I think we're onto something....

My buddy Barry has come up with a fantabulous plan.

First, we need to install a giant dry-cleaners' rack. You know, the automatic ones that you push the button and it brings all the clothes around?

Then, when a patient signs in for triage, you hang them from a hook, and send them to the next station, which is the giant Valium salt lick. After the salt lick, they will go through a healing mist of aerosolized Ativan.

When they are benzo-ed into complacency, they stop in triage, where they will actually be able to give you an appropriate number on the pain scale.

Once triage is finished, they remain on their respective hooks until it is their turn to come to the back. A push of the button and they are deposited into the bed for you to treat and disposition.

If they are admitted, back on another track they go, to be whisked upstairs to their new room.

If they are discharged, they go on a track that spins them around in circles in the parking lot until they cough up a co-pay or a deposit. No pay, no go home. State- funded medicaid or not!

Notice that the hooks are single person only. NO VISITORS!!!!!!

I think we're onto something here.

Any other suggestions?

How was YOUR night?

At 1915 I walked into room 5, where we were holding a CCU patient with a K+ of 8.4 (that would not be getting a bed on my shift), and the first thing I saw were 4 empty little brown bottles with black lids.

Some of you know where this is going. (Pun intended.)

At 0030, the flow had slowed, and her K+ was 7.1.

4 more little brown bottles with black lids. (Actually, the bottle isn't brown, is it? It's the goo inside that makes it brown.)

Did I mention that she weighed 300 lbs?

*sigh*

How was YOUR night?



For those of you that are feeling left out, K+ is potassium, and anything over 5.5 is bad. 8.4 is super bad, as is 7.1. The little bottles with the black lids contain Kayexalate, which binds with excess potassium and is then excreted by the body. In the form of large quantities of liquid poo. You can figure the rest out.

Directing traffic

Our waiting room has literally been standing room only for about six weeks.

You open the door to call patients to the back, and it's like a swarm of freakin' piranha descending upon you.

Our LWBS rate has increased exponentially (except for the patients with Emergency Colds and "free" medical care).

We need to call the Romanian Police Department and see if we can borrow a few of their "specially trained officers" to direct traffic until flu season is over.

Perhaps they can help our frequent flyers "get rid of their stress or sadness."

*snerk*

Your mother was a hamster and your father smelt of elderberries.

Now go away or I shall taunt you a second time.

Ow.

For those of you who like to look at pictures that make you cringe, I submit the following link: Soccer: The Most Dangerous Sport on Earth. I would just post the picture, but it kinda made me cringe.

BTW: There's a doc who always calls me over to look at all of his "cool" chest and abdomen films, you know, the ones with a big pneumonia or obstruction or something, and I've told him repeatedly to stop because I just don't see anything but fractures on x-ray, everything else just makes me go blind and cross-eyed (for instance, I really liked the .25 to the thigh that created a fantastically shattered femur) so hey, Doc? This is an x-ray I would like to see.

*sniffle*

Dammit, stop coming to the ER with your stupid colds.

This is the second one I've caught from you freaks in as many weeks.

It's an Emergency Room. There's no such thing as an Emergency Cold.

Sheez.

Peer Pressure

*giggle-snort*

Hey, Crayzee!

Do you have relatives in the South?

It's all EE's fault. She started it.

"Guns Heal the Sick!"

*giggle-snort*

Night Shift Floor Nurses will let you die!

No, they won't. But you'd think so, if you read this article on MSN about how a "Code Blue" is more deadly at night. In other words, if you become dead in the hospital at night, you're more likely to stay that way than if you become dead in the daytime.

Now, I have to point out that it says

"Only in the emergency room was there no night-or-day difference in survival. "

Theoretically, in the ER, we have one eye on our patients all of the time, and if they go bad, we notice it right away.

"But researchers found among the late night cases a higher portion of instances where patients were discovered with no heart electrical activity, that is, too late to deliver a lifesaving shock."

Because on the floor, the nurses are running their asses off trying to keep up with their 8 patients, they don't get a tech or a CNA anymore due to cost-cutting, and who the hell can keep a good eye on 8 people at once? I sure can't.

Here's another side to this.

Lately, we've been holding anywhere from 2 to 12 admits in the ER all night long. And we're usually working at least one RN short, if not two. (They won't pay much overtime anymore, it's too expensive, so often, if someone calls off, we work short. And 'tis the season for cold and flu.) There used to be 2 ED Techs in the back every night, now we only have 1, and sometimes none.

You never know if you're going to be a ER/CCU nurse, or an ER/Med-Surg nurse, or sometimes even an ER/CCU/Ortho/Med-Surg nurse. You can have 2 CCU holds, and still be expected to help out when the next Chest Pain or Trauma comes in.

The holds take up all of the monitored beds, and you're doing full CP workups in the back corner without a monitor.

So what happens when that CP in the back corner goes into V-Fib? Are you going to catch it while he's still in a shockable rhythm? Maybe, maybe not.

But it's going to be like running a code on the floor, because you'll have to go find all of the supplies (crash cart) and people (Docs, additional Nurses) to help, and then while they're all tied up in the back corner, Grandma Susie in Trauma 3 is going to crump, and nobody will see it, because her ER/CCU nurse is helping with the code, and on, and on, and on.

"Staff who are fatigued, less experienced or too few in number could be to blame, researchers speculated."

I get sick of people saying that fatigue is one of the reasons why "bad things" happen at night. F**k fatigue. That is such a bullshit answer. Running your ass off is running your ass off, regardless of the time of day. I'll buy the "too few in number", though. Because at night, they cut the crap out of the staffing and everything else, and it's "out of sight, out of mind." So everyone is trying to get twice as much done with half of the resources.

Funny, when we're working short two RNs, holding 10 patients, and the charge nurse calls our Director to tell her we're drowning, suddenly 5 beds open up upstairs. And I'd like to be happy that we're getting 5 patients up to where they need to be, until I see the Floor Nurses. They're just as exhausted as I am, and each of them just added one more patient to their already full load.

So, tell me. When one of their new patients code, how soon will they notice it? Sooner than we would? I doubt it.

We're failing patients and risking our licenses, just to put money into the bottom line.

Is it worth it, Mr. CEO?

Hey, Crayzee!

Look, someone wrote a poem about you!

The Crazy Woman
by Gwendolyn Brooks

I shall not sing a May song.
A May song should be gay.
I'll wait until November
And sing a song of gray.

I'll wait until November
That is the time for me.
I'll go out in the frosty dark
And sing most terribly.

And all the little people
Will stare at me and say,
"That is the Crazy Woman
Who would not sing in May."

You know how I know it's about you? Aside from the Crazy Woman part, of course?

First, there's the part about waiting until November, which is obviously a political reference to the coming exit of your nemesis, President George W. Bush. And second, there's the reference to "all the little people"; obviously, that refers to those of us who refuse to acknowledge your superiority in all things.

Gwendolyn Brooks has mad poem-writing skillz. Somebody should tell her how to spell crayzee, though.

Public Service Announcement

Dear Co-worker with the Ass-splody Virus:

I am very sorry that you allowed yourself to be pressured by our oxygen-wasting esteemed clipboard nurses into coming in and working your shift when you are obviously in no condition to do so.

However, I should not be punished for your illness.

I have placed a bottle of Virex and a stack of paper towels on the back of the commode.

Please clean your ass-splody splashin's from the toilet seat before exiting the bathroom.

Thank you,
Your co-worker who is tired of cleaning up your poo.

Hey, Crayzee!

I have re-discovered your theme song.

And just out of curiosity; is this what the computer from which you spew forth all your crayzee-ness looks like?

In which I bag on tOSU

Michigan basketball pretty much sucks this year. Other than beating MonkeyHusband's beloved Penn State last weekend, it's been fairly dismal. So imagine my joy as I was watching 17-8 tOSU get beat down by my 7-17 (now 8-17) Wolverines yesterday.

In other Ohio news, apparently the most romantic place to get married on Valentine's Day when you're a Buckeye is White Castle.

As always: Go Blue!

Theme of the night

The theme of the night was Poop.

Big Poop, Little Poop.

Smelly GI Bleed Poop, Smelly C-Diff Poop.

Poop in the Bedpan, Poop in the Commode.

Poop on the Sheets, Poop in the Depends.

Little Babies making Little Poops, Big Babies making Big Poops.

Status Poopicus on Bed 9, Haven't Pooped in a Week on Bed 12.

I cleaned up more poop in a 12 hour shift than I can ever remember cleaning up before.

My nose hairs are singed.

Hey, Crayzee!

Did you get any flowers yesterday, Crayzee? I bet not.......

(Photo Credit: PostSecret)

What's wrong with this picture?

I saw this at Walmart this morning whilst grocery shopping.

Perhaps it's a combination of a receipt box and a recipe box.

(I know, The Dawn, only losers shop at Walmart. I'm okay with my lack of coolness.)

A Tip for the Homeless in my Town

It's winter time, and it's cold outside. Even if you're homeless, you'd obviously like to be indoors at night.

Some of you may be tempted to abuse utilize the resources of your local emergency room with imaginary medical conditions. A sandwich and a warm blanket goes a long way when it's 20 degrees outside and you haven't eaten today.

But let me share with you a tip that one of your brethren discovered tonight.

You can get a motel room and a hot meal paid for by our esteemed local Police Department if you follow the steps outlined below.

1. Hunker down for the night in the alley behind a local retail business, preferrably hidden from view from anyone that might look down said alley.

2. Wake from your drunken stupor shortly after midnight because you hear the sound of breaking glass.

3. Observe a ne'er-do-well entering the business through the space that used to hold a window.

4. Wait several minutes until the ne'er-do-well exits said business with his hands full of "loot", then take him by surprise and beat the hell out of him, effectively holding him up until the police arrive to check out the alarm.

5. Wait patiently for 15 minutes for the next available unit to come get you to take you to the previously mentioned motel, as this officer will have to transport his drunk, bloody, crying, handcuffed soon-to-be-felon to the ER to have his boo-boos fixed.

That, ladies and gentlemen, is how a homeless man gets a meal and a bed in my town.

I killed it.

The Reciprocal Blogroll is dead.

It was just too huge of a monster to keep feeding. It kept getting bigger, and bigger, and then I'd find blogs that I had neglected to add, and then I'd find blogs that had disappeared without my noticing, and I just don't have time to read that many blogs anymore, and it just was making me crazy.

So I killed it.

I'm sorry.

5 of 5

Cranky Prof tagged me for one of those damn meme thingees.

Two things stand out about this tag. First of all, she said the onus is on us which makes me laugh for two reasons. The obviously funny onus = on+us, and the fact that onus looks like anus, and butt holes are just funny. Second of all, she said that I have creative cussing, which is funny, too. See, I have a horrible potty mouth. In fact, I should have a copy of the language warning on her blog tattooed on my forehead. But my mommy reads my blog, so I try to temper my outbursts for her sake. It doesn't always happen.

So here goes. More random things about me, since obviously these ones and these ones weren't enough.

1. My second favorite movie of all time (behind Die Hard, of course) is The Boondock Saints. They use the f-word like punctuation. It's delicious.

2. I say "Son of a motherless goat!" (a la Three Amigos) when I can't say what I'm really thinking. The version in my head has two very bad words in it, and one moderately bad word. When I say the real version, people run in the opposite direction, as those words, in that order, spoken out loud, indicate that I have lost control of whatever irrational fury has been simmering in my mind. On the plus side, just saying them out loud is often cathartic enough to regain control of the fury.

3. I bleep myself at work. You know how when you're watching a movie on TV and instead of replacing the swear words with something ridiculous, they just have a second of silence where the character would have been talking? Yeah, I do that. When I get angry, it's like I'm having a verbal seizure. And if you're looking at me, you catch the full effect, because I still mouth whatever I'm not saying out loud. And the f-word is very easy to pick out when reading lips. Just watch the sidelines after any bad play in any pro football game.

4. I work with a guy who says "That's bowwwlll-shee-it" in your standard southern accent, and it will make me laugh no matter how mad I am. It's just so funny hearing such a crisp, two syllable word turned into a long, drawn out four syllable word.

5. I had never heard the word "asshat" before I started blogging. 3/4 of the people I come in contact with on a daily basis are asshats. I just didn't know it until a year ago.

6. I think that Cranky is the most creative cusser of them all. This is why she's my hero. Of course, this is also why she's my hero.

So there you have it. Random facts about cussing. This is the only thing missing. Don't watch it, mom.

4 of 5

OK, so I have to say, the fact that I angered a Crayzee enough for her to start her own blog in order to continue her crayzee rants is kinda cool. I hadn't realized how much I missed The Speaker. Hopefully this Crayzee will stick around longer. She's bizarrely fun.

A word of caution: it'll hurt your brain to read her disjointed thoughts, even more so because she has the worst grammar and punctuation skills ever.

Which leads to my theory that she is a home-schooled lawyer. It's easy to be valedictorian in a class of one! And apparently daddy dearest is also an attorney, so she could have easily learned all of her lawyer-type stuff from him. Hopefully he wasn't the one who taught her grammar classes. I'll bet her degrees look just like the scrapbook pages that her mommy made for her with pinking shears and minty flavored paste, only they're framed! With big, expensive custom frames, not cheap frames from Wal-Mart.

So here's a toast to the Crayzees. May they forever be around to entertain us. One at a time, though, please. Crowds of Crayzees are scary.

Update: The Dawn is dead. Long live The Dawn. *sigh* Is there anything sadder than a multi-cat catfight cut short by the untimely death of one of the cats? Oh well. At least it was the crazy, scraggly-toothed stray cat, and not one of the purebreds. We're still here for further catfights.

3 of 5

Once upon a time I used to read a lot of blogs. One of my favorite non-medical blogs was Life with Joey. Joey has autism, and his mom has a wonderful way with words as she describes the things that happen in their daily lives. She is also a fantastic resource for people with autistic children.

I'm ashamed to say that I haven't been back over there for a long time, and I probably wouldn't have made it back as soon as I did if she hadn't given me an award that I don't deserve.

She's always been in my corner, ever since I first started blogging. And since she's one of those people that can see through the superfluous details of my posts to the meat of the matter, she always gets the point.

She's one of the few people that I've come in contact with (either in real life, or in cyberspace), that I can truly say has many of the qualities that I respect in my mother. (And I have a lot of respect for my mom.) So instead of passing on the award that she gave me, (since I really don't deserve it), I've created a new award, just for her.

I'd like to bestow upon JoeyMom the first ever "I See the Beauty Within" Award. Because she does. And that's a special quality to have.

There's no rules to this award. Just pass it on as you see fit. Because people that can see the beauty within should be acknowledged and rewarded, even if it is just a token award.

On a side note, though I stole this photo off the internet, it reminds me of one that my mom took that looks just like this. And that's why I chose it. Because she is the original Beauty Within See-er.

2 of 5

Today was a Royal Chestpainapalooza. Not real Chest Pains, but "Holy Shit! Look at these 30 other equally not sick people in the lobby waiting to be seen! I suddenly have Chest Pain!" Chest Pains.

Not necessarily in any order:

58 y.o. male CP- actually neck pain from a pinched nerve for 3 days.

62 y.o. female CP/SOB- diagnosed with bronchitis 3 days ago, O2 sats 97%, chronic back pain patient whose PMD cut off her Lortab supply exactly 28 days ago.

85 y.o. female from the nursing home with CP- she hasn't been able to sleep for three nights because her new roommate snores, so she told them she had chest pain so that they'd send her here. She wants to be admitted so she can get some sleep.

48 y.o. male CP/ left arm pain/ jaw pain- Flu. Lied about slightly exaggerated the arm and jaw pain to get back.

92 y.o. female CP/left shoulder pain- torn rotator cuff x 2 years. Not a candidate for surgery, here for a fourth (or maybe fifth) opinion from the ER doc. No one to refer her to; she's already seen all the ortho guys in town. Full cardiac workup because of her presenting lie complaint and an abnormal EKG because she's, um, old.

56 y.o. female CP- her CP miraculously disappears and becomes ankle pain once she's in the bed. Ankle pain.

Jeez.

1 of 5

In case you don't regularly read my "Blogs I Check Every Day", I must point out that two of my most favoritest bloggers have been on quite the roll lately. Every time I go to link them, they have a new post that I want to link.

So go over to madness: tales of an emergency room nurse and ERNursey - An ER Nurse's Blog and just start reading. The latest 4 or 5 posts on each blog are particularly exceptional, but just about anything that either of them have to say is worth reading.

You know what really sucks?

When you have enough blog fodder for about 5 posts and you have to leave right now and won't be back at the computer until late tonight or maybe even in the morning.

That's what really sucks.

Pick-up-Stix

What do you get when you cross a cat, an opened box of spaghetti, and a messy pantry?


No, it's not as fun as the game I played when I was a kid.

Name of the week: College football recruits edition

Meet Yourhighness Morgan. I guess if you're a 6'2" tall 218# linebacker, you don't have to worry as much about people beating the hell outta you because your parents were retarded.....

There's something wrong with this picture...

There's a whole bunch of these laying around at work lately.

You know what they say: The only difference between an oral and a rectal thermometer is...... wait for it..... the taste.

A letter to a frequent flyer with actual medical problems

Dear Obese Woman with Poorly Controlled DM, HTN and COPD;

We would like to take this opportunity to thank you for allowing us to be your Emergency Room of choice for your thrice-weekly 'medical events'. The chance to serve you has never lost its appeal. The fact that you have always been horrendously rude to all of the staff involved in your care, from tech to RN to MD, as well as to the family members who dragged their asses out of bed at 0300 to sit by your bedside and have abuse heaped upon them is completely understandable. After all, you are a very sick woman.

Of course, the fact that you have repeatedly refused to put down the beer, the cigarette, or the bacon cheeseburger has greatly increased the level of 'sickness' that you have achieved. But I digress.

We appreciate the chance you have provided for us to brush up on our IV skills. I must say, the one who gets the 22g in your pinky finger is highly regarded at the nurses' station for at least 10 minutes.

And the fact that inserting your Foley catheter has always been a two-person task (one to hold panus traction, the other to go diving in the depths of the unwashed kootch), allowing us to tie up an additional person that could be doing something else, indicates that you must be Somebody Important; somebody that it has always been our pleasure to serve.

We are aware that you could have greatly reduced, or even eliminated, your trips to the ER by simply being compliant with your medications, (most of which can be purchased at Wal-Mart for $4.00), and we have always seen that as a vote of confidence in our excellent care.

And the fact that everything from the ambulance rides to the Cardene drips to the Bi-Pap to the insulin to the serial EKGs and cardiac enzymes have always been paid for by our local, state and federal government medical aid programs means that reimbursement for your care has always been prompt and accurate. Except when it wasn't. But that's ok. As long as you could afford your Budweiser and Marlboros, we've always been happy to serve you.

So you can understand how sad we are tonight, having seen you for the last time in our ER. We worked so very hard to make sure you could come back and see us another day. Your visits mean so much to us, after all. But alas, asystole is not a rhythm oft recovered from, and though the medics did their best, as did we, your family will just have to spend the 0300 hour in bed from now on, as they won't need to be here, by your bedside in the ER.

Though the tube in your throat isn't helping your COPD much anymore, and the 20 g in your thumb won't be used for Cardene or Insulin tonight, and well, we didn't bother with the catheter, since there's no such thing as a stat Foley, we can tell you with utter certainty that you are in no way hypertensive.

And we consider that a success.

Thank you again for choosing us for your medical care-
The ER Staff

If I was a cat...

In retrospect: Freakin' Awesome

No, I did not take this picture. But it's exactly what it looked like at my house last night.

At the time, it was a bit scary.

I love thunder and lightning. There was plenty of that. In fact, you couldn't tell where one display ended and the next began.

I love heavy wind and rain. There was plenty of that.

Not so big on the death and destruction. Though there was plenty of that, too.

My sister called me from where she lives in the middle of Tornado Alley to make sure I was OK. The irony did not escape me.

I wish I could describe it to you. It was fantastic. I stood in my bathroom looking out the open window for hours. (The wind was blowing from the other side of the house, so I could see and hear everything but not get wet. Much.) I was like a little kid on their first trip to FAO Schwartz. My jaw hurts from grinning so big for 2 1/2 hours.

What a geek.

Undefeated no more!

And the Football Gods speak: Though Shalt Not Cheat, Bill Belichick.

It doesn't matter what you do in the regular season if you can't win the Big One, Mr. "It's Always Somebody Else's Fault" Brady.

Strong work, Eli. Strong work.

I *heart* Dilbert!

In other news, it's Super Bowl Sunday! Nachos and Burgers and Beer for all!

AD was bored.... so was I

What military aircraft are you? F-16 Fighting Falcon You are an F-16. You love to flaunt your slick appearance, but aren't afraid to get your hands dirty, either. You can outmaneuver any of your contemporaries, and you possess a technological edge. And above all, you are a true showman.

Click Here to Take This Quiz Brought to you by YouThink.com quizzes and personality tests.

*********************************

Hmmm, it doesn't say anything in there about shooting down drug seekers. Must be an upgrade that only came with my model.

Saving the world, one idiot at a time

The guy from the furniture store came to fix a broken part on my sofa/recliner today, just in time for the Super Bowl.

He was the bestest repair guy E-V-E-R! When I scheduled the appointment, I told him that I would be getting up early (at 4 pm) so that he could come fix it, and he said, "Just put your phone by your bed and I'll call you and wake you up when I'm driving down your street. That way you don't have to get up early if I'm running late."

While he was fixing the part, he aked me where I worked nights, and I told him.

His response?

"I have a friend that used to work nights in the ER. She quit and started working home health. She said that the idiots are much easier to deal with one at a time."