Monday, November 9, 2015


Subject: New (to me) nursing blog

Title: Florence Is Dead


Florence kicks @$$.
Made my day. Added to the Bloglist--->.
MOAR please!

(h/t to Shrtstormtrooper, and her bloglist )

Tuesday, October 27, 2015

Financial Education For The Learning Impaired

Way too many shots of booze downtown on Saturday night:                       $167
Facial adjustment by Rocco and his 3 friends after lipping off:                  FREE
Ambulance ride to the E.D.:                                                                              $500
E.D. CT scan and lac repairs:                                                                         $4000
Admission to the ICU for subdural hematoma:                                         $12,000
Price for signing out of ICU AMA, going home, and waking up dead: LIFELESS

Scientific proof #3,467,882 that brain impulses cannot swim upstream against the current of alcohol.

Oh, and your Darwin Award nomination is in the mail.

I can tell people the truth, but no matter how hard I try, I can't make them smarter...

Monday, August 31, 2015

Take A Bow, Douchecanoe @$$hole Mouthy Visitors

It never ceases to baffle me how people who would never lip off at the DMV, or when getting dinner at a restaurant, or while standing in line at Starbucks, or anywhere else, think that when they show up at the hospital, the rules of civility and decency have suddenly magically disappeared - for them.

Dear fuckweasels: Thought For The Rest Of Your Life
Didja ever lip off at a restaurant, and show that dumb waiter who's the boss?
Didja ever notice afterwards that your food all tasted like spit??!!!

Take a lesson: some of us won't be badgered by your rude assholerry, and will not only give you worse than you send, and that right in front of your friends and family, we're big enough to make it stick, including sideways up your ass in the parking lot if you think you can go there.

And nota bene: your friend/relative in the bed is the patient. They have an actual reason for being here. Your presence is a mere courtesy, and a revocable one at that. The minute, no, the second dealing with a knobjob like you interferes in the slightest way with patient care in my room, I don't care if you're the Pope's uncle, your ass is out, for good, permanently. I will make you persona non grata, with no visiting privileges, and I'll happily swear out the restraining order in the morning to make that a permanent situation. Test me, I triple dog dare you.

If you shut down your mouth long enough to engage your eyes and ears, you might also notice that your friend is
1) Getting damned good care
2) Not very happy when you're being an obnoxious litter box nugget
3) Eager to forget he/she knows you when you bring your Inner Jackass, and let him/her out to play in front of God and everybody.

So instead of "advocating for your friend"*, realize that you're just another pain in my ass, because all you're really doing is demonstrating your impotence to do anything more helpful than dropping a hand grenade into the outhouse just to watch the shit fly.

My cure for your problem is sending you to Siberia, forever, and if you want to go double or nothing, you can find out what the bail is on Monday morning for disturbing the peace, trespassing, and/or assault and making terroristic threats. See if the judge thinks it's as funny then as you do now. Especially if you blow a point-anything on the jail breathalyzer.
BTW, I document the antics of lunatics for a living; good luck with "your side" of things after I file my totally accurate notes of the encounter in a legal document, for the permanent record, right after it all happens, while you're still hitching up your trousers and looking for that missing piece of your hindquarters, sobering up in a holding cell, or trying to get someone to go good for your bond.

Or just cowboy up, and realize that if we're taking care of a friend or family member who's having a heart attack, a stroke, or bleeding out, fucking with us while we're doing our jobs probably isn't in their best interests either.

So do yourself and your buddy a great big favor: sit your ignorant ass down, or go get yourself a nice steaming hot cup of STFU, while people smarter than you do the job they're being paid to do, instead of dealing with dumbasses like you interfering with other peoples' care.

Momma may have pinned your diapers up on the family refrigerator and told you they were art since you were two years old, but now that you're only acting like a two year old, the rest of us can see your handiwork for exactly what it is, and reality is about to slap you real hard right in the back of the head. With a sock full of quarters.

*(After 20 years of this BS, it's no longer anecdotal evidence: 99.98% of these Special Snowflake Wannabe Patient Advocate douchenozzles are the visitors, not the patients. If you like watching Wheel Of Fortune for hours, and reading old dental hygiene magazines, keep bucking for Permanent Waiting Room Flourescent Light Therapy, proud soldiers of the Dumbass Army.)

Thursday, August 27, 2015

Trauma Is Never Pretty

I've been working trauma cases professionally since the early 1990s. (Before that was simply happenstance.) And while all trauma is the same after the first 500 times, no two are ever exactly alike.

Something you have to know, in a way most of you hopefully will never learn from bitter experience, is that some wounds are non-fixable. Whether you're working with a victim of a car accident or someone attacked by a mob, or simply one dedicated assailant, you have to know going in that you will not fix certain things, and that in many cases, no one can.
Not even if the injury in question happened inside a trauma surgical suite, with the doctors and team prepped and ready to go, even if you had 20 units of O-negative blood hanging ready to transfuse.

HIPPA and concern for a certain family prevent me from getting detailed at this point.
But suffice it to say that sometimes, a gunshot or blade will create more damage than can be fixed, and that person is simply going to die, rapidly.

There's a scene at the beginning of the plane crash in The Grey, when Liam Neeson's character is surveying the injured and dead, and he finds a guy with traumatic abdominal bleeding, and he tells the man, in his final moments, that yes, he is indeed going to die, right there, and rather quickly, which he then proceeds to do on screen.

That was truth: it works just like that in the real world too. When someone pumps out all their lifeblood in ten or twenty pumps, like they will, that's it. Getting an IV won't work, you aren't going to cut them open and crossclamp their aorta, and an IV or five isn't going to save them, because there's no hemoglobin in normal saline.

That means you can start IVs, even IO lines (that's an IV in your bones for the laymen in the audience), and pump in liter after liter of fluid, even with whole blood, and it ain't gonna do anything but come out the hole(s) you can't fix. And run all over the place outside. They'll still get no oxygen in their vital organs, and they'll simply be warm and dead and white as a ghost when you're finished, and that truth is ordained before you ever lay hands on your patient.

That's going to be true in a disaster, or even a trauma unit. In the latter, you do every damned thing you can, especially on a young healthy victim, because they have the best chance. Best being relative when the absolute odds are close to absolutely zero.

In a disaster or worse scenario, you aren't - and probably shouldn't - do all that. At that point, you're simply wasting precious supplies to feel better about someone dying that you couldn't save. Which is both wasteful and unwise.

God help you and your conscience if you haven't wrapped your head around that reality long before the day you get there. Even knowing the truth, the moments will hang around in your head for a good long time.

If you're going to do this, yeah, you save the ones you can.
But you have to know in your bones that there will be plenty you can't save, and you have to let them go. Physically, mentally, and emotionally.

And I can't even begin to tell someone how to do that when it's someone you know, or care for deeply.

Thursday, July 2, 2015

Dewey Defeats Truman

From the fishwrap of record:

MONROVIA, Liberia — More than a month after Liberia was declared free of Ebola, at least two new cases have emerged, the first discovered when the body of a 17-year-old boy tested positive for the virus, officials said Tuesday. 
The World Health Organization declared Liberia Ebola-free on May 9, a landmark moment in the country, which has suffered more deaths from the epidemic than any other.
But on Tuesday, Tolbert Nyenswah, Liberia’s deputy minister for health, announced at a news conference here in the capital that a new case had emerged.
It occurred in a small town just outside Monrovia. The family of Abraham Memaigar, 17, who died over the weekend, called a burial team that took swabs of the body and sent them to a laboratory. It confirmed that the boy had been infected by the virus.
On Tuesday, an Ebola response team exhumed the body and had blood drawn for a more precise swab test. That test also came back positive.
Dr. Moses Massaquoi, the case manager for the response team, said the blood test was necessary because investigators could not find the source of the infection and were trying to determine whether it was an “isolated outbreak or new strain of the virus.”

Late Tuesday, a person connected to Abraham tested positive for Ebola, and tests of two other people were inconclusive, Dr. Massaquoi said.
Thirty-three people who had contact with the teenager were isolated in their homes and were being monitored, he said. Three people will be sent to a treatment unit here Wednesday, he said.
“The Ebola fight is not over, but we must not lose hope,” said Dr. Bernice Dahn, Liberia’s newly appointed minister of health. She contended that the quick response to Abraham’s case, including the rapid testing and confirmation that the boy had the virus, demonstrated Liberia’s preparedness to deal with another outbreak.
Liberia has recorded close to 5,000 lives lost to the virus.
The country reactivated an Ebola treatment unit at a time when the facilities, built with the help of the United States military, had stood empty and Liberia was beginning to close them.
Mr. Nyenswah said it was not yet known whether the infection came from Guinea or Sierra Leone, West African neighbors that still have small numbers of new Ebola cases.
Abraham, who sold used clothes at a local market, fell ill at his mother’s house a week before his death, experiencing fever, diarrhea and vomiting.
Abraham’s father, James S. Memaigar, 49, a shoe salesman, said a local clinic had told him just three days before his son’s death that Abraham had malaria. The clinic had sent him home with a handful of tablets, Mr. Memaigar said.
Abraham died Sunday in his father’s home in a community known as Smell No Taste, a few miles from his mother’s home and a short distance from Liberia’s international airport and the Firestone rubber plantation.
Mr. Memaigar had contacted the burial team and dragged his son’s body out of his room on a mattress. Abraham was buried the same day by an Ebola burial team in an overgrown cemetery a short distance from the house.
Dr. Dahn said investigators were trying to determine how the boy had become infected.

Points of note:
1) In a country ravaged by Ebola, and desperate to convince everyone they're free of it, with purportedly only one case to deal with, the crack Liberia medical care system missed the initial diagnosis. Until it had doubled. Perhaps multiple times. Stop me if you've heard this one...
2) The virus, certainly not a new strain, but the same one that's been rampant since December 2013 in West Africa, has done its main thing: it has already spread to at least one other person, and perhaps a dozen symptomatic ones and/or a hundred asymptomatic soon-to-be diagnosed ones. A month later. Stop me if you've heard this one...
3) Liberia has proven competent to confirm two cases, now that they don't have people dying by the hundreds this year. Yet. But as far as stamping out the disease at such a low level, they are about as competent as the Iraqi Army against ISIS.
4) We have no idea how many other cases they've missed/mis-diagnosed since outside attention has waned.
5) With the uninterrupted media blackout of most all Ebola-related news, we never will, either there, nor here. It's frankly almost a miracle that the NYT even chose to publish this piece.

Don't worry, though.
Ebola will never ever get here from there, so there's no need for flight quarantines, and our superior health care system and dedicated medical practitioners would stop it in its tracks if it ever...oh, wait, nevermind.

Wednesday, June 24, 2015

The Real Thing

One interesting bit of apocrypha, is that the way they teach (or used to teach) bank tellers to distinguish counterfeit bills is by giving them the real bills to handle. After handling actual currency, the failings of counterfeit bills are immediately evident. Why this is germane may become evident as you read on.

For a wee decade or so, I took my prior job at Callous Bastard Hospital for granted. I was staff, I aced the interview, and I was senior in time served to most of the people there except the doctors I worked with. I also knew my job, both generally, and specifically with regard to that facility, and I was damned good at it.

But as my shifts were pre-ordained by scheduling fiat, I could guarantee several weeks in advance when and how much I'd work, and by dint of seniority had carved out a schedule that was about as sacred as it's possible to get. I could pick up extra days, but Uncle's confiscatory withholding made that option a fool's errand.

I also didn't notice, being the frog in the frying pan, how The Powers That Be had consciously and unconsciously (mostly the former) made the place progressively more of a hellhole to work in, by short-staffing, under-equipping, micromanaging, nannying, neutering, hamstringing, and generally undercutting everyone trying to do excellent work, mainly because Managerial Head Up The Ass Syndrome On Crack (times) Who Gives A Fuck About Actual Results As Long As We Meet Our Overlords' Asinine Goals.

The end result was that when I was set adrift with about as much concern as scraping mushrooms off the lawn, I was both depressed, because I felt like I'd failed to do something, and unaccountably relieved at not having to go to work there.

Flash forward to working a registry gig: I can't tell you how many days' work I'll get next week, next month or next year. I've been in quite a number of local E.D.s, all new to me before. I've been universally asked to return/stay/apply for a permanent position at most of them. I know I can work 9 days a week forever if I choose to. As it is, I've been pulling 5- and 6-day weeks with 12 hour shifts, pretty much non-stop since I started this in January. And I've noticed a few things.

1. You can tell a bad hospital in about one shift, after you've worked in a couple of good ones.*
2. I look forward to going to work now pretty much every day.
3. I've been told more times by patients and their families in the last 10 weeks (something like 50x) that "You really love your job, don't you?", than the total number of times I heard that in the prior 10+ years.
4. I'm smiling at work, even when it sucks whale turds, most of the time.
5. Measuring myself against the yardstick at a dozen other hospitals, I'm damned good at what I do, and I always was.
6. I really do like my job. A lot. And it isn't about the paycheck.
7. And oh, by the way, my paychecks have doubled.

So thanks for canning me, Callous Bastard Hospital. I got rid of everything I didn't like, I've maxxed out my income, and I've increased my personal job satisfaction tenfold, simply by not working for you. And now your staff is leaving in droves, and you're begging for people to replace them. Funny old world, i'n'it?

Among the few things you can change frequently in your life are your underwear, your location, and your attitude. If something in life isn't right, it's probably because you've skipped one or more of those three for too long.

And when life give you lemons, freeze them.
Because when you throw them back, they'll hurt more.

* I learned this lesson with film and television productions. But I expected most of them to suck. Realizing the principle applies universally To Everything was a real "Doh!" moment.

Friday, May 8, 2015

Nurse Week

When anyone wishes me a "happy Nurse Week", I feel about the same way as I do whenever someone who finds out about my military time says "Thanks for your service."

Which is, specifically, that I think, "Yeah, whatever."

I know the vast majority of them mean it in both instances out of sincerity and a desire to say thank you for a couple of largely thankless professions. So I respect them for making the effort, and I know their hearts are in the right place.

1) I knew the jobs were tough when I took them;
2) I was (fairly) well-compensated for both of them, and I was just doing my job;
3) Random thanks don't cost anything, especially as they largely come from the sort of people who probably say thanks to their actual nurse when it actually matters.

But in my heart of hearts, what I'd rather have a cup full of, rather that the wheelbarrow of thanks from people I didn't likely do anything special for is this:

1) Pay your goddamned hospital bill, and on time, so my employers won't be such penny-pinching cheesedicks when it's time to hire enough staff to do the jobs
2) When you have to wait for any sort of care, write a letter to those MoFos, for not properly staffing everything from the registration desk, to the OR, to the recovery ward, to the outpatient clinic, which is why your dog or cat gets better care faster than you do (and cheaper!) for the same injury and level of care.
3) When you're in the hospital, stop pulling the kind of crap and general assholery that would get you punched in the dick with brass knuckles if you tried it at the supermarket or the mall.
4) Go back and read #3 again, and then go back and read it one more time. Then make your spouse/relative/friend/coworker who was probably a big @$$hole the last time they were in the hospital read it too. Or, punch them in the dick.
5) Tell your congressman/woman to kill Obamacare, before it kills all of you and the entire medical care sector, replacing it forever with care that will make the VA look good by comparison, before it gets even worse than that.

Those things would mean more to me than another mountain of cutesy Nurse Week cupcakes in the break room, and more than all the "thank yous" do from people who I've never directly cared for ever will, regardless of how well-intended both are.

Part of my bittersweet outlook on Nurse Week is the fact that every year since forever, it seems I get $#!^ on the hardest during Nurse Week. And not just figuratively, as I've related in an earlier post.

This year has set a new personal world record, although it's nothing so clinically related, and nothing I can share at this point in time; maybe I can at some point down the road. Maybe.

At any rate, I'm pretty sure getting craped on from great height during Nurse Week is in the contract somewhere, kind of like when the SAS holds selection, and the trucks pull away just before the guys trying out finish their 20 mile march can get to them, and have to march another 10 miles back to base.

That's pretty much every day in nursing, one way or the other. Those of us doing this gig shrug it off, but it takes a toll on our backs, and on our souls, even so.
So does the fact that my personal number ( a la a certain scene in The Guardian) is now 13.
Not my fault, but still my patients.  And every once in a while they come back into memory for a bit, and it gets dusty if you think about it very long.

Some of my colleagues "fix" that with a bottle, or pills, or turning a blowtorch on the part of a person that makes us human. As Will Rogers said about the two theories on arguing with women, none of them work.

So I blog from time to time. And I try to spend a lot of time not thinking about work once I leave it.

I like what I do as a nurse very much.
But sometimes, being honest, if I had a good Plan B that'd pay the bills, I'd probably walk away from the entire profession without a second's hesitation or a backwards glance, and even odds I'd toss a lit Molotov cocktail over my shoulder as a parting gift.

And then I get a good night's sleep, wake up tomorrow, and go back to work again.
Even if it's Nurse Week.

Wednesday, May 6, 2015

Emergency Vs. Not So Much

For the benefit of about 85% of those of you who visit Emergency Departments annually, this helpful guide:

Having a heart attack: Emergency
Not giving you a pillow during your heartburn: Not So Much

Having a stroke: Emergency
Not getting you a cup of ice: Not So Much

Having acute appendicitis: Emergency
Not letting you eat your flaming Cheetos while we rule out appendicitis: Not So Much

Having febrile seizures: Emergency
Not letting you have 27 warmed blankets with an oral temp of 103F: Not So Much

Admitting you for acute status asthmaticus: Emergency
Not fetching you OTC cough syrup during your asthma attack treatment: Not So Much

Your child having bacterial meningitis: Emergency
Not allowing you to bring in the seven not-sick siblings to the same room: Not So Much

Admitting you for suicidal ideation: Emergency
Not getting you a blanket, a pillow, two turkey sandwiches, three orders of juice, and two varieties of crackers while waiting for a transfer to a psychiatric facility for same: Not So Much

This is not intended as any sort of comprehensive list, but I offer it as a guideline, to assist you in deciding firstly whether or not to come to the Emergency Department at all, and secondy to further assist you in Shutting The Eff Up vs. complaining to my supervisor about my alleged attentions or failings regarding any of the above situations, and perhaps towards explaining why, after your piehole closes regarding such complaints, their response is hysterical laughter, and a hasty exit from your room to go deal with actually important things.

If afterwards you really feel peeved off about things, do what most people do: don't leave me any tip in the tip jar, and don't go back to that restaurant, m'kay?

As a bonus, if you think you might wish to elope from the ED at any point, I heartily suggest you do so while still in your car before even darkening the door mat on the lobby door, rather than after taking up 4 hours of valuable time when I and your doctor(s) could have been treating one of the other patients for actual emergent illnesses and injuries instead of wasting it on your drama queenery. For you, there's Oprah, not the ED. Just drive the eff through and go back home, and I won't mind a bit, pinkie swear.

And it's also why if I ever meet Mr. Press or Mr. Ganey alive and in person this side of the hereafter (or even beyond it), I'm going to tenderly and lovingly beat the ever-loving shit out of them with my bare hands until the desire to continue to do so passes away, and/or they do. Nothing less will suffice, and it will be worth the charges, I promise you. I'll probably only be able to raise several million dollars in legal defense funds, if I only get a dollar apiece just from my medical colleagues. (Seriously, you two, you're that evil and worthless, and you should kill yourselves now as a service to humanity, ideally by setting fire to yourselves inside your corporate offices with all your employees locked inside, and I'm not kidding about any of that one little bit.)

Hear me, God.

Thursday, April 30, 2015

Thought For The Day

"A good shift is one where you get to go pee twice, and neither time is in your pants."

Monday, April 13, 2015

Real American Heroes


So this week, after spending the weekend at St. Sisyphus (if you're hazy on mythology, look it up) see if you can spot the hidden trend:

--- 20-something dude, too drunk to skateboard, so he walks into traffic, gets hit by car, ambulance ride to ED, elopes (forgets skateboard), brought back by PD from his home a few blocks away, found drunk off his ass and returned for trauma work-up, alcohol level 240
--- guy who jumps off second level of building, breaks fall with face, blood alcohol level >300
--- guy who's drunk goes out to get more beer, falls down on head, comes home, family notices he's way more dopey than when he left, and he full on seizes in ED due to a massive brain bleed, alcohol level 180
--- guy comes into ED claiming to have been shot in face, actually has minor trauma from getting bounced from club after acting like an a-hole, blood alcohol level 250
--- homeless guy takes all his daily psych meds and drinking beer, passes out, does faceplant on concrete, alcohol level 225
--- drunk chick falls in parking lot, breaks fall with face, alcohol level 225
--- way underage coed waiting in line to get into illegal rave, passes out before she even gets in, blood alcohol level 270

And that's just a random HIPPA-compliant mix-and-match sample of the week's actual patients, with descriptions/sexes/etc. scrambled at whim.

If you guessed the common factor was an overdose of braincell-killing Judgement Juice, buy yourself another round.
These aren't lifetime problem drinkers, these are simply young jackasses whom society needs to stop rescuing. (Seriously, let's just let a few of them go under, to drive the point home.) A couple of those are going to be effed up for life already, and then, surprise surprise, will probably drown their problems in alcohol for another 40 years.
Just to pile on, this is the week after Spring Break, which brought out hitherto unheard-of levels of alcohol-induced assholery, judging strictly by a few media stories from around the country. So my sample were merely the Everyday Drunkholes.

I shouldn't complain, because Budweiser et al will be paying for my mortgage and cruise vacation tickets at this rate, and it's barely April.

But when you can afford to get so f****d up you can't walk straight and not play in traffic without a keeper, but you can't afford health insurance or a hospital bill despite the government handing you that shit on a platter, it's time to bring back galleys, where you could work off your hospital bill by rowing at wages of 10 cents a mile, or by being chained between two poles on a street corner, and letting people kick you in the junk for $1 a kick.

Ill be the guy in line with a wad of singles bigger than a pole dancer's on Monday morning, and wearing a pair of steel-toed boots.

And either solution would keep those a-holes from procreating anytime soon, which would be a net plus for society. But the next time some soopergenius bitches that their hospital bill listed a Tylenol for $65, remind them how much it costs to subsidize these ignorant jackasses who rang up a $40,000 trauma bill at the hospital while on welfare and food stamps, or while still living in momma's basement. Then tell them to STFU.