Thursday, April 19, 2007

Patient's that are absolutely bonkers..

Oh boy! Ran into some serious wackos tonight...(yes, wackos is a medical term):

A guy came in with a complaint of "out of Valium". On his chart he had listed a long, long list of medications he says he regularly takes, including heavy duty narcotics. But reports he has no regular physician. I asked him, "Where do you get your medications?" He answers, "The pharmacy". Brilliant. "No," I said. "Who prescribes your medications?" He says various Emergency rooms he visits. He has insurance, people! He has no reason not to have a regular doctor to prescribe! Instead he racks up gigantic ER bills because he is too lazy (or too drug seeking) to get a regular doctor. And you wonder why insurance is so f*cking expensive?! Blame assholes like this, working the system. Guess what? We didn't give him shit except advice to see a regular doctor.

A woman came in because she just had genital warts frozen off. She said she wanted information about cervical cancer. The PA asked her "Didn't your doctor give you information?" She said, "My doctor told me I was going to die in 3 to 15 years from cervical cancer." Okay... So we gave her information after telling her that she must have misunderstood what her doctor meant. When I brought her discharge instructions she asked me if she could volunteer at the hospital. I said she would have to call the volunteer department. She asked if she could volunteer on the cancer ward. "I don't know how it works but you can ask," I responded. Then she said, (obviously this girl was only hearing what she wanted to hear) "I want to work on the cancer ward so that I can learn about cervical cancer." Whoah, whoah! "You cannot volunteer on a cancer ward and quiz patient's about cancer!! Look on the internet, go to your doctor, the local library, whatever! But do not volunteer with cancer patient's to get info!" I called the volunteer office and left them a message that this woman probably wouldn't be a good choice.

A woman came in after being "assaulted" by the police. Her daughter had been pulled over for a traffic violation and had somehow ended up in handcuffs. The mother had showed up on the scene and apparently charged the police officers. They grabbed her arm and pinned her against the hood of a police car. The cops let both of them go eventually but the mother ended up in our ER in hysterics. "I'm a teacher! They can't do that to ME!" (Common elitist view) In an ER we are required by law to report, to the police, any assaults. So a sargeant showed up to take a statement and of course this woman flipped. "I don't want this man in my room!", etc, etc. I felt bad for the poor sargeant because he was not involved in the incident and he was just trying to do his job. And I have to give him props for being polite even though she was verbally abusive toward him. She refused to give a statement to him but did agree to sign a medical report waiver so that the police station would receive a copy of her chart. The police asked me to accompany him to the car where he had the paperwork. I walked them out to the police cruiser and this women would not shut up about the "travesty" that had occured to her and her daughter. All the policeman wanted her to do was sign a peice of paper. But she couldn't stop bitching and complaining. So I took her by the shoulders, looked her in the eyes, and asked her, "What is your top priority right now?" She immediately responded, "My daughter." I said, "Sign the papers, go to your daughter, and deal with all this bullshit tomorrow!" She got my point and left 10 seconds after signing the paper. So the poor sargeant and I had a good laugh over what a freak she was. Now, don't get me wrong. I understand why she was so upset. But if you had been there to hear everything she said and did, you might be a little more cynical. I tried to explain to her that she is in LA and the cops don't know that her daughter who they pulled over is "a sweet, smart girl who goes to UCLA". They just know some girl who was just pulled over is now not obeying their commands and freaking out. And they also don't know that the mother is a 2nd grade teacher just trying to protect her "mentally unstable daughter". They just see two freaky ladies trying to fight with them. My name was involved in the police report because I witnessed her refusing to make a statement and that the sargeant was civil to her. Hopefully I won't ever get involved but in this in this sue happy society, you never know...

Wednesday, April 11, 2007

On the other side of the bed: nurse becomes patient

It's always weird for a nurse or other health professional to get sick and (gasp!) become a patient. Suddenly subjected to giving over your body and put your trust in people you don't even know, then having to make decisions about your health (usually while under the effects of narcotics). Much like bringing your car to the mechanic and having to trust that they know what they are talking about and trusting their recommendations. Here's what happened to me on Monday night...

Noah and I had been having a lazy, relaxing day after entertaining his family for Easter the day before. I admit, I was a little hungover, but had been taking care of myself during the day, drinking lots of water, and eating good. It was around ten o'clock and I was on the couch watching TV. Noah was working on laundry and went outside to check on the laundry. (our machines are at the back of the apartment building.) After he went outside, I decided to grab some cookies in the cupboard. I rarely crave sweets but they sounded good. I walked into the kitchen, reached into the cupboard, and suddenly my heart started to pound in my chest. At first I just thought I had gotten up too fast and maybe my blood pressure didn't have time to catch up to the sudden movement, then, as my heart beat harder, I thought that maybe I was having a panic attack. I hadn't had one in years but you never know. Granted, all this thought process happened in maybe 2 seconds. Then, I was having an odd dream. I opened my eyes and Noah was standing above me asking why I was on the floor. Cookies were scattered about the floor. I was very confused. "I don't know why I'm on the floor. What happened?" Noah helped me up and brought me to the couch. I was covered in sweat and very pale. Noah looked worried. I kept asking, "What happened?". As my mind cleared, I realized that my tongue was swollen, I had bit it! Now it started to sink in. "I think I fainted!" Then my head hurt and I put my hand up and that's when I felt a gigantic lump forming. "You have to take me to the hospital right now," I told Noah but he was already in action, grabbing me a jacket and his car keys.

My head started to clear a little as we drove and I started to realize what a surreal situation this was. What the hell had caused me to black out and how had it happened so fast, with hardly any warning. And worse, how hard and fast had my poor head hit the kitchen tile to cause this enourmous misshapen lump that was growing on the back of my head? I still felt unsteady as we walked into the doors of the ER, my ER, where I know everyone. The ambulance bay was packed and I knew, and felt guilty, that the ER was busy. I also knew that I needed a CAT scan to make sure I wasn't bleeding into my brain from the fall. They got me into a room right away and got to work. I had to appreciate the nurses as this point. Already anticipating what tests the doctor was going to do and doing them but at the same time being caring and attentive, trying to make me as comfortable as possible. Of course I knew everyone and they were all shocked I was now on....THE OTHER SIDE.

I hate to say it like that but it is true. You have to have compassion and empathy as a nurse but at the same time you have to keep a little bit of distance. If you completely empathized with every single patient, all the hurt, all the sad stories, you would basically be an emotional wreck, unable to get the job done. To a patient it may seem uncaring, but it is a defense mechanism that all medical workers have. Nurses walk a fine line; yes, we want to take care of our patient's emotionally as well as physically, but, we must also save energy for all the other patients that come through our doors, as well as saving some for ourselves and our families when we come home.

So, even though I was "one of them", I did feel the "clinicalness" of the nurses, that is to say, I felt the subtle but still palpable distance as they went about their jobs. And I understand why some patient's complain about their nurse not caring or their doctor not caring. So I watched the nurses start an IV in my arm and draw blood, get an EKG, take my blood pressure, and get my paperwork started. This was them caring about me. Getting things done quickly and efficiently, so that I may start to feel better, find out what's wrong (or not), and then letting me go home with my husband and putting all this behind me. Making sure I'm not in pain, I'm warm enough, I have ice for my head. They cannot stay in the room and hold my hand and stroke my hair. But they can show me that they care about me by getting the job done. I think that is a big misunderstanding in our society right now. The role of nurse has changed, they have bigger responsibilities than ever before. And while some patient's think it is important for the nurse to hold the straw to their mouth while they drink, the nurse must also be getting the labs, running the tests, starting the IV's, giving the get the picture.

I went for a CT scan and, phew!, no inner bleed just a subcutaneous hematoma from the fall. (We were jokingly calling it my "hematomato" because it was visible from across the room, practically). All my labs were normal. My blood pressure was normal. My EKG...well, that's where it got a little tricky. The doc asked me if I had ever been diagnosed with WPW, aka Wolf Parkinsons White syndrome. It's a heart condition that can cause arrythmias. Well, no I had never been diagnosed with it. He said that my EKG showed only one of the two hallmark signs for WPW so that he wasn't ruling it out. But, like I tell all my patients, this is an ER and I would have to take my health in my own hands and follow up with a cardiologist. I was hemodynamically stable, my BP was normal, I no longer had a pounding headache (after 8 mg of morphine and 1/2mg of Dilaudid), so I was free to go home. That is another thing that people don't understand about Emergency Rooms. We can't heal you, we can't always tell you exactly what is wrong. What we can do is make you stable and comfortable enough to go home and take care of it later or, if you are really sick, we will admit you to the hospital where a more appropriate doctor, a specialist, can take the time to figure out the problem. People expect to walk into the ER sick and walk out two hours later feeling "all better", but that is not a reality and people need to know that.

So, I have taken a few days off work to let my poor noggin shrink back to size. I admit, I had a little post traumatic stress syndrome. I kept imagining what the sound of my head hitting the tiles must have sounded like. And I kept getting nervous when I was in the kitchen or the bathroom, I'd think 'What if I passed out right now?'. But so far so good. I met with my doctor today who is internal medicine. I have an HMO so I am not "allowed" to go directly to a cardiologist until I see my primary doc. He was very nice but also annoying. Doctors have these big brains and they don't rule out anything so as he droned on about possible seizure activity or heart arrythmias or thryoid problems, I had to tune him out. No sense worrying about a thing until it is proved it is actually that thing. My diagnosis? After being a tad dehydrated, I jumped up from the couch a little too quickly and vasovagaled. It seemed more dramatic than it was because I happened to bite my tongue and bruise my skull. But, like a "responsible" adult (and like going to a mechanic), I let him take a few more tests and am currently wearing a Holter monitor which records the electrical activity of my heart for 24 hours. I will follow up with the cardiologist on Tuesday, as recommended. Meanwhile, I'm taking it easy and thanking god I didn't land face first!!

Monday, April 2, 2007

Sunday suppers

We went out to eat twice today. For lunch we went to one of our favorite bistros in West LA/Brentwood called Literati II. Noah had been offered a job there but declined for certain reasons. It has become one of our favorite places to eat, the food is always good and consistent. Farmer's market driven and simple. Since it was Sunday, they were serving brunch. Noah had grilled asparagus with burrata cheese, prosciutto, and a walnut vinagrette. I had a bacon and broccoli quiche. We snacked on pomme frites with aoli, first. Very relaxing Sunday, 2pm. And Noah, being the insanely sweet husband he is, accompanied me to a fabric store where I bought some beautiful apron making material. (See above photo for the awesome finished product! Thank you Amy Butler!)

For dinner, we traveled to West Hollywood (pretty much the mecca of all great LA restaurants), and a place we only go when we are seeking out said great restaurants. We went to a place called Celadon, Noah worked with the chef a couple of years ago. The chef is half Jewish, half Japanese; the food "asian fusion". The food had great clean flavors, was fun, and the kitchen sent us some special dishes on the house. But probably not a place I would go back to. The decor made me feel like I was in Pier One. The service was great though. I was having really bad menstrual cramps toward the end of the meal, you know the kind, feels like you are starting to have contractions. (I say that in theory, of course.) Needless to say, I wanted to cut the meal short and go home and get in my jammies but I also wanted to have dessert. I asked if I could get "The Lemon Trio" to go but, alas, the server informed me it was not possible. Oh well. We paid the bill and started to walk out, me half doubled over my contracting uterus, when the server called us back. The chef had sent us the lemon trio to eat before we left! So, we sat back down and ate gratefully, my cramps momentarily forgotten.

Noah and I never feel guilty for these overindulgent days. Yes, we're taking in far too many calories, and yes, we are spending way too much money. But who cares? We are enjoying our time in LA, the sights, the food, the weather. We are enjoying our years of fast metabolism, low cholesterol, and healthy livers. We will probably pay the price later but for now we are loving our lives, loving food, and, most importantly, loving each other.