Princess MiMi Crybaby About To Get Second Spanking

 

A nurse who treated Ebola patients in West Africa before being briefly and controversially quarantined in New Jersey could be the focus of a new battle over state health policy as she returns to her home state of Maine.
Kaci Hickox left a Newark hospital on Monday and was expected to arrive in the northern Maine town of Fort Kent early Tuesday. Maine health officials have already announced that Hickox is expected to comply with a 21-day voluntary in-home quarantine put in place by the state's governor, Paul LePage.
However, one of Hickox's lawyers, Steve Hyman, said he expected her to remain in seclusion for only the "next day or so" while he works with Maine health officials. He said he believes the state should follow the Centers for Disease Control and Prevention guidelines that require only monitoring, not quarantine, for health care workers who show no symptoms after treating Ebola patients.

LePage defended the quarantine in a news release Monday, saying that state officials must be "vigilant in our duty to protect the health and safety of all Mainers." Adrienne Bennett, a spokeswoman for the governor, told the Portland Press Herald that authorities would take "appropriate action" if Hickox does not comply with the quarantine, though she did not specify what that action might be.

Word to your mother, MiMi: Maine isn't Joisy. That governor doesn't sound like you're getting his lunch money, and is about to jump on your stupid ass with both feet. And this time, it sounds like they won't send a spokeshole, they'll send armed deputies, and your ass will be nailed inside the damn house.
STFU and take your medicine, or your next quarantine may well be the new isolation bed in the county lockup.
State nursing licensure boards tend to view those sorts of legal entanglements as the sort of thing that has a direct bearing on your ongoing fitness and suitably for "the continued practice of nursing", in a professionally influential way.
Dumbass.

 

 

And if friend-boy cohabitates with Hickox during her enforced quarantine, U. Maine-Fort Kent, where he's a nursing student, has announced they will refuse him access to campus, which will have a teensy affect on his continued nursing school education there. Like get him suspended and then dropped from the program, and have to ask for re-admission next semester, typically. He may not get back in for some time, given how impacted such programs are.

 

Play stupid games, win stupid prizes, kids.

 

And nota bene that despite screwing up the execution, the tally is now 9 states using the Q-word, while D.C. has dithered.

Dear NYFC: Who Left The Bag Of Idiots Open?

The preparedness of New York City officials and workers to deal with Ebola has once again left much to be desired as a hazmat team sent in to decontaminate the apartment of Craig Spencer, the first person to contract the deadly virus in the city, was seen leaving his apartment with sealed barrels, but wearing no protective gear. The men were photographed exiting the apartment without gloves, face masks, or anything else to protect them as they loaded the barrels with possibly contaminated goods into the back of a truck.

Please, by all means, go to the linked DailyMailUK article for the multiple photographs of this Clowncarnucopia of Fail.

Especially moving are the shots with numerous Big Horseapple bystanders wandering through the procession, faces buried in their smartphones, tweeting to their crosstown pals, in total obliviousness to walking through a hazmat cleanup. (The one small orange cone wasn't really a lot of help there, either.)

I didn't think it was possible to make the folks in Dallas pressurewashing the vomit look brilliant by comparison, but once again NYFC takes the cake:
that city's collection of 60-IQ assclowns puts every other city's 70-IQ assclowns to absolute shame.

Walk tall, you bunch of public school dropouts. You are, beyond any doubt, the stupidest collection of morons ever assembled in one place in all of human history. It's only a wonder you don't all require iPods with a twelve-a-minute loop tape to remind you to breathe 24/7, and if you hadn't mastered the use of your elbows, your knuckles would certainly drag on the ground. Thank God you had the surgery to remove the prehensile tails, or you'd never have gotten your pants on.

Special Assclown Award!

It's fun to be interviewed by the media for your expertise, but when you pull your pants down and spank yourself in front of God and everyone, on the biggest news topic of the day, probably not so much:

From Canada's National Post

In Akron, Ohio, officials dismissed students at the Resnik Community Learning Center at midday and said it would remain closed until Monday. In a letter to parents, the schools superintendent, David James, said that “a parent at the school had spent time with Ebola patient Amber Vinson when she visited the area this past weekend.”
Health care specialists expressed skepticism about the closings.
Dr. Paul Offit, the chief of infectious diseases at the Children’s Hospital of Philadelphia, likened the response to the early days of the AIDS epidemic “when people were afraid to walk into a grocery store and pick up a piece of fruit because they didn’t know who’d touched it.”
“This isn’t flu or smallpox,” Dr. Offit said. “It's not spread by droplet transmission. As long as nobody kissed the person on the plane, they’re safe.”

 Apparently Chief of Infectious Diseases is more of an honorary title.

(CDC Info): When an infection does occur in humans, the virus can be spread in several ways to others. Ebola is spread through direct contact (through broken skin or mucous membranes in, for example, the eyes, nose, or mouth) with

• blood or body fluids (including but not limited to urine, saliva, sweat, feces, vomit, breast milk, and semen) of a person who is sick with Ebola
• objects (like needles and syringes) that have been contaminated with the virus
• infected animals
• Ebola is not spread through the air or by water, or in general, by food. However, in Africa, Ebola may be spread as a result of handling bushmeat (wild animals hunted for food) and contact with infected bats. There is no evidence that mosquitos or other insects can transmit Ebola virus. Only mammals (for example, humans, bats, monkeys, and apes) have shown the ability to become infected with and spread Ebola virus.

Healthcare providers caring for Ebola patients and the family and friends in close contact with Ebola patients are at the highest risk of getting sick because they may come in contact with infected blood or body fluids of sick patients.
During outbreaks of Ebola, the disease can spread quickly within healthcare settings (such as a clinic or hospital). Exposure to Ebola can occur in healthcare settings where hospital staff are not wearing appropriate protective equipment, including masks, gowns, and gloves and eye protection.

In case the recommendation for masks and eye protection wasn't obvious enough, let's go to the CDC's current recommendation for Healthcare Providers, (which a normally intelligent person could be forgiven for thinking might actually apply to the Chief of Infectious Diseases at Children's Hospital in Philadelphia):

CDC FAQ: If a patient in a U.S. hospital is identified to have suspected or confirmed EVD, what infection control precautions should be put into place?

If a patient in a U.S. hospital is suspected or known to have Ebola virus disease, healthcare teams should follow standard, contact, and droplet!!! precautions, including the following recommendations:

• Isolate the patient: Patients should be isolated in a single patient room (containing a private bathroom) with the door closed.
• Wear appropriate PPE: Healthcare providers entering the patients room should wear: gloves, gown (fluid resistant or impermeable), eye protection (goggles or face shield), and a facemask. Additional protective equipment might be required in certain situations (e.g., copious amounts of blood, other body fluids, vomit, or feces present in the environment), including but not limited to double gloving, disposable shoe covers, and leg coverings.
• Restrict visitors: Avoid entry of visitors into the patient's room. Exceptions may be considered on a case by case basis for those who are essential for the patient's wellbeing. A logbook should be kept to document all persons entering the patient's room. See CDC's infection control guidance(http://www.cdc.gov/vhf/ebola/hcp/infection-prevention-and-control-recommendations.html) on procedures for monitoring, managing, and training of visitors.
• Avoid aerosol-generating procedures: Avoid aerosol-generating procedures. If performing these procedures, PPE should include respiratory protection (N95 or higher filtering facepiece respirator) and the procedure should be performed in an airborne infection isolation room.
• Implement environmental infection control measures: Diligent environmental cleaning and disinfection and safe handling of potentially contaminated materials is of paramount importance, as blood, sweat, vomit, feces, urine and other body secretions represent potentially infectious materials should be done following hospital protocols.

Dr. Offitt, you're evidently an ignorant, uninformed, unprofessional assclown, who should resign your position immediately for the good of humanity, before your errant jackassery gets people under your care or supervision killed from your total lack of knowledge on this critical topic, supossedly your very area of clinical expertise. Especially for someone who took journalism to task and advocated "Journalism Jail" for bad medical reporting. Consider yourself busted, and go spend a year or two in self-imposed exile for criminal medical stupidity.

Only consideration for your years of good work before you evidently lost your mind restrains me from suggesting you change your specialty to cats and dogs, or go home for some quiet time with a gun and a single bullet.

But you're still a dangerous assclown, and a threat to the safety of every child within 500 miles as long as you practice medicine without your brains, or open your mouth on the topic.


Bravo. The Cocobongo School Of Witchdoctory would be proud of you.

Raping The Constitution - Just Another Day in Deming NM

(I'm cross-posting this, because there's way too much crossover applicability to the medical field going on here. - A.)

Caveat: Good cops are worth their body weight in gold. Bad ones can - and should - be melted down to make fishing sinkers.

"Welcome to Deming NM, where the only safe @$$holes wear badges!" - proposed sign for the Deming NM Chamber of Commerce to put up at city limits

Yes, I'm late getting to this, because everyone else is having so much fun with it.

First, the LINK.

Now, the highlights:

One Mr. Eckert, of southern New Mexico, having concluded his shopping at a local Wal-Mart last January 2nd, did a rolling not-quite-a-stop as he left the parking lot, and was immediately selected to donate to the town's tax coffers pulled over for a  moving violation by the Deming PD.
Whereupon, for this grave breach of public order and safety, he was ordered to exit the vehicle.
(WTF. Why?? For a ticket, all you need is a promise to appear, and normal observables for citing officers don't include the behavior of your ass muscles.){Update: Aha! Because their Talking Dog told them! More later.}

Whereupon, based on personal observation, and a career familiarity with proper buttocks etiquette, Officers Assclown and Dipshit decided that the driver was almost certainly clenching his cheeks to maintain an imaginary stash of illicit narcotics in his booty hideout.
Whereupon they contacted and received from a local graduate of New Mexico's finest internet law school and all-night taco stand judge a search warrant for the anus of the motorist in question.

Apparently in Luna County, NM, probable cause of no more than some jackassical officer's desire to have a peek up your ass is sufficient to set aside the entire Bill Of Rights.
There's doubtless a thumping sound coming from the vicinity of 77 graveyards as the signers of said document spin in their graves.

Our brave butt pirates in blue took him to a local Deming ER, whereupon the medical professional on duty told them not just no, but Hell NO! because performing such a procedure, warrant or no, was a violation of his professional ethics. Doctors typically bill separately from the hospital, so this guy's medical group should award him an on-the-spot 5-figure cash sum for sparing them the lawsuits and ridicule to follow, a sum that should be matched by the hospital out of sheer gratitude. And if the AMA has an Ethics prize, this unnamed doctor just won it for 2013, whether they acknowledge it or not.

Undeterred by such flawless ethical reasoning, Officers Assclown and Dipshit, assisted at some point by Officer Shitforbrains, and later joined by Hidalgo County sheriff's deputies Bumblefuck, Stumblefuck, and Bufflefuck, trundled the motorist outside the county limits (and the limits of the jurisdiction of said search warrant, nota bene) to the Gila Regional Medical Center in Silver City NM, in Hidalgo County, where the local disciples of Dr. Mengele were more than happy to use a search warrant from an alleged judge in another county as a pretext for an epic butt-fishing expedition.

As noted in the federal filing complaint and linked story, the motorist was then subjected to the following:

1. Eckert's abdominal area was x-rayed; no narcotics were found.
{Nota bene that at this point, it ceased being a search, and the torture began. - A.}
2. Doctors then performed an exam of Eckert's anus with their fingers; no narcotics were found.
3. Doctors performed a second exam of Eckert's anus with their fingers; no narcotics were found.
4. Doctors penetrated Eckert's anus to insert an enema.  Eckert was forced to defecate in front of doctors and police officers.  Eckert watched as doctors searched his stool.  No narcotics were found.
5. Doctors penetrated Eckert's anus to insert an enema a second time.  Eckert was forced to defecate in front of doctors and police officers.  Eckert watched as doctors searched his stool.  No narcotics were found.
{At this point chronologically, after failing to notice that the warrant itself was invalid in their locale, no one noticed that the time limit for said warrant had also expired even if it had been a valid warrant. Which it wasn't.}
6. Doctors penetrated Eckert's anus to insert an enema a third time.  Eckert was forced to defecate in front of doctors and police officers.  Eckert watched as doctors searched his stool.  No narcotics were found.
7. Doctors then x-rayed Eckert again; no narcotics were found.
8. Doctors prepared Eckert for surgery, sedated him, and then performed a colonoscopy where a scope with a camera was inserted into Eckert's anus, rectum, colon, and large intestines.  No narcotics were found.
Throughout this ordeal, Eckert protested and never gave doctors at the Gila Regional Medical Center consent to perform any of these medical procedures.

This all took place in January 2013, and while it's a wonderful practical demonstration of Obamacare a few months early, like most of the activities of the current president, it's also a wee bit afoul of tiny details like the Bill of Rights and that pesky Constitution thingie.

My original response to that catalogue of nonsense was to a fellow online commentor who wondered why they didn't "just give him a dose of salts, and wait for the results" is as follows:

Because he has the legal right to refuse anything and everything. The only thing that can be done to anyone without their own consent in the ER is drawing blood for alcohol/drug tests, and administering emergency psych medication and strapping them down when they're actually violent and a danger to themselves or others (by which I mean swinging punches, kicking, and frothingly Hannibal Lecter bite-happy, not merely enamored with dropping F-bombs due to a lack of serotonin or social graces).

For everything else, they can tell everyone up to and including the President to "Eff off" with a mere 500 years of English Common Law and the full faith and credit of the U.S. Constitution on their side, something I regularly have to remind both cops and doctors of, but which our Legal Dept./Risk Mgmt. drones pound out in memos about 3X/yr.

Evidently somebody forgot to tell the local gauleiter, statspolizei, and the local disciples of Dr. Mengele in this instance that this sort of behavior was rather discredited post-1945.

Remember this when someone tells you the average h.s. grad doesn't need to know civics and political history for life beyond the 12th grade.

"These guys need to be locked up."

Letting the punishment fit the crime dictates that during confinement, they also be placed in restraints - by court order - and ass-raped by convicts repeatedly.
It's also funnier that way.

And for the record, every medical professional who didn't say not only "no" but "Hell no!" at the offending facility, from the lowest clerk up to the attending physician, just forfeited their licenses to practice, everything they own, and the next 10 years of their lives, at minimum.

Whether anyone admits it or not, this victim is on the short list to becoming the new co-owner of that entire hospital. This is a $20M judgement, and that's if it never gets to a jury's ears. He'd be crazy to settle for anything less than that, and if he has competent counsel, they've made that clear to him.

If it were me, I'd let them off with $5M in damages, provided they all stood in the town square for a week while any resident of the city limits was permitted to come up and kick them in the crotches as hard as they desired, once apiece.

And in all probability, Eckert was still issued a citation for the moving violation, and the medical center sent him a $6000 bill for sexually assaulting and humiliating him with glee multiple times, and showing a shockingly reckless disregard for anything we normally associate with professional ethics or common sense.
But, as countless late-night infomercials have told us, "Wait - there's MORE!"

They've done this before!

And come to find out, the original suspicion in both cases was the K-9 partner of Officer Shitforbrains: Leo the Ass-Sniffing Drug Dog!

Whose Crack Hound certification as a drug dog expired in 2011, at least a year before both incidents. Thus neither the dog, nor the probable cause, passed the smell test.

Not to mention that he doesn't know drugs from dirty underwear, and the false positives in both such notable occasions were ignored by everyone from Officer Shitforbrains to the Chief, because ass-raping both the citizenry and the Constitution in Deming and Hidalgo County is apparently so commonplace there that it doesn't even rate a yawn.

And notably, they again took their prospective butt-rapee to the same Gila Regional Medical Center in Silver City. One might notice a pattern here.

To the disciple(s) of Dr. Mengele working at that particular would-be Nazi Concentration Camp Processing Station and Sexual Assault Training Camp brilliant example of what you get when you make doctors the tools of the government at Gila RMC, particularly the really really questionable ones who should probably have been flunked before licensure, and be dissecting cattle for the local butcher shop instead of practicing medicine last seen at Auschwitz circa 1944, and best left there:
Show some self-respect, and burn down your hospital, for the good of all mankind, not least of which includes the local citizenry.
And then, please, if you personally had anything whatsoever to do with participating in the above or similar incidents, with all dispatch, go home and hang yourselves, as a mark that you have some shred of personal honor and a sense of shame.
Or turn yourselves in and become State's Evidence witnesses, and offer a full confession. It's the very least you can do, and clearly long overdue.

And one wonders just how many times this sort of outrageous conduct will have to be repeated before the Governor of New Mexico directs the State Police to step in, suspend the entire city of Deming Police and Hidalgo County Sheriff's Departments, and take over both until further notice to restore the rule of law and order, after referring both and any other such matters (and if they've done this twice, they've probably done it twenty times) to the state's Attorney General for some rather speedy and sweeping show trials in Albuquerque, ideally no later than close of business Friday.

When the U.S. Attorney for New Mexico will commence an investigation into the issuance of dodgy search warrants by judicial jackholes in and around Luna County has not been addressed, even by reporters who should know better. C'mon, counselor, this is an easy ticket to Congress or the governorship, and looks to be as hard as shooting fish in a barrel. Jump right in.

No points for guessing the winners of the 2013 Jackbooted Thugs Of The Year Award, by miles.

Nuke the site from orbit. It's the only way to be sure.

And please, for the love of all that's holy, it's long past time for SCOTUS to revisit the Fourth and Fifth Amendments relating to automobile and personal searches during traffic stops, and the admissibility of using drug dog "testimony" as probably cause for doing anything but handing out Milkbones. I pray that counsel for plaintiff uses some of the undoubted civil damages in this case to seek redress at the highest level for what has become a long train of abuses and usurpations of the Constitution, evincing a design to reduce us all under absolute despotism. Jefferson had a solution for that. What say let's nip things before we go there?

Diagnosis Of The Week

Your child is sick.
We know this because you've dragged the little troll here, under the general precept that "If Momma ain't happy, ain't nobody happy."

Okay, well played.

But you know what undercuts any shred of compassion we would otherwise have for someone who's visited us so often that your registration now consists of the clerk typing "F12", and your entire life history is instantly uploaded to the sign in paperwork?

It's that you brought your other 5 kids, and signed yourself in as well.

Crack medical professionals that we are, we know that the correct diagnosis is not "Mass Casualty Incident", "Attempted Mass Murder", nor even "Multiple Food Poisoning" (though your aunt's two-week old casserole has almost reached the status of agar as a culture medium in microbiology circles).

No, gentle reader, the correct diagnosis of this ailment is "Family Plan".

Now, we understand that the economy is tough, so it's hard to resist bringing your entire brood, because babysitters cost money, whereas to you, the ER is free. And we know we have better cable than you, and more video consoles. We also know it's hard to resist the free $5 universal remotes in the rooms, despite the docs having replaced them three times, and having sash-chained them to the walls, along with the free crayons we buy by the bucket, rather than see your spawn reduced to actually waiting quietly while the TV plays.

But what boggles our collective minds is that you frequently show up with both parents, grandmama, and your 7 kids, when you, we, and every person in triage can tell that there's only one sick kid among the bunch (if that, but I'm giving you the benefit of the doubt).

Allow me to be so unfeeling as to suggest that next time, 1 parent brings one kid in your 1 car, and the other stays at home with the other 11 not-sick kids. Sociologists have a name for this: they call it "parenting".

I know I'm being unfeeling, because, really, how could I possibly know at a single glance, before a single vital sign is taken, that all 17 of your offspring don't each have Dengue Fever? It could very well be exactly that, and who am I to assume otherwise? And I apologize for thinking that you brought them all because you cleverly noted that since the doctor's already in the room, why not let him do 25 full physical assessments instead of wasting his precious time with one actually minimally sick child?

Clearly, yours is the superior outlook on the proper role of the ER in your life.

So the next time your big yellow bus rolls up, and you, your spouse, his brother and sister-in-law, their 9 kids, your grandmother, and 32 of your kids tumble out of the Clowncarnucopia of Fail, I'm not going to bother to explain to you why, on a 5-level triage system, where 1 is dying, and 5 is minimally acute, you're all the only "6"s on the tracker, and the entire Western Hemisphere will be evaluated first (including the guy who signed in with lycanthropy), before I even consider shuffling you along to the clinic side.

And thanks for bringing your entire village all the way here, because nothing says reasonable health care usage like seeing the entire chorus of Les Miserables descend on my desk simultaneously, grab an entire bucket of pens and sign in forms, occupy every seat in the waiting room, and turn a busy waiting room into a school field trip for the entire district, while they run around, scream and yell, and eat half of 117 bags of Flaming Hot Cheetos, while scattering the other half of each bag all over every horizontal surface as a sacrificial offering to the Mayan God Of Faux Corn Products.

The only thing rolling in my favor is that the day they authorize a minimal $5 co-pay for your nonsense, one of these trips will wipe out your EBT card balance for the month, and you'll have to sell the Mercedes.

But until then, you're on notice: the next time you pull this crap, I'm not telling the Fast Track Doc we have a Family Plan.
One more visit from the Bratty Bunch, and I'm upgrading you to a Flash Mob.
And on my 5-point triage scale, that's a 32.
Be warned.

Dear Obnoxious @$$holes

Fortunately, this isn't all of my patients every night.

But it's too damned many of them.

So if this isn't you, let it roll off your back.

But if the shells are landing closer each time, catch a clue before you catch the shrapnel.

So, all you clever @$$holes, the ones who were fed while you were growing up, rather than actually raised, let me undertake to catch you up on the life lessons your dear old ma and pa neglected to pass along to you before you crossed paths with me and my co-workers.

Apparently, you seem to have mistaken the emergency department for your little plantation, and you imagine somehow that you're Boss Hawg. While I'm sure that's a comforting fantasy for you to carry around in your head, let me disabuse you of the notion that reality looks anything like the playground in your mind.

My techs, fellow nurses, and doctors see several hundred folks a day. You might have noticed that when you came in, and saw all those other people waiting, in this area we've cleverly named the Waiting Room. You got put out there because all the beds are full, and you aren't dying any faster than the rest of the human race. You may be sick, injured, or severely inconvenienced, but you're not at imminent risk of dropping dead. Which, judging by your behavior, is really quite a shame, if only life were fair.

But it isn't, which is why that nice little man is having a stroke, and you're not. If you needed a reason to fall to your knees and thank a merciful god for something, consider that I don't have the ability to assign disease to the most deserving.

I realize that waiting in the Waiting Room is a major bummer for you, but let's flash back a few minutes. Remember when you drove up? Did you, perhaps, notice that we don't have a drive-through window? So if that's true, ponder what that fact bodes for your chances of getting whisked right in, and right out.

A second data point for most people, if not yourself, should be the lack of a menu at the window I'm sitting behind. Most particularly in your case, note carefully the complete absence of french fries on the missing menu, or the logo of that famous hamburger grill, Burger King. These twin items notify most folks that you can't have fries with that, and you won't be having things your way here. Pretty much ever, since about, oh...when Warren Harding was president, hereabouts.

Astonishing as the feat may seem to you, about 99% of the other people who came in before you, and yet are waiting quietly until we can see them, figured this all out in about 0 seconds. Maybe you were told by everyone from kindergarten until last week that the rules and procedures don't apply to you, because you're a Special Snowflake. So let me introduce our special super power: we're the blowtorch for Special Snowflakes, and today there's a special on STFU With The Attitude.

You should also be aware of a few things: we all talk to each other. The triage nurse talks to the charge nurse, the doctors, and the nurse whose area we take you to, long before you even get your butt unstuck from the vinyl waiting room cushion on the bench. So all that attitude and sarcasm you came in with has been documented electronically, and verbally shared with everyone who's going to be caring for you. Because it's how we roll, and even HIPPA and the US Government says I can tell your caregivers all about you.

So when you thought you were being cute, and took your little 'tude back outside, we were just typing away, documenting your entire life story, to ensure you get the care you rate.

Let's try a simple association for you: ever notice when you act like you are now, but out in other places, like for instance at an actual restaurant, that your food always seems to taste like spit?
Did you ever wonder why that is?
No? Well, let me clear up that mystery for you.

And if you haven't had that experience, because you'd never act like as big a jackhole out there that you do in here, maybe that should be a lesson to you as well.

Because here's the thing:
Once you get put in a room, the doctor can see you next. Or not.
And order pain meds for you right away. Or not.
And the unit secretary, who's desk you passed by making all those clever comments?
They can process those orders quickly. Or not.
And my co-workers and I can get right on them. Or not,
And I can spare you a lot of waiting and suffering. Or not.
I can even make sure to take care of you before all my other patients. Or not.
Stop me when the light begins to dawn.

So you should realize that I'm not going to do anything to hurt you. In fact, if you're here, you've probably already covered that little task all by yourself. But we're all human. And when I have sick patients, and they add a frothing jackhole to my list of things to do, well, you have no idea how long it can take me to find time for you, and grease your little squeaky wheel. Or not.

So, am I getting through yet?

Some of you like to talk tough. Okay, try that one on and see how it plays.
I dress out at about 225. What skills I've lost in reflexes since my prime years, I can more than make up for in pure orneriness. As annoying as it is, I have to deal with cranky jack@$$#$ just about every night. And about once a week, one or more of them is so certifiably crazy that they end up strapped down in hard restraints. What that means is, while you've doubtless had a few bar fights or parking lot brawls from time to time, I've had about 500. I'm 500-0. (And if you thought you could try that on my 95 pound colleague, you should read up on how inmates think of child molesters, and look around at the other techs, nurses, and doctors working a couple of steps away, and realize we think of each other like family. Especially when we can hear you mouthing off to someone we see as petite little ray of sunshine, half a corridor away.) Maybe at home, spouting off gets you attention. It gets you attention in my house, but not the kind you want. And when I say the magic words, twenty of my closest friends show up to play too. And then security comes. And then the police. And we all stay, and you get to leave.

We don't like it, in fact we really hate it; but we'll go through it if you give us a reason.

But all this can be avoided, and that's your super power: spare us your sarcastic comments, skip the snotty smartass wisecracks, don't raise your voice, and don't be an obnoxious jackass from the moment you get here until you leave. Treat us like professionals who show up every day to help people in trouble, and that's what you'll get.

Treat us like your private whipping bitches, and you'll get something entirely different.
And I promise, it isn't what you thought you were going to get, and it isn't what you wanted when you came here. So cool your jets, give your mouth a rest, and deal with things the way they are, and not how you wish they were in your little fantasy world. Start off by coming in the door acting like a human being, and we won't have any trouble treating you like one.


Or not.

Wound Care 101 For Dummies

For today, a few thoughts on that hole you made in your slipcover:

Prior to the dawn of the 20th century, and inoculations and antibiotics, "simple" cuts and scrapes that turned septic accounted for a respectable number of annual deaths.

So for your general fund of knowledge, if you cut, punctured, burned, got bitten by anything*, or otherwise screwed up the factory finish on your shiny pink carcass, unless you were bathing in Betadine at the time, it's infected.

Now, mind you, your ordinary immune system can handle quite a bit, but there's nothing quite as good as prevention when it comes to infections, which is 100 times better than treatment after you gave it a good head start. So let's cover the highly secret, only available to medical professionals, revealed in secret lectures during training, method to prevent a lot of trouble for you:

Go to the sink or shower, and wash out the wound. Using soap isn't a bad idea either.

If you have phisodermahexagoo, great, but plain old soap isn't bad either.
If you have a bottle of Betadine (Solution, NOT Scrub), and you aren't allergic to iodine, please, alternate that with the washing, i.e. water-betadine-water.

Quite literally, lather-rinse-repeat.

Every medical student learns "The solution to pollution is dilution.", right?
So keep washing, and washing, and washing, until it's really next-to-godliness clean.

"But I'm BLEEDING!"

Yeah, yeah, call the waaahmbulance, and get over it. The treatment for losing a pint of blood is...wait for it...a glass of orange juice and a cookie. That's how the Red Cross treats people who donate a full pint, 24/7/365. Unless you're spurting blood forcefully, you aren't going to lose a pint washing the wound.

While you're washing it, take note:
Is it all the way through the skin? (i.e. can you see some of your stuffing down inside there, like fat, muscle, tendons, bone, etc.)
If that answer is "Yes", you've already answered the "Do I need stitches/staples?" question.
Finish washing it out, cover it with clean gauze pads, and wrap it securely. You may need to apply firm pressure for several minutes, and elevate the part higher than your heart, to get the bleeding to stop. If we're talking arms, legs, or head lacerations, there isn't much likelihood that you can't control the bleeding, unless you have underlying issues like being a hemophiliac, or if you're taking aspirin or coumadin every day to decrease your risk for things like clots, strokes, and heart attacks. If that's you, take a few more minutes with the pressure and elevation.

Once things are stabilized, have someone take you to the ER.
If they don't stabilize, call 911 to take you to the ER.

And when you get there, one of the first ten questions we'll ask is "When was your last tetanus shot?"
If it was less than 5 years, you're good.
Between 5-10, or for larger wounds, you may get a booster.
If it was more than 10, OR YOU DON'T KNOW, you're getting a booster.
{Hint: Write "Tetanus booster", and the date, on a Post-it, and stick it to the back of your driver's license. Then you'll have it, without having to remember it.}

The description of someone who dies of tetanus (old term "lockjaw") is one I reread recently, from an early 1900s era description. Picture someone bent like a bow, with their head and heels touching the bed, and their body arched to the ceiling, as all their muscles go rigid (tetany) until they finally die from asphyxiation from paralysis of the muscles of breathing, fully conscious, dehydrated, hungry, and in incredible pain, with no possible cure, as they suffocate. That's what happens when you don't get your booster, if tetanus takes over. It doesn't live on rusty nails, it's everywhere. The spores sit dormant on everything forever, including in the dirt on your skin, and if they get in you, and make a home, and you don't have current immunity from inoculation, put your affairs in order.

Or stop crybabying, and take the shot.
I usually ask my patients: Shot? Or Horrible Death? Shot? Horrible Death?
I have yet to be turned down, although I've seen some godawful crybabying and whining.
Please don't be That Guy.
(Though if you're the 6' 275# Crip with four gunshot wounds, who's crying about a 1" needle like I was going to castrate you, I'll probably blog about you too, just like that giant pussy.)

That's it. They numb the area with a local anesthetic (another couple of shots) then when you can't feel it, they clean it out some more, make sure you didn't slice anything else more important, like tendons or blood vessels, they stitch or staple it closed, you get them out in a few days: problem solved.
Keep it clean, dry for a couple of days to let scabbing seal the holes, and watch for infection signs, then keep the follow-up appointment to take them out. This isn't rocket science.

Now, about all those other things you want to do.

Hydrogen peroxide: it bubbles up, and looks all sciency and high-tech.
Unfortunately, it only kills organic stuff, and only what it hits. It doesn't penetrate very well. And it stings, because it's killing healthy tissue. It's better than rubbing doggie poo in the wound, but it's not a good choice unless your only alternative is the doggie poo.
(Save it for getting the blood stains out of clothing - like scrubs; ask me how I know - carpeting, and upholstery. Like if you need to move the body before the cops get there.)

Alcohol: kills germs, if left in place for 10-15 minutes. During which time it's slightly more comfortable than pouring scalding lava on the wound, and that's once again because it's also killing healthy tissue. Save this for people you really, really loathe, and be sure to duck after you put it on, because they're going to swing at you - once they let go of the ceiling.

Merthiolate: (or, as Bill Engvall calls it, "monkey blood"). A tincture (weak solution) of iodine, popular with people from circa 1930-1960. If you're going to use iodine, don't dabble. Get Betadine, and go full strength. You're supposed to be doing first aid, not art class.

Everything else that's not water, betadine, or topical antibiotic ointment: probably belongs in the same category as doggie poo.
This includes butter, Crisco, dog spit (hey, ever notice that dogs eat their poo?), and most other magical witchdoctor concoctions your grandaunt, shaman, or witch doctor told you would work. The only exception is topical honey, provided it's covered with the same clean dressing afterwards, you're on a desert island, and there's no drug store or ER anywhere.

If your wound is superficial, not requiring stitches, your tetanus shot is up to date, and you decided to skip the ER visit, put some topical antibiotic ointment on the injury, dress it with a clean gauze and a good wrap, and change the dressing daily, watching for any signs of infection.
If you see any, come in anyways.
Ditto if you waited over 12 hours for something you knew needed stitches, but you're lazy or brain-challenged. We aren't going to stitch it up after half a day, but you may still want/need the tetanus booster or antibiotics, especially if you noticed it's growing red streaks up your arm/leg, or it's huge, hot, painful, and/or draining nasty pus.

For the other 90 million people who can't grasp this, we'll be ready and waiting to scrape the peanut butter, drywall spackle, axle grease, and every other wild thing out of the holes and treat the wound. For the few folks who read this and pay attention, thanks. This'll just be our little secret, 'kay? 





*("anything" includes, but is not limited to, power tools, power fools, people, dogs, cats, small pets, large pets, wild animals, fish, birds, reptiles, insects, velociraptors, vampires, werewolves, Bigfoot, and alien embryo implants bursting from your chest. Clear?)

Nurse Sherlock Holmes

So, I'm in triage (which is about like saying "I was breathing"), and it's well after midnight. And for once, things have actually quieted down, like they used to do every night, instead of once every leap year. But tonight wasn't looking like it was going to be too bad.

And then in comes a certified relative of Wile E. Coyote, Supergenius.

Mr. Wiley has a towel around his left forearm, and announces loudly "I been shot."

Okay, we're not a trauma center, so minus 5 points for being not-so-bright. But we're on the barrio border, so it's not like this never happens.

And, with normal vitals, little apparent blood, and after minimal questions and a visual check, it turns out he has, indeed, only been shot in the forearm.

So during the abbreviated triage, it comes out spontaneously that Wiley, quite the party animal, was "looking for a party" in Not-so-nearby City when Sumdood (damn him!) shot our hero in his left forearm, as he drove by just minding his own business with the arm on the windowsill. Trying to get the mechanism of injury down, he's very certain that he was shot from outside the vehicle as he was driving.

So he then apparently had the presence of mind to drive through 6 surrounding cities, and then come to our not-a-trauma-facility for his emergency gunshot injury.

So I quickly get him settled in the back, notify the doc, and make the obligatory police agency notification, to spare the nurse in back another headache. And because I speak fairly fluent cop, and am pretty darn bitchin good at making mandatory calls painless for us and them.

Therefore I know that on an assault with fists and no desire to report on a busy Friday night, they'll only want us to inform the patient that they can always file a complaint report at the station later, if they change their mind; but I know that when a firearm injury is involved, police will drive across several counties to take the report. People getting shot in their jurisdictions tends to get their constituencies rather upset. So I know this guy is getting a visit, even if he doesn't.

With no one else to deal with, I go outside to let the parking minions know not to park, move, touch, or breathe too closely to Wiley's vehicle, because it's now a crime scene until further notice. Pity that he couldn't have shown up at 7PM, it might have chased a few more folks away to see their regular docs in the AM, but oh well.

So I take a quick look at the car from outside and a few feet away, through the open window. I notice after a minute's inspection that there doesn't appear to be any obvious blood inside the vehicle, nor any extra holes in the cabin. And on the outside, I notice there's a whole LOT of blood, up high and behind the driver's window, and sprayed back towards the rear.

Now, I'm not a cop, forensics examiner, or even a huge fan of CSI. But I know a tad bit about guns, and physics. So, as a rule, when a bullet passes into and out of your arm, blood usually spatters in the direction of the projectile. And people shot in the arm, don't, as a rule, wave their arms higher than their heads outside the car, for the 5-10 minutes it would take to create the Jackson Pollock-like canvas evident on the upper outside of Wiley's car. And the odds of them doing that without having a single drop get inside the car, and having a handy towel for the bleeding, and not having a single drop of blood on their clothing, and somehow driving past a dozen ERs before arriving at ours, are approaching Lotto Powerball numbers.

And, because it's slow, and the PD from Not-so-nearby City won't arrive in 2 minutes, it means I have time for a brief confab with the treating ER doc. We don't get into official forensic caliber diagnosis, nor describe entry and exit wounds. That's for the professionals and pathologists. But Wiley, it turns out, has suffered a very small hole consistent with a .22 on the medial side of his top L forearm, and a somewhat larger hole on the lateral side. Not diagnosing, mind you, but that's consistent with a bullet from inside the car going through his arm towards the outside. And Wiley, it turns out, was right-handed.

I file all this away, until about half an hour later, when a sergeant from Not-so-nearby City arrives. He questions me, and I volunteer my observations, and let him conduct his investigation and draw his own conclusions.

He notes the same data points. And during his investigation, recovers the loaded magazine for a .22 caliber semiautomatic pistol shoved inside the passenger seat crack. With one bullet less than a full load in it.

Then, last of all, he has a chat with Victim Wiley. Whereupon it transpires that Wiley can't remember the party he was looking for, any of the names of people who would be at the party, the supposed address (or approximate zip code, area code, time zone, or hemisphere), or where he was driving when he was shot "by Sumdood" closer than about a 10-mile radius. How...curious. He also has no explanation for what a magazine for a pistol got into the car next to his seat, nor where the towel came from, nor for why the car and his clothes are spotless, but the sidepanel looks like a butcher shop.

He isn't charged at the time, but elects to leave AMA after we bandage his wounds. And the police tow his car for further investigation.

So as a word to those with Low Grey Matter Titer, when you're a black guy with a multi-page rap sheet of prior gang-related offenses on your greatest hits list, cruising around an overwhelmingly asian neighborhood at 3AM "looking for a (mythical) party" in an area where you have no known friends or contacts, and you're resting the muzzle of your heater across your outer forearm while trying to set up a nice drive-by, you need to either avoid those "Pulp Fiction" style bumps in the road, or at least keep your booger hook off the bang switch, to avoid shooting yourself through the arm, having to go home, ditch the gun, and change all your clothes,  grab a towel, and drive across town and make up a total horseshit story before you get treated at an ER 30 miles away, hoping the cops won't show, and we'll swallow all that fertilizer like we were born yesterday.

But at least in this case, the stupid, it burns.

Read This Until You Get It

I know, with the 24 hour newscycle, and the endless rotation of stories that suit the agenda of Damning The Things The Liberal Media Hates intersects so nicely with Ratings, Ratings, Ratings Until Our Heads Explode, that lately certain stories pound you on the head until you think you have to opine.

Rule One of Having An Opinion: Make sure it's an informed opinion. Take it to the library and read to it, maybe get it a cable subscription and learn a thing or two, before you turn it loose in the city unaccompanied. Sort of precisely like you'd do with those other supergeniuses of Western civilization, your teenaged offspring. Until that point, resist the urge to prematurely launch.

And I know that some people mistake having earned certain letters after their name with The Right To Think For All Those Great Unwashed Stoopid People Over There.

So whether you're a doctor, nurse, professor, butcher, baker, or candlestickmaker, I would counsel that before you let your mouth, or your fingers, run away with you, you steadfastly avoid plopping out opinions that, much like your smelly socks, ought to be kept to yourself on Some Weighty Topic. Because usually, they just stink, and you embarrass yourself.

My case in point:

"I'm a really bitchin trauma nurse who's seen too many shooting victims, and if only people had to see what I saw, they'd set the Constitution on fire and melt all the guns down for scrap, just like I want to do. But they haven't, so they're not as smart as me. You don't need any gun I don't like for anything that isn't absolutely criminal."*

When you spew that much non-sequitr magical thinking childish psychotic nonsense out in one breath, you aren't speaking as a nurse (or a doctor, professor, etc., etc.). You're speaking purely as as a fucktard jackhole, and you've just wasted the few brain cells that your body hoarded all those years to maintain a pulse and respirations, and shot them right out of your ass. In front of the entire Internet, forever.

Unless you think that once someone had seen enough diabetic patients, they should be allowed to discuss banning Twinkies and Ding dongs.
And that once someone had seen enough rape patients they should be able to demand all men surrender their penises.
Or that after seeing enough drunks, we should re-enact Prohibition, or that enough MVA patients would justify banning all cars. Because, really, who NEEDS anything faster than a skateboard, unless you're a criminal, you frightened stupid babykilling kitten-stomping loser??

That's the level of retarded jackassical thinking we train 3 year olds out of, and which we document as proof of psychosis in crazy people.

If guns bug you, there's a far simpler solution: don't buy any. By no strange coincidence, that approach is also entirely legal under the Constitution. You can even tell your friends that in the realm of being a victim, you've elected to surrender, rather than risk being able to defend yourself against someone younger, bigger, stronger, and meaner. And to make sure all your family members are equally helpless, including children and infants. So if you don't have the moral resolve to announce what a cowardly jackass you are, don't try to ascend the mountain of your own imaginary moral superiority, and tell everyone else to follow your example, or worse, declare fiat ex cathedra that you'll just do all their thinking for them, based on your superior global omniscience.

"Medical misadventure" and pharmaceutical mistakes by doctors and nurses kill 10 times more people annually than all 300,000,000 guns in this country, going back to probably Jamestown Colony. Shouldn't we ban doctors and nurses then, because really, who needs a doctor more than once a year? And why should doctors be allowed to see more than 15 patients a week? Only a criminal would want to give them access to more victims.
I'm sorry you were sick the day they covered logic in school every year from about 10th grade to your Ph.D., but it doesn't work like that.

And such monumental jackassery is exactly the reason the Founding Fathers of this republic made sure that the closest you came to directly voting for anyone was to elect a bare 1 congressperson, thus ensuring that at any one given time, almost 49% of the brilliant "people" would be soundly ignored in each district, and up to 49% of the congress would be ignored in the capitol, on every issue, on every vote, forever. And they saw this limit on your would-be dictatorship as a feature, not a bug.

So next time you get a great idea, and you want to hear it echo because of its pure brilliance, go to the local big box hardware store, buy a galvanized bucket, put it over your head, then launch into your tirade, and drown out the sound of the rest of us with the cacophony of your own awesomeness.

Both you and we will be properly ecstatic at the results that step will guarantee on future results.





*Lovingly edited and paraphrased so that you'll never find out the actual identity of the intarwebxz Soopergeneyus who plopped that nugget out, while carefully paraphrasing every thought so that you, gentle reader, got the full impact of the author's self-evident rhetorical brilliance.

Violence In The ER

Maybe it's just me. Perhaps I've only worked in terrible places with terrible people. But I don't think so.
Maybe it's just that I'm a big, bad former Marine, and when one's only tool is a hammer, all their problems look like nails. Except I'm average sized, with a middle-aged donut (despite my brain's insistence that I'm still young), thus not really physically intimidating to anyone except perhaps Warwick Davis, a hobbit, or my cat. So in looking back at my anything-but-extraordinary career in the ER, I'm frankly rather astounded at what a throw-down knockdown hog-wrassling time it's been.

I've been spit on and at, punched, kicked, slapped, choked, hit in the head, clawed, gouged, bitten, urinated on, pelted with any number of objects and body fluids, dog-piled, injured to the point of temporary disability twice, one of which was potentially permanent and career-ending (and thankfully fully recovered from), assaulted, battered, and of course verbally abused, cursed at and threatened almost daily.

I've broken up fights, disarmed lunatics, and made at least as many tackles in my career lifetime as Dick Butkus did in any one year he played, and no disrespect to Mr. Butkus, but I did mine while wearing less pads and no helmet.

I've seen co-workers stalked, threatened with death, punched in the eyes, nose, mouth, and throat, had their heads yanked back by the hair, bitten so hard they had teeth marks a week later, had faces scratched, legs and knees twisted, need ice packs, Ace wraps, and stitches, been kicked in the groin, and had IV poles, power cords, chairs, instrument trays, canes, shoes, full and empty urinals and bedpans, and just about anything else you could imagine wielded, swung, or thrown at them, time after dozens of times.

Total number of patients or visitors arrested for assault or battery, let alone actually charged with violence against us, or prosecuted for same, in all that time: zero.

Is it just me, or is there something more than a little f*****d up with that ratio?

Police have bullet-resistant vests, pepper spray, tasers, batons, and guns. And numerous other cops one radio call away.

If we're really, really lucky, the hospital, one time in a thousand, might file a restraining order against somebody, once they've gone apeshit enough to get charged and booked into jail anywhere else in society. And hand to God, had anything like this happened to me at home, I'd have been well within commonsense rights and responses to have blown a few heads off.

So Houston, WTF?
Saying this is a problem is like saying the explosion of Mt. St. Helens was unsettling. It's telling the astronauts on the last Challenger ride that things would be a little bumpy.

Whose fault is this?

Society in general, for thinking that walking into the ER is carte blanche for doing what the jacktards with Ph.Ds, and too many with Nursing Ph.Ds, call "acting out".
What the police call it when it happens anywhere else is aggravated assault and mayhem, so let's quite pussyfooting around and using psychobabble happytalk instead of precise clinical language. Five year olds "act out". Adults are being criminally violent.

Hospital management, from relief charge nurses to CEOs and every worthless waste of skin and oxygen thief in between, for collectively and reflexively shrugging, and adopting the "Tough Shit, You Knew The Job Was Tough When You Took It" philosophy, which is a remarkably callous, spineless, gutless, and self-serving crock of a well-known substance when employee safety (not to mention the safety of everyone else in the hospital) is what's at stake. Coal miners in Appalachia get more respect from management than staff workers do in hospitals. In the words of one former military commander, "F*** You. Strong message follows." Those penny-pinching short-sighted bastards have never had anyone's backs except their own buttcheeks, mainly because that's where they store their heads on this issue, 365 days a year, plus an extra day during leap years. I'm remarkably well-read, and I've got pretty comprehensive recollection of my nursing school days, and I can't seem to recall reading in either the state penal code nor any textbook of nursing that the job of healthcare workers is to get the shit kicked out of them, literally, day in and day out until they either quit, retire, or die, yet I've seen and experienced that is the reality.

The police, for taking a "So what do you want US to do?" attitude, as if suddenly the laws of the city and state magically don't apply inside a hospital like they do at Fred's Bar & Grill.
(For the record, Officer, I want you to do to them what you would if it had been a "brother officer" they'd kicked, punched, spit on, or tried to choke out. Because if you don't, Hear Me God, I'm going to treat you like them, every time you and your brethren in blue enter my ER. Think about that long and hard when you just can't feel me about cuffing Mister Douchebag and filling out those nasty reports.) 
And a lot of that is because of the city and district attorneys who are too gutless and chickenshit to prosecute, in their entire careers, one case of violence against health care workers anywhere I've lived, worked, driven by or flown over since I Australian rappelled out of the womb on the end of an umbilical cord. As Casey Stengel said time after time, "You could look it up."

And lastly - not mostly, not substantially, not firstly, but certainly lastly - us.
Those of us who put up with being treated like punching bags, as though getting jacked up is some mark of special blessing, machismo, or street cred. Or because we didn't know any better, or because supposedly older and wiser colleagues told us, explicitly or implicitly "That's just the way it is." As Bruce Hornsby's song should have taught you, "Aw, but don't you believe it."

It's bullshit, boys and girls.
For the love of Jesus, Buddha, or the Flying Spaghetti Monster, stop acting like the dumbass battered wives and girlfriends you diss and scream at, strap a 2x4 to your spines, and stop putting up with being whomped on like it was some freshman hazing or dumbass rite of passage.

It's assault, battery, mayhem, and attempted murder.
Swear out the complaints, press the charges, and if necessary make the citizen's arrests required, and don't take no for an answer, or tolerate getting undermined by higher-ups.
When you feed the pigeons, you get more pigeons, and more pigeon crap. When you appease the bullies, you encourage more bullying. (And yes, you worthless wankers, I mean every one of you in a supervisory position who doesn't kick abusive people out the door on their fat whining asses, in 100% of cases, with zero tolerance, with security and if necessary a police escort.)

Or someday when one or fourteen of your co-workers, God forbid, finally gets a window blown in them by somebody with a 'tude and a firearm, because of all the times you didn't stand up and scream "ENOUGH!", it's going to be too goddamned late to tell yourself, or their families and kids, that you're really sorry you couldn't find the will, the wisdom, or the sense given to the dumbest jackass on the planet, with any number of legs, to act to end things before they went that far.

I'm not expecting to speed-dial 9-1-1 for every insaniac. That's what Geodon, Ativan, Haldol, hard restraints, and big security guards are for. And I get that both those on booze, PCP, meth, and those stricken with Alzheimers' or otherwise altered may be a handful.
Those are patients, and we'll deal with them.

But the ones who are AOX4 and just aggressive, hostile @$$holes, including spouses, parents, family, and friends in about a 10:1 ratio to the actual patient seeking care, need to be confronted with a simple common-sense standard: you attack those trying to help, you leave in handcuffs, and you never get to come back to us again.

I want the law in 50 states and every U.S. territory to be blessedly simple, straightforward, and unconfusing:
any threatened assault or actual battery on anyone in healthcare, from an EMT at the side of the freeway to so much as a custodial person at a hospital or a clerk in the doctor's office, is a straight out-and-out non-negotiable felony, and with the same mandatory 24 hour no-bail no-release jail time as spousal abuse. From Bangor to Guam, from the Bering Sea to the Canal Zone. And yes, that goes for drunks and drugheads. If we can charge them for manslaughter behind the wheel, we can damn skippy charge them for felony battery in the hospital or ambulance, and the quickest way to take the fun out of things is for The Man to deliver the smackdown.
And any continued verbal abuse or threat of violence whatsoever gets you kicked out so fast it takes your clothes a minute to catch up to your sphincter when you get ejected, and you get a restraining order filed the next morning in perpetuity.
To hell with "Three Strikes", let's try the "One Strike" policy, and see how it works. And post it in big red letters on signs right next to the cutesy "Patients Rights" plaques, at every entrance to every hospital:
"Any assault, battery, or threat of same by anyone against any employee here, for any reason, will result in immediate arrest and prosecution. Any verbal abuse will result in immediate and permanent ejection from the premises. There will be no exceptions under any circumstances and no second chances."

It's ridiculous that flight attendants serving Diet Cokes are given more protection from obnoxious businessmen under the law than the doctor, nurse, or tech working to save a life in the ER or at an accident scene working with drunks, drug addicts, certified lunatics, and world-class violent jerks, but they are.

None of us should have to lift weights and work for a martial arts black belt, or seriously consider wearing shin guards and knee pads, a cup, and possibly even a bulletproof vest under our scrubs just to do our jobs. Or to soberly weigh whether we'd rather carry pepper spray, a taser, or even a pistol hidden on our persons, breaking ethics, hospital policy, and possibly even state law, in preference to being one of the half-dozen pictures in the paper when some sub-human ghoul decides hospitals are the new place to go on a shooting rampage with no one who can shoot back.

There's a way to reverse things before it goes that far. (And if we don't, it's going to go that far, mark my words and note the date.)

It's far past time to stop mollycoddling the f*cktards, and start applying a little tough love. Generally, by giving them steel bracelets, and a 24 hour time out at the Graybar Motel, until the day comes when you're more likely to see icebergs off Miami Beach than hear about a healthcare worker getting roughed up.

Can I get an "Amen"?
And how many of the yapping pointyheads constantly carping about "getting nursing the respect it deserves" will help make such a policy reality, and how many will instead stare blankly like you've just grown another head, cough, shrug, and move on to studying the latest JCAHO Happygas, rather than saddle up for this fight?
Watch closely, and look and see who your real friends are when your own safety is under discussion, ladies and gentlemen.

Can I Get That In Writing?

"You guys are The. Worst. E.R. I've. Ever. Been. To!
If you aren't going to let me in to see a doctor right now,
I'M LEAVING and I'm NOT COMING BACK!"


Oh, by sweet Florence Nightengale's underpants, if I had only stipulated that I get paid $1 cash bonus every time Patient Crankypants pulled that withering nugget out of their diaper and flung it at me, I could have paid for trips to Maui to sit on the beach and ooze into the sands out of the proceeds annually since the day I graduated school.

(I should mention that I was ordered to remove the sticker on my badge I made with
DLTDHYITAOYWO 
as my last name, after some sharp-eyed House Super figured out what it meant. In case you aren't gifted at word problems, I'll give you a hint: "Don't Let The Door Hit You..." should get you started. You can probably work out the rest for yourselves.)

Hey, I'm all for choice in healthcare. Please, feel free to exercise yours by going somewhere else. Particularly any one of the 20 hospitals you passed on your way here, all of them with longer wait times, fewer beds and staff members, and lower ratings in virtualy every meaningful metric measured by human minds. If you thought your tantrum was going to reduce my coworkers or I into quivering blobs of tears, or rub our noses in the shame of the willful departure of someone healthy enough to shriek out the door, down the corridor, out the lobby exit, and all the way to their parked car, and get us to fling ourselves at your ankles to bodily restrain you from departing before we'd had a chance to fix whatever's ailing you, let me spew some of the Golden Warmth of Truth from my bladder right onto your pointy little entitled heads.

It. Isn't. Going. To. Happen.

Sorry if that reduces to tatters your master plan for getting all the turkey sandwiches and juice you could demand while you wait for the CT scan of your weekly abdominal pain, and enough blankets to shelter a tribe of Inuits on the tundra north of the Arctic Circle, plus enough sympathy from your friends and relatives over your tragic plight to redeem your broken childhood, and a never-ending fountain of opiates to make life's slings and arrows bearable, and all delivered to you on bended knee by your personal butlers and maids of the white-tiled linoleum palace you see as your private hotel, which we all call the ER we work in.

But see, it's like this:
even if you go, that only leaves 145,999 of your friends and neighbors, of the 400 people daily and nightly who literally darken our doorstep, who I'll have to fall back on to provide me with something to do, professional and personal satisfaction, and the resultant paychecks.

In fact, if someone stormed out in a huff every 15 minutes, 24/7/365, I'd be forced to console myself with the fact that we'd go from being one of the busiest ERs in the country, to only one of the Top 100. O, the shame, the ignominy of it all! 
And since most of you are paying for your visit, when you do at all, with money taken out of my paycheck to pay for it, frankly, my back's been hurting for a while just from carrying you all for so long, so you going away isn't killing me, and in all likelihood, you either.

May I suggest further that you take advantage of all the electronic gadgetry you tote around, and further decry our horrible insensitivity on Yelp, Twitter, and the local Restaurant Guide, and tell all the other whiny crybabies of your tribe out there that we suck harder than a thirsty elephant, and give service lower than whale droppings in the Marianas Trench.
If perhaps you could also tell the jacktards from Press Ganey that as well, maybe you could single-handedly induce the dipwads who pay for your shenanigans to stop reimbursing us for folks like you, and force us into the shame of only seeing people who actually retired from or still work at actual jobs to afford the healthcare they consume, pretty much like happened from the dawn of time until 2009, or perhaps even speed the demise of relying on how you feel about your hospital experience, rather than such worthless metrics as how many people we see, how many of them survive and improve, and how few of them get sicker, get infections from us, or have the gall to die under, let alone as a result of, our actual care. Because what could all THAT matter when compared to the unimaginable platinum and diamond-encrusted magnitude of your pwecious feeeeeewings?

And as you leave, could I possibly be allowed to reveal to you, that when everyone from your first pre-school teacher, to the principal who handed you your social promotion diploma, told you every day in every way that you were the Most Special Snowflake The Universe Ever Created, that they were lying their fool @$$#$ off, right through their teeth?

And thanks for choosing Callous Bastard Hospital for your healthcare needs today.


Sadly, despite the promise in your little hissyfit, we know that you'll be back again another time with the predictability of the tides.

#42

Lately I've been pondering a lot about What Is Wrong With (U.S.) Healthcare.
Mainly because so much is.
And none of it is what the genius "experts" think is the problem.

Suffice it to say, about 1000 things, and you aren't going to get them all in one blog post.

Let's call this one Reason #42.
It's a quote I read from someone who has nothing to do with healthcare other than reading the stories of those who work in the field.

"Health care “reform” nowadays consists of people with seven-figure incomes hiring consultants with six-figure incomes to make recommendations on how to step up the pressure on people with five-figure incomes."

Amen, brother.

1) If you're working in healthcare and making seven figures, unless you do brain or heart surgery on multi-millionaires, you're a selfish @$$hole. Bear in mind, I'm pro-business, a registered Republican with a firm grasp on the fundamentals of capitalism, and I believe that Bill Gates deserves every penny he makes. But there is nothing, nothing whatsoever, on God's green earth, you could possibly ever do, short of invent a cure for cancer, that justifies getting paid 5-10 times more than the doctors, 20 times more than the nurses, and 30 times more than the techs working for you, who actually do the work. A least the top guys at Ford Motors invented the Mustang. But you didn't invent the CT scan, or surgery, or f*ck-all else that makes the medical carousel go around every day. You're paper-pushing flunkies who somehow conned some hospital's board of $#!^-for-brains jacktards into believing that you possessed some magical inexplicable power that required compensation beyond all rational explanation. The next time you hear about one of your custodial staff qualifying for food stamps, please go kill yourself.

2) If you're hiring consultants, you're also an out-of-touch dipshit who should be getting off your fat ass, and taking a day every week to roll up your sleeves and see how things tick in your hospital. Look closely, and notice that admirals don't "hire consultants" to tell them WTF goes on anywhere on an aircraft carrier. This is because they freaking know what's going on, and if they had any questions, they'd take a short walk and ask a couple of questions. And they'd damn sure know in about 60 seconds, because that's how running a large operation works, if you don't have your head shoved somewhere looking for colon problems from the inside.

3) If you are one of those "consultants" (the best definition for which is "someone with a clipboard and a briefcase 500 miles from home reporting on something they don't understand"), I can't begin to express how loathsome and worthless you are, except to point out that even used-car salesmen and politicians have some quantifiable utility, unlike yourselves, and they both score at the bottom of the esteem scales for the entire rest of the population. So either quit and get a real job, or let's just repeat the desire that you go kill yourselves. Take one for the team, and improve healthcare for everyone else by not jacking it over any worse than you've already done, by checking out of the gene pool with all due haste.

4) The people you're stepping up the pressure on aren't cylinder head gaskets, they're flesh and blood. Every time you crank up the ratchets to fatten your bonus portfolio, they get ulcers, high blood pressure, more colds, more flu, and heart attacks. That is, if they don't call off sick, quit, change jobs, or kill themselves. Every drop of their blood is on your hands. And every time you damage or destroy one, everyone else left behind has to strap on that much more extra work. If you're a patient, think about how this burgeoning stress load on your doctors, nurses, etc., affects the care you receive.

I'm certainly no Norma Rae. I've belonged to two unions in my life, and I resent the hell out of them, for their dues out of my pocket, and for what they don't accomplish, as well as the protection and crappy work ethic they promote by protecting the incompetent, the lazy, and the criminal.

Despite that, it's becoming crystal clear that if we're going to continue running hospitals in general, and ERs in particular, like an immigrant-staffed sweatshop in the early 1900s, the only thing that's going to put a kink in somebody's truss is them running full face into an employees' union, or unions, to give out the kick in the crotch most management so desperately needs, and deserves.

Either that, or I get to carry a baseball bat to work, and I get five free swings at targets of opportunity per shift. And to be sporting, I'll do it from in front, and I'll give them all the dodges they can manage.