Sunday, July 20, 2008

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...


Unknown said...

Loud and clear on the east coast. In which SM hospital do you work?

Leah Perlingieri said...

reading that made me all tense! i hope you get to treat yourself to a little Vicodin now and then.....:-)

seriously, just like food and homes, we (in the US) really tend to take for granted that fact that we have access to ANY medical care, for any size health problem.