Gettin' ready for the big initiation!

Last Wednesday I woke up to get ready for work and I had a feeling. I grabbed my stethoscope and my EKG quick reference guide and stuck them in my back pack. Sure enough, when I got to the hospital I was told the ER charge nurse wanted to see me. They were short staffed and asked if I could fill in. I usually work in the urgent care area and have never really been "trained" to work in the main ER. I was nervous of course. They deal with critical patients, I usually deal with sprained ankles and lacerations. But, I'm a realistic gal and I know that it's time for me to step things up. I accepted!

They gave me four rooms to take care of. Luckily not the trauma bay or the chest pain/stroke rooms. It started out kinda slow so I was able to ease in gradually and find my way around. I think sometimes we take our regular job for granted: how easy we find things, how we just automatically know where to grab for things without actually thinking about it. Another FABULOUS part was that I had a secretary to put in all the orders for me, make phone calls, copy shit. What a load off! I also had at my fingertips a tech who did all the EKG's, hooked patients up to the monitors, and did vital signs. And volunteers who brought patients' blankets, water, food, the phone, answered questions... Wow! And to top it all off a charge nurse who had no patient's of her own, she was just there to lend a hand, a float nurse who also could lend a hand, and 5 other RN's as backup. There were Physician assistant's (PA) seeing patients and easing the doc's workload. AMAZING! All I had to do was focus on my nursing skills and assessment. (What a concept!)

I jumped in to help other nurses, I especially wanted to get my feet wet in Room 2 (the trauma room), and help with the really critical patients. How can you go wrong when you've got so much help and support around you? I helped stabilize a septic patient who ended having 7 or 8 attempts at intubation that lasted over an hour. He never coded but in my selfishness I kinda wish he had so that I could've assisted. It was sooo cool to see the teamwork of the whole ER team: nurses, techs, RT's, PA's, MD's, secretaries.... You can't save a person's life if one of these elements are missing.

So, I'm doing an actual preceptorship shift on Monday where I will follow an experienced nurse and have her teach me the ropes. (Thank you Tina!) I asked them to give me the hardest "pod" so that I may see and experience as much as I can. (Check future blogs for my complaints on how I went down in flames and how much working in the ER sucks...)

So kudos to all you ER nurses/docs/PA's/techs/secretaries/volunteers that do this everyday. I'm impressed, awed, and bow down at your feet.

101 uses of a carrot...

A patient came into the ER with the complaint of "something stuck in my rectum".  His story was that he was "impacted" (meaning hard stool is stuck in the rectum and regular poo can't get by).  To solve his problem he decided to insert a carrot to dig out the offending hard poo.  Well, the carrot got away from him and lodged itself so deep that he was unable to get it out.  The doc who examined him is this cute little Asian girl who looks all about 14 years old but is a fabulous doctor.  She told us that she attempted to retrieve the carrot with forceps.  Unfortunately, once something is lodged in the rectum, a vacuum seal is created, making extraction difficult.  She tried to pull out the carrot, just to have it sucked back in.  She tried again to pull it out and once again it got sucked back in.  This happened about 5 times when the man turned around (imagine him  on his hands and knees) and said, "Just pull it out already!".  Appalled, she said "What do you think I'm trying to do?".  For god's sake, did he think she was just pulling it out and pushing it back in for fun?!?  

She realized she could not get it out on her own and called the GI (gastrointerologist) specialists.  Basically they performed a lower endoscopy which entails putting a rubber tube complete with a camera up the rectum to pull out the offending object.  After two hours of trying they were unsuccessful.  They even tried to burn holes into the end of the carrot to get a better grip.  No dice.  What they were successful at was taking photos of the carrot.

The decision was made to send the man to the operating room.  Poor guy, I saw him sitting outside his ER room, slumped shoulders, looking so defeated.  And he looked like a regular guy, not like what you might imagine.  I felt sorry for him.  I read the operative report the next day:

Patient was placed in the lithotomy position. (On his back, legs bent and spread wide open, much like getting a gynecological exam.)  Medications were given to relax the muscles.  (The rectum is just a nice, tight muscle).  Spreading devices were used to open the orifice as much as possible.  Reaching in with a special clamp, the surgeon was able to remove the carrot in its entirety.  All 13 inches of it.   

Do I believe his story?  Not really.  Do I feel bad for him?  Absolutely.  Maybe just a fetish gone wrong.  His paperwork said he was married.  Did he have to explain to his wife why he spent over 8 hours in the emergency room and accumulated a gigantic bill?  Maybe she already knew...  Does she do the grocery shopping????

ER stories (long time coming)

My sister recently sent me a shout out and reminded me that I need to write some ER stories!

I work in an area of the ER that is more like an urgent care. No gun shot wounds or traumas, just the usual bumps and bruises that can't wait to see someone's regular doc. For example, a man visiting from ******. (I won't say where to protect his identity and his pride.) He decided, while at the beach, to "pet" a sting ray. Not very bright. He walked away with a 2 inch laceration to the back of his hand. (By the way, if you are ever punctured by a stingray stinger, soak your affected appendage in hot water for about an hour. The hot water denaturizes the proteins in the poison.) Anyway, the doc sewed up his laceration and I was called upon to clean him up and bandage him. I cleaned up his bloody hand with normal saline and spread a nice layer of antibiotic ointment before bandaging his hand. This guy complained about my clean up job, was demanding ointment before I was even done cleaning, then complained about the amount of tape I used to secure his bandage. That's okay, I'm used to people being bossy because usually it is a cover up for how stupid they feel for being there in the first place. Fast forward two days. He comes in for a wound check and my intuition is screaming at me not to deal with him. But, I decide, why subject another nurse to his pickiness. I already know him. I walk in to his exam room and am immediately barraged by insults. He tells me what a "crappy" job I did washing his hand, my "terrible" bandage job, and if I'm having a bad day I shouldn't take it out on him, so on and so forth. "Remember the tape?!" he proclaims, like he is putting me in my place. So I tell him this: "I'm sorry that you are upset.". Not really an apology, because I have nothing to apologize for. As far as my "crappy" wash job, I invite him to wash his own hands in the sink. Well, that didn't go over so well. Apparently I should've soaked my hair in oil and washed his hands that way. He continued to insult me. I calmly set down my bandages and told him I would be right back. Now here is the part where I feel bad. I had to ask another nurse to go in and take over for me. Maybe he just hated me and treated her nicely. But I felt bad putting another nurse in the crossfire. And I refuse to apologize to someone who is asking too much. I did my best job like I would have done for any other patient. I really had to bite my tongue as he left. I wanted to say, "Feel better! Don't pet sting rays!!" It is so hard to give, give, give to people and then have someone treat you as if you are a servant.

A very sweet woman came in after taking a big fall on her skateboard. She was visiting from Seattle. She was sobbing as I brought her into the exam room. This normally doesn't mean anything to me (don't think me callous but some people sob because they stubbed their toe). She told me what happened and I carefully took off her shoe and sock. It was apparent to me that she had a severe fracture, possible needing surgery, at the very least a reduction (re-set). She told me where it had happened and it turns out it was one block away from my house! As she continued to cry she said, "People told me that nobody is nice in LA but people came out to help me!" This statement made me think. Before I moved to LA, I thought the same. The first week I was here I was visually assaulted by someone as I was walking down the street. Some douchebag decided it would be a turn on to jack off in his car and watch me catch a glimpse as I walked by. At the time I was very upset but never called the cops because I thought nobody would care. After living here for over 4 years I know better. Los Angeles is a city made of many small communities. Yes, there are a bunch of idiots, but there are also lots of very nice, loving people who make this city their home, as well. I learn that every day at my job. Lots of idiots, lots of cool people. What can you expect in a city of 10 million people? By the way, we re-set her ankle and as far as I know, is enjoying LA from her moms couch with her foot elevated...

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...