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

Punintended Joy

Call me S-ilvertongue. I finagled my way out of being in the drunk tank for 8 hours out of the 12 I was working tonight. Thank goodness, because we had the rowdiest, most foul-mouthed, foul-spirited, putrid drunk patients ever, evidenced by the fact that all 4 of them were put indefinitely into 4-point restraints and some had spit-masks. On top of that, we were completely inundated with patients. So in the spirit of recuperating from the night's trials and tribulations, I will tell you a story with a happy ending.

I had a half-hour conversation with a nice old man. It was only when he told me that I realized he was totally and completely deaf. One could never tell because his elocution was perfect and he told a lot of punny jokes.

How do you transport blood to Europe? Through blood vessels. Where is it taken? To the Red Sea.

I got hit with a fish as a child. That's why I have a herring problem.

He was hilarious. His stories looped round and around- and I must admit, I dearly love a silly pun. I got a notepad and a pen for him. This was my lame joke that I told him:
What's the most dangerous vegetable to have on a boat?

A leek.

He loved it. "You really love doing what you do, don't you? I can tell." Yes, sir, I do.

"Through all my years of (extensive and very serious) health problems, I have come to find that humor really is the best medicine."

Oh, delightful LOM, I totally agree.

He was discharged with no complications. :-) It's nice to see that humor really does keep him going.

S

Critical Heat

I had some very ill patients today that should not have been in the general emergency section I was working in.

Lady #1 had a blood-glucose level of 35mg/dl. Normal is 70-100mg/dl. At such a low number, she could go into seizures or coma, so we kept a very close eye on her.

Lady #2 had uncontrolled diabetes and a critical high glucose that the meter could not read. She was still "CRITICAL HIGH-NOTIFY NURSE" 4 hours later when I checked again.

But my most worrisome was a middle-aged man, Mr. HMH (Huge medical history). Mr. HMH could barely speak; when he did, it was in a high, whiny, breathless voice. Noticeably weak, he could barely lift his arm for me to wrap a blood pressure cuff around him. His pressure was 80/50, much too low because he kept nodding off with his eyes wide open. Because his skin felt hot, I fetched a rectal thermometer. As the nurse rolled him over, I pulled down the diaper and saw a large stool stuck in the rectum. We also found a bedsore that was unknown to us before. We tried to clean the stool, but soon found that he was completely and deeply compacted with feces. Then, we unwrapped the dressing and found an advanced stage bedsore (http://en.wikipedia.org/wiki/Bedsore) with tunneling into the wound. Ouch! His rectal temperature was 100.0degF, so he had a low-grade fever. When I asked him his pain level 1-10, 10 being the worst you've ever felt, he replied 10.

"Where is your pain, sir?"

"Everywhere."

"Is there anywhere that hurts the worst?"

"My butt."

"Can we roll you off your sore? Maybe that will help."
"Yes, please."

With shaking hands, he held onto the railing and I stuffed a pillow under him to take pressure off his hip.

"Is that better?"
"Yes, thank you, thank you."

"Ok, is there anything else I can do for you?"
"Can I see your arm?"

"...Sure." I handed him my arm. He held it slowly to his lips and kissed it, murmuring, "God bless you. Thank you."

I felt tears spring to my eyes. I patted him a few times on the shoulder. Later, I brought him some orange juice with a straw, that he drank slowly. It must be a terrible experience to be sitting in a stiff stretcher for 10 hours with nothing to eat and not being allowed to move around much.

And then they pulled me out to sit with combative drunks, one of whom told me "you're too nice to live in this country"- thanks buddy... but that's a story for another day. I went to my ER for a ceremony this morning. Upon seeing me, I was recruited to come into work early. It will be a veeery long shift- I know it already. At least I cajoled the charge nurse to switch me out of the drunk tank tonight. :-)

S

Dalliances with Drunks

Mr. Slick began his ER hallway drunk-tank adventure as an explorer. He sailed through the halls, through uncharted wildernesses of unused stretchers and linen closets, stopping man and beast alike to chat and build local street cred. He sensed the triage nurses were inattentive and slow and he knew the system like the back of his hand. Eventually, he was caught by the native security guards and escorted back to his bed without being tied down. He tried to talk me out of his involuntary stay on his stretcher, but it was to no avail. Grumbling, he covered himself with a sheet and passed out for a few hours. His BAC was .380.

Mr. Scumbag then wheeled in with a BAC of .327. He refused to admit he drank anything and proceeded to ask directly for a sandwich as soon as he was settled on the stretcher. He also needed a glass of water and needed to go to the bathroom, too. Despite these needs, the floor was "too dirty to walk on" for him. Eventually someone fetched him a sandwich. He didn't eat a bite before he asked me to throw it out, "not to be a scumbag or anything." Winking at me, he kept making a come-hither sign, saying "hey, hey, pssst, come'ere." The first time, I did go near him and all he said was, "you're gorgeous." Uh, thanks. "Wait, come back, come'ere." He looked conspiratorial- "whatever you have to say to me, you can just say it out loud." "Tsk... no, really, come here, it's important." "You know you're into me." Half an hour later, he gave up, "you don't want to talk to me because you know I'm a scumbag." I did take him to the bathroom and suddenly, he put me in a bear-hug. Feeling his arm around my throat was not a good feeling, so I called security and he tried to laugh it off. He was escorted back to his stretcher and warned. He soon became bored and woke up Mr. Slick.

They became great buddies, feeding off each other. Mr. Slick knew our system well from coming in all the time and taught Mr. Scumbag what "AMA" means- against medical advice. This prompted a chorus of "I want to sign out AMA! I want to sign out AMA!" Of course, as I explained calmly, this was impossible considering they were intoxicated and therefore incompetent to make that decision. Then, Mr. Slick pulled out a cellphone, which was not allowed. I told the nurse, who totally undermined me by saying "I don't care if they have it if it makes them calmer." Way to go for standing up for your co-workers and workplace morale. Mr. Scumbag snatched the cell phone and tried to use it, too, to no avail. Our radiology department was next door and the leaded walls blocked out signal. Mr. Scumbag declared my explanation as "a crock of ****", and Mr. Slick became convinced the hospital was full of voodoo that blocked cellphone signals instead. "Hey, I'll give you $100 if you go get Burger King for me," Mr. Slick offered me. I laughed at him and turned to help the nurse with Mr. Scumbag.

A nurse tried to take vital signs on Mr. Scumbag. The cuff kept popping off. His arms weren't that big and I watched him to see why- he was flexing as the meter read and being a general d-bag. He started bragging "You can't take my blood pressure because they're DIESEL," posing for all to see. The nurse gave up. Soon, Mr. Scumbag realized nobody was watching him flex and he got bored, declaring "I just wanna go home and get laid."

Mr. Slick shook his head, deciding he did not like his new friend. That was when Mr. Slick's neighbor, Mr. Goldfish, wheeled in. Mr. Goldfish was looking for his phone, which was in his pocket the whole time. Security took it out and put it in the bag under his stretcher because he was not allowed a phone. He had some sort of short-term memory loss- he didn't remember anything that happened about 10 seconds before. So he kept asking for his phone. Pleading for it. Pleading for us to find it. So he could call our hospital. He did not stop and mournfully wailed for it, even crying large tears out of both eyes. Why are you crying, Mr. Goldfish? My mother died! he wailed. He continued crying inconsolably. He refused to breathalyze for about half an hour despite our most insistent nurse drilling at him. Finally, I asked him- when did your mother die? 20 years ago. Geez, the way he was crying, one would have thought it was yesterday. Soon, Mr. Goldfish was put in 2-point restraints because he kept flailing and refusing to sit back. When he was taken out of restraints, based on a verbal agreement that he'd behave, 30 seconds later, he had to be put back in. He didn't register there ever was any sort of agreement. Completely incapable of normal cognition, my hours with him wailing and asking for his phone really grated on my nerves.

"This is a sobering experience," observed Mr. Slick. "I wanna go get laid," interjected Mr. Scumbag. "WHERE IS MY PHONE? CAN I HAVE MY PHONE?" asked Mr. Goldfish.

8 Hours later, the noise level was still the same and I was beat. Drunk tank tech is done for the day. Time to go for a long run.

S

Fencing, ER-Style

Mr. Mumble-de-Gook is incomprehensible. He is one of my regular drunks that I ignore completely because the last time he begged me for a sandwich, he thanked me by eating it, then peeing in the box for me.

Ms. Prissy Regular comes in like clockwork- every week. There is usually nothing wrong with her, but she likes to come in for a nap and a sandwich under the guise of some problem related to her morbid obesity.

Our ER was full to capacity again last night and both of them were put in the same back hallway to await sobriety. The stage was set for disaster because Ms. Regular is spoiled and Mr. Mumble-de-Gook does not ever shut up. I have never understood a word he said except that time I figured out, he was saying "hungry" and gave him the sandwich.

Ms. Regular: Can you please be quiet?

Mr. Mumble-de-Gook: Hrrrrngh! muauambuleaa-aggh.

Mr. Mumble-de-Gook: Arrrm aerrddd nyumm uh huhh errdaastt meehh

Mr. Mumble-de-Good: auyumm aereeedsss miisssto miiiikkk meraamernumer astimurkat

Ms. Regular: What is wrong with you? I'm trying to sleep here.

Mr. Mumble-de-Gook: aghg-mummbrrr orrr ehhhh

Ms. Regular: I don't need to sit here and listen to you all night. You sound retarded.

Mr. Mumble-de-Gook: ARRR-EEMBB EEREM NYAN NYAN NYAN

He stands up and makes a menacing motion.

Ms. Regular: You get any closer I'm gonna clock you with my cane. (She swings it for effect)

Mr. Mumble-de-Gook swings out *his* cane and says the first comprehensible sentence I have ever heard from him: MMRM I'mmmm gonnarr knock mrrr your wigg offf.

There was to be a cane fight as both of them started brandishing the canes in menacingly, but I called security and Mr. MdG was released back onto the street because he was walking as steadily as he ever did. Oh, the joys of sitting...

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

Inappropriate Dinnertime Conversation

I have changed the diapers of countless old grandmas and grandpas with the expectation of cleaning up urine, diarrhea, blood, etc from their ample or skeletal behinds, wiping the creases of delicate, wrinkled skin, avoiding sores, applying barrier cream. I have learned to recognize the smell of UTI (urinary tract infection) so well that I can sometimes tell with people walking by in the grocery store. But I had never changed a baby. That was a realm totally unknown to me, until recently.

The new mother had just given birth by C-section only a few days ago and had a fever. I took her vital signs and asked if she was warm enough. The husband stood by nervously, cradling a carrier and two friends stood in the corner. They did not speak English and I came back with a few chairs so they could all sit down.

As I was leaving the room, I heard "Miss, miss." I turned around, "Excuse me..." it was the husband, looking sheepish. I went in the room where they gesticulated that they would be very thankful if I could change the baby that just started crying- little sobs of pure want and need. The patient was in too much pain to sit up and the other three visitors had no idea how to do it. Totally taken aback, I said, sure!

Running back outside, I grabbed a clean pad for a working surface and a few pairs of gloves, took a deep breath, and walked in. I was unexpectedly nervous as I gingerly lifted the little one from the cradle, just a few pounds of flailing arms wearing a small pink cap. Unbuttoning the onesie, I saw green liquid everywhere- is it called meconium? As I lifted the little legs to wipe her, she stopped crying and began to coo, looking at my face.

This is as it is supposed to be, I smiled to myself, as I applied the stickers on the diaper and changed the baby into another set of pajamas. I had seen everything else in my time at the ER, practically, but a baby was a totally new and wonderful experience. What an excellent end to a long shift.

S