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?

Thursday, September 27, 2007

Who's in charge?

I got this by email from my brother. I think it's funny. (sorry to all who are in charge and aren't assholes, one bad one gives everyone a bad name)

All the organs of the body were having a meeting, trying to decide who
was the one in charge.

"I should be in charge," said the brain, "because I run all the body's
systems, so without me nothing would happen."

"I should be in charge," said the blood, "because I circulate oxygen all
over, so without me you'd all waste away."

"I should be in charge," said the stomach, "because I process food and
give all of you energy."

"I should be in charge," said the legs, "because I carry the body
wherever it needs to go."

"I should be in charge," said the eyes, "because I allow the body to see
where it goes."

"I should be in charge," said the rectum, "because I'm responsible for
waste removal."

All the other body parts laughed at the rectum and insulted him, so in a
huff, he shut down tight.
Within a few days, the brain had a terrible headache, the stomach was
bloated, the legs got wobbly, the eyes got watery, and the blood was
toxic. They all decided that the rectum should be the boss.

The Moral of the story? Even though the others do all the work, the
asshole is usually in charge.

Wednesday, September 26, 2007

Milk and Molasses Enema-STAT!!!

A friend of mine had to call and vent about a shift recently. My days off are sacred, and I really don't like hearing about bad things that happen at work, it messes up my feng shui, screws with my chi, fluffs my aura! But, since she is like my little sister, I let her proceed.

She was on the cardiac assignment and among her patients was a patient being admitted to the floor..he had a few complaints but one of them was he was chock FOS. Another patient was pretty unstable...being put on a neo gtt, etc. The admitting dr wanted patient A's enema given before they went to the floor. What tha.....? Are you kidding me, lets delay the admission to give a milk and molasses enema? Sounds like he is literally shitting on the ER. (or has a crush on the floor nurse) Well, my friend told him, 'No....can't do the enema, I'm busy in another room.' the admitting dr. called the nursing supervisor to complain he felt she was too good to do an enema!!! Huh...wha? And, after hearing the facts...the supervisor still wanted to know what my friend could have done better to make sure that all of her patients had their needs met. As an old nurse I used to work with used to say....why not shove a broom up my ass and I can sweep the floors at the same time!

I know I read in nsg school that the old time nurses tended the wood stoves and cleaned and swept the floors and gave a head to toe bath TID....but they didn't have neo gtts to start and titrate. OR milk and mollasses enemas, STAT!

Tuesday, September 25, 2007

Press-Ganey survey answers that make me smile

-In answer to nursing-attention to your needs-It took 2 hours to get a cup of coffee for a patient with abdominal pain.....when I work for Starbucks I will worry about that one.

-Under arrival-comfort of waiting area-The waiting area was very UNcomfortable-there were people coughing and getting sick almost everywhere! (welcome to my life)

-Under courtesy of the nurses-Nurse rudely told me to move my car from the ambulance bay when I was dropping off my wife. (Unless you are in a big truck with lights on top and a stretcher in the back...yes, I'll ask you to move your car)

-The patient with the POOR waiting time in the treatment area before they were seen by the dr, when time of registration to, time to room, to time to dr. was 17 minutes. For something not life threatening a waiting time like that is not POOR. The world doesn't revolve around you and though it may seem 'quiet' you don't know what is in the other rooms and most likely you weren't the 'only patient' we had!

-Nurses-attention to your needs-The nurses were just standing around talking at the nursing station. I won't say this never happens, but sometimes when people think we are just 'talking' we are actually communicating about our patients, what we need to do, what we have done, who needs to be consulted, how someone is getting to CT, whether there will be a room for the newly admitted patient on the floors or do we hold them in the ER, And can the guy with the abdominal pain have some coffee...he's been asking for 2 hours now.

Saturday, September 22, 2007

Don't take this personally, but....

In catching up on some of my favorite medical/er blogs I have seen a lot of posts by patients who seem offended by the cynicism they see on the medical blogs. I understand how disturbing it is to hear people who are in the profession of caring saying seemingly derogatory things about the patients they are caring for. But, truthfully, nursing is at once one of the most rewarding and degrading, thankless jobs I have ever had or could imagine. I wouldn't change my job for the world, I love it.

If you are a patient, please, don't take the things you read in medical blogs personally. Try to understand that no matter our personal feelings about a few frustrating patients, most medical providers maintain a professional attitude with the patients. Blogs are sometimes our ways to vent about the frustrating part of our lifes work, just like anyone else can have complaints about their jobs.

People in the medical field seem to appreciate a darker sort of humor that other's don't appreciate either. I can't count the number of times I've inadvertently 'grossed out' people at dinner. It doesn't always occur to me that the stories will bother some people, while at work we will talk about a nasty chainsaw injury while eating cafeteria lasagna. (which can sometimes look worse than a nasty chainsaw injury )

Thursday, September 13, 2007

Self service ER?

An ER in Texas has set up self serve kiosks for check in. I don't know about Texas, but in NH a medically trained professional has to be the first person to see you on arrival in the ER. Patients in this article feel that the kiosks are a little 'impersonal'. I can see now the people who will choose a complaint that is a bit more serious than their back or dental pain so they can move ahead in the que. What are we coming to?

Wednesday, September 12, 2007

255kg + w/c= pain in my back

I had a 255kg guy sign in yesterday with leg pain. His legs were probably protesting the 500+ lbs they were forced to carry around! Well, after pushing his w/c to a room I realized that I couldn't stand up straight or take a breath. I was in so much pain I broke out in a sweat and started crying. I am not a baby, I was in excruciating pain :( I was forced to sign in to be treated as a patient in my own ER.

I'm feeling a lot better today, but it still feels like I have a charlie horse in my side. I can't lift my arms or twist my torso without increased pain. I'm out of work now til monday. Kinda pisses me off that people can allow themselves to get so freaking big...seriously, isn't he the size of two refrigerators? Then I hurt myself trying to help them! There oughta be a law.

A friend of mine let me know what I missed today. 0730, someone had fallen from a second story window sometime in the night and was discovered come morning...skull fractures, pneumocephalus, hypothermic. Later someone was thrown from a horse...c6 fx. Then a nice cardiac arrest that they got back but ? hypoxic brain injury. Then a stellar citizen with a BAL of 495. ER waiting room bursting at the seams. Another day in paradise that I missed due to the incredible 255kg man.

Friday, September 7, 2007

Self injecting insulin?

There was a sick call at work the other day and I decided to work 11a-7p. I could tell from the minute I walked in that it was one of 'those days'. Security sitting in the hall 'guarding' someone, people moving with purpose, flags up on a lot of charts, charts in the 'right rack' where we put people who have been triaged back to the waiting room since all the ER rooms are full....the only things missing were the police and victims inc. Before too long they were in attendance too.

Since it wasn't my usual day to work I was put on the trauma assignment (my least favorite assignment...give me a nice clean MI (not inferior) any day) A friend of mine was on my usual assignment, cardiac. And she looked pretty busy with an admission and young diabetic who kept going hypoglycemic even with a D10 gtt and a few amps of dextrose. It wasn't really the time to hear the paramedics calling in with a guy who fell off his roof and was in respiratory arrest.

When the ambulance arrived it was obvious how severely injured this poor guy was. He was intubated and still, not the stillness of succs either. He was brought to a cardiac room briefly while CT was called, a dopamine drip was hung since he was hypotensive despite two large bore IV's w/o. During this I answered a call in the hypoglycemics room, she wanted something for pain....ummm, ok. I'll let your nurse know when she is done trying to save the guys life in exam #7.

CT revealed a C2 fracture with splaying. It just confirmed what we wasn't good. We are a small, community hospital, and before the patient had even arrived we had called lifeflight to take him to a larger hospital, they were still 10-20 minutes out. As we don't even have a helipad the medics had to package the patient up to bring him to the small airport up the street that almost looks like farmer John's cows must be in the lower pasture this week.

My friend went in to check on her hypoglycemic patient and found an insulin syringe uncapped in the patients bed. The patient said that it must have fallen out of her purse, but my friend suspected that she had self injected insulin and that was why her glucose kept dropping. She lost it on the patient and they searched her things and found some oxycontin and a few other drugs, but not insulin that I know of.

This girl is known to us as someone whose baby came in with bilateral burns to her hands and who will have a 'seizure' when she doesn't get meds she asks for in the ER. So, I don't doubt that she would self inject insulin. The question is has she now crossed the line from drug seeking dirt bag to someone who should be IEA'd and lose custody of her child? She had already been reported to DCYF for the previous visit.

I know that I'm glad I wasn't in my usual assignment that day!