Monday, June 30, 2008
Some of the other ED doc bloggers have posted their advice for recently graduated residents about to start their first "real" jobs. Check out what 10/10 and Shadowfax have to say about that.
I have no advice for the new ED grads; if you don't know by now that the nurses in the ED can be your best friend or your worst enemy, my telling you isn't going to help you. And as for you new interns, you'll hear that bit of advice over and over from your colleagues.
Here is my advice to the new interns: dispo, dispo, DISPO!!!
This is the way to endear yourself to your upperclass colleagues, to the attendings, to the managers, to the nurses. I know that as med students you may not have gotten in as many procedures as you could have. But when the ED is packed, and everyone is busy, we all appreciate efforts to move the patients along as quickly as possible.
Every July I have to give several new interns my standard speech: Hey, it's GREAT that you want to help me out by starting that line and drawing blood. And it's awesome that you want to administer meds yourself. And thanks for trying to put that NG tube in. And that Foley catheter. But these are all things that I can do. What I CAN'T (officially) do is interpret x-rays and lab results, I can't present to the attending MDs, I can't call the patient's primary doc, I can't put in admit or discharge orders, and I can't fill out your t-sheet for you. And that's what needs to be done to get this patient where he or she needs to be so we can bring in some more bodies to fill stretchers, since the wait out in the waiting room is approaching four to five hours, and people are starting to get really cranky. Go forth, young intern, and DISPO!!
SO: when it slows down a little, like in the late evenings or early mornings, we'll get you aaaallll the practice you need with all those little things. Believe me, I love to teach interns how to do stuff. Because when you're a second-year resident and it gets busy, us nurses LOVE it when you stick an IV in when you're doing your assessment (if we haven't gotten there first), we love it when you do all those little things to help us along. But when you're an intern, and are still getting hung up on where the IV starter kits are, and people are howling "How come I've been here for three hours and haven't seen a doctor yet!!" please concentrate on doing your doctor things that, as a nurse, I can't do.
We've got to whip you guys into shape before cold and flu season starts!
Sunday, June 29, 2008
Apparently in 1918 they started accepting female residents. They put up a picture of the surgical residents from that year, including the first woman.
Her name? Dr. Goodenough.
Friday, June 27, 2008
Apparently someone was wondering what to do with their own toenail, because my blog came up on a search with those words.
There are a lot of idiots out there who believe that the ED is a place to go for this problem. Like here. Apparently Yahoo is full of dumbasses, like the one who answered the question "How do I care for an ingrown toenail?" with, "Make time and go to the ER screaming that it hurts."
Thursday, June 26, 2008
Sunday, June 22, 2008
Oh boy. And in the one class I wasn't acing, either.
Well, let's hope that my last paper got full marks. MAYBE I'll get a B then. I can't believe it.
Well, Cranky Professor would be proud; at least I'm not whining to administration (or my instructor) about it. It's my own fault for not marking it on my calendar anyway.
GACK! I'm mortified.
Saturday, June 21, 2008
I had a new stove put in, since the old one was decrepit and kept breaking. The installer showed them how it worked, and reported to me that all was well. The next morning at 6 AM I got a call: "The new stove is broke!" I went over there. The woman said, "I turn the knob, but nothing happens! The fire doesn't start!" She was turning the knob all the way up. I turned it to the "light" position and heard the telltale click click click whoosh of the automatic ignition. The flame ignited. My tenant was completely baffled. (Please note: This was exactly how the OLD STOVE worked, too.)
In the spring I got an irate phone message about how selfish I was for cutting all the flowers in the yard, how "other people" deserved to enjoy them, how I wasn't the only person living on this property, and how dare I. I looked out the window into the backyard. The tulips and irises *I* had planted in the fall had bloomed, and as most flowers like that do, had faded, the heads withering or falling off. I called her back and explained that while they were MY flowers, I hadn't cut them; they die after a while. Her response? "Oh."
One month, my water bill for both houses was $800. (It was usually about $70-$130.) I freaked out, thinking that there was some crazy leak somewhere; I called the water company, who started checking their equipment for leaks, I called a plumber and made an appointment for him to come inspect both houses for any problems. The next day, I was out in my front yard chatting with a neighbor who lived across the street and mentioned my huge bill. She said, "Oh, that's because [tenant] has been taking in laundry for the whole neighborhood! I see people going in and out of there with huge laundry bags every day while you're at work!" I cancelled the plumber and had a few words with my tenant. The next month the bill was normal.
I got a call at ten o'clock at night once. There was screaming in the background. "Is everything all right? What's going on?!?" There was a roach in the kitchen and my tenant wanted me to come over and kill it.
One night at eleven pm, I got a knock on my door. It was the tenant's teenage daughter. They had tripped the electric breaker, and my tenant wanted me to come over and fix it. I told the daughter that the breaker box was in the tiny basement, right next to the stairs, and that they should flip the switch back, and the lights would come back on. Her response? "My mom wants you to come and do it, cause my dad [the tenant's boyfriend] isn't here and she doesn't like to go in the basement." I handed her a flashlight and said, "good luck!"
I've been to the ER once in my life, and that was because a glass-top patio table shattered all over my foot. I had a deep cut in the top of my toe. My boyfriend at the time wanted me to go to the hospital right away, and I wanted to wait for it to stop bleeding. And we were on vacation, so I didn't want to spend hours in the ER. Six hours later, though, it hadn't stopped; I had bled through several pressure dressings. I finally acquiesced, and off we went. Turned out I had a piece of glass in there, which was why it wasn't stopping. After five stitches and a conversation with a very nice ER nurse, I went back to our little beach house and decided to go to nursing school.
Here are two things I didn't go to the ER for. As a matter of fact, it never even occurred to me.
I had been working very hard for weeks, going to work and traveling for my job in publishing while I had the flu. I was under heavy deadlines, a lot of pressure, and one morning I woke up feeling like hot coals were living in my chest. My eyes were burning, and I couldn't seem to catch my breath. I called my doctor's office, and expected to get the answering service, since it was about 7 am; I was trying to see what time they opened so I could call back. Much to my surprise, my doc himself answered. He heard what I sounded like and said, "How quick can you get here? Take a taxi if you have to." When I got there, he took my vitals and a quick exam (104 F fever, 02 sat of 91 on room air, resp rate of 26) and sent me for a chest x-ray next door. Pneumonia. He wanted to admit me but I was vehemently opposed. I made a deal: If I wasn't feeling better after three days of rest, antibiotics, and fluids, I would come in to be admitted. He agreed on the condition that I took at least ten days off work to recuperate. (It was also my birthday.) He even called my boss and HER boss. Of course, they FedExed me work to my apartment, but whatever. I got better.
The second story: When I first started playing guitar in a band, I used to keep my equipment at our rehearsal space and ride my motorcycle to and from rehearsal. One day as I was leaving the studio, it started to rain. Being young and stupid, I figured I could hurry home before it got too bad. In an attempt to keep dry, I rode on a street under an elevated roadway. I didn't know that when it rains on an elevated roadway, all the grease and oil on that surface gets washed off onto the street below. So as I tried to stop for a red light, I started fishtailing and skidding all over the place, but not stopping. I had a choice: dump the bike or skid right into the traffic at the intersection. I flew off the bike and slid across the three-lane street on my side. Did I mention I was wearing black stretch pants, boots, and a t-shirt? Smart choice of attire. (At least I was wearing a full-face helmet!) I got up a little shakily and started limping back to my bike. A guy in a truck offered to take me to the hospital. I turned around in a circle and asked, "Why? Are there bones sticking out of me or something that I can't see?" My knee was swelling up, I had some road rash, and I had the word "YAMAHA" stamped in a bruise on the inside of my left calf. Two guys from a nearby store came out and helped me pick my bike up. It started fine, and I rode it the rest of the way home (about two miles), even though the front alignment was off and I had to go about ten miles an hour the whole way. I got home and limped upstairs, where I cleaned all my boo-boos, took some Motrin, and sat down in front of the TV with a beer. I put my sore leg up and iced my swollen knee, and never rode in the rain again. (At least not without full leathers on!)
Monday, June 16, 2008
We get contracted patients from nursing homes whose hands have not been opened in DECADES. I made the mistake of trying once...with an ungloved finger. My finger came out covered with stinky, viscous, slimy goo. I gagged.
It's LOL paste! (Brought to you by the makers of "LOL flakes!")
Tuesday, June 10, 2008
Two people tied for the "Holy Crap" award (so named because they're the people that make you go, "holy crap" when you're done triaging them. And they were at opposite ends of the Holy Crap scale.
At one end of the spectrum was a guy who got drunk last night and fell, injuring his thumb. Eh, whatever, right? When he held out his hand for me to inspect it, HOLY CRAP! It was bent backwards at the distal knuckle. The tip was bluish with no capillary refill and . . . What's that? Oh, the bone from his knuckle protruding through the skin--on the ventral side. Lotsa meat hanging offa there. Not a lot of blood, and when I asked the guy if it hurt, he was more concerned about his scraped knee.
At the other end of the spectrum was the gal who sat down in triage with a chief complaint of . . . Sunburn. Her legs were sunburned. No fever, no blisters, no sun poisoning. Rated the pain 10/10. Refused motrin, just wanted some "cream or something." HOLY CRAP! Seriously. "I can't sleep! I can't get comfortable!" Know why? Cause you have a sunburn. You know, at the drugstore they have all sorts of creams and lotions for sunburn. Even ones with aloe and lidocaine! There is a 24-hour pharmacy about four blocks from the hospital--if you could make it here, you could make it there.
Sunday, June 8, 2008
If a 30-year-old man wants to regularly drink himself into a stupor, why is it my responsibility to stop him? When he is sober, I can offer him a chance to talk to a psychologist, to a social worker who can help him go to detox if he wants to. If he refuses (when he is sober), that's his business.
If you, as an adult man, regularly drink so much alcohol that your friends worry that you are going to fall over and crack your skull open, or that you are going to get hit by a bus, that's your problem. I resent being treated like a babysitter for adults who completely know what they are doing. If you drink a whole bottle of Bacardi, you're going to be so drunk that you get hit by a bus.
I resent the fact that I have to take care of your swearing, spitting, screaming, crying, pissing, shitting, pleading ass until you are sober enough to go home and not fall on the train tracks. I resent the fact that your friends, who bring you in EVERY WEEK, keep asking me, "What are you going to DO FOR HIM? Can't you see he's sick?" Yeah, I can. But HE CAN'T. He refuses all the help that we try to give him (in terms of detox, and rehab, and psychiatric help for his alcohol addiction). So I mop him up, give him fluids, give him medicine to make him feel better--so he can get up and go out and start all over again. YOU are his community! Whatever happened to interventions? Whatever happened to a little tough love by friends and family? Whatever happened to "Dude, you can't drink like this anymore. It makes me not like you. You are going to die if you don't stop." It might mean a lot more coming from a friend than from a stranger. But instead, you go out with him. You watch him drink himself into a pissing, crying mess. For all I know, YOU buy him his booze. And then you dump him on us when you can't deal with him anymore.
So when he comes in with a skull fracture after a faceplant onto the concrete, I'll take care of him. When he comes in after having a seizure, I'll take care of him. And I'll be nice. But I don't have to like it. And I don't have to like YOU, either.
Saturday, June 7, 2008
In addition, since our budget has been tight, I've started accepting freelance editorial work again. The hospital where I work won't pay overtime (they're even canceling the shifts of some of the per diems), and the other hospital in my area wants a commitment of four 12-hour shifts a month from per diems there. That would be a lot of dough, but I can't possibly do seventeen 12-hour shifts a month and maintain my sanity. So right now I'm copyediting an awful mass-market crime novel (there are plot holes you could drive a truck through). It pays about $8 less an hour than my regular salary, but I can do it at home in my jammies. And manuscripts never throw up on you.
And on a more fun note, the band DR and I play in has been doing great! We finally got our own rehearsal space, and we also got ourselves a fantastic new drummer, who is an old friend and music partner of DR's. We have new songs and a gig in early July, so we're rehearsing like crazy to be ready--and we may record in late summer/early fall. And I still haven't given up on my surf band project, but I have NO idea how I'm going to make that happen with all that's going on these days.
So again, sorry I've been AWOL. I really DO have good posts stored up, but mostly in my head. I try to write them out on my Treo on the way to and from work, but I luckily don't have a very long commute, and can't get more than a few sentences out before I'm at my stop.
Please bear with me! I'll get back to posting regularly soon!
Monday, June 2, 2008
So last night it got busy around 8 pm. My area was full and under control. The area next to mine got slammed with a bunch of new patients while the RN there was busy dealing with her sickest patient. So I pitched in.
A very sick, and very neglected elderly lady was placed in one of the beds. She was confused, and had been for two weeks, ever since she fell at home and wasn't able to get up, according to her family. She was obviously not being taken care of properly at home. She was covered in poop and urine from her knees to her navel (back and front), her butt was excoriated from the poop, and she had some sores on her belly. She would wake up and holler if I tried to move her, but other than that, she was very quiet. She had a raging fever and was probably septic.
I worked her up for the other nurse.
And I cleaned her.
And then she became unresponsive about a half-hour after that. Then she died about four hours later, according to my coworker.
I'm the angel of death. Except that instead of a scythe, I carry a washcloth and towels.
Sunday, June 1, 2008
He died of a massive gi bleed today. I'm convinced it's my fault.
I think that when I cleaned him, I removed his protective coating!