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Ever the optimist, I began to rationalize as I unpacked my things and settled in to my new, if temporary, abode in IHS housing. So what if my initial impressions of the reservation were not what I expected? What did I expect, anyway- A John Wayne movie? I had yet to really explore the natural beauty of the place, and with the exception of the obnoxious MD with whom I shared the house (as noted previously), the people seemed rather nice. The house itself was clean and had air conditioning. The topographical features were pretty amazing, too. On that front,...

After more than eight years of employment at a busy hospital in the Seattle area, I felt it was time for a change. I had considered travel nursing in the past, but either the timing was not right or the opportunity was not there. I wanted to learn different approaches to emergency nursing and see new sights. And I wanted to make more money doing it. My household was knee-deep in debt and the extra money made by traveling was going to help us reach solvency. Once we got to that point, I would look for a permanent job again....

Once again, the media has released a "nature is out to kill us all" article. Source: Comcast News. The writer of the article was, to be quite blunt, pretty damned irresponsible in selecting the information with which the reader is presented. Go figure. I will break this down point by point and fill in the blanks after each article snippet. My comments are in boldface: Para.1: More than 10,000 people per year are hospitalized with Clostridium difficile.Response: 10,000 people is about 0.00003% of the population of the United States. Hardly a widespread epidemic. Para. 2: The germ is resistant to...

It was about 4PM on a Sunday. The waiting area was packed with malingering whiney-baws, harried soccer moms and their bruised, violent hooligans, armchair football warriors who tripped over their coffee tables and sacked themselves- right into the TV-, and the "Bucket Brigade" (seasonal GI bug sufferers). I was float RN and I was covering the Charge RN for a lunch break when the Charge RN's phone rang; I picked it up. On the other end was the Triage RN. Her rather hushed tone was laden with, oh, I don't know... a strange, pressured awkwardness, I suppose. (I am here...

I was recently shadowed by a high school senior during a couple of shifts. She was considering becoming a nurse and had an interest in Emergency Nursing. She followed me as I provided care for patients with a broad spectrum of problems- from a known narcotic seeker who demanded (read: screamed) that we address his pain, to a homeless patient with a peritonsilar abscess and no access to continuity of care, to a nonogenarian woman who suffered cardiac arrest and whose family had kept her on "full code" (all measures to maintain life) status because they could not let her...

Looking back, I can't really explain why or how it happened. The moon was not full. Quite the contrary; it was a mere silver cutting of a fingernail in a pristine, clear sky. It wasn't Friday, Payday, State Welfare Check Day, Psych Facility Dump Day, Rehab Reject Day, or even Taco Tuesday. Tent City was nowhere near my location. It wasn't raining, and yet it wasn't particularly hot outside either. It was really just a run-of-the-mill, clear, and comfortably warm, middle-of-the-week summer evening that gave me absolutely no warning that it planned on going straight to hell in a spectacular...

Being an ER nurse, I tend to fasten my attention onto cases such as this one. According the the AP story, a 49-year-old woman came into the ER complaining of chest pain, nausea, and shortness of breath. (Okay, all you nurses out there: pipe down and let the laypersons catch up.) She is triaged, classified "semi-emergent," and instructed to wait for her name to be called. Two hours later, when the woman's turn to be seen had arrived and her name was called by the triage nurse, the woman did not respond, The nurse approached the woman and found her...

Last night a "GDFD" (get drunk, fall down) was brought into the Emergency Department by aid car. She arrived, as most drunks do, bellowing obscenities and calling the staff vile names. And this young lady was also a spitter. Nice.The law allows us to restrain a patient who poses a threat to himself or to staff, and our MD, a particularly excellent one, wasted no time in decreeing that it be made so. Security is always down there, so we summoned them to help us put the leathers and a spit sock on the young lady. We then shifted her...

There are some days that I encounter patients whose actions, driven by an utter absence of common sense, cause me to leave a treatment room shaking my head in dismay and mumbling to myself. I'm not talking about the basic run-of-the-mill honest mistakes here. These are not the "I thought I had shut off that circuit before cutting the wires" kind of crowd. These are the runner-ups for the Darwin Awards who tried very hard to kill themselves but failed through sheer incompetence, thus disqualifying themselves from glory. Their survival was not so much a matter of God mercifully wrapping...

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...

The ER is a complex and challenging environment where success is not always achieved, and where futility rears its ugly head far more frequently than we would wish. In such an environment, the quick successes can often have the effect of restoring confidence, especially after a long string of difficult cases where success has been elusive. The confidence factor is magnified when the case involves a scared patient with a heart that has decided to do its own thing. I arrived for the beginning of my shift and received report from the offgoing RN about a patient who had just...

He came in at 1 in the morning, and I triaged him. His chief complaint: "Well, my chest kind of hurts, and my girlfriend made me come in." His girlfriend sat next to him, appearing fretful and unhappy. The patient was a 37 year old who appeared to be in general good health. I was tired. It had been a long shift so far, having been spent sticking IVs into dehydrated babies suffering from GI bugs that have been particularly vicious this year. I was shipping demented elderly people to the floor at a record pace, and the nurses in...

I wish I had a nickel for every patient who drove himself/herself to the hospital when they experienced chest pain and shortness of breath and wound up having a heart attack. I'd be living on my own private island in French Polynesia right now. Note to all and sundry: if you are having chest pain, nausea, sweating, weakness, palpitations, or shortness of breath- or any combination of one or more of those symptoms- CALL 911. DO NOT DRIVE YOURSELF TO THE HOSPITAL. This may seem silly to someone who only lives five or ten minutes away from a hospital. But...

The prizewinner of this week's Stupid Award is a Hispanic woman who brought her child to the ER three times on the same day. The kid had a viral upper respiratory infection and the family's clinic was closed. The first time in, the kid got a chest x-ray (which was negative), a Rapid-Flu nasal wash (which was also negative), and a Rapid-RSV screen (which was also negative). Although the illness was viral, the mom demanded that her son be given an antibiotic. The MD refused. The kid was given Tylenol for a low-grade fever, the family was given a recommendation...

Sometime around 2AM a couple of weeks ago, a woman came into the ER complaining of nausea and epigastric pain that went up into her left chest and shoulder. She was old enough to be in the prime age group for heart attacks, and she was having a couple of the symptoms that make us a little nervous. That was reason enough for us to suspect that she was having a heart attack. Remember the ER chest pain creed, kids? Come on, say it with me... "Every human being who comes through the door is having a heart attack...

They came out without warning. They seemed to have been dumped off by the busload (both short and long). They clogged our ER triage area all night long with non-acute complaints. They also filled the ER treatment areas with the high-acuity consequences of their stupidity. They caused highly-educated and battle-hardened ER doctors and nurses to bang their heads against the walls in frustration and dismay. They became fodder for endless hours of break room stories for months to come. The ER was awash in knotheads. On the night about which I write, it seemed like the Great Big Knothead Circus...

In my last post, I described my encounter with a patient who was diagnosed with an aortic dissection and whisked away by airlift to a Super-Hospital for treatment. Due to the demand of all and sundry who have threatened to lynch me if I did not tell the rest of the story, here is the rest of the story, as far as I know it. The patient faced a truly brutal and frightening surgery. I had it described to me by a nurse who has sat in in one, and here is my best attempt to relate it. Anyone out...

Language is the capital that drives the economy of human communication. Each social or professional culture presides over its own unique lexicon. The observer will also note further subdivisions related to slang or specific specialty. Nurses and physicians often use abbreviated terms among ourselves. We do this for two reasons: 1: It saves time; 2: The other person knows what we are saying (as long as the speaker is not just making something up in order to sound cool, which happens from time to time). But I was reminded this week about how easy it is to fall into the...

Recently, I received an elderly patient brought in by the medics who was “found down” (unconscious and unresponsive) by a neighbor who had passed by her apartment and noticed a foul odor. She had fallen for some inexplicable reason, and lay immobilized on her right side for what we estimate to have been about a week. Her entire right side from her knees to her shoulder was burned by the chemicals in her own urine. Her right hip looked like a rotten apple, bruised and mushy, destroyed to the bone under damaged skin. The wasting of her muscles caused a...