In Which I Lose My Temper

I'm not proud of it, but I showed my temper last night.  Thinking of it still makes my blood boil.

The attending physician asked me to take vital signs on a woman in room 13, a section that I was not working in.  I agreed to do it, however, as it was the attending and came to the room just as the OB-GYN residents exited the room.  I knocked the partially open door and the young and obese drama queen told me to stay out as she got dressed. The doctors outside were discussing her impending ultrasound and such, so I knew that she was not supposed to get dressed.  I paused at the door and told her to wait a second before getting dressed.  When I peeked inside that they had left her lying back, exposed, and still in the stirrups.  So sloppy. It was understandable why she was upset.

"Din't I tell you not to stay out, miss?" 
"You look so uncomfortable and the head doctor is worried about you. He wanted me to get your blood pressure right away. Can I help you with getting up?"
"No, you can get out. I don't need your help."

The OB-GYNS then barged in without knocking and she ordered them around.  For whatever reason, I was the target of her ire. I'm not sure what kind of hold she had over the doctors, perhaps she had something seriously wrong with her, but they did her bidding as she imperiously commanded them around the room.  Silly, as the clumsy new residents had no idea where we kept anything. I watched silently as she flexed her ugly attitude.

"Get me a pad," she turned to me, "and you can get the **** out while I get changed."
Obviously, she was not going to cooperate with getting vital signs.

Wordlessly, I left and shut the door without responding. I didn't think I could muster anything polite at that point. This perceived insult incurred bellowing on the other side of the door as vicious curses and rejoinders that I should never enter that room again.

Honestly, how does she expect hand-to-foot waiting service when her manner is so horrible? Boggles the mind...

S

Fat Chance You'll Catch Me Again

"Are you sure this thing is locked??" Ms. Peevish O'Bese whined about the stretcher as she tried to use it for support and it gave easily.
"No, ma'am, the stretcher is actually locked..." I observed, you just weigh more than 500 lb and its locking system can't sustain the effort of you trying to stand up.

I had been asked by a nurse to help bed 1 to the bathroom and oh, by the way, we also want labs and an EKG while you're at it.  When I pulled aside the curtain, I realized with dismay that I had been signed up for a bigger project than advertised. I was met with the whiniest voice telling me she had to PEE NOW, a bedpan on the chair and a distressed pair of eyes on a body I knew I couldn't move, that couldn't rotate on the bed far enough for me to even insert a bedpan, that would have crushed and actually broken the plastic bedpan. I'd seen worse from smaller patients.

"Please, I need to pee. I need to pee now. I want to walk to the bathroom, but I don't want to fall. I've fallen 4 TIMES since I've been at this place. Oh God, I don't want fall again."
 "Ok, Ms. O'Bese, give me one minute while I run for a commode."
"HURRY."

I returned 30 seconds later to her screaming about how she needs to go, Oh God, somebody help her, please help her, nobody cares, etc etc.
"Ms. O'bese, didn't I tell you I'd be back to help you? Please stop yelling."
"Oh, it's just that nobody ever listens here. This place sucks."
I ignored her running commentary about how my workplace sucks and set up the bedpan. She eyed it, "I'm not gonna fit in that, Oh God, it's not gonna work but I need to pee now. You don't understand. I NEED to PEE."
"Ok, well, how about we try it, because you've no other option right now."
"This place sucks. Don't you have the bigger ones?"
"In my 30 seconds searching and finding one (which is miraculous on its own), this is the best I could find (I had picked the bigger/sturdier one), and we don't carry bariatric commodes down here in the ED (I hadn't seen one for months). I'm sorry."
"This place sucks. I'm never coming here again. You guys aren't equipped to handle your customers." She struggled to pull herself up. I unlatched the bar and helped her swing her huge, swollen, weeping legs over. She tried to stand up by pressing against the bed, which gave against her immense force and, frightened, she sat back down and wailed, pounding her fists on the bed.  I persuaded her to try again. As she collapsed onto the commode, her backside was too wide to fit entirely, so she was wedged in it. Wailing and cursing she yelled at me to pull her nightgown up.  I did so, and she began to pee, filling the commode, then leaking all over the floor. It was time to call for help.  I beckoned the nurse who assigned me this mammoth job, who grudgingly came in. "You'll need gloves," I told her.

Nurse Snark's eyes widened and she immediately began to lay pillowcases and towels on the ground.  The whiny, peevish voice raised in volume and pitch.  "AREN'T YOU EVEN GOING TO HELP ME?"
"I'm not going to fall. We have to clean this up first."
"Oh, so you don't want to fall, but I have to."
We ignored her and realized the job required more people.  Nurse Snark called out, "I need 2 gentlemen to come in here to help." Two of our new residents came in to behold the sight of Ms. O'Bese stuck in the commode with her nightgown up, smelly urine all over the ground with towels haphazardly arranged, and Nurse Snark and me trying to steady the bed.  Eventually we did get her back to the bed, where she started yelling again about how much we sucked.  "Don't forget the labs and EKG," Nurse Snark reminded as she scooted out the room, leaving me with Ms. O'Bese.  Great.

I actually managed to talk her down, and a short while later, she apologized to me, "I didn't mean to take it out on you. I don't like her (Nurse Snark). It's like she owns the place or something." Hmm, ok.  But it was the end of my shift, and I wasn't about to stay to help with any more bathroom incidents with Ms. O'Bese, who must live a very stressful life.  How else does a person's voice get that way?

S

Because Dentistry is just like Emergency Medicine

"Hi Mrs. Dentist's Wife, my name is S and I am a technician here. There will be a lot going on at once, so I'd like to explain what will happen. First, I will help you into this hospital gown and put you on our monitor. Then, I will be taking an electrocardiogram and nurses will come in to insert an IV and draw labs..."

"Now just wait a minute," her husband interjected, "I'll tell you exactly what she needs." He puffed up his chest, and straightened to his full height to try to intimidate me. "She doesn't need an EKG or labs, she needs to go to the OR now because she has a small bowel obstruction."

"Sir, I'm sorry I don't know about any of that, but it is protocol for us to get a cardiogram for every patient of a certain age that comes to our critical care section."

"I know you don't know anything. But I'm here telling you that she doesn't need an EKG."

"I'm not in charge of that, sir, but..."

"Well find me someone who is."

As it turns out, this gentleman was a dentist; he and his wife were visiting from the midwest when she had abdominal pain and decided to stop by our fair establishment. What possessed him to try to bully us into treating her as he thought fit was a mystery to me, but he remained surly the whole visit. Luckily, I did get my cardiogram after several rounds of different people explaining that if she were to be admitted and to go to the operating room, she would definitely need an EKG.

I sure wouldn't want this guy pulling any of my teeth!

S

In Which I Finally Pass Drunken Standardized Testing

In my first hour or two in the drunk tank last night, I had a colorful row with a regular drunk patient, who wore sunglasses all the time. He'd never seen me before, or, rather, he does not remember seeing me and immediately tried to test me.

"What is this? The ******* drunk tank?? I am not ******* staying here."

"Sir, you have to stay. You've been here often enough know the drill."

"I haven't been here in 11 years, you obviously weren't here so don't tell me what I know."

"Actually, I saw you last week. And I know that you know that if you get up, you will get tied down to the bed by security."

He made motions to stand up and leave. I looked him coolly in the eye and issued a final warning. He defiantly stood up, at which point, security came bursting through the door. Slinking back on his stretcher, he waited until they left to spew a series of curses, epithets and threats pointless to type out here for interpretive purposes with all the asterisks necessary to keep this story PG-13.

Then, he said, "now do your job and give me a m-f sandwich."

There was a time in the not so distant past that I would have been disgusted and upset. However, I had already met some of the wilier and more terrible patients, so I summoned the presence of mind to just keep my affect very flat, and replied, "Only if you ask politely."

"**** you. You dare disrespect me. I have to kiss your *** to get a ****** sandwich? **** you. I have diabetes!"

"Your sugar was checked as you were rolling in here. It was 115 half an hour ago."

"You smart**** ******* *******. **** you. You better watch your back. When you least expect it, you'll get what's ****** coming to you. My woman and I will give you what you ***** deserve. The city's a small place and one day, you won't see it coming, but you'll get your ******* mouth shut for you when we jump you after work one day."

"Well, ok. But don't get off that stretcher."

"Don't tell me what to ******* do, c***, **** you. You should learn your place as a woman, to respect men. I'm gonna kick your *** so hard and you won't know it's coming. Don't let your guard down, little girl, we're gonna get you."

"(sigh) I warned you not to get up. Now I have to call."

I reached for the phone. He stared, daring me to call, so I did. As security came through the door, Mr. Sunglasses scrambled back on the stretcher.

The conversation continued in a similar vein for a few hours. It took a lot out of me to keep it impersonal. When people lash out in these situations, I have found that they play good cop/bad cop, usually focusing on one person to treat poorly as an example to everyone else- today, that person was me. Every nurse, doctor, social worker that came in was told that I was a ******** ******** ******.

For example:

Doctor: so how did you hurt your head?

Mr. Sunglasses: Doctor, you're all right. I ******* hate her. (points at me) she probably was the one who did it because I don't like her.

Of course, such statements as this and others really helped articulate his irrationality much better than any report I could have given the doctor. Mr. Sunglasses obviously needed much more time to sober before any evaluation can take place.

Luckily for me, he described enough alarming symptoms to ensure his return to the main treatment area- chest pain, shortness of breath, severe headache, hypertension, hearing voices, uncontrolled diabetes, etc etc. So many apparent maladies... Unfortunately, none of them were deemed legitimate, because a little while later, after I heard his many loud curses protesting blood draw/urine samples/etc coming from the treatment area, he was back in the drunk tank.

"They want you to take his vitals, because I couldn't do it." The tech informed me.

"I don't like her," he said, pointing at me. He was noticeably calmer, so I decided to try my luck.

"Blow in this straw for me, Mr. Sunglasses, maybe your numbers are getting lower so you can get out soon."

He blew in the straw for me and after a bit of cajoling ("This is for your own health!"), he allowed me to take his vital signs.

I slipped a blood pressure cuff on his arm and he got a good look at me. Maybe he meant to intimidate me and make it look like he was going to remember my face in order to jump me on the street like he promised a few hours ago. Increased sobriety really calmed him down, however, and he was not as combative as before. (or maybe he received calming medication from the doctors in the treatment area... I'm not sure)

The nurses soon changed their minds again and wheeled him back to the treatment area for good. I felt a little giddy; I didn't let him get to me. It was the first time I officially passed the drunk tank test... and that's when Mr. Reen, on his 270something-th visit rolled in. To be continued...

S

Urgent Nonsense

Patient 1 had her toe stepped on 3 weeks ago. The pain was suddenly unbearable, so she came in today, wearing really cute sandals, baring all her toes. I can see how they got stepped on...

X-rays showed nothing, so she went home with a post-op shoe. Very cute, but a bit clunky for my taste.

Patient 2 had an abscess on her buttock. She hyperventilated to freak herself out, then screamed before the lidocaine (numbing agent) even went in. She didn't want to admit she didn't feel the pain anymore, so she screamed at times she thought were reasonable for pain production. If she is like this for popping a pimple in her (well-padded) butt-cheek, I really feel bad for the nurse on duty the day she has a baby.

Patient 3, Ms. Excuses, wasn't really our patient, but she said she was here last week. She needed a work note to replace the note she had "lost."

Me: Hmm, Ms. Excuses, let me check for you... How do you spell your last name?

IE: E-x-c-u-s-e-s.

Me: Ok, that's what I thought. What date were you here?

IE: July 6, and the doctor gave me the whole week off.

Me: Hmm, Ms. Excuses, I don't see you in our database.

IE: (Wide-eyed) Oh! But I was really here. I was here twice for the same thing... The first time was in April, where they gave me prescription xyz, and I came back last week to get another one.

Me: Ok, Ms. Excuses, I'm looking at all records with your last name through April. Is your first name "Illegitimate"?

IE: Yes, that's me!

Me: Ok, you're right. You were here two times. The first time was May 3, where it says you eloped. You left without being seen.
IE: Oh yeah, that's because it just took so long and I was feeling better... (trails off)

Me: (continuing) You were also here on June 1, and the x-ray did show you had a small amount of fluid around your knee.

IE: Yeah, so I was wondering if I could get a work note for when I was here last week. I can't believe I'm not in the system! Computers these days! (increasing nervous pitch) But yes, I had a note for the whole week.

Doctor: Well, we can write you one for when you were actually here. (writes note for June 1, able to return to work on June 2, gives to Ms Excuses)

IE: Ok, thanks Doc!

(returns 5 min later)

IE: I just wanted to make sure- is this a 6 or 7? I see you wrote over the 6, and I just wanted my employer to know for sure that it's the right date.

(Doctor writes new note with "JUNE" and hands to her.)

IE: Thanks Doc! Have a great night.

You, too.

S

(Thanks Dave H. for image sources)

Too Sweet

"Hey, can you go to pedi side and find me numbing cream so I can start an IV?" A nurse asked me.

Uh, sure... it was an odd request, but interesting. I came back to see the child it was for.

Just kidding, it was for room 9, a man in his 60's. The nurse and I walked in to see his glaring face.

"Now I'm gunna tell yous right now, I ain't gonna be nobody's pincushion. There won't be no stick stick stickin', you got that? I won't do it without numbing cream, so yous better go and get it now. And after this, tell the doc I'm ready to go home."

"Well, sir, I just brought the numbing cream. Please be patient with us because we're trying to help you." I said in my most calming voice. He glared.

Oh boy.

The patient has a baseline blood sugar of 400mg/dl every day. For normal people, the range is 70-100mg/dl. He came in today because his sugar hit over 500. Having such a high baseline is extremely dangerous and can cause raging infections and organ failure. His limbs were swollen to at least twice their size, scaly like old tree trunks, and darkened, like he had stuck them in molasses, then Oreo cookie crumbs. There were numerous open sores, like ulcers, pink and unlikely to heal. He didn't seem to care, though, and thoroughly resented being in a hospital. "I'm fine," he snarled, "can't wait to sign myself out of this ****hole."

It was already late in the evening, almost 2100, but in trudged some family members and a young toddler as we were going to begin the process. He ignored us now (thankfully) and started cooing to his grandson.

Grandpa: "Come 'ere. You's a bad boy, y'know that? A bad boy. But it's ok, if anybody messes with you, you say **** 'em."

"**** em," the boy repeats

Grandpa: "Ahaha, that's right, **** them"

Boy:"**** them" (stop saying that! says the mother)

Grandpa:"Pay 'em no mind. you can say **** them too"

Boy:"**** them."

Grandpa: "**** 'em."

Boy: "**** 'em."

The nurse I was with was losing his cool. He had young children at home. I watched the red slowly creep up his face at the exchange. "**** 'em!" "**** 'em!" "**** them all!" "**** them all!"He was still searching for a good vein, finally finding one on the wrist. He cleaned the site, but couldn't take it anymore.

"Excuse me sir, there are some very sick patients next door, please stop yelling- they don't need to hear that."

Our patient jerked his hand away, and shoved his blanket aside, pulling out his penis. "I'm gonna pee. now"

I ran for a urinal, and he peed, nonchalantly, in front of everybody. Finished, he handed it to me with a huff, as if it disgusted him, then went back to cooing at his grandson. The urine dipped positive for lots of proteins (bad sign for kidney filtering), ketones , lots of glucose, and blood.

I handed my 'numbing cream' to the nurse. It is actually quite cool- a refrigerant, if you will;

It temporarily freezes the area of contact, turning the skin white, distracting children from the pain of an IV insertion.

"**** that's cold!"

He barely felt the IV, which is good, but unfortunately it was only good enough to draw some labs, not good enough to use for fluids.

The nurse went out to the hall and recruited another nurse. We returned for round 2.

The patient rolled his eyes, yelled loudly about how terrible this place was, flailed, but to no avail. The doctor came in once more to cajole him and his family did too.

"I'm a let you know- this is the LAST time I'm gonna get stuck, you hear that?"

The nurse looked for a site, cleaning the skin with an alcohol wipe. Filthy! He showed it to me. Sixteen alcohol pads later with furious scrubbing, the alcohol wipes were still coming back black and dirt-like.

"What are you doing? Scrubbin my skin off?"

"Sir, it needs to be sterile."

"You don't need to scrub so hard."

"Well, sir, it's dirty." Oh boy, this nurse had a snarky sense of humor.

He jerked his hand back again and screamed some profanities. "Sir," I ventured, "we are really doing this for you- you really don't want to develop an infection, ok? We're trying to help you. It'll be over really quick, and look, we'll use the numbing stuff again."

He pulled the blanket down again. "I'm gonna doo doo."

"Come on, sir, are you really gonna whip that out in front of everybody?" The exasperated nurse asked. The family took this as a cue to say good night to grandpa.

I rushed out to look for a scat pan.

Coming back, we were to try again.

"So, where are you from?" I tried to distract him.

Grandpa: "Down South."

"Oh, I love it down there, people are so nice."

"You got that right," he smiled, "where you from?"

"well, I grew up right around here."

Grandpa: "really??"

"yeah, hard to tell, right?"

Grandpa: "I grew up here. I got the **** outta here when I could, boyyyy, ain't never comin' back. I'm here to see the family, then gettin the **** outta here."

"I see."

By now, the nurse successfully inserted an IV in the finger and drew the rest of the labs. Unfortunately, he was going to need another IV site- perhaps by ultrasound. Speak of the devil- the transporter was there to take him to x-ray and ultrasound. He left the room and we all looked forward to trying again when he got back.

I sprayed the numbing canister at the back of a co-worker's scrub pants and heard a yelp as the cold seeped through. I think I found a new toy. :-)

S

The Drunk Tank

"Oh ($@*#&, they put me in there again". My last name was written in pencil in the box. I was in the drunk tank again last night. I have been there almost every single shift for a month and I work 5 evenings/week.

The charge nurse saw me- hey, we need you to open the drunk tank now.
"Sure, but I need to make sure it's stocked first. Give me a few minutes."

"Everybody gets their drunk tank initiation," a wizened nurse commented as he watched me grudgingly walk to the isolated room in the back hallway.

It is a dimly lit room smelling of stale air, acid and alcohol, unwashed bodies, and wet socks. There were no gloves, no urinals, no food, stale water, no blankets. As I took this inventory, a nurse brought me my first patient.

"I'm not open yet, will be in 5 minutes. I will pick him up myself," I promised.

The nurse grumbled and informed the charge nurse, who burst in indignantly to ask me if I really sent a patient back, lecturing me on the importance of decongesting the hallway of extra patients.

Once upon a time, I might have apologized, but now I know better. The room is totally isolated; it is difficult to find someone walking by to fetch supplies. The patients must be constantly watched. As drunks, they are fall risks, and almost all of them try to walk around. Many of them are "frequent fliers" who know the system better than me. They press buttons to test the new person; but I'm impervious now. I have been since 2 weeks ago, the first time I cried.

The patients started coming in, regardless of whether I was ready or not, so I took notes:

Patient 1 was on his 148th visit; he laid in his stretcher and barely moved for the hours he was there with me. His BAC (blood alcohol content) was still .266 (legal limit= .080, it generally goes out of the system at about .010-.030/hour) at the 6th hour of his stay in the hospital.

Patient 2 was on his 134th visit; I had seen him many times. He was supposed to be going to detox but kept threatening to leave if they didn't give him ativan/valium immediately. I took his vital signs and he was tachycardic at 125bpm, at a BAC of .278!! He had no other symptoms of withdrawl, but after a few pills from the nurse, he quieted down until he felt like he wanted another pill. Then he raised a fuss again. He sneered at the food and refused to eat it; apparently it wasn't good enough for his homeless palate. The nurse asked me to take his blood sugar. Darn! I forgot the gloves. I looked in the hallway, no one was there. I yelled out desperately, but no one came. I finally just took his glucose, without gloves. The blood poured from his needle prick like water- thinned, no doubt by all that alcohol. I stemmed the flow, but felt horrified I touched his blood. Looking in his chart, I saw that he was contact precautions for VRE (multiple antibiotic-resistant organism). Great. I washed my hands in alcohol 4x.

Patient 3 was on his 72nd visit. In the waiting area, he got up from his stretcher several times and almost fell. Indignant that he wasn't getting any ativan/valium/food on command, he got up when the nurse turned her back and peed on the floor in our main hallway, right as my manager was walking by. This, coupled with his constant attempts at shaky ambulation was means to put him in 4 point restraints. He could still reach his pants, though, and pulled out his penis whenever anybody walked by. Someone threw a blanket over him, and that's how he came in.
He asked me to come over- I took his vital signs- fine. Breathalyzer- .230, blood sugar-149. "I'm diabetic, you know. I need to pee". I gave him a urinal.
He called me again- "I have this thing, it's called something like (thinks hard) spinal tendinitis- I really need medication for my back". he wouldn't have been cleared to come to the drunk tank if the ct scans or xrays showed anything, so I just noted it to the nurse.
He called me again- "can you take these restraints off?" not without doctor's orders. remember you peed on the floor?
He called again- "I'm hungry. Give me a sandwich." "Can you peel this orange for me?"
And again- "I need to pee again."
And again- "take these restraints off."
And again- "when am I going to get that pain medication?"
And again- "where is my nurse?"
And again- "what nationality are you?"
And again- "I'm in so much pain, please, give me meds now."
And again- "Do you have anything else to eat?"

I stopped answering. He was testing me. So he called- louder, and louder, and louder. Finally he yelled "If you don't answer me, I'm gonna pee on this #)($@*U floor." And so he did.

There were more people in line for getting cleared to come to this room before I was relieved by a colleague, one guy who was on his 180th visit. Regardless, it was actually a pretty good night there for me- nobody was spitting, screaming non-stop, or getting up to assault me.

Working this 4th of July weekend will be crazy, I'm sure. Updates and stories to come...
S