Monday, March 24, 2008

Chefs' Widow. Again...

I am once again a chefs' widow. I pretend I look like this: but this is probably more reality..
I suppose I had forgotten, after 8 months of having my husband home and at my beck and call, what it truly was like to be married to a chef. His last day off was, ummm, 3 weeks ago. I think. I can't remember. I do remember that he got about a thousand phone calls, from work. He leaves the house before I get up and comes home pretty much right around the time I decide I'm done waiting up for him to come home. When he does come home he is his usual loving self, but then falls asleep in his chair while I'm midsentence. I find his clothes all over the house. Dirty aprons by the door, pants by the closet, and his undies on the bathroom floor in front of the shower. I can piece together his time at home by following the clues of his clothing. I've taken out the garbage several times. The fridge is bare. My cooking is WAY out of practice. We "share" a car, which means I haven't been in it in several weeks and I know my bus routes by heart.

He finally has a day off tomorrow. You know what he wants to do? Visit his grandmother! I hate to be selfish but, what?!? So I will be the dutiful wife and visit gramma Lea on our one day off together. One cool thing is that we can hit the Chino Farm stand and get all sorts of goodies and cook a fabulous lunch for her. My husband loves to cook even on his days off. (or maybe he would rather cook than have me cook, out of practice and all..)

So, I'm back in the club all you chef wives! My fave chef wife is funny, smart, and cute. Check her out at

The Top Ten Reasons you are lucky...

#1: You either haven't gotten or are (finally) over influenza this season.

#2: You haven't bitten into a prickly pear cactus and filled your mouth full of thorns because you "heard they are edible" and took a bite.

#3: You didn't dip your finger into the sauce you were making, not thinking that you also had a hand held blender at full speed in the same bowl.

#4: You didn't amputate the tip of your finger and then the leave the ER (with your finger dangling) because you are an illegal alien.

#5: You didn't get bacterial pneumonia and just happen to be allergic to almost every antibiotic known to man.

#6: Your rectum didn't prolapse as you were having a particularly trying bowel movement.

#7: You're not homeless and the best prospect to having sex is in an ER exam room after your peritonsillar abscess is drained of pus. (See last blog.)

#8: You didn't break your collarbone jogging because you stared so hard at another jogger of the opposite sex running by that you ran into a stop sign.

#9: You didn't slice your hand open from "cutting cheese".

#10: You didn't give a guy a blow job who happened to have an outbreak of herpes and now you have genital herpes covering the whole inside of your mouth.

Sunday, March 16, 2008

For God's Sake!

As you know, Santa Monica is the "home of the homeless". Out of a population of 85,000, there are approximately 1,000 homeless people. The craziness of Santa Monica is that there are insanely wealthy people here and the dirt,dirt poor. Working in an ER setting, I can take care of a urine-stinking homeless person and then (after its cleaned) put the CEO of some gigantic corporation in the same gurney. The population in Santa Monica runs the whole gamut of every conceivable class of society. It's a little disturbing when I stop to think about it...

We see a large population of homeless people in the ER. Some are nice, some are horrible. Some reek to high heaven, some manage to keep themselves clean. Some abuse the system, some avoid us unless they are really ill. I could use these same examples for every social class. (i.e., the wealthy patients who come in; some are nice, some are horrible. Some reek (of perfume or BO), some are clean, etc.) We are all the same when it comes down to it. Everyone, no matter who you are, has to come to an ER sometime.

A homeless guy came in complaining of severe throat pain. He was with his (homeless) girlfriend. They were nice enough. But what I couldn't stop thinking about was that they were not mentally ill, nor did they come across as junkies. I couldn't quite figure out why they were homeless at their age. He was early 40's, she looked to be late 20's. It got me thinking that homelessness is a hard cycle. I think once you become homeless, you can't break it. How do you get a job, to pay rent, if you cant' shower on a regular basis? And even if you got a job (minimum wage), there is no way you would actually want to pay taxes, or an electric bill or all the other responsibilities that come with renting. I think it must be easier for these people to "live off the grid" and not have to deal with the day to day bill-paying, rent-owing, mail-getting, dog-feeding life that we all see as totally normal. Put yourself in a homeless persons position for a moment. Where do you take a shit? Where do you shower? Where do you put your "things"? What about your period? How do you get food? And even if you get food, it has to be ready to eat. You can't cook anywhere. Yeah, there are homeless shelters but the rules are strict and the scabies runs rampant. It's a shitty life.

Anyway, back to my homeless guy with the sore throat. He could barely swallow and had a fever. The PA seeing him diagnosed a peritonsillar abscess. Nasty shit. It means an infection has started in the tonsils but never could make it's way out so it just festers in the back of the throat. I started an IV (possible track marks but I wasn't sure), and gave him some antibiotics and morphine. He was obviously ill and we did our best to keep him comfortable while we waited for the ENT (ear,nose, throat) doctor to come in. The great thing about a catholic hospital is that if someone is truly in need, we will take care of them. So, the ENT doc came in and did what he had to do. Which means numbing up the back of the throat with shots of lidocaine, then using a scalpel to slice into the back of throat and let the pus drain out. Totally barbaric but the only way to do it. If that isn't gross enough, the doc made the patient spit the pus that was draining out of his mouth into a basin instead of using suction to whisk it away. So this guy had been struggling the whole time. How many of us would voluntarily open our mouths knowing that this horribleness was about to happen? The doc successfully drained the abscess and decided the patient could leave the hospital, aka "go home". When we know a patient cannot pay for a prescription we fill it for them through our "indigent fund". We told "throat abscess guy" that we were waiting for the pharmacy to fill the prescriptions for him. Our nurse, Holly, had taken the long trek to the hospital pharmacy to pick up the medications. When she got back, she opened the door to the exam room and found homeless guy and girlfriend in a "compromising" position. They were doing it on the gurney! She had her pants down and her leg up, he was pumping away like there was no tomorrow. Wow, draining that abscess obviously made him feel a lot better! Holly, the nurse, yelled, "For God's Sake! This is a hospital, not a brothel!" We kicked them out after they had pulled up their pants. Another question, where do you have sex if you are homeless? I had to excuse this couple for doing what they did. It's probably been a while since they had the opportunity to have sex on an actual bed...

Feel lucky you can have sex on a comfortable bed, or couch, or kitchen table...

Thursday, March 6, 2008

Late night reflections...

Had a patient who came in after hot roof tar in a bucket overturned and splashed all over his hands, neck, ears, and face. We called a burn center and they told us mineral oil would take it off. Believe it or not, we did not have access to a vat of mineral oil. The work crew that came in with the patient brought in a large amount of alkali "degreaser". We tested it on his hand and it took the tar off without doing any more skin damage. We went to work to remove all the tar. Of course, under the tar was a second degree blister. Everywhere the tar splashed was a painful blister. The patient was amazingly cool about the whole situation. He smiled, he joked, he helped remove the tar along with his buddies. We took over the ER bathroom with sponges, towels, degreaser and fumes. What I learned: Cool the tar as fast as can using cold water. Use a alkaline degreaser or mineral oil to remove the tar as fast as you can. Take antibiotics to ward off infection and apply silvadene or neosporin to help heal the burns. This guy was lucky, he was wearing a hard hat and goggles that protected his head and eyes. His safety goggles were covered in tar...

Had another patient who came in complaining of "the worst headache" of her life. This is a key phrasing that many health care professionals interpret as either a brain bleed or meningitis. Either way, a life threatening illness. The patient was in her early twenties and, in my opinion, was so focused on herself that she didn't pay any attention to anyone else. When she was brought to our waiting room we had four other patients waiting to be seen. So basically she walked into a "full" waiting room. She proceeded to walk straight up to the nurses station and ask, "Am I supposed to wait? Can't you put me a room right now?". So basically she is saying, 'I am more important than everyone else.". That pisses me off. I told her she needs to wait, just like everyone else. Not that we down played her complaint. But the possible appendicitis and the severely broken ankle was just as important. We got her into a room and did our usual, blood draws, IVs, meds, ordered a head CT. The PA (physicians assistant) had told the patient the possibility of meningitis (which any good practitioner would because of the original complaint) and the tests we would be doing. What bothered me about this patient (besides the fact that she thought she was the only person in the department) was that she was not acting like a typical meningitis case. I know, because I had meningitis three years ago. She claimed to have the worst headache of her life, but she was laughing and joking with the twenty family members coming in and out of the room. I couldn't tolerate light, voices, and sent everyone out of my room. She claimed to have neck pain but easily moved and adjusted herself to a position "to get comfortable". I hate to be cynical but when I had meningitis I was unable to move, open my eyes, and was vomiting (dry heaving) about every minute. I just wasn't buying it but I have been wrong before. I kept my opinions to myself this time. Well, every test turned out negative and she went home with a diagnosis of sinusitis. (Infection of the sinuses which causes a bad headache but far from life threatening.) An ER nurse has to be very careful of peoples complaints because some people way over exaggerate and some people are so stoic you have no idea how sick they are until they "crash".

Sunday, March 2, 2008

True story..

So, you all know it is flu season. I've waxed poetic about the flu shot and the flu itself. How we (as an ER) can't really help, you just have to sweat it out, etc, etc. A patient came in today complaining of cough and fever. (Classic signs!) We encourage all our patients who have these symptoms to wear a face mask and we, as health care providers, also wear masks to keep from spreading the flu and starting an epidemic (or pandemic, god forbid). I was helping this particular patient, all the while wearing my mask. She refused to wear a mask, even after I asked her to. She asked me, "Is there something going on in the hospital that 'you all' don't want to get coughed on?" I replied, as pleasantly as I could, "Yes, influenza. It's contagious. And no-one likes to get 'coughed on', regardless." After I discharged her, her husband came to the nurses station and asked, "Are you the nurse that took care of my wife?" I answered yes. He asked for my first name and wanted to know if my supervisor would know who they were talking about when they filed their complaint. I answered yes. Are you kidding me? You want to complain because I am trying to protect myself and other patients? It pains me that we actually have a staff member that deals with complaints and this is what she has to deal with.