Yesterday, we had to go on ambulance divert since we had no available heart-monitoring equipment in our emergency department. Obviously, if someone having a heart attack or stroke arrives in the lobby, we get to play the fun, potentially life-ending game of 'whose heart monitor can we take away?' **because there's no such thing as lobby-divert. At some point yesterday, all of my patients were in the hallway on portable monitors. Nothing says "party" like having a patient in the hallway on a nitro drip with no way to remotely monitor blood pressure. Under the "Room" section of the chart, I was putting things like "Hallway-Computer", meaning "the cart parked next to the computer in the hall".
Anyway, we were all running our asses off in a state of delirium, and having no further ambuli coming in was nice because we were able to mass-admit like 9 patients in 30 minutes. After 58 minutes, we were able to go off ambulance divert and our secretary arrived with 38 Dairy Queen Dilly Bars, one for each staff member, paid for out of the pocketbook of our clinical manager.
I asked childishly as I chomped down,"Can we go on divert tomorrow too?"
**=Okay, we can use the monitors/defibrillators off the code carts, too, but we didn't bother counting those in our total available heart monitors. We sorta think a code cart should have a defibrillator attached to it and not someone in the hallway because there's no other heart monitors.
Friday, March 30, 2007
Wednesday, March 28, 2007
Elderly woman spills her long-hidden secret
A 90-something-year-old woman, who had, by all reports, been doing "fine" at an assisted living despite mild age-related dementia, suddenly became paranoid and began acting out. She was yelling, attempting to hit people, etc.
Maybe she thought it was the end because she had some dirty laundry to air in our fine acute care facility.
First, literary critics, we have the foreshadowing to the big secret.
[Aide attempts to draw labs from patients arm]
Elderly woman, slapping at the aide: Don't touch me! I'm a hooker and have gonorrhea. You don't want to catch THAT do you?
Then, some time later, she beckons for the male nurse to come over. In a whisper, we have the big reveal:
Elderly woman: You know, I like you. You're a handsome young man, so I'll tell you something. I used to be a high-up official in the Catholic church, but they fired me from my job...because I was selling the pussy.
I just about died when I heard that.
Maybe she thought it was the end because she had some dirty laundry to air in our fine acute care facility.
First, literary critics, we have the foreshadowing to the big secret.
[Aide attempts to draw labs from patients arm]
Elderly woman, slapping at the aide: Don't touch me! I'm a hooker and have gonorrhea. You don't want to catch THAT do you?
Then, some time later, she beckons for the male nurse to come over. In a whisper, we have the big reveal:
Elderly woman: You know, I like you. You're a handsome young man, so I'll tell you something. I used to be a high-up official in the Catholic church, but they fired me from my job...because I was selling the pussy.
I just about died when I heard that.
It's 5 am, time to call the ER and ask odd questions
Time: 5:08 am
ER status: Holding 10 telemetry patients, which alone would theoretically account for 1/2 of our skeleton nighttime nursing staff. Many more ER patients being worked up than we'd normally be working up at 5 am. I've personally admitted about 8 people in rather revolving-door fashion, including two elderly ladies with lower extremity cellulitis and dime-sized pus-draining wounds on their calves. Short a secretary, short an aide, which is a problem when you need to transport patients to other departments or enter orders. I've not had anything to eat, nor have I pissed, nor have I had my coffee, nor have I been able to sit down for more than a minute or two at a time.
A call comes in. Sure, we get the people who ask if they should come to the ER, and we are instructed to tell them that we're always open and it's up to them to determine if they think their condition is an emergency requiring immediate care. Then they usually ramble on and on and we say the same thing, then they ramble on and on and I say that we can't diagnose anything over the phone and they can come in and they ramble on some more and then I say that I can't offer anything else and hang up the phone as politely as I can.
This was even worse than that.
"My daughter was seen there last night [she describes what she was there for and I recall the case] and I'm wondering what the standard charge is for ER visits."
There is no standard charge. It's based on what all we did for you. This is the nurses' station, and we don't do our own billing. A separate department off-site handles that.
"But I just need to know how much it will be."
Like I said, there is no way for us to know that. There is a billing department that will review the charts and send you a bill. You can call the number on the bill if you have questions.
"But I need a ballpark figure so I can plan."
Once again, I don't know. All we do here is take care of patients and the billing department generates the bill. The emergency department is equipped for all matters of life-threatening emergencies and we bill accordingly.
"So, like how much then?"
You're calling the wrong place. It's five in the morning, and we don't have billing people here in the department, nor will there have been a bill made up for you already. Trust me, you'll receive it in the mail. I have to go now.
"So I should wait and call back at like 8 am then?"
Ma'am, again. This is an emergency department. There are no billers nor customer service agents on staff in this department. You'll need to call the number on your bill when it arrives if you have questions or want to set up a payment plan. Good night.
I'm kinda glad she rambled on, completely ignoring everything I had to say because I got to sit down for a good 2 minutes with a good excuse and the co-workers standing next to me got a good giggle, especially when I said "customer service agents." Hehehe.
ER status: Holding 10 telemetry patients, which alone would theoretically account for 1/2 of our skeleton nighttime nursing staff. Many more ER patients being worked up than we'd normally be working up at 5 am. I've personally admitted about 8 people in rather revolving-door fashion, including two elderly ladies with lower extremity cellulitis and dime-sized pus-draining wounds on their calves. Short a secretary, short an aide, which is a problem when you need to transport patients to other departments or enter orders. I've not had anything to eat, nor have I pissed, nor have I had my coffee, nor have I been able to sit down for more than a minute or two at a time.
A call comes in. Sure, we get the people who ask if they should come to the ER, and we are instructed to tell them that we're always open and it's up to them to determine if they think their condition is an emergency requiring immediate care. Then they usually ramble on and on and we say the same thing, then they ramble on and on and I say that we can't diagnose anything over the phone and they can come in and they ramble on some more and then I say that I can't offer anything else and hang up the phone as politely as I can.
This was even worse than that.
"My daughter was seen there last night [she describes what she was there for and I recall the case] and I'm wondering what the standard charge is for ER visits."
There is no standard charge. It's based on what all we did for you. This is the nurses' station, and we don't do our own billing. A separate department off-site handles that.
"But I just need to know how much it will be."
Like I said, there is no way for us to know that. There is a billing department that will review the charts and send you a bill. You can call the number on the bill if you have questions.
"But I need a ballpark figure so I can plan."
Once again, I don't know. All we do here is take care of patients and the billing department generates the bill. The emergency department is equipped for all matters of life-threatening emergencies and we bill accordingly.
"So, like how much then?"
You're calling the wrong place. It's five in the morning, and we don't have billing people here in the department, nor will there have been a bill made up for you already. Trust me, you'll receive it in the mail. I have to go now.
"So I should wait and call back at like 8 am then?"
Ma'am, again. This is an emergency department. There are no billers nor customer service agents on staff in this department. You'll need to call the number on your bill when it arrives if you have questions or want to set up a payment plan. Good night.
I'm kinda glad she rambled on, completely ignoring everything I had to say because I got to sit down for a good 2 minutes with a good excuse and the co-workers standing next to me got a good giggle, especially when I said "customer service agents." Hehehe.
Sunday, March 25, 2007
Tuesday, March 20, 2007
ER insider phrase of the day
Urban outdoorsman: A proper way to refer to a 'homeless man'.
Sample usage: Mr. Peterson is a 55-year old urban outdoorsman who's coming in for a medication refill for his chronic knee pain.
This phrase is especially effective because 'outdoorsman' evokes an image of a rather rugged flannel-shirted, beared man, perhaps carrying a backpack and likely exhibiting body odor from a long day of splitting wood. Then the 'urban' places this 'outdoorsman' in the middle of Downtown USA, and you have a picture of nearly all homeless males who will have or will set foot in your ER.
Sample usage: Mr. Peterson is a 55-year old urban outdoorsman who's coming in for a medication refill for his chronic knee pain.
This phrase is especially effective because 'outdoorsman' evokes an image of a rather rugged flannel-shirted, beared man, perhaps carrying a backpack and likely exhibiting body odor from a long day of splitting wood. Then the 'urban' places this 'outdoorsman' in the middle of Downtown USA, and you have a picture of nearly all homeless males who will have or will set foot in your ER.
Saturday, March 10, 2007
Time Magazine on emergency pain management
A typical drug-seeker/cross-pollinator presentation. The 'percogesic' suggestion is a good one.
Charlene's face fell. "Toradol doesn't work on me. I'm immune to it. Another doctor once gave me something that worked really well though, it was light, just a pill, I can't even remember what he called it, perca or perco something."
Charlene's ruse is so common, so old, it's like listening to Beatles music. And I can't help but sing along.
"Percogesic?" I asked, with mock innocence. This is the non-narcotic pain reliever whose primary selling point is a name quite similar to the highly addictive Percocet that Charlene was trying to get me to give her.
"No...oh..., its... Percocet! That's right, Percocet. They worked really well, no side effects or anything. That's what I need."
Uh huh. This article, apparently by an ER doc, encourages the medical professionals to deviate from the pain scale drug-dosing if deemed appropriate based on the one thing that pain-scale based drug dosing doesn't allow: Drug orders based on an entire assessment of the patient. Don't tell administration though. ;-)
How to get a cramped nurse's station all to yourself
The other day for some reason it wasn't busy on the critical care side of the ER. Our ER is divided up into critical care for things like chest pain, stroke, GI bleeding, sepsis, or anything else that requires a lot of nursing/doctor time. All non-critical things go to the larger non-critical care side, unless someone is just really off on what one is supposed to visit an ER for; these people go away into the corner known as 'urgent care' (sniffly nose, muscle pain, earaches, etc) to see a nurse practitioner.
We on the critical care side were taking tons of miscellany, 23 year olds with appropriately scare-quoted "chest pain" and even a woman who had a few seconds of chest pain "yesterday" but decided to be seen a good 24 hours later when she was pain-free. In other words, we were just chillin'.
Well, both 'House' AND 'American Idol' were on last night. Duh.
The 'nurses' station' sounds very official, a hub of activity. Perhaps other places. For us, it's a little cramped area of 5 or 6 chairs smooshed next to each other which is populated with a heart monitor, computers, printer, etc. If one wants to sit down to chart something, you have to sit on someone else's shoulders because there isn't anywhere else to sit. Surrounding us is sound-proof glass 'to preserve patient confidentiality', or as we see it, block out the F-bombs, group taunting, and other such things other people wouldn't find professional.
Our illustrious ER staff was gathered in the nurse's nook, a happenstance group of some of the better taunters and/or people concerned with not populating one's rectum with sticks and other detritis. We were crackin' jokes, talking to each other in funny accents. I was doing Marge Gunderson from Fargo, for example.
There's no cause to get snippy with me, I'm just trying to do my job here. ---Marge
We were on a serious roll, including the doctor. We were all laughing hard, but the doctor took it to the next level. In the middle of a good roaring laugh, the doctor let one rip. LOUD. UNDENIABLE. TOOOT. Of course, this made us all start crying-laughing.
The doc cleared it out. More for effect than from actual stinkiness, everyone exited in an orderly fashion, as if in a fire drill, bombing him with last-second goofy insults and taunts on our way out. Yes, this is how we treat our doctors; you really have to be working in an ER to understand.
We on the critical care side were taking tons of miscellany, 23 year olds with appropriately scare-quoted "chest pain" and even a woman who had a few seconds of chest pain "yesterday" but decided to be seen a good 24 hours later when she was pain-free. In other words, we were just chillin'.
Well, both 'House' AND 'American Idol' were on last night. Duh.
The 'nurses' station' sounds very official, a hub of activity. Perhaps other places. For us, it's a little cramped area of 5 or 6 chairs smooshed next to each other which is populated with a heart monitor, computers, printer, etc. If one wants to sit down to chart something, you have to sit on someone else's shoulders because there isn't anywhere else to sit. Surrounding us is sound-proof glass 'to preserve patient confidentiality', or as we see it, block out the F-bombs, group taunting, and other such things other people wouldn't find professional.
Our illustrious ER staff was gathered in the nurse's nook, a happenstance group of some of the better taunters and/or people concerned with not populating one's rectum with sticks and other detritis. We were crackin' jokes, talking to each other in funny accents. I was doing Marge Gunderson from Fargo, for example.
There's no cause to get snippy with me, I'm just trying to do my job here. ---Marge
We were on a serious roll, including the doctor. We were all laughing hard, but the doctor took it to the next level. In the middle of a good roaring laugh, the doctor let one rip. LOUD. UNDENIABLE. TOOOT. Of course, this made us all start crying-laughing.
The doc cleared it out. More for effect than from actual stinkiness, everyone exited in an orderly fashion, as if in a fire drill, bombing him with last-second goofy insults and taunts on our way out. Yes, this is how we treat our doctors; you really have to be working in an ER to understand.
Tuesday, March 6, 2007
An important ER skill: How to fabricate fake poop
Kleenex, betadine, and a strong, heartfelt desire to create a life-like work of art is all one needs.
Sunday, March 4, 2007
Homemakers, the frazzled women who arrive at 3 am with a collection of 8 complaints
Homemaker (n.): An impoverished or frazzled-appearing woman, usually with many allergies, many health "problems" (eg daily migraines, fibromyalgia, ovarian cysts, chronic pain syndrome, depression, anxiety, polymyalgia) for her stated age who doesn't work and is on state-funded medical assistance. They are called "homemakers" since they often state this as their job when prompted by registration. No one with a true health complaint worthy of an ER visit is referred to as such. Homemakers characteristically show up at odd times of the night and rarely, if ever, list a "spouse". See also: Cross-pollination, drug seekers.
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