So, it's 2am. The "bat phone" rings and my coworker picks it up. The ambulance operator on the other end says we've got a 45 yr old male with stable vital signs coming in with.............testicles that have been swollen for a month... Okay, look. Sure, it's not normal when your testicles are swelling. That's a given. But how in the hell do you just up and decide at 2 in the morning that you've just had enough. Not only have you had enough of the swelling, but you're so fed up that you don't even want to drive yourself (or let someone else drive you) to the ER. You just HAVE to call for an ambulance.
There was no pain, no sudden intensifying of the symptoms, no nothing. He just up and decided that he wanted to go waste our damn time. All we did was end up referring him to a urologist, which he could have done himself. Doesn't matter anyway. He won't go to the urologist cuz that would involve having to PAY for the care given. Why do that when he can get a full work-up and exam for free if he comes to the ER? And while he's at it, why not get the actual ride to the ER taken care of as well? Let's call an ambulance and waste their time, too! Yay!
Monday, November 29, 2010
Wednesday, November 24, 2010
A New Definition of Sex
Oh buddy. Sometimes I just can't believe it when it happens. And sometimes I just laugh until I can believe that it happened. Guy brings his girlfriend to us and says that she has been really pale for the last day or so and "isn't really feeling herself." After a history and physical have been obtained, I ask about her allergies, the meds she's on at home, recent surgeries, anyone else close to her who has been ill lately, etc.
Looking at the girl, yeah, she had that "look" that tells you they're really really sick. Not just the usual crap that clogs the ER like the sniffles and hangnails. Then I ask her when the last time she's had a BM was...she says that she is constantly pooping b/c she has a colostomy that it is coming out of, which had been put in after some major issues with her large intestine that led to much of it being removed.
"Aha!" is what I'm thinking. Now I'm getting somewhere (apparently she didn't consider this a "surgery" b/c it wasn't mentioned when I asked her about recent surgeries.). So, if this was a recent procedure then I'm probably on to a post-surgical complication. But alas, she had had the colostomy in place for a year and a half, so much of my guesswork was shot down. So, I asked to look at it. When I did, I knew that it was the source of the problem. It was as if the stoma had been pushed inside of itself, and it was inflammed with a bit of pus-like drainage around the rim.
When I query her about the condition that her colostomy is in, she says, "Oh, it always looks that way for a while after we have sex." I ask for clarification... "Well, it always ends up pushed in like that and is sometimes very raw after he is finished." OMG! Apparently, she has been letting her boyfriend have sex with the stoma/hole of her colostomy!!! The pus-like drainage I saw...well, let's just say it actually wasn't pus, it was some donated material from him. Ick! Why do people do this shit?!
It turned out to be a very good thing that she had come in b/c she had a massive infection along with a pretty good sized bleed from his, um, appendage poking around in there. Sheesh.
Looking at the girl, yeah, she had that "look" that tells you they're really really sick. Not just the usual crap that clogs the ER like the sniffles and hangnails. Then I ask her when the last time she's had a BM was...she says that she is constantly pooping b/c she has a colostomy that it is coming out of, which had been put in after some major issues with her large intestine that led to much of it being removed.
"Aha!" is what I'm thinking. Now I'm getting somewhere (apparently she didn't consider this a "surgery" b/c it wasn't mentioned when I asked her about recent surgeries.). So, if this was a recent procedure then I'm probably on to a post-surgical complication. But alas, she had had the colostomy in place for a year and a half, so much of my guesswork was shot down. So, I asked to look at it. When I did, I knew that it was the source of the problem. It was as if the stoma had been pushed inside of itself, and it was inflammed with a bit of pus-like drainage around the rim.
When I query her about the condition that her colostomy is in, she says, "Oh, it always looks that way for a while after we have sex." I ask for clarification... "Well, it always ends up pushed in like that and is sometimes very raw after he is finished." OMG! Apparently, she has been letting her boyfriend have sex with the stoma/hole of her colostomy!!! The pus-like drainage I saw...well, let's just say it actually wasn't pus, it was some donated material from him. Ick! Why do people do this shit?!
It turned out to be a very good thing that she had come in b/c she had a massive infection along with a pretty good sized bleed from his, um, appendage poking around in there. Sheesh.
I Missed Out
I was thinking the other day that I really missed out on some totally free healthcare when I was a bit younger and poorer. There's a problem with healthcare in general, and it needs a major overhaul I agree, but I just don't have the time or energy anymore to try to fix everything that's screwed up in this world. When I had just gotten married, we were fairly poor as most younger married folks tend to start out. We had no insurance like most of the population, too. However, I can remember going to the ER only once in those 5 years without insurance. I apparently had a kidney stone, and it was pretty bad. I got the bill a month later...$1300 for fluids, pain meds, and preventative antibiotics. *Sigh* I was crushed. Not only were we already poor, but now we owed $1300. But, we paid it off over the course of one year. Little did I know that I could have just refused to pay it and got off scot free. It's frickin ridiculous the stupid crap people come crawling into the ER with. And they have no insurance and no intention of ever paying one cent for the care they receive. Now, I understand that there really are cases of folks who downright really can't pay. But you can't tell me that the lady who brings her toddler to the ER for a runny nose is utilizing our services properly. Especially since she's visited us 35 times this year for similar complaints (mild headache, stuffy nose, zit on chin, etc.) It's stupid. They know what they're doing. They don't give a shit, though. They just keep coming back and wasting time and resources, which then drives the price of healthcare up even further.
Why does an aspirin given to you in the hospital cost $35? Because of the dirt-lickin' idiot down the hall who came in for "toe pain." A full workup later, and there's nothing wrong, but they want their pain medicine, and they want it quickly. They don't care if someone else just got brought in by ambulance who can't breathe or who's heart has stopped beating. They want their candy and they want it now (and for free.) And then there's the stupid moronic people who call an ambulance to pick them up for a minor cough b/c they know that if they come in by ambulance, that they will get to go straight back and not wait in line. They really need to change the law that says we can't turn anyone away. We should be able to screen folks and say, "Sorry, but you're just an idiot with a hangnail trying to get some free medical care that you could do for yourself at home. Goodbye."
One man actually went on and on telling me about how he keeps coming back every week b/c of his particular ailment, and then he had the nerve to say, "And all y'all do is give me a shot of pain medicine and send me home." Uh, duh. We're here for emergencies, not primary care. We stabilize you, not fix you. Our job is to stabilize you to a point to where you can either last through the illness or make it to your primary care doctor. From there, your dr should be able to devise a course of treatment for your problem and follow your progress. But like I said, I missed out on loads of free health care. I can't count the times when I stayed home for a day due to sickness and just slept and took Nyquil when I could've just gone to the ER and gotten some free drugs and wasted time. Oh, what times I could have had...
Why does an aspirin given to you in the hospital cost $35? Because of the dirt-lickin' idiot down the hall who came in for "toe pain." A full workup later, and there's nothing wrong, but they want their pain medicine, and they want it quickly. They don't care if someone else just got brought in by ambulance who can't breathe or who's heart has stopped beating. They want their candy and they want it now (and for free.) And then there's the stupid moronic people who call an ambulance to pick them up for a minor cough b/c they know that if they come in by ambulance, that they will get to go straight back and not wait in line. They really need to change the law that says we can't turn anyone away. We should be able to screen folks and say, "Sorry, but you're just an idiot with a hangnail trying to get some free medical care that you could do for yourself at home. Goodbye."
One man actually went on and on telling me about how he keeps coming back every week b/c of his particular ailment, and then he had the nerve to say, "And all y'all do is give me a shot of pain medicine and send me home." Uh, duh. We're here for emergencies, not primary care. We stabilize you, not fix you. Our job is to stabilize you to a point to where you can either last through the illness or make it to your primary care doctor. From there, your dr should be able to devise a course of treatment for your problem and follow your progress. But like I said, I missed out on loads of free health care. I can't count the times when I stayed home for a day due to sickness and just slept and took Nyquil when I could've just gone to the ER and gotten some free drugs and wasted time. Oh, what times I could have had...
Sicko
Ugh. In addition to weird phone questions last night, I also had a rape case come in...the victim was in the form of a 4 year old boy. WTF?! Gah, I hate people. I really do. One of the many and varied reasons I could never be president is b/c I would actually mutilate and kill people who were 100% convicted of crimes like these. You rape a child? Guess what? You're about to get your ass reamed! Kill some lady? Guess what then? You're gonna get the same death, possibly longer and more drawn out, than you gave to your victim! Bastards. I mean really, with harsher punishments I think the rate of these crimes would drop dramatically. But I'm just wishful thinking.
Phone call questions of the weird and fabulous
Oh boy. A lady called for advice last night. Apparently, she had been discharged from the ER some few hours before she made this call. Her blood sugar was very high, so she had come in and been "treated and streeted" as they say. She had called b/c she had just checked her blood sugar at 7:15pm and it was in the 500's. I asked if she had any insulin to take, and she said she hadn't filled the Rx yet. I asked if she had any other meds she could take. She had glucophage. I told her to take that and recheck her sugar in 1 hr. If it hadn't come down by then, then she should return to the ER. She then said, "Oh, I figured out the problem I think." I asked her what it was. She said, "Well, the clock on my Blood Glucose Meter is wrong. It says it's now 9:30pm, and it's only 7:30pm. That's got to be what messed up my reading." .......... Um, yeah, okay. She then said, "It's adding what my sugar will be at 9:30 to what it is now at 7:30, which has made it read really high." Oooooookay. I guess she thought the machine was psychic or something. I told her to just come back in. Jeez, she didn't while I was still on shift. I hate to think what must've become of her...
Tuesday, November 23, 2010
Whatta Job...Hats Off To Psych Nurses
Had a lady come in with acute exacerbation of her schizophrenia. Always a fun thing... Anyway, she was practically dragged to us by her friend b/c of her dangerous tendencies during these episodes. I felt bad for the lady, but she sure was entertaining to speak with. She accused us all of being government agents who were in league with her enemies. And who were her enemies you might ask? Why, her neighborhood of course! They had apparently all gone to Walmart and picked up some discount nuclear missiles and bombs with which to accost her. I was surprised that she let us draw blood from her at all really, but she said that we'd only devise some form of torture for her if she didn't cooperate.
About 1 hr after she arrived, I guess she got tired of watching us walk by in the hall. She shoved past our CNA who was doing a one-on-one observation and vaulted over the desk that serves as the nurse's station. She landed on the copier and took it down with her, after which she claimed it was an explosive device that we were planning to "insert" in her (still not sure how she thought we planned to pull that off.) Security was all over her by then and got a firm hold on her. A little Ativan injection to her gluteus, and 20 minutes later she was at least calm enough to be wheeled up to the psych floor finally. I really don't know how y'all psych nurses do it. Bravo to you. There's no way I could deal with that over and over.
About 1 hr after she arrived, I guess she got tired of watching us walk by in the hall. She shoved past our CNA who was doing a one-on-one observation and vaulted over the desk that serves as the nurse's station. She landed on the copier and took it down with her, after which she claimed it was an explosive device that we were planning to "insert" in her (still not sure how she thought we planned to pull that off.) Security was all over her by then and got a firm hold on her. A little Ativan injection to her gluteus, and 20 minutes later she was at least calm enough to be wheeled up to the psych floor finally. I really don't know how y'all psych nurses do it. Bravo to you. There's no way I could deal with that over and over.
Monday, November 22, 2010
Wow, just wow.
Every now and then you get a little jaw dropper moment you know? Well, I got told about a new pt I had to go see, which was a 2 year old little boy. Apparently his mom had been drying her hair and set the dryer down, which of course the kid grabbed. So, 1st and 2nd degree burns to right hand. I grab the chart and head for the room.
Upon entering, I see 2 preteens (obviously sisters) standing by one wall, a 30ish woman sitting on the stretcher/bed, and then the little boy. I introduced myself and then looked toward the 30ish woman and said, "So mom, what happened?" And that was when one of the preteen girls said, "Well, I was drying my hair and my boy grabbed the hot end of the dryer right after I had set it down." .................. Well, I was floored mentally, but kept up with the assessment of the child. When I left the room, I looked up the stats on that family in the old chart. The "mom" is 12 years old! The boy is 2! Couldn't help but wonder about the circumstances surrounding that poor child's conception....
Upon entering, I see 2 preteens (obviously sisters) standing by one wall, a 30ish woman sitting on the stretcher/bed, and then the little boy. I introduced myself and then looked toward the 30ish woman and said, "So mom, what happened?" And that was when one of the preteen girls said, "Well, I was drying my hair and my boy grabbed the hot end of the dryer right after I had set it down." .................. Well, I was floored mentally, but kept up with the assessment of the child. When I left the room, I looked up the stats on that family in the old chart. The "mom" is 12 years old! The boy is 2! Couldn't help but wonder about the circumstances surrounding that poor child's conception....
Last night...
Wow. Saw the worst, nastiest thing in a good while since I've been a nurse, and I've seen some nasty crap. Had a girl come in from an accident with a HUGE laceration down the front of her face (down to the skull) and several other similar breaks in the skin. The laceration ran from her forehead to her lower jaw, too. However, what took the frickin cake was her arm... OMG! It literally looked as if it had been put through a wood chipper!
Picture this: At about the elbow, the girl's arm begins to peel away the skin and reveal the muscles/tendons beneath it. You get past the elbow and see meat just flopping everywhere with bone fragments pushing up and out of that pile of meat. All of the little bones in her wrist were clearly visible and becoming separated from each other (those that hadn't shattered anyway.) Some few blood vessels were still hanging on (I don't know how) so the hand hadn't turned color yet from lack of blood/O2. There was a thick band tied around her upper arm, but it was still oozing an alarming amount of blood. Add to this the fact that dirt and leaves were swirled into the meaty mass, and you've got one badass wounded girl.
We elevated the "arm" (if it could even still be considered such) and wrapped the most gruesome parts in gauze and heavy absorbing pads. Then we rolled to do a CT of her head/neck/chest/abdomen/pelvis. More broken bones inside, but no internal bleeding in her chest/abd/pelvis. She did have a slow bleeder in her skull, though. Called the trauma team to confirm that the OR was gonna be ready soon, and brought her back down to her room.
And then her mother got there... I tell you, one of the most horrible things you'll ever hear is the wail of a mother whose child is as bad off as this girl was. The girl had, apparently, been drinking and decided to drive home, which then resulted in her wreck. Wonderful. Actually, it was probably better for her that she was drunk b/c it at least dulled the pain she must've had going on. Her mother ran to her side and just clutched at her and said her name over and over. My coworker and I consoled her and updated her on all we knew, and what we were probably going to end up doing (give blood, go to suregery, etc.) And then the Dr came in...
I haven't worked at this particular facility for very long, but from what I've seen, the Drs here are very good at what they do and very easy to work with. However, I found out that this was not the case with this particular one. Upon entering the room, he introduced himself, and then he jumped right to "Her arm is just nasty and awful, so we're gonna get it taken off." No slow buildup or buffering, just threw it out there. The mother screamed (of course) and begged the Dr to find something that could be done. His only reply was " Well, you really should just be glad she's still breathing b/c her arm is just awful. Do you want me to show it to you?" OMG?! I thought "He must be nuts!" I've seen blood and guts a lot as a nurse, and even I was shaken when I had seen this girl's arm. No mother should EVER have to see something like that! Thank God she refused, though. And with that, he turned on his heel and left the room, which was probably the best thing he did. She eventually went out to try to notify her husband, who is in Iraq, in some way. Then the girl's brother and sister arrived. The sister collapsed, but the brother wanted to see the injury. He was very persistent about it, even after I described it to him. So I eventually uncovered a small portion of the arm. He was pale and stone-faced after, but he thanked me all the same, saying that he needed to see it to make it real.
We ended up giving almost 2 liters worth of blood to her before shipping her off to surgery. Poor thing, she had woken up one time and began thrashing about trying to fight us. She even thrashed that arm (ugh) before we got her sedated enough to be safe again. The whole time I tried to keep as much of her covered as possible in order to save the mother from even more horror.
What a night. We worked on her for 5 hrs before she went to surgery. That's some tough crap to do when you've got grieving family members around. It taxes you emotionally. When I got home, I fell in bed, literally fell and slept like the dead for 11 hrs. I don't regret it one bit though. If feeling beaten up is what it takes to help save a girl's life, then so be it.
Picture this: At about the elbow, the girl's arm begins to peel away the skin and reveal the muscles/tendons beneath it. You get past the elbow and see meat just flopping everywhere with bone fragments pushing up and out of that pile of meat. All of the little bones in her wrist were clearly visible and becoming separated from each other (those that hadn't shattered anyway.) Some few blood vessels were still hanging on (I don't know how) so the hand hadn't turned color yet from lack of blood/O2. There was a thick band tied around her upper arm, but it was still oozing an alarming amount of blood. Add to this the fact that dirt and leaves were swirled into the meaty mass, and you've got one badass wounded girl.
We elevated the "arm" (if it could even still be considered such) and wrapped the most gruesome parts in gauze and heavy absorbing pads. Then we rolled to do a CT of her head/neck/chest/abdomen/pelvis. More broken bones inside, but no internal bleeding in her chest/abd/pelvis. She did have a slow bleeder in her skull, though. Called the trauma team to confirm that the OR was gonna be ready soon, and brought her back down to her room.
And then her mother got there... I tell you, one of the most horrible things you'll ever hear is the wail of a mother whose child is as bad off as this girl was. The girl had, apparently, been drinking and decided to drive home, which then resulted in her wreck. Wonderful. Actually, it was probably better for her that she was drunk b/c it at least dulled the pain she must've had going on. Her mother ran to her side and just clutched at her and said her name over and over. My coworker and I consoled her and updated her on all we knew, and what we were probably going to end up doing (give blood, go to suregery, etc.) And then the Dr came in...
I haven't worked at this particular facility for very long, but from what I've seen, the Drs here are very good at what they do and very easy to work with. However, I found out that this was not the case with this particular one. Upon entering the room, he introduced himself, and then he jumped right to "Her arm is just nasty and awful, so we're gonna get it taken off." No slow buildup or buffering, just threw it out there. The mother screamed (of course) and begged the Dr to find something that could be done. His only reply was " Well, you really should just be glad she's still breathing b/c her arm is just awful. Do you want me to show it to you?" OMG?! I thought "He must be nuts!" I've seen blood and guts a lot as a nurse, and even I was shaken when I had seen this girl's arm. No mother should EVER have to see something like that! Thank God she refused, though. And with that, he turned on his heel and left the room, which was probably the best thing he did. She eventually went out to try to notify her husband, who is in Iraq, in some way. Then the girl's brother and sister arrived. The sister collapsed, but the brother wanted to see the injury. He was very persistent about it, even after I described it to him. So I eventually uncovered a small portion of the arm. He was pale and stone-faced after, but he thanked me all the same, saying that he needed to see it to make it real.
We ended up giving almost 2 liters worth of blood to her before shipping her off to surgery. Poor thing, she had woken up one time and began thrashing about trying to fight us. She even thrashed that arm (ugh) before we got her sedated enough to be safe again. The whole time I tried to keep as much of her covered as possible in order to save the mother from even more horror.
What a night. We worked on her for 5 hrs before she went to surgery. That's some tough crap to do when you've got grieving family members around. It taxes you emotionally. When I got home, I fell in bed, literally fell and slept like the dead for 11 hrs. I don't regret it one bit though. If feeling beaten up is what it takes to help save a girl's life, then so be it.
Subscribe to:
Posts (Atom)