Saturday, June 2, 2007

The Rules

If it requires the ambulance team and entire truck of firefighters to transport you and safely place you on a hospital stretcher, it is time to go on a diet.

When you present to the triage nurse, do not tell him/her that your doctor called ahead. If you survey our waiting area, probably 50% of the people waiting said the same thing and the other 50% use the ER as their regular doctor.

Never start out by saying, "I was searching the Internet....."

When asked how much you weigh, please do not give the deer in the headlights look, and tell us you really don't know. It's a simple question, simple answer.

Just because you have a phone and know how to call 911, we are not impressed by your arrival on an ambulance stretcher. You had better be sick.

If you came escorted via EMS for multiple complaints that started more than one week ago and your entire family followed the ambulance to the hospital, you will be labeled a pussy and treated like one. Enjoy the waiting area with your family.

One complaint/ailment per visit, please.

Just because you came in on an ambulance, doesn't mean you're going home on one. You better start making arrangements, now. I am not driving you home, or figuring out how to get you home. Cab vouchers are not an option.

If you have one of these four, go to your own doctor in the morning: a migraine, the flu, a stomach virus, or a stuffy nose.

Do not ask us how long it will be. We don't know. I don't know what is coming through my door 30 seconds from now and so I sure as hell don't know when you're getting a room.

We have priorities. We understand that you have been waiting for two hours in the waiting room. If you don't want to wait, make an appointment with a doctor. The little old lady that just walked in looking OK to you is probably having a massive heart attack. That is why she goes first.

If your mother is a patient and we ask her a question, let her answer it.

If your child has a fever, you had damn well better give it Tylenol before coming in. DO NOT let the fever remain high just so I will believe the child has a fever. Do you want your child to have a seizure? Do you?

If you are well enough to complain about the wait, you are well enough to go home.

Do not utter the words "It is in my chart." I don't have your chart, and I don't have the time to call and get it. Just tell me.

We know how many times you've been to an ER. We can usually tell if you are faking it during the first 5 seconds of talking to you.

Do not lie to us. If you lie about one thing, we will assume you are lying about everything. You don't want that.

If you have diabetes and do not control it, you are committing slow suicide.

If you are a female between 16 and 42 and your last period was between 28-35 days ago, and you are here for abdominal pain and vaginal bleeding, guess what? You got your period. Again.

Do not bring your entire posse with you. One person at the bedside is all you need. It is really difficult to get around seven people in the event that you are really sick.

Every time I ask you a question, I learn more about what is wrong with you. I don't care if I asked you what day it is four different times. Each time I ask, it is for a reason. Just answer the questions, regardless whether you have answered them before.

If you want something, be nice. I will go out of my way to piss off rude people.

Our definition of sick is not your definition of sick. If a member of the ER staff says that someone is sick, it means that they are in the process of DYING. They have had a massive stroke, are bleeding out, having a heart attack, or shot. We don't consider a kidney stone sick. Painful, yes. Sick, no.

At any given time, one nurse has four patients. One doctor has up to 15. There is a law (similar to Murphy's) in the ER. If you have four patients: one of them will be sick (see above for definition); one of them will be whining constantly; one of them will be homeless; and one of them will a delightful patient. Don't be the whiner.

Please. If you see someone pushing a big cart down the hall at full speed and you hear bells going off, do not ask for a cup of coffee. Someone is dying, you inconsiderate asshole. In the ER, bells don't ring for nothing. Sit down, shut up, and let us work.

If you can bitch about the blood pressure cuff being too tight, or the IV hurting, you are not in that much pain.

Physicians and nurses are not waiters. We are not customer service representatives. This is not McDonalds, and you very well may NOT have it your way. Our job is to save your life, or at least make you feel better. If you want a pillow, two blankets and the lights dimmed, go to the Ramada.

If you have any sort of stomach pain and you ask for something to eat, you are not sick.

Do not talk shit about the other members of staff I work with. The doctor that you hate? I work with him every day, and I know that he knows what he is doing. I trust him a lot more that I trust you. I am not here to be your friend, and neither is he. I will tell him what you said, and we will laugh about it. If you want a buddy, go somewhere else.

If you are homeless, don't ask for a bus token or cab voucher to get home. It just confuses the staff.

Please don't tell us how to do our job. Do we go to your place of business and tell you how to do your job?

Please don't bring in a show and tell. If you have to fish it out of the toilet, it's really not necessary to bring it in. We will take your word. If you did fish something out of the toilet, you may not use my pen.

***No, I didn't make these up. Somebody much funnier than I did. No, I don't know who it was. But if it was you, let me know, and I will happily give you credit.


Anonymous said...

I've read this before, but I still love it. Maybe I should hand out copies when people start bitching. Since most of our patients are functioning illiterates, it should take them a couple of hours to get through and, hey, by that time maybe I'll be at lunch.

Fever Dog said...

Oh man, you mean I can't go to the hospital for a stuffy nose any more? That is so unfair.

(loved this)

Catherine said...

Make me glad that I laid down and shut the hell up when it was my turn in the ER (I was the delightful one!)

Cannot imagine dealing with this on a regular basis.

ERnursey said...

I first read this on a blog called 'Protect the Airway' but I don't know if he was the author.

frostedlexicharm said... giving kids tylenol for fever before going to the ED...we can't. My kiddo is a post-transplant patient and we've been told by his team not to give him any fever-reducing agents before he's seen at the ED. But, we usually bring along a DVD player and coloring books and other things to keep him entertained during the (long) waits. :) --lexi

girlvet said...

God, this is so great and funny and real. I love the thing about fishing things out of the toilet!

Joeymom said...

I always remember the one time I took my kid to the walk-in clinic (I only going to the emergency room if we have a life-threatening emergency) and explained that my kid had a fever, but I had given him tylenol before coming; and sure enough, the tylenol had worked, and the thermometer read normal. Those immortal words fell from that nurse's lips: "Why did you come in? Your kid doesn't have a fever." As it turned out, he had a very painful double ear infection. I filed that one with the another clinic where the doctor tried to prescribe amoxicillin right after I had just explained to every staff person in the place, including the doctor not two minutes before, that my child is allergic to amoxicillin- it was even stamped in red across the top of the chart, inside and out. Also the OB/GYN who walked into the room took one look at me and informed me that I was to consume no sweets, juice, breads, or pasta (none of which I eat much of to begin with) and gain no weight during my pregnancy. When I started to freak out and ask how bad the glucose test number had been to warrant such advice (and the rather abrasive manner the advice was given), her response was "what glucose test?"

I avoid all of these places like the plague.

Birdwell said...

I stumbled upon your blog via and you got your self a new dedicated reader---you are hilarious and awesome. Thank you for the work you do in the ER.

KC Saul said...

Um, actually, just so you know, reference the kid-with-the-fever thing, pediatricians are telling some of us not to reduce the fever because in an otherwise healthy kid, the fever is the body's mechanism for removing the infection. They say that giving NSAIDs or Tylenol causes cumulative damage to the liver and kidneys and not to give these.

I have also had more than one pediatrician tell me that unless the high temperature was caused by heat stroke or similar, a child cannot be harmed by a high fever. Not all kids get seizures in response to fever.

I am not arguing with you guys, I am just telling you what the pediatricians are telling some of us.

The reason that we are taking our feverish kids to the ED, when we do, is because (1) our pediatrician told us to and (2) there is no alternative open anywhere near us. We would rather not touch the ED with a ten-foot pole, because, as irritating as some of you find us, we find the group of drunks near us waiting for their family member equally as offensive, and everyone around us looks to be carrying a communicable disease.

To some of us, fever and/or pain are a sign that something is broken and wrong. Making the fever go away or administering painkiller doesn't fix the problem that made the fever happen or the pain -- uh, painful. We are not reassured with a shot of Tylenol and a statement that the fever is now gone, for obvious reasons.

I have been told, "Well, now the fever is gone. You can go home." Uh, no we can't. He still has an infection.

Elliott said...

So if I am in so much pain that delightful is out of the question THEN I am damn well not going to choose dying or homeless as the only alternatives. Sorry.

Mousie said...

And another thing...

If you have had the pain for a week and you haven't been taking anlagesia, your pain score is NOT 10 out of 10.

It's the same all over the world, MG. Love it!

mrks said...

I'm with Joeymom on the fever/tylenol thing. Several times, I've been told, "Well, she seems to be fine now!" from medical personel. But I also understand you meaning - it's a referrence to most first-time moms/hysterical overprotective moms.
Love your blog!