Tuesday, March 24, 2015

Big Guns

People joke about being nice to your nurse. "We decide what size needles to use, tee hee." It's not really meant seriously. We have a lot of options for how to manage your care, but nobody casually suggests we go around abusing our control.

There are good reasons that nurses are the single most trusted profession in the US. We are in this job because we care about helping people. Nobody lasts long as a nurse unless they truly do want to do the right thing for patients.

Plus, it's not easy to upset us. We develop thick skin very early on, because we really do meet a lot of mean and nasty people. A good nurse can take the meanest insults and the nastiest shouting with barely more than a shrug, and still do her best to make that patient comfortable.


All that being said, I don't think most people realize exactly how many control options a nurse really does have.

If you are aggressive, out of control, and present a danger to me or to my staff, I am permitted to:

  • strap you down spread-eagle on a gurney
  • tie a spit mask over your mouth
  • cut off all your clothes
  • shove a short tube up your nose
  • shove a long tube into your urethra
  • have all your visitors forcibly removed
  • prevent you from contacting anyone else
  • inject you with sedatives
  • and isolate you all by yourself in a very dark room where nobody can hear you shouting.

Of course such measures are never taken casually. Not a single one of the above things would be done unless it were necessary for our physical safety, and rare indeed would be the situation requiring all of them at once. And in truth, I can only maintain any of the above for a certain period of time without getting a physician's approval. If I were to make a vindictive judgement or even a bad call, I would immediately be made to answer for it. There is a lot of auditing and oversight for such things.

Nobody is ever, ever threatened with these major interventions just because they're mean and nasty.

Still, we really do all those things sometimes, and it makes me wonder. If people were aware of the kind of discretionary weaponry that gets issued with the letters RN, do you think they would choose to be nicer?

Monday, March 9, 2015

Every Four Weeks

Research indicates that emergency department activity during a full moon is no different than at any other time of the month.

Research clearly shows there is no statistical correlation between moon phase and the number of patients, their acuity of illness, or the occurrence of aggressive confrontations in the ED.

Research can bite my shiny metal ass.

This last full moon night was absolutely crazynuts. We had four cardiac complaints walk in during the first hour of my shift, one of which was a STEMI (an acutely life-threatening heart attack). Two aircraft with critical transfer patients landed right one after the other, so a third aircraft carrying a Code Stroke had to hover and wait for a helipad slot. Ambulances showed up an average of once every thirty minutes, all. night. long.

Every exam room was full, or even doubled up. Some patients had to be treated on stretchers in the hallway. Our major trauma bay was constantly in use for moderate injuries (mostly slips on the ice), because those patients were too bloody to sit out in the waiting room and we had literally no place else to put them.

We had multiple drug-seeking frequent flyers who refused to be discharged without their desired pain meds, and had to be escorted off premises by security. We had the obligatory uncooperative drunk who kept taking his clothes off and wandering bare-assed into the hallway. We had one dude tripping out of his mind on multiple substances, who was hallucinating and violently psychotic, who spent the night in locked leather restraints and a spit mask.

We had a guy who came to the desk and said he didn't need to see a doctor, but wanted to check in anyway so he could warn us about "those Obamacares that watch the people with the computers."

I know we have good and reliable science saying this all is completely unaffected by the pattern of light reflecting from a big orbiting rock. But, damn that is hard to believe sometimes.

Wednesday, March 4, 2015

Don't Touch That. Not Yours.

Recently I met a guy who thought we were doing everything wrong for his poor comatose grandma. He made a point of telling me that at least once an hour. He also hovered over my shoulder every time I was in the room, making a big show of double checking every little thing I touched-- the oxygen rate, the IV pump, the level of suction on her NG tube, the degrees of elevation of the head of her bed, everything.

That's all fine. I don't mind another set of eyes. Even though I'm a nurse and you're an unemployed waiter who knows only what you read on WebMD, you still might notice something I did not. Stranger things have happened. So I wasn't bothered that this dude followed behind me to double check the equipment.

What did bother me was how he went about checking grandma's abdominal wound.

I walked into the room at midnight to find that the guy had unwrapped her abdominal binder, disconnected her wound vac, taken down all three layers of the dressing, and was peeling up a corner of the Gore-Tex mesh beneath. Never mind that the mesh was stitched in place and not supposed to move. More worrying was that the mesh was standing in for the inner membrane of grandma's peritoneal cavity, which means genius was poking her internal organs with his unwashed and ungloved hands. (The technical medical term for this is "Yikes.")

I'm rather proud of how calmly I told him to stop.

Dude's response was to say I should "chill out," because he had "the legal right to check out her healing without all that useless stuff in the way." He further claimed that if I put the dressing back, he would only take it apart again as soon as I left, and there was nothing I could do to stop him.

I chose not to argue.

I just pushed a button on the wall. A pair of burly security officers showed up within about thirty seconds, and I let them do the arguing. When last I saw our friend, he was being politely but quite firmly escorted from the premises. He won't be back.

Getting the dressing rebuilt properly took over an hour of combined work for me, the surgery resident, and the wound care nurse. Fortunately none of the sutures were disturbed, and it appears that the patient won't be suffering any further complications because of this.

Sunday, March 1, 2015

Stuff happened

I've been busy. New job, new city, new house, new dog, new new new.

I have kept delaying a return to this blog, because I kept adding material to an enormous this-is-my-life post explaining all of what has been going on. But then, I had an epiphany, and I threw that post away. It was fun to live but boring to read. The fun, gross stories are much better.

Long story short: I'm working the ED at a big trauma center. I have stories. I'm going to start writing them down again.