Sunday, January 18, 2009

Los Angeles and the failing economy

I know that crime is a daily occurrence here.  It has been for years.  After all, we are the 2nd biggest city in the US.  But I have always felt a little sheltered from it living in Santa Monica.  Sure, we have crime but I usually feel pretty safe in our neighborhood.  We also don't have a lot of crime victims come in to the ER.  

So today I got a nice eye opener when we took care of a doctor that works at our hospital who had been robbed and beaten in downtown LA.  (Yeah, I know, who goes downtown??)  He had driven to the jewelry district at 230 in the afternoon on a Saturday.  Broad daylight.  As he was locking up his car he had his fanny pack (slight snicker here.  Fanny pack?!) slung over his shoulder.  A man grabbed his fanny pack and then punched him full on in the face and ran.  The doc didn't have a phone (it was in his fanny pack) so got into his car and drove all the way to our hospital.  He reported his cards stolen and was told by the credit card company that one of them had already been used at a downtown gas station convenience store.  

(What wrenches at my heart strings a little bit is that even though this doc knew he was bad off, his eye was swollen shut and he was rapidly losing vision in that eye, he drove all the way to us.  He could have gone to several closer hospitals but he went to where he felt safe, felt at home.  His own hospital.)

We thought he had a ruptured globe.  We all waited anxiously for the CT report while the eye doctor examined him.  Luckily, his eye was okay.  His retina was bleeding, his orbit was fractured, and he had a laceration under his eye but he wasn't going to lose his eye.  Can you imagine how one moment could change your life forever?

What really spooked me was that this doc is not a small man.  He doesn't look "weak" or "vulnerable" in any way.  If it can happen to him, it can happen to anybody.  And even worse, what if this robber had a gun?  Yikes.  The LAPD came to take a report.  They said that the gas station store had got the guy on surveillence tapes when he bought things with the credit card.  So maybe they'll catch him... but if you've ever seen those grainy tapes they probably won't.  

I hate to think that we should be worried about our safety every  time we go out.  Or even in our homes if we forget to lock the door and some crazy person decides to home invade.  And what really scares me is that this stressful economic time may drive some people to commit crimes they normally wouldn't.  Desperation causes people to do desperate things.        

Saturday, January 10, 2009


I apologize for my last rant.  I was very tired and frustrated.  I'm taking a much needed vacation in February so I will be able (hopefully) to decompress.  Our ER is also trial running a new system that allows labs and xrays to get started while each patient waits when we don't have available beds.  

I also admit that I have put myself into this situation because of the department I work.  We are SUPPOSED to see the less urgent patients.  That's my job.  I can't get upset about the non urgent complaints.  They pay my salary.  I just get frustrated that people can't look around them for a moment and see how busy we are and that other people are just as ill.  

Also, I have come across many wonderful patients and their families who are kind, complimentary and appreciative.  I need to focus on them and not let the "squeeky wheels" upset me.  

So, once again, sorry for my cynicism and bitchy attitude...

In case you'd like to hear a story or two... 

A woman came in who thought she had "lost" a tampon.  She had her period about 3 1/2 weeks before and she noticed an "odor" coming from her vagina.  Normally we don't take this complaint seriously.  The vagina is a cul-de-sac and things cannot be "lost" in it.  Especially something as big as a tampon.  Normally they just have a vaginal infection.  She told us she had just had sex with her husband the night before.  So, I set up all the equipment for a pelvic exam and I included a sterile ring forcep, just in case something needed to be pulled out.  I got busy with another patient and was suddenly bombarded by a putrid smell coming from Room 3.  Her room.  The smell got so bad that another nurse sprayed an equally obnoxious perfume to try to mask the smell.  The PA came out of the room a few minutes later and told us that she had pulled out a blackened, shriveled tampon that reeked to high heaven.  The poor woman was obviously embarrassed.  But why didn't she just reach up there herself and pull it out?  Tampons don't get stuck, they don't get lost.  And, sorry to be crude, how in the world did they have sex with that putrid odor emanating from her vag??  We put her on antibiotics to make sure she didn't get any kind of infection and sent her home, with her husband....

A man in his sixties came in by ambulance with an ankle injury.  There was a little bit of a language barrier but what we understood was that he had simply twisted his ankle walking.  I took the splint off and saw an obviously swollen, deformed ankle.  His pulse and color were good and he could wiggle his toes without any problem.  I wanted to get his foot elevated on a pillow to help prevent swelling and as I was about to lift his leg he said, "I do it".  He lifted up his leg and his whole foot just DANGLED from the ankle.  I don't feel sick to my stomach often but this time I did.  His foot was flopping all around on its own.  GROSS!  Xrays showed that not only did he have a bad ankle fracture but it was also dislocated.  The crazy thing?  The guy felt no pain.  He was like a superhero or something.  He didn't require any pain medication even when the MD "reduced" his dislocation.  Which means pulling it back into place.  Most patients require conscious sedation (basically knocking them out).  I would.  The MD put it back into place, we splinted it, and he went home on crutches to follow up with an orthopedist in the morning.  Either totally bad ass or totally stoic...

Monday, January 5, 2009

Flu season again?

Well, the little respite we had for the last two weeks over the holidays is over.  The ER is packed once again with every type of patient:  the actively dying all the way down to the paper cut.  I don't know what it is!?  For some reason after the holidays, people are just banging down the doors to be seen in the ER.  On one hand we have people who are really, really ill.  Did they just hope that their illness would go away?  Or did they just try to ignore it to celebrate with the family?  On the other hand, our ER is packed with people that aren't really sick at all.  But for some reason, they decide that an EMERGENCY room is the place to go when they've "had stomach pains for 3 months and my doctor has given me every test and can't figure it out".  Well what the hell are WE going to do?  Or back pain for 7 months.  Or a cough for two years.  Why THIS weekend, people??? Why???  We have SICK people to attend to!

I apologize for my tone but I am so frustrated right now.  The last two days were absolutely horrible.  I've been yelled at, cursed at, told I was stupid, slow, and accused of not caring.  All the while my shirt is soaked with sweat, I haven't peed or eaten in 8 hours, I've started 15 IV's (with blood cultures), and listened to every patient tell me how sick THEY are.  I suppose they didn't notice the 15 other sick people waiting in the waiting room.  I've had people come in at 4 in the afternoon and then throw a fit that I won't feed them because they "haven't eaten all day!!"  Why is that my fault?  They've had all morning and afternoon to eat and now I'm the asshole because I won't stop my NURSING duties and get them something to eat.  Do you want the pain medicine you've been asking for for the last hour or do you want me to get you a fucking turkey sandwich?  Your choice.  

All the docs and nurses kept asking (when we were slow), "Where's the flu?  How come we haven't seen any flu patients?".  Today was a torrent of headaches, bodyaches, fever, etc, etc. All signs point to the flu but guess what?  Their flu swabs were all negative.  So some crazy virus (that is probably just a very virulent cold virus) is making its way through the populace.  The worst thing about it is that yes, it feels shitty, yes it feels like you're really sick.  BUT, it is a virus and there is nothing we can do for you.  We can give you advil and tylenol to get the fever down, we can give you fluids, we can let you rest.  Or, you can do all of this at home for about $2540 cheaper.  In your own cozy bed, with your fave jammies, watching your best comfort movie, and eating chicken noodle soup.  I don't blame these people for feeling a bit desperate because they feel so ill, but PLEASE, PLEASE don't come into the ER and yell at the staff that you are the sickest person and need to be seen RIGHT AWAY!  We are not impressed.  Are your lips blue and you can't finish a sentence?  I'm impressed.  Blood pressure in the toilet and heart rate sky high?  You're getting seen right away.  Rectal fever so high you are so lethargic and can't complain about the wait?  I'm carrying you to a room myself.  Have enough energy to come and yell at me about how sick you are?  Fuck you!    It frustrates me to no end that the people who aren't urgently sick will whine and complain and totally disregard the fact that their are people much sicker than them, waiting in the same waiting room, and demand to be seen first.  What, buddy?  You didn't notice the elderly lady, pale, having a hard time keeping awake, thats putting off heat like a baked potato?  You still think your cough for two weeks takes priority?  What about the 6 year old with the arm so broken it looks like "W".  Still think your cough is that important?  AARRGGHHHH!!!!!!

I need to calm down...  I think I've got serious job burnout.  One more rant and then I'm done.  This is a perfect example of the entitlement people think they have.  A patient comes in after falling off his bicycle.  He's got hip pain and it could possibly be broken.  Okay, I'm paying attention.  But the wife is all over us.  "He's an MD.  He's an MD."  She's calling all her doctor friends to get them to call us.  (By the way, he's a psychiatrist.)  While we are taking care of him our code system alerts.  It's a buzzing noise over the PA system and it alerts our ER docs and nurses that a patient is dying.  The code team drops what they are doing to attend to this patient.  Our hip patient's wife asks what the noise is.  I tell her, "It's a code.  Someone is dying".  She's quiet for a few minutes and then she asks, "When are they going to turn off that annoying noise?"  Man, I wanted to punch her.  I wanted to say "When the patient dies, they'll turn it off.  Will that annoy you less?".  Whatever happened to our humanity?  I feel like I'm losing mine...