LeBron James is a God!

LeBron James scored 48 points and Cleveland beat Detroit 109-107 in double overtime. That puts them up 3-2 in the series and the next game is in Cleveland.

What I wouldn't give to see LeBron beat Tim Duncan.....

Well, hell, that changes things....

I've had runs of PSVT for years. Non-symptomatic, easy to vagal out of, (with an exception or two), no biggie.

Lately I've been throwing PVCs, anywhere from one every 10 beats to one every 5-6 beats. Still no symptoms and no identified cause (caffeine, nicotine, etc).

I was sitting on the couch watching TV the other night and I went into what I thought was PSVT. I looked at my watch to see how fast it was, and it quit before I counted for 15 seconds. It was about 160-ish.

This morning it dawned on me; the PVCs and the PSVT feel pretty much the same. What if it was a run of V-Tach? That could be a bad thing....

Perhaps I'll see if I can get a holter monitor for a day or two....

Change of Shift

Change of shift is up over at Emergiblog; go check it out! Kim has done a fantastic job, as usual!

Does "Thinking" really mean "Bitchy"?

Jerseygirl89 over at Dirty Little Secret has just given me a Thinking Blogger award. I'm befuddled, frankly. I mostly just bitch and moan with a rant or two thrown in. I suppose it's flattering to be considered a "Thinking Blogger", but I've been trying to wrap my brain around it for two days now, and I just can't. So much for thinking.

I'm supposed to pick 5 more people and pass this on like a good little Blogger. I'm very sorry, Jerseygirl, but I really dislike the whole pick 5 people or 8 people or whatever. So I'm not going to make anyone play. However, I will say this.

Kelly at Crass-Pollination makes me think. She makes me think that I'm not totally crazy, because she sees the same shit that I do.

ERnursey makes me think. She makes me think about the serious side of the things that we do. She doesn't just make fun of people like I do.

girlvet over at madness: tales of an emergency room nurse makes me think. She makes me think that there is a way to be serious sometimes and funny, too. A lot of the stuff she comes up with is really thought provoking. (She intimidates me a bit, too. But don't tell her I said that.)

Mother Jones at Nurse Ratched's Place makes me think. She makes me think that I'm a bit of an ER snob, and she has probably forgotten more about nursing than I've ever known. She can tie just about anything in the world (with a picture included) into a story about nursing. Now that is someone to look up to.

And last, but certainly not least, is Kim over at Emergiblog. She makes me think that someday, I would like to grow up. And if and when I do grow up, I think that I would like to be Kim. Because Kim has been there, done that, and is still doing it.

Thank you, ladies. You make me think.

He's Invincible

Head on over to Ambulance Driver's place and read about Sumdood.

You've heard of him before. But I bet you didn't realize how evil he was.....

When you have too much time on your hands......

.......you sit down one day and make this.

The most disturbing thing is that I can see my dad making this. He's crafty like that. My mom would kill him, though.

I made a mistake.

An error. A faux pas. A lapse of good judgement. Even better, it was an attempt at good judgement gone terribly wrong.

All of you currently suffering from apoplexy simply because I admitted to making an error, knock it off.

Here's the deal. My husband, bless his heart, has decided to turn our spare bedroom into a home gym. Now, that's not such a big deal, but the jackass insists on using it as such. Consequently, he's lost 10 lbs, his gut is gone, his biceps have biceps, and his neck is missing. There's just a couple of huge freakin' trapezii where his neck used to be.

Now that has led me into a bit of, shall we say, self-image crisis. So I decided that I should do something about it. No, I haven't set foot into the gym room. Yet. Baby steps, people, baby steps. But I did buy a nice workout book, with lots of pictures, and exercises that I might use someday. (Note the lack of the word soon after the word someday.)

And when I went to the store on Sunday, I bought, *gasp* fruits and vegetables. I had some peas with dinner on Sunday. I had a salad for lunch yesterday. I ate apples for a snack. I had Lima beans with dinner last night. Some of you have figured out where this is going. Better yet, where I am going.

TO THE CAN!!!!! All the freakin' time! My bowels have absolutely no clue what to do with this foreign matter that has invaded them. They're screaming, "Get it out! Get it out! " and then getting it out. Explosively. As my sister put it, I am my own little Salad Shooter.

To top it all off, I have PMS. Horrible, evil, I-want-to-die-and-take-the-whole-world-with-me PMS. Motrin and Midol every 4 hours PMS. (Did you know that in the 1920's, Midol was marketed to men? I know some that could benefit from it in the 2000's...)

Anyhoo, everywhere between my neck and my kneecaps hurts. My ass is raw. All of my reproductive organs are in a state of status spasmus, and my GI organs are so hyperactive that I'm pretty sure they could use some Ritalin. And as I sat on the john this last time, I said to myself, "Self, we should head down to the ER for some Lortab!"

Hear me out, hear me out.... It'll help with the pain, (or at least make me not care about the pain), and in a day or two, I'll be constipated! Win-win!

Now, all I need is a good story..... Not too specific, or I'll get booted without the drugs. Not too vague, or I'll get stuck with an abdominal CT and a pelvic exam. **shiver of horror**

Wait, I need to take a shower. No, if I shower, I won't fit in with the other female abd pain drug-seekers. (An aside to the aforementioned drug-seekers: If you're going to come in with gynecological complaints, think ahead and shower, for crying out loud. We have to look at it, you know. If you break your ankle, we look at it, don't we? So why wouldn't we look at your kootch if you say it hurts?)

OK. Shower, Story, Script for Lortab. The three S's.........

Oh, screw it. I'll just go eat some cheese and chocolate. That'll work just fine. I'd never make a convincing drug-seeker anyway. I exude disdain for them. I'd end up talking the doc out of giving me the script for Lortab, anyway. That is what I do best, you know.

Do you ever have one of those days.....

.......where you just want to slap the crap out of every single person you come in contact with?

Today is one of those days.

PMS, thy name is woman. Where the hell's my chocolate?

Remember the Heroes

Today is a day to remember those who died fighting for freedom, and thank those who still fight for freedom.

If it wasn't for them, I wouldn't be able to comfortably sit here in suburbia and piss off all the sensitive people out there.

Thank you, Soldiers. You Are Not Forgotten.

Ja'Quan's

26 y.o. female, 8 weeks pregnant, abd pain. 4th pregnancy, no live births. Baby Daddy in the room with her. Pelvic exam reveals two things: the nastiest discharge I have EVER seen, (and the doc just had to make sure I saw it, too) and a tattoo right above the bikini line, that says "Ja'Quan's" with an arrow pointing down. (Can you say ouch?)

We discharge her and Ja'Quan with antibiotics and instructions that you know they won't follow.

Fast forward two hours. A polite young man of the African American persuasion walks in and asks the clerk at the front desk for the previously mentioned patient. He's her husband. His name is Ja'Quan. He is NOT the previously mentioned Baby Daddy.

We tell him that she was discharged two hours ago. He thanks us and walks out.

We spend the rest of the night at the nurses' station deeply immersed in social commentary.

But it's been two hours!

"Excuse me, nurse? Can you ax them when my girlfriend is goin' to be seen? Because we been here for over 2 hours and her back is really hurtin' her sittin' in this chair."

"It'll probably be a little while, sir. We have several critical patients back there right now, and once things are a little bit calmer, they'll start calling people back again."

"Well, how come people who got here first don't get to go back first? We been waitin' a lot longer than that last guy."

"Sir, the patients with medical emergencies get to go back to the emergency room first. After that, it's first come, first served."

"But she's been waitin' and she's hurtin'!" **mumbling curse words under his breath as he storms away**

These are the patients that got to go in front of Ms. Back Pain:
--70 y.o. male w/ SOB, O2 sat 78%, Hx CHF
--5 y.o. male w/ SOB, O2 sat 90%, active asthma attack, no inhalers
--25 y.o. male w/ 6 inch laceration on his forearm, copious bleeding
--40 y.o. male w/ CP x 1 hour, diaphoretic and SOB
--30 y.o. female w/ flank pain, hx of kidney stones, actively vomiting, pulse 150
-- 80 y.o. female w/ ALOC, hx CVA, unable to walk today

Jeez. Where are our priorities?

Lilies, Part 2

Do you think this will be enough?

Kelly, I've got another group blooming in the backyard for you....

Anybody else need any Fire Lilies for their crazy ex-whatevers?

Hiccups

The step-kid and I were driving around a while ago and she had the hiccups. We had a long discussion about what causes hiccups, none of which did I actually expect her to retain, because, well, she's 5!

About a week later we were in the car again, this time with her dad, and she started hiccuping. She said, "Hey daddy, guess what? My diagram is spasming!"

Out of the mouths of babes......

Say what?

There's an article on MSNBC about a kid who killed his dad while defending his mom. Apparently there aren't a lot of details about the case yet, because there were only two quotes, one of which was this:

"I was standing over him like this and he was like, dude, he said, 'Man, can you please help me?' I was like, man, you can just sit there, man. I said, they're coming. The police, the ambulance, they're coming. I said you can just sit there 'because you're bleeding too bad, man.'"

Now that's what I call journalism at it's finest.

It's Bud Selig's Fault

Josh Hancock's dad (the MLB pitcher who died driving drunk last month) is suing the bar where his son got drunk, the tow company that owns the truck his drunk son crashed into, and the driver of the car that the tow truck was stopped for.

Perhaps he should also sue Verizon Wireless for providing cell service to the phone his drunk son was talking on. And maybe he should sue Ford for building the Explorer that he was speeding in while not wearing a seatbelt. He should also sue the St. Louis PD for not arresting him 3 days earlier when he was in another wreck.

But most definitely, he should sue the St. Louis Cardinals for paying him so damn much money. Because if they hadn't, he wouldn't have been able to afford the ton of booze he drank, the two cars he wrecked, and the cell phone he was on. Instead, he might have been the poor sap in the Geo Prizm stalled on the side of the road, who is now being sued by some moron's equally moronic father for being in the wrong place at the wrong time.

Public Service Announcement

Attention Homeowners!

If you live in a subdivision, and your lot is less than half an acre, and your lawnmower has a seat....

YOU ARE LAZY!!!!!!!!

Thank you. Have a nice day.

Car Wrecks

On the way to work the other night, my front passenger tire blew out and I ended up in the ditch. Thankfully it happened on a low speed stretch of road with only a 6-inch drop. An hour and a half later, the tow truck driver finished changing my tire and I was on my way no worse for the wear. (I'm a chick, people. Just because I can change my tire, doesn't mean I will change my tire. That's what roadside assistance is for!)

It made me think of something that happened years ago on a lonely stretch of road.........

I was living in the Republic of California, and my best friend HT and I had decided to drive to Las Vegas for the weekend. We were both EMTs working for a private ambulance company on a Medic/EMT ALS 911 response bus. I was brand new and part-time; she had just finished her first month of paramedic school. I had worked the night shift, and she picked me up after work. She was drivin', I was sleepin', and when we got to Vegas we was gonna PARTY, baby.........

About an hour into the drive I woke up to a loud, "Oh Shit! MonkeyGirl, wake up!" I looked out the window with bleary eyes and saw a huge cloud of dust going off the two-lane highway and across a field. There was a car about 50 yards off the road; it looked like it had rolled, and there was smoke coming from the engine compartment. (No, not steam, smoke. Not white, black.) Not good. We stopped a safe distance away (well, probably not really, but we thought it was) , grabbed our Gung-Ho EMT First Aid Kit, and headed for the wreck.

Climbing out of the car (which HAD rolled) was a mostly non-English speaking Hispanic gentleman. He had a HUGE laceration across his forehead from hitting either the steering wheel or the windshield, I'm not quite sure which. His wife was also self-extricated, hysterically running around in a panic screaming something at the top of her lungs. As we got up to the car, she picked up something out of the field about 25 feet in front of the car. My stomach hit my toes when I realized that it was a baby.

I headed for mama while HT headed for the car. She got the only seatbelted passenger (an apparently uninjured 5-year old girl) out of the backseat, and headed for the road with her, papa, and grandma, who had also been in the backseat, also unrestrained. Grandma wasn't moving too quickly; she was leaning on papa pretty heavily (I think she had a broken hip).

By now the engine compartment of the car is fully engulfed, and the whole passenger compartment is filled with thick, black smoke. I get to mama, and she's wailing and crying, and I'm sure she must be holding a dead baby.

She thrusts it at me, like "here, fix it!" and I swear to God, the first thing I noticed was the foxtail embedded in her forehead. The second thing I noticed is that she was still breathing. I cradled her against my chest and we ran for the road.

When we got to the road, there was a cop who had stopped and was directing traffic. HT had her 3 patients laid out on the side of the road behind the cop car, and she came to meet me with an O2 tank and an adult simple mask. It was all the cop had. He had already called for the helicopter, but they were 20 minutes out.

Right about then, we started hearing gunshots. Turns out papa had 2 boxes of .22 ammo in the trunk. For those of you non-gun nuts, there's 500 rounds in a box. 1000 rounds going off in a completely uncontrolled environment is a scary thing.

The next 20 minutes were literally the longest 20 minutes of my life. While HT bandaged, splinted and consoled the other 4 patients, I sat with a barely breathing baby and nothing but blow-by o2. I could see the deformity in her skull where she had hit the ground. She was completely unconscious, and didn't move a muscle the whole time I held her. A couple of times, I was sure that she was going to stop breathing altogether. I'd flick the bottom of her feet and she'd start again, though I had no clue if that was the reason.

I have never been so happy to hear the sound of helicopter rotors. When the first medic got to us, he took one look at the baby and said,"Oh shit!" We got her papoosed and padded, and they took off. About the time they were leaving, two ground ambulances got there, and packaged up the other 4. They weren't interested in any help from us; they basically said, "Thank you, buh-bye." So we went back over and got in the car, and waited for them to clear the scene so we could continue on our way.

As we went by the cop a little later (he was still directing traffic), he waved at us to stop; he told us that we did a good job and he was glad that we were there. And that was when it hit us- the only other person that stopped to help was a truck driver who had a fire extinguisher. It was quickly apparent that it wouldn't do any good, so he went on his way. Nobody else did anything but looky-loo on their way by. This wasn't a busy freeway, but it was a main highway, and probably 100 cars passed us while we sat behind that cop car on the side of the road. Nobody stopped.

About 10 miles down the road we stopped at a rest area to try and clean up a bit. I proceeded to cry like a girl. We didn't know which hospital they were going to, and we didn't know anything but papa's name (Jose) and baby's name (Alejandra). So on to Vegas. Needless to say, it wasn't quite the fun weekend we had planned. Reality kept intruding.

On the way home, we stopped in the big city closest to the accident and made a few phone calls trying to find our patients, but got nowhere. Not that we were surprised. We were hoping, though. I was sure the baby hadn't made it. If you'd seen her........ it was just impossible. Anyway, we headed home and resumed our daily lives. The story got told a gazillion times, and then it slowly faded away into the background of my memory.

About a year later, at about 11:00 at night, the phone rang. A man's voice asked for me. When I identified myself, he said, "This is Jose. Do you you remember me? "

Now, I was living in California. I had known a LOT of Jose's. So I said, "Umm, I'm not sure." He said, "I was in an accident, and I think you helped me." We talked for a minute more, and I realized who he was. I said, "I remember your family." He started to cry, and I thought, oh shit, he called me to yell at me for killing his baby. And then he said 5 words that I've only heard once in my life and will probably never hear again. "You saved my baby's life."

She spent 4 months in the hospital. 2 of them in the PICU on a vent. They didn't think that she'd live. But she started improving slowly. When she went home, she was 8 months old. They said she might never be a normal baby. He told me she was crawling now, and standing up with something to hold on to. She was 16 months old now and almost back to normal.

He'd been trying to find me for 6 months. He remembered my first name, and he remembered me telling him that I was an EMT. He called dozens of ambulance companies trying to track me down. He didn't know HT's name; could I tell her about Alejandra? We talked for a minute more and hung up. I called HT. We cried. Life was good.

Sometimes the shit just turns to roses. And it makes up for all the times the roses turn to shit.

I Think I Must Live in Crack City.....

......because I see this patient almost every night.

PS: According to the date, the post I linked to has been up for a week. I just saw it today. Not sure how I missed it, since I check CharityDoc's blog daily, but better late than never....

Thongs

I had a class yesterday. You know the kind. Where you sit for 2-3 hours trying to stay awake, avoiding eye contact with the guy who's talking at the front of the room, lest he call on you to answer one of the rhetorical questions that he feels obligated to have an answer for.

I got there early enough to snag a seat in the back in the room, and apparently I smelled bad, because nobody sat in front of me. Either that or I looked crazy. Which is pretty much just the way people always look around here.

There was a girl two rows up. She was hot. Girls Gone Wild coed hot. She was wearing a white t-shirt and low-rider black capris. Why do I remember this? Because she had a black bra under the white t-shirt. And she was wearing a hot pink thong.

And I spent two hours staring at this girl's underwear completely against my will. My eyes were kidnapped. My brain was turned off. I was unable to look away. I tried to look to the left. But there was a fat guy with plumber's crack to the left. So I had to avert my eyes.

WHAT THE HELL WAS I SUPPOSED TO DO?!?!?!

If I look at the guy giving the class, he calls on me. If I look at the plumber, I lose my lunch. If I look at the hot chick, I'm a pervert. I'm screwed!

So I start reading the handout he gave us. It's one page long. It takes 35 seconds to read. So I read it again. And again. OK, that took 2 minutes. I still have an hour and a half.

Hmmm. It's not really hot pink, more of a coral........Yikes! I'm looking again!

Oh Goody. Another handout. Read it 3 times. 2 more minutes gone.

Start looking at all of the cheap art on the wall. Count ceiling tiles. Make shapes out of the stains on the carpet. Do anything but stare at this chick's ass.

AHHHH. The ever-present Power Point Presentation. With the requisite Power Point Handout. Yay! Doodle pages! Lights go down, projector goes on.......

......and all I see in front of me is a hot pink thong. The damn thing is glowing in the dark, I swear to God it is.

I give up. If your underwear is that hard for me to ignore, you obviously want me to look at it. So I did. And so did the other 10 people sitting all around me. I checked. We all had our eyes glued to this chick's butt.

I don't even remember what the class was about.

This Could Be Where I Work....

Filed under: WTF?

A 60-year-old woman from New Jersey just gave birth to twins. OK, I'm not brilliant or anything, but even I can add 18 to 60.

Joe Pa Is the Shiznit!

Football is life here at Monkey Central, and since my professional team of choice has sucked since the mid-90's (Go Chiefs!), any and all football (no, not Arena- that's not football) is not only acceptable, it's required. I don't sleep on the weekends from September to February (work all night, watch football all day, repeat).

MonkeyHusband is from Pennsylvania, which makes him a huge Steelers fan (talk about living hell- a Chiefs fan in a Steelers Super Bowl Season household...) and an even more huge-er Penn State fan. I like Penn State, so that's all good. I'm of the opinion that Joe Paterno is one of the greatest football coaches of all time, and a hell of a lot of fun to watch during press conferences.

So imagine my glee when Joe Pa decided that his team was going to be punished as a team for their off-season transgressions.

Perhaps Marvin Lewis should give him a call.

Internal Electricity

It's the middle of the evening. My laundry list of horrible things to do to patients has rapidly been depleted. The board is emptying quickly. At this rate, we're either going to be bored for the next 8 hours, or there's going to be some sort of gnarly MCI because too many people said the "Q" word.

On the front side (where the real patients go), we have a sweet little old man who came in via EMS for a syncopal episode. Upon arrival, all his vitals are normal, he's embarrassed, and he wants to go home. His wife is keeping him here by sheer power of guilt trip.

He has a fairly significant cardiac history, so the doc ordered a full workup, and since I have literally nothing to do, being the helpful Monkey that I am, I head in to stick a needle in him.

I've got the tourniquet on, the site prepped, and I'm ready to poke him when he starts coughing. Coughing + needle = blown vein most of the time. So I wait a minute. He stops coughing. I return to said site. Veins are now flat. In fact, patient is starting to look like shit awful quick-like. I look up on the monitor and he's in v-tach.

A lot of things happened really fast at that point. First of all, my anal sphincter did the proverbial "crack a walnut" squeeze. I put the head of his bed down and felt for a pulse. (Which was not really necessary, since he was complaining about being poked again, but still the first thing I did.) Then, as I went around the bed to hit the "take BP" and "record strip" buttons on the monitor, I got on the radio and said, "Could somebody bring a crash cart into room 5, pretty please?"

One of the paramedics that was walking by stuck his head in to see what was up and I said, "He's in v-tach." The patient, who had been whining about his bed being flat, says, "I don't feel so good." I reach for his wrist again, and all of a sudden he does the internal defibrillator flop. (Not nearly as entertaining as the external electricity arch, but much safer for the innocent Monkey holding his wrist.) It startled me enough that I might have let a little poo go if my anus hadn't been squeezed up so tight!

I look at the monitor: normal sinus. I look at the patient: he's glaring at me like I just killed his dog. I said, "What?" To which he replies, "What'd you do THAT for?"

I said,"Sir, I didn't do that. The defibrillator that you have implanted in your chest did that. I just watched." (Though it would have been nice if it had done it about 30 seconds earlier!)

About now, the cavalry arrives with the doc and the crash cart. We twittered around for a few minutes, but apparently he was "fixed" for the time being. His vitals were back to normal again, but he was now officially staying for breakfast. (And we all know that breakfast is the only semi-edible meal in the hospital.) I went back to my previous task, which was much easier now that his veins were the traditional round shape, not flat as pancakes.

Note to self: Bring a change of underwear to keep in locker. Sphincter control may not always be so reliable.

Damn memes

OK, so I just finished saying that I wouldn't play again after the last one, and I get tagged by 911DOC over at M.D.O.D. (which I'm pretty sure means Mad Doctor Of Death, since he's already threatened to kill me once, and he even had a plan, which means a 72-hour hold, right?)

So, because he scares me, and because I found a cool new meme on CrankyProf's Blog, I will play one more time. I will not, however, send this to 8 people in 8 minutes. So if bad luck befalls me, I blame 911DOC.

Rules:
1. Go to Wikipedia and put in your birthday, without the year, in the search bar.
2. List on your blog 3 events, 2 births, 1 death and 1 holiday that happens(ed) on your birthday.

3 Events:
1582- Due to the implementation of the Gregorian calendar this day does not exist in this year in Italy, Poland, Portugal and Spain. (Sweet! It's almost like being born on February 29th!)

1919 - Black Sox scandal: The Cincinnati Reds "win" the World Series. ("Say it ain't so, Joe!")

2006- North Korea allegedly tests its first nuclear device. (Kim Jong Il in Team America:World Police was the funniest thing I've ever seen.)

2 Births:
1873 - Charles Walgreen, American entrepreneur (d. 1939) (Happy Birthday from drug seekers all over the world....)

1940 - John Lennon, British musician and songwriter (The Beatles) (d. 1980) (Insert any inappropriate Yoko Ono joke here...)

1 Death:
1967 - Che Guevara, Argentine revolutionary and guerrilla leader (executed) (b. 1928)(Hmmm, I don't like the rules and my name is MonkeyGirl.... hmmmm......)

1 Holiday:
Leif Erikson Day- in United States, Iceland and Norway: celebrating the first European landing in North America (Not to be confused with Leif Garrett.)

OK, I've played nice twice. You can't expect me to play nice again. Well, unless I see another cool, new meme.....

Lilies

I'm highly allergic to Stargazer Lilies. We just bought a house in January, and this spring, a multitude of lilies began sprouting all over the yard. I've been anxiously waiting to see what kind they are. Today one bloomed.

I was glad it wasn't a stargazer, but I didn't know exactly what it was. So I Googled "orange lily" and this is what Wikipedia says.

The Orange Lily or Fire Lily is a lily species native to Europe. When offered as a gift, the Orange Lily also signifies death to the recipient.

In a day or two, there will be about 10 blooming. My husband's crazy ex-wife is getting a beautiful bouquet of lilies.

Won-Ton Physics

The science of the Chinese Buffet:

Theorem: The number of times you will return to the buffet is directly proportional to the number of times you have to walk past the morbidly obese woman at the next table.

Corollary to the Theorem: The dessert item you choose will be the direct inverse of the item chosen by said woman.

Translation: After walking past the 450-lb woman in order to sit at my table, it was hard to talk myself into returning for a second plate. But I persevered. It is a buffet, after all! However, I had to walk past her again to get to the food. So by the time I got there, my "Oh my God I don't want to look like that" sense had kicked in and I ended up dishing up some soup and a won-ton. Dessert? Cantaloupe and pineapple. The owners of the Chinese food place made their money off me yesterday. Her? Not so much.

Stinky Feet

Two nights last week I almost lost it. And it was for the same thing on two different patients.


It wasn't the appearance of the toe. I can handle the appearance. It was the smell of the toe.

At first I was just breathing normally. I figured that my olfactory adaptation would kick in any minute. Nope. Some things are just too powerful to adapt to.

So I started breathing through my mouth. Nope, that won't work, either. Now I can taste it.

So I start breathing very shallowly, first through my nose, then through my mouth. Nope, just as bad, only now I'm getting hypoxic.

"Ma'am, I'll be right back. I, um, need to check on something in the fresh air, I mean the nurses' station."

**Opening door, gasping for breath, crawling down the hall for the outside door, like a slave lost in the Sahara, searching for an oasis.......**

One Marlboro Menthol later I was back in the room trying again. This time my olfactory receptors were stunned into unconsciousness by the shock of:

A: Nicotine (I quit smoking in November)
B: Menthol (I hate menthol)

Gangrenous toe goes to surgery. Much post-patient bitching and moaning ensues. Consequently, when new gangrenous toe comes in the next night, guess who gets to play? Yup, yours truly. At least this one was in an open room, not one with a door. I couldn't have handled Marlboro Menthol two nights in a row........

Where To Go For Vacation

If you live, oh, anywhere, and work in the ER, you have met these people.

Grand Rounds

Grand Rounds is up over at impactEDnurse. It's quite good. Check it out.

So THAT'S What They're Teaching 'em These Days...

We went to the step-kid's kindergarten graduation today. This was on the shelf behind me.

Theatrics

Oh, how I love the patients writhing around on the gurney, moaning and crying in pain, with one eye partially open, scanning the room for a nurse who will bring them pain medicine in reward for their performance....

Mudslinging

I'm reading a book called That's Not In My American History Book by Thomas Ayres. (No, I'm normally not that big of a nerd, but my husband is, and he said I would like it.)

"Politics and political mudslinging have been around almost from the day prehistoric man discovered mud. .......One of the strangest campaigns ever waged was the one by George Smathers against Claude Pepper for the U.S. Senate in Florida in 1950. In his campaign speeches, Smathers began referring to Pepper as 'a known extrovert.' He spat out the words with such disdain, many in his audiences assumed the worst of Pepper. While Pepper was trying to figure out how to respond, Smathers revealed that his opponent's sister was 'a thespian.' He then accused Pepper's brother of being a 'practicing homo sapiens.' He then charged that while attending college, Pepper 'matriculated on campus,' and that he 'engaged in celibacy' before he was married. Smathers won the election."

If Smathers lived where I live, he'd still win. There ain't no rocket scientists 'round here!

Sharing

The old man placed an order for one hamburger, french fries and a drink.

He unwrapped the plain hamburger and carefully cut it in half, placing one half in front of his wife.

He then carefully counted out the french fries, dividing them into two piles and neatly placed one pile in front of his wife.

He took a sip of the drink; his wife took a sip and then set the cup down between them.

As he began to eat his few bites of hamburger, the people around them were looking over and whispering. Obviously they were thinking, "That poor old couple - all they can afford is one meal for the two of them.”

As the man began to eat his fries a young man came to the table and politely offered to buy another meal for the old couple.

The old man said they were just fine: they were used to sharing everything.

People closer to the table noticed the little old lady hadn't eaten a bite. She sat there watching her husband eat and occasionally took turns sipping the drink.

Again, the young man came over and begged them to let him buy another meal for them.

This time the old woman said, "No, thank you, we are used to sharing everything."

Finally, as the old man finished and was wiping his face neatly with the napkin, the young man again came over to the little old lady (who had yet to eat a single bite of food) and asked, "What is it you are waiting for?"

She answered, "The teeth."

Cops need Xanax, too....

Written on the triage slip on the "Complaint" line:

The cops beat me up and nocked me out with a batton just becuse I didnt get in there car. then they stold my zanex and I had 100 pills.

The Cardiac Taxi

A man pulls up outside the ambulance doors and rings the buzzer. "Can we help you, sir?" "I need help getting my wife and mother-in-law out of the car."

I go out to see what's going on. In the front seat is an 80-ish female doing the guppy. Pulse 34, SPO2 83%, white as a ghost. We manhandle her into a wheelchair and run for the pacer pads. In the backseat is a 60-ish female trying to pretend she's ok. History of cardiac cath 2 weeks ago, BP 260/130, pulse 145, headache, nausea, and mild SOB.

They both get admitted upstairs. One to CCU, one to the Step Down Unit. Their rooms are only about 50 feet apart, (though there's a set of metal doors between them). Makes it more convenient for the family to visit if mom and grandma are in the hospital at the same time.

Housework Redefined

I absolutely hate to vacuum. A big thank you to CrankyProf, who found a vacuum attachment that doesn't suck. Or does it?

Men and their Pee-Pees

I was watching the History Channel for a few minutes before work tonight, and in the space of 15 minutes, I saw commercials for Serenity (male incontinence pads), Cialis (erectile dysfunction), Vesicare (overactive bladder) and Valtrex (genital herpes.)

Now, I am of the opinion that if it relates to feminine hygiene or menstruation, or anything to do with male genitalia, I shouldn't have to hear about it on TV. It makes me crazy.

However, after thinking about it for a moment I decided that they could have combined all four of these commercials and done a Public Service Announcement all at the same time.

*Quirky, obnoxious Enzyte music playing in background*

Meet Bob. Bob was having a little bit of trouble with his Gangster of Love. He had both a going problem and a growing problem. So his doctor prescribed Cialis for the growing problem, and Vesicare for the going problem. And Bob was a happy man.

*Sad, lonely Cymbalta music playing in background*

But Bob went a little bit overboard living it up with his Pocket Rocket. Now he has painful blisters and embarrassing drips after he pees.

*Uplifting, happy Volkswagen music playing in background*

But there's hope! With once-daily Valtrex and Serenity for Men, nobody will be able to tell that Mr. Johnson is purulent and dripping. Bob will soon be back on top of the world, and the ladies will be none the wiser.

Thank God for modern medicine.

Buh-Bye PMS?

This article on MSNBC says that if I take these new birth control pills, then I won't be a bitch once a month.

Translation: If I take these new birth control pills, everyone will know that I really am that bitchy all the time. I will no longer have an excuse for one week out of the month.

Nursing Home Dichotomy, Part II

Transport Dichotomy:

Tonight at 2300, one of our local nursing homes sent us a LOMFDGB (Little Old Man Fall Down Go Boom) with an obvious shoulder deformity that ended up being a fracture/dislocation. They sent him in by POV with his daughter.

Tonight at 0400, another nursing home sent in a LOL (Little Old Lady, not Laughing Out Loud) with a plugged PEG tube. They sent her in on a 9-1-1 ambulance. At 4:00 in the morning. For a feeding tube.

I Hate Tim Duncan

The damn Spurs won. I'm so annoyed. Not surprised, annoyed.

I swear, everytime I see Tim Duncan and that wide-eyed "who, me?" look he gets when he gets called for a foul, I just want to slap him. Yes, you, jackass. You can't elbow him in the head when you're trying to block the ball. The innocent child look may be something you learned while getting your psychology degree, but it looks a little stupid on a 31-year-old.

I'm just about done with the Playoffs. If it wasn't for LeBron, this postseason would be a wash.

He Throws Poo, Too

Nice rant by Scalpel.

I Didn't Mean Right Now!

I'm sitting up front at the check-in desk doing a four hour stint sitting on my butt. This 45-ish year old guy walks in and brings a mushroom cloud of cigarette smoke with him. I swear to God, he had to have been sitting in his car chain-smoking for the last 2 days to smell like this. He's filling out the little "What do you want" slip, and I notice that he's breathing a wee bit funny. So I ask him, "What's going on tonight?"

He says, "I'm having trouble breathing and my arthritis is acting up."

I said, "Did you smoke all the way here in the car? Because I'm smelling quite a bit of cigarette smoke on you."

He said, "Yeah, I had a couple."

I whip out my handy-dandy portable pulse ox and see that his o2 sat is 90%. I said, "Maybe you should think about cutting back on that a little bit, or you're going to end up with a tube down your throat and a machine breathing for you!"

He gives me the "I know, I know" look that means "But as long as you're paying for my healthcare, what else do I have to spend my money on but beer and cigarettes?" and I take him to the back.

About 3 hours later I head back to the back, having been relieved of my post up front. I notice a bit of activity around room 4, and so I stick my head in to see what's going on.

They're intubating the guy I lectured up front about getting intubated! I'm like, "What the Hell?"

Turns out he had started acting funny and gotten more and more disoriented as the previous couple of hours had gone on. All of his tests were negative, even the LP they ended up doing. The doc thinks maybe he accidentally OD'd on his Soma. They were transferring him to the Big Hospital in the Big City when I was leaving.

Goes to show you, smokers- if I tell you that you're going to end up on a vent, I mean it!

Highly Emergent UTI

If your UTI is so bad that you have to call 9-1-1 and have an ambulance bring you to our fine ER, and then when you get here and we stick your sorry ass out in triage because the actually SICK PEOPLE are filling up all the ER beds, and you call your mommy who lives over 2000 miles away so that she can complain loudly and abusively over the phone to the triage nurse about how sick her poor daughter is, and you sit in the lobby and make a general PITA of yourself for 2 hours,

don't be surprised if we wait until you storm out the door to "go to another damn ER" to call your name to be seen.

Sometimes "LWBS" is just all we want to chart.

Against Medical Advice

How many times should a patient be allowed to sign out AMA and then come back with the same complaint in a 24 hour period? I mean, seriously. If your chest pain keeps coming back, perhaps you should stay in the hospital so we can run the rest of the tests you need.

Yes, I understand that you can't smoke your 3 packs a day while you're admitted. That's what we call a two-fer.

Change of Shift

Change of Shift is up over at Nurse Ratched's Place --- check it out!

Our System Sucks

Ok, no jokes. Just outrage. My mom told me about this.

Across the country, there are whiny, lazy, worthless drug-seekers and system abusers that think that they are entitled to free everything. Drugs, money, food, whatever. They've figured out the angle to keep them fed, clothed, and drugged, and in the meantime, they are taking resources away from the people that not only need them, but deserve them.

These are the people that we are failing. This is a man who worked hard, did his best, and at the end of it all, he still drew the short straw. Desperation drove him to do the unthinkable.

I'm going to go cry now.

Gangsta Gun Club

In the last few months, the Gangsta Gun Club has been busy in our little hamlet. On shifts that I've worked, we've had two patients with GSWs to the thigh resulting in broken femurs. This picture from the MSNBC article on Grady Hospital in Hotlanta is exactly what both of the xrays looked like. Kinda cool, I thought. (By the way, for anyone that's keeping count, femur fracture is #1 on my list of Things I NEVER Want to Happen to Me.)

We've also had two GSW to the chest. One was self inflicted at point blank range, one was shot (I'm pretty sure with a rifle)by a freak from across the street. Both died. Shotgun boy was a depressed alcoholic that lost all vital signs in the helicopter on the way from Middle-of-Nowheresville to the Big Trauma Hospital, so they stopped at our ER. (Apparently they hadn't gotten the bulletin that real patients leave here in helicopters, not come here in helicopters.) He was DRT (Dead Right There). We didn't even get to try.

Now, Mr Shot-by-a-Freak was another story. He was awake and alert on scene, told the cops who shot him, was talking to the EMS crew, then lost vitals in the ambulance bay as they pulled in. We cracked his chest, and worked him forEVER, with no luck. (They caught the guy that killed him. Kinda cool to be able to tell the cops who killed you; not so cool to be dead.)

A couple of nights ago we got in a 21 year old punk complete with saggy pants, baggy underwear and all of the gangsta attire that I can't even recognize. He had a GSW to the shoulder. In actuality, it was a ricochet off the wall beside him that glanced off his clavicle. In other words, A SCRATCH. It requires very little direct force to break a clavicle. If it had hit him with any kind of real trajectory, it would have shattered that puppy, right?

Well. Mr. Gangsta had just gotten out of jail. Apparently he had been completely rehabilitated, since he was just minding his own business and some guy shot him.

**Note to all Gangstas with Guns- don't aim for the head. You'll miss. Aim for the belly. Then you'll at least break his freakin' leg, and you might get lucky and actually kill him!

Better than I could have said it.....

Jerry Falwell dies. Much blogging ensues.

This Just In.....

Oh. My. God.

Help Wanted: Moral Majority Head Honcho

Jerry Falwell - Lest We Forget

I just keep hearing this tune in my head......

Road Rage

Mom, don't read this. It'll offend you. And then you'll get mad at me because I thought it was hilarious.

I followed a link to a link to a link and found this gem.

Pong

Remember Pong? Here's a new take on it.....

(Thanks, MarlaQuack!)

If you don't send this to 8 people in 8 minutes.....

I think that these meme thingees are like those pesky e-mails that people forward to everyone in their address book. I usually just delete the e-mails. After all, you can't prove I even got it, right? How is that bad luck going to follow me now, eh? Besides, they usually tell me I'm going to have good luck in my love life, and my husband is totally against me having a love life.

But Girlvet over at Madness: Tales of an Emergency Room Nurse tagged me, and since I'm pretending to be a team player this week, I'll bite. (Don't tell my boss about the team player bit. Then it'll be expected ALL the time.)

Here are the rules: Each player starts with eight random facts/habits about themselves. Write a post about your own random things. Post these rules. At the end of your blog, tag 8 people and post their names. Don't forget to leave them a comment and tell them they're tagged.

1. I'm a gun nut. My 2 favorites are my Bushmaster AR-15 and my Kimber Custom II in .45 ACP. There hasn't been a toaster yet that could stand up to either if them.

2. I'm a nerd. I'd rather read than do just about anything else. If a movie looks interesting and I hear it was based on a book, I'll read the book instead. I Tivo stuff to watch it if I'm out of books.

3. My trailer burned down two years ago and I lost everything. I was in the shower when the fire started. I was about 30 seconds from having to climb nekkid out the bathroom window. Them babies go up FAST!

4. I could live on Bacon Cheeseburgers and Chocolate Brownie ice cream. (Not for long, but hey, who needs arteries anyway?)

5. I chew my fingernails.

6. I have two theories on business. I think that we should LET Bill Gates take over the world. Furthermore, I think that Wal-mart is a pervasive subculture, and I'm okay with that.

7. I think that Peyton Manning and Lebron James are Gods. In no particular order of hierarchy. Barry Bonds is the Devil.

8. Along that line, my idea of reality television is football, basketball, and baseball. NASCAR is not a sport. Neither is golf. Tiger Woods does possess deity-like qualities, though.

Now, I tag Catherine, Someday...Nurse, Xavier Emmanuelle, SeaSpray, The Platypus, Miranda5, Jen, and Hannah.

Don't feel obligated to do it. It won't hurt my feelings a bit.

******Note to anyone who may tag me in the future..... I won't play nice next time. I'm just sayin'.....

Apology to Fibromyalgia Sufferers

If you were offended by the fibromyalgia post, here's the apology you were so desperately seeking.

Nope, I didn't write it. Ambulance Driver did. I remain unapologetic. I'm evil that way. Just ask my mother.

Just a Little Bit......

Scalpel's post brought back a lovely memory of a drunk man and an ATV......

It was 3 am. (Yes. Everything that has ever happened to me in my whole life has happened at 3 am.) We were full to the gills with drunk locals out enjoying the summer weather. That means there were a gazillian people being sutured, splinted, Silvadene'd, and sleepin' it off.

EMS calls in with a single vehicle MCA; ATV into a parked car. He's got an isolated tib/fib from where his foot got caught under the bumper. (Can you say, "OW!"?)

Now, I personally hate tib/fib fractures. In the grand old scheme of things, they are usually relatively minor. But when you're holding traction on that floppy foot to splint it, and you feel the crepitation from the shattered bones.... It just turns my stomach. Gives me the willies for hours afterwards. (Had 4 in one night once. The last one made me puke. Probably the cumulative effect.)

Anyway, EMS arrives, and Upstanding Citizen ATV Rider has obviously been imbibing a wee bit of firewater. I can smell him from the nurses' station as the gurney wheels by 15 feet away. Of course, upon questioning, he has had the usual 2 beers. I swear, they must have been pony kegs.

We do the usual labs, xrays, and a head CT because he fell off the ATV after he snagged his foot, and hit his head. He had a vacuum splint on his ankle, (God, I love those things!) and EMS did a great job of getting and keeping it aligned, so his fiberglass splint was put off until we had a few more sets of hands to help. I was scrubbing asphalt out of his forehead (in my usual gentle manner) when the cops came in to tell him he was under arrest for DUI.

Cute But Mean Chick Cop: "Sir, you are under arrest for operating a motorized vehicle on a public street while under the influence of alcohol.......etc, etc...."

Upstanding Citizen ATV Rider: "But Officer, I wasn't on the street. I was in my yard. You can't arrest me for being in my yard! That's my private property......drunken ramblings about how a man has rights on his own property..."

CBMCC: "Sir, you were involved in a motor vehicle accident in the street. That isn't your property."

UCAR: "But I was only a LITTLE BIT in the street. Damn car shouldn't have been there! It's their fault." (Recall that it was an empty, parked car.)

Discussion ensued about the definition of "in the street", "drunk driving" and after Upstanding Citizen mentioned that it was his "cousin's fault because he gave him the joint", "illegal substances". Discussion deteriorated when Upstanding Citizen began calling the cop various derogatory names rhyming with switch, trike, and mucking blunt.

Ah. Drunks and psych patients. My favorites. And judging from the fact that he went to jail, I guess "little bit in the street" is kinda like "little bit pregnant". It counts for all the way!

Babysittin' the drunks

It's my day off. I'm reluctantly doing housework, laundry, etc. With so little time to blog today, I'll leave you with this gem.

Drunk guy in room 20.
"Here, buddy, pee in this urinal for me." (Gotta do a drug screen so we can medically clear him to go sleep it off across the hall where security gets to babysit, not me.)

Step out of the room. (Like I want to watch drunk guy whip it out.) Oh, Crap! Good thing I didn't stay within spraying distance, he's peeing all over everything. Gurney, cabinets, curtains, floor....... nope, NOT urinal.

Enter big male nurse with a catheter. Drunken screaming ensues. Urine obtained. Housekeeping called. Drunk moved. Ahhhh.

Happy Mother's Day!

This morning, at a little after midnight, a sweet little 27 year old mother of six-month old twins came into our ER with a complaint of abdominal pain. Further exam revealed a bit of postpartum depression, exacerbated by the fact that she has absolutely NO support system. Her husband is in the Army, and (surprise, surprise) not at home.

We gave her some Ativan, let her talk with our Mobile Crisis counselor, and gave her a few hours of free babysitting. We passed the babies around the nurses' station, fed 'em, burped 'em, changed their diapers, and put them to bed on the gurney in the "room" next to mom. She got to sleep off the Ativan. Probably the best sleep she's gotten in months.

I didn't have much contact with her, so I don't know her story. But I do know that everyone needs a little help sometimes. So we set her up with some phone numbers of resources to help her out until her husband gets back.

To all of those Moms out there that keep on doing it day after day: Happy Mother's Day! You're the best!

Boys and Cars (and Booze and Sex)

Ok, these are too funny not to link.

Check out JB on the Rocks and The Lawdog Files for clear examples of what NOT to do if you are a young male out and about.

Happy Fibromyalgia Awareness Day!

AD pointed out that today is National Fibromyalgia Awareness Day. In honor of that, I have assembled a few links to help those who are afflicted *sniff* with this horrible *sob* disease.

Dr. Rodger Murphree, a nutritional specialist and chiropractor (hey, chiropracters are doctors, too, dammit!) has a website, Are Fibromyalgia Patients Crazy? that can give you all the answers. Well, some of the answers are on his website. The rest of the answers can be purchased for $145.95, and he'll include some fantastic vitamins.

The Fibromyalgia Network is available to help those who need a self-help support system. As their website says, "Fibromyalgia Network takes your pain, fatigue and brain-fog symptoms seriously!" For only $28.00 a year, you can receive reliable information and advice on coping. If you won't cough up the cash, you get bad information and they don't give a crap if you can cope or not.

There is also the "true" story of Maggie, at Breaking the Vicious Circle of Fibromyalgia. Read the moving story of a woman with absolutely nothing wrong with her, that was cured by the miracle drug EZorb, for just $39.95 a month! (EZorb, by the way, is 560mg of calcium).

You can also read about a scientific breakthrough that will save fibromyalgia victims safely and quickly! Activive helps you get "Reconnected To Your Inner Power Source, Plus You'll Be More Productive In Every Way Sexually and Financially!" You can read heartwarming, (or is it heartwrenching?) testimonials, and then order this fantastic cure for only $134.00! Better yet, if you belong to a family of malingerers, you can get the family pack for $335.00! What a fantastic deal!

Last, but certainly not least, we have the Fibromyalgia and Fatigue Center, conveniently located in a major metropolitan area near you. They have a revolutionary 6-step inpatient approach that, according to their testimonial page, has helped at least 7 people. (That's 1.67 people helped per step!) In case you don't live near a major metropolitan area, they even have a convenient "Out of Town Treatment Package". Ahh. Humanitarians.

I hope this has been helpful for all of those *sniff* fibromyalgia sufferers out there. And please, take it easy today. Maybe visit your local ER for some Vicodin or Percocet. It is, after all, YOUR day!

Zits

I'm trying to read my email, and over on the sidebar, there's this ad for some pimple fixer that's supposedly better than pro-activ. (Like I give a crap that Jessica Simpson had zits)

It's a magnified, pimply section of somebody's face, and then it's photoshopped for the after shot. It's making me nauseous.

Do they think that if they make me sick I'll buy their zit cream?

Dental work

I have the night off, and my circadian rhythm is always screwed up, so I'm up all night watching shows I've Tivo'd.

I'm watching the last "Criminal Minds" episode, and there's this crack whore that the serial killer they're trying to catch is tormenting. She's locked in a big, huge slaughterhouse, and he's doing the "Saw" thing. (Well, at least it's what I think the "Saw" thing is. I was too chicken to watch "Saw".)

Anyway, all the way through the episode, she's running into walls and falling down stairs, etc, etc, and I'm looking at her and her face is all bloody and I'm thinking, "What's wrong with this picture?" (well, besides the fact that she's going to get killed by a psychopath).

And it dawned on me.... She has PERFECT TEETH. Not just a little perfect, I'm talking GORGEOUS perfect. Straight, whitened, the whole nine yards. What crack whore has perfect teeth? Around here, you don't even have to be a crack whore to have horrible teeth. If we didn't have the locals with the little brown nubbins coming in for narcotics and antibiotics (and then trying to fill the narcs without filling the abx), I don't think my night would be complete!

So somebody tell Hollyweird that if they're going to cast someone as a crack whore, please do something with her teeth. If they need an example of actual druggie teeth, give me a call. Shouldn't take more than about ten minutes for one to come in.

More Electricity...

I really like cardiac stories. I really like cardiac patients. I REALLY like cardiac interventions, especially defibrillation/cardioversion. I might run out of LIFEPAK stories, but probably not.

We had a cardiologist that was a really good doctor. He knew everything, always came to the ER in the middle of the night, and saved many a life through his expertise and knowledge, I'm sure. He also had no idea how to treat the nurses like humans, not dog-slaves, and had the absolute worst bedside manner I've ever seen. He didn't smile, used big medical-sounding words, (which is a huge no-no if you want the gene-pool floaters we see to understand ANYTHING you say), and didn't ever hold question-and-answer time. We all hated him.

One night we were treating a patient, we'll call him Mr. Jones, in A-Fib with RVR. It was new onset within the last hour or so. Nothing was really working, and he wasn't compensating very well. Mean Cardiologist just happened to be in the building for some reason, so he zoomed down to help us out.

Turns out that Mrs. Jones had been seen by Mean Cardiologist before, and Mr. Jones didn't much like him. Go figure. Mr. Jones started yelling at Mean Cardiologist as soon as he came in the door. (which DID help his BP to go up a little. For a minute.) Of course Mean Cardiologist had no idea who Mr. Jones was, because Mrs. Jones had been his patient, and she wasn't in the room.

Mean Cardiologist talked to the ED doc for a second, then went over to tell Mr. Jones, "I'm sorry you don't like me. We're going to fix your heart so you're still alive to not like me tomorrow."

Anyway, long story short, we got Mr. Jones ready for cardioversion, and Mean Cardiologist stood beside the bed while we shocked...... And when Mr. Jones did the Electricity Shuffle on the gurney, his flailing arm hit Mean Cardiologist right in the nuts.

Thank God he converted. Because Mean Cardiologist was a bit miffed, and not feeling very helpful anymore. Mrs. Jones passed him in the hall a minute later on her way in and said to the ED doc, "Was Mean Cardiologist in here? Mr. Jones wasn't rude to him, was he? He really doesn't like him. Why was he walking funny?"

She didn't understand the hysterical laughter. I wonder if her husband will remember......

Maternal What?

I just read an article on MSNBC about the two retarded Vegans that starved their kid to death. (Note to people with mentally handicapped/developmentally disabled family members: I say retarded. I'm sorry it offends you. I don't call mentally handicapped/developmentally disabled people retarded. I call retarded people retarded.)

Then I read this post by CharityDoc about how he couldn't find anyone else to give a shit about a poor, abused kid.

Then I read this article, through a post by Dr. Nic, about a kid who was kidnapped while her parents ate dinner in a restaurant down the street.

The majority of the pregnant women and mothers that I come in contact with are either high school students, drug addicts/alcoholics, or unemployed. (And every single one of them smoke at least a pack a day.) Very few have the ability to take care of themselves, much less their kids. I was born without a biological clock, and I still feel the urge to take at least two babies a day away from their parents.

Once upon a time, having a kid was a big decision that people prepared for. Now it's a side effect of sex. It's disturbing and it's sad.

Maternal Instinct is no more. It's now Maternal Extinct.

It's a little fast......

A brand new hospital is being built for us. Completion time is sometime next summer. In the meantime, the attitude is, "If it's broken, just hang in there; the new hospital will have one that works."

I purchased (out of my own very pathetically lined pocket) a nice, expensive portable pulse ox because none of the ones in the ER work. It has paid for itself in the 3 months I've had it. I'm still a bit pissy about the expense, but like I said, in my mind, it was worth it. Case in point....

A couple of nights ago we had a guy come in complaining of weakness (Busy, busy). I slapped my cute little Nonin on him and it showed a rate of 195. Go figure, he was feeling a bit weak. I called to the back on my handy-dandy walkie-talkie for an empty bed, and then on the way back to said bed, called for backup. (No, don't backup!) My charge nurse said she didn't have anyone who could help me right then, to which I responded (in my usual sweet, courteous manner) that my SVT guy was sicker than her drunk guy and she needed to come help me. A couple of other people (including the Doc) copied my oh so very polite traffic on the walkie-talkie, and by the time I got him to the back, they were hanging out waiting. From that point on it was like Buttah, Baby. Smooth. In less than 5 minutes, we had him hooked up, EKG'd, IV'd, and were giving him drugs. In less than 10 minutes he was normal sinus at a rate of 75.

Now, I always get a little stressed at SVT. (And I know I'm not the only one.) For some reason, anything over about 150 tends to make me nervous. Which is silly, because I have my own PSVT issues. This reminded me of the time......

I go into PSVT about once every 2-3 months for no reason whatsoever. (I personally think that all those years on the ambulance, with the tones waking me out of a sound sleep, sending adrenaline coursing through my body, fried my AV node). I can always vagal out of it, I'm never symptomatic, and it usually only lasts for a minute or two. I only get concerned with my own PSVT if it happens more than once in a 30 day period, or if it takes me more than a minute or two to vagal out of it.

I was at work, it was about 3 o'clock in the morning (because all good stories happen in the middle of the night) and there were only 2 patients in the ER. A little old lady with a broken hip that we were holding for surgery in the morning, and a drunk who was sleeping it off in the psych bed. I was doing the pre-op EKG on the little old lady so she could get some Demerol-induced sleep, when I had that familiar Uh-Oh feeling. No, Dr. Pervert was not touching me in my no-no place. I was using more than my minutely allotment of heartbeats. About 150 more.

I finished the EKG on Mrs. We're-going-to-cut-your-leg-open-and-put-in-a-couple-of-pins-but-you're-probably-going-to-die-now-because-you're-85-years-old-with-a-broken-hip-so-call-your-family-and-say-goodbye, the whole time bearing down and hoping I wouldn't crap myself. Then I swung by the nurses' station and told Nonchalant Nurse Who Has Seen and Done Everything to come back to room 3 (where there's a crash cart) and hang out for a few.

When he got there, I was hooking myself up to the EKG machine, and I laid back and told him to capture it. It was going on 10 minutes, and I was getting a little worried. He looked at the screen, said, "Oh Shit!" , and stuck his head out the door and called Dr. Pervert.

I said, "What'd you do that for?"

NNWHSaDE: "Because your heart's beating 230 times a minute!"

ME: "No kidding, really? Is that why I'm laying here trying not to crap myself?"

The other RN and Dr. Pervert showed up at the same time, and proceeded to try to treat me like a patient. I, of course, wouldn't allow that.

So NNWHSaDE said, "Just wait for her to pass out and we'll do it. She won't last too much longer at this rate."

Other RN ran to get a barf bin of ice water for me to stick my face in, and Dr. Pervert started rubbing on my neck in an imitation of a carotid massage. I told him that if his hands got below my collar bones, I'd stab him in the eye with an 18 gauge. He laughed his creepy laugh and backed off.

NNWHSaDE was standing right next to me with an IV start kit and a couple of boxes of Adenosine. (Like the first 6 ever works.) I told him that if I went out and he let Dr. Pervert tube me, I would kill him when I woke up. (Dr. Pervert is SCARY with a laryngoscope.) He promised to bag me.

And then he said the most horrible 9 words in the English Language: "But I might let him do a rectal exam." (Dr. Pervert LOVES rectal exams.)

My sphincter tightened so fast that I'm pretty sure it sucked part of the gurney mattress in there with it.

And I converted. Normal sinus, 80 bpm.

Now, any time I go into PSVT, I just think of Dr. Pervert. It's the best vagal maneuver there is.

**In case you didn't notice, I gratuitously linked myself three times in this post. Shameless!**

They just don't raise 'em to be men these days.....

Apparently the pussies are taking over Tennessee.

If you crash your car because you are scared of spiders, make up another reason when the cop askes you what happened. Duh.

If you get beat up and shot by the 77 year old man you are trying to rob, well, I have no advice for you. Pray for death. Your street cred is now in the toilet.

Busy, busy

It was crazy busy last night. Every time we thought we had it under control, it would explode again. EMS came in with back-to-back intubated patients, (both bleeds that got shipped to the Big Neuro Hospital in the Big City), a guy came in through the front door feeling "weak", (SVT at a rate of 195), back-to-back kids with asthma and sats in the 80's, and an aspirin/Unisom/Stacker2 OD that was WAY wiggin' out. In between that was the usual smattering of chest pains, SOBs, broken bones, lacerations, ear infections, etc. The drug seekers, drunks and general pains in my ass were minimal. And as I ran around like a crazy monkey, I had a thought several times that I haven't had for a loooooong time; "God I love this job!"

On Being Dead

I witnessed a DNR for a co-worker the other day. She and I share the opinion the we would rather not be cabbage. Some of the other nurses were upset by the fact that she was so emphatic in her wishes because she's "so young". She's in her late 30's. My husband and I are going to be drawing up a bunch of stuff with a lawyer soon, including Living Wills and DNRs. We're 32.

Newsweek has an article about new studies in resuscitation. It's interesting, but I'm personally more concerned about what's going on with my brain once my heart has been convinced to do it's job again after a 15 minute foray into unemployment.

AD hit it from the EMS side, and then had to defend the crap out of himself when it turned predictably ugly. He was initially talking about traumatic codes, but it quickly turned into, "But what about babies and puppies and sweet little old ladies (not the nasty ones)?" I've said it before and I'll say it again. Dead is dead, alive is alive, and cabbage is NOT alive. I'd rather be dead than in the salad bar, no matter how it happened or how old I am.

I understand that there are exceptions to every rule, and that's what makes anecdotal evidence so dang much fun. But I'm not big on gambling. And that doesn't make me a pessimist, it makes me a realist. So if and when I go to all the effort of dying, kindly leave me that way. My crisper will thank you.

Status Dramaticus

1915 Thursday night: 23 year old female presents with abdominal pain. Moaning, thrashing around in the wheelchair, hyperventilating. "Honey, you need to slow down your breathing." "I can't! The pain! Can't you get me something for the pain?" Fast forward 6 hours. Patient discharged without narcotics script due to the fact that ALL OF HER TESTS WERE DEAD NORMAL. Labs, CT, Xrays, everything. She did, however, receive enough Dialudid to knock me unconscious for a month.

0630 Friday morning: 23 year old female presents with abdominal pain. Moaning, thrashing around in the wheelchair, hyperventilating. Yup. Same girl. "Honey, you need to slow down your breathing." "I can't! The pain! They didn't do anything to fix the pain! Can't you get me something for the pain?" Fast forward 3 hours. Patient discharged again, because EVERYTHING IS STILL DEAD NORMAL!

0130 Saturday morning: 23 year old female presents with abdominal pain. Walks in, moaning, leaning against the check in counter, hyperventilating. Hey, we've done this before, haven't we? Yup. Maybe third time's a charm. "Honey, you need to slow down your breathing." "Stop telling me that! You're always telling me that! Can't you understand I'm in pain?" I give up. Fast forward 4 hours. Patient is stoned and pain free, all of her tests are STILL dead normal, and she's going home again. This time she's got a script for Lortab.

Moral of the story? If at first you don't succeed, try, try again!

No, I am NOT Crazy...

Do you ever see or hear something that reminds you of something from a TV show or commercial or movie or something, and then when you say it people look at you like you're crazy?

These are the top three things that I am reminded of all the time that NOBODY ELSE remembers.

Trigger: "I'm on my way."

Response: "I am on my WAYYYYYYYY! I am calling for Backup! No, DON'T BACK UP!" (the only Travelocity commercial that I thought was funny)

Trigger: "God, it's hot in here."

Response: "It is so very HOT...." followed by, "Cold coal." followed by,"While MuMu the Tahitian Sun Goddess fans me with her solar panels..." (bits and pieces of an old Coors Light Radio Commercial)

Trigger: "I thought I was never going to get out of that room!"

Response: "I'm trapped....in an ATM vestibule....with Jill Goodacre!" (Scene from the only episode of 'Friends' I remember)

If only somebody had those three things in their brain, too. Then I wouldn't feel so lonely.

Of course, if I could keep myself from blurting out the response everytime somebody says the trigger, it might help, too.

What the.........?

OK, so those of you who have been doing this a while probably don't even blink at such occurrences, but I am definitely a little weirded out by the fact that my last post was linked to the New York Personal Injury Law Blog.

Linkage to other ER blogs, or other sarcastic blogs, etc, etc, I can understand. But who sicced the piranhas on my blog? Ambulance Driver probably has experience with this, seeings how they're ambulance chasers and all, but I gotta say, I'm looking over my shoulder right now, and I'm feeling a bit creepy.

Nursing Home Dichotomy

Tonight at 2000, we received an unresponsive patient from the nursing home down the street that subsequently bought a tube, coded twice, and ended up in CCU on Epi and Levophed drips. This lady was normally alert and oriented, but today at 1400 they noticed that she was unresponsive. They didn't call EMS until 1945.

Tonight at 2300, we received a patient from the same nursing home with a complaint of a fever for one hour. Her temp on arrival was 99.1 and was reported to have been 100.3 earlier. We did a CBC and a UA, diagnosed a UTI and sent her back. She was in the ER for less than 45 minutes.

How on earth can you not send an unresponsive patient to the ER for almost 6 hours, but send a patient with a low grade temp in after 1 hour?

I Love New Docs, Part 2

It's a normal night in the ER. Not much going on, but a lot of patients. When there's nothing but clinic stuff in the waiting room, we try to keep two beds open; one cardiac/trauma bed for any real EMS patients, and then the Code room. Sore throats and earaches have been known to circulate through the Code room because you can park them in a chair in the hall if a Code comes in. Any other beds are pretty much doing the revolving door- "Here's your Lortab and your work note, follow up with your family doctor (who you should have gone to in the first place) in 2-3 days."

EMS calls in with a Chest Pain x 30 minutes. They report initial pain as 2/10, no other symptoms but a little nausea. Nitro made it 0/10, vitals are totally dead normal. But she's a 55 year old female, so we're waiting with the whole 9 yards just in case. (That and the fact that none of the 25 people currently in the ER even really need to be here...)

So they get there with Nice Church Lady Martha, and surprise, surprise; 12-lead shows gnarly ST elevation. Kinda like CharityDoc's only not quite that cool. One of our Super Nurses had this patient, and she had everything out and ready to go before we realized that our doc on that night was a TNKase virgin. He was a bit reluctant, (I think the speech about possible adverse reactions scared him more than the patient) and understandably so, because TNKase is a pretty serious thing to give. Anyway, they got through it, gave it, and she was doing as well as could be expected, waiting for transfer to the Big Heart Hospital in the Big City down the road.

At the same time, EMS calls in with another Chest Pain, only this one is ETOH positive, combative as hell, and apparently on something besides Jack Daniels. They are inclined to think that she's a legit Chest Pain, though, because she's got a second degree heart block and her BP sucks. So she gets the Code Room. (Which incidentally is right across the curtain from the first MI.)

Well, when she gets hooked to the 12-lead, she doesn't have a second degree block. Nope, she's sinus. With gnarly ST elevation. Swear to God, they were twin EKG's. Meanwhile, Trailer Trash Suzie is screaming for pain medicine, won't answer any questions, is denying drinking, drug use, medical history, etc, and her daughter is standing there yelling at the nurse because we're "being mean" to her mom.

New Doc hasn't recovered from the first TNKase 20 minutes ago. Super Nurse is pretty much on her own in with Nice Church Lady, dealing with the reperfusion bradycardia and increasing pain all by herself, because we're all in the Code room dealing with crazy drunk MI. It sounds (and smells) like the cheap seats at a NASCAR race, only I can't tell what the high pitched whine is, because there aren't any cars in the Code room. And then we all realize; it is the sound of a New Doc growing his testicles.

"Enough!" he shouts. (And he's a big guy, so it was an impressive, 'shut the hell up now' type of shout). He looks at the daughter and says, "We're not being mean to your mom, we're trying to save her life. So either help or get out." And then he looks at no longer screaming Trailer Trash Suzie (I'm telling you, it was an impressive shout) and says, very distinctly, " If you don't start helping us out here, and stop lying to us, you are going to LEAVE HERE IN A BOX! Now tell me what drugs you've been doing."

Trailer Trash Suzie became a tad more helpful, Trailer Trash Daughter picked up the slack, TNKase was given, both patients were transferred to the Big Heart Hospital, and it was a happy ending all the way around. Suzie and her daughter came in about 2 weeks later trying to get the names of the paramedics that brought her in, because they were "mean to her". We didn't help her out.

And New Doc has a pair of shiny new testicles. I've seen him use them several times without any hesitation. I think they might be stainless steel. Which is good, because he'll need them around here.

Change of Shift

My Change of Shift cherry has been popped. Check it out over at Emergiblog.

Holy Readers, Batman!

I go to bed and nobody but my mom and my sister are reading this blog. I wake up and I've got a ton of new blogs to check out. Sweet!

Keep returning, I'll try to keep you entertained.

PS: Any of you that want to blogroll me, feel free. I'm honored. Because the only thing better than an audience is an audience that can't throw things at you.

A Letter to the Not Sick Man in Bed 1

Dear Mr. Not Sick Man in Bed 1;

I am sorry that you are having a rough day. I understand that it happens to all of us sometimes. Especially the part about running out of Lortab. I, too, am out of Lortab. The fact that I don't actually ever take Lortab is completely beside the point.

I appreciate the fact that you know that the words "chest pain" coming from your lips in the waiting room will get you straight back to a bed and force us to pay attention to you for at least the 15 minutes it requires to initiate the chest pain protocol. After all, you've been on this earth for 45 years, and it means a lot to me that you have learned these important things. Things like the fact that Morphine is an adequate substitute for Lortab, though I am so sorry that we had to poke that mean, mean IV catheter into your arm to give it to you.

I'll be happy to ask the Doctor for more pain medicine for you, just as soon as I'm done helping this lady in Bed 2. I am very sorry that she has interrupted your crisis today. I would put her in a different bed, so that you can rest a bit more comfortably as you wait in your Morphine-induced haze for your negative cardiac enzyme results to come back from the lab, but she needs to be in a cardiac bed, of which we have two, and of which you are occupying one. I know she doesn't appear to be sick to you, because she isn't flailing about and crying about her "terrible 12/10 chest pain", but that is simply because when I got her out of her husband's car just now, she was barely breathing. Her oxygen saturation is only 50%. And although her color may seem to be "normal old lady white" to you, I recognize it to be "truly sick patient gray".

I'm very sorry if we seem to be rushing around and not paying any attention to you, after all, you are having a very bad day. I realize that you need a cigarette. Indeed, you have been in that bed for almost 45 minutes. That's a long time to go without nicotine. I will address that as soon as possible. As soon as I have attached this mask with non-nicotinated oxygen to this patient. And attached these very large sticky patches to her chest. I understand that they are much bigger than the ones you got, but that's because we may have to shock her heart if it stops. It's only beating about 35 times a minute right now.

I'm sorry that the slamming of the drawers right by your head is so loud. These crash carts make a bit of noise when we're digging through them for Atropine. Perhaps you could write a letter to hospital administration requesting newer, quieter ones so that the next time you're in here requesting narcotics, our movements won't startle you.

I would be happy to bring you a glass of water. It will be a moment, though, because I need to finish this EKG. You remember that, don't you? That thing we did to you 30 minutes ago that said "Normal Sinus Rhythm" at the top? Hers says something just a little bit different, though. Think of it this way; you got an "A" on the test, she's currently getting an "F".

I apologize for not answering your questions quickly enough. You see, I couldn't hear you because of the stethoscope in my ears. I was trying to get a blood pressure on this patient because the machine can't find it. Oh, your blood pressure cuff is too tight? I'm so sorry. I'll fix that right away.

Yes, I realize that your girlfriend will be coming in to visit you later. But I'm going to borrow this chair for a little while anyway, because this gentleman is 85 years old, and he's not feeling so hot right now. I'd kinda like for him to sit down. Oh no, no, he's not having a bad day like yours. It's much different. He's watching the woman he's been married to for 67 years fight for her life. I don't think Lortab will help that.

Yes sir, I'd be happy to remind the Doctor that you need a note for work. Thank you for being so patient.

Who Me? Drugs?

Great post over at 10/10.

Funny, I think I've seen every one of those patients in the last day or two. Most of them two or three times.

Thank God I'm Right-Handed

Left-handed women may have a shorter life-span

Somebody actually funded a study on this, and somebody actually studied it for 13 years.

Maybe the left-handed women started committing suicide so that the freaky Dutch reasearchers would stop following them. Can you imagine having a freaky little Dutch scientist stalking you for 13 years?