Unions

A dedicated Teamsters union worker was attending a convention in Las Vegas and decided to check out the local brothels.

When he got to the first one, he asked the Madam, "Is this a union house?" "No," she replied, "I'm sorry it isn't." "Well, if I pay you $100, what cut do the girls get?" "The house gets $80 and the girls get $20," she answered.

Offended at such unfair dealings, the union man stomped off down the street in search of a more equitable, hopefully unionized shop.

His search continued until finally he reached a brothel where the Madam responded, "Why yes sir, this is a union house. We observe all union rules." The man asked, "And if I pay you $100, what cut do the girls get?" "The girls get $80 and the house gets $20." "That's more like it!" the union man said.

He handed the Madam $100, looked around the room, and pointed to a stunningly attractive blonde. "I'd like her," he said. "I'm sure you would, sir," said the Madam. Then she gestured to a 92-year old woman in the corner, "But Ethel here has 67 years seniority and according to union rules, she's next."

I Love New Docs, Part 1

A few years back, I was working in a little bitty 10 bed community hospital ER. After 3 am, there were 2 nurses, a tech, and a doc on until 7am. Needless to say, some of the best stuff happened after 3am.

We had a guy in his early 60's come in for chest pain. His workup had been negative so far, but we were hanging on to him to do repeat labs and such. His daughter was at the bedside, and they were laughing and talking like they were sitting in the living room drinking Coke and playing Scrabble. (Or drinking beer and playing Poker, depending on who you are.) Three of us were sitting at the nurses station drinking Coke and playing Poker (cuz we were just like that.)

From down the hall we hear, "Dad? Dad? Somebody help meeeeeeeeeee!" (It was an ear-piercing shriek by the end of the multi-syllabic "me".)

We all dropped our hands (which frankly, I didn't mind, because I was getting my butt kicked anyway) and ran (well, they ran. I don't run. )

Upon my arrival to bed 5, I found a hysterical daughter, a pulseless, apneic patient, a freaking out Doc, and a nonchalant RN. I headed for the patient's face, attached the BVM to the wall, started ventilations and watched the fun begin.

Freaking Out New ER Doc: "Oh my God! He's in V-tach!"

Nonchalant Nurse Who's Seen and Done Everything: (as he begins compressions) "Yup. Why don't you wheel that crash cart over here."

FONERD: "OK. Right. Now, I need somebody to push Epi, and we need another line, and...."

NNWSaDE: "Doc, how 'bout we try some electricity first?"

FONERD: "OK. Right. Let's get the paddles and charge them......."

NNWSaDE: "Doc, it's just us three. How 'bout you grab the paddles and come over here with them?"

FONERD: "OK. Right. Here you go."

NNWSaDE: "Doc, how 'bout you squirt some of this pretty blue gel on his chest and hit the charge button."

FONERD: "OK. Right."

Defibrillation ensues. Sinus Rhythm returns. Patient begins breathing. etc, etc.

About a minute or so later, patient's color has returned to that of a live, breathing person, not that of a dead, blue guy. He starts to come around. FONERD is no longer freaked out. Now he is totally amped. I'm talking bouncing off the walls amped.

Totally Amped New ER Doc: "Did you see that? He was in V-Tach, and I shocked him and now he's Sinus, did you see it? did you? huh?"

NNWSaDE: " Yup, Saw it, Doc. I was right here. Front row seat. Saw the whole thing."

Previously Dead But Now Alive Patient: "What happened?"

TANERD: "Dude! You DIED! You were DEAD! And I brought you BACK!"

Pumping of fists and other testosterone laden behavior ensues.

Gotta love 'em!

Dogs are people, too...

We're contemplating getting a couple of dogs once we fence in the backyard, so I've been thinking up dog names. Since people can name their kids any retarded thing they want, I've adopted the same approach with my dog names. Any suggestions will be appreciated!

• Smegma & Phlegm
• Haldol & Ativan
• Pneumocystis & Pneumococcus (you know what they'll get shortened to...)
• Thrombus & Embolus
• Ennui & Apathy
• Vilify & Vitriol
• Sildenafil & Tadalafil
• Drunk & Nekkid
• Paroxysmal & Spasmodic
• Corpulent & Hebetude

Cops and Metallica

One of our esteemed City Police Officers moonlights as a rent-a-cop in the ED about once a week. We generally spend the majority of his 8 hour shift trading insults. He has a gun AND a Taser, so I try to keep it semi-nice, you know, in order to not be on the receiving end of a High Velocity Lead Treatment.

Last night he came in about 3 times with DUIs that needed a legal BA drawn. I razzed him a bit each time, and my parting shot at 5am was, "I'm getting off work in 2 hours, hurry up and clean those streets so I can make it home to bed!" Or something like that.

Fast forward to 0730. I'm 3 blocks from my house, (which is 30 minutes from the hospital), and I've got the window rolled down and Metallica S&M blaring to stay awake for *please God* just 2 more minutes. (And everybody knows that Michael Kamen was the best thing that ever happened to Metallica.) Enter the flashing red lights behind me. I look down- 25 in a 25, that's not it, not weaving (I don't think), nobody's out and about but the High School Hoodlums from the High School down the street, and their stereos are louder than mine, so that can't be it; not on the cell phone......WHAT THE HELL?

Esteemed City Police Officer steps up to the window...."License and registration, please...."

That's what we call getting the last word, folks.

tee-hee

'Nuff said.

Books and Movies

Tonight two teenage patients were discussing The Lord of the Rings and Harry Potter. They were trying to decide which series was better, and I was impressed that they had read them, because, hey, that's a lot of reading for a teenage boy. A geek like me can knock out a book like that in a day or so, but like I said, I'm a geek. Then the lightbulb came on. They were talking about the movies, not the books.

I about wet myself when one of them said, "I think all books should be made into movies so everyone can enjoy them."

And they say our schools aren't teaching kids like they used to........

I'm getting hypoxic, here.....

It was one of those nights. We've all had them. 25+ patients in the ER and only one needed to be there. He was on Bi-Pap (it's a breathing machine, Mom) because he couldn't breathe too well on his own, what with all the cigarette smoke clogging his damn lungs, and all. So he needed to be there, but it was his own stupid fault. The rest of the group was a combination of drug seekers, retarded parents, (Tylenol and Motrin, people! You can buy it over the counter for a reason!) and non-emergent "emergencies". (And why exactly did you need to come in at 2 o'clock in the morning with a cold that you've had for 3 days?)

After about 5 hours of this, I was getting cranky. (I know, I know, "Say it isn't SO!") I got a warm blanket for the anxiety attack getting a full cardiac workup in Room 4, a glass of water for the whiplash from an MVA 2 days ago (with full negative workup on the day of the accident) in Room 10 (yes, I've had it, yes, it hurts, no, you don't need to go to the ER twice for it), a set of disposable scrubs complete with those cute little feetie socks with the treads on the bottom for the drunk who peed all over herself in room 16, and some peanut butter and graham crackers for the 5 year-old kid of the lady in Room 20, who thought it would be a good idea to drag the poor thing down to the ER in the middle of the night to try and increase her chances of getting her Lortab script refilled. (It doesn't make us feel more sympathy for you, dear. It makes us want to beat you for depriving your kid of the sleep she needs.) And I did it all with a smile. Well, a grimace that could pass for a smile if not examined too closely. You know, a non-threatening baring of the teeth. A smile-ish.

Then I got a portable oxygen tank and a non-rebreather, sat down at the nurses' station, turned it on, put it on, and leaned back and closed my eyes. About 2 minutes later, I was aware of a strange feeling; kinda like I was being watched. I opened my eyes and there were about 10 people all around me with very concerned looks on their faces. The charge nurse said, "MonkeyGirl, what's up? Are you OK?" I said, "Not really, I'm getting kinda hypoxic, I think." She said ,"Why, what's wrong?" By this time there was a crowd of cranky nurses (and a mildly cranky ER doc) trying to swallow their crankiness for me, to help me in my hour of need. I felt all warm and fuzzy inside as I lifted up my mask and said, "Because these freaks that are filling our beds are STEALING MY OXYGEN!!!!!"

Needless to say, we were in better moods for a little bit after that. Except for the charge nurse. She doesn't always appreciate my sense of humor.

Ode to Benadryl

This weekend, Benadryl was the bizarre drug of choice.

We had a 13 year old manipulative sh*t that came in for a reported OD on Benadryl 3 (count 'em, three) different times in 3 days before getting an EWOL and a psych admit (finally!) the last time. Bet the EWOL (commonly known as stomach-pumping, Mom) has more effect than the psych admit.

We had a real Benadryl OD (talk about a horrendous way to spend your Friday night! I actually felt sorry for this guy. A little bit.)

Then we had a 23 year old druggie that ground up her sister's Benadryl and snorted it. Not enough to do any damage, cuz she stopped when she wasn't getting high.

That is the "retarded patients" part of the story. Now for the happy ending.

I have horrendous allergies. Between the pollen outside, my co-workers' various perfumes and lotions, and the fact that I am allergic to my cats (no, I am not geting rid of them. They make me laugh.) I haven't been able to breathe for about 10 years. I buy Kleenex in the 12 boxes at a time shrink-wrapped package at Costco. Monthly. Claritin, Allegra, and Zyrtec do not work. Sudafed does not work. I have been taking 2 Benadryl every 4 hours for about the last 5 years. Literally. Now for the DUH part of the story.

I haven't ever tried any of the prescription nasal sprays because, frankly, I can't breathe, so how am I gonna inhale my medicine? Besides, dumb me (with some misinformation from a dumb doctor at some point) thought that they were all just antihistamines and wouldn't work anyway. WRONG! They're actually steriods. One of our ED docs took pity on me this weekend (I was quite pathetic, even more so than usual) and wrote me a script for Flonase. He said he didn't care what my arguments were, go get it and try it for at least 2 weeks. (I think there was a "Now, before I kill you myself" in there somewhere.)

The first day it mostly just dribbled back out of my nose. (I really can't breathe most of the time.) The second day I got some in; it made me sneeze for 30 minutes. The third day I think I got a full dose. The fourth day I could breathe. I have taken 4 (count 'em, four) Benadryl in the last 3 days. My Kleenex boxes are gathering dust. My cats are sleeping on my bed again (much to my husband's dismay.)

And for 15 seconds every morning, I feel like I just snorted Raid. Swear to God. I hate it. Oh well.

Shoulda bought him a Corvette...

13 year old kid, white as a ghost, clutching his belly and curled up in the fetal position in the wheelchair. Mom says he was jumping on the trampoline, and when he fell off, hit right across his abdomen right below his ribcage. uh-oh. I'm pretty sure there's a couple of vital organs in that area. Bedside ultrasound showed free fluid in his belly. His blood pressure was slowly coming down and his pulse was slowly going up. His initial labs were fine, but the repeat 30 minutes later showed a decrease in his H&H. Not bad yet, just lower.

We're not a trauma center. We don't have any docs that will admit and follow trauma patients. Anything that looks like it could get ugly goes to the Level I Trauma Center in the Big City 45 minutes away. If it looks like it could get ugly quickly, it goes in the pretty helicopter that lives across the parking lot. This qualified for the pretty helicopter.

Apparently the kid's parents bought him this trampoline because they are in the middle of an ugly divorce. (You know, "Mommy and Daddy still love you; let us prove it by buying you something that will keep you occupied so that you won't notice us ignoring you.") They cost, what, anywhere from $200.00 to $1000.00, right? So after that, the $500.00 ambulance ride, the $2000 to $3000 ED bill from our ED, the $10,000 helicopter ride, and the $5000 to $50,000 bill from the Trauma Center, (depending on what kind of surgery/treatment he ends up needing), best case scenario is about $20,000 and it could be over $100,000 if he ruptured his spleen or has a big ol' liver laceration.

Yup. Shoulda just bought him a Corvette.

What Are They Teaching Our Children?

Tonight I was drawing labs on a 21 year-old guy whose wife was at the bedside. As I would fill a tube and set it beside him on the bed, he would pick it up and look at it, and he was asking me questions about the additives in the tubes, etc. We were carrying on what seemed to be a normal conversation, until his wife said, "Now, honey, what color is your blood when it's inside your body?" He promptly replied "Blue. Everybody knows that." She said, "Well, at least you paid attention in science class."

I looked back and forth between them for at least a full minute before it dawned on me that they were SERIOUS!!! I said, "No, your blood was the same color inside your body as it is now that it's in these tubes." Neither of them believed me, and after a couple of minutes, I just gave up. Patient education be damned.

Could somebody please 'splain to me how you can get even a sub-standard education and not know what color blood is? Does this mean that somebody actually taught these two at some point that blood is blue inside your body? Jeez!!!

How Bad Do You Want It?

If you come into the ED with a complaint of dental pain, and halfway through treatment for said dental pain you realize that you're not going to get any narcotics, so you change your complaint to abdominal pain, and then proceed to insist on the entire gamut of tests up to and including pelvic exam and pelvic ultrasound, just to get some morphine, you have an illness that cannot be cured here.

(I feel sorry for the coders in medical records. I can see it now, "How do you code this gynecological workup for this dental pain patient?")

What color Volkswagen was it?

Nurse Kelly over at Crass-Pollination just took all of my thoughts about the pain scale and turned them into the funniest thing I've read today.

I was going to gripe about pain scale abuse a couple of days ago but it just came out as a high pitched whine, and I couldn't figure out how to type that. Now I'm glad I couldn't- this is much better.

Night Shift Fitness

Anyone that has ever worked night shift knows that diet and exercise are very hard to keep up with (and even harder to get back on track with) because your eating habits suck (ie: scarfing down a burger in the 2 minutes you have before the next ambulance gets here) and you're too exhausted to go to the gym when you get off work. Now, when I used to smoke, I was skinny, because the "2-Minute Burger Scarf" was replaced by the "2-Minute Cigarette Scarf".

But now I'm trying to develop better habits so that I don't have an MI before I hit 50. This is what I'm doing.

1. I read Fitness Magazine (while I wait for my batch of Chocolate Chip Cookies to bake.)

2. I drink Diet Dr. Pepper (with my double cheeseburger). I don't eat fries (who the hell has room for fries after a double cheeseburger?)

3. My husband and I have turned our spare bedroom (which we never used because nobody ever comes to see us) into an exercise room. Now I have a treadmill and a really cool Smith cage, with which I can do almost every exercise I ever tried to do at the gym. (And I don't have to dry my comforters in the dryer. I can hang three up at a time now!)

4. When I take candy in for the staff to share, I always take the individually wrapped ones. That way, by the time I've unwrapped the first one, all of my co-workers have descended upon the bag like a horde of locusts, and there's only one more left. If they weren't wrapped, I could eat 10 or 15 before they were snatched from my grip.

5. Last, but not least, I've replaced all my Guinness with hard alcohol. It has less calories. (OK, not all my Guinness. A girl's gotta have something to look forward to sometimes!)

It Seems So Trivial....

The rant I had planned for today no longer seems appropriate.

My thoughts go out to those directly impacted by yesterday's shooting at Virginia Tech.

LawDog was dead on and Marko made a couple of thought-provoking points that had me looking up info on concealed carry permits in my home state.

GruntDoc hit it from the flip side.

Beyond that, I got nothin'.

Go hug your kids.

How about a shower?

So this chick comes in complaining of a rash (invisible, of course) and horrible pain all over after spilling gas on herself.

Gassy Chick: "I just need something for the PAIN!"

MonkeyGirl: "When did you spill gas on yourself?" (Note: Absolutely NO odor of gasoline detectable)

GC: "About 15 minutes ago! It hurts all over my arms, and it's burning and itching!" *sob*

MG: "Did you wash it off?"

GC: "No! It hurts too bad! I need something for the pain!" *swoon*

MG: "Where did you spill it?" (Note: no oily residue, redness, rash, etc... ANYWHERE within sight)

GC: "Right here! See? All over my arms! It's KILLING me!" *tears*

MG: "Well, if you think that this is an emergency, and not something that a shower will take care of, you can go ahead and have a seat and we'll get to you as soon as possible."

GC: "Can't you give me something for the PAIN while I'm waiting?"

MG: "Not until the Doctor sees you, ma'am. Sorry." (Not)

She was gone when we called her name 3 hours later. Guess the shower was calling her name after all......

Conundrum

It's Sunday and I actually have the day off. I could go shootin', but it's cold and rainy outside. Of course, that also means I don't have to mow the lawn or do any other suburban yardwork. I have a legitimate excuse to sit on the couch and vegetate. Yay! No, wait.......

It's April. No football. Damn.

Rutgers chicks and guns

So did the Governor of New Jersey really wreck so that he wouldn't have to mediate the apology-fest between Don Imus and the Rutgers chick-basketball team? He was probably telling his State Trooper/Bodyguard/Chauffeur, "I'd rather eat the guardrail than deal with this group of volatile idiots!" and voila! he ate the guardrail! I'd better stop saying, "Somebody shoot me now," when I walk out of patient's rooms. Somebody might.

Welcome to the Zoo

Friday the 13th in the ER. The only thing better is a full moon. The psych beds are full, the natives are restless, and I swear to God, if one more person says, "I KNEW something bad was going to happen today!" I'll punch 'em. Guess what, lady? The fact that you aren't smart enough to give your kid some Tylenol or Motrin for their temp of 105 has a lot more to do with the seizure he had than the freakin' date does. Jeez! And take the snowsuit off him, for crying out loud! It's 50 degrees outside, not 50 below.

That's enough venom for my opening post. Don't worry. There's a lot more where that came from.