Telephone Advice

{Medicolegal boilerplate warning: Reader(s) of the following advice scenarios acknowledge(s) in a legally binding manner that by following any of the advice given below , he/she/they have stipulated to being dumber than a box of hammers, and accept full responsibility for all subsequent results, included, but not limited to, death, dismemberment, ridicule, and/or subsequent Finalist status on the Darwin Awards Website Hall Of Perpetual Fame. They further assume full responsibility for all government legal costs for recovery of penalties related to posthumous prosecution and conviction under the Air Theft and Skin Waste statutes of the Omnibus Ohmygod Howinblisteringhell Did You Ever Make It Onto The Internet Without Setting Yourself And Nine Contiguous States On Fire Act of 1972, as amended in U.S Code.}

RINGRING!!...RINGRING!! [which double ring designates an incoming call from outside the hospital].

“Thank you for calling Emergency Triage.”

“I have a thing on my whatsis, and it looks horrible? Should I come to the Emergency Room?

“Describe the thing please.”

“Oh, it’s ginormous! It’s multicolored, and gives me transient attacks of anaphylactic fibromyalgia and intermittent pseudosiezures, with cranial impaction to my sigmoid colon. And it’s excruciating!”

“Sorry, as you’ll know from reading WebMD all day, the alien larvae have almost reached full gestation, and they’re about to rip through your sternum and go in search of a new host for the next subbronchial  egg implantation. You should probably just book the cruise you’ve always dreamed of, and max out all your credit cards. B’bye. [Click]”

RINGRING!!...RINGRING!!

“Thank You for calling Emergency Triage.”

“My child looks sick. What should I do?”

“You mean besides taking your child to the doctor?”

“We tried that. The doctor’s office is only open Monday to Friday from 8-6, and 6 hours on Saturdays, and I’d have to miss my soap operas AND wait almost 45 minutes to be seen for a $25 co-pay.”

“Gotcha. We can’t have that. Let me take a look. Hold the phone up to your child’s face so I can have a look.”

“What?? You can’t see my child over the phone!”

“Wow, ma’am, lazy and smart is a rare combination. So you must have figured out how this is call is wasting my time and yours, and I’m getting paid for it, whereas you aren’t. B’Bye! [Click]”

RINGRING!!...RINGRING!!

“Thank you for calling Emergency Triage.”

“How long is the wait there?”

"Twenty seconds longer than it was before I answered this call. B’Bye! [Click]”

RINGRING!!...RINGRING!!

“Thank you for calling Emergency Triage.”

“I ran over my foot with the lawnmower, my toes are in a tree, and I can’t get the bleeding to stop spurting. Should I come to the ER?”

“Oh heavens no. Just soak that extremity in  warm running water in the tub until the pain goes away, and you start feeling sleepy. And tell St. Peter I sent you. B’bye. [Click]”

RINGRING!!...RINGRING!!

“Thank you for calling Emergency Triage.”

“I’ve had this headache for 47 years. Should I come to Emergency?”

“Wow, I know exactly how you feel. I’ve had this headache for 20 years, three times a week, whenever I answer the phone here at Emergency. So honestly, I think Emergency CAUSES the headaches, and you should stay right where you are. But if the headaches ever stop, rush right down here, m’kay? And promise to donate your body to scientific research after you die, so maybe next century, neuroscientists can find a cure for headaches like you, er umm, I mean like yours. B’Bye.[Click]”

RINGRING!!...RINGRING!!

“Thank you for calling Emergency Triage.”

“I need help right away!”

“No problem. I’ll tell the 47 people in the waiting room, including the two febrile pediatric leukemia patients, the 70 year old guy with crushing chest pain and blue lips, and the 37 people hurling into trash cans with flu to just hang on while I deal with you. Let’s start with your phone number.”

“In case we get disconnected?”

“No. I’m posting it on a 3x5 card I’m sticking up in the front window under the heading “Complaints Hotline”, so that when people here wonder why we’re taking so long to get their sick family members into rooms, they can get right to the source.”

“You’re crazy! I’m not giving you my number for that!”

“Wow, with diagnostic skills like that, you should seriously consider a career in the psychiatric profession. B’Bye.[Click]”

 Morals of the Story:

Dear Beloved Telephonic @$$clowns Of The Universe:

1)      Make an appointment with your doctor.

       2)      Keep the appointment with your doctor.
       3)      Follow the doctor’s advice. (Yes, that includes GETTING the pills, and TAKING the pills, until you’re FINISHED with the pills. What a concept, right?)
       4)      If it doesn’t work, either repeat steps 1-3 with that doctor, or get a second opinion by repeating steps 1-3 with another doctor.
       5)      If this is a real life-and-death emergency, call 9-1-1.
      6)      This includes when it takes 5 of you to drag grandma’s comatose body down 5 flights of stairs, bringing her to the drive-up door, and expecting all 1 of me to pry her out of the backseat of your MiniCooper.
       7)      If you’re too stupid to figure out if this is a life-and-death emergency or not, don’t call me or anyone like me. Just sit down and wait. If it isn’t a life and death emergency, and you refuse to try steps 1-3 above, you’ll be fine.  And if it is, we’ll be fine without you. Remember, all bleeding stops, eventually.

And note for reference that in Eternity Hereafter, if I don’t find Florence Nightengale and Clara Barton kicking Alexander Graham Bell in the junk forever, know that the line for that will be forming right behind me.

Thank you for calling Callous Bastard Hospital ER.

Please Stand By

Work is crazy busy, which is a good thing in this economy, so paying bills is taking priority at the moment. I'll have some new posts by the end of the week.

Soundtrack 3.0

Once again, another magical Mix To Treat Patients By, 21 cuts to cover all the bases, and get you through another long weekend in the ER:

"No Particular Place To Go" by Chuck Berry
"Why" by Annie Lennox
"Cuts Like A Knife" by Bryan Adams
"Ring Of Fire" by Johhny Cash
"Emotional Rescue" by the Rolling Stones
"Maxwell's Silver Hammer" by the Beatles
"Heartache Tonight" by the Eagles
"How Do The Fools Survive?" by the Doobie Brothers
"Mack The Knife" by Bobby Darin
"Crash and Burn" by the Bangles
"Can't Get It Out Of My Head" by ELO
"She Blinded Me With Science" by Thomas Dolby
"I'm Hurtin" by Roy Orbison
"Heartbeat City" by the Cars
"Only The Good Die Young" by Billy Joel
"The Bug" by Mary Chapin Carpenter
"You Wreck Me" by Tom Petty
"Murder By The Numbers" by the Police
"Homeless" by Paul Simon
"I Think I'm Paranoid" by Garbage
"O Yeah" by Yello

Sour Trout

The title is one of the best and funniest sign-ins I've ever seen as a triage nurse, and I only wish I'd written the first 500 like that down, because I could write a book, and retire on the royalties. Or at least get a nice week on Maui.

In case you, unlike just about any ER nurse worth their salt, can't tell what the chief complaint is, it's "sore throat", approximated lovingly and with due diligence by someone whose English skills are somewhat lacking, which is about half my patients hereabouts.

And while that one isn't bad to read, it isn't the first time I've run across it.

Once upon a time, as a tender apprentice in the program at Seventh Circle Of Hell Hospital, where they took six months of class and clinical to push larval ER nurses out of their little Playdoh Fun Factory Mold, I ran across the same chief complaint.

Helpfully, they would do our classes two days a week, and run us through 3 days a week of clinical, on training wheels, with experienced nurses nearby. Which was good, because while I'd been a nurse for half a dozen years and worked without a safety net outside the hospital, their particular brand of patient experience was truly a priceless way to learn, by which I mean the place was ghastly in terms of volume, acuity, and overall suckiness. But hey, once you've played at the Palace, you can work anywhere, right?

So one day found me as the nurse in the back half, treatment, of the walk-in ward. The great part about this area was that everything would walk up, from hangnails to full-on heart attacks. We only kept the minor stuff, but in the pre-ratio days, that meant 8 hopefully minor patients for me, and 50 people waiting for the other nurse out front bringing them back.

And on this particular day, I not only had a brand-spanking new ER resident right out of internship, but the good fortune and favor of the Gods of Emergency Medicine had also helpfully provided me with Dr. DoneItAll. Dr. DoneItAll was able to open up his wallet and tumble out a cascade of about 200 cards, certs, training, and a like number of boards, peer-reviewed articles, etc. covering just about everything. Including probably radiation treatment in the Arctic for the hyperbaric chamber patient, come to think of it. On top of which, he was a really outstanding ED physician, excellent teacher, and a helluva nice guy to boot, which made him not just tolerable, but a genuine delight to work with.

And to help me in my monkey-see, monkey-do days of learning the business of emergency nursing, just the day before, the lectures had helpfully covered the main details regarding eye, ear, nose, and throat complaints we needed to pay attention for.

Thus when my patient presented with fever, sore throat, swollen neck, painful swallowing, drooling, and told me "I habb a sour trout" in the most classic I-have-a-hot-potato-on-my-tongue voice I could have hoped for, I wasted no time in stepping out to go tug on Dr. DoneItAll's sleeve, and inform him "You need to see the patient in Cubicle 2 NOW, please."
And, without questioning me, he stepped in, did about a 30-second physical exam, and stepped out.

"Peritonsillar abscess. Pt. to EENT Emergency, STAT."

And turned to me and said "Nice catch. Strong work."
Which, at Seventh Circle Of Hell, was the equivalent of hitting a home run.

But it's always nice when Fate lobs a nice slow breaking ball right out over the plate for you to smack over the fence in the first place. If only they were all that easy.

The Legendary Mr. Shipley

In my tenure at Seventh Circle Of Hell Hospital, it was observed on more than one occasion that we didn't see 3000 patients a week; actually, we saw 150 patients 20 times apiece. Which came far closer to the truth than anyone wanted to admit.

But King of the Cockroaches (as many refer to the patients who refuse to die, despite massive doses of radiation) was everyone's favorite, Mr. Shipley. And when I say everyone, I mean, everyone within 100 miles.

No mere gainsaying and hyperbole this, because on countless occasions, I personally witnessed paramedics from 3 cities away, who hadn't worked our area in years, or even decades, observe no more of him than Mr. Shipley's Santa-white mane of hair poking out from under an ambulance blanket as he lay waiting in the hallway for a room, who then kicked the gurney as they went past, and greeted him by name. And they all knew to take his cane away from him, because when sober he was the nicest guy you'd ever meet, but when he was drunk (about 90% of every waking moment) he was a mean mofo of a drunkaholic to deal with, not above whacking you with his county-supplied walking stick.

His modus operandi was stupid simple. He would get drunk, on whatever. He would fall down. His drinking buddies on Waste Of Skin Row would call 9-1-1, and report he was having a seizure. He would be picked up by paramedics. He would be brought to the hospital. He would receive multi-thousand dollars' worth of full-court work up, including head CT, all while roundly m*****f****** everyone around. He would sober up somewhat, along a blood alcohol continuum from 700 to the low 200s. He would be admitted. He would elope. Then he would get drunk, on whatever, and begin the cycle anew.

One July, a new resident guilty of nothing but unsupervised greenness, ill-advisedly called medical records, and requested Mr. Shipley's medical file. About 15 minutes later, two file clerks rolled up with two mini-shopping carts, and dumped the equivalent of four Manhattan telephone directories on the resident's desk. It was seriously a stack 3-4 feet tall.

"That's everything for this year, doc. If you want anything more, I'm going to have to call in some help to haul it all upstairs."

Conservative guesstimates put Shipley's recidivism in the ER at upwards of 250 visits/year. One week, I worked 5 12-hour shifts, but he beat me, arriving there 6 times. I discharged him one early morning and he was back in the ER before I was, on the same day. Assuming a generously low rate of $2K/visit, you figure it out.

Even at Califrutopian real estate prices, it would have been cheaper for the County to buy Shipley a modest house, and have enough left over to employ both round-the-clock bartenders, and nurses, plus all the distilled consumables he required, with change back from what his medical care was costing annually(and been able to resell the house, someday). And Shipley was merely one of hundreds in our little slice of paradise by the Pacific.

I only half-mockingly proposed that instead of my third shift every week, they instead purchase a 40-pass. party bus, a paper shredder, and a couple of cases of 40 ouncers and other stuff. I outlined that I'd drive around downtown picking up our favorite derelicts, get them on the bus with free beer and booze, and deliver them, suitably lubricated, to a different city west of the Rockies every week. After helpfully shredding all their personal IDs and paperwork. Portland, Salt Lake City, Denver, Albuquerque, whatever.

There was some slight risk that those cities' constables might have figured out what was going on, when 40 bums they'd previously not seen arrived, all claiming to be from the greater SoCal area, and all without a shred of documentation in proof thereof. But such was a minor irritation, because
1) They might send the bums back to us, but we'd still have gained a few days respite from their predations on our medical resources.
2) They might retaliate by sending us their bums, but at least we'd get new faces, and perhaps set up a Bum Exchange Program among the various metropolii, which might also broaden the horizons of the bums in question, and give everyone new folks to play with.
3) Most likely, once they realized they weren't in Kansas anymore (or rather, were in Kansas, but wanted to be in L.A.) the bums would avoid the cops, and set out to return homeward. And pass a liquor store on the way. And that, quite simply, would be the end of that Grand Scheme.

I could never get the Head Wheels to go for my plan, but they were suitably impressed that I'd thought it through so thoroughly.

Leaving us, day in and day out, stuck in the clutches of the federal EMTALA act, mandating that we have to lather, rinse, and repeat, for everyone, despite the futility and wastefulness of the effort. Next time your grandmother has to wait in the waiting room, or her ambulance gets diverted three hospitals away for her heart attack, be sure afterwards to take pen in hand, and thank your congressman. And please remember, you're picking up the check.