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.        

Sorry!

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...

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...

Please let this never happen to me!

A patient came in complaining of left ear pain.  A common enough complaint.  I brought her to her room and decided I was going to take a peek inside her ear with the otoscope.  I was looking for ear wax so I could flush it out before the doc came in to see her.  The otoscope has a light and a magnifying glass to look through.  I placed it in her ear canal and what was looking back at me?  A HUGE cockroach!  Still alive, wiggling its antennae, and backing away from my light.  The woman was saying "Ow ow! Something's moving in there!"  I was shocked.  I looked right at her and told her about the cockroach.

Even worse, we couldn't get it out!  The PA was trying to pull it out with clamps but it kept backing further into the ear canal every time we put the light in.  She finally ended up pulling off the head but leaving the big ol' exoskeleton and guts.  We tried to flush it out with water but it didn't work.  We finally called the ear, nose, throat specialist and he told us that cockroaches are the hardest to remove from the ear because they have little pinchers on their legs that they dig into skin with.  She had to meet him at his office where he had specialty microscopic equipment to pull it out.  Poor lady!

For the rest of the day, every time my ear itched, I freaked out.   

Overheard in Los Angeles...

A 4 year old came into the ER with a laceration above his chin but under his lip.  (You know where I'm talking about?)  So he does really good while we glue him and a nurse says "You did so good Santa is going to bring you lots of presents!"

He says: "Oh, I'm only getting one present".

Nurse: "Really?"

Kid: "Yeah, the economy is really tough this year".

Hahahhahhahhhaaa!  That is friggin awesome!

Just in time for the holidays!

Check out zoomtozoom for some fabulous holiday gift ideas!

Work stuff...

For some weird reason we have been (gasp) quiet these last few weeks at work.  Is it the economy? Maybe people are waiting until they are really sick before coming in to the ER.  Some good news, we will be moving into the new wing next August and our nurse educator is providing us with some much needed classes to deal with the more urgent cases that our department will be handling.  I'm glad to be stepping up my education but also nervous...  Sick people make me anxious.  I know that sounds weird but it is basically performance anxiety.  I don't want to make a mistake.  I also get upset when really old people come in and we are expected to do all sorts of invasive procedures to prolong their life for another day, week, month?..  It's hard to deal with families that are not ready to say goodbye.  I understand it, it just upsets me.  

I wish there was a nursing specialty that just dealt with teenagers.  As annoying as they and their fifteen friends can be, I find that I really connect to issues of injury and body image.  It is important for me to share my experiences with them just to let them know that they "are not alone".  It was something I thought about while I was in the hospital at the age of 14.  I truly believed that no one could possibly know what I was going through until I met an RN named Gary who shared his story with me, and spent time with me talking about other things besides my injuries.  We had a 17 year old girl who broke her right tibia (the big shin bone) after a collision with another soccer player.  Her parents were fussing over her and she acted teenage style annoyed with them.  I was able to understand both her point of view as well as her parents.  She was going straight to surgery and I spent time with her and her mother discussing not only what to expect right after surgery but also the weeks and months to come.  She seemed to cheer up after our talk and afterwards her mother gave me a huge hug and kiss and thanked me for sharing my story.  Believe it or not, nursing is often a thankless job and this show of appreciation got me a little teary eyed.  

The best thing about work right now?  Being able to ride my scootie to and fro.  The ride there relaxes me and gets my mind focused, the ride home allows the wind to whip away the annoyances the smells and the stress.  So much fun.  

FYI:  There is a real phenomenon known as the "Throckmorton" sign.  When a male patient has an xray of his pelvis area, his penis will be "pointing" to the side of pathology.  Meaning: if he is complaining of left hip pain his penis will be pointing to his left side.  Hysterical but mostly true.  Check it out on Wikipedia.