had been asleep through his methadone clinic appointment and therefore didn't have any methadone for the weekend, so could we please give him some. (It's more likely that he took all his methadone for the weekend in advance, and no way were we going to give him any more.)

I amusedly watched him get his things together, nodding off a few times as he did so. Then, without skipping a beat, he carefully folded his patient gown and put it in his bag. Then he added the nonrebreather mask that had been on his face. Then he folded the sheet from the bed and stuffed that in there too. He was about to add the ambu-bag from above the bed when I casually said, "Dude, whatcha doin'?"

He looked at me dopily for a minute. "Uh...I really like souvenirs," he said. "I'm an industrial artist and I like to use things I find in my artwork."

I smiled and said, "Nice try." I took all the stuff back. "Sorry! We don't give out doggie bags at our hospital."


(admittedly, I could have let him have the nonrebreather; those are one-use only. But I wasn't feeling very charitable.)

Paging Dr. Grim Reaper for a second opinion

Sometimes people don't grasp the concept of the word "EMERGENCY."

You know, like all the folks who come in with complaints of "vomited twice today" and "my toe is really sore" and "diarrhea four times."

And then there are the folks who just don't grasp that what is happening to them is a REAL EMERGENCY.

Like the young guy with chest pain radiating to the back and slight shortness of breath. Who had an aortic dissection. A big one. It was a miracle that he was feeling so well. The surgeons gathered around and told him and his wife what was going on and that he was going to go the OR within the hour. They agreed, but minutes later I heard the guy saying to his wife, "I really feel OK now. Why don't we go home and just make an appointment with Dr. So and So?"

I poked my head in and reiterated that the patient's life was in danger, and that they were coming to take him to the OR in about fifteen minutes. The couple was just not grasping what was going on with the situation. They wanted a second opinion. The wife actually asked if the man would be back at work on Monday. (Keep in mind that English was these people's only language!) It was all I could do to not say, "Your aorta is busting open. They need to fillet you like a fish and fix it. You will NOT be back at work on Monday." I ended up calling the docs to come back and re-explain everything with a patient rep standing there. We drew pictures. Finally they seemed to understand, and off to surgery he went.

Whew!

Oh Don Pian-o

Don't know why this made me laugh so hard I almost puked, but whatever.