Sunday, June 30, 2013

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.

Tuesday, June 11, 2013

Raging Bull&#!^

Okay, first, read this tale over at Dr. Whitecoat's blog.

Just for reference, I may have mentioned this subject before.

And I may, perhaps, keep bringing it up until any assault on any health care provider gets you an instant non-negotiable 24-hour stay in the Graybar Motel, just like wife-beaters and drunk drivers.

One, because that's not too much to expect, and
Two, because it's f***ing the way it should be.

We have, in the referenced tale, a perfectly reasonable description of an incident that happens with tedious regularity, especially in emergency departments, but in fact, throughout healthcare, and we yawn at a situation where someone committed criminal battery on the nurse, then multiple staff members, but had to rise to actually assaulting and battering a police officer - a man with multiple backup officers right next to him, and a tazer, bulletproof vest, service pistol, and 50+ rounds of ammunition on him, as opposed to someone in cotton hospital pajamas with just an ID tag for armorplate - before anything like a certainty of a trip to jail, rather than merely being tenderly escorted onto the street, was contemplated.

How do I feel about that? Thanks for asking.
My apologies if I was too subtle there.

To be fair, the story wasn't the first one Whitecoat has referenced; tales of ED violence around the country and around the world are a regular feature on his blog, because they're so easy to find, again and again and again. This one just frosted me, because of the tacit acknowledgement that "that's just the way it is".

When we, as a work unit, as a hospital, as a profession, as an entire segment of society, agree to let ourselves get kicked in the crotch daily, as though it was okay, guess what's going to happen to you and I tomorrow?

If you guessed "get kicked in the crotch again", congratulations.

Enough is enough.
Start rattling cages, and get the monkeys working for you for a change, instead of sucking up to their Press-Ganey score whores.

Or start making plans to bury your friends.
Because if you think the nutbags who keep shooting up Gun Free Zones at schools aren't going to figure out very soon it'll work at hospitals too, you're certifiably insane.

Friday, June 7, 2013

Not The Fashion Police

From time to time, as noted earlier, some folks come to my house, and one way or another, wind up strapped to a gurney, dressed in a patient gown, under close observation every minute, until we can find a nice soft room for them in the psych unit so someone with the patience of Job and the compassion of Dr. Schweitzer can sort them out, and help them get the voices out of their head.

We do an excellent job, but sometimes, there's just too many crazies, and not enough watchers.

So when you get someone settled in, rotate them off the restraints, get all the prelims done to grease the skids for their departure to our/somebody else's psych eval unit, sometimes they've become such model citizens that the need for being tied to the bed rails has long since passed, and can't be justified.

And then Mr. Murphy punches in, and that split second the minder is busy dealing with one of the unstable campers, one of the calmer ones notes the merest sliver of a chance for freedom, and bolts for it, leaving the minder with nothing to show for a last desperate effort but a handful of patient gown with no patient inside it.

When you're the one who sees someone sans obligatory hospital gown, or anything else, go flying past you, out the front door, over parked cars and parking attendants, bushes, hedges, parking meters, and fire hydrants like a gazelle on crack, it's probably better that you noted the patient is now running in nothing but a smile up the nearest freeway onramp, rather than attempting to replicate her feats of Olympic steeplechase prowess into the dead of night.

Now, I know at that hour, human response and higher brain function aren't at their peak, even when you've been on the nightshift for, seemingly, your entire adult natural life.

But when you pick up the phone, and report the incident to the local Patrolers of Highways, you expect a certain level of...well, not competence, which they have, but more like...perspicacity, which they might sometimes lack. Just a bit.

You would then be forgiven, after telling them a naked crazy woman is running down their freeway, and asking for a wee bit of assistance in corralling said waif, and returning her to the land of Milk and Geodon, when they ask in reply, "Could you give us a physical description?" and your jaw hits the floor.

But when you ask, in a voice dripping with sarcasm and pathos, heard plaintively across the entire waiting room, "Officer Notthesharpestpencilinthebox, just exactly how many naked women do you figure you're going to find running down the freeway at 3AM???" and this reduces both the security chief and your charge nurse to hysterical giggling tears for 10 minutes afterwards, it makes the entire shift almost worthwhile.

Monday, June 3, 2013

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.