Lead bitch

Lead, like the metal.

Our ER docs are trained in placement of transvenous pacers, which is an awesome thing to watch, way more awesome than transcutaneous pacing which is soooo 2005. To set up the procedure, you need the pacer box, the thing that looks like a central line to thread through the veins along with associated sterile gowns/gloves, etc, a special fluoro cart for the patient to lie on (so the fluoro arm can fit under it) and a portable fluoro arm and fluoro tech to run it. Or if you're doing it how I do it, push the lines cart into the room and hope everything's where it's supposed to be and that the ER doc can find it all. Since placement of the transvenous temporary pacer includes the need to use fluoro, everyone in the room needs a lead vest to shield themselves from the Xrays.

And when there's cool crap going on the ER, people come out of nowhere to make an excuse to watch. Med students, nursing students, Xray tech students, doctors, residents, more doctors, respiratory, five nurses.

"Nurse K, follow me! We need to get the fluoro arm!" said a tech.

Sure! An enthused nurse, am I; I'll help you push the fluoro arm!

I'm thinking I'm going to be grabbing the fluoro, but, no, I was apparently summoned to be the "lead bitch". Lead, like the metal.

"Here, there's like 10 people in the room, grab some vests, Nurse K."

Uh, sure! One, two, three, um, four, ugh, shit, five....six....fucking A this stuff is heavy, sheesh, I'm just some skinny white chick, why do I have to be lead bitch? Don't you work out? I sure don't.

Then I started putting vests on the chick pushing the fluoro arm and throwing them on top of the machine itself. Meanwhile, of course, the patient was crashing and we only had a minute to get what we needed.

So, yeah, peeps. One skinny white nurse, ten lead vests in one trip. If you get summoned to "help get the fluoro arm" just know that you're about to be designated lead (like the metal) bitch. I suffer so you don't have to. Maybe bring a little cart with you or something. Gr.

****Friendly reminder****

Vomiting x 1 is not an emergency!

Happy Thanksgiving!

Congratulations to EE

...on her new baby! I remember when that chick emailed me about it for the first time. The baby widget, the vomiting, the swelling, PO reglan, urinary frequency...

If you're a hospital security officer...

...sitting outside the room with the curtain half-closed while a labile EtOHer pulls his line out and gets out of bed without you being aware of either of those incidents, I'm writing you up and telling your boss in person you're a layzee piece of crap. It also means you're cleaning up the blood splatter all over the room.

Just so you know.

Sitting 15 feet outside the room and refusing to enter the room when I go to give meds to calm the bastard down is another reason to write you up.

Just so you know.

Why the Hell did I ask you to come down and help again? May as well just get slugged in the face and get it over with so they'll let me go home.

Confession

I cried today at work. I couldn't handle the bullshit. The patients I could handle, it was the bullshit that I couldn't. That's different.

Could anything just get done without me having to fight, beg, and plead? Could somebody on the floor just take my fucking patient and not try to pass it off on everyone else and stall? Can security actually watch my patient who just tried to punch the PA in the face, yah know, the one you decided didn't need to watch my patient when I said he did? Do I really need to approve this with the security supervisor? Are you the the fucking nurse or am I? Can the doctor order the labs correctly? Can the doctor not tell me "I ordered that because that's the only choice the computer gave me on the standard orders and don't know how to change it"? Can the Pyxis machine not break? Can the lab not lose blood? Can somebody take one of these ambulances or do I really need to take three in a row in 15 minutes? Can someone not put a bunch of critically ill people in my non-monitored rooms? Can somebody draw this lady, it's been two hours. Can I eat some lunch or something? Does the CEO have to stare at me when I'm trying to admit someone? If you're going to be down here, clean some rooms or something. Do we really need to admit the chick that keeps putting her light wanting her "crotch scratched"? Do you really think this "little old lady fall, been on the floor for hours" isn't going to be a critically ill patient? Oh, look, HR of 180, yes, another fucking critical in one of my 5 rooms.

Fucking fuck fuck. Fuck this shit. Fuckity fuck fuck FUCK GODDAMMIT.

More on tubing people

I saw some anesthesiologist attempt to tube some ueber-hypertensive guy who had a brain bleed but wasn't exactly out for the count yet. Dood was choking on the tube: Gag, gag and was awake, hypertensive but stroking out, yah know. No RSI meds nor other sedation had been given.

Me (coming in to help/assist a bunch of other people and find out why somedood behind a curtain was gagging and making choking noises at the top of his lungs): [Takes 5 seconds to figure out what was going on] Uh, he's choking on the tube, doc, can we drug him first? [This was not said meekly, let's just say]

Anesthesiologist: Do you want the airway secured or not?

Me: He's going to vomit and aspirate? He needs to be sedated![Five people in the room including the ER doc stare at me who'd just arrived on the scene calling out the anesthesiologist]

Anesthesiologist: Fine. Get etomidate, sux, and versed then.

I've never seen anything like it before or since. Who is this, some CRNA student on the first day of clinicals? No, an anesthesiologist! I was so shocked that I stared at his nametag and made sure his face matched the face on the nametag. The Hell?

Call it what you want, but I, essentially a curious passerby, had to step in to be like "what the f*ck" when five other people including a doc were in the room. If you're a social psychologist, the fact that I hadn't been in the room prior to hearing the guy gag is probably why I was the one to speak up. I wasn't part of the group caring for the patient.

Anyway, Dood got sedated, his bp went down oddly enough after someone stopped shoving a tube in his throat while alert, and life carried on as usual.

So, the moral of the story is: Dood was bleeding in his brain for shitsakes and somedood who was supposed to be an expert on airways was shoving a tube in his throat without sedating him first. Call that stuff out even if dood is an "expert". Don't watch that and say nothing even if you're "just" a nurse and not even the primary nurse. If you're the doc who called the anesthesiologist down, it's still your patient too.

Classroom drama

I was in some class the other day that had emergency nurses from all over my state and a couple of the neighboring states too.

During one of the breaks, somebody was discussing (read: bitching about) medication reconciliation and one of the suburban ER nurses casually chimes in, "Oh, our emergency department pharmacist does ours; I haven't done one in awhile."

If you want to witness an event that throws a group of nurses into a jealousy-mediated riot-caliber tizzy fit, apparently all you have to do is mention in a crowd of ER nurses that there is someone else besides you at your facility whose job it is to do the med-rec form.

HEY WHY DO YOU HAVE THAT AND WE DON'T!?
WE HAVE A PHARMACIST BUT HE DOESN'T DO MED RECS. WTF?
WHERE DO YOU WORK AGAIN? YOU ALL HIRING?

People were standing up and literally shouting across the room. Chairs and Starbucks travel mugs flying. Awesome. FU med recs!

Outside-the-curtain conversation to remember

So this lady is brought in by EMS, and I recognize her as a frequent flyer. She's not really a drug-seeker frequent flyer, but has been diagnosed by our ER docs with things like "loneliness", "early dementia or depression or something", "bored", "needs a puppy" and other such things. She'll call 9-1-1 if her morning BM was looser than normal or her chronic cough was more harsh for a day, stuff like that. Nothing is ever REALLY wrong with her.

The chief complaint was atraumatic knee pain. Gee, I woke up and my knee was sore. Holy crap, not that. She already had vikies and ibuprofen at home, but didn't think to try either prior to calling 9-1-1 of course.

Medic report went something like this:

Patient complaints of knee pain in her left knee, that's about it. No trauma, swelling, bruising noted. CMS is intact. She was able to ambulate to the stretcher without trouble. Medic control said to bring her in due to her age and possibility of a fall she doesn't remember.

Then the medics did the "come here" and led me outside the curtain. Outside-the-curtain conversations usually are "the patient's house was a pit" or "the house smelled of methamphetamine" or "the patient had rotten food everywhere with a mouse or two spotted" or something like that. But, no, not this time.

When we arrived on the scene, the patient's husband was dressed in a lacy, purple satin woman's nightgown and a pink robe. He also had a couple curlers in his hair and fuzzy pink slippers. That's not relevant, but it was weird.

Okay, sounds good to me, where do I sign?

Oh fuck

...were the words I uttered when my [monitored] previously alert and oriented head trauma patient returned from CT and his rhythm came back up on the screen at my desk. I hate seeing really oh-fuckish rhythm changes in head trauma because you know when you go in the room, yep...

Decreased LOC. HEY! WAKE UP! HEY!

I hope you're okay, Old Dood With Head Trauma.

How to cheer up your co-workers

As we all know, downtime in the ER on night shifts turns weird fast. If you want to cheer up your co-workers during a similar episode of downtime, play this song at 4:30 am on a slow night shift. It's a crowd favorite, especially if you don't warn anyone what it's about. Warning: Be sure there aren't patients in earshot nor uptight staff members/bosses/JCAHO in the vicinity. I had Dr. WTF in tears laughing his ass off (which is why we played it in the first place), and he actually stayed out of the back room to listen to our playlist of ever-increasingly more raunchy and inappropriate music.

Always check anal sphincter tone

MDOD's Old Fart is back in action after a traumatic brain and neck/spinal cord injury caused by a cardiac arrythmia. I mean, what the Hell, cut the dood some slack, World.

If you understand to what the title of this post refers, you're either sick and wrong or trained in trauma assessment. If you're curious, OldFart probably had what is referred to as "spinal shock" following a traumatic spinal cord injury. Remember kidz, if your patient is paralyzed upon arrival to your ER, don't give up hope right away. It might not be a complete cord a la Christopher Reeve; it might be spinal shock, and he'll be up practicing emergency medicine in no time or, I guess, relatively no time...

Way to go dood!

I hate fake days off

So, I've been on a string of nights and today is a day "off". I celebrated my day off with a 0730 Happy Hour then went to sleep at 1130. I got up at 1600 permanently.

Basically, I purposefully got 4 hours of sleep when my body demands at least 8, but I have no choice in the matter for today is....

A FAKE DAY OFF.

I have to be back on day shift at 0700 tomorrow, so, whatever, I have to attempt to both accomplish stuff and not fall back asleep. I'm sitting here in some sort of hallucinogenic haze thinking about maybe doing some laundry, but that sounds like too much effort. I desperately want a nap, but that would jack up my sleep schedule, and I'd be up until 0300 or something. So, whatever. I'll just sit here and read blogs.

I hate fake days off.

Crayzee link of the day

Crayzee in love!

Detective Nurse K uses med list and paranoia to crack the case

There was a non-English-speaking patient that came in on one of the busiest night shifts I've ever worked at some awful hour with upper abdominal pain with vomiting and a med list with five meds for BP/cardiac, sublingual nitro, two pills for Type II diabetes, something for reflux, a Vikie script, and a cholesterol pill. She was not in our system anywhere, so she had no medical nor surgical history entered into her e-chart. Her broken-English-speaking daughter knew she had "diabetes" and that was it. Blood pressure was 210/115 in triage and she looked yucky and was dry heaving.

Via interpreter: Blah, blah, blah, my pain is right here. I can't eat, I'm nauseated!

Me: [Looking at crayzee-long med list] What heart problems do you have?

Patient: I had something wrong with my heart in 1994 but I got medicine and that's better now.

Me: What was wrong?

Patient: I don't know.

I get the rest of the story: Pain got gradually worse all night, started feeling nauseated. Doesn't feel like pain she's had before, is constant, no black/bloody stools nor blood in her vomit, feels like it's hard to catch her breath a bit "because it hurts". Not super tender in the right upper quadrant or epigastric area.

Now, let me tell you, this patient would have been fifth in the rack for a doc who was moving at about 1-2 patients per hour, so she would have been seen by the oncoming day shift doctor probably two hours later. I'd been getting verbal orders all night for my patients. I'm like, hm, gallbladder, gastritis, but...diabetic, middle-aged, hypertensive female who has nitro on her med list for some reason....

*Paging Overhead*: EKG to room 12!

The aide came to do the EKG while I spent the next five minutes assuring the patient via interpreter that I understood that her "stomach" hurt and not her heart while putting in her IV and giving some morphine and zofran.

Well, what do you know? An MI. Go me, go me, go me....

I did a victory dance, cath lab came, then I cleaned the room and took my next patient: A chronic back paineur who couldn't sleep due to the pain and ran out of his Percocet prescribed three days ago at his last ER visit. I let him be fifth in the rack for the next doctor without any verbal orders.

Evolution

There was this one dood fresh out of residency who our ER doc group hired. Hot shot, taking asstons of patients, hilarious, smart, fun to work with, not layzee, etc. If a nurse saw that she was assigned to his side, whew, big sigh of relief.

Now, something has happened a couple years later. It turns out he is evolving into a big work-up doctor who can't dispo anyone. He's unsure of himself. Ordering lots of tests on rather benign-appearing patients. He's not unpleasant, but he hides in the back room and charts, rarely talking to the nurses or staff.

In 10 years, he'll probably be a full-fledged "one of them"s (ie the docs I bitch and moan about all the time). What happened to you, dood?

Just throwing this out there...

Maybe it's just my ER, but what's the deal with male ER doctors dressing like their only source of clothing is the discount rack at the thrift store? Whenever I see somedood walking around in a ratty old T-shirt and torn up old Levi's out in public, I think "must be an ER doc." Given the number of ERs per capita in my area, I'm usually right too.

There was one particularly bad dresser in my ER and one of the aides "adopted" him and took him to the mall. Now he looks more tolerable and is maybe a little more confident overall. This has been an inspiration to my altruism. I think maybe I should start some sort of nationwide movement:

ER NURSES FOR ER DOCS' FASHION SENSE

Go to the hair salon (not CostCutters), introduce him to styling products, take him to Bloomingdales. Nice cologne (not Old Spice). Anything. Just do something, nurses; step up to the plate. Adopt a ratty T-shirt-wearing ER doc today!

No, I will not drug your roommate so you can have sex

KevinMD linked to an article from a patient blog called "Duncan Cross" supposedly about a guy who has Crohn's disease. He talks about his desire to have sex in the hospital while admitted, so if you want to hear about some dood having sex in the hospital, click the link. Otherwise, run away screaming. He lists some tips to having sex in the hospital, most of which creep me out:

• Don’t look to the nurses, medical staff, or other patients as potential sexual partners. Oh, why not? Am I not attractive enough for your high standards?
  
• If you have a roommate, you can suggest a night-time dose of diphenhydramine [Benadryl] to help them sleep. Once they’re under, you have at least an hour of relative privacy. If you suggest that I give a sleeper to your roommate so you can have sex, I'll tell you it's none of your damn business what I do or do not give your roommate for sleep and your desire to doink in a double room separated by a curtain is not a "PRN" reason for Benadryl. Sorry. That is what we refer to as "malpractice". Also, if you want some "private time" in a double room, whatever, I'm not going to not tend to the other patient in the room as well. You're not the only one in this hospital.
  
• Barring that, the showers in most hospital rooms have a sturdy fold-down bench. A few towels can make it more bed-like. Gross. I'm guessing you'll want me to soak up the spooge too when you're done?

Crohn's disease sucksass and can cause pain and diarrhea, but, yo, if the pain and diarrhea and/or surgical resection of your colon isn't enough to keep you from getting it on at my workplace, then, hey, guess what? Congrats. Probably time for discharge. Talk to your doctor in the morning.

While you say that you have a right to be "human" in the hospital up to and including sex, I also have a right to not be confronted with you having sex when I'm just trying to pass meds and keep you from dying of some sort of surgical complication. Imagine me showing up at your job and deciding, in between diarrhea stools, to have sex in your office. Your hospital room is not your house.

Thanks for giving me flashbacks to the time my two Down's Syndrome patients on the same unit "hooked up" and the time a lady was straddling her dood while actively miscarrying, by the way.

In short, eeew. No sex in the hospital. Hold hands for Crapsakes, whisper softly in your lover's ear that you love them. People don't do that anymore and they should. Now's as good a time as any to start.

Night shift concert

As any ER person knows, night shifts without patients can turn weird in no time. For instance, one night, an otherwise unmemorable conversation about our best friends turned into a discussion about friends who had weird pubic hair. In any other workplace on Earth, patientless night shift conversations would get us all fired, but, whatever, not in the ER.

So, on one recent patientless night shift, we decided to mix it up and have a concert. Everyone went to their cars and got CDs. I sang a couple of solos then did a duet with another nurse in the middle of the critical care hallway of the following song, complete with cheerleader moves and urinals as "pompoms":



The best part of working in the ER is not working in the ER.

Emergent chief complaint of the day

19 year old female's chief complaint: "I was walking around all day at da mall and now BOTH of my feet hurt!"

The patient removes her shoes and shows me a little redness where her whore-shoes hurt her feet.

I guess this life-threatening pinkness on her foot was supposed to shock me and/or make me feel sorry for the patient who can go to the mall and shop while I work hard in a dirty-ass ER to pay for her "insurance." Good thing she rushed to the ER when she did; she was on the cusp of needing a band-aid and possibly a little bacitracin. It could have gotten ugly. Oh, and please never remove your shoes in the triage area again.

"Okay, but what's the reason you came here to the emergency room today?"

"That's why! My feet hurt! They really sore!"

Okay, whatever, have a seat. We'll give you the therapeutic wait---off your feet, yah know---until you sign out.

Amazingly enough, having sore feet after shopping wasn't worth the three-hour wait.

Fast Track + Students + Dr. Big Work-Up = Slow Track

Q: What's a good way to turn your Fast Track into a SLOWWWW TRACK?

A: Assign Dr. Big Work-Up back there with a NP student.

A perfectly well, ambulatory "twisted ankle" patient does NOT need a 30-minute student discussion/H&P then a 20-minute patented Dr. Big Work-Up H&P, an XRAY (Ottawa Ankle Rules anyone? No?), then a 20-minute discussion with the student regarding treatment of twisted ankles, complete with medical reference books being busted out which delays discharge even more. Following the perversely lengthy discussion on said inane topic and 50-point review of the normal XRAY, then the entire medical work-up for the student and the doctor must be entered into the computer, taking about 15 additional minutes. Then he must sign the scripts and enter the discharge instructions (which I already did, but he, of course, has to type a paragraph of his own to reiterate the standard instructions). Then I have to fight with him about his discharge med selection (Vikies for a 100% normal-looking/non-swollen "twisted ankle"?!) because, through all this time, he never bothered to read the patient's chart and learn that he was a frequent flyer and known drug seeker. Then he and the student must go back into the room and give the patient verbal instructions.

If you people know me, and you do, you'll know that my patience shrunk two sizes that day. This is him with a made-up problem patient with zero findings on exam. Imagine him on a patient with a real problem.

Let the CRAYZEE begin!

Sorry for a political post, but this, from Obama's website, is too good to pass up:

Obama will call on citizens of all ages to serve America, by developing a plan to require 50 hours of community service in middle school and high school and 100 hours of community service in college every year. Obama will encourage retiring Americans to serve by improving programs available for individuals over age 55, while at the same time promoting youth programs such as Youth Build and Head Start.

Yeah, requiring 100 hours of community service each year of college sounds like a great idea to keep people out of college. Some people have to work to survive in college, like, well, me, who had to work nearly full time to support a child and barely provide just the basics, and, sometimes, not even that. If I oxymoronically "had" to volunteer or else not be allowed to continue, I'd still be flingin' trays at the white trash nightclub that I worked at instead of talking to you people about nursing. Either that, or I'd have had to quit my secretarial job which provided my family's insurance and went on Medicaid and cash assistance.

I mean, I worked at the bar until 2 am, came home, slept for 4 hours, went to class, maybe did a secretary shift, did homework until 3 am, slept for 4 hours, did my $6.75/hr student job in the lab, went to class, did homework, worked in the bar from 5pm-2 am, slept, woke up at 6 am for clinicals, did that, fell asleep on the couch with some sort of death headache, went to work again...WHAT THE HELL OBAMA? College students aren't all jobless, wild rich kids with nothing better to do.

Thank God that I got into college before I had to fight with Obama about how the best way was to spend my time. Good luck all you nursing students with children who are looking to move up from CNA to RN, it's going to suckass for you if this crap passes.

H/T to Ace.

Shut up about....

(1) Flu shots making you sick. No, dumbasses, you're sick because everyone is sick with a cold this time of year and you just happen to be getting the flu shot at the same time as your "illness". This is why it's called the cold and flu season and why we don't get flu shots in the summer. Don't cry to me about your sniffles when you catch the real flu and need to be intubated.

(2) Barack Obama being the first "black" President. No, he's the first biracial President. I've started calling him the 44th white President just to even things out a bit and piss off Democrats in the process. He's just as white as he is black, people. Even though I think the guy's policies are silly and irrelevant to being the commander-in-chief like "wanting 10% of cars to be electric plug-ins by 2015" and then in the next sentence wanting people to reduce electricity usage, let's just settle on "the next President", Kay?

(3) "America has voted for change." Duhrrrrr. President Bush can't have a 3rd term, so, obviously, whoever wins is going to change who is in office. If McCain won, America STILL would have been voting for change. By the way, "America" doesn't vote for anyone.

(4) Lacs. If you've been a doctor with our hospital for 25 years and STILL don't know where the supplies are to set-up a lac repair, you suck. It's all in the same cupboard, the same cupboard you're standing by. The lac trays are still in the lac cupboard. The 5-0 nylon is STILL in the lac cupboard too. You don't need me to draw up the lidocaine for you either; your hands work just fine. You are scatterbrained and you're annoying me. I'm a nurse, not a lac babysitter. Note how I put the patient in the "lac room", the same room as the lac cupboard. If you have any sort of deduction skills, you'll note how there has been a very oddly-similar patient population in this lac room to include patients needing lac repairs.

(5) The cost of airline tickets when you're a doctor. Um, doc? That round-trip airline ticket to Europe costs LESS than you make in a shift. Just go there if you want to go there. You'll have fun and won't be so stressed out all the time. You worked your ass off to have a certain lifestyle, now go live it.

(6) Your weight loss surgery. I'm sick of listening to co-workers talk about the surgeries they needed to lose 200 pounds. Really, it's kinda gross that you needed surgery to lose weight, and I'm trying to eat lunch. It's not really an accomplishment to lose weight when your stomach was surgically made the size of a grape either. What about all the people who are always in shape because they bike to work, walk on their breaks, or go to the gym? I want to hear about what they're doing, not your surgery. If the conversation moves on to post-gastric-bypass panniculectomies, I'm going to eat somewhere else.

Prozac

Dr. Republican: I was on Prozac the entire Clinton administration. If anyone needs anything after this election, I'll be glad to write for it...

Nursing student education: Wang issues

I had a male nursing student with me today.

Me: Hey, let's go grab this dood with the wang issues.

Student: Um...wang issues?

Me: Yeah, wang issues. It's ER tradition that male nurses and doctors take all the wang issues whenever possible. There are no male staff nurses on today, so we're the best he's gonna get.

If you're a male nurse interested in ER, prepare to look at a lot of funky schlongs. It's tradition.

Ghetto Fab: Vote Handouts!

As we all know, those with no tax burden will be getting checks/handouts/tax "rebates" despite not paying any taxes under Obama. I had a potential Obama beneficiary in recently and it was nearly the most ghetto conversation that I've ever had and that's saying something.

Me: What are you here for today?

Patient: I'm coming here for a FREE PREGNANCY TEST AND FREE STD CHECK.

Me: Do you have a clinic?

Patient: WELL I AIN'T GOIN TO NO CLINIC, I GOT MEDICAL [welfare] AND I CAN GIT A PREGNANCY TEST HERE IF I WANT AND I'VE DONE IT BEFO SO DON'T TELL ME YOU DON'T DO NO FREE PREGNANCY TESTS. I DON'T WANT TO WAIT FOR NO APPOINTMENT.

Me: You're more than welcome to be seen [F-U EMTALA, NO SHE'S NOT, I HATE HER ALREADY]. When was your last period?

Patient: TWO WEEKS AGO, WHY YOU AXING ME ALL THESE QUESTIONS, I JUST COME HERE FOR A FREE PREGNANCY AND STD TEST.

Me: What makes you think you're pregnant if you're last period was only two weeks ago?

Patient: I PUKE LASS WEEK NOW I WANT MY FREE TEST.

Me: Young lady, you need to calm down and stop raising your voice to me. Everyone who comes in has to answer all these questions.

Are you having vaginal bleeding, abnormal or foul-smelling vaginal discharge, or do you have any partners that have been diagnosed as having an STD?

Patient: NO I JUSS WANNA GIT CHECKED OUT. I AIN'T GOT NONE OF THAT.

And on and on until she signed out without being seen after a 2.5 hour wait. I mean, really, do you really think we're rushing you back? I must've said "young lady, the emergency patients get seen first, the time you're seen is based on the severity of your problem not how long you've been here..." a bajillion times to her.

Go OBAMA! This lady obviously needs more money because she can't afford a $1 pregnancy test nor a trip to the free clinic. Paradoxically, her cell phone and new purse were better than mine though, and I know because she spent half the triage assessment rifling through her purse for makeup and answering texts.

Update: 2215 11/4: CNN is calling the election for Obama. I'm celebrating by robbing a doctor in the physician's parking lot and giving my loot to someone who didn't pay a dime of taxes. I mean, those doctors really don't need their money! Just because you have a fancy degree doesn't mean you have a right to any of the money you earn.

Deaf people

I'm announcing for continuing education purposes that functional, lifelong deaf people (ie with the ASL interpreter and who generally reside in the "deaf community") don't go to the ER unless there is something wrong that will require surgery and/or admission. Keep that in mind.

Advice please

When you KNOW someone is repeatedly signing in to your hospital under different names, birth dates and/or fake social security numbers, should you call the police?

Is there anything ILLEGAL about intentionally signing in under a fake name seeing as we have to see everyone no matter what? She's obviously a drug seeker because her chief complaints are always like toothache, back pain, or assault with no injury seen. She never has ID nor anything with her name on it, so who knows what her real name is.

Stroke...toothache....whatever

Some little punkass kid signed in "stroke" at like 3 am. He said his face was tingly and was having trouble walking. Hm...really? I mean you walked right in just now, no problems.

Turns out he just wanted to be seen for a "toothache"/narcotic deficit and didn't want to have to wait for a long time. If you want to just make stuff up, sure, whatever, people fake sh*t all the time, makes my job more interesting. Just don't make our lives harder for us when THERE ARE NO OTHER PEOPLE IN THE LOBBY AND ONLY THREE IN THE DEPARTMENT TOTAL because you just end up looking like a total tool.

I hope your Ibuprofen is helping your fake toothache!! Come back anytime, Mr. My Chart Will Aways Show That I Faked A Stroke to Be Seen for a Toothache Guy.

Charity care Fs over our hospital

Our hospital is in the 'hood and provides charity care for the privilege of not paying taxes. Problem is...charity care is spiraling out of control.

In 2006, we provided 15 million dollars of "free" care to our patients. In 2007, that was up to 20 million. In 2008, we're on pace to hit 39 million dollars of unreimbursed or charity care, made worse due to overall volume of charity cases as well as people paying their health care bills last, if at all (a known economic phenomenon, especially in a faltering economy).

Needless to say, we're laying off left and right and we have been forced to cut a nurse from night shift, so I guess I'm going to have to get used to these seven and eight patient assignments that we get when we're "short" because that's going to be a permanent thing.

Thank you, EMTALA. Thank you people who think health care should be a "right" because, um, your "rights" to narcotics for migraine, CT scans for gas pains, and a work note for a stuffy nose are going to bankrupt our hospital eventually. You'll still have "rights" to health care after we're done with, but those will have to be exercised at County and we all know you don't want to go to County.

Guess what? You all are in on this too. Let's take a moment here, dear readers, and think about ways we can help our hospital budgets and decrease the cost of health care. If you see something going on that you know is wasteful, write a little note to your manager suggesting something different.

For instance, in our hospital, Zofran is the only anti-emetic that we can pull out of the drug machine without pharmacist approval, and it's one of the more expensive ones out there, even though it went generic a couple years ago. We hate waiting around for compazine, phenergan, reglan and droperidol to be approved, so the doctors write for Zofran much more than other drugs. This is an example of something stupid that is needlessly raising the costs of health care. Also, obviously, having a pharmacist involved at all raises the cost of health care, but, I guess, our hospital wants to do it that way. Hell, we even have ODT (oral dissolving tablet) Zofran in the drug machine which is $20 PER PILL when Reglan is pennies.

It's better to not get paid for a penny-pill than a $20 pill.

Do your patients REALLY need that bag of normal saline for emesis x 1, doctors? Do they REALLY need that XRay of the ankle they walked in on? Do they REALLY need that single dose of antibiotic prior to discharge for a UTI? Do they REALLY need their third abdominal CT this month?

Do you REALLY want to not have a job?