The "burn" or striving for mediocracy

Dear folks, your local er nurse is "burned".
For those of you in the business, you know it all too well. It's that
feeling that creeps up on you every year or so. The feeling when
you just can't go back even one more shift, where caffeine won't
even keep you going anymore. Even the appeal of a good "real" trauma
is just more paper work. Nurses are numbers, not wives, mothers,
PEOPLE with lives
outside of your schedule.

Yep, burned.

Therefore, I strive to give mediocre care. Yes, I said it.

You come in with chronic anything of any sort, and you'll get exactly that. Oh, I'll be professional, and even courteous.

• Will you be taken care of? Yes.


• Will I be competent in your care? Yes.


• Will I answer the call bell and change the bed pan. Yes


• Will I take every class offered again this year? Yes.


• Will I learn new things to help those who are truly ill/injured? Yes.

But at times like these, I lose touch with the "nursing" part of nursing. The things that
get me down are the things that get all nurses emergency down. (misuse of the system, addicts,
lawsuit happy, chronic complainers ect ect ect....)
Will it get better? No, but I will. In the mean time, mediocre.

It's the best I can do right now.

I'm ready

I'm ready for trauma season. Morbid-yup, but I'm ready. I have all these new, latest, greatest certifications and classes and I'm itching to put it to use!
We have a whole new crew this year. A few left overs from last year are still hanging on. They are far from the doe eyed new nurses who thought they could actually make a difference and that people actually wanted help and/or a little education! Most people just want to create a problem and drop in on you to fix it.

• I didn't take my insulin, I ate a whole pie today, why should I wait in the waiting room...
• I got drunk and slept with god-knows-how-many strangers, now I have PID and I want that morning after pill (oh and a little something for the pain)
  
• I've been on lortabs-shooting-snorting-whatever, Now I'm outta money and drugs and I'm "jonesing" for something. When I come in can you give me something for withdrawl? (yes, this was a quote from an actual call I answered last weekend) I personally liked the dry out method in that Johnny Cash movie....
• and of course the 3 am cold symptoms for two weeks on new years who was PISSED she had to wait TWO hours d/t the mvc/traumas

These people should all be exposed to diseases and experimented on-much more ethical than using rats and monkeys.

I am not an ambulance driver

So I got to ride with the ambulance crew. No, they would not let me drive. Yes, I really did (sorta) want to drive (just a teeny way and maybe hit the sirens just a time or two)...anyway....we didn't do any of the really cool and fun stuff that they sometimes get to do. Mostly we were a taxi that day. Seven hours of triage...seems like a LOOONNNNGGG time when your waiting and wishing you could get this granny off your bed and get to the GOOD calls like smashed cars and cardiac arrests. No, you are in triage with granny who seems a little more confused today than she was for the last FIVE freakin' years that she's had ADVANCED alzheimers. (not that granny shouldn't get the best medical care we have to offer-but emergency rooms should be for EMERGENCIES and EMS should not be used as a granny shuttle) Have I gone to the dark side? (no Johnny) but I am seeing things in a new light.....flashing red ones on top of a big blue and white ambulance....

Somethings not right here....

So I've learned to go with the gut feeling...and something wasn't right....
Seizures? Post-ictal? Wait a minute....crushing chest pain into left arm
nausea and diaphoresis....oh SOB too? Didn't take a genius....wonder though
if the "seizure" wasn't some sort of spontaneous arrythmia that converted....
didn't have any pvcs though....I just wonder....So I'm yelling down the hall
at the doc (and a good one at that) it's time for intubation.....wow-why do these
people always have 20000 family members and why does security let them ALL in
at the same time???? AUGH!!!! anyway....some one asks if I think maybe the patient
has been poisoned by the spouse...well, who knows? I'd still bet cardiac but maybe a
little cocktail of sorts was served at the dinner table...ICU staff wanted to know what
the spouse was like...I said "quiet, but so was Jeffrey Dahmer" hmmm....

Manic

So what do you do yesterday? Not much here....feeling the old pendulum swing to manic so I've been listening to 80s dance music...Oh how our music tells our age!
Should have known it was coming though. I was such a total bitch all weekend. That's the precursor to mania-royal bitchness. That and the fact I found out which married someone was sleeping with someone new! Oh-you didn't know I knew? Be glad I'm not your spouse.
It must have scared everyone though, they all avoided me like the plague. That's ok. I didn't feel like small talk. Well, enough post-back to dancing....nothing like disco in sock feet!

Oysters and Pearls

The smell of hospitals in winter,
and the feeling that it's all a lot of oysters but no pearls.... (counting crow-long december)

Could anything be more true? Lots of slimy creatures drag themselves from the trailer park long enough to cuss, spit and swear at you because they won't be IMMEDIATELY seen by the doctor for the cold symptoms they've drug around for 2 weeks. Fuck off. My chest hurts from smoking crack! Fuck off-you shouldn't even allowed to be seen anywhere for a week! I ran out of money and am going through withdraw from my "tabs" I can only take 10's I am allergic to the 5's. Oh a super fuck off to you!. I just want to climb on top of the security desk and tell them all those lazy worthless slime sucking oyster bastards to fuck off. If they had a job and actually had to pay for their healthcare-they wouldn't use the er as a primary clinic and cure for boredom. Got some aggression? Just go to the ER and swing at the staff-they don't hit back. Well FUCK FUCK FUCK you all! ASSHOLES-everyone! Everyone of those slimy bastards will outlive us all. I'll go to the grave fighting and they will suck whats left of my estate. I hate them. Just when I am counting down the minutes on the triage clock.....in totters a lil' ole man in a brown overcoat, whispy whiskers, pale (oh very pale)but with a twinkle in his bright green eyes.
Finally (and at change of shift) appears a PEARL! Lil' ole man who complains of rib pain a little short of breath-not too bad. doesn't smoke. Just come on all of a sudden like and couldn't get any sleep. Better when he is laying down. No injury-hasn't fallen. traige bp 55/10 pulse 140 WWWHHHOOOOAAA!
Straight to treatment room for you gramps! (oh and a fuck off to the glaring slime of society bitching about being here first-this is not burger king you CANNOT have it your way asshole!)

Anyway....Gramps thanks us for the bed-he stands up he gets dizzy ya know? We scurry all
over like a hive of excited bees (both shifts).....buzzing to get him on the moniter-2 large bore ivs-stat ekg and chest xray....oh and someone tells dr smart ass who is sure this patient can wait till shift change to be seen. (collective eye rolling from every nurse there)...and we drag dr smart ass in the room -actually I pushed him in the rolling chair....

Turns out gramps had a leaky AAA but something bad went soooo goood. He's had a textbook recovery and is expected to be discharged to home! YEAH! I love the pearls!

And for the oyster sitting in the waiting room-he was still there when I left-smiling for once :)
I am sure he survived his cold, went back to his trailer park life and is currently scheming up new ways to fraud the government (aka disability from fake injuries) and manufacture meth in his bathtub.

I finally lose it at work

Sometimes everything that can go wrong, will go wrong.
Even if you leave home determined to have a good night.

The sickest patient in the ER is assigned to me. No problem.
A frail, elderly gentleman, new onset confusion. A super nice little
wife, so attentive, always apologizing for "being in the way". No probs.
With a fair amount of luck and a tad bit of skill, he gets a peripheral
line and some fluids. Lab is at besided trying to get blood samples.
So, do you think the girl with the bulb nose told me she didn't get
them? No, why would she? Why would I need to know? So 30 more
minutes pass. I call the lab looking for results. Well, of course they
don't have them-and now I know why. I am screaming mad but keep it
under control. Come on up and I'll do a fem stick. So big bulb nose girls
meanders into the dept 20 mins later. I do the fem stick (hard one to get)
and she takes the blood to the lab. Twenty more minutes-it's hemolized!
WHAT THE F? This guy has already spent way too damn long in the er
with a whole lotta nothing helping him and this girl with the bulb nose
has managed to f up a fem stick?
Geez! I go completely 100% over the edge
flipped over/ out/ and off.
My co-workers will tell you that I rarely get
ruffled, much less down right pissed off. But I just couldn't help it.
I can't think of any other time in the last 14 years that I have been that outraged.
I scared the er doc (yes, that's hard to do) and my charge nurse (even harder to do)
and hopefully the bulb nosed lab girl. I've only seen her once since, and she ran the
other way. So eventually, the patient is handed off to the oncoming nurse, with
it still being a mystery as to his real condition-other than a thin pale pasty little
tachypnic, tachycardic, hypotensive patient.
Now, usually our patients aren't sick. I mean aren't sick in what medical people consider
sick. I Know that you have this or that ailement, but when we say someone is sick, we mean impending death. Had this situation occurred with one of our regular shmoz, I would have been annoyed, but no where near going over the edge. I think in retrospect, I like to pride myself on taking good care of sick people and I don't feel this patient received good care. Not so much from me personally but from the institution. The delay in labs delayed cts which delayed diagnosis and dispostition. All the while, the little couple never complain or fuss. They don't have to-I'm making enough noise for all of us....

Trusting you instincts

Over the years we have learned to trust our instincts-except for last night....

When I call you Dr. Resident to look at your patient that I say "I think she's a little sicker than you thought" it is because SHE IS! Don't tell me she'll be ok with a bp in the 60's and o2 sat in the mid 80's-just fucking do something or I will......So I gave her a liter bolus and put her on 100% o2-even though she "didn't need it" and miracle of all miracles her bp came up as did her oxygen. ms crumpet avoided the black shroud again....geesh...I should have went to lunch.

Example 2: A new and I mean NEW medic rushes through the door (yelling mind you) MA'AM I think HE's CRASHING! and i give the old goober the once over and think bullshit but go a head and stick him in resus anyway....Normal bp nsr on ekg o2 perfect on room air GCS 15! The medic said "I can't get a radial pulse" and of course I was a smart ass and said "did ya check his wrist-on the radial side?" geesh....and at that point-I moved goober to a regular room and WENT TO LUNCH!
*medic later said "im new and i panicked a little" I fought the urge to roll my eyes and say "yah think?" so as not to squash the newbie. I said "that's ok-he's fine and you did ok-don't worry about it" HOW UNCHARACTARISTIC OF ME! I was proud of myself....

Important lesson: TRUST your instincts!

Pain!

Pain-without love-Pain-I can't get enough-Pain-I like it rough cause I'd rather feel pain than nothing at all .....

We've all heard the urban legends...

• I swear I was making a salad in the kitchen naked-and just slipped-I don't know how it ended up in there...
• I passed out because someone put cocaine in my drink and when I woke up, it was there
• I was rowing and it just slipped (my personal fav) Were you naked rowing?
  
• slipped in the shower and landed on a shampoo bottle....

Come on folks! We don't believe it any more than your mum or best friend will! If your gonna play these games-someone please invent a safety string or something to retrieve it so nurses like me aren't stuck in one room for 90 minutes why the residents fumble with a concious sedation to remove the foreign object....No I DO NOT want to take a lunch now....

Jesus and the President

Not much to tell over the last few shifts.....

But I did meet Jesus and the President. It's amazing when people finally break because they are always someone famous. No one ever thinks they are a butcher, baker or candlestick maker. No, this weekend, I met Jesus and the President. I wished I could have intro'd them to eachother! Now that would have been something to write about.

Just ask any ER folks you know, the psych patients always talk about sex and/or religion....Why? who knows-but it is a proven scientific fact!

The juice

For folks who aren't medical....
Sometimes your heart can beat funny. We have many tricks up our sleeves to talk your heart into beating right again. Most of us prefer to do it with medications....except Dr. Wrong.

Dr. Wrong was probably beaten as a child. He probably had the worst luck of anyone, anywhere. Why would I come to this conclusion? He is probably the most miserable toad alive... He is feared by all for his biting attitude (ok feared by the newbie-us oldies roll our eyes alot)

Anyway-Dr. Wrong prefers the juice....

Zap him!
But doc-he's awake...
Charge it anyway....
But shouldn't we medicate???
I said charge it!
I don't think this is...
Do it!!!
ZAP!
UGH!

And of course it DIDN'T work-so what do we do? UP the juice!
Which didn't work.....so what did we do?????

(INSISTED ON MEDS)

Score 1 for the nurse and patient (Singed)
We may have won the battle-but I fear we're losing the war....

Mum on seeing dead people

It was a rainy afternoon and not much to do but set on the porch swing and reflect. We were sitting silently for a while when mum stuck up the conversation...

My thoughts in italics

Mum: Do you see dead people?
Me: like in the movie?
Mum: No, I mean like when the ambulance men bring them in.
Me: yeah (now where the hell is this going)
Mum: Oh, I never knew you had to see them
Me: yeah, I do
Mum: Do you have to touch them?
Me: sometimes, you know when your giving CPR or something
Mum: oh, I never thought about that. Have you ever seen someone die?
Me: yeah, a few times (like over 13 years in the er, and last night saw 2 traumas catch the Jesus train)
Mum: How awful for you!
Me: it was worse for them. Mum, you know I work in the ER. What do you think I do?
Mum: You know, give shots and help the doctors.
Me: yeah, that's usually what I do

Now, for those of you who don't know mum-southern genteel lady who teaches primary school and has never ever thought of seeing someone dead.....
Sad part is-I think mum's assessment of what I do at work is shared by way to many people in the general public. So nurses are either handmaidens or whores to the doctors....gotta love it

mrs. DR. Posh

A new doctor, exciting! Along with a new doctor comes "the wife" ahhh the sterotypes playing through my mind. Just so happens Dr. Posh was working a few nights ago. Who would happen in you ask? Why mrs. DR. Posh. (just happened to be at the posh resturant with posh friends and stopped by the posh er with a posh goodie bag for the poor working husband)

No, I am not standing here to eye you or your husband mrs. DR. Posh-I want your husband the DR. to address this lady's hypotension and the nurse in line behind me wants him to address the potassium level of 1.8. No mrs DR. Posh-we do NOT want to flirt or otherwise mingle with your husband. Contrary to what your mama taught you, not all women are out to marry, sleep with or otherwise molest a man because he is a DOCTOR! To be honest, he's not even mediocre looking and he's certainly not the sharpest guy I've ever met...IN FACT you couldn't even double his salary to make him attractive enough for me! ha-take that mrs. DR Posh. Besides, most gals I work with are married to cops or firemen/medics. Something about a pysically fit guy in a uniform....So DR's wives rest assured! We DO NOT want your husbands! We've seen them at the best and their worst (usually the worst) and we are all to happy to send them right back home to you at the end of the shift!

A new start

This year, I've promised myself I'd do some new things I've been wanting to try. (blogging for one) I have been a long term blog fan but haven't had the time or energy to devote to anything else. So this is a new start to a new blog for me.

Some background: I have been a nurse for 13 years. I've mainly worked in emergency departments. Some big-some not so big. The "customers" are all the same. I thought being a nurse meant "helping people" HA! About 3 or 4 a month actually want/need your help (sorry to my ethics professor) the rest have another angle all together (drugs, attention from family, ect)

Why I continue to be a nurse: for those 3 or 4 a month that actually want/need help, mortgage, feeding my kids......

Now onto the trauma drama!
I love trauma. Always have. (hey, someone's gotta do it) I love the "emergent factor". Maybe that's why people like me stay. I like never knowing what's coming through the door. I like chaos and madness, and yes, sometimes the drama of it all.....

Most nights, it's all I can do to stay awake. Of course, there is the usual patients-excuse me administration "customers" between the interesting stuff....

• Yes sir, I know your mother wants a drink of water and I know I have explained why she can't have anything until her CT is done for the tenth time but right now I am trying to get this man's BP above 50/12 and that is more urgent! UGH!
  

• Yes ma'am, I know you've waited for an hour to be seen for these cold symptoms you've had for 6 days, but right now we are doing CPR on someone. No, I don't know how long it will take!

• It's called "being on your period" It happens every 28 days or so, yes, you will bleed and have cramps for a few days. No, you are not dying. Yes, it's normal.