Burn-out

I was standing in the trauma room, wedged in a space between the trauma closet and another patient bed, holding the penis of a rotund drunk who could not reach it himself. He possessed a perfumed aura of fermented dairy products and neglected hygiene and graciously obliged us with a true-to-life rendition of his favorite soundtrack of mating large mammals. As I nimbly caught most of his interrupted spurts of diseased brown fluid in a deluxe male urinal, the techs who were gossiping on the other side of the trauma room looked at me in disgust. Then, they turned away and continued their analysis of a co-worker's perceived slight in hushed tones, lest I hear too much.  The absurdity almost made me laugh out loud.  It was my second time holding someone's genitals that day.

The first was a very weak old man who could not move much. From behind the curtain, I had heard the doctors musing, 'well we definitely need a urine on him' so I quickly fetched a urinal.  From across the room, I heard, 'Oh, sir, are you able to pee? Oh, he's going now.' Rushing in and pushing aside the curtain, I saw the doctors standing nonchalantly away from the bed. The looked at me and nodded as if it were a matter of course that I should be getting that urine sample now. I cut open the soaked diaper and despite that urine sprayed in uncertain spurts all over the bed, I managed to grab the slippery thing and get enough of a sample to send.  Unfortunately, Mr. Peed-on-Me was soiled and nobody would come in despite my pleas, so I moved him, cleaned him and changed his linens by myself.  As I was preparing to send the hard-won urine sample, a nurse popped her head in "Hey, what's your name again, can you go put bed 1 on a bedpan?" Before I could reply, she left, and the very obese lady in bed 1 refused to use the bedpan until I lugged a commode across the department to accommodate her. When I helped drag her body out of bed, I felt something in my mid thoracic back shift and twinge... so far, it's turned out to be nothing. (knock on wood)

The trauma room was uncomfortably warm and my drunk seemed to stop grunting.
"Are you about done, Mr. Drunk Half-Passed-Out?"
"LEAVE ME ALONE I WANNA SLEEP why won't you just... let me... go... ho... zZZZZzzzzzzzzzzzzzzzzzzz......"

I wheeled the sleeping Mr. DrunkHPO back to the hallway where I had first apprehended his "I NEED TO PEE NOW NOW NOW NOW NOW HURRY I NEED TO PEE NOW" request to find that the spot was already staked by a little old lady who looked like she had Death flexing his fingers over her shoulder.  I left Mr. DHPO in front of a closet to assess Lady Shriveled and a transporter yelled into the phone next to me "I'm sorry, but it's crazy down here, I can't find her. They've got people in hallway spots that aren't even spots! Does that even make sense?"

I had more than 12 patients in my section of critical care, several of whom needed labs, several more of whom needed to use the bathroom/had already gone in bed and needed to be cleaned, almost all of whom needed vital signs charted, urines dipped and sent, a transfusion to pick up from the blood bank, and the nurses from the other critical care section asking me to do quick blood assays.
What's more, patients just kept coming into my critical care section, one after another, with no end in sight.
With each patient comes a set of duties that should be performed immediately, such as the vital signs monitor, bloodwork and an EKG.

EKG's can be difficult to perform with certain patients, but each patient needs to have an EKG within 10 minutes of being triaged. In the time it takes to be registered, triaged, then brought to our section, I am left with only a few minutes to undress, expose, and perform the EKG with nurses and doctors at my elbows trying to assess the patient.  An EKG requires the patient to stay still, so this can be a challenging task if the patient is nervous and moving incontrollably.  As I was doing an EKG on Lady Shriveled, a student nurse sniffed at me, "we've got this, can you go put bed 3 on a bedpan?" Bed 3 was a code-brown.  As I gathered the materials to clean her/change her linens, a nurse from the other critical section team came to ask me to do a quick blood test.

I was wearing thin, and somehow, this helped me think more clearly.
S: "I can do it, but where is your tech?"
RN: "Tech Useful is doing an EKG in room 9."
S: "Wait, Tech Useful is extra today."
RN: "Oh, really? Who is our tech?"
S: "Actually, Tech Laid-Back is supposed to be in your section... Also, Trauma Tech Sour-face is supposed to be out here too.  You have 3 techs, and they only have me. Nobody has helped me out all day."
RN: "Hm, let me go check."

He walked around the department and looked at the assignment sheet- nobody else was to be found.  I ran the blood test anyway, but at least now, the charge nurse and team leader nurse became aware and concerned about the people missing in action, even prompting an overhead page, to no avail.

One patient began to code, and out of nowhere, Trauma Tech Sour-face, who had been hiding in the trauma room appeared, pushing us all aside to say, "I've got this," and jumped on the patient's chest to do compressions. Other techs appeared too, and suddenly, our department was full of dedicated, hard-working heroes. It wasn't the first time I laughed in absurdity that day.

It was, however, the first time I ever reported anyone to the managers.  Tech Laid-Back had tried to do damage control with me, saying that she accompanied a helipad transport. However, helipad transfers usually take 45 minutes and she was gone for more than 3 hours.   She offered me help when she finally appeared, but the rush was already over. My impending burn-out was still prescient, however, and it took all I had to finish the shift gracefully.

Believe it or not, the overall workload that night was only a bit heavier than it usually is for our busy sections.   I was only subjected to the abuse that night because of the lack of teamwork that night.  In my section, 2 of 3 nurses were new graduates and unused to the procedures and stress of treating of critical patients.  Their preceptors unfortunately took their training status as an opportunity to gossip instead of helping.  Between Tech Useful and me, the sections stayed functional, but barely.  If any of the other techs had done even the bare minimum instead of hiding wherever they were, we could have functioned very smoothly. The coding patient in 9 might even have been caught earlier had another pair of eyes been watching.  Ugh.

I carefully control my internal environment to exclude resentment, but it became very difficult that night last week.  It took me a week to work through these emotions and I can only hope the new nurses don't learn to become complacent like their preceptors.

Meanwhile, here's to the successful completion of another week in the life of a ERTech.

S

Holiday Plans

Holidays are great times to work... On Halloween, I apprehended a bunch of frat guys wearing superhero costumes, on Thanksgiving, I told patients that we had a "Thanksgiving Day Turkey Sandwich Special", and this ChanuChristmas, I will be working, but as a side project, I am organizing a caroling group to go around the hospital wards. I figured it will be fun to do something together with my co-workers and volunteer program.

The ER is festively decorated with shiny baubles and there are wreaths and garlands hanging around.
The most wonderful time of the year, indeed.

S

Perils of ER Dating Predators

NQ Honest is a co-worker from a different department who I see often at work.  He is a friendly young man with more than a hint of exaggerated machismo. NQ took to winking at me every time he saw me. I would return a curt nod.  Although he seemed nice, I maintained my strong ideas against dating anyone from the workplace.  There are stories (not mine) out there that can curl your hair!

NQ seemed to be encouraged by my lukewarm acknowledgment, however, and escalated his advances so far as to ask for my number.  I declined every day for a week until he told me it was his birthday. I can safely say, I will never be guilted by the birthday excuse again.

Strike one: After a barrage of "y havnt u been txting me lol" messages, he exchanged numbers the same week with RN McSlutty in the back hallway.  Oops.... Sloppy game, man. Subsequent pretenses to be infatuated with me were that much more alarming in the next few days.

Strike two: I was introduced to his mom 3 days after the strike one incident.  But this isn't going where you think it is. Working in critical care early in the morning, he rolled in as my patient, tachycardic at 160.  I was shocked to see him so pale, but ever the gentleman, he first introduced me to his mother. Although he told me he was there because he had worked overnight and was overtired, his chart told me that he had tried Cialis for the first time and took too much.  That would explain his extreme difficulty urinating and need to be catheterized after he downed 8+ glasses of water.

Strike three: Asking me out for drinks because his mom was so taken with me. My polite decline caused him to loudly proclaim in front of my co-workers, "you should be nicer to me after all those drinks I bought for you."

O_o 

Mr. Not Quite Honest has since been a strong reminder of the perils of dating in general.  It's a scary world out there, but apparently not as scary as taking a dip in the company cookie jar.

S

The worse insult

PA: How could you not tell me this patient had an O2 sat of 87?!
S: I thought telling the nurse would have sufficed (considering pt x was on a bedpan, patients y,z,a, and b needed vital signs, crazy patient c was puking all over the floor, patients d and e both needed labs drawn asap, poor patient f needed to be wheeled to the bathroom, then home, and we got new patients g and h.)
PA: Well, I just would have expected that someone that just got into PA school would actually care about letting someone know, that's all.

The biggest insult in her remark? It wasn't that it was in full view of doctors, nurses, and patients. Nor that I was yelled at, nor that she snidely thought I didn't care, considering how many people told me the opposite during the course of the day. It was probably that she assumed I got into PA school. At this point, I would probably be very happy. Unfortunately, medical schools haven't given me much of an indication of anything yet. Sigh.

S

New Blood

The first new tech, Newbie, has been hired! Hitherto, I had been the newest tech for about a year now.  Interestingly enough, I was chosen to train him for my 12 hour shift last night, which was great. His unadulterated enthusiasm and appreciation for his exciting new job was heartwarming.  Moreover, his focus is on patient-care and making sure our patients were happy and comfortable.  This aligned well with my own philosophy and we worked very well together.  The best part of Newbie was that he wasn't lazy. He followed me throughout my high-energy day with no complaints, though I realized at the end of the night that his legs were very sore from standing all day.

In direct contrast there had been another tech-hopeful that visited the ER often, hoping to get a foot in the door. A manager had approached me and asked me about her performance. Although our tech-hopeful had a lot of ER experience in another hospital and seemed to really want to be here, I had a feeling she had too much prior experience.  Experience can make a person more adept at a job, but it can also give a person insight into how to take shortcuts and become inert.  Although she stated she had worked many codes before, when we received one, she did not jump into the action and I worked the code alone, compressions and all.  Her manner and upturned nose suggested a weary boredom of her current job and an apathy for getting to know our ER and our people.  Therefore, to the manager, I replied that she was not a good fit for us, despite or because of her experience.

Newbie, on the other hand, wanted to get into everything, but not in a competitive way.  I was resolved to give him some organization in his training and showed him at least once, in detail, how I performed each task.  My own tutorage followed a "thrown to the wolves" philosophy.  I had to learn everything by trial and error.  Secretly watching the person "training" me helped me grasp details of the trade; otherwise, there were many instances in which I could have gotten in trouble.  It felt good leading Newbie into the rooms and jumping in with a plan of attack.  We cleaned up a massive GI-bleed, helped with draining abscesses, helped set up a lumbar puncture, etc. Though the amount of information was overwhelming, he was beyond satisfied with his new job.  It was also interesting seeing him perform his own little brand of personable magic with our patients.

I was holding Ms. Lumbar Puncture's hand when she said "I can't believe I'm getting a spinal tap on 11/11/11. This is going on my Facebook!" I laughed at the reference, but Newbie went further and launched into a spirited discussion with her about various obscure movies with the same actors. I have never been a movie-person, but watching them form an instant bond because of movies was enlightening.  Everyone has different skill-sets. Whether a person can be bothered to use these skills to relate to and help other people is what makes the difference. Newbie has this wonderful quality and I am proud of him.

Yesterday's shift helped me realize I wasn't doing myself any favors by abstaining from blogging.  The plan was that I used my weekly blogging time to work on applications for medical school, but that is a very different kind of writing that I don't enjoy nearly as much.  If anything, my informal little stories will help me get back on track.  Therefore, I am back.  Sorry for the wait.

S

Hulk in the Trauma Room

When I come to work, the first thing I do is take inventory. Especially in the trauma room, I need to know where everything is and how to use set it up/use it because the technician should be the #1 resource when something emergent comes in and panic sets everyone yelling for x, y, and z.  That being said, when I see on the assignment sheet that I am trauma for 12 hours, and there has been no one in trauma for the shift before mine, I know that there are probably essential items missing from that room.

At this point, I hope and pray to my white cloud of trauma not to send anything my way as I feverishly restock that room. Simple things like normal saline bags, lactated ringers, and blankets must be put in the warming closet can save someone's life by keeping body temperature high as they are losing blood.  Unfortunately, these blankets are always disappearing as people come in to steal them for patients. (I do take them for my little old ladies and gentlemen, but at least I replace the blanket I take with one from the rack... ) Gauze pads, needles, gowns, flashlights, chest tubes, lube, cervical collars, invasive temperature modules, staplers, traction splints... hundreds of items and kits that need to be immediately handy just in case.  

It took me over an hour and a half to stock that room. We received only one trauma, but when I was checking his vital signs, I found a sneaky female technician snooping around the yet unused area behind me. She informed me, you can clean the other side, I am doing this side.  I stared at her in a bemused fashion as she shuffled around said, this side is almost done. She then told the nurses, I stocked that whole side, so you're good in the trauma room! The she-hulk stared down at me. I smiled ironically and said, well... thank you, that's all, I think. She slunk out reluctantly, returning to the chaos of critical care that she was probably seeking to escape for a longer period of time.  I saw that she had rearranged and removed some of my items, so I fixed what I could and sighed. At least the nurses had seen me at work and laughed at the she-hulk's brazen attack.

S

Health-Care Team

For whatever reason, all my patients tonight were extraordinarily ill.  Intubation after intubation, respiratory emergency after respiratory emergency, significant chest pains, intestinal blockages, internal bleeding, traumas, ingestions, you name it- we were swamped.

Mr. Cat-eyes, one of my regular drunks who is here at least 3x a week was a critical patient today.  Because he was unresponsive (and still drunk), we pumped his stomach and fed him activated charcoal through that same oral-gastric tube.  Activated charcoal is pretty gross. It got all over my gloves, then on my bare hand when I removed the gloves. It's thick, sludgy, and tastes terrible, so I hear, except for one girl who took the pediatric cherry-flavored charcoal and said it tasted like cookies.  He was sweating profusely (diaphoretically) so I wiped his familiar face several times with a towel.  He wasn't clean- streaks of yellow exudate covered my towel.  The respiratory therapist was a nice young man.  He actually wiped a spot I had missed on the other side of Mr. Cat-eyes' face.  When Mr. Cat-eyes went upstairs, I couldn't help but wonder what had made him this way today. :(

In the other room, a nice old gentleman had come in for difficulty breathing.  Throughout the day, his eyes were half-closed, but he was fully aware and answered questions appropriately.  It reminded me of when animals are sick. They don't vocalize, but lie there, panting and staring through half-closed, glassy eyes.  I felt so bad for him and made it a point to go to his room often to shut off the constantly ringing alarm on his monitor. Both his heart rate and breathing rate were extraordinarily high.  The same respiratory tberapist from before came to find me because my LOM asked said to him "I feel so tired, but I wonder if I fall asleep if I'll ever wake up again." He made me promise to check on him often, which I was doing already. It really touched me to know that someone else was caring for patients. Not "caring" in the cold, clinical sense, but caring in the way that you move a lock of hair from somebody's face, or tuck a blanket around someone's bare neck.  This therapist even did something that I normally do; he came back when he was about to go home, to check on this LOM once more, to reassure him that he was in good hands, and that we were going to take care of him.  I think that my faith in humanity jumped a few points today.

I did my own mitzvah today after seeing the respiratory therapist with my LOM. An older man had come in for syncope.  Apparently, he had been fasting all day for Yom Kippur and fainted dead away after a glass of wine.  He and his wife were lovely people and very grateful for my detailed attentions to them despite the craziness of 2 intubations in the rooms around them and several patients down the hallway screaming from PCP use.  It was worth the extra effort to me. They were kind people- you can tell from the way their bright eyes crinkled when they smiled. After I changed out of my scrubs, I stopped in to see them one last time and wish them luck. Luck would have it that they were being discharged at that very moment and as my final work-related action of the night, I removed his IV and sent the pair of them out into the warm autumn night.  Work felt good tonight... Can't wait for 12 hours of trauma drama-rama tomorrow!

S

On the Wings of Karma

Someone decided to switch me out of Urgent Care for 8 of the 12 hours I was supposed to be there. 8 Hours working as helipad tech isn't so bad though, so I refrained from notifying anyone that such a change had been made without my consent (not that it would even matter).

As I peered through squinted eyes in delight at the gorgeous day, feeling the warm breeze wash over my body, I received several patients and met some really cool medics that fly helicoptors for a living.  There was a crazy trauma where a man got his leg caught in a machine that has a threshing mechanism of action; the whole leg was bound with a tourniquet, and when they opened the cardboard encasing it, it was mangled beyond repair.  There is a middle-aged man out there tonight without a leg that had accompanied him his whole life.  

Meanwhile, Urgent Care got slammed. 8 patients at once is already overwhelming, but there were literally 18-20 patients in that waiting room. Whoever wanted a cake-walk shift was definitely mistaken to take this hellish post from me today. (Thank you!!!)

The balmy breeze on top of the helipad tonight lifted my spirits with the dancing lights of the helicoptor.  I watched the patients and their families in the tower across the way stick their faces up close to their windows, watching us working.  I waved and they waved back.  Being outside in that night air is definitely one of the keener sensory pleasures of being a tech.  

S

First Time for Everything

I can log a few firsts tonight:

My first confrontation with a co-worker.
My first instigation of a confrontation ever.
My first time trying to speak French with a patient.
My first time observing a glass eye at close range.
My first time taking a break to let off steam.
My first traumatic code
Working my first traumatic code death without help.
My first time being directly appreciated and recognized by a co-worker.

Which of these should I start with in my next entry?
S

Schizophrenic Encouragement

I was in a somber, pensive mood walking to the gym early in the morning when I saw Mr. Orange Juice riding toward me on his bike.

The first time I met Mr. OJ a few months ago, he came up to the triage desk and asked me for orange juice.  I asked him if he was a patient.  Then, the other nurses pulled me aside in hushed voices and told me, it's just Mr. OJ the happy schizophrenic. Just give it to him and he'll leave because he is harmless.  I was curious- ok, but why the hushed voices? He was good friends with K, they explained. K was a middle-aged night-shift Charge Nurse who had suddenly died a few weeks before of a brain aneurysm. It shook the whole department to the core because she was a constant presence up until that fateful day.

I took out two little cartons of orange juice.  Mr. OJ graciously thanked me and called out, WANT TO SEE MY NEW BIKE????? The staff followed him out to see his new bike. I didn't go, but was highly amused..

Mr. OJ probably didn't remember this instance when he saw me on the old flagstone entrance of the gym. I lowered my eyes as he got closer, but then I heard an indulgent "you'll be all right." The huge black schizophrenic man on the bicycle grinned ebulliently at me as I looked up in surprise, "you are just like me when I was younger. You'll turn out ok." He zoomed by me without stopping, a flash of fluorescent orange, and called cheerfully once more over his shoulder, "you'll turn out ok!"

I couldn't help but grin stupidly to myself.  He is the happiest schizophrenic I ever saw. And totally made my day.

S

Musical Misinterpretation

I got to work today in Valhalla, the Emergency Room section above the rest, upstairs in an area resembling an actual hospital wing, It always smells like fried food, is bright, cheery, and actually has windows.  Up here, there is signal for the cell phones, patients have their own rooms, bathrooms, and a television to remedy the long hours of sitting there waiting for test results. Patients are happier up here, and so are we.

A few weeks ago up in Valhalla, I had a tough-guy patient. Wiry, with a sleeveless black shirt, a mustache-beard, and bald, he was the epitome of "biker".  He talked in a folksy but brusque way and was an all-in-all stereotypical middle-aged biker dude.  Imagine my surprise when I walked by his room to hear, blasting, the most beautiful Beethoven quartet. I smiled to myself and listened outside the door for a few minutes- I miss hearing this kind of music. I remember chastising myself mentally for stereotyping.  Maybe even biker dudes had that sort of introspective, sentimental side to them.  

Today, when I was taking vital signs on a patient, I heard elevator-grade flute music playing loudly from the room next door. Curious, I walked in and asked the patient if she was playing the music to calm herself.  "Are you kidding?" she stuttered in an agitated way, "it's a pain in the *** and I can't even turn it off."

I checked the controller- the tv wouldn't turn on or off. The volume controls for the music would only get louder. And the music was awful.  The off-button was not working.  The only way I could get the music to turn off was by unplugging the whole TV set-up.  

I couldn't help but laugh, remembering my tough biker guy sitting in the room, captive audience to very loud Classical string quartets for 8 hours.  I don't know if he was enjoying it or gritting his teeth trying to jam all the buttons on the controller, to no avail.  Poor man, I hope it was the former. 

S

Luck of the Draw

For some patients, coming to the ER can be a wonderful experience.  The team that is taking care of you might be the A-team, a well-oiled machine that provides conscientious, pleasant, professional, and indulgent care of you. Not only are things done immediately and with great skill and precision, the bedside manners of the doctors, nurses, and staff are warm and reassuring.  Especially if you are in critical care, this can make a huge difference for your nerves, happiness, and prognosis during your considerably shorter stay.  Don't worry, a few hours is normal- if you had the L-team, you might have to suffer through many more hours of discomfort, though.  Working with the A-team is an incredible learning experience; we are calm, at ease, and responsible.  Therefore, when working with the A-team I might even venture to ask and doctors might even approach me about the biology behind what is happening to a patient. On these days, I don't even mind working double-shifts. It's such a good experience.  And even crabby patients leave us with a grudging respect, because everything that could or should be done, was. (picture of lucky cat)

There are other teams, of course, made of a mix of these personalities: http://talesofanemergencytech.blogspot.com/2011/08/nursing-species-in-er-jungle.html

Some teams are all-business. Things get done, but you leave feeling a little cold. Other teams are anything but professional; the staff is "personable" but you can't help but question if they know what they are doing.  Then, there is another category entirely- team-Lazybones.

I had to work with the ultimate L-team the other day.  Between the three nurses, Nurse Negative, Nurse Airy Fairy, and Nurse Lazy, all of whom liked to disappear into the ether when the trauma drama died down, I could not find a single one for an hour and a half at a time when my trauma patients were begging for legitimate pain relief.  Then, they ignored my request on behalf of the patient until the resident asked them directly, and disappeared again.  The surgical resident was more frustrated than I- the medications were ordered as she was suturing pieces of torn muscle and skin and the patient was crying out. But for the life of me, I again could not locate a single nurse from my team.  Then the O.R. secretary called me, livid, to pick up a stretcher that Nurse Airy Fairy had left there on purpose, covered in blood, bloody vomit, and other bloody gore.  She decided she didn't want to clean it.  Nurse Lazy couldn't get an IV in a patient and stuck him 5 times with the same needle, ripping off the blood pressure cuff sloppily every time I applied it. We never got a good blood pressure reading until it was absolutely required when the unstable patient went to CT scan, and then he asked me to draw all the labs with a butterfly.  Meanwhile, I was still the only one doing all the vital signs every hour, stocking the room, cleaning the rooms, helping the residents with the patients.  Where did they go for the whole shift? I still have no idea- maybe taking smoke breaks.  It's scary to imagine anything serious coming in that trauma room with such a dysfunctional team of nurses; thank you, white cloud! I can't imagine that any of them actually consider themselves competent with such attitudes towards working.

(picture of doom cat)
How to avoid such craziness when or if you come in as a patient? How do you make sure that we don't harm you more than whatever had happened to you already?

The details of the room you enter might give you a clue: if the johnny coat is strewn across the bed in a haphazard way, if the bed wasn't cleaned and newly made from the last patient, if there is garbage on the floors, if the drawers aren't stocked, you might be out of luck. That or we're just having a busy day. Nothing is for certain in that crazy place, after all.

S

Trauma Clouds

There is a common superstition about working in trauma. Certain people have "black clouds" and elicit groans from all staff working that day when they find out they have to work with you.  Having a black cloud over your head means that the bloodiest, blackest, most heart-wrenching traumas will more likely roll through the door when you are present than not.  You could be a doctor, a nurse, a tech- anybody. People will whisper and shake their heads; you are cursed.

I have the opposite problem, for better or worse.  When I work in trauma, I hardly get any. I average maybe 2 light ones per shift, whether 12 hour or 8 hour.  Several times, after a shift totally devoid of traumas, I hear overhead "full trauma now, full trauma now" as I am walking out the door on my way home.  They like to tell me that I've cursed myself by saying it, but I've been saying it for months. It's just the luck of some people, I guess. Nurses clutch at me for protection when I leave, maybe trying to stand under my "white cloud" for a little while.

I had 2 traumas yesterday, both crush injuries occurring between man and machine. One man got his fingers sucked in by a commercial dryer. Several of his fingers were slashed open and nails were shorn off, but he luckily avoided any nerve and bone damage.  The other was more serious, where a man crawled under heavy machinery to flip a switch when it fell on him, pinning him, shattering his pelvis, and rupturing his bladder. Not good.

Take care out there, gentle readers. Don't do anything silly when working with machinery or equipment or work without having your wits about you; the machine has its own intentions for which it is made and it takes  only a few seconds to change your life forever.

S

The Doctor I Will Never Be

Mrs. Unlucky had terrible abdominal pain, but test results were delayed for a long time because she had a prolapsed urethra and we couldn't get any urine on her. The catheter wouldn't pass through the nodule of protruding tissue.  http://en.wikipedia.org/wiki/Prolapse

The lack of urine sample was the least of our problems, though. Throughout the day, I took her vital signs, which were normal, every two hours.  Suddenly, in her sixth hour, her temperature shot up to 102.5F.  Her test results confirmed that she had a perforated colon, a dangerous and emergency condition where the bacteria were entering her abdominal cavity and causing a raging infection. All this confused her, as Mrs. Unlucky was a blue-collar worker with very little formal education. All she knew was that she was in pain and she was terrified.  Unfortunately, her problem was one that could only be helped by surgery, and I needed to do a pre-operation EKG, since she was going to go under full anesthesia.  The surgeon came in while I was setting up and stared at me in a patronizing manner. Perhaps he thought I was moving too slowly.  As I placed a sticker on her chest and whispered to her that the EKG wouldn't take long, he stood up straight over me and said nastily, "you need to stop what you're doing." I looked up in surprise. "Why does she need an EKG?" He quizzed me. Because she is going to be admitted for surgery, I wanted to say, but in this instance, I felt uncomfortable answering him.  It was beyond my "scope" to say so as a technician to a surgeon, in any event, and people have been fired for far less than saying things they don't have the authority to say. So instead, I replied simply,
"I was asked to do one."
"You'll need to do it later, then, because this is important," with an ever so slight emphasis on "this." He stared at me and waited for me to leave the room, and I did so without another word, feeling my blood pressure heighten and my face flush.

I had been part of a very nice team of nurses and doctors taking care of Mrs. Unlucky for many hours and now she was subject this surgeon's very different- abrupt and impersonal- care.   After he left, I found her crying, bewildered. The doctor had given her the choice of having a colostomy or an ileostomy, a bag that is connected to the intestines for waste removal, while the surgery site heals.  She didn't want either and didn't really know the difference, but she was pressed to make a decision, since he had to go get set up for her surgery immediately. I understood that he wanted to move quickly, but she was completely overwhelmed by how quickly the transaction came to pass.

May I never be too busy or haughty to intimidate patients or staff. That sort of manner doesn't at all come off as powerful or efficient. Rather, it just makes a person look like a total jerk.

S

The Section Above All The Rest

There is a section in our Emergency Room that is different from the others. It looks like a real hospital ward and smells like fried chicken and warmth. Compared with our real Emergency Room downstairs, it is like a hotel. Here, patients with stable vital signs, screened against drunks and the seriously ill, come to rest. They have call buttons, they have TV's, and they have yours truly, S, to serve them during their stay at Hotel ER.

After a few ghoulish shifts downstairs, working in heaven isn't bad at all. The isolation with a select few co-workers is ripe for camaraderie as well as vicious gossip, depending on who is there. It is a place where cougars can fawn over a new nurse and nothing gets done until closing time so no new patients are sent upstairs, or a really great team-leader nurse and attending physician can lead an organized healthcare battalion.

Last night, we had to close the section down early, in the wake of Hurricane Irene's approach. Our day staff did not want to drive home in the weather and drive back in the middle of the storm this morning, so they get to stay in "heaven". A charge nurse even sent cleaning people up to sterilize the room she was staying in. I made sure to stock the closets with extra blankets. I hope they don't ravage my section because I will have to restock everything before patients arrive today!

Stay safe in the storm and if I don't blow away, I will be back to update with adventures of storm-day.

S

Drunk Tank Pentameter

The night was waning, shift was ending fast,

when charge had tracked me down with this request:

please open up the doors to yonder room,

where idiots who drink avoid arrest.

Thus far I *had* been very fortunate,

escaped the boring fate it is to sit.

Well bring them on, this can't be all that bad,

With forty minutes left, why not commit?

The dank and dim-lit room was prepped and set,

the stretcher sounds came drifting to my space,

a million miles away my mind had rest',

in girlish dreams of etiquette and lace.

Hi ho- the first intoxicated hailed,

but why and how did I end up o'er here?

You're drunk, the tech who brought him in had sneered,

with that, she turned her fat and ugly rear.

Come back! My resident had yelled- in vain,

and anger, seething, hot, and fueled by drinks-

induced the large and dang'rous brute to leap

from bed with limber strength to strike the minx.

Now I had no desire to be thus stuck-

though no immediate danger came my way.

against the wall I slunk to freedom safe,

escaping waving limbs and spittle spray.

Security came quickly at my call,

my boor became a gentleman in haste.

And all was peaceful, only for a while,

because the tech returned, smirk unerased.

Now I don't really mean to yell, she said,

the panic button, you have heard of it?

Stay *in* the room, and you will be okay,

Six years, I've worked and I have not been hit.

I thanked her with a smile upon my lips,

with irony appropriately placed.

When you're here, which will happen soon, I'm sure,

You might not boast an injury-less face.

When there is malice brooding in your breast,

don't instigate my drunks and cause a mess.

Naivete may seem to be my fault,

advice like yours, I could not ---

---regardless, shifts were changing very soon,

my soft and comfy bed was calling me to sleep,

which rare occasion is a cause for glee,

though even dreams are not immune from creeps.

S

Idle Tongues

At work tonight, I found out I am an exotic bisexual, great at performing oral sex, and wild in bed. Great to know- I always wondered about that, but now I'm sure, since I heard it from my co-workers who know much more about it than me. While I was covered in (other peoples') blood, much less. Silly me. Who needs to watch TV dramas when you can live the real thing working in the Emergency Room? I wish I lived half as exciting a life as they think I do. ;-)

S

A Social Faux Pas

A month or two ago, a bunch of nurses were talking about Nurse Needy- a huffy-puffy, heavy-set, short, and reeally needy nurse. There is something in the water in our ER- everybody is pregnant- about 15 nurses at a time. Anyway, they were saying how Nurse Needy was expecting, was slowing down a bit at work, looked good being pregnant, etc etc. That stuck in my mind for the past month and I had a silly moment last night.

NN: S, can you go move bed 4 into 7 and 11 into 7 for me?

S: Sure.

NN: Ugh, what is wrong with today? There are so many people and yadda yadda yadda and I get so tired and cranky, as if enough wasn't on my plate already, yadda yadda yadda and it's hard to move around, yadda yadda yadda.

S: Is it that you're expecting?

NN burst into bewildered laughter. WHAT? What are you talking about? I'm not pregnant.

Insert foot in mouth.

S: Oh, I am so sorry- I was just thinking to myself, I see you all the time and you never mentioned it. A bunch of people were talking about it and they were so sure, like it was a done deal. I am so sorry.

NN: It's ok, don't bite your tongue about it (more loud, high-pitched laughter)- it's just that I have no children and can't have any children, ever.

S: I am so sorry. Really.

NN: It's ok. It's just really funny to me. I can't believe anybody would think that.

S: :-( Ok, I'll go move the beds now.

I was going without eating for 8 hours, on my feet for the past 11, and caused a terrible moment for somebody. There was no excuse, though, and I just felt so young, so inexperienced, so socially awkward. But I had patients to see so I bit my lip, refocused, and continued with my crazy night. I'm so sorry, Nurse Needy!!!

And I work with some real a-holes. And I am not referring to patients.

S

Nursing Species in the ER Jungle

The Lifer: She's hardened, ruthless, scathing. There is sarcasm driven deep into every wrinkle and she is a valuable warhorse in the trauma room or when something serious is happening because she knows due process for almost every situation. She is usually precepting some meek new nurses and works them hard as a rite of passage. Other people would call it hazing- she will call it conditioning. She was probably nice once, but got twisted and jaded one day and crystallized to be stuck as the timeless ***** she is now. She needs to retire or take a long vacation. Seriously.

The Student/New Nurse: Unambiguously awesome; will do what s/he is supposed to do- does not depend on the technician for everything. Might actually take vitals for him/herself. Still speaks respectfully to patients, will grab them blankets, food, drink, socks, bedpans without sarcasm. Will get picked on early on. The nice ones tend to leave fairly quickly to become a floor nurse or take Nurse Practitioner school. The tough ones who stick it out usually have all the trappings necessary to eventually become a lifer.

The Filipinos: Glib, quick on their feet, generally cheerful- they get worked hard and take on some of the toughest patients per ER hierarchy. They generally socialize closely with each other only and are friendly but reserved to everyone else.

The Perpetual Team Leader/Charge Nurse: They no longer touch patients, might start an IV once in a while if everyone else is busy/not to be found for a new patient. Otherwise totally immersed in the drama of assigning patients to other nurses, getting the the patients upstairs into the wards, moving patients around. Stand in direct line to eventually become managers or administrative workers.

The Traveler: Have seen and done it all. Keep to themselves and will tell great tales if you get them going. Usually leave as soon as everyone starts to like them.

The Technician-turned-Nurse: They know the exact job description of the technician and will use one to the fullest extent of their power. Some had built up heavy resentment and will ask more of you than is practical or necessary. Either super sweet or rife with issues- there is no in-between. Are usually very handy and have a wealth of experience.

The Clique-sters: You know them. They wear the same danskos, same brand of scrub bottoms, wear their hair in similar ways, smack of gum and gossip. Hipper, hotter, holier than thou- as far as they think. They patronize patients by calling them sweetie, honey, young lady (when referring to grandma). They get grossed out by pee and vomit even though they are ER nurses. Will question or defy new residents (especially female residents) on decisions and laugh constantly, usually regarding inside jokes. The male version are all, for lack of a better word, studly- who trade workout tips behind the nursing station and strut around. Most likely found carrying heavy boxes, putting the largest gauge IV catheters in patients as possible, or looking up supplement/motorbike/working out information on the computer at the working station.

The Whore: Males love her but still call her one. Females won't touch it with a 20-foot pole. Probably has the phone numbers of the male residents over there, there, and there if you look in the phone that is permanently stuck to her hands.

Former Floor Nurses: Genuinely nice nurses who love the excitement of the ER. Invariably shocked at the lack of caution and regard for isolation procedures. They don't get caught up in drama when they first come in because they actually like it here. Yay!

Nursing Managers: Super diplomatic. All have the "soft" voice they use when talking to patients who are pissed off. Know everything about everyone- up on all the gossip. Harbor secret desires to return to the floor, but know that everyone else depends on them to do what they do. Unpopular by default, which is too bad- they are probably wonderful people, but it's hard to tell anymore.

Everyone else: it really takes all sorts- for example, the Paramedic-nurses are really cool to talk to. They are in the field half of the time- they know what it's all about and tell great stories. Everyone else keeps to themselves and are inconspicuous. They deserve to be treated as the awesome individuals they are, not subscribing to drama, gossip, or bile. These are often the introverts and observers who put patients ahead of their own "personas" and perceived values. There are d-bags in this group too, by the nature of all-inclusiveness, but nobody cares about them.

I raise a toast to everyone, good and bad, for making my workplace the menagerie it is every day. Thanks for keeping it interesting- I'll see you at work in a few hours...

S

Now I Understand

I loved you. But it was not enough to move you. Now I know that no one was enough to move you.

The tech who taught me most of what I know is gone. He helped me get this job and tonight, he shot himself in his house. The whole department wept at the news.

He was gentle, he was strong, he was handsome. He had a heck of a sense of humor, always a smile on his lips and a glint in his eye.

He was a romantic, a real ladies' man, protective of the weak and persecutor of the lazy. He was always working, which is why he liked me, because I never stop moving when I work.

From him, I learned how to set a proper EKG, and how to apply cardiac leads. From his gentle manners, I learned how to approach an angry patient, how to lower my voice to calm them, how to be firm to establish command with a drunk. I learned how a long-term ER worker can maintain a sense of humor and composure. I learned how PTSD can ravage a soul. His eyes sometimes looked far away. I loved the way they refocused back onto me and crinkled into a twinkling smile.

We parted because I could no longer be content with being anything less than stuck to him. He gently affirmed his need for space with a sad, but firm resolution. He had demons, I knew, but I respected his choice to spare me from dealing with them. I would have traveled the world just to glimpse him again, but I accepted his choice.

Tonight, I think back to all the happy moments I spent with him- he, who taught me what chivalry is supposed to be, who taught me what it means to be brave, who taught me how to grin and bear it all. I'd cried countless tears for him, but tonight, the meter is reset- there are more coming.

Rest in Peace.