Friday, February 1, 2008

3 in a row, again...

I'm working three shifts in a row, again. And I know that a lot of you nine to fivers do five in a row every week, for some reason three 12 hour shifts back-to-back is really hard. My husband will scoff, he being a chef and does five to six 12 hour shifts every week. But it is a tiny bit different owing to the fact that he is cooking food and I am saving lives (ha ha). A small sampling:

A patient came in complaining of a swollen, painful calf. This is usually indicative of a DVT (blood clot in the leg). He looks ill, he's red in the face, he's kinda huffin and puffin, although his vitals are good and he doesn't complain of SOB (shortness of breath). I ask him about recent travel. "I just got back from Wisconsin to see Green Bay play (lose)." This guy not only had a ginormous blood clot in his leg but several in each lung. Staying idle during a long flight will do this to you so flex your calves, get up and walk around a bit. Life threatening condition, all for the love of a football team. I tell ya...

The triage nurse calls us and says she has a 77 year old with a simple laceration of the leg. "Send him on over!" I tell her enthusiastically. Here he comes, bleeding like a stuck pig from practically every orifice. What the hell? Oh, he's on Coumadin, a potent blood thinner that in too high of doses can completely block the body's ability to clot. His nostrils are filled with blood, every time we stick him to get a blood sample he develops a huge hematoma at the site. This guy has the pharmaceutical equivalent to the Ebola virus. He bruises just breathing on him. His INR is over 10! (for all you medical folk) Not good. We sent him back to the main ER for closer monitoring. We got too busy and I could never follow up to see what happened. The weird thing though is that the man used to be an attorney and he had a very loving and attentive family at his bedside. He also was suffering from multiple sclerosis and being treated for lung cancer. According to his MD's office, his blood clotting time was perfectly therapeutic 5 days ago. Was it the chemo or was it an accidental overdose of Coumadin? As sick as he was, and has been for the past few years, I just hope he lives out the rest of his years in peace...

During all this time that we are dealing with very sick patients, we have to deal with several of these scenarios:

Patient (with a swollen ankle): We've been waiting for 45 minutes for an xray.

Me: I know and I understand, we are very busy.

Patient: I'm just going to leave. I have somewhere to be, this is ridiculous.

Me: If you have something more important to do then leave. But we would like to treat you.

And another (common):

Patient: I have a fever and body aches.

Me: Did Tylenol reduce your fever?

Patient: Um. Tylenol?

Me: Yes, Tylenol. Here, let me give you a (50 dollar) dose of Tylenol.


DBN said...

I often wonder WHY there is such a disconnect with people-- WHY they go to the ER for small things. I was raised that the ER was a place for serious, serious problems, and people in a lot of pain. I know it is connected to the lack of viable options for people without health insurance, but a lot of the people don't even need a doctor, much less the ER!

LA RN said...

Tell me about it.. A lot of people just don't have common sense. And a lot of these people are having babies! Yikes!