Back Pain

This is one of those times where, if I hadn’t seen this with my own eyes, I’d have trouble believing it.

While I’m in the room with a patient, checking vitals or somesuch, one of our financial minions comes in to get the patient’s financial info, and take care of any copays, etc.

Queen Latifah puts down her iPhone, reaches her $200 custom nails into her Coach purse, and  hands Minion her government issue Medigimme card.

While I’m cycling a blood pressure on her on the machine, Minion returns.

“This card is no good.”

Mind you, it’s a state-issued medical benefit card, ridiculously easy to get, with no expiration date.

Queen Latifah doesn’t miss a beat, pulls out another card, and says “Try this one.”

Before the BP has finished, Minion returns again.

“This one’s no good either.”

This time, with my own eyes, I watch in amazement as Queen Latifah pulls out a stack of Medigimme cards, fans them open like a Vegas dealer, pulls one of at least a baker’s dozen out of the fan, and says, “Try this one.”

Minion returns after about 3 minutes, just as I’m moving along, and says, “Here’s your card. Thanks.”

As we're leaving the room, I ask Minion if the cards were all the same for the patient.

“Oh no,” she says. “All different names.”
 

Well, color me surprised.
Here I am busting my @$$ nightly to take care of the poor indigent downtrodden masses, and they’re busy working the system like a broken slot machine with both hands and a crowbar. No wonder my feet and back hurt. I’m carrying this lady and her 15 alternate identities around for a piggyback ride every day I’m working.

And so are you.

Tell me again how there’s no health care for the poor.

Gun Control

Don't expect a political rant. I visit other blogs for that.

Patient is signed in with "GSW L Eye".
Consequently those of us working in the Minor BS section of the ER wonder how that qualifies him for our little corner of heaven.

So when he's delivered to us, it turns out that he's suffered a pellet gun shot to the L orbit. Actually, about 1/2" below and proximal to the L eyeball. But natzsofast, because some of those pellet guns are pretty darn powerful.

Both eyes are fine. He's conscious, breathing, and sees 20/20. And has a small (.177", in point of fact) puncture wound through his L lower orbit, almost in the L nostril. And he's 15, with the obligatory sh*t-eating grin of the invincible immortals of adolesence, along with the near-total lack of higher brain function characteristic of the species.

Seems that Boy Genius royally pissed off his baby sister, when he and some of his partners in crime shot her in the gluteus with his paintball gun. It was clearly a snort-worthy affair for them, whereas she was, to put it mildly, a tad put out over the pain, embarassment, and her brothers' general @$$holeishness. Doing it in front of his friends was bad. Doing it in front of her friends was bloody well unforgiveable.

Apparently in sis' doctrine of equivalent retribution, the correct punishment is "An eye for an @$$", so when next time her older brother decided to mete out some sibling douchebaggery, she retrieved his pump-up pellet gun, and 10-ringed him in the face, just south of his eye and slightly east of his snot locker.

Which gave Boy Genius a moment's pause, and landed him in our little lashup.

CT of the head revealed, nay demonstrated, that God clearly looks out for drunks and fools. Boy Genius had a blood alcohol of .000, so you do the math on what remains.

Treatment was uncomplicated: topical bacitracin and bandaid to puncture site.

Discharge instructions were threefold:
1) "Thank Jesus, Buddha, or the Flying Spaghetti Monster, that you're still alive and whole.
If she'd hit you 1/2" higher, you'd be blind in one eye. The radiologist says that the pellet is lodged just short of your brainstem - that's the part that makes you breathe, have a heartbeat, and maintain a blood pressure - after passing within less than 1/2" of your interior and exterior carotid arteries to the brain, and contact with any one of which would have killed you deader than canned tuna before you'd hit the floor. God gave you a second chance in life, so don't screw it up." - ER nurse
2) "The pellet may contain iron or steel. If anyone, anywhere, ever mentions sending you for an 'MRI', get up and run far, far away." - ER doc
3) "Stop pissing your sister off." - local cop, mandatorily notified and dispatched upon report of GSW sign-in.


We can treat pellet gun holes.
Treating @$$holes is a bit more problematic.

Some Things I Know

A couple of former girlfriends would get bent seven ways out of shape when I'd occasionally, gently, but rather forcefully direct them away from perceived trouble, or make hasty departures. It was only after I told them that people speaking inappropriately loud in public are usually either drunk, crazy, or both and I wished to avoid the splatter and spare them as well. When a couple of incidents went predictably pear-shaped as we were making an exit, the grumbling ceased.

I know that people who get obnoxiously abusive aren't that sick or in pain, they're just personally offended that we haven't recognized their inate superiority to the rest of us humble mortals. That judgement has never been disproven in thousands of experiments.

And when you earnestly and precisely announce to me, inside triage while I'm checking your vitals, that you need help breathing, because you're not a bird, because you can't fly; but you are a fish, because you have gills, I know with absolute certainty, despite your denial of prior mental health issues, care, or prescriptions, and despite never earning a license to practice psychiatry, that you are incontrovertably just plain batsh*t nuts.

But just to be scientific, I checked, and nope, no visible gills.

Chief complaint on tracker of "SOB/Blocked Gills" got me a phone call. Hey, it was your policy to have us type it in just as the patient described it. I would have simply put in "psych eval", but noooooooooooo.
The charge nurse was somewhat surprised when I asked for an open aquarium stat, and the doc politely declined my offer to acquire a diving mask for him before his physical exam.

Flying Fickle Finger Of Fate

I, like 50,000 other emergency nurses, am pretty damn good at my job.

Which makes losing someone just that much harder to deal with, most times.

I'm not talking about when the 89-year-old senile hypertensive diabetic post-CVA Parkinson's patient with metastasized brain CA comes in as a full code, in full arrest, and with no family closer than 2,000 miles away, if any can even be found. Those are times when, instead of recording what's being done, I want to kneel down next to their ears and whisper "Walk towards the light." as the compressions continue.

I know hospice and ICU nurses who do exactly that, without apology, to let patients who've struggled in excruciating pain beyond any reasonable expectation for so long, know that they just want them to relax and let go of the rope, and they tell them it's okay to go.

And for them, and us, it is okay that they go.

But when an acutely sick patient comes in, and it's someone too young in our mortal estimation to be ready to check out, and our efforts fail, it really really sucks. Deep down inside, where we put the things we feel too much. It makes you feel want-to-cry sad, not-a-Catholic-and-still-feel-like-you-need-confession guilty, and how-did-this-happen inadequate. And if you're anybody but me, for whom a Dr. Pepper is a hypercaffeinated binge and alcohol is only for mouthwash and Nyquil, you probably have an urge to knock back an adult beverage or two. It's hard on our egos and humbles the sober estimation of our own skills and abilities against an implacable universe, it's tragic for the family, especially when they're standing right there, and obviously it's generally quite a shock for the patient.

Like Captain Kirk, I don't believe in the Kobayashi Maru scenario, the unwinnable test. It's an affront to our skills, looks bad, feels bad, and dammit it just ain't fair. We win so many times we forget sometimes we don't. So helpfully, reality delivers a nice cruel stinging gobsmack, just to keep us honest with ourselves.

There's a scene in The Guardian when movie Coast Guard rescue swimmer Ashton Kutcher asks Kevin Costner what his number, i.e. how many people he's saved, is.
Costner, playing a 20-year veteran rescuer, tells him it's 22.
Then he tells him that's how many people he lost over the years, which number, he says, is the only one he ever kept track of.

I can totally relate to that mentality. (In fact, I wish the guy who wrote it would get out of my head.)

As much time as we spend with the whiners, the crazies, the system abusers, and all the walking minor wounded, the battle we...alright, that *I* fight, is really mainly against Death itself. I say this fully appreciating that his batting average is 1.000. But by and large, not on my watch.

So when a guy not old enough for social security comes in the last 30 minutes of shift with severe abdominal pain, and you get his IV, draw the labs, and get him medicated, comfortable, and off to CT in mere minutes, glad he's feeling better and relieved that you aren't leaving any messes for day shift to clean up, nothing takes the wind out of your sails like the doc telling you just before hand off that he thinks the guy is ripping a Triple A.

Except coming back to get report from the same nurse you handed off to the same night of the day you went home, and finding out after he got his CT, and with his family standing all around the bedside, the ones who thanked you for easing his pain that morning, he finished ripping that AAA, bled out internally and died in about 3 minutes, an hour after you went home.

Sucks, sucks, sucks.




My number is 11.

Soundtrack

Tonight, your ER DJ has cued up the official 21-track weekend mix, Soundtrack To Treat Patients By, for your listening pleasure: 


"Saturday Night's All Right For Fighting" by Elton John
"Shattered" by the Rolling Stones
"Stiletto" by Billy Joel
"They're Coming To Take Me Away, Ha Haaa!" by Napoleon XIV
"Heart Attack" by Olivia Newton John
"You Don't Mess Around With Jim" by Jim Croce
"Maybe Baby" by Buddy Holly
"Dead Man's Curve" by Jan and Dean
"Twilight Zone" by Golden Earring
"Go Insane" by Lindsey Buckingham
"Don't Fear The Reaper" by Blue Oyster Cult
"Just Another Manic Monday" by the Bangles
"Achy Breaky Heart" by Billy Ray Cyrus
"The Stroke" by Billy Squier
"Tubthumping" by Chumbawumba
"Big Gun" by AC/DC
"Crazy" by Aerosmith
"King of Pain" by the Police
"Zombie Zoo" by Tom Petty
"Died In Your Arms Tonight" by Cutting Crew
"Send Me An Angel" by Real Life

Enjoy.