Posted on 12/30/2006 1:54:50 AM PST by 60Gunner
Christmas Eve was a solid-gold nightmare. We had one open bed in the entire hospital, and the private ambulance services were bringing in critically-ill people without calling us, because they knew if they did, we would divert them to hospitals that we knew had open beds. But they make their living on calls, not on mileage. (This may differ in other states. Armed & Christian may correct me on this point.) So after the fifth "patient dump," the staff in my ER and the private ambulance services were not experiencing a lot of good will toward each other. And of course, the practice of patient dumping so saturated our ER that we had to place the hospital on "divert," meaning we were so full that there was neither room nor staff to care for any more patients until we cleared out the patients we had. There was no room at the Inn.
Most of the patients we had on Christmas Eve were genuinely sick. On my shift I cared for two patients who had had strokes, one patient who had a heart attack, a family of four who had carbon monoxide poisoning (a non-English-speaking family), one patient with acute appendicitis, two female patients having miscarriages, one elderly female with a hip fracture, and one psychotic female frequent flyer who neglects herself in order to get attention and pain medications. (This time she nearly killed herself by laying in her bed for nine days without getting up to go to the bathroom. She was, of course, a frigging mess. All this to get attention. She was also one of our private ambulance "patient dumps.")
That was one long, long Christmas Eve. I dragged myself to bed, sore and tired, at 9PM and awoke, sore and tired, at 5AM on Christmas Morning.
Man, this is going to be a long day, I thought to myself. Christmas in the ER usually is. I was not worried that someone would die in my ER on Christmas; people die every day (but as it turned out, none died in my ER on Christmas). I suspected that if Christmas Eve was any indication, Christmas was going to be a rough ride.
Boy, was I right.
It started off ominously. I schlepped in at 7AM to find only one patient in the entire ER. I went through my area checklist (trauma cart inventory) and sat down, sipping my coffee. Nobody dared say the word: "Quiet."
That one word, when uttered by an on-duty ER staffer, can send the whole day spiraling into hell. The whole staff sat in uneasy silence. Then the medic line rang. Five minutes later, it rang again. And again, and again, and again. And then the aid cars began calling in with short reports; six in a twenty minute period. By 9AM, the walk-ins came flooding in. By 9:30, the ER was full, and the triage area was filling fast.
Now, let me acquaint the reader with the demographic of the Christmas day ER patient, because it is not comprised of the usual crowd. Nobody in their right mind wants to come into the ER on Christmas, for the love of Pete. So what we see are the really, really sick people, the people who slice their fingers while preparing the meals, the people who slip and fall on whatever causes them to slip and fall (ice, gravy, beer, etc.), the people who get together when they shouldn't, and of course the absolute lunatics.
In the morning, the usual crowd comprised of the genuinely sick ones. Heart attacks, appendicitis cases, one full-term lady in labor (on Christmas- cool!), a couple of strokes, a couple of really sick kids, a seizure, and a bowel obstruction. But as the morning wore on, we got more and more lacerations (knife vs. finger). And then the psych cases began rolling in.
We had one obese young woman with the classic hallmarks of Meth addiction who insisted she be classified NIK (no information known) because the Mafia was after her. Never mind that she dragged her whole family with her. They also decided to check themselves in for various reasons. Her mother began loudly and obnoxiously retching in the triage area (BLEEEEEEAAAAACHH!!!! BLEEEEEEEAAAAACCCCCHHHHH!!!!). She didn't produce anything, of course. She just sat there and retched, loudly and with great flourish, whenever she saw someone looking at her. She fell strangely silent when nobody acknowledged her. Situational nausea, I guess.
As the day wore on, we saw the usual assault victims.
"Usual assault victims," you ask?
Yep.
You see, Christmas is one of those holidays that brings families together, even when they have no business being anywhere near each other. Uncle Phil arrives, gets drunk and obnoxious, and someone decides to tell him to pipe down. He declines, and rudely so. He takes a swing at Cousin Ed. Ed parks a left hook in Uncle Phil's mouth. Uncle Phil arrives at our ER drunk, belligerent, swinging, spitting bloody froth at us, and with a BAC of 384. I'm not making this up.
Never mind decking the halls. Somebody "decked" Uncle Phil, I thought.
So the twelve hours I spent in the ER on Christmas Day were not idyllic. Guess who had the Mafia runaway, her mother (BLLEEEEAAAAAAHHHH!!!!!!) and Uncle Effing Phil?
Where's the frigging eggnog?
Many women I work with are divorced, single moms etc..I don't know how they do it!
The job pays better than most but not enough for what I do - I can't imagine many people putting up with the stress, incredible responsibility, demands, unpleasant body fluids type "thingies" (ha)....etc etc...for the pay we recieve....that's why I never hesitate to call the doctors....they certainly need to share the load and earn their pay too even I have to wake them up!
happy new year!
You have been added to the ping list. Thanks for your kind words!
60
Since so many people have suggested it, I have begun compiling what I have written. Perhaps when I gather a year's worth of entries I may put it all into a book, or use it for material for a book. I don't know. We'll see.
Parkland, eh? Wow. She's seen some stuff.
Yeah, I kind of missed the boat on getting the holidays off. I was in Taiwan observing the healthcare system for amonth and by the time I got back, everyone else jumped on the holidays. C'est la vie. But the double-pay takes some of the sting out of it.
I believe it, Jim. I have often thought that the ER would be so much more peaceful if we could somehow rig the fire sprinklers to release an Ativan aerosol when the ER gets crazy. Everybody would be so happy...
Hey (giggle) the medics just brought in another GDFB (sigh), and he's a spitter. Isn't that just dreeeeeeeeeamy?"
(Spitter:) "Wow, man, I don't know what it is, but whenever I come here I just get this wonderful sense of calm. In fact, I think I'll go get my life together and stop breaking into your cars in the ER parking lot to get money for my fix!"
Well, it's a thought.
BTDT, now I am retired.
"We, the unwilling, led by the unknowing, have done so much for so long with so little that we are now qualified to do anything with nothing."
Just a cheery note. ;-D
Made a mistake. Here it is again:
We the unwilling, led by the unknowing, are doing the impossible for the ungrateful. We have done so much for so long with so little, that we are now qualified to do anything with nothing.
There, fixed it.
Our ER (won't say the name just the town its in (Hershey)gets so full that they have designated the hallways as places to park patients.
Talk about your HIPPA violations.One time I'm down there collecting blood in a patients room. The doctors show up in the hallway to exam some poor old ladys rectum,all they had for privacy was a folding screen. I'm listening to her case being discussed,she's yelping and my patients laying there looking terrified...
I did work Christmas Eve and part of Christmas Day. It was quiet for us but they let some nurses go home early off the floors and when they did that the admits began to roll in.
My AZ buddy told me MEXICAN RODEO is the term for when a large number of smuggled illegals flip on the highway and every resource in the state is sent to transport them to trauma centers.
I have been doing the 24/7 healthcare job for 27yrs.
No he missed the point or rather tired of human suffering.
He is grandstanding on others suffering I have worked with his ilk.
I hope his patients and fellow workers don't lurk here.
Don't bother responding back at you...I have always enjoyed your posts in the past too...
What do you do when it's Christmas AND a full moon????
My Mom was an X-Ray Tech. She loathed her rotation in ER on Full Moon nights and any night remotely resembling a 'Family Holiday.'
People get wild and crazy or drunk and crazy or off-their-meds and crazy on Easter, Fourth of July, Halloween, and Arbor day and whale upon each other.
Violence ain't just for Christmas anymore. ;)
Friend used to work ER in his younger days. One story I liked involved this guy who walks into the ER on an otherwise quiet night. He was babeling on a bit and not making much sense. Finally he turns around and my friend notices the knife sticking out his back
I love that quote! How appropriate! :)
What you describe here is not "cynicism" but rather "moral outrage." Allow me to explain.
The capstone of practice as an RN is what I call "nursing ethos." This is best described as that moral and ethical compass which guides a nurse throughout his or her career to seek the right thing to do and to do the right thing. Nursing ethos is shaped, among other things, by the moral absolutes of fidelity, honesty, and justice.
I propose that this sense of justice is what gives you the sense of disgust that you seem to be describing when you spot a malingerer. But that is not cynicism. The nurse experiencing a sense of moral outrage will say, "This person is wasting the ER staff's time and resources and making things harder for the patients who need us most. That's wrong, and I will not play that game." On the other hand, the cynic would just say, "Hell, they just want drugs. We aren't going to change them. Stop wasting time and money running tests. Shoot them up and get them out of my ER."
Cynicism is what perpetuates the cycle and allows malingerers to get away with what they do. And that robs the genuinely sick patients of the time and effort they deserve from those of us who went to school for a helluva long time to learn how to do what we do in order to do great good for other human beings. Malingerers anger me for that very reason. They are the hyenas of the healthcare system.
But getting mad at malingerers isn't going to change them, because they simply don't make the connection between their behavior and the underlying problems in their lives that drive them to seek sympathy, validation, attention and medication, the true purpose of which is to alter, however briefly, their personal reality. And at the heart of it, that is all the malingerer wants.
Then again, calling a malingerer out on his or her fakery is not cynicism; in fact, it is simply patient advocacy. By confronting the malingerer we do two things: we present the truth of the problem to the malingerer, and we defend the patient who is genuinely ill from having to suffer for the predatory selfishness of the malingerer.
Cynicism is a compassion-killer, and has no place in any nurse's heart. When I hear cynicism from a nurse, I simply tell him/her that perhaps it is time for them to find another career.
Tickmeister, that was extremely well-said. Thanks for your work. We need you, too!
I enjoy your posts about your job. I have been retired for 2 years now and couldn't be happier. Can you add me to your ER/RN ping list?
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