Important Safety Tip

 

F**king It Up By The Numbers

 

Today's tale of How Not To Do Your Jobs:

(PITTSBURGH) Eugene Wright of Meadville says police and medical workers got the wrong man when they transported him to the local hospital this summer and injected him with anti-psychotic drugs against his will, thinking he was someone else.
"The experience that I went through, this should never happen to anybody. It's very simple to check ID," said Mr. Wright, 63. "These people need to be held responsible."
Mr. Wright and his wife, Carolyn Wright, made their allegations in a federal lawsuit filed Wednesday against the police in Meadville, the Meadville Medical Center and a local crisis center, Stairways Behavioral Health.
Mr. Wright had the misfortune to have the same name as another Eugene Wright, a psychiatric patient who police said had issued threats at his doctor's office, his suit says.

RTWT.

Long story short: they did, in fact, have the wrong guy.
"But they were acting in good faith!"

Yeah, right up until that failure to look in his wallet, or call his employer or the ortho doc to confirm they had the right guy- or not. Times everyone from A to Z. No exercise of due dilligence equals gross negligence and depraved indifference to the consequences. And deserves a prison sentence.

So Innocent Bystander gets hauled away to the nuthouse.

And now, I'm the Pittsburgh D.A., by the power of the Internet.
What happens?

Officers Sh*thead and F**kstick are suspended without pay for battery, kidnapping, false arrest, false imprisonment, criminal conspiracy to do all of the above, and making terroristic threats. They deserve to be fired for cause, and referred for criminal prosecution.
The representative for Stairways who accompanied them gets charged with making a false report, criminal negligence, and accessory to all the charges against the Meadville PD.
Any nurse(s) who gave the medications has their license suspended, and is charged with criminal medical battery on a patient and gross professional negligence, along with false arrest and false imprisonment. Their license(s) gets revoked by their state board, and they get referred to criminal prosecution.
Ditto for the ordering MD at the hospital.
All of the above: the PD, the crisis center, the hospital, the nurse(s), the doctor, get civilly sued for the maximum penalty that a jury will accept. The chief of police, and the CEOs of both health facilities are also named as co-defendants civilly and criminally for gross incompetence and criminal negligence leading to battery, medical battery, kidnapping, false arrest, and false imprisonment.
Oh, and sue the orthopedic doctor and his staff for failing to make a complete report. They deserve some love in this too. 
The cardinal rule I've observed in a couple of decades in the E.D. is that the more you're arguing with someone, the exponentially greater the likelihood that they're right and you're not. Break the chain early, and double check, especially when it's as easy at it would have been here to sort it out with certainty.

It was the responsibility of the nurse treating that patient to make sure he/she had the right patient - not just the one the doctor pointed at, but that he was indeed the mental health case in question. When nothing more than an ID check and one phone call would have raised the question and undone the entire chain of errors here, there's no excuse, for anyone involved. Some criminal arrests and indictments would drive that home satisfactorily.

I don't have the medical record info here, but if the patient was not in any way an imminent danger to himself or others in the hospital, there was no reason whatsoever to administer ANY medications to him under any circumstances. If the record shows that he did nothing but raise the obviously valid legal and medical point that they had the wrong guy, and was not physically combative, they should be fired and sued just for that act. That's medical battery all by itself, even if he was the correct whackjob in question.

There should be five to ten people facing actual state and federal prison for this incident, and the plaintiff deserves a mid eight-figure payout to drive the point well home.
And then every staff member of the PD, crisis center, and hospital, down to admitting clerks, has to undergo mandatory training by the state, at their employers' expense, on properly validating the ID of a mental health patient in crisis adequately and properly.

When you have someone frothing and barking on scene, that problem is solved. But when you send your minions to round up people in the community, and end up kidnapping the innocent off the streets and hooking them up as psych cases, it needs to leave a mark, in both the criminal and civil divisions of the superior court, and at the federal level. (Posit this guy as someone with a valid CCW and carrying when the cops roll up, and let your mind wander how it turns out. One or more people dead, because a clerk had his/her head up their own ass. That's why everyone who screwed this pooch should be fired and criminally prosecuted, and not just sued into poverty.)

This is utterly unconscionable and inexcusable behavior at every level, and several people need a long, quiet time in a small gray cell - let alone some frequent group sex sessions in pound-you-in-the-ass-prison - to contemplate the responsibilities of their former jobs, and the rights of the people they're supposed to be serving.

After that, they can get jobs greeting people at f**king WalMart for all I care.
They're shitbags as human beings, and if it were my relative or yours involved, the full measure of justice in this kind of case would require baseball bats and some emergency dental and orthopedic surgery. Blowtorches and pliers might possibly be involved.

The Show That Never Ends

So, with the entire hospital full and packed to the rafters this week, X number of E.D. beds, and 4X number of waiting room patients all friggin' night, I walk into my shift after clocking in early, because of the page of a violent patient in the E.D.

Four hard restraints, three assaulted staff members, two police responses, one bite mark, and a cuckoo in a bare room later, and that issue is settled while the meds kick in.

Oh, and no points for guessing who's getting that patient as part of their assignment.
So as the night wears on, Fate has firmly tattooed her heelprints on my backside, because I'm getting my ass thoroughly kicked, and even though we're closed, we get a call we can't turn away, for a STEMI inbound in 5 minutes.

And I'm also doing the critical beds tonight.

FML.

That'll be me in the white tonight.

 

So our patient arrives, with the paramedics having done damn near everything (mad props, guys), he's got a STEMI on the field 12-lead, tombstones on the 3-lead monitor, and a STEMI on our 12-lead. And a classic CP presentation. So we're pretty sure it's a heart attack. We dotted all the "I"s and crossed all the "T"s, and we're just waiting for the cath lab doc's arrival to move him over, when the little stinker patient codes. Fifteen seconds of compressions and one defibrillation later, he's back, with the wife biting her fingers off watching, and off he goes to cath lab, finally.

Where it turns out he's got one coronary artery 99% occluded, and another distal one that's at 90%, both of which they stent.

So as I leave, the family is in the ICU waiting room, and I've already talked to his ICU nurse, where the patient is smiling and joking with the nurses, and liable to get a few more decades with his family, after getting to the hospital just in time.

Because everyone from the paramedics to the E.D. to the cath lab to the ICU are badass rockstars, on their "A" game.
And I get to leave the family with smiles, instead of tears.

That'll be me as I walk to the parking lot that morning end of shift.

Stream Of Subconciousness

welcome to Hell I'll be your tour guide I love the sound of a waiting room full of screaming babies at the beginning of the shift because at least you know it has to get better everything's done on all your patients but the entire hospital's full so let me make sure everything's really all done oh look, a few details missing hey we're just waiting for beds and waiting for beds and waiting for beds and I don't know how long it's going to take another call light ma'am the alarm goes off because you keep bending your arm and playing with the pulse ox why haven't I sent my patients up maybe because you gave us bed assignments that still have the old patients in them oh hey they moved all their patients out now so all your beds are ready simultaneously but you'll have to transport them all yourself because we have no tech and there's no transport are you ready for report see you in five minutes are you ready for report see you in ten minutes are you ready for report see you in twenty minutes are you ready for report see you in about half an hour tell triage all my beds are empty clean and ready for the next batch ready for your lunch break see ya so we loaded up all your beds but one full arrest found down doing cpr eta five minutes out they're here PEA stop compressions vfib CLEAR we've got a pulse vfib CLEAR PEA resume compressions pulse check vfib CLEAR we've got a pulse get me an ekg right away doc vfib f**K! CLEAR we've got a pulse vfib CLEAR PEA resume compression pulse check we've got a pulse here's the EKG if that pulse holds we can get them to cath lab vfib F**K! CLEAR pulse is holding cath lab is here yes sir you can go with her there's a waiting area the surgeon will come find you right afterwards ICU is still full so cath lab is bringing the patient back here after they're done surprise the cardiac stuff wasn't the reason at all but your patient isn't going to make it and there's nothing else we can do great I'll just tell dad to explain to the four young kids that mommy's never coming home again with only two weeks from Christmas that should really cheer them all up but the chaplain's here Holy Father, we ask you to please ICU is sending a nurse to monitor your patient until something opens up in the unit, so you can just take care of the other patients you have while the twelve family members are sobbing their hearts out across the hall from the crazy patient we just gave you who decided he's fine and wants to elope because he's crazy whatever and hey look the docs ordered food for everyone and thank god it's two hours until day shift and the waiting room is finally empty and now I only have twelve patients in that room and the one the ICU nurse is taking care of is the only one in there with nothing to worry about if I hear one more heart-wrenching sob I'm going to completely lose it myself and then I'm no good to anyone and why isn't it shift change yet my knees were over tonight five hours ago free at last free at last and how come the shittiest nights ever in recorded history are always the first of three in a row instead of the last one, every single time, forever and Dear God, WHY? WHY? Just WHY...? hug your kids and WTH? how am I ever going to see to drive home when it's so damned dusty inside my eyeballs

So, how was your night?

Some days, I actually get home with enough energy to go do a couple of miles of jogging, have a nice shower, and go to bed.
Other nights, I get home with enough energy for a short bike ride, then have a shower, and go to bed.
And then, thank a merciful heaven not too damned often, are days like today: when I'm putting on the gloves, and beating on the heavy bag until my arms are too numb to hold up, and my soul stops hurting, so I can stumble to sleep from exhaustion, and hope I don't wake up until it's time to get up again for the next shift.

Level I Drama Center

There are precious few things you can control as a nurse.
As a nurse in the E.D., that number dwindles even more.

Because whatever comes in the front door, or gets delivered on a platter at the ambulance bay, you're getting. 
An entire basketball team of DKA patients, all with blood sugars of over 900, and the highest at 1300.Back to back to back to back STEMIs, all going to cath lab.

Train wreck stroke, who gets an ICU bed, followed by another train wreck stroke.
Four hot appys in a row, the night the whiniest surgeon/OR charge nurse is on call.
Ten psych patients, half before lunch, whom you get placed, followed by five more.

Tag, you're it!

And, truth be told, that can actually be the fun part, when you dig in and get it done, because you get an oak leaf cluster on your Badass Recertification Ribbon.

But there are things you can control.
Write them on your hand in sharpie in case you forget.

1) Don't make your workplace a Level I Drama Center.
I'm working travel and registry, and I promise you, I'm all out of f***ks to give about whatever bitchy little internal squabbles you want to unpack and play with in the middle of a code, or a biblical level of ambulance bay shitstorm.
Do that to me in the middle of a code, and I will wait for you to go into the med room, I will bring a #11 scalpel, and I will cut your carotids, and leave your carcass there for the next luckless sumbitch to find and deal with, I swear to you.
Do it because you have nothing better to do on an average busy night and I'll tie every monitor cable in all your rooms into square knots, I'll triage you every crying puking kid with a fever, and I'll pay the lab tech to tell you all your blood draws were hemolyzed and need to be re-drawn. Better than 50/50 odds they don't like you either, and will do it for free. Ask me how I know.

2) When a co-worker is drowning, you throw lifelines, not boat anchors. 
I'm not talking about the one who's never around when you need help; letting them drown is karma in action. But FFS, when you're caught up, and you see someone else getting beat down, pitch the f*** in. And when somebody does it for you, you say "Thank you", and you owe them a solid, which you pay back the next time it's their turn getting fed into the Giant Woodchipper of Karma, feet-first.
Sometimes just doing one thing for them can take the last straw off the camel's breaking back, and turn their night around. I've been on both ends of that deal, and it's really a thing.
If you don't have that work ethic, you should die of crotch cancer.
Slowly.

3) There's no "Fuck you" in "Team".
If I have to remind you of this, you've already fucked up, and you're not on the team.
I am middle-aged, devious, under-handed, and I have a memory like an elephant, and I will pay you back, with interest, when you've forgotten why you're getting the 30-foot-long party sub sh*t sandwich.
And then I'll make sure you get seconds.

I generally enjoy my job, I appreciate everyone I work with from janitors to surgical chiefs, and I tell them when they're getting it right. It costs me nothing.

But I have passed the point in life where I care if your feelings are hurt because I had to tell you to stop being a wand-waving crap-stirring drama queen, and in fact, if I see it pushes your buttons, I'll make sure to do it in front of God and everybody at the main station, during shift change, and leave you with a big pie-face of fail to wear around as a trophy.

The patients bring enough crap in the door, some of them because they're having a serious problem.

If you aren't getting enough drama in your life without bringing yours to work, quit your hospital job and watch soap operas.
As an old master sergeant explained to me way back in the day,
"You play my game, and I'll play yours. You work with me, and I'll work with you. But if you try to screw with me, I'll screw you over twice as hard, and then again, and again, until you cry for your momma. Do not test me on this."