Musings of a Highly Trained Monkey

In which my jaw hits the floor....

2010-01-07T07:21:00.000-06:00

Some of you recognize the irony. When I'm finished crying, my common sense will set in and I'll be happy. That will not occur today. Or tomorrow. Or even next week. Maybe in April.

Irony

2009-11-25T21:34:00.000-06:00

When you have one of those damn Bluetooth things in your ear, but when you open your mouth so I can take your temp, there are no teeth to be found, blue or otherwise.

Dental hygiene- is there an app for that?

Too much information

2009-09-26T04:49:00.000-06:00

Overheard in the breakroom last night: "Man, I gotta get the doc to write me a script for some Cipro. When I just went pee, it smelled so bad that I looked around to see if there was a nursing home geester Foley hidden in the trash can or something."

Darwin 1, MonkeyGirl 1

2009-09-17T17:23:00.000-06:00

Last night was cardiac night in my rooms.

First patient was a CPR in progress coming in via EMS.

"54 year old male has been experiencing chest pain and shortness of breath all week. Tonight he decided to get on the treadmill. Family reports he was on it for about 5 minutes when they heard the crash and went in and found him pulseless and apneic on the floor."

Our resuscitation was unsuccessful. Darwin wins that one.

Patient number 2 was a 58 year old man who was told after a positive stress test two months ago that he needed two stents, and was putting it off because it was too expensive. Tonight he comes in with a classic presentation STEMI. Door to balloon time: 75 minutes. At 0300, I'll take it. LAD 100% blocked, RCA almost 100%, both stented, dude's gonna be fine, 'cept for the angina when the bill comes.

His wife leaned over to kiss him goodbye as he went to the cath lab and I heard her whisper, "I told you so."

MonkeyGirl wins that one.

Darwin's up!

Does Charlie Weis put gravy on his serving of defeat?

2009-09-12T17:28:00.001-06:00

Michigan 38, Notre Dame 34.

Go Blue!

Four and a half hours.

2009-09-12T02:14:00.000-06:00

That's how long it takes to get the smell of c-diff out of your nostrils after you have taken the patient upstairs.

The first two will be spent repeatedly checking your shoes, scrubs, stethoscope, etc, to make sure that you don't have any on you, because are sure that the smell is coming from something that you missed. After all, you spent five hours cleaning up massive quantities of slimy (yes, Mom, it really is slimy) poo every 30 minutes, it had to have gotten on you somewhere, right? Those gowns are only paper, after all.

But alas, it is coming from your own abused little olfactory cells. The cells that hate you now. The cells that will make everything you eat in that 4 1/2 hours taste like c-diff, too.

C-diff is a powerful little bug. Kinda like Slimer, from Ghostbusters.

Word of the Day

2009-09-03T19:58:00.002-06:00

entubulate \en-TOOB-yoo-late\ (verb): to place a breathing tube down the throat of a redneck for the purpose of mechanically ventilating the lungs.

ie: "The doctor told me after my gallbladder surgery that I have a crooked neck and he had a hard time entubulatin' me."

During a redneck code, often the patient will be both entubulated and defibulated.

I think there's a new TV show coming out......

2009-09-02T21:32:00.007-06:00

....and I'm fairly certain it was filmed last night in my ER.*

I worked with two docs that were younger than me, and 4 of the 5 RNs were young enough that I could have given birth to them. The other RN was old enough to be my mother. Almost all of them were Hollywood beautiful.

Mixed in amongst all of the stinky and annoying not-sick patients, we had a "stopped-breathing-right-in-front-of-EMS" code, an internal carotid dissection, a new onset paranoid schizophrenia, a classic presentation STEMI with a 31 minute door-to-balloon time, a ruptured appy, and a GSW to the head.

I swear, I spent the whole night looking around for the cameras.

*(No, it's not an ED, Whitecoat. It is one super-big room with a bunch of curtains and partitions. Some of the partitions just happen to be made of wood, metal and glass.)

How to Quantify Good Care

2009-07-15T20:30:00.003-06:00

I went to the Farmer's Market today, because I wanted some fresh corn, and the produce section at our Super Wally World sucks.

"How much is the corn?" I inquired of the sweet farmer lady with the huge pickup truck bed full of ears of corn.

"Six fo' two dolla or a dozen fo' tree," she said.

I told her that six was plenty and handed her two bucks. She counted out eight ears and handed them to me in a gently used Wally World plastic bag.

"I think you gave me a couple more than I paid for," says I, not wanting to cheat the sweet farmer lady out of 50 cents worth of corn.

"Oh, I knows," she replied. "I did it a purpose. You took care of mama in the 'Mergency Room over Christmas time when she done had her stroke. You brang me a blanket and some coffee when they didn't have no rooms to put her in upstairs. I jest wanted ta say thanks."

A short discussion later I found out that mama was back at the farm, no worse for the wear. In fact, if I come back next week for some more corn, I could talk to her myself, because she'd prolly be there. I said I would try to do so, bid her farewell, and went on my way.

So now you know. A cup of hot coffee and a warm blanket is worth two ears of corn.

And it was damn good corn, too.

Happy Independence Day

2009-07-04T06:57:00.002-06:00

Still the best movie speech ever.

Cardiac Arrest

2009-06-26T13:44:00.002-06:00

I swear to GOD, if I hear one more person say that Michael Jackson appears to have died from "cardiac arrest", I'm going to have a stroke.

Of course he died from "cardiac arrest"! Everyone dies from cardiac arrest.

Farrah Fawcett? Cardiac arrest.

Ed McMahon? Yup. Cardiac arrest again.

Eventually, cardiac arrest is going to get us all. Drugs, cancer, and heart disease just help it get us faster.

Jeez.

Now departing from gate C-13

2008-12-29T19:12:00.002-06:00

I tried to think of a clever way to say goodbye, but I can't come up with one.

When I started out, it was a lot of fun.

Now it's more like work.

And work sucks.

So I'm going to make like a shepherd and get the flock outta here.

In the words of Dr. Seuss: "Don't cry because it's over. Smile because it happened."

12 days of Christmas

2008-12-24T07:08:00.002-06:00

Most of you have already been over to Addicted to Medblogs and checked out her 12 days of Christmas posts over the last couple of weeks.

A few of you might have noticed that the 5th day of Christmas was missing.

That would be because the 5th day of Christmas was retarded and forgot to get her questions in on time.

*sigh*

My one and only chance to be a Calendar Doc and I nearly ruin it.

Go check out my interview, and then read all the others. Good holiday fun.

Chief Complaint of the Night

2008-12-22T11:31:00.002-06:00

"I think I'm having a miscarriage or my ovary fell out."

Complete with show and tell in a baggie.

She left without being seen after waiting for an hour, so we'll never know if it really was her ovary.

Best email of the week

2008-12-17T10:11:00.002-06:00

Doctors:
(a) The number of doctors in the US is 700,000
(b) Accidental deaths caused by physicians per year are 120,000
(c) Accidental deaths per physician is 0.17

Guns:
(a) The number of gun owners in the US is 80,000,000
(b) Accidental gun deaths per year is 1,500
(c) Accidental deaths per gun owner is 0.000019

So, statistically, doctors are approximately 9,000 times more dangerous than gun owners.

Remember: Guns don't kill people; doctors do.

Not everyone has a gun, but almost everyone has a doctor.

Please alert your friends to this alarming threat. Doctors should be banned, or at least more strictly controlled, before this gets more out of hand.

Out of concern for general public safety, there should be no statistics published about lawyers for fear the shock would cause people to panic and seek a doctor's assistance.

Guilt trip to the extreme

2008-12-16T05:50:00.002-06:00

An LOL comes in from an assisted living place.

She was found down on the floor with a blood sugar of 26.

The medics fixed her. She was coming around by the time they got to us a few minutes later.

After all of the important just-got-to-the-ER stuff, like vitals, labs, EKG, etc, I went to get her some food.

"Oh, good, I haven't eaten all day. I'm starving."

When I asked why she didn't eat all day, she responded with, "I don't know. I guess I was too busy."

Yeah, right. Too busy hanging out watching TV in the single room apartment of your assisted living place to eat? Sure.

I hear her a little later on the phone with her daughter telling her that if she paid a little more attention to her and came over to see her, this wouldn't have happened. She told her it was all her fault.

Of course, daughter rushed down to be with mom.

Doc wanted to keep her overnight for observation.

Nope. LOL signs out AMA. Daughter is going to take her home and stay with her. She'll keep an eye on her.

ALS Ambulance transport = $1500.00
ER visit complete with various diagnostic tests = $3000.00
Using the ER to guilt trip your kids during the holidays = Priceless.

Happy Endings

2008-12-10T10:49:00.002-06:00

A while back we had a bad case.

40 year old healthy female with almost no risk factors came in via EMS complaining of chest pain. You could tell by looking at her that she was having a big fat MI.

About 5 minutes after she got on the gurney, we were preparing to transfer her, because we didn't have anyone on call to take her to the cath lab. (Note to people in my town: don't have an MI on the weekend.)

And then it happened.

She coded.

And it was a sucky code. You know, the kind where there's no suction hooked up. And there's no ambu-bag. And when the doc hollered for something, everyone thought that someone else was going to get it, but no one went and got it.

If she had been 90, we would have just called it. But she wasn't.

She was 40.

At one point I looked at the doc and said, "You know this isn't going to turn out well, right?" And he said, "I have to try."

(BTW, he left to go work somewhere else a few months ago, and I miss him horribly.) *waves*

We'd get her back, and then she'd code again, and then we'd get her back again and on and on.

Oh yeah, the Big Shiny Helicopter wasn't flying, either, so she was going to have to go ground, which is a 45 minute transport.

Finally we got her back for about 5 minutes, and decided that it was now or never.

We put her on a Epi drip, and loaded her up. The other doc was going off shift right then, and he decided to go with EMS since she was so unstable, just to lend a hand.

It's a good thing he did, because she coded two or three times on the way to the Fancy Cardiac Hospital in the Big City.

But by the time they got there, she had a pulse and a pressure, and a couple hours later we heard that she made it through the cath lab, where they cleared a couple of really ugly blockages.

I told the doc that I hoped she didn't end up a vegetable. He agreed. But like he said, he had to try.

A couple of weeks ago I noticed a two xerox copies of two thank you notes hanging on the doc's bulletin board in their "office".

They were from her.

Written by her.

Thanking them for saving her life.

She's almost back to normal. She can't remember that night or the next few days, but she has almost no deficits.

Her kids still have their mom. Her husband still has his wife. Her parents still have their daughter.

Because of our two docs that wouldn't give up, even when it looked hopeless.

That, my friends, is why we do what we do.

Expiration Date

2008-12-08T14:09:00.002-06:00

Yesterday was the 6 month anniversary of the day that our brand new shiny-floored hospital opened its doors.

Last night, major water leaks developed on three floors.

The back half of the ER nurses' station looks like a third world country disaster zone.

Looks like they shoulda bought the extended warranty.

MonkeyHusband says that's what happens when you low-bid a $200 million project. Perhaps they should have gone with the $201 million bid. Maybe they would have filled all the holes and plugged all the seams.

Corollary to the the Announcement

2008-12-02T05:30:00.002-06:00

All previous promises for a belated Thanksgiving post are superseded by the fact that I have

A cold.
The week off.

Come back in a few days. Or a week. Or two.

Announcement

2008-11-27T17:47:00.002-06:00

Due to the fact that MonkeyHusband and I are both in the middle of a 4 night stretch, Thanksgiving and all of its associated posts and celebrations have been postponed until Sunday.

To all of you celebrating it on the customary date: Have a good one.

I heart Dilbert!

2008-11-21T15:10:00.002-06:00

Hey boys....

2008-11-20T04:35:00.002-06:00

....did you know that your penis is only worth $300,000?

There are several questions that beg to be asked about this article. For instance,

What was it doing when it caught the necrotizing faciitis?
At 61 years old, is this a reduced rate? How much is a, say, 30 year old penis worth?
How's that replacement penis working out for you?

Ah. The joys of prison.

------------------------------
Sorry Mom. I just can't resist a good penis joke.

No big deal

2008-11-20T04:27:00.002-06:00

So there's a 14 year old South Carolina Girl that lived without a heart for 4 months.

Big Whoop.

I've been doing it for 34 years.

*rimshot*

Poetic Justice

2008-11-12T04:02:00.000-06:00

Tonight I had the dubious pleasure of taking care of a 36 year old fibromyalgeur. She was also unemployed, obese, a 2 PPD smoker, with a history of COPD and hypertension. I was surprised to find that she doesn't have diabetes and CHF, too. Give it time.

She predictably has "allergies" to all non-narcotic pain medications, several antidepressants, a couple of psych meds, and methadone.

Her current prescriptions include:

MS-Contin 30 mg Q 4-6 hrs
Lortab 10/500 Q 4-6 hours PRN (apparently her allergy to Tylenol is tempered by the hydrocodone)
Celexa 40 mg/day
Lyrica 225 mg BID
Ativan 1 mg TID
as well as various HTN and COPD meds.

Today, either because she saw the full lobby, or because her complaint of "abdominal pain" last week didn't score her any narcs, she signed in with "Chest Pain".

As per usual, her workup was stone cold normal. Well, as stone cold normal as an obese non-compliant hypertensive COPD-er could be.

Unfortunately, her "chest pain" just wouldn't go away. "Hey, Doctor, could I have some of that Dil...Dilad...Dila-something medicine?"

Eventually she turned into an admission for observation, mostly because she was giving the ER doc chest pain.

When I took her upstairs, as I pushed her wheelchair into a semiprivate room, past a gorked-out, snoring-like-a-lumberjack old lady, she said, "You mean I don't get a private room?"

I said, "No ma'am, there are no private rooms on this floor." I had to practically shout to be heard over the lumberjack in the next bed.

I smiled all the way back downstairs.

The ER doc laughed out loud when I told him.

That Karma, sometimes she is a bitch.

Thank you.

2008-11-11T04:02:00.003-06:00

Night shift Jeopardy!

2008-11-08T08:59:00.003-06:00

Answer: 800 mg of Motrin and two bottles of Guinness.

Question: What is MonkeyGirl's standard breakfast on mornings in which a "dear God is that bright red blood gushing out of her ass?" rectal bleed is immediately followed by 90 minute completely futile "but she was breathing when we got there" code is immediately followed by a "I didn't feel like taking my Clonidine" hypertensive crisis/pulmonary edema?

Sometimes I love my job and hate it all at the same time.

Another good one gone.

2008-11-05T17:56:00.002-06:00

Dear Mr. Crichton:

I loved you for your books, and I forgive you for ER.

Rest in Peace,
MonkeyGirl

Yay! It's Election Day!

2008-11-04T22:27:00.002-06:00

Please excuse me whilst I go hide my guns and money. When I return, we can commence celebrating what an enlightened nation we have become that we can elect a President whose sole qualifications are "charisma" and "skin color".

(Alright, you got me. I really did have one political post in me.)

Honestly, people.

2008-10-31T16:08:00.002-06:00

OK, I need to know.

How soon before the freakin' med bloggers stop political blogging and start medical blogging again?

One week after the election? Two weeks? A month?

Jeez, guys. You're killing me.

Can't you just start another blog like Girlvet did?

It's like when you're watching a good shoot 'em up flick and all of a sudden there's lots of bad romance. WTF? Stick with the plan, Stan!

Shoot 'em up movies get a good sex scene and a couple of romantically charged "moments".

Med Blogs get one good political rant and a couple of politically charged "moments".

That's it.

Arrgh!

How often do you change your socks?

2008-10-27T06:12:00.004-06:00

This guy comes running into the front of the ER hollering, "My girlfriend's having a seizure! Help me!"

So the triage nurse and tech grab a wheelchair and head out to get her.

When they get to the car, they find a 250+ lb 20-something young woman having the worst fake seizure EVER.

The triage nurse tells her to knock it off and get into the chair.

She does.

While pushing her through the waiting room to triage, she starts up again.

Since the lobby is full of ~~suckers~~ medically uneducated patients, the triage nurse calls us for a bed and wheels her back to the back, in an effort to keep her from flopping onto the floor in the lobby (the next step in the "get attention by faking a seizure" algorithm.)

We meet her in the room and apply our mad assessment skillz, noting the lack of urine in the crotch of the jeans, the lack of blood in the mouth, as well as the really bad fake seizure going on, and plan our immediate interventions accordingly.

I head to the cabinet that holds the STAT 16 Fr Punitive Foley Catheter, and Nurse Tinkerbell heads for the cabinet that holds the STAT 16g Punitive IV Catheter.

It's called a "16 Squared", and it's the first line treatment for ODs and fake seizures.

Meanwhile the triage nurse is telling her to knock it off and get into the bed.

Which she does.

Now, the ER nurses out there will tell you that this story is pretty much scripted from this point on. It usually involves the aforementioned 16 Squared, a dead normal prolactin level, a lengthy story about how her boyfriend doesn't love her anymore, a whole lot of drama, and either a discharge home or a Mental Health consult.

That alone is not worth a blog post.

What happened next, however, is.

While the triage nurse was getting her vitals, and Tinkerbell was trying to find a vein buried in the massive rolls of subcutaneous tissue on her arm, I was trying to peel the size 20 jeans off the size 28 ass. (I try not to cut off the clothes of the patients that I know will be leaving, because then I have to find something else for them to wear home. Not easy to do in my ER.)

Once the jeans finally came off, it was time for the underwear removal. Thankfully, it wasn't a thong.

But when I pulled down her panties, I discovered the answer to an age-old question: "What does a redneck girl use when she runs out of panty liners?" The answer: "A sock."

Once upon a time this sock was a plain, white athletic sock.

No more.

Now it was an interesting shade of yellowish-green that falls somewhere in between asparagus and inch worm.

Now, I'm not positive why she was using the sock, but I'm pretty sure it's because a regular panty liner would have dissolved.

The smell was like a cross between athlete's foot and crotch rot. Sort of a Crotchlete's Foot, if you will.

Which begs the question: Do you treat it with Monistat? Or *bam* tough-actin' Tinactin?

Quote of the Night

2008-10-23T05:43:00.002-06:00

From the little old man that we were helping get dressed to go back to the nursing home, after we pulled his underwear up a little too far:

"Hey, take it easy! You just wrapped my balls around my tonsils!"

Sorry, dude. My balls are purely figurative, but I wouldn't want them wrapped around my tonsils, either.

I heart Dilbert!

2008-10-20T05:04:00.003-06:00

If you have an iPhone, this is for you.

If you have a Blackberry, you're next.

Seriously. Who the hell could possibly be e-mailing you at 0200 in the morning that requires you to have your phone/PDA/laptop/lawnmower/toaster in your hand checking it whilst I am trying to talk to you about this very sick patient?!?!?!?!?!?

If football games ended at halftime....

2008-10-19T06:47:00.002-06:00

....I would be the happy one at the Monkey House.

Instead, MonkeyHusband's obnoxious gloating continues.

With good reason, of course.

*sigh*

Go Blue.

Mmmmm... tasty.

2008-10-19T06:35:00.003-06:00

A 600+ lb woman comes in.

It takes 8 people to transfer her from the ambulance stretcher to the bed.

When removing said patient's clothing from her, in the folds of her abdomen, we find:

a paperclip
a plastic fork
a package of duck sauce

Question: Would you assume that this is the leftover remnants of lunch, or would you continue looking until you found the egg rolls?

Prayers

2008-10-14T05:03:00.003-06:00

Little old guy comes in cuz he can't pee.

"Jeebus, pleeeeeeeeze, halp me, Jeebus!" over and over with nary a pause for breath.

I get him up on the stretcher, pop in a Foley, and lo and behold, out comes 1500 mls of nucky-looking urine.

"Thank 'ee, Jeebus! Oh Lawd, thank 'ee, Jeebus!" over and over with nary a pause for breath.

I said, "Sir, Jeebus didn't put that catheter in, I did."

"Lawd, thank 'ee Jeebus for this purty lady wif'n the caffeter. Lawd, thank 'ee Jeebus!" over and over with nary a pause for breath.

He was still thanking Jeebus for the purty lady wif'n the caffeter 10 minutes later.

I love little old guys.

I'm sick and wrong.

2008-10-13T08:50:00.002-06:00

But you knew that.

The 90- proof woman

2008-10-04T05:04:00.004-06:00

She came in with a head lac and a BAL of .474.

"Can I have something for the pain?"

Uh, no.

If I knew any vampires, I'd tell them to party with this chick.

And the Football Gods smiled.......

2008-09-28T15:25:00.004-06:00

......as Arrowhead rattled and rolled.

happy sigh

2008-09-27T22:08:00.002-06:00

OMG!!!!!

and

WTF!?!?!?!

and

WTF!?!?!?!

Go Blue!!!!!!

News from my Football World

2008-09-22T10:38:00.003-06:00

1. The Wolverines didn't lose on Saturday! OK, so they didn't play on Saturday. Go ahead. Be all technical about it.

2. The Chiefs lost yet again (at one point in the first quarter, our starting quarterback, who was the third string quarterback two weeks ago, was 2/14 for 12 yards and 2 INTs.) But the Patriots got beat worse by MIAMI, so that cancels out the loss. Sorta.

I was wearing my Michigan hat when I went to Costco the day after the Notre Dame loss, and a complete stranger went out of his way to tell me that he was sorry about my team.

*sigh*

SOB is right

2008-09-18T05:37:00.002-06:00

If you can breathe and move well enough to stand up on your stretcher and scream at the top of your lungs for narcotics.........

.......you are well enough to be discharged.

Don't make me spell it out for you.

2008-09-16T04:22:00.002-06:00

An 85 year old lady presents with left sided weakness, slurred speech, and a room air sat of 85%. She has been very healthy until last week, when she fell and broke her pelvis. She was just discharged from our fine establishment two days ago. Would you work her up for:

A: Nothing. She's just old. Old people have problems. It's the circle of life.
B: A hemorrhagic CVA. CT comes back normal, she must be OK. We'll sit on her in the ER for a bit and then send her home.
C: An ischemic CVA. CT comes back normal, lets's keep her overnight and see what her CT says tomorrow. She needs supportive care anyway.
D: An ischemic CVA, and oh, hey, let's go ahead and check for a PE, because her sats are 85% for no apparent reason, and those obnoxious clots can sure get around.

Sometimes new docs are great.

The ones who listen to their nurses and pay attention to their patients and are only arrogant up to the point where they don't know the answer, and then they turn off the arrogance and work as part of the team trying to fix the patient; I love those ones.

The ones who walk in with the "I'm better and smarter than you because I'm a doctor and you're not" attitude, that don't recognize clinically significant details about patients, but you can't tell them anything, because they know everything; not too fond of those ones.

Not too fond at all.

Observations from my day

2008-09-14T06:39:00.002-06:00

Yesterday I watched the best movie I've seen in a very long time and the worst football I've seen in a long time.

If you can tolerate the F-bomb (alot) and don't mind having to use your brain once or twice whilst watching a movie, you will love "Burn after Reading". I laughed through the entire movie. It was exactly what I expected it to be and totally fantastic.

Then I went home and watched football.

Dear God.

In the first 5 minutes of the Michigan-Notre Dame game, I threw everything within reach at the television. Seriously, could my team suck any worse? I did enjoy watching the freshman running back (who we referred to as the "fast little white guy") rack up 185 all-purpose yards, but jeez, did you have to spot 'em 21 points?

Last week my Chiefs got their asses handed to them by the Patriots, but they blew out Tom Brady's knee. This week my Wolverines got their asses handed to them by the Irish, but they blew out Charlie Weis' knee. What the hell?

(On a side note: Who is Charlie gonna find to do his knee surgery? He doesn't have a very good reputation as a patient....)

Then, to cap it all off, I watched one of the most over-rated teams in football, The Ohio State Buckeyes, be decapitated by the dynastic USC Trojans. Quite literally, the only match-up possible where I would root for the freakin' Trojans.

3 points? The #5 team in the country was only able to score a field goal? I thought their ranking was a bit, shall we say, inflated. Proof positive.

Go Blue!

Pain Control

2008-09-11T16:16:00.002-06:00

I was talking to my sister on the phone today, and she was telling me how my 2 year old niece has a fuzzy pink knit hat that she won't let out of her sight, or often, out of her grasp.

*flashback*
I had a fuzzy pink blankie once, that kept me warm and protected me from the zombies. Then one day my grandma decided it was too worn and she re-covered it with another layer of pink fabric, thus destroying its protective zombie repelling powers and turning it from a blankie to a regular blanket.
*/flashback*

All of a sudden, in the background, I hear crying. My sister goes to check on the kids, and comes back laughing.

It seems that my 4 year old nephew fell and started crying, as 4 year olds are wont to do. My niece ran up to him and started petting him with her hat, and said, "Don't cry! Here, do you want to hold my hat? How about a story?"

I've got it figured out.

From now on, when the drug seekers come into my ER, they're gonna get a hat, and a story.

And you thought I didn't care.

Oh, bother.

2008-09-10T04:47:00.003-06:00

I was kinda hoping that they would suck the world into a black hole of quarks and whatever else when they fired up the Hadron Collider, so that I wouldn't have to go to work.

When I woke up this morning, the world was still there. So much for that.

Guess I should prolly come up with a quality post at some point, too.

I'll think about it.

Don't hold your breath.

I heart Dilbert!

2008-09-03T04:15:00.002-06:00

I have a question.

2008-09-01T13:38:00.002-06:00

I just came from ER Stories, where I was a little late to the feeding frenzy that occured in the comments section.

It was the same old story, "You are evil and uncaring, you should get another job, blah, blah, blah, blah."

Here's my question.

If all of us "evil, uncaring" nurses, physicians, etc, go get another job, who the hell, exactly, do you think is going to take care of your fat, lazy, fibromyalgic, drug-seeking ass?

Those "caring" nurses and docs that you speak of? They can only see three patients a night, because they're spending all their time "caring", and no time "treating". The rest of us take care of the other 150 patients.

Sorry we didn't "care" enough, but hey, glad your blood pressure isn't high enough to kill you anymore. Oh, and sorry about that 3 hour wait. We would have had a bed for you 2 1/2 hours ago, but Snow White was back in the B Pod singing lullabies to her patients or some shit.

BTW, be careful what you ask for. You might get it. And those of us that know better realize that somewhere, an emergency room just got a lot worse than it used to be.

Zombies

2008-09-01T09:17:00.003-06:00

I had a very realistic dream about zombies invading my house last night.

You will be happy to know that I survived.

When I woke up, I realized that I didn't remember the combination to the ammo safe (guns with no ammo are useless against zombies). I asked MonkeyHusband to remind me what it is, and he was not nearly as amused as I was when I told him "in case the zombies attack."

*sigh*

Some people just don't appreciate good zombie preparedness.

Green stuff

2008-08-20T13:13:00.002-06:00

Green stuff should not come out of any of your bodily orifices.

Not your lungs, not your bowels, and not your vagina.

And if it is coming out of the latter, and it is the third time in the last year that you have been to my ER with this complaint, you need to be a little bit more careful who you're letting put what where.

Normal people go a lifetime without ever getting PID. If you've had it more than once, you've got problems.

It's like Magic!

2008-08-14T07:08:00.002-06:00

When I took the crazy guy in room 11's vitals at 0330, he had a full urinal.

When I brought him a new urinal and a Coke at 0345, he had an empty urinal.

There was no puddle on the bed or floor.

I didn't bother giving him the Coke or the new urinal.

I did, however, get him some mouthwash.

Rehab

2008-08-11T04:16:00.002-06:00

I took care of a 65 year old gentleman the other day that had a stroke 3 months ago. It left him unable to feel or move most of his left side.

He had a lump on his left calf, and since he couldn't tell if it hurt or not, his wife brought him in, concerned that he might have a DVT.

He and his wife had a very good routine down for transferring him from his wheelchair to the bed, and I commented on how well he was moving. His wife said, "We've been going to Rehab twice a day, and we work for several hours a day at home, as well."

I told her that I was impressed with how well the Rehab was going.

He piped up with, "Yup. I haven't had a drink since I went to Rehab. 3 months, one week, and 5 days."

Some patients put a smile on your face that stays there for hours. He was one of them.

Images of Poo

2008-08-08T08:51:00.002-06:00

I just wanted to share with you a visual and olfactory image that I hope will stay with you for at least an hour.

GI bleed poo...... with corn.

Be glad you weren't there.

Have a nice weekend.

Jesus Heals

2008-08-05T22:16:00.002-06:00

Jesus came to the ER last night.

He was strapped to a backboard, bloody and battered, after he jumped from a moving car.

He was shouting at the top of his lungs, "I am the Lord, Jesus Christ! I see everything!"

All of a sudden he stopped shouting and got a terrified look on his face and screamed, "I didn't see anything! I didn't see anything!"

His full body CT scan was negative.

Ativan and Haldol put Jesus into remission.

Jesus wasn't as fun when he wasn't screaming.

The confused LOL two doors down was praying to Jesus as we tried to get a needle into her 97-year-old veins. I told her he was next door, did she want me to go get him?

When he left for the Psych Hospital in the Big City, the cop asked his nurse if he needed to do anything special for his road rash. She said, "Naw. He'll heal."

To which I responded, "Jesus heals, huh?"

When I got home this morning I found a couple of spots of blood on my scrubs from when pre-Haldol Jesus was flailing around.

How much do you think that G0ldenPalace.c0m will pay for my scrubs with Jesus' blood on them?

Guilt.

2008-08-03T06:50:00.002-06:00

She comes in more often than she should.

Her body is a mass of bedsores and contractures. She is permanently folded into the fetal position.

She doesn't speak. She simply moans. Sometimes I'm glad that I don't know what she's saying. It's easier for me to pretend that she doesn't know what is going on around her, even though I always talk to her as if she understands me. I'm afraid that she does.

She has a PEG tube keeping her alive. She hasn't eaten a bite in years. The staff at the nursing home forgets to keep her head elevated. Most of the time she comes in because she has aspirated, and she has pneumonia, again.

She is the reason I question the existence of God.

About six months ago she came in with the worst GI bleed I've ever seen. She was pooping blood. She was puking blood. When we turned her, blood poured out of her stoma around her PEG tube. She was laying in a puddle of blood.

We stuck her for a line at least 10 times. The doc made two attempts to put in a central line. He couldn't get it. There was no way to even try for the groin because of her leg contractures, and we couldn't straighten her shoulders out enough for a subclavian. Her H&H was in the basement. Her vitals sucked. She was trying to die.

She doesn't have a DNR. In almost three years of taking care of her, I've never seen a family member. But she doesn't have a DNR. So we kept doing everything that we could.

We were moving her around to clean her up when I spotted a vein on the inside of her arm. Somehow I got an IV into it. I told myself that she really needed pain meds. But that IV was the portal through which all of her lifesaving interventions were pushed.

We shipped her to the Real Hospital in the Big City. I watched the obituaries for months. I never saw her name. But I didn't see her in our ER (or ED, if you're WhiteCoat), either.

She came in tonight.

Her bedsores are bigger.

Her contractures are tighter.

She has two 100 mcg Fentanyl patches on. She is still moaning. And awake.

She didn't aspirate this time.

Now she has a necrotic foot.

After I took her upstairs, I cried in the elevator all the way back down. And all the way back to the ER (or ED if you're WhiteCoat).

I wish that I hadn't gotten that IV.

The guilt is crushing.

Just in case you were wondering.....

2008-07-30T04:16:00.003-06:00

This is my blog:

This is me:

Be back soon. (Of course, I work in an ER, so 'soon' is a relative term.)

The great internet embargo of 2008

2008-07-14T02:23:00.002-06:00

Those of you that visit on a regular basis will not be surprised to hear that I'm considering hanging it up for good. I'm pretty sure that the lack of quality posting has not escaped your notice.

Frankly, the effort it takes to come up with a post is becoming more than I care to exert.

So I'm putting the keyboard away for a while.

Someone else will have to entertain you for a while. I have people in real life to annoy and amuse.

I heart Dilbert!

2008-07-12T17:04:00.002-06:00

Superheroes

2008-07-11T01:05:00.002-06:00

Just in case you were wondering, if you are a 41 year old man, and you drink a bottle of bourbon, smoke a joint or two, and try to break into your ex-wife's house (who has a restraining order against you).........

........your Spider-Man underpants will not help you win the battle against the three very big cops, each with a Taser and pepper spray. Especially once they use said Tasers and pepper spray.

In addition, your Spider-Man underpants will not protect you from the nurse with a B-52. (I can just pull them down.)

And finally, when you are unconscious and snoring from all the chemicals in your bloodstream, your Spider-Man underpants will not protect you when you pee yourself.

Congratulations, you're a Superhero.

The $85.00 Diet Dr. Pepper

2008-07-09T09:42:00.000-06:00

Monday was the Brat's 7th birthday, so we took her to the Zoo in the Big City 3 Hours Away, instead of our usual trip to the Zoo in the Big City 1 Hour Away. We stayed overnight at a "Bestern Western" and she got to swim in the pool, so the trip was a success.

On the way up, we drove for 10-15 minute stretches of time through absolute nothingness except trees and rocks. No cities, towns, or gas stations.

After one of these sections of nothing, I told MonkeyHusband to pull off at the next exit so I could get a caffeinated beverage. (I had worked the night before, and I was feeling it.)

When I got out to get my Diet Dr. Pepper, I noticed that the rear passenger tire was a little low, so he pulled up to the air thingee to fill it up a little.

A s soon as he put some air in the tire, a strange hissing noise commenced. Now, I don't know much of anything about tires, but I know that when they are hissing, it's bad.

As luck would have it, the service station where we had stopped to purchase my Diet Dr. Pepper was also a tire repair shop of sorts. From the look of their selection, there are a lot of ATVs and lawn mowers in that part of the state.

Nevertheless, the extra from 'Deliverance' who worked there jacked up the car and pulled off the tire to find.....

Well, I don't know what exactly was wrong with it, but I know that the rubber is supposed to be smooth and noiseless, and it was all bubbly and hissing.

He said we were lucky we didn't have a blowout on the freeway.

So they replaced my High Performance Michelin with something that was at least close to the right size, and I went in and bought my Diet Dr. Pepper. Which was now worth $85.00.

And 20 minutes after we got off the freeway, we were getting back on the freeway.

Tomorrow I'm going to have to go in and buy a $160.00 tire to replace the one that will have been on the car for 3 days. So technically, my Diet Dr. Pepper cost $250 bucks.

But at least we didn't have a blowout on a busy interstate on a holiday weekend. Dear God. Can you imagine the nightmare that would have been?

Foley catheter woes

2008-07-06T02:39:00.002-06:00

I was drawing grody pee out of the port of a nursing home foley with a needle, you know, the ones without a luer lock for pee removal, and the gorked old lady kicked the syringe, causing the needle to scratch across the back of my thumb.

Great. Now I'm gonna get a UTI in my thumb.

Happy Independence Day

2008-07-04T16:11:00.002-06:00

Last night we had a gentlemen with a triage note stating, "Pt states he has been drinking and he thought he threw the firework but it went off in his hand. Small burns noted to R index and middle fingers and palm."

Be careful out there. The idiots are everywhere.

Bizarre simple illnesses

2008-07-01T08:34:00.002-06:00

The strangest thing happened to me yesterday..... I called my PMD's office (he's part of the biggest Family Medicine Conglomerate in our town) at 0830 and said, "I need to make an appointment as soon as I can get in for this cough that I can't kick." And the appointment girl said, "He has an opening at 1140."

What are the chances of an appointment within 3 hours with a PMD? Creepy.

Anyway, remember the new disease that I caught at the beginning of the month? Well, 3 bottles of Tussionex later, I'm still coughing every time I lay down to go to sleep.

(First bottle was from a friend who had some on hand, second was a script from my favorite ER doc, and the third was a script from the ER doc whose wedding I just went to on the left coast. I told my PMD, "I figured I better come in," and he said, "Why, running out of suppliers?")

He thinks I have an occult sinus infection. He added some Augmentin to my Flonase and chlorpheniramine cocktail, and said that will fix it. Maybe. If that's what it is.

He also switched the Tussionex script to Robitussin AC, which is 10 bucks a bottle instead of 50. After the first dose when I went to bed last night, I can see why. It tastes like ass. With an ass aftertaste. That outlasts toothpaste. And mouthwash.

But it's working so far.

*sigh*

Goodbye, Hydrocodone. I'll miss you. I'm sorry I never got the chance to abuse you properly. Maybe next time.

I have discovered something in the last week

2008-06-28T00:24:00.002-06:00

I didn't miss my job, and I didn't miss the internet.

I have to go back to work, but I don't have to blog.

I'll be back when I feel like it.

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

PS: We had a patient yesterday whose wife had a service dog for........ wait for it........ FIBROMYALGIA!

"He goes with me to the grocery store, and to the mall, and if I want to bring him in here, you can't stop me!"

I think I popped a little aneurysm in my brain when she told me. I couldn't talk to her for long enough to find out exactly what the hell the dog does to help her.

She has disabled placards on her car, too.

What is this world coming to?

Would you please go away so that I can miss you?

2008-06-18T04:37:00.003-06:00

I'm leaving this morning on a short-ish trip to the left coast.

Two of my bestest friends are getting married on Friday, and I'm the best man. (Which leads right into the jokes about what this world is coming to when the best man is a woman.)

Then I'm going to my Mommy's for her birthday on Monday.

I'll be gone for a week or so.

You may commence missing me.

Trolls

2008-06-16T15:57:00.002-06:00

On my last post, somebody left this comment:

"Did your shit job make you stupid, or do you have a shit job because you're so stupid?"

So I'm thinking, "What the hell does that mean? It doesn't even make any sense! I don't have a shit job and I'm not stupid. Did one of my whiny co-workers take offense? (Though most of my co-workers make sure I know who is posting when they comment.) What is this Condoleeza person talking about? I don't get it!

Then I re-read the post. When I was talking about the Stocking and Cleaning Fairy, I said:

"Like Fibromyalgia, she does not exist."

Ah-ha! It's a Fibromyalgeur!

Yay, trolls!

Unlike fairies, trolls are real.

I heart Dilbert!

2008-06-15T06:42:00.003-06:00

(click to make the picture bigger)

This is how our administrators budget, too!

Public Service Announcement: Whiny Co-workers Edition

2008-06-12T07:27:00.002-06:00

Dear Co-workers:

In case you didn't know, this brand-new, big, shiny hospital that we just moved into is not equipped with an auto-clean function.

If you don't clean up after yourself, return items where they belong, and restock your rooms, the magical Cleaning/Stocking Fairy will not show up do it.

Like Fibromyalgia, she does not exist.

If you don't take care of your brand-new, big, shiny hospital, it will soon look just like the other one. Old, dingy, and broken-down. Remember when all of your equipment either didn't work or was held together with duct tape? Including the ELEVATOR!?!? Remember this copier? (Yes, that is indeed a ream of paper holding it up.)

And stop freakin' whining about "how hard you have to work now because everything is so big and so far away."

You have brand new equipment that WORKS in every room. You have a place for most of your supplies and all of your linens in every room. There is a fully stocked med room, supply room, and nutrition room within 30 feet of every room. There is a door, and a curtain, in every room.

If you'd stop bitching for 5 minutes and look around, you'd realize that you are in ER heaven.

Healthcare, and especially the ER, sucks most of the time, and it's getting worse. It definitely doesn't get any better than this. If you can't handle it at its best, get the hell out now.

I'm tired of your whining.

Life's little drain plug

2008-06-09T05:10:00.002-06:00

I had a patient a while back that was a frequent flier with COPD. You know the type; non-compliant with his meds, smokes 2 packs a day, and calls EMS when he's about a second from intubation.

His only redeeming feature? The HUGE ball of belly button lint that increased in size every time we saw him. I'm talking massive. And blue.

Every time we'd wrestle him out of his sweat-soaked shirt, it would catch our eyes.

Soon it became a contest.

"I'll bring you lunch next shift if you take it out."

"I'll do all your pelvic exams for a shift if you take it out."

"I'll do all your guiacs for a shift if you take it out."

"I'll do your next Code Brown if you take it out."

My response was always, "No way. It's prolly the only thing keeping him alive!"

One day, another, less superstitious, nurse pulled out his ball of lint.

Two days later he came in via EMS in full arrest.

I think that I was right.

Never, ever touch the belly button lint.

It's as sacred as the protective coating of filth.

Search of the day

2008-06-08T07:41:00.002-06:00

I have no idea what this search engine is, but apparently, I am the #1 result for "what does bitchy means".

I can tell you for a fact that lately, I am indeed the definition of bitchy.

You don't say...

2008-06-08T07:24:00.002-06:00

Headline of the week:

Man jumps from plane with no parachute, dies

So what, exactly, is the newsflash? The fact that he jumped out of an airplane without a parachute? Or the fact that it killed him? Because I'm pretty sure that the one's gonna lead to the other just about 100% of the time.

Besides, you know what they say: "It's not the fall that kills you. It's the landing."

I have to pay extra for my homeowner's insurance to cover roof damage due to hail. I wonder how much it would cost to cover falling dumbasses?

New disease

2008-06-06T06:36:00.002-06:00

I've had a cold for a week, and it really hasn't been too bad, except that I can't stop coughing. At all. Ever. As in, NO SLEEP. I'm exhausted. (Don't bother offering your remedies in the comment section. I've heard, and tried, them all.)

Anyway, I took a patient upstairs to the floor yesterday, and when I got back, there was a fine layer of LOL Flakes left on the gurney, as there often is.

And it made me think, "What if this isn't just a regular cold? What if this is a new respiratory disease? What if I have inhaled enough LOL Flakes to give me Deborah Peel Lung?"

So I'm thinking of calling one of those fine law firms that advertise on late-night television and see if I have grounds for a class-action lawsuit.

Anyone else want in?

Dysfunctional Redux:

2008-06-04T08:03:00.002-06:00

If you and the missus leave your kids with the babysitter so that you can go down to the local Super 8 and smoke crack, and the resulting anxiety, tachycardia, and chest pain send you into the ER via EMS, you're prolly not gonna win any "Parent of the Year" awards.

At least you're not doing it in front of them.

Dumbass.

Opinions?

2008-06-03T15:14:00.002-06:00

Dumpster diving: Good or bad?

Apparently MSNBC thinks it's a good thing.

I still say that eating food out of the trash is not something I could do unless I was starving and homeless.

Which, at the rate our healthcare system is declining, could be a year from next Tuesday.

The annual gift

2008-06-01T16:00:00.002-06:00

I just sent my stepdaughter home to her mother with the annual bouquet of flowers that I give her as a token of my esteem.

I sent them in a styrofoam drink cup from Sonic. Is that tacky?

Dysfunctional?

2008-06-01T14:02:00.003-06:00

If a man comes in to the ER with his adult child, and in the course of treatment is told that said adult child is suffering from a critical medical condition that requires transport to the Neuro Hospital in the Big City, and that to increase this patient's chance of living through this medical emergency and retaining the ability to say, tie his shoes again, he will need to go via the shiny helicopter, and could he please sign here to authorize the transfer and does he have any questions, and the parent of the adult child's only question is, "If he dies, I'm not gonna have to pay for all of this, am I?".........

......one might think that perhaps they don't have the most loving of families.

New addition....

2008-06-01T13:57:00.001-06:00

..... to the "Blogs I Check Every Day" List.

Check out the Crusty Ambulance Driver. It's like me driving an ambulance.

Ah, the good old days.

Public Service Announcement: Drunk Driving Edition

2008-05-30T07:00:00.002-06:00

If you're going to try to drive home drunk from the bar, do not run into the bar's Dumpster when backing out of the parking space. Especially if there's a cop parked behind the Dumpster waiting for closing time.

If you're going to get caught drunk driving, don't try to get out of going to jail by using a medical condition that can be verified with a little bitty prick of the finger. "I need to go to the hospital, my blood sugar is low," actually translates to, "I'm drunk, my glucose is 110, and maybe the cops will forget about me if I get into this ambulance."

When the cops decide to write you a citation and forego the trip to jail since we're gonna babysit your dumb ass until you're sober, don't sneak out while nobody's looking and take off down the street. We'll just call the cops, and guess what? Public Intox will send you straight.... you guessed it. To jail.

Don't mess with the IRS

2008-05-30T06:51:00.002-06:00

So this guy in Louisiana declared himself an "Ambassador and Citizen of the Kingdom of Heaven under its King Jesus the Christ", which supposedly gave him diplomatic immunity from federal jurisdiction and meant he didn't have to pay his taxes.

He's been sentenced to 2 1/2 years in prison and owes Uncle Sam over $150K.

So much for that.

Who Dat?

2008-05-29T00:02:00.002-06:00

Earle Hagen died on Monday. You might remember him from this.

One of my three favorite tunes to whistle in the ER at 0300.

These are the other two.

I don't care how expensive food gets....

2008-05-28T17:40:00.001-06:00

....for me, this is not a solution.

Ew.

Beating a Dead Horse

2008-05-28T00:22:00.002-06:00

Though I agree that fibromyalgia has gotten way too much discussion here in the last couple of weeks, I just found a diatribe by a fibromyalgeur that I had missed, and wanted to share.

It made me laugh out loud.

As did her magic wish and her desire to remain on narcotics forever.

I have a feeling this one's gonna start hitting the ER for some Dilaudid pretty soon.

A Query

2008-05-27T16:27:00.003-06:00

On what planet is is acceptable to use the ambu-bags in all 5 cardiac/trauma rooms over the weekend and not re-stock any of them when the rooms become vacant?

Not this planet. The supply room is a loooooooong way from the coding guy in room 4. Forgetting one room is understandable. Forgetting all 5 is not.

Remember....

2008-05-26T00:10:00.001-06:00

....those who have died for our freedom.

A Tip for the Rabble-Rousers in my Town

2008-05-24T13:35:00.002-06:00

We all know that God created bars so that single men might have a place to drink. And He created Friday nights so that they might have a time to go to those bars, just like Sunday is for going to church.

Now, everybody knows that sometimes a man might have a bit too much to drink, and may act like a fool or do something dumb, and it's okay, because it's not his fault. It's the alcohol. So of course it's forgiven.

Something dumb like starting a fight in said bar.

Which causes the patrons (and bouncers) at said bar to beat the ever-loving hell outta you. With fists, bottles, and even a barstool.

Which leads to you stumbling out the door in fear for your life and collapsing against your very nice car in the parking lot.

Where a Good Samaritan asks you if you are okay, and when he gets no reply in the affirmative, helps you into your very nice car and drives you across town to the Emergency Room.

Where he pulls up into the ambulance bay and frantically asks for help, and offloads you into our very capable (and now very bloody) hands for care.

And then drives off in your car.

So here's the tip, Rabble-Rousers: Put your mama on speed-dial.

That way, you can call her from the bar after you get beat up, and she can take you to the hospital and stand around in an indignant huff because somebody beat up her baby.

Or, she can come pick you up at the hospital after you get fixed because somebody stole her baby's car.

Or, she can come pick you up at the County Jail when you get arrested for possession when the nurses happen to find a large quantity of a certain controlled substance in your pocket while the police are questioning you about the bar fight.

In any case, you're gonna need your mama.

YouTube to the rescue

2008-05-23T08:30:00.002-06:00

I'm working all week. No time to blog. But here's two things that made me laugh yesterday.

Attitude Adjustment

2008-05-21T05:18:00.003-06:00

It has been pointed out to me that the reason that I am burned out could very well be that I am focusing on the negative instead of the positive. So in an attempt to counteract the cloud of negativity that seems to be following me, I have compiled the following:

Six things that I love about my job

1. The look that little old ladies give me when I give them a blanket fresh out of the blanket warmer. It's amazing to me that a warm blanket has the same effect on a little old lady as 1 mg of Dilaudid has on a drug seeker.

2. That rush of adrenaline that I get when we get the first look at the EKG of a STEMI. Yes, I'm a dork. I love STEMIs. That tombstone gets my blood flowing like nothing else. Well, at work, anyway.

3. When floppy, listless babies turn into normal, crying babies with the help of some Tylenol, Motrin and and a fluid bolus or two. Some people think that the sound of babies crying is bad. I disagree. Crying babies are music to my ears. It's the ones that don't cry that make me nervous.

4.*POP*SNAP*SNAP*SNAP*!!!!!! The fact that I love it when belligerent drunks get tazed in my ER doesn't make me a bad person, does it?

5. When I get an IV on someone that's already been stuck 10 times. Because now that poor, sick person can get some medicine to help them feel better...... No, not really. It's an ego thing. I admit it.

6. The sound that the automatic door makes as it closes behind me on my way home. Sorry guys. If you're looking for something deep and meaningful, this is not the blog for you.

Wow! I feel so much better! In fact, I think I can make it through the last three nights of my five night stretch now.

Thank goodness for the positive people. It gives me someone to focus my negativity on.

If all else fails, watch this. It'll put you in a good mood, guaranteed. Unless you're a sociopath, of course.

Damn Meme thingees

2008-05-19T09:57:00.002-06:00

I've been tagged twice over the last couple of months, and in the middle of my burnout funk, I have forgotten who tagged me. Leave me a comment, and I'll link you. Sorry I'm retarded.

In honor of my burnout, I'm going to modify the meme. And so, for your reading pleasure:

Six things that are causing my burnout

1. Co-workers with no work ethic.
I know you think that you're working harder than you should be. But so are the rest of us. Stop making us carry your load as well as our own.

2. Equipment that doesn't work.
I understand that we are moving to a nice, new hospital in 3 weeks. In the meantime, the monitors don't work, the gurneys don't steer, there isn't a portable O2 tank within 15 miles, and I have to beg, borrow and steal freakin' Jelcos from the other floors because all of the stock is being moved over to the new facility. What about this facility for the next 3 weeks?

3. CYA medicine.
I get so tired of drawing Type and Screens and Blood Cultures and prepping for Abdominal CTs on patients that don't need them, simply because that is the way that our docs are forced to practice ER medicine in our new litigious and entitled society. Hey Doc? That little box that you checked on the order sheet equals 15 additional minutes of my time spent in this patient's room prepping for a test that we both know she doesn't need, as well as another hour and a half in the ER taking up a bed that I could really use for one of the 20 patients still waiting to come back.

4. Back pain and sore feet.
No, not the patient's, mine! My freakin' back is killing me. Right between my shoulder blades. And my feet hurt. I don't even get to sit for 2 seconds anymore.

5. Rudeness.
Can't you at least be polite as you waste everyone's time and money bringing your lazy Medicaid ass in on a 911 ambulance for dental pain? Why do you have to be so damn rude?

6. Demented and contractured little old ladies with PEG tubes.
It should be a crime. 'Nuff said.

What's burning you out at work this week?

I heart Dilbert!

2008-05-18T16:13:00.003-06:00

(click on it to make it bigger)

I don't get it.

2008-05-16T16:15:00.002-06:00

Oscar Pistorius has been given permission to compete for a spot in the Olympics.

There are people that think that he shouldn't be allowed to compete because his blades give him an unfair advantage.

He is missing both of his legs below the knees.

I am of the opinion that if something provides an advantage in sports, then other people will try to do it to get an edge over the competition, no matter how dangerous it is. (ie: steroids)

I think that the Court of Arbitration for Sport has set a dangerous precedent. It won't be long before runners all over the world start cutting off their legs in order to run faster. Be alert. You may see these patients in your ER when their black-market or home amputation goes bad.

Anonymous internet angst

2008-05-15T16:21:00.003-06:00

Some of you were around for the strange affair of "The Dawn". She created a blog just to tell the world how much she hated me because I was an evil nurse. She took it down after much fun.

Now there is "Busymom345". She's a fibromyalgeur who has created a blog just to tell the world what an evil nurse I am. You know, because I don't believe in fairies and fibromyalgia and such.

That's two blogs that have been created so far just to talk about what an evil nurse I am. Created, of course, by people who don't know me. But that's totally beside the point.

How many people on the internet hate you?

It's Fibromyalgia Awareness Day!!!!

2008-05-12T11:16:00.003-06:00

In case you didn't see last year's post, check it out. There is a plethora of helpful links to assist you in managing your fake disease.

After working my ass off for the last 3 nights, I'm going to take my exhausted and sore feet, neck, back, arms and legs outside into the sunshine to work in the yard for a few hours. Then I'm going to come inside and take some *gasp* Motrin, and relax for the evening. I'll prolly even drink a beer or two. It's not the same as going to the ER for narcotics, but it'll have to do.

What are YOU doing to celebrate Fibromyalgia Awareness Day?

Happy Mother's Day!

2008-05-11T07:04:00.002-06:00

Not just to my Mom, (though especially to my Mom) but to all of you moms who visit my little corner of the blogosphere.

Being a Mom is hard work. Each and every one of you have my utmost respect.

Pain Scale Dichotomy

2008-05-10T08:12:00.002-06:00

Whiny 22 year old female on her period, c/o cramps, rates pain as a 10/10
= 1 mg Dilaudid IV.

Stoic 87 year female with broken hip after falling at home, rates pain as a 4/10
= 2 mg Morphine IV.

WTF?

Disgusting

2008-05-07T08:13:00.002-06:00

Does anyone else find the amount of money wasted by campaigning politicians nauseating?

Think of what you could do with $860 million. And that's just for president. The Senate and House campaigns raised another $715 million. For a total of $1.6 billion.

That's enough to run Feed the Children for 3 1/2 years.

That's enough to run St. Jude's Children's Research Hospital for 3 1/2 years.

That's enough to run Habitat for Humanity for over 5 years.

That's enough to run The Breast Cancer Research Foundation for 44 years.

That's enough to run The Intrepid Fallen Heroes Fund for 38 1/2 years.

That's disgusting.

Blue

2008-05-04T14:32:00.004-06:00

They wheel around the corner to the trauma bay, where the three of us are waiting. Bright yellow Stryker with a black mattress, blue and black Zoll at the foot, O2 tank with the green canvas cover.

Mabel is standing on the side of the gurney as they wheel in, doing compressions as the medic squeezes the ambu-bag. I meet her eyes across our patient.

"Ready?" she says.

I nod.

She lets go and steps back. I reach over and wrap my hands around the tiny body, continuing CPR with my thumbs as I lift him from the gurney to the infant warmer.

I know immediately that our efforts will be in vain. He is too cold, too stiff, too blue.

But we do it anyway. Because he's only 6 weeks old.

Lucy takes his temp. "Core temp of 89.6, doc," she says.

Doc shakes his head. They've got an IO established, but we need an airway. He's holding the miniaturized laryngoscope in one hand as he looks for the chords. In the other is an equally miniature ET tube.

He and his wife will be having a baby next weekend. I wonder what he's thinking. If he's thinking.

"Tube's in." RT connects the BVM and starts ventilating again. She puffs his little lungs for him as I pump his little heart for him.

I feel the cold of his skin under my hands and the warmth of the heat lamp on my arms. I try to will some of my heat into him.

"Another round of Epi," says Doc. Mabel reaches for one of the syringes she made up when we heard they were coming.

I squeeze my thumbs and fingers together over and over, circulating the drug as she flushes it through the line.

My forearms are cramping. I ignore it. An alarm sounds and a robotic voice intones, "Check patient." I can see the monitor over Lucy's shoulder. It looks like we have a rhythm.

"Hold CPR," says Doc.

The deflections turn to a straight line. It was just me. I was only fooling myself.

"Resume CPR."

I start to feel a burning behind my eyes. Reality is rearing its ugly head.

Doc squirts the ultrasound gel on the tiny chest. The transluscent blue shines on his pale, pale skin. I do compressions in between each look at his tiny heart. The gel squishes around my thumbs.

"Stop CPR."

We all wait for the words. We know they are coming.

"No cardiac activity on the monitor. No cardiac activity on ultrasound. There's nothing else we can do. Time of death: 0316."

We stand there for a minute looking at the tiny body in front of us. Then we start disconnecting leads and lines.

We swaddle him in blanket, leaving only his face showing. I think to myself that our blankets aren't soft enough to wrap a baby in. The tube sticks out of his mouth, reminding us that there will not be a happy ending to this story.

Sometimes you know that there was nothing you could have done.

It doesn't make it any better.

snerk

2008-05-03T07:57:00.001-06:00

Have a nice weekend.

Quote of the Night

2008-05-02T07:07:00.002-06:00

"Since you're taking all that blood, can you see if the doctor will do a test to check if I have fibromyalgia? I think I do."

I'll allow you to use your imagination and picture her age, size, activity level, employment status, "health insurance" provider, and narcotic of choice.

Public Service Announcement: Healthcare Edition

2008-05-02T06:53:00.002-06:00

If you are doing really good CPR, and your compressions look like V-Tach on the monitor, and your patient has a pacemaker/defibrillator, you may just get shocked.

And it will hurt.

And your co-workers will laugh at you.

The Body Bag

2008-04-28T04:23:00.003-06:00

In the past, we have been known to place a body bag on the bed with a sheet over it when a code with a long down time is coming in. It facilitates movement of said body to the morgue.

In the last few months, every time we place a body bag on the bed, the patient gets pulses and a pressure back.

They can be asystolic for 30 minutes when we move 'em over, but by god, the body bag brings 'em back.

I think we should incorporate this into our ACLS protocols.

PS: I've made "Not dead yet!" and "I'm getting better!" jokes twice in the last week. Once, one person got them. It's a travesty. Monty Python should be required viewing during ER orientation.

Forgive

2008-04-25T08:42:00.002-06:00

I'm a bit burned out at the moment.

As soon as I can turn all of my gripes into something entertaining instead of something whiny, I'll post them for your reading pleasure.

In the meantime, I'm just going to sit here and hate my job.

Normal MG will be back soon. I hope.

Musings of a Highly Trained Monkey

In which my jaw hits the floor....

Irony

Too much information

Darwin 1, MonkeyGirl 1

Does Charlie Weis put gravy on his serving of defeat?

Four and a half hours.

Word of the Day

I think there's a new TV show coming out......

How to Quantify Good Care

Happy Independence Day

Cardiac Arrest

Now departing from gate C-13

12 days of Christmas

Chief Complaint of the Night

Best email of the week

Guilt trip to the extreme

Happy Endings

Expiration Date

Corollary to the the Announcement

Announcement

I *heart* Dilbert!

Hey boys....

No big deal

Poetic Justice

Thank you.

Night shift Jeopardy!

Another good one gone.

Yay! It's Election Day!

Honestly, people.

How often do you change your socks?

Quote of the Night

I *heart* Dilbert!

If football games ended at halftime....

Mmmmm... tasty.

Prayers

I'm sick and wrong.

The 90- proof woman

And the Football Gods smiled.......

*happy sigh*

News from my Football World

SOB is right

Don't make me spell it out for you.

Observations from my day

Pain Control

Oh, bother.

I *heart* Dilbert!

I have a question.

Zombies

Green stuff

It's like Magic!

Rehab

Images of Poo

Jesus Heals

Guilt.

Just in case you were wondering.....

The great internet embargo of 2008

I *heart* Dilbert!

Superheroes

The $85.00 Diet Dr. Pepper

Foley catheter woes

Happy Independence Day

Bizarre simple illnesses

I have discovered something in the last week

Would you please go away so that I can miss you?

Trolls

I *heart* Dilbert!

Public Service Announcement: Whiny Co-workers Edition

Life's little drain plug

Search of the day

You don't say...

New disease

Dysfunctional Redux:

Opinions?

The annual gift

Dysfunctional?

New addition....

Public Service Announcement: Drunk Driving Edition

Don't mess with the IRS

Who Dat?

I heart Dilbert!

I heart Dilbert!

happy sigh

I heart Dilbert!

I heart Dilbert!

I heart Dilbert!

I heart Dilbert!

snerk