Stupid fights at work: It ain't me, babe

So I had this young, unfortunate lady who had just decided to transition to hospice/comfort care only for metastatic cancer "everywhere". She was to go home from a nursing home later that day with hospice but made a little pit stop in the ER for some irritating but treatable medical problems. She was still a full code...sorta...the nursing home documentation said full code, but the patient's husband said no code; to me, that means full code, sorry, unless you change the order in the chart, I'm going by the official legal documents.

Anyway, she was there for something else, but had her usual severe chronic pain, and wanted something for breakthrough pain. I think she was on something like 200 mcg Fentanyl patches along with some buffalo-killing dose of oxycontin.

So the order came back as...6mg dilaudid IVP and 2 mg ativan IVP.

Me: Uh, how much dilaudid do you normally get for breakthrough pain in the hospital?

Patient: 2 milligrams I think.

Husband: She usually gets 2 mg then maybe more later if it's still bad.

So, anyway, I ask the doc if we could change the order to 2 mg since the patient basically lived in the hospital and knew what dose worked and, even for a narcotic-dependent person, I've never given 6 mg of dilaudid in one dose (which is, by the way, the equivalent of 60 mg of morphine in addition to her extremely high-dose Fentanyl patches and oxycontin).

"She's on hospice."

"Yeah, she's a full code, plus I'm pretty sure she'd respiratory arrest with 6 mg of dilaudid and 2 mg of Ativan. That's euthanasia, and I'm not doing it unless you can show me something that says she has tolerated that dose in the past for breakthrough pain."

"She's not a full code, and that's the dose I want."

"Well, unless you want to write a DNR/DNI order, she's full code. I'm not bagging her for 6 mg when she only wants 2 mg."

"She's a hospice patient!"

"She wants only 2 mg, and I can't give her only 2 mg unless you change your order; otherwise, JCAHO and the state say I'm prescribing!" *

And on it went for nearly ten minutes.

Are you really going to fight me over euthanizing or at least killing the respiratory drive of an alert and oriented but painful hospice patient with her teenage daughter and son in the room? It ain't gonna be me to finish her off, babe.

RIP.

* Yes, kids, you can't get an order for "6 mg dilaudid" and decide to only give 2 mg on your own any moreso than you can change someone's lopressor or Rocephin dose because you feel like it. That's illegal. Remember it: JCAHO is Watching.

Nurses: Please don't ever do this

So, our ER is bigger than a porn star's hoohah; ergo, our staff members must carry portable phones so that we can have some sort of rope? fuzzy handcuffs? nevermind? tethered to us at all times. Triage nurses are expected to keep the rooms full. When a room is empty and we notice it, we're supposed to put a new patient in the room if the nurse assigned to the patient didn't pick their own patient for the room. We call ahead from the desk on those annoying telephonic encumbrances to make sure the nurse can take a new patient. Most nurses are happy to have someone retrieve and walk a new patient back for them so they're gowned and gloved and blanketed and hooked to the monitor or whateverthefuck.

However, you'll know right away who the evil nurses are if all you do is make phone calls from triage. Here is one example from a nurse who hates her job:

Me: Hi, it's K...couldja....

Nurse Hate: I'M ON BREAK! /hangs up

Oh, okay, hm, no "hey, call so-and-so who is covering"? What am I, your ex-husband? Sheesh. Don't hang up on your co-worker like that!

The big-assed zit

So, sorry to break this to all the guys out there who think I'm practically perfect in every way, but I have this huge-assed zit on my face right now. Like, I mean, Puberty is even humbled by its enormousness. When I go shopping, junior high school girls at the mall are looking me in the eye with that saddened, silent empathy and performing the courtesy nod. We're in this together, they say non-verbally.

At some point during the night while at work, probably after 3 am when people (me included) start getting weird and bored in the mind, the zit took me over completely, and I was at its mercy.

Favorite Doc: "K, can you get a UA in room 15?"

Me: "The zit is amenable to that."

Favorite Doc:"K, how about setting up for a pelvic?"

Me: "The zit is a wee bit nauseated this morning, and will ask the aide to set up the pelvic exam as to not exacerbate its condition."

Favorite Doc:"K, what's wrong in room 11?"

Me: "Well, honestly, it's a boil the size of a frickin cantaloupe, and the zit is feeling threatened by the whole thing."

Good for a giggle or two at least!

Oops

Change-of-shift report:

Me: ...the patient was just here yesterday and got a pelvic ultrasound and abdominal CT that were negative, but the previous doctor didn't do a pelvic exam or cultures. She's having abnormal discharge, so I think that's what she needs...

Charge: Was there one done?

Me: No, not yet anyway, because it's Dr. Controlfreak, and I accidentally suggested she get a pelvic exam after I did my assessment.

Charge [disgusted]: Well, YOU KNOW BETTER THAN THAT! Maybe he'll just order the antibiotics without the pelvic, but, sheesh, K...[shakes head]

Buying stuff doesn't replace learning stuff

One thing that's always bothered me is the fact that doctors in my ER aren't expected to be able to intubate their own patients. If you can't or don't want to tube patients, you're not expected to become competent in this area; you're just expected to know the number for anesthesia. Luckily, I work in a big, old urban ER in a bajillion bed hospital, and there seems to be a CRNA or anesthesiologist just hanging around somewhere in the hospital not doing anything else pretty much each time we call them, so clinically, it's not a HUGE deal, I guess.

I kind of wondered out loud last night why this bothers me so much. Why do I cringe each time an ER doc asks the secretary to page anesthesia when someone is crashing? I think the reason is that it's just embarrassing and indicative of a lax attitude towards clinical standards and holding doctors up to them. Maybe I'm being melodramatic, but isn't intubation like 'ER doc 101'? AA-degree paramedics are supposed to be competent in intubation, but an ER doc is not? Paramedics can't call anesthesia, but our doctors can for every intubation? Nobody cares about this? What if there is only one anesthesiologist and he's doing an emergency OR case? Then what? Thumb up the ass and bagging?

Sure, we do quite well with door-to-cath-lab times, stroke protocols, and giving the antibiotics within six hours of arrival for pneumonia patients (*gag*), but for things that we don't measure by times or checkboxes, it's a little lax around this joint. We don't checkbox the docs on successful intubations.

If you can see only 0.75 patients per hour, that's how many you can see, and that can't be modified. The fast doctors will just pick up the slack.

If you can't intubate, you can't intubate, and that's the way it is.

If you don't know how to put in any type of line other than a femoral, you can put in all femorals.

If a patient has a migraine, just order whatever you want. Demerol 100mg , nubain 20mg, morphine 10 mg IM, or non-narcotic stuff. It doesn't really matter, does it? Whatever you want. If someone stubs their toe, 50 mg Demerol or a medical screening exam and discharge home with instructions to grow a pair are fine. No need to patrol that stuff, whatever y'all want.

So, given all this, I kind of giggled when I was informed that we now have a video laryngoscope for the doctors to use. As the lady who trained me on it noted, "The doctors who can tube will have a new toy to play with and those who can't will still call anesthesia. Just don't drop it in any water, kay?"

A new $10,000 toy to play with.

The battle of the bulge in the pants

So our friend Dr. Bloody Gloves was assessing--I mean, talking at--a male patient who had a complaint of a "bulge in his pants". Of course, when doods are around me, that exact same complaint seems to be quite prevalent, but moreso after work...in a nightclub...after a couple shots of Jag and three rounds of 2-fers. It's easily remedied by reducing the amount of blood supply to the affected organ which, in practice, means discussing health policy posts on Shadowfax's blog or reading about Happy's infertility issues* if you're in a similar situation, but I digress.

The patient said that he'd had this bulge in his groin off and on for a year or two, and it was hurting worse today. To clarify, this sounded more like a groin (inguinal) hernia than an overflowing of the Wangse or banana-in-the-pocket situation, and, sure enough, a tiny little...hernia, yes, a tiny hernia**...was staring right at me when I had dood drop his pants. Easily reducible. Nothing concerning other than a lack of outward signs of pain and demands for narcotics. Oh, and he hasn't had it fixed yet because he doesn't have insurance.

Oh, no problem on the insurance, so sayeth Dr. Bloody Gloves. Rather than telling him that there was no emergency here and giving him the surgeon referral and a boot out the door, he gave him a twenty-minute how-to on how to submit this ER visit as a work comp claim because it just so happened that he left work early to come to the ER.

But, Dr. BG, he just told me he's had it for two years off and on and usually inguinal hernias are not work injuries! But no, he insisted that it was illegal for work comp to not cover the hernia visit and he recommended pursuing it as a work comp claim. Apparently, Dr. Bloody Gloves'd be a bad lawyer too.

*If you still have wood after reading this stuff , you're a sick fuck

** Amongst other things

Non-urgent affective disorder

Knee pain, back pain, out of meds, doesn't have primary MD here with list of complaints, out of narcs, cough, cold, fever, sprain, strain, vag itching, 22-year-old females with sharpains, N/V daily and in first trimester of pregnancy, and other such nonsense complaints have been my specialty as of late, except for yesterday where my theme was "labs off or mental status changes in demented patients at the nursing home" with normal vitals.

So I'm sitting there today, waiting, waiting, waiting the standard slow-doc 0.75 patients per hour thinking "is it time to move on? I'm bored as F up in this joint." At some point, when I worked on the floors, I just declared that I was too bored to continue working there, and I landed into my exciting ER career. Adrenaline and dopamine were released with each sweaty kidney stoneur and MI, and I was content. Now, even an uneventful MI is boring. Yawn, cath lab, yawn, yawn.

Then it occurred to me as I got up to answer the call light in room 7 for the 5th time to assure him that he hadn't been forgotton: I haven't saved anyone's life lately. What the Hell? Sure, I gave $10,000 worth of IV NovoSeven, FFP, and 500,000,000 mg IV mannitol bolus to an actively-herniating coumadin-abusing head-bleedeur with a GCS of 3, but I haven't like saved a life lately. Not that people are just croaking on me or anything; I still have my streak going where no one assigned to me has died on my watch either on the floors or in the ER (except for a couple who were dead before they got there and remained dead after arrival).

Maybe this is the ER nurse equivalent of seasonal affective disorder. I just need a couple doses of "actively life-threatening" to keep me going.

In other words: Someone code for no reason, already. Someone have a dissection that I can beg a doctor to work-up. Someone blow out a AAA with an 8 minute race to the OR. Someone. Anyone. Now's the time. Your ER nurse is bored. Of course, I'll probably ruin my own fun by detecting the problem far in advance of it causing the patient to significantly decompensate where a resuscitation is necessary, but I can only hope.

I think Girlvet is morphing into me

Being unwilling middlemen in someone's drug addiction is not the reason we got into nursing, so it's no surprise that it contributes to burn-out when we're expected to abide by unreasonable and dangerous orders that have no basis in sound medical practices. Yes, you should refuse, dammit.

Fun fact about today

I triaged two asthmatics, three or four people with shortness of breath (none over the age of 24 or so), and the lowest sat I got was 99%. With a string of such boring Medicaid-y non-emergencies, I had to keep a running tab of something to keep myself from getting bored.

While today I chose to pay special attention to sats for young shortness-of-breath patients, there is an endless continuum of things one can pay special attention to for no reason other than it's boring signing people in unless someone does you a favor and collapses from an MI in the lobby or something.

Notably, amongst this cohort of those who didn't find it beneficial to arrive at a job on a Friday morning, the most egregious WTFity was the young man who had "asthma symptoms for a couple minutes yesterday but feels okay now". Uh, okay?

Today, moreso than usual, I was proud that my Medicaid taxes helped people to seek necessary health care services like work notes for asthma attacks yesterday and Vicodin for an afebrile sore throat x "2 weeks"*. America, I'm proud to call you my motherland. Or some shit.

* = Bloody Gloves was on, of course

Here's a new one

I had a frequent flying patient the other day who thought we were all just diaper-wearing, thumb-sucking noobies with a complete and utter lack of ability to know our asses from a hole in the wall.

The patient signed in with "med reaction". I looked at his exposed skin, lips, and breathing and, well, nothing abnormal. Probably going to be something stupid.

---

So what would you like to be seen for today?

Well, I was prescribed this the other day (shows me a prescription bottle with plain 500 mg acetaminophen in it) and I read the insert that said you can get "liver failure" from the medication. I would like to see the doctor so I can get something different because I don't want to get liver failure.

Oh, well, do you have liver disease?

No, I don't.

Did you take more of this than was prescribed?

No, I didn't take any.

Okay, just make sure you don't take more than was prescribed and you should be fine. Liver failure can come from acetaminophen--which is just Tylenol--if you overdose on it. Do you still want to see the doctor?

Yes, I was hoping to see if I could get oxycodone instead. That doesn't cause liver failure.

Okay, I see now. Have a seat.

----

Dr. Big Work-Up facility tour

Dr. Big Work-Up, as we've learned, loves students and was taking a new plain-clothes med student or resident or PA or NP or nursing student or volunteer or locum doc or whatever around the ER showing him where everything is, where to sit, where to get coffee in the morning, etc.

He brought his foundling over to where I was sitting and said the following, "This is K. She's another one of my bosses who tells me what to do."

Based on his spot-on observation regarding yours truly, I guess he doesn't totally have his head up his arse.

It's Dr. Bloody Gloves on caffeine!

An Arizona physician gets busted for what amounts to a Scalpel blog post-inspired drive-thru narcotics clinic:

Golden Valley, west of Kingman in Mohave County, is home to 5,000 people. Over the past five years, officials say, the town got some extra visitors every Tuesday, when [arrested doctor] Yeh opened the doors of his Pain Wellness Center on Arizona 68.

A steady stream of patients from across Arizona poured through the doors, they say.

Each one left quickly, only to be replaced by another.

Inside, officials say, Yeh was operating what amounted to a pay-for-prescription service.

For $200, a first-time patient could get a painkiller prescription. Returning customers had to pay $75 for a "refill" visit.

"Dr. Yeh did not practice medicine," Kempshall said. "He dealt drugs."

Yeh routinely wrote prescriptions for narcotics heavily regulated under the Controlled Substances Act, known as Schedule II and Schedule III medications. These drugs have documented medical uses but carry a high risk of addiction.

To prescribe those painkillers, like hydrocodone or oxycodone, a physician must take a patient's complete medical history, complete a physical examination and establish the presence of chronic pain. But on many days, Yeh's patients were in and out in an average of two minutes.

He billed insurance for 32,000 visits in five years and was only open one day per week! That's some talent right there. I mean, Scalpel takes five minutes per patient at his drive-thru Vicodin clinic...but he's an internist and we all know that, no matter what, dispositions are going to take twice as long, drive-thru, ER or otherwise.

Hat-tip to my pal Grumpy for the article via email.

SHARpains

I go on little streaks where one thing will annoying the snot out of me, like when people say "irregardless" or misspell "psych" as "pysch" like this one chick always does. Lately, I cringe each time I hear the term "SHARpains".

What brings you in today?

I'm having SHARpains in my side real bad!

How bad is your pain from 0-10, if 10 is the worst imagineable pain?

A ten!

Of course it is.

---

So...says here you're pregnant...how pregnant are you?

I just found out I'm pregnant yesterday.

Mm-kay, so what brings you in?

I'm having SHARpains in my stomach (points to lower abdomen) and I want an ultrasound!

There's a shar pei on your stomach? Down, boy, down!

No, SHARpains!

Oh. Sharpains. Yeah. Those. *Yawn*

How bad is your pain from 0-10, if 10 is the worst imagineable pain?

A ten!

Worse than labor?

No, not worse than labor, like a 9 and a half then! I think I need an ultrasound of my baybee!

---

So, looks like you have a cough?

Yeah, I got a cough.

So, what brings you in today?

Well the cough and SHARpains in my heart when I cough!

No, those are SHARpains in your chest. Your chest has muscle, bone, cartilage, and lungs too!

Well, it feel like those SHARpains is in my heart. I think I'm havin' a heart attack or somethin'!

How bad is your pain from 0-10, if 10 is the worst imagineable pain?

A ten!

---

Features of SHARpains: Always 10/10 pain. Always. If they're in the "stomach", don't assume they're in the stomach, although the anatomic thing known as the stomach is a SHARpains hotspot. They can be anywhere in the entire abdomen if they are described as being in the "stomach". If they're in the "chest", they are most definitely originating from the "heart", especially if you have a cough. If your SHARpains start after receiving a positive pregnancy test the day before, there is a 0% chance of miscarriage anytime in the next 24 hours and 100% chance of a stupid, unnecessary ultrasound. If your SHARpains start while eating a hamburger and Funyons, don't eat the frickin' hamburger and Funyons.

I hate you, SHARpains. If only all pain was steady, in one spot, and unrelenting, I'd be happy.

Societal commentary from ultra-elderly patient

Me: What took you so long to come in, if you don't mind me asking?

Really old dood: Well, last time I was here, there were a lot of...welfare people...and I had to wait four hours! *Cough, cough, gasp, gasp*

Just say no

Dr. Big Work-Up: I really think nursing should start doing my review of systems. Nurses should really start doing some of this stuff. K, can do you do the review of systems? I'll pull up the note and you just click off the positive findings...Also, it's a pain in the butt to cut and paste the lab results into my note. Can you cut and paste the labs into my notes for me?

Me: No and no.

Weird blogging paranoia

As you all know, in my efforts to educate the globe on stuff that chaps my ass to no end, I talk constantly about Dr. Bloody Gloves, Dr. Big Work-Up, Dr. Controlfreak, etc. whether it's on the blog, Twitter, or on IM. Currently, I'm having paranoia that I may have charted a note to the effect of "Blah blah blah....Dr. Bloody Gloves informed."

Now, I will sit here and worry about it. Of course, if I open up the e-chart three days later to see if I did, in fact, chart such a note, and it gets audited, I will be in HR getting disciplined for reading a chart of a patient not currently in my department, so it's a classic lose-lose situation.

You know you ain't getting narcotics when...

...you admit on your last six visits occurring over the course of the last 8 days, including the current one, that you're "high on crack and drunk"...when I'm the nurse. Bloody Gloves, of course, initially wrote for 15 Percocet for his fake tooth pain.

You know you're ghetto when...

...the ER security officer is throwing you out at my behest for cussing out (F-bombs-a-flyin!) the two-month-old baby next door at the top of your lungs.

My salary

Patient: Do you make like one million dollars an hour for this?

Me: Yeah, and OH MY GOD, I'm closing on another mansion today, and I'm SOOOO stressed out about it!

Dr. Big Work-Up big work-up du jour

Athletic eighteen-year-old male with no past medical history and normal vitals except a low-grade temp comes in with....chest pain (for ONE MONTH!) worse with cough, vomiting, nausea, malaise, bodyaches, etc, etc. Does your right toe hurt? Yes! How about your brachial plexus? Yes! How about your hips? Right AND left? Great. Now, here's the important one...the left side of your left nostril? Yes! Heyyyy Macarena!

DRUMROLL PLEASE! AND NOW........The BIG WORK UP!

Cardiac monitor, 12-lead EKG (I was chastised for not immediately obtaining one*), aspirin 325 mg (on an 18-year-old vomiter!), saline lock (nope, sorry), chest XR, CBC, BMP, troponin (yep), CK, d-dimer

Wow, an acute coronary syndrome work-up and treatments for an 18-year-old with chest and Macarena pain for a month! Isn't that precious?

* = Whereby I dryly responded, "Sorry, I didn't consider acute coronary syndrome in this patient." That pissed him off and gave me a Happyesque, smug** sense of self-satisfaction.

**= Sorry, "Happyesque, smug" is redundant on second thought.

It's that time again...

Time to rip on something Happy says seeing as he's a pompous, self-important, yet emotionally- vapid ass and whatnot. Today's topic of discussion: People are too stupid to understand their own health care, so I'm just going to confuse them even more with my greasy, Brylcreem-laced explanations and used car salesman charm so they don't question me.

Can you imagine trying to explain the pathophysiology of stable vs unstable angina vs NSTEMI vs STEMI to 75 year old retired lady who can't even tell you where the heart is located. In this day and age where conversation is uncompensated and technology is viewed as the savior of our health care needs, it's no wonder why it's just easier to talk fast, sound important and recommend "tests" that make loud beeps, take fancy pictures and cost a lot of money, paid for by the Medicare National Bank. Perception is 90% of reality. And who's going to question the doctor when you don't even know where the heart is?

Yeah, I can imagine it, and you hopefully can too seeing as it's part of your and my JOB to help people to understand. I hate it when doctors feel the need to talk like Brylcreem, Wal-Mart cologne, and 10-year-old JCPenney suit-wearing fast-talking used car salesmen. Nothing is more anxiety-provoking for a patient than being in a situation where they don't know WTF is going on because people are rattling off unnecessarily-detailed explanations of catalytic converters or how troponin is attached to the protein tropomysin and lies within the groove between actin filaments in muscle tissue or some shit.

Your job is to help the patient---yes, you're in medicine to help patients, not look sexy and rattle off pathophysiology lecture notes---understand their disease and be totally into the really helpful tests and treatments that you're ordering. It shouldn't be an breathlessly unimaginably-foreign concept to you, Doctor. Guess what, conversations aren't compensated by the used car salesman's boss either; they only get paid when they make the sale.

Do you want to say the things that will help "make the sale", or do you want a frustrated little old lady giving you the proverbial double bird on the way to the Buick dealership where they explain everything clearly (or, worse yet, forget about "cars" all together because they're too confusing)? If it's the latter, don't get all holy and righteous when she doesn't "take care of herself" after your [wahhh] hard and tedious clear-as-mud explanations fail to impress.

Brylcreem, a little dab'll do yah, the gals will all pursue yah, but your patients will be anxious and die!!!!

The official Nurse K extremely short GET A BLOG list

There are some people who are naturally great writers and/or hilarious, and I feel as if I can tell who these people are. So, here it is...the short list of people who comment or tweet that need to entertain me by GETTING A BLOG now. If you were unaware, when I say "get a blog", it means I think your comment or whatever was particularly funny or insightful and well-worded. So, here it is...

1. ConnieRN1 from Twitter, a hilarious ER nurse in Chicago who is also fighting breast cancer with daily radiation treatments. GET A BLOG, CONNIE. Like no one but me and Girlvet are posting these days in the ER nurse genre, so we need more! Favorite tweet as of late: "I luv the good drunks! Hugs and kisses with etoh breath! Oops he forgot his briefs! Streaky jeans, he needs oxy clean bad!" It has a poetic Monkeygirlesque quality to it, doesn't it? Also, if you can get radiation in the morning and then work a 12 later in the day, you fucking rule just in general. I know I'd like this chick. She could probably kick my ass.
2. iglooDoc from the comments of every medical blog everywhere. I've been working on dood for awhile to GET A BLOG, and now is the time to listen. That comment I linked? A blog post. I walked into the room, blood pressure rising, to have a 5 inch by 3 inch piece of skin ripped off of my ass by the patient... See, good writing right there, using one of my favorite techniques, the unnecessarily-detailed description. Remember, the point of 'GET A BLOG' is to entertain ME.
3. Peter the firefighter. He only had one comment on my blog of which I'm aware, but it was hilarious, so that's good enough to GET A BLOG. It's not often that I literally laugh-out-loud at stuff. [A couple good iglooDoc comments on that thread too].

Now, the offer: Connie and Igloo are more than welcome to be co-bloggers on this blog. You won't get any money from my ads or anything, just the joy of being able to write without the pressure to post a certain number of times per week. Instant fame! Just email me (crasspollination@yahoo.com) if you're interested or get your own damn blogs and send me the links. There are no other choices here. Sorry, Peter, firefighters aren't quite on-topic enough, but if you're funny as shit, you need a blog.

Who stuck the intern with Dr. Big Work-Up?

So, we have a new non-emergency medicine intern in the ER* and some genius decided to pair him up with Dr. Big Work-Up. If you were unaware, it seems that many residency programs require a rotation in the ER*, so, in addition to the regular ER* residents, we get non-ER residents as well, which is fine in theory; the more the merrier, right?

However, as we all know, Dr. BWU is slower than a morbidly-obese turtle with quadriplegia when it comes to working up and discharging patients to begin with. He not only orders huge work-ups, he can't disposition the patients after the 20-step work-up is eventually complete. One nurse was so bored the other day, that she was counting how many times it took to ask for a disposition before each patient was dispositioned, and it averaged about 1.5 hours or three requests.

I like Dr. BWU as a person; he's nice and caring and whatnot. In keeping with this general disposition for public servcie, rainbows, and sunshine, Dr. BWU loves students and loves to teach them about the ins-and-outs of the 45-minute initial patient assessment for chest pain with cough in a 16-year-old or his favorite lesson: "Everyone needs a chest CT to rule out dissection". I mean, how can this guy get by with spending 20-45 minutes in each patient's room followed by a 20-minute discussion with the intern and not kill anyone? I don't get it.**

Of course, the non-layzee nursing staff has been going crayzee with this particular combo. One day, I got bribed to switch places with another nurse because she "couldn't take it anymore" (Hell no, I ain't takin' that switch for all the money in the world). Since people know that I don't mind giving docs a little kick in the ass when necessary, other less-assertive nurses were coming up to me asking me to tell him to stop talking and start discharging when I wasn't even charge. The average work-up was taking 5-7 hours, and the most basic of all patients were taking 2-3 hours, most of which amounted to sitting around waiting for a discharge.

The point of this story is simple. I, as a random ER* nurse, feel as if interns and residents, whether they be ER* or internal medicine or family practice or whatever, should only be taught by board-certified emergency medicine doctors or those who are indistinguishable from those who are. If you can't do your job well without a resident, why have one? If you can't pass a test on emergency medicine, why teach others about it?

* = Emergency Room, which colloquially means 'Emergency Department' but is used such that we don't have to think about penis issues whenever we discuss our place of employment and to irk WhiteCoat, of course.

**=Well, actually I do...the other docs pick up his slack.

Happy 'Loss of Colonies Day'

America might be the best country in the world for at least another year or so

To celebrate the 233rd anniversary of the completion of the Declaration of Independence, I present to you a Twitter thread between yours truly and Dr. Shroom, an ER/ED (if you're WhiteCoat)/A&E (if you're English) doctor from England:

--
Mourning 'Loss Of The Colonies Day'about 6 hours ago from TweetDeck

drshroom

@drshroom You ain't gettin' them back neither and I'm going to blow up some sh*t and eat a lot to prove it!about 6 hours ago from web in reply to drshroom

ernursek

Nurse K

@ernursek somehow, that makes me feel better. Thanks :)about 4 hours ago from TwitterFon in reply to ernursek

drshroom

Layzee central

"I'm not taking a patient in that room because someone called from home saying they might come in with chest pain." Um, sorry, you can't block off a room for an hour and refuse to take a new patient because of that! She actually had the balls to argue with me about it too. Remember, we're not like Podunk ER and Crawfish Stand; we were on the cusp of having a buttload of people in the waiting room.

"I'm not taking a regular patient because that's a resuscitation room." Well, there are numerous hallway locations that we can move the patient to if there is a resuscitation as well as a lot of admits and discharges. "No, I'm not taking anything in that room." She had one patient with a sprained ankle at the time. Just to be a bitch, I took a patient in the room and assigned myself to it...my fourth. I'm sure that pissed her off, but, oh well, stop being layzee.

"Can someone help me with this [extremely busy, high acuity] patient? This will be my fourth again...really, you guys with 1 and 2 non-critical patients can't help?" "Oh, I'm busy. Call the charge."

People need to work or I'm going to go apeshit and/or switch to straight nights like everyone else who used to work days but couldn't take it anymore.

"Allergy" cause-and-effect confusion

It's a question I ask no fewer than 6.6 gigatimes per day: Are you allergic to anything? Needless to say, humans as a cohort have no clue what an allergy is and will come up with some weird things that they consider an allergy.

The other day, I had a patient tell me she was allergic to "Fosamax" because it caused her to have a bad bone density test soon after starting the drug.

Rest easy, y'all. She is not without help for her osteoporosis. She is now on "alendronate" which has been helping her bone density.

I just nod and smile as I affix the "NKDA" band to her wrist.