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I’ve stopped with pre-shift religious meditation parked my car along with soothing piece of music. No more prayers to God the way to work asking for more patience, more humanitarian, more understanding. I have noted the fact that it will be no different than any other night in the emergency department, whether I blare Rancid piano YANNI’s Etudes or make a promise to God to go beyond their own body parts to release my patients as they go. Nothing will change. I used to look forward to making a difference in someone’s life, help the poor soul that the body has issued. Those moments are few and far between now. Instead, I tell myself that in the next 12 hours will be spent fake smile pasted on a tired body, going through the motions concern, repeating lines ready false concern and issue medical falling on deaf ears. I used to feel important in my role as a Charge Nurse in the main by the inner-city charity hospitals. Now, as I sit in my car at 6:45 in the evening, gangster rap blaring, I sent out a quick impromptu message to God ….. “Please God, allow me the opportunity to be gainfully employed for 12 hours from now. “
7:02 PM-
I get a quick report on clingons and leftovers that have not made it out of the department with the change of shift and no surprise to me and the night crew, some names all too familiar and the latest reports of “illness” recitable easily from memory. The usual apologies from the day the crew to get them out before we get to go unnoticed. A shrill Shri from one of psych beds startles no. We all look just within “safe” limits of the nursing station from, confirm that obesity safety of our force is camped out next to the room, shaking his head briefly in and go about our business. We go through the ritual take our own baseline vital signs, some popping Xanax and remove sharp objects from our pockets. patient safety is important and we would not want to accidentally stab one of them repeatedly in the chest.
7:17 PM-
main my job aside from direct patient care is Triage. Initial interview, vital signs, short medical history, current medical problems, current medications, height, weight etc etc my first 35 or so matches the typical information on this or any other in the country. 40 years old, female, morbidly obese, diabetes, hypertension, multiple Psych meds, very little Enska, less common sense, no way to pay. She complains of the usual nausea, vomiting, diarrhea and general pain. She has already spent thousands of dollars of other people’s money last week for the same complaint. She did not complete her manuscripts, not monitor gastroenterologist her request and was not at this 300 + £, truffle hunting leech going to change their diet one iota in order to prevent another attack of diverticulitis. her idea of ”Clear Liquid Diet” was a bucket of chicken and a bowl of Menudo hour for her arrival. So here she is, totally unaware of why she is still weak. Non-compliant with its meds, non-compliant with discharge instructions, or follow the dietary guidelines, which included gentle, low-fat, liquid diet for a few days until she was able to endure the semi-solid / or solid food.
She bitches profusely when it is brought straight back and put to bed, instead it is sent back out to the waiting area for the long wait. We are very busy and the truly “floating” patients, but she can not seem to fathom this. She barrels through the exit door in the waiting area calling me every name in the book (in Spanish) and swearing never to return. “Pendejo!”, She mutters. Oh, she’ll be back.
“NEXT”!
7:31 PM-
3 My patient is a 23 year old mother of three, the oldest being 10. She has somehow mistaken our “emergency unit” for children clinic and wants her young “checked out “because they feel” hot “. No heat ever taken home, no Tylenol or Motrin given before the decision was made to spend $ 1,500.00 on other people’s money and spend our time Babysitting 3 snot-nosed, unkempt Ankle-Biters are not more sicker than a man in the moon. I usher them one by one on the scale of the plot and is not surprised that anyone is twice the size they should be limited to their age. One, I have to pry finger foods and “Big Gulp” from their stubborn little mitts before the weight so as not to inadvertently add 5 lbs to the triple-digit reading his. Electronic scale beeps incessantly and says: “one at a time, PLEASE.” (Ok, not quite) With all their vitals are normal they are started out of the hold where they eagerly jump on the furniture and run around like defense for attention deficit.
I verbally assault obese stomach pain my wife, who has “been waiting time” (uh, how about 20 minutes). I immediately took the “Cheetos positive signal” on her fingers and around her lips and remind her of the sickest are seen first and to have a seat. She throws me “Pinch pendejo” and rumbles back to his or her seat. I sneak in a quick call to God, praying that he makes sure she looks before she plops back down in his chair (s). I hear intercom announcer now, “CODE BLUE trauma, ER waiting room.” I mentally picture the scenario of the code team spend the next hour remove the child Julio rectal 300-lb verbally abusive Hispanic woman.
“NEXT” !!
9:21 PM-
I’ve lived dinner crowd with my work intact and make my way back to the treatment area to assist the rest of my team in the treatment of patients who were lucky enough to do it again before non-liquid riff-raff. I make my way to EMS radio station when I hear ….. “Unit 842 number 2 patients report” …. we have 102 years of nursing home patient, …. found unresponsive on the floor .. ..not IV .. .. she is now awake, combative, confused, falling into a chair, urinary incontinence, bla, bla, bla … “the report from the nursing home before its EMS transport reveals that this patient had a tendency to” dig out stool rectal when their constipation. “” Oh, it’s just friggin lovely “
9:25 PM-
waiting room intercom buzz ……” I beeen waiting for 10 hours, pendejo you … you piece of …. “click!
9:33 PM
wonderful our elderly finger painter comes, covered in poop from head to toe. EMS personnel that smirk they wheel her in, updating us that any change in the way. no, no changes, except that now she has given up the fight and return unresponsive and her breathing shallow. an instant her breathing stops and immediately rushed to the trauma 1 where CPR is started. “CODE BLUE IS-1, CODE BLUE IS-1.”
9:57 PM-
“Time of death, 9:55” is belted out by the code team leader. “She never stood a chance.” “It was her time.” “She had a long and good life.” Bla bla bla bla. She had a horrendous death. Born fall into the amniotic fluid, but certainly proud parents can be sure of. She died, however, covered in shit, piss and bedsores. Nursing home where she spent her remaining days in perpetual anguish and loneliness must be burned to the ground. No family, no attention, nowhere near as prominent and proud as she once was. Left to spend while understaffed employees Mary Perpetual petri dish were able fraction of them and plundered through her personal belongings. A courtesy call to the nursing home is placed to tell them that Mrs. Mullins will not come back and have been transferred to the ECU (Eternal Care Unit). I hear, “Whew, thank God ….. CLICK.”
10:22 PM-
our usual group of drug-seeking, bipolar disorder, depression, suicidal thoughts, Xanax, Vicodin, Demerol dogs arrive as scheduled with many and varied complaints, migraine, chronic back pain , stress, anxiety, fibromyalgia, bla, bla, bla .. ..!
They are easy to spot, almost always familiar with the history Same Ole ‘. Most people we know on a first name basis. They are all, incidentally, the same allergy medications; Tylenol, Motrin, will save, Toradol, Aspirin or other drugs or not harmless placebo we have tried to quell the “pain” of the past. The only thing that works is “Demerol” and they must have a large supply of Vicodin in the form of a prescription when they leave. (Vicodin have Tylenol in it but does not seem to cause severe allergic reactions when mixed with euphoria, …. go figure!)
Security is usually called, to tell them “no drugs Tonight” is just asking for fighting. $ 1,000.00 later other peoples money and they usually go with their noise and their script for Vicodin. But usually not before asking for “shots for the road” or more scripts for anxiety (preferably Xanax) or sleep aids. 30 pills are often given the number of pills, depending on the frequency of the prescribed dose. This typically last a few days for typical agents found and then they usually return with more “pain” and hungry monkey.
In an age when doctors are sued for both the treatment of pain or to prescribe too many drugs and “get them addicted”, the medical personal are caught up in the proverbial “Catch 22”. More often than not, I’ve been written up several times and was a place where my work was in danger because I challenge sad their lies when the low life drug addicts undertaken is ours. Now I just shut up, shaking his head and asking for overdose.
11:12 PM
Waiting Room PTT ring in the wall. “… How long will I ……. can you tell me where I am on the list …… Donde esta su Doctor ……. I can not find my baby … ….. is Dingo ate my baby ….. pinche PEDEJO, I have been Heer goes for two days and my ASS feel like someone poured salsa right up my ………. click.
midnight in the garden of good (good for nothings) and evil (doers) –
After a flurry of non triage liquid, (sore toe, “shakes”, anal abscess, foreign body in the nose, ears and stomach of 2 years, blah, blah) I call the astute, well-dressed, middle-aged white male, who is walking quite gingerly and refuse to sit. Differential diagnoses race through my head, back pain, abdominal pain, rectal abscess or ,. maybe …. no! …. No! …… NOOOOOOOOOOO!
Yes!
story goes (and it is common) that he and his wife were “attempts “in bed (against his wishes, no doubt) when the vibrator was stuck in his keester and is now painfully out of reach. Given the nature of “injury” he is whisked back private room, put on his side, Kent like a 57 Chevy, and valiant efforts are required to attend 12-inch “perpetrator with ribs” from his colon. All to no avail. At one point we had to keep the foreign body (actually, it was done in the US) colon would not let go of it’s new found friend cylindrical. We pulled, twisted, yanked, pulled, all efforts prove futile. Finally, the doctor stopped, exhausted by the tug-o-war game, with forceps, commonly used to remove large headed children, protruding from prominent lawyers butt, he made the decision to call the surgery team. All efforts to be a professional, however, fell by the wayside when in a moment of silence, the low noise found in the room. Had the blood pressure cuff inflated? Incandescent lights were buzzing? Was on TV?
No, no and no. We looked at the tongs and took them were vibrating uncontrollably, instead realize at the time that this article was still on. A mad rush of nearly crew to close the door of the private room was not trying to humiliate this local experts with boisterous laughter us. No dice.
We will all end up writing and apologies made for “unprofessionalism and disregard for the privacy of the patient and mental well-being” our.
It’s okay. We had to preserve their own spiritual welfare. Still true that laughter is still the best medicine.
1:02
Ten triage and later dinner time for this mentally worn crew. We apply our food, locate it in the middle of the nursing station and we eat. Not all at once, mind you, but usually bite at a time. Eating French fry, go wipe ass in ER-1, a bite of the Big Mac, go clean up cherries cool-Aid flavored success of ER-4, a sip of Dr Pepper, then physically restrain a combative patient Scitzo-effective. By 2:15 we have polished off the last bite tighten hamburgers, ate the last old French fry us and sucked down the last sip of our watered down soda. A soda is now as hot as fresh urine and food which is as cold as Mrs. Mullins in ER13.
2:30 the AM
Ahhh, my favorite time of the entire shift is upon us. The “Last Call at the local bar group” (LCLBC) start pouring in the front entrance, but EMS brings those who got the shit kicked out of them through the back of the ambulance entrance. “Santa Rosa, this is unit 842 …. we are coming Code 2 trauma 19 years Male ….. closed head injury …. drown … combative …. dirty …. bloody. …. no guarantees ….. bla, bla, bla.
the Same Ole Song and dance spews from these patients grow bloodied as he is wheeled into trauma-2 ….. . “I was just minding my own business” …… “I only had two beers” … .. “I do not do drugs” ….. “Can I get something to eat?” “RAALLLLLLPHHH ! “” Housekeeping to trauma-2, cleaning …. “
2:31 the AM
” Dear Lord, if anyone can make time travel possible, it’s you, God. “” Pleeeese, send me on to 7 AM.
3:03 the AM
Patient waiting room intercom is screaming ……….. “Click” ……. “BANG, BANG, BANG “.
3:15 the AM
I started in the staff break room for “time out” and reminded the night supervisor that the cost of intercom will be deducted from my paycheck.
4:18 the AM
Portly our female animal woman finally began again in the room, but not before mumbling under her breath as she brushed past me, “pendejo”! Large “abdominal work up” is ordered. 40 lab tests, urine tests, stool culture, abdominal x-rays, Cat Scans, bla, bla, bla …… It is set in a gown that looks like curtains stolen from the Grand Ole Opry, and given a reprimand “opening on the back, please, “thrown in for good measure. ( “Lord, give me strength ……….. Oh forget it, never mind”)
She is given urine cup as she bounces his way to the bathroom. She fills it with a chair. “Offered in ER, STAT.”
Can not find the blood pressure cuff large enough so we have to take a chance on an erroneous reading by placing it around her calf or forearm. The fluid bed grunts and groans with some twitch and shift from this woman substances. She continues to bitch and moan and will eventually complaint with (a) human resources, I’m sure. Many attempts IV access provider finally vein that has not been choked off by a mass of arm fat and IV fluids are initiated. After a quick assessment is a doctor she’s off to radiology, with a slight 120 pounds technology pushing £ 600 of the patient bed and the third floor for a series of $ 3,000.00 radiologic examinations. X-rays was done just last week and it has no intention or means to pay for. It would have been easier (and cheaper) that she had driven to Sea World instead. Certainly more accommodating to a woman of her stature.
5:57 the AM
Many early morning stragglers are classified and sent to wait. The foul odor of urine, poop, BO, booze, vomit, etc, permeates the air. “One Hour Left”, I thought. We get all the test results voluptuous Ms. Hinojosa is back and surprise, surprise …. “diverticulitis.” Maybe this time it will be in accordance with the meds her, according to her diet, according to her guide, in accordance with life. “Fat chance,” I thought. (Pun intended).
IV it is removed and a half liters of fat globules ooze from harpoon hole. She pulled off the bed with the help of several departments within the hospital; half of which will call in sick the morning with severe back spasms. The battered stretcher which now resembles a low rider after disaster is withdrawn for repairs. Ms. Hinojosa is drained but not before asking for breakfast tray. Request denied.
Off she goes to the local “Taco Cabana” for a flurry of various breakfast tacos and a bowl of Menudo. “She you in a few days, Ms. Hinojosa.”
“pinche pendejo!”
6:47 the AM
miserable face morning crew are obvious as they make there way into reluctantly, some still in the middle of town, new nurses with the Walkman is, listening to the ocean waves or cricket noise saturated with Muzac. A quick report is given to the mentally exhausted night crew and made an apology for missing bed in the ER 3 and the body of IS-12.
7:07 the AM
Each member of the night crew, each with a phone in hand, waiting for the moment the clock strikes 7:08 in with lightning speed, the flurry of buttons will be punched in the clock out, end another horrendous but typical night in the ER.
7:47 the AM
I pull up to my apartment and sit quietly in my car. I recall the events of the night and wonder if I had made no major errors in care or court. I prepare mentally for answers to complaints the night before of this unique culture is ignorant, non-compliant, offensive, poor, helpless, drugged up, psychosis, dregs of society.
I say a prayer for Mrs. Mullins and her family and curse all those who have abused the system in the last 12 hours, spending thousands upon thousands of dollars of other people’s money while contributing nothing to society what- so-ever. When I think that I will have a job to come 6:45 in the evening, I relieve the tired body and mind shattered out of my vehicle, meander up my apartment and in bed, hungry, frustrated, angry. Since I will fight the evil spirits in an hour or so until I’m able to sleep. Not me. I awakened from a dream in which workers of all patients in the waiting room on a busy night. I called back as 500-lb female nurse is ripping my clothes off with one hand and swing 6 foot rectal scope in other like a pair of numchucks in a Bruce Lee movie. The alarm sounds and I immediately spring up and grab my ass, asking for a 6-foot proctoscope is not hanging precariously from it. It is not. I breathe a sigh of relief and make my way in the shower and another fateful night of chaos and mayhem.
6:43 PM-
I pull up to the ER, park my car and sit. I clip on my name badge, giggle as I read our “Mission statement” tattooed on his back. “To extend the healing ministry of Christ,” it reads, and I take a minute to reflect on that statement. I smile, admit it is a powerful and significant activity and turning my head to pray.
“Lord, today, give me divine authority to accept my responsibility in this service. I pray …”
Just then enter a Delta 88 rolls of two-wheeled, with a certain slope aside. I watch as they take up two parking spaces in the “staff” full and out pops Ms Hinojosa. I cringe. She leaves a trail of urped a Fajita and Menudo patient through the parking lot, parking in the brook, toward the ER entrance. Anger byltist inside me and I hang my head, looking down at my shield and the instructions on the back. I try desperately to find peace, and I felt proud just 2 minutes earlier and I continue my prayer …… “Sir, I just …. ……. if you could only find it in your heart ………… oh forget it !!!!! ……. never mind. “
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Source by Michael Wayne Brown