Twenty

One day you're the best the next you're a goat (and not the greatest of all time) Crusty is considered second string until you need him.

Now go out and knock back some leaded egg nog, have a great holiday season and please do your best to stay out of our trauma bays!

Nineteen

Bad Behavior.

This is a three beer entry. so if things are misspelled or the grammer ain't quite right then you need to just get over it. Crusty ER Tech and his other cohorts have been taking it in the giblets as of late and I gotta tell ya it's like every other holiday season.

Today's story is titled

"I tell you to jump you should ask 'How High?' are you clear on that?!"

No shit said by a nurse to one of my fellow techs in front of a waiting room full of patients who have been waiting at least 8-10 hrs to go back to get care. One thing I learned long ago was 'Praise in public and counsel (discipline) in private.' Another words pat someone one the back in front of folks and if they fuck up ream them a new one behind closed doors. Granted sometimes a fuck up is so heinous you deserve a reaming in public but those are truly few and far between. But when you get reamed for doing what you are told and then ordered to see the charge nurse in front of 50 plus waiting patients.

The story is unimportant it really is but I will say after talking to a couple of folks that the tech did what they were suppose to do and only got mouthy after the nurse tried to peel her a new one in front of folks.

Unfortunately in this ER this behavior is not new. The Crusty one recently got reamed for bringing a patient to another area of this large ER without report even though the sending nurse PROMISED and PINKY SWORE she called report. What did the crusty ER tech get told right in front of the patient?

"This is ridiculous" Let's take a moment and note that this nurse who got a case of the premature ass that she only had ONE patient in her area at the time while the rest of the ED was getting killed with a waiting time of 10+ hrs for some patients and was on every sort of divert imaginable yet still receiving patients. I was also told I was "stupid" and lacked "common sense" by this same receiving nurse all in front of the patient.

I'm pissed yet I don't fight back I have learned that much over the years. I go back and tell the charge nurse, I do this because I think the nurse is going to be a cunt to the patient out of spite. Sure it feels good to tell an uppity ass of a nurse to fuck off but really in the end it just does not help the patient in the end. Let the charge nurse handle it, if you're lucky they'll give a shit. If she's gonna ream a tech for bringing over a patient then hey it's not beneath her to be an unmasked bitch to a sick patient.

Funny thing was I was doing a favor for the sending nurse.

The road to hell is paved with good intentions.

I've been told the situation got straightened out but as far as I know the patient never got an apology. As for my tech friend the situation is unresolved cause they got lippy today my feeling is that everyone will get a solid hand slap out of this episode.

It goes to confirm what I already knew about the holiday season it brings out the worst in people. If you are reading this take a moment and be nice to one of your fellow staff members especially the lowly ER tech. We got a job to do as well and although we are glorified and over qualified ass wipers we're right there in the trenches with you. Be a little respectful would ya? Santa is watching for christ sakes!

Eighteen

The holiday season is in full swing and in my view folks are unfortunately dropping like flies. It's been a harrowing week at the old inner city trauma hospital. At one point we were holding over 10 ICU patients and another 10-15+ other patients cause the floors although fully staffed simply did not have the room. Every bed in the hospital was full.

The recent cold snap and holiday binges has made the dialysis patients miss their appointments, pancreatic flare ups from folks with pancreatitis and of course everyone else who is cooped up and catches something a retaliative gave them. Then of course comes the holiday robberies, DUI's, suicidal and depressed patients and the general meanness that the holidays tends to bring out in folks this time of year.

It can make for a rough day or actually week in the ER.

It was a mass of humanity we were dealing with. At one point we had the ER manager on the phone with various EMS agencies begging them NOT to send us patients for a few hours so we could get up outta this hole.

Tragedy of the night. 80's + year old patient comes in with massive MI. Although Pt has some CHF and lung issues she's alright for a 80+ y.o.f. Her son comes by the house and checks on her he knocks on the door she answers it and says hello to the son and drops dead. I dunno about anyone else but it makes me NOT want to visit my elderly parents ever again for fear of them dropping dead when I swing by for a visit. I saw the son for a minute after we called her. He was crushed, he has a tough burden to bear eventhough he had little to nothing to do with her death, shit happens.

Earlier in the week I was personally upset by us working a patient for a few hours. He'd die we'd give him epi and he'd come back this happened several times,  we pressed him and did everything imaginable up and down the protocols. I was upset because the guy was 2 years younger than me. I am no spring chicken but a bit middle aged. The attending figured he died of a GI bleed. History supported it because for the week before he was "vomiting blood" Turns out this patient was waiting on the bus with his girlfriend and keeled over.

Back and forth for a few hours with this patient. He'd code over and over again, I lost count how many times I did chest compressions on him. The room got trashed we went through 2 crash carts and at one point had a ICU bed waiting on him but we could never leave the room with him cause he'd code again and again. 
He ended up dying after a bit. The attending left it up to the third year and he decided to throw in the towel. This patient was not coming back.

The nurse starts on the death paperwork and the tech is left dealing with the body of the dead patient. I kind of pride myself on getting a patient looking presentable to family when  pts die of medical causes. Of course we have to leave all interventions in but at least not zip em up in a body bag with their eyes open. I try to have some class. Sometimes I leave hands out for family to pat or touch. I usually tuck the body bag under the patient zipped up to mid sternum and tuck the sheet around them just so that way when the M.E., Corner or whoever picks them up it's not a huge hassle.

It was two shifts in a row in dealing with dead patients. Death is never easy to deal with you just get use to it, but I HATE it when patients die during the holiday season. Because deep down in my tiny black crusty heart I feel for families who loose a loved one during the holidays it will forever mar a supposedly happy time of year forever for these family members who live on.

When I have to deal with it on the holidays I just wanna curl up with copious amounts of beer and find some woman to get horizontal with and reaffirm life.Yeah, I know it's a way of NOT dealing with it but you gotta do what you gotta do to make it to the next shift. It also does not help if you develop a crush on an attractive resident that same shift. This ain't a TV show and this lovely resident will not notice me during some dramatic moment. We won't dash off into the ambulance bay together hand in hand and make out in the back of an ambulance (EWWWW Ambulances are disgusting), just goddamn she reminds me of an old girlfriend. It's a cold hard reality and I know my position and that I am not exactly attractive. I deal with it by drinking a beer or two going home and watching silly comedy on the T.V.

Times like these makes me realize that I'm not cut out for anything else really and I'm in this field for a long while to come. Although I do have problems with my job and career choice from time to time, I do LOVE my job. Some nights you help save the lives and some nights you sit in the car and force yourself to drive home, it's never easy. You just gotta keep going.

Now if you don't mind I think I'm going to flush my head in my toilet. I'm feeling a bit dumb tonight with a forecast of weird on the horizon.

Well that concludes me dumping my emotional purse out for the day. This is part of being an ER Tech.

Seventeen

I have to take a refresher in December to recert for 2014. I Have been reviewing some of my online CE's as of late. So for those of you out there wondering what these CE's are like well take a look at the latest module:

Remember this is the ongoing series of "What the hell do they teach you guys in EMS?!"

You're welcome

Number Sixteen

One morning I had to come into work early to get my annual done, which is a type of health screening. You get your required flu shot, they read your TB test and check your vitals. Then unless your TB comes up funky (if it does you get a chest xray). You get your paper work down to the back office secretary then you are free to go unless you have a shift or training to do that day.

I had neither but I had rushed into the screening and did not have breakfast. I went around the corner restaurant/bar and to my surprise I saw some of my night shift cronies with a cool 3rd year having breakfast and post work drinks. Honestly this is one of the occasional rituals I miss most about working nights. When I went to days I left that behind, as the months and years at my present job went by most of the crew left to be replaced by newer folks I did not know. As always there are a couple of old hands around who show the young 'uns where to get a stiff drink at 8am (0800) after a nerve wracking, mind numbing, nightmare inducing shift.

I was out of place in my normal people clothes sitting beside my scrubbed up co-workers. Once the old hands said that I was a night shift tech from way on back I was greeted warmly and grilled. I got asked one question over and over by the newbies:

What's one tip you would give someone new to the ER at Big Inner City Trauma Hospital? (B.I.T.C.H, I know two letters are switched but work with me here)

My reply? Remember who you serve and don't take it personally.

The who you serve thing I overheard a bright former military 3rd year tell a very rattled 1st year after tough shift a year or so ago. I work at a big public hospital AKA "safety net" hospital. We serve the fringe population most of the time the folks where good private medical insurance is not the norm. It's a teaching hospital as well and with the abuse we receive it's easy to forget that usually these folks are SICK. With a population that lives below the poverty line life can be exceptionally hard decisions have to be made do I eat or do I get my meds or go to the doctor where I can sit for hours and miss a day of making money not getting paid and going further into the hole? I'll also admit there maybe a laziness factor or even a lurking denial about their illness. That kind of thinking inevitably leads to chronic conditions or undiagnosed maladies getting worse and worse sometimes with a not so pleasant outcome for the patient (death).  

Yeah...yeah..yeah what are you getting at you underpaid ass wiper?

My point is that despite your intentions here at BITCH we serve the public and really despite the politics of health care right now most old hands here don't give a nasty ugly rat fuck about insurance or ability to pay. EMTALA is not something we trudge on regularly or wave a dismissive hand at. The money end is important mind you but the folks in finance and billing can worry over that shit. So if you wanna work 6-7 days straight and make OT money great. Just remember that we take care of often truly SICK patients here.

The other is don't take it personally. I remind myself of that one often getting called a racial slur several times a shift and being talked down to by a idiot nurse or a new nurse can try what's left of my soul. Getting snapped at by any resident during a code or a trauma call is par for the course. Often there are unseen pressures that you might not be privy to especially if it's menial horse shit. Why did not I telepathically know that there was an add on lab and not draw a special tube when I started the IV? Then getting threatened with a write up. I always say go ahead and do me but I'm gonna be drawing labs for you in the mean time. I'll cut you some slack once or twice but being an ass to me constantly is often uncalled for. I know when it's right to stand up for myself and I'll take the hits but not for long. There is stress and then there is just being a cunt for the sake of being a cunt.

Patients unless they physically attack me or someone else are usually given the benefit of the doubt. Being outraged over drug seeking behavior or the bipolar who is manic at the moment does little if any good. We deal with people and often we see the worst that society has dredged up from the bottom of the cesspool and unfortunately they will make themselves known. But let's not forget the little old man sitting outside the "big room" who is a veteran of WW2 and saw some truly grizzly shit he's a hard man he killed Japanese marines with his bare hands, crying over his wife of 60 plus years who is having acute stroke symptoms and has never been sick a day in her life. Yes of course he deserves and has even earned your time and kindness but so has the insane hemophiliac paroled convict who rips out hard fought IV's and leaves so he can binge on heroin for the first time in 5 years. I'm sure I am at odds with many people over this kind of thought but it has taken me well over a decade to get to this frame of mind. Because I realized being otherwise is a drain on my overtaxed soul.

It takes time and patience with yourself to learn your limits with patients. Yes I know and have experienced many times over what irks us about certain attention seeking personalities of patients AND coworkers. Although I have had my moments I am proud to say that most of the time I don't take it personally because I know at the end of the shift unless something has horribly gone wrong that I'll go home watch a funny brainless comedy show and wash it all down with a cold beer then shower go to sleep and do it all over again.

Number 15

Sweet talk will get you nowhere...

Especially if the Attending is in a foul mood.

Overheard during a discussion turned ugly about opening up an area for overflow in the ED.

Attending:  "Hey charge nurse help me help you, how long does it take to open up those other beds? I know you have staffing, all the midshift nurses came in, I saw them. It's been an hour."

Charge Nurse: "Don't worry about it sugar I got it covered."

Attending: "First off I am NOT YOUR SUGAR. I AM THE ATTENDING PHYSICIAN AT A LARGE URBAN HOSPITAL! Do I have to get the manager and house supervisor involved because you cannot handle opening up a few more assignments? You nurses are all over my people (residents) about moving patients and now you're screwing around. OPEN THE ASSIGNMENTS!"

Charge Nurse: *tearing up & voice cracking* "Yes doctor I'll do that right now."

The assignments opened up in the next 15 minutes. Later in the shift this same male attending physician found a small bottle of Midol in one of his coat pockets. This Crusty ER Tech may or may not have had something to do with it. He was not pleased and his wrath was unpleasant to say the least even though he had no clue who did it.

Never piss off an Attending Physician even further when he has a case of the ass.

It was the best use of five or so bucks that day. We all had a good laugh out of it anyways.

Number 14

I do look at my info from google about how folks get to my little space on the internets. A question that was posed is "Is being an ER tech worth it?"

It's a toughie.

In previous blogs I have explained why this job to put it lightly can be an incredible hemorrhoidal pain in the ass challenge. I have said here that in the short term say under a 2-3 years sure it's worth it. But once you stretch beyond the three year mark then you should seriously look into going BEYOND being a lousy ER tech.

2-3 years in a good ER (Like a real hoppin' level one or a remote rural level two) can bring you a wealth of experience that can propel you into most any job in the medical field. You'll have a high degree of bedside skills and will be able to work with a wide variety of people.

Fact is give it a whirl for six months to a year then if you like it start getting pre-reqs knocked out for whatever medical field degree you wish to have. BELIEVE me when I say if you tell folks you are knocking out pre-reqs for anything in medicine folks will do their best to guide you and help you out. At least the ones worth a shit.

In the end (pun intended) it's a job. Do not come into this job thinking that you are going to save lives every damn day and it's all glory. You won't deliver babies all the damn time and cardioverting someone in triage or waiting room happens only once in a very very rare while. Good trauma happens but it can be very hit or miss.

It ain't even close.

There is no glory when you are doing your ump-teenth code brown of the night for that c. diff patient with MRSA. There is no glory in getting racial epithets hurled at you at any given moment. There is no glory in working a LONG 12 hour shift overnight and then getting horrible code or violent patient right before the next shift comes on. There is no glory putting a six year old in a body bag after they drowned. There is no glory trying to find beds for patients who come in via ambulance even though you're suppose to be on divert (again). There is no glory in getting run into the ground because the other techs are unavailable, hiding or a nurse (or anyone else for that matter) is being a horrific asshole.

I have to confess that I have seen the job break several folks over the years and I freely admit I have had similar moments myself. Now don't worry I ain't going to dump my emotional purse out all over the counter for all to see. But if you're in this job there are other pit falls that you need to expect. Stress and strain are magnificent monsters.

But there are rewards too.

Calling a family after their elderly parent has been missing for days and hearing the relief in their voice. Learning and seeing critical bedside thinking come to fruition as a team and helping save a life. My personal fave is camaraderie after work drinking breakfasts after a tough night. I have made some incredible life long friends all over the country in the job.

In the end it's a JOB. Like all jobs in it's worst hours it sucks. In it's best times it's fantastic. I cannot give you a yes or no to that question but I will say when I sit back and think on it that I can certainly say as of TODAY after over 10 years as an ER Tech that the pros outweigh the cons by a tiny bit. But only by the thinnest of margins.

Have a plan go forward and prepare yourself cause getting the job is easy, staying in the job is the hard part.

Seriously consider being an assistant manager at subway. I heard it pays better at least.

Number 13

I wanted to do something special for my 13th entry but I lack the time. I'll share with you a couple of things from my past few shifts at local trauma center/ER:

- Mid 20's Male patient was found on side walk in semi-conscious state wearing cowboy chaps (yes fringes and all) with no undergarment, naked from the waist up and no cowboy hat. Tells ambulance crew he is looking for a plumber. Pt is brought to hospital and when Doc asks pt his drug of choice the pt responds "Cum!"

"Hi yo silver, Away!"

- Female early 20's patient brought in. Schizophrenic and off her meds with history of drug abuse (pretty much you name it she takes it when she is off her psych meds) Pt has serious delusions of grandeur and  feels as though she is caught up in some sort of universal conspiracy involving an an ancient evil. Which naturally EVERYONE except her is a part of she is just trying to bring all us "evil mother fuckers down". She is highly articulate and even convinces the Doc to discharge her. Shortly after doc leaves she goes into a manic phase where she yells "Shut up!" for nearly 30 minutes straight. Staff pleads with attending to admit patient. Attending comes back to talk with patient. Doc tells pt he just wanted to check on her one more time to which she responds "Your army of cockroaches will never capture me, I am the queen of the universe!" At which point she throws her blanket at the Doc.

Pt is admitted to the psych unit.

Number 12

I wanted to write about Nurse No (a floor nurse) who trapped a patient in a bathroom because she misread a chart and thought it said tuberculosis instead of a simple pneumonia. It’s a funny story. Instead since school has started and I lack time to properly write a longish story I’ll write about the 2 minute call for a T.O.D.

A young male is the victim of a single small caliber (turned out to be a .25 caliber) GSW to the chest, it appears to exit around the t-spine area.  The patient comes in via ambulance; a trauma surgeon is present in the trauma bay.  The trauma surgeon is watching the entire scene from the door. He says the usual things “Put him on the monitor and let’s get him stripped to see if he’s got another wound someplace.” The trauma doc says “Look if I’m going crack his chest we got to know some things real fast.”  Both happen real quick, yup only the two wounds (Apparently the entrance and exit wounds). He asks the paramedics how long the transport was and when the call dropped. He looks at the patient and looks at the clock, then the monitor, then asks his team if anyone fees a pulse. 

No pulse.

He says “He’s dead.” The trauma surgeon and his team leaves without a word. 

Time of death was exactly two minutes from when the patient rolled into the trauma bay.

It does happen that quickly. No shit.

I'll try now to put in an entry a month since school has started back so check back in a few weeks. The Crusty ER Tech has to get his degree so he can get the hell out of the ER.

Number Eleven

There has been a recent drought of posts here of late. I could give you lame excuses but it boils down to it is summer time and the ol’ Crusty ER Tech is drinking cold microbrews and chasing women. Not nurses or anyone else that works in a hospital or on an ambulance. Although I have crossed this line often in the past I think the shit is just not worth the hassle. 

Today’s entry is not about dating and the perils of “seeing” someone from the job outside of work. We’re all adults here, for some folks it works for others meh, it does not work out so well.

So what to write about? Not that I have run out of shit to say after just eleven entries. Today I will talk about the dreaded “mandatory department meeting” that I had to attend a few weeks ago.

The “mandatory department meeting” in my experience in the past is a chance for the higher ups to get most of the department crammed in a room and tell us that we are a bunch of fuck ups.

It’s filled with a tinsy bit of a pat on the head at the beginning and then the verbal beatings begin. They pat themselves on the back as well “See we feed you” is always said. Feeding us consists of cold coffee and day old doughnuts and pastries bought at the discount rack in the local grocery store. 

Thanks for the hard bowel movement later on.

I now work in a very large urban emergency room.  The staff in this ER is larger than the staff in most of the surrounding hospitals. Yet management has yet to learn that when we have these “mandatory department meetings” that hey since we are a teaching hospital and have access to large auditoriums on campus that someone should reserve a large auditorium so we can at least be comfortable. Not crammed into a classroom that is barely big enough to fit 20 people in. It’s like cramming clowns into a car; a couple of charge nurses are outside acting like pushers in a subway. “Go in go in you have to hear all this important information!”  Meanwhile it’s SRO in this small classroom with folks pushed all the way up underneath the management types so much so that they are looking up their noses like the front seats in an old movie theater.

This meeting was a bit different. Yes, we were all crammed into a small classroom status quo there. And yes, we had the day old doughnuts and cold coffee in the back of the room. But now we are getting new buzzwords. “We are reintroducing a policy that we feel can be successful because it was not rolled properly in the past.” Another words they are trying that square wheel idea out again. They are rewording a policy to show that manglement (yes I spelled it right) is doing something and fuck it nothing else worked to get wait times down so we’ll bring back a broken square wheel and shove it down folks throats in hopes that maybe this version will work. 

Another word thrown around was said by a really high muckety muck “I want to promote a collegial atmosphere” Which I agree with to a point but sometimes folks need a kick in the ass. “Hey jack ass, watch what you’re doing you nearly killed the fucking patient” and “This patient look like shit on a stick” works tons better than “Please be aware of your surroundings, your actions could be detrimental to the patients outcome” and “This patient looks acutely ill and requires immediate attention” Say that horseshit in our ER and you’ll get a fucked up look and asked “What the fuck did you just say?!”

I get it they are trying to take the nasty edge off the place. It’s a kinder gentler face we are trying to put on the old large urban ER. Like my uncle from the Allegany mountains use to say “Son, you can’t polish a turd” and “Put lipstick on a pig it’s still a pig” 

So buzz words are becoming big now. Another thing that was introduced is a progress nurse. This nurse insures that flow (pushing patients through the system) is never held up or stopped. Another level of management was introduced too.  I won’t explain or show the algorithm to this management gerrymander because it will give away where I currently work. Let’s just say as a tech I thought I saw a lot of chiefs before walking around and not enough of us Indians now we will have 2-3 more management types in pissing matches with each other during the shift.  It effects me by having another 2-3 people telling me what I can and cannot do on top of a long list of nurses and a charge nurse as well AND the plethora of other players in the ER as well. 

In short my negative view of “mandatory meetings” is jaded by the usual pattern no matter where I have worked in the country.  This is how it works:

-Introduction. Told we are great. Minor pats on the head.

-Stale food and cold coffee is pointed out.

-Charge nurses push people into the small room/class room

-We are told we are a bunch of fuck ups.

-The mad search for the sign in sheet by ER staff. You MUST sign it or you’ll get a write  up. The meeting IS MANDATORY!
-This is how you are fucking up.
-Stop fucking up or else!
-The executive that was suppose to open this mandatory meeting, shows up 15-20 minutes late. Tells us we are great BUT he has a letter of complaint he/she wants to read to us.
-ER manager glares at entire department over this. 
-Exec leaves, gets at least one persons name wrong in the room despite that we are all wearing name badges.
-ER manager reminds us that we are fuck ups. Since we are fuck ups an old policy will be dragged back and flogged into paste and enforced to the nth degree.
-“And we mean it THIS time!” 
-Staff begins checking watches meeting is running a bit long.
-Dumb ass questions are asked about new/old policy by new staff. Usually new nurses or techs that have not learned to keep quiet.
-New old/policy questioned rehashed and reexplained.
-Staff begins to leave to “use the bath room”
-ER mangler realizes that the attention span of those in attendance has expired. Reminds everyone of stale food and cold coffee.
-Everyone leaves. Shift to be relived is pissed because this “short” meeting took 2 hours their 12 hour shift is now 14+ hrs long.
-ER manglement is heard to say "That was a good meeting, we made progress today."

 

So it goes in the common ER mandatory meeting. In the past I have openly questioned this wisdom. I have said “Why can’t we record or video it to play later on to whoever OR have like a teleconference so we can watch it from home” I am ignored of course because after all I am “just a tech”. The crusty one continues the job cynicism firmly entrenched into his soul.

Number Ten

Or Numba ten. I thought that you nurses out there would like to know what in the hell they teach us in EMS schools. Well you're in luck! I dug deep into my archives and found a few of the on line CE videos I watched a short while back:

And you're welcome now go forth and well...whatever.

Number Nine

A waste of training, time and talent.

I know I said a couple of entries ago that “Deserve’s got nothing to do with it” when it comes to getting shit assignments in the ER. It does no good whining about it, it least of all does no good asking for a different assignment unless there is some sort of friction with another person (I.E CN15) In spite of all of that shit that I said I have to whine about constantly getting the shit end of the stick.

Let me say here I do not mind doing the dirty, hard, thankless tasks that encompass a tech’s every shift, sometimes though it gets ridiculous. For awhile after I started big urban trauma hospital (my most recent job) the crew there took full advantage of my training and talent. I got to work things I had never worked before. I worked with a great crew and made a difference. I was actually once again excited about the health care profession in the ER after a mind numbing, soul trying 2 years of west of the Mississippi low level hospital.

Then I somehow pissed off a charge nurse by being associated with a hard working bunch and by pissing off this charge nurse I also angered her cronies. For the next year despite the knowledge that I was caring for a dying father at home they worked to make my life miserable on the job, they succeeded. I was then routinely assigned away from the hard working crew and stuck in the triage area. That was pretty good I hung out with ambulance crews and I jumped in on things that truly needed my help. But then I got put there EVERY shift and eventually her cronies as directed by her put the screws down tight on me. Which consisted of and I shit you not a special list of tasks for me and only me to do when I was seen to have free time. Any truly dirty frustrating job that came up I got stuck with often in spite of the other techs saying that they’d do it for me.

A great example of that is cleaning the same urban outdoorsman (homeless guy aka hobo) 2-3 times per shift when he was there, because once despite spending nearly an hour scrubbing this dude down was not good enough. It became comical after awhile “I ain’t ever coming back here again cause your faggot ass keeps cleaning my ass over and over and over…get away from me motherfucka! I ain’t got no skin left.” I seriously started keeping lava soap in my locker after awhile for these folks. This supervisor and her cronies would pull the dirtiest people out of their rooms bring them to triage for me to clean 2-3 times a shift. That means out of other techs areas of responsibility, this was not done to anyone else just me. When this did not work and I began to develop a rapport with the local homeless she thought of another assignment. I did this assignment every shift 3x a week for months.

The psych-obs unit, which I do not mind either but after every shift for weeks of dealing with clinically insane violent patients you begin to crack, you start in a sense acting like the psych patients to a degree because that’s your reality 36-40 hours a week. This is alright because you learn to deal with these unfortunates better. I was even written up for defending myself against a violent patient ,it did not help her case that she did not know the patients name or check the chart to see that I was documenting this patient’s escalating behavior or the patient’s violent past, fortunately the nurse assigned to that patient explained the situation to the manager. The object was to make me quit or change shifts, normally I would say something but at the time I had a lot going on outside of work, I decided to go to day shifts instead, they won.

But the thing is that after awhile of being assigned low acuity areas your skills start to die off. I knew EKG’s pretty well for a while there now I CRS (can’t remember shit) I was assigned the monitor room to relive a lunch the other day and I was terrified. I really do not even how to use the new monitor equipment in there and could not find numbers to call nurses when their patients threw funky rhythms. There was a long while where I hardly ever missed an IV now I still get the IV but it’s not as effortless as it use to be. IV’s are very few and far between. I knew lab values off the top of my head. I knew where nearly everything was in the department and depending on the shift, knew who to get in touch with for anything from wrangling crutches from the ortho floor to a stray set of rib spreaders when the open chest tray did not have any while cracking a chest (this happened more than a few times). Heavens help me if I ever have to run a Level 1 infuser again. I knew what parts of the hospital were under construction and where to find the ultrasound tech at 0100 in the morning. It’s a damn big hospital I work in now so knowing that shit is a feat. All that knowledge is gone now.

That’s the point I’m at. The hard working crew has gone on to other things in other hospitals and I’m on a different shift working PRN. Since I am a stranger to the day shift charge nurse I am assigned to two areas constantly. I am either in triage or psych-obs, because those are the shit assignments and I’m the new guy on the shift, despite having more experience as a tech than any other tech on shift. Hell I have more healthcare experience than many of our new herd of new hires. I know nurses and techs are VASTLY different but experience plays a role in team work and patient care. I don’t blame her, I need to prove myself to her, but I’m tired of this proving myself over and over again thing, its old very old.

I am well aware of fair, right and deserve has nothing to do with it. It’s a big damn cup full of vicious diarrhea and I gotta keep taking long pulls from it for the foreseeable future, maybe until one of the violent patients kills or seriously injuries me.

I had a now ex-girlfriend tell me I should go to another hospital or quit the field altogether. I told her what’s the point, I’d just have to prove myself over again and I’m tired of that shit and quit and do what in this horrid economy. Besides it’s best to stick with the demon you know rather than the demon you don’t know anything about. Funny thing is that she’s now an ex-girlfriend and I’m still on the job.

I take comfort in the knowledge that the charge nurse that started all this mess at urban trauma center was forced out and left this hospital but her cronies on night shift remain. One even now has moved into her vacant charge nurse position. Things change but stay the same. If we had a manager now I’d go talk to them about moving up to the ICU in hopes of learning something different. I have applied to another hospital for a PRN ICU tech position and heard nothing. I’ve considered going to paramedic school recently and returning to the trucks. That thought of going back to the ambulance has bounced around in my little skull for years, I know better.

So where does that put the crusty one. Well, the same place I started. In a damn dead end job working to roll away the stone in college so I can get a nursing degree and get out of the damn emergency department. Here’s a bit of advice for you folks who want to be an ER tech or just started the game. It’s good for a couple of years but then move on to something else, get educated and get out of being a tech, it’s only worth it for a little while.

Cynical and tired is what I am. I am the Crusty ER Tech.