Sunday, December 2, 2007

Blame it on the ER

I was home Friday (I hurt myself and need surgery). After having five abdominal surgeries in six months last year I think I have a little PTSD...but enough about me. This post is about something else. As I said, I was home Friday...flipping through the channels, and what do I see, my little town on CNN...then MSNBC... Hey, maybe that is why I keep hearing helicopters overhead and sirens screaming. One of our local psych/etoh'ers decided it would be a great idea to take a few hostages at the Hillary Clinton campaign office. Well, most people know that ended with him releasing his hostages and surrendering peacefully.

Today the local paper had his 'story'. His family claims he came into the ER and wanted help for his psych problems and we sent him away since he had no insurance or money. This is absolutely NOT TRUE. But, they are making our little, non-profit hospital out to be this horrible institution that sends psych patients away without treatment. I cannot discuss this patient, of course. But, as anyone familiar with EMTALA knows, ALL patients are given a medical screening when they present to the ER. Typically psych patients are screened to make sure it's not a medical problem then we call in emergency services and they determine the appropriate dispensation of said patient. If it is a drug/etoh problem we refer them to the drug rehab and other services in the area.

This morning I worked in the ER and I can't count the number of calls we got from people letting us know how horrible we are for not treating this poor guy. Of course we transfer the calls to the nursing supervisor so she can handle it. It's terrible that the newspapers aren't more responsible in their reporting and checking facts. The hospital hasn't released a statement yet, but I hope they do. People like to point fingers when something like that happens, and right now the fingers are pointing at us...and I don't like it!

Sunday, November 11, 2007

Baby G

I grew up about 20 minutes from where I live now, so I end up seeing a lot of people in the ER that I knew as a kid. Sometimes it's great, sometimes not so great. Today was one of those not so great days. Today I took care of Baby G. I had taken care of Baby G before. He was beautiful, healthy and one month old when I met him. He looked so much like my son did when he was a baby. Baby G is my sons second cousin on his fathers side (his cousins child). I couldn't recognize him today, just four months later.

He was brought in to the ER today, his head swollen to twice the size. A skull fracture, hydrocephaly, fractured ribs. I had never seen a CT that looked like his. When I realized who he was I literally felt faint. The parents deny abusing him, of course they would. Those injuries could not be caused any other way than by abuse. He ended up getting intubated and medflighted to Boston.

It's so tragic. It always is. But, knowing the family, having held this little boy in my arms just a few months ago and marveling at how much he looked like my own hurts. His parents are teenagers (I changed his dad's diapers when he was a baby). I just never saw this coming. They had seemed so attentive and caring. And, now...if he survives, he will have profound brain damage. I hope they are able to determine who hurt him, and no matter the punishment, it is not enough. It breaks my heart.

Saturday, October 13, 2007

Mom's heart goes Ka-chunk

My mother is the picture of health. She's 67, active, thin, but smokes. (far less than a pack a day) Well, a few weeks ago she told me that she had a problem. Every so often she can feel her heart go 'ka-chunk' then she gets dizzy, then it passes within seconds and she feels fine so she goes about her business. Apparently it had happened a few times in the past month, but she didn't want to say anything. She wanted me to tell her what it could be. Well, of course I told her she needed to see her PCP and get checked out. But, that if it did it again, go to the ER.

My mom went to her PCP. Who sent her to cardiology, who scheduled her for a stress test. My mother lives next door to me so when she got back from her stress test I went over to see how it went. She looked pretty scared. She was hooked up to a holtor monitor and said that they were going to call to schedule a diagnostic cardiac cath. When I asked what the cardiologist said she couldn't tell me. Just that there was 'something wrong' with her stress test so they hooked her up to the holtor and told her that she needed a diagnostic cath. So, I reassured her that everything would be alright. But, I'm scared. I want to know details, what exactly did they find? She didn't know and I didn't want to grill her. So, my Mom's cath is scheduled for Wednesday, and then we'll know more.

My mom told me that as a child the doctor was worried about her heart. She stood behind a machine and he could look at her heart. The nurse even brought in a mirror so she could see her heart beating too. This would have been in the 1940's-early '50's. I have never heard of such a machine. Of course, she's had a good 60 years since that test without any problems, so I just don't know.

Please, say a little prayer that my mom's cath comes out ok. And, if you don't pray, well wishes are just as good.

Monday, October 8, 2007


For the most part I love the ER. Coming from the ICU I was pretty shell shocked at the frenzy of the ER sometimes. But, I've even come to love that too. Today was one of those days. I had two men with sudden onset of unilateral hemiparesis come in almost simultaneously. I had time to get one to CT and back to the dept. to receive the next one and get him to CT before I had even gotten an ER chart.

He also had an SVT in the 150's that we got down into the 80's with some dig, then cardizem and a cardizem gtt. Even got echo in to see the patient before admission in the ER. While he was getting his echo I got the first patient to ICU just in time to get the cardiac arrest into his just vacated bed. Poor guy was well known to us, CAD, CHF, COPD, O2 dependent, DM, HTN. He was found in asystole, but the family wanted 'everything done'. He didn't make it.

Gave me a chance to check on my other rooms with the r/o dvt, viral syndrome, seizure and migraine in a patient with seizure and migraine history. Got my admitting orders for hemiparesis #2 and call admitting. Get my admitting paperwork back and a big MRSA is on the guys demographic sheet. I check the admitting orders again and don't see MRSA, so I figure it's an error that they can correct after admission.

When I brought the patient over to the ICU the receiving nurse is gowned and gloved because there is a flag on the computer that this patient has a Hx of MRSA. I'm thinking, that's nice, wonder when they were going to tell me since I have been all over this guy with my assessment, IV's, EKG's, etc. Then I go back to the ER.

The code's family was here and would like to see their father. So, I go to the family room. I know some of them from his frequent visits, I comfort them and bring them in to see their father. Some are crying, blaming themselves for not calling 911 sooner. They needed to hear me tell them it wasn't their fault. They needed me to be with them right then. But, there is a knock on the door, ICU is calling me.

I excuse myself, thinking it was a simple question, like did the carotid U/S get done, when was his last BM...whatever. No, it's that there wasn't a green sticker on the chart, as per policy, for patients who have MRSA or VRE. I explained that seemed to be more of a registration thing than something that was my responsibility, and that I was busy with a grieving family. The ICU nurse is a friend and completely understood and told me to go back to the family. End of

Next thing you know, I have the ER nurse manager out at the nurses station along with the infection control nurse. They wanted to know why CT, US, Lab, X-ray wasn't told by me that the patient had MRSA. My question is why didn't someone tell me?! Oh, it's in the computer, and supposed to be on the ER demographic sheet. Well, excuse me, but I was rather busy and didn't look at the demographic sheet. Our nurse manager KNEW how busy we were, she did order us some dry turkey on white bread sandwiches from the cafeteria since we had to work through lunch and went on diversion. (We NEVER go on diversion)

I didn't even have a chart before the patient went to CT. After that I had cardiology, er and neuro orders on him and drips to hang and titrate. Then a code...not to mention my other patients. The infectious disease nurse tried to make it sound that by me not checking the demographic sheet I put the whole hospital at risk of MRSA. Do people routinely check the demographic sheets on their patients? There has to be a better way to alert us to things like that. I'm not taking responsibility for it. Especially on a day like we had today.

And, since I'm ranting. WTF is up with 12 hr shifts and no breaks? I understand we are really busy, but if we don't have time to go to the cafeteria why must we be served turkey sandwiches, without any veggies, dry on white bread (mayo on the side) I am positive that prisoners get better food! Not only that, I don't get paid to work through my break. Luckily I have gotten smart and I pack a lunch now. Mostly portable food, fruit, a pudding, then chicken/broccoli/rice in a bowl with a cover. (I can always grab a few bites)


I have worked at the same hospital for well over a decade. We have always gotten a 'bonus' around the holidays. Last spring we were told that our bonus would be dependent on receiving >80% press-ganey reports. I never depend on my bonus, but I found out that there are people I work with who aren't dr's and nurses that pay their heating bills for the winter with the bonus.

There is a complete multimillion dollar renovation going on for the past few years and new dr's offices, urgent care, etc. I may be cynical, but I was convinced they were over budget and wanted to balance the books by creating an unobtainable goal. How would we improve our scores with MAJOR construction and confusion just finding the main entrance of the hospital? Not to mention a loss of rooms during construction and an increase in the numbers of patients. It almost became routine to be holding admitted patients in the ER, treating ER patients in hallways. We even commandeered other departments that were closed on weekends to treat fast-track type patients. Still, we did our best, and met our goal. And, we got our bonuses.

Saturday, September 29, 2007

Our Welfare State

The definitions of welfare are curious because they are in some ways opposite. One definition is Welfare-good-fortune, health, happiness, prosperity etc. Another is Welfare-a government agency that provides aid to people in need esp. people unable to work.

I personally don't think welfare is what the people who envisioned it thought it would be. For one...just in the definition-'unable to work'. I'd say the majority of people I see who are on welfare are capable of working. More than capable of working, they chose not to. Then, because they can gain greater 'prosperity', they do what they can to get it, it's almost a job to them. Have a few more babies...get a little more $$$.

And, in my opinion, there is no way that government welfare can lead to 'good-fortune, health and happiness'. I believe that part of being a happy person is being a productive person. I think that there is more to being a productive person than having children that you can't support without the means of 'welfare'.

People who chose a life on welfare are almost choosing NOT to live. The money they do get is not enough to support themselves and their children. How discouraging it must be to try to have any quality of life for your child or yourself on the pittance that welfare pays. Welfare seems like a viscous cycle of degradation that is perpetuated in future generations. People who want a better life nearly have to claw their way out of the whirlpool of welfare dragging them down, cause I think welfare is self perpetuating. I don't think they really try to help people get off welfare. I have so much respect for people who use welfare for what it is meant help in times of need, then to get back on their feet. I have an equal amount of disrespect for people who see welfare as a career. Especially people who have at least $40 manicures, starbucks coffee, cell phones, chunky hi-lights and kids without shoes that fit, and 'no money' to get OTC tylenol for their childs mild fever.

I could go on, but I may save that for another time....

Friday, September 28, 2007

Least favorite EMS radio reports

Feel free to add your own...

-Patient was unresponsive on EMS arrival, but is combative in the back of the ambulance after 2mg of Narcan.....and I think they have been incontinent....

-This is EMS III, Status 2 traffic, approximately 3-5 out with MVC patient and their left foot.....

-Patient is well known to us, hospice patient with end stage CA, on arrival patient in respiratory arrest, family begged us to 'do something' patient has ETT now, no spontaneous respirations.....

-(from a 1st responder) Patient A&O x3, unresponsive to painful stimuli.......huh?