NR, RN's Page

Oh, some crazy days at work! Drunks, schizos, and attention seekers try my patience while really cool, normal, beautiful people remind me that we are all just humanity trying to enjoy life.

One of the challenges of my job is trying to be patient with people if I am stressed out. I believe everyone has a "cup" that can fill up with stress and once that cup bubbles over... Beware! We have a certain amount of energy to spend and once it is spent we have no more energy to give out. Like a checking account. Luckily we have days off and nights of sleep to replenish our account. I feel bad when I have "spent" everything I have, yet still have 4 more hours of work left.

The other day we were short a nurse (typical) and had an extremely busy day (Murphy's Law). The patient's were piling up in the waiting room while we were trying to treat the ones we already had in the exam rooms. One of the rules we have in the Fast Track is that we do not take psychiatric patients. I can understand not taking them if they are suicidal but if someone is schizophrenic but just happens to twist their ankle, I didn't see any reason why we couldn't see them. Now I know why. We were sent three psych patient's, one after the other. One was having trouble breathing (history of asthma), so we put him in a room right away. Unfortunately, I was working with a nurse who didn't have much experience in our department and she put him in the room directly behind the nurses station, room number 2. Room 2 has such a bad history that we often refer to it as "haunted" because it seems that everyone we put in there starts to flip out somehow. And because it is right behind us, we have little protection from the inevitable "flip out". Right away this homeless asthmatic starts accusing all of us of stealing his cigarettes. He's standing in the nurses station in sagging, dingy long johns, stinking to high heaven, pointing a cigarette stained finger at all us doc's and nurses. About this time, psych patient #2 comes up to the nurses station and asks me, "Do you have an internist I can see?" I explain to her, patiently, that she is in an Emergency Room, that the only doctors available are emergency room doctors. "Oh, I see", she says but her face says she is clearly confused. "It is Saturday", I continue. "The only doctors available today are ER doctors."

"Oh, okay." She walks back to the waiting room just as Psych #3 walks up to the desk. "Is a doctor going to look at my foot?" she asks. She's got a decidedly Haldol or Thorazine induced look to her.

"As soon as we can get a room for you, someone will look at your foot," I reply.

"Then I'm going to go. My foot feels fine." She says this with conviction.

"Okay, just sign this Against Medical Advice form and you can go." I hand her a pen and push a form toward her. I am impatient because Mr. Saggy Long Johns is getting louder with his accusations. She hesitates, then signs the form and walks away. Thank God! One less freak to worry about! Meanwhile, someone has pushed the "duress" button, designed to get security in our department in a hurry when we are fearing for our lives. So far, no one has showed up from security.

I start to prepare some antibiotics for a patient with pneumonia, when psych #2 approaches me. "Is there an internist here?" she asks. "No, only ER doctors, remember? I told you that two minutes ago." I continue preparing my medications.

"Oh." She looks defeated. Then she brightens up again. "Do you think I can see an internist?"

What am I to do? I have 7 other patient's in exam rooms, family members peering out the doors, looking at me like, "Are you coming back?" and meanwhile I have six patient's waiting in the waiting room, peering out at me, "Are you going to see us now?". I understand that when people are not feeling well that they become egocentric. They feel like hell, so the only world that exists is their own. Get over yourself people! Go visit a third world country or back woods America and see what suffering really is... Anyway...

I'm in a room taking care of someone and then walk out to the nurses station. Psych #3 is standing there. "I think I'll spend the night", she says. "You can"t", I reply. "You signed out AMA (Against Medical Advice)."

"I signed out what?" She obviously does not understand. Security has finally made it over and is haggling with Mr. Saggy Long Johns. I am at my breaking point. I call the main ER and ask to speak to the Charge Nurse. "Tell security to bring psych #2 and #3 to our waiting room," she says. Thank God! I don't have time for this! Security escorts out Mr. Saggy Long Johns, Psych #2 and 3. I feel a lot better.

One of the patient's (patience) waiting in the waiting room is a 15 month old girl who has a smashed toe. I mean bloody, smashed, open fracture, toe. We are supposed to take patients first come, first serve. But sometimes I don't think that is right. This poor baby is about six down on the line up. I call the ER and ask them how they are doing. The charge nurse says she has two open beds. Wow! We are drowning and they have open beds! So I explain the situation and ask her to take the baby with the smashed toe. She says no. Flat out. The two open beds are monitored and she doesn't want to risk giving up a bed to a "Fast Track" patient if a stroke or heart attack comes in. I understand but am still frustrated. I have a bed open up and instead of giving it to the next patient in line, I gesture to the parents of the 15 month old to come back to the open exam room. I know I am taking a risk because people are told that the Fast Track is first come, first serve. I brace myself for trouble in the waiting room.

30 seconds later, I face what I have feared. A 28 year old kid with a twisted ankle saw us take the baby before him and he decides to throw himself onto the waiting room floor and "hyperventilate" in supposed pain. His mother runs up to us and screams, "He's going into shock!"

I am already aware of all the malady's of the patient's waiting and am pretty sure that none of the injuries would make someone go "into shock". My patience has run it's course. "He is not going into shock", I tell the mother with a unimpressed tone. I reluctantly walk into the waiting room where a man is laid out onto the floor, breathing heavily. I pull a gurney into the waiting room and kneel down next to him. In an even tone I say to him, "You need to slow down your breathing". He is able (miraculously!) to catch his breath long enough to say, sarcastically, "Yeah, thanks!". Then he resumes his heavy breathing. Lordy! I scoop him up onto the gurney and all of a sudden he is calm. I walk back to the nurses station and tell the doc the situation. She tells me to give him 1mg Dilaudid IM. No way. The doc looks at me as I defy her. "The last thing we need is this stupid kid all fucked up and can't leave our department because his is overmedicated." The physician's assistant backs me up: "Why don't we give him two Vicodin?" The doctor agrees and that's what I give him. I wheel the gurney into an exam room as his mom and grandma follow. After the xray? He's got a sprained ankle. That's it. A sprained ankle. Hardly an emergency. The clincher is that two people waiting to be seen, that technically should have been seen before him, had broken ankles. Broken!!!! And they had waited patiently during his temper tantrum.

Guess what happened to the 15 month old with the smashed toe? She ultimately got sent back to the ER so she could go under conscious sedation to get her toe fixed by a plastic surgeon. Turns out she needed the "monitored" bed after all...

I work in a hospital in Santa Monica, California. The clientele include movie stars all the way down to the homeless. I'm told by other nurses that the patient's in other Los Angeles hospitals never complain about waiting 6 to 12 hours (!!) to be seen. I guess I just live in an area of "entitled" people that don't know what real suffering is. Maybe I don't know what real suffering is. I get worked up about twisted ankles...

Another annoying thing about nursing... Picture this: Busy Friday night on a hot, sweltering June night in Santa Monica. I actually told someone that the only people coming into the ER are the very sick or the very stupid. Boy, was I right. In one room I have a elderly woman with severe dementia who had her leg ripped open while seated in some sort of chair that is supposed to keep her stayed put. In the next room, a girl who (we piece together) is telling her friends and family that she has a brain tumor. We do all sorts of tests and find out there is absolutely nothing wrong with her. A CAT scan of her head shows a perfectly normal 23 year old brain. Kinda what we thought in the first place. She specifically asked us not to reveal her test results to her friends. This STUPID girl is faking an illness while the woman in the next room needs our full attention. I'm more than pissed. I just wasted time on a silly game while I could have been assisting the actual sick person right next door.

I'm driven nuts by the "trolls", "malingerers", and hypochondriacs that waste all the staff's time when we could be focused on the actual sick people. Wonder why medical care and insurance is expensive? Blame these assholes...

Just a little note tonight to plead to dog owners/lovers: Never, ever try to break up a fight between two dogs. You will lose, every time. As much as you may love them and want to protect them, let them injure each other. They have thicker skin. You do not. I saw a patient today who practically had her thumb ripped off while trying to break up a fight. She had numerous lacerations and puncture wounds. We had to call in a hand specialist and the chance of getting an infection is astronomical. Her medical expenses will well surpass any she would have had to pay at the vet if she would have just let them do their thing...

My sister recently sent me a shout out and reminded me that I need to write some ER stories!

I work in an area of the ER that is more like an urgent care. No gun shot wounds or traumas, just the usual bumps and bruises that can't wait to see someone's regular doc. For example, a man visiting from ******. (I won't say where to protect his identity and his pride.) He decided, while at the beach, to "pet" a sting ray. Not very bright. He walked away with a 2 inch laceration to the back of his hand. (By the way, if you are ever punctured by a stingray stinger, soak your affected appendage in hot water for about an hour. The hot water denaturizes the proteins in the poison.) Anyway, the doc sewed up his laceration and I was called upon to clean him up and bandage him. I cleaned up his bloody hand with normal saline and spread a nice layer of antibiotic ointment before bandaging his hand. This guy complained about my clean up job, was demanding ointment before I was even done cleaning, then complained about the amount of tape I used to secure his bandage. That's okay, I'm used to people being bossy because usually it is a cover up for how stupid they feel for being there in the first place. Fast forward two days. He comes in for a wound check and my intuition is screaming at me not to deal with him. But, I decide, why subject another nurse to his pickiness. I already know him. I walk in to his exam room and am immediately barraged by insults. He tells me what a "crappy" job I did washing his hand, my "terrible" bandage job, and if I'm having a bad day I shouldn't take it out on him, so on and so forth. "Remember the tape?!" he proclaims, like he is putting me in my place. So I tell him this: "I'm sorry that you are upset.". Not really an apology, because I have nothing to apologize for. As far as my "crappy" wash job, I invite him to wash his own hands in the sink. Well, that didn't go over so well. Apparently I should've soaked my hair in oil and washed his hands that way. He continued to insult me. I calmly set down my bandages and told him I would be right back. Now here is the part where I feel bad. I had to ask another nurse to go in and take over for me. Maybe he just hated me and treated her nicely. But I felt bad putting another nurse in the crossfire. And I refuse to apologize to someone who is asking too much. I did my best job like I would have done for any other patient. I really had to bite my tongue as he left. I wanted to say, "Feel better! Don't pet sting rays!!" It is so hard to give, give, give to people and then have someone treat you as if you are a servant.

A very sweet woman came in after taking a big fall on her skateboard. She was visiting from Seattle. She was sobbing as I brought her into the exam room. This normally doesn't mean anything to me (don't think me callous but some people sob because they stubbed their toe). She told me what happened and I carefully took off her shoe and sock. It was apparent to me that she had a severe fracture, possible needing surgery, at the very least a reduction (re-set). She told me where it had happened and it turns out it was one block away from my house! As she continued to cry she said, "People told me that nobody is nice in LA but people came out to help me!" This statement made me think. Before I moved to LA, I thought the same. The first week I was here I was visually assaulted by someone as I was walking down the street. Some douchebag decided it would be a turn on to jack off in his car and watch me catch a glimpse as I walked by. At the time I was very upset but never called the cops because I thought nobody would care. After living here for over 4 years I know better. Los Angeles is a city made of many small communities. Yes, there are a bunch of idiots, but there are also lots of very nice, loving people who make this city their home, as well. I learn that every day at my job. Lots of idiots, lots of cool people. What can you expect in a city of 10 million people? By the way, we re-set her ankle and as far as I know, is enjoying LA from her moms couch with her foot elevated...

Spent a fabulous week in Bend and Portland. Got to see all the family, including new inductee George! The girls are super cute and we had a great time playing "school" and learning about the body and first aid.
I spent some quality time in Bend...
The drive over the mountains was insane...
I even saw snow.. (in May!)...
I got to see my bro play drums again...

His band was great!

I got to celebrate my friend Melanie's 35th birthday...

I even saw my very first boyfriend! (With his beautiful girlfriend)...

New baby George is sooo cute!!!

Spending time with the family was so much fun!