When ER patients stay WAY beyond their discharge.
I get a lot of guff from patients and co-workers about cutting off patient armbands after they have been discharged from the ER. Patients and their family members and I think the public in general sees the arm band as a sort of strange badge of honor. Ive had serious "discussions" with patients about the validity of an armband once it's cut off. "I have to show it to my boss" I always explain that well we also gave you a work excuse and your name is still on the arm band even after we cut it off.
I've been told by a lot of co-workers that it's trivial bullshit on my part to cut off armbands, naturally I scoff at that and then tell them this little story.
I was at my first ever ER tech job after getting off the ambulance and really dug the hospital I was working at. It was a moderate level one on a weekend night crew that was seemingly always understaffed so naturally all of were close. In fact even to this day if I run across another person who has worked at that ER ever I give them a lot of deference. I digress though.
I never thought twice about cutting off armbands then. In fact I would think it would be safe to say I never did it was not standard practice. Then all hell broke loose after someone did not cut off the ER arm band of a particular patient. When I say all hell broke loose I mean on a corporate level. I was working for a large corporation hospital whose interests lie over several states.
What happened was that someone from my shift (It could have been anyone of us) did not cut off an arm band. The patient and her family then packed up all their stuff and went to the little used strange corner of the hospital that was the "overflow" for the maternity ward. In my time at this hospital I never saw patients go up to this area. Sure you would walk through it to get to the other older part of the hospital, seriously though no patients or staff were ever assigned these rooms.
There in this semi-abandoned corner of the hospital was where this family stayed for a little over a week. By family I mean father, mother a couple of kids and a grand parent of some sort as well. "Preposterous" you may think certainly person from security would have picked up on this with their patrols. Um...no. Keep in mind this is a corporate chain of hospitals, security is low on their priorities, the security went to the lowest bidding security company and I hate to say this you get what you pay for. Our security personnel's primary focus was patroling the parting decks keeping all the cars safe especially where the corporate hacks cars were parked. This naturally caused probs in the ER later, that's another story though.
Well then a doc, nurse, tech or other hospital personnel would have noticed. Well not really, I'll get to that in a moment. In your daily wanderings in the hospital do you even pay attention to the people you pass in the hospital that look semi-normal. Also in the entire hospital's defense it was a couple of years post 9/11 in a part of the country NOT known for terrorist attacks and mass shootings. Noone thought twice and if they did ask they were promptly shown the patients arm band that was still attached to the discharged patient.
Finally after a little over a week someone noticed. It was a house supervisor who gave a fuck (another words who did their job) noticing this patient for the umteenth time and running over to a computer and running the record number and seeing that the patient was discharged over a week earlier. Security was called and since they were just really low level parking lot observers the local police were contacted and showed up.
As the police say "upon further investigation" they all found this family living in a room on this little used corner of the maternity ward that was nowhere near a nursing station that was in use. Turns out that the family was contacted several times by hospital staff but once seeing the still intact armband on the patient let them slide because they had an intact armband. The family made many visits to the cafeteria and in fact some how were getting trays delivered to the room. They had found a linen cart and were getting fresh towels and sheets from it and had even gotten toiletries (soap and toilet paper etc) from the hospital as well. I would even go as far to say that this was epic.
This got the attention of the hospital's corp types and then on up the chain to regional corp. Naturally the family got tossed out on their asses by the hospital. I don't know if they were homeless or not and it was all hushed up this incredible story never made it to the local news. Well shit went up in the air and landed right in our laps there in the ER.
We all got lectured to for weeks about the prompt removal of armbands from patients upon discharge. In fact they then went to different colored arm bands for the ER just in case. The admit clerks were to cut off the ER arm band if the patient got admitted. We had to keep up with the armbands and I'm sure someone some where was keeping count. It became policy in our ER to cut off armbands no matter where the patient came from and put on our own and that the armbands we put on patients in our ER were hospital property and to be retrieved. If you missed an armband and it was found that you neglected to collect it you were verbally warned then got written up for your lack of attention to this particular detail. Seriously, no shit.
Yup this happened. So that dear readers is why I cut hospital arm bands off of patients now. I'll even say you should too once a patient has been discharged from the ER.
Reality is quite strange sometimes.
Sunday, January 31, 2016
Sunday, January 24, 2016
Sixty One
Talking to a Paramedic after a particular stroke call a few weeks ago, I just heard that the call was coming in and did not know the entire story.
Crusty ER Tech: Dude what happened?
Paramedic: "Got toned to an elderly woman having a stroke. Got on scene to this woman who was all contracted in bed. Breathing like 6 times a minute. Family says that they decided to take her out of the nursing home she was in. After a night or two at home she starts acting altered. Family decides fuck it she's tired lets put her to bed. Ten hours later they check on her and she's like this. They had no clue about her history or meds. They acted like they did not even care, no one even asked what hospital we were going to. I asked them when they tried to get her up and they said 'We got her up when we got her up'. Goddamn that place was a hell hole.
Crusty ER Tech: They should have left her in the nursing home. If it ain't broken don't fix it.
Paramedic: This is my first call of the day on a 24 hrs shift. Humanity is not my favorite species right now. This family was something else.
Crusty ER Tech: Sorry bro, hard times, anything I can do for you?
Paramedic: Nope, we're a truck down today and I gotta get back in service ASAP.
With that he split. I've stated before that for the most part I like patients. Although sometimes there are exceptions. I have no way of knowing the whole story, it's just damn tragic no matter how you cut it.
Crusty ER Tech: Dude what happened?
Paramedic: "Got toned to an elderly woman having a stroke. Got on scene to this woman who was all contracted in bed. Breathing like 6 times a minute. Family says that they decided to take her out of the nursing home she was in. After a night or two at home she starts acting altered. Family decides fuck it she's tired lets put her to bed. Ten hours later they check on her and she's like this. They had no clue about her history or meds. They acted like they did not even care, no one even asked what hospital we were going to. I asked them when they tried to get her up and they said 'We got her up when we got her up'. Goddamn that place was a hell hole.
Crusty ER Tech: They should have left her in the nursing home. If it ain't broken don't fix it.
Paramedic: This is my first call of the day on a 24 hrs shift. Humanity is not my favorite species right now. This family was something else.
Crusty ER Tech: Sorry bro, hard times, anything I can do for you?
Paramedic: Nope, we're a truck down today and I gotta get back in service ASAP.
With that he split. I've stated before that for the most part I like patients. Although sometimes there are exceptions. I have no way of knowing the whole story, it's just damn tragic no matter how you cut it.
Saturday, January 16, 2016
Sixty
Wanting rib spreaders vs. needing rib spreaders
Since this small dysfunctional corner of the internet has made it to sixty that's right folks 60 entries I decided to relate one story of a distant past. Plus crusty is a few strong beers in on a late weekend night. Forgive the typos and hold on to the popcorn cause this folks is a true doozy.
I was working a trauma shift in one of the trauma centers I had worked in my past. One of the responsibilities of this area that night was taking inventory of the equipment on hand vs needed for the night. The preference is for every trauma bed that there be a thoracotomy tray.
Before I go any further let me state a few things:
1) I know precious little about surgery
2) Although exciting it still to this day well over a decade later as a dumbass ER tech that surgery on a major scale terrifies me.
3) I have a LARGE amount of respect for anyone who takes knife to skin in hopes of healing
4) I am NOT an OR tech nor do I have any OR experience. I could not tell you the components of a thoracotomy tray but I can tell you once you get to that point that GODDAMN EVERYTHING IS IMPORTANT. I am an old EMS type who has seen a thing or two with a keen sense for shit really going sideways and figurung (drinking here remember) out how to dig out of the proverbial hole.
5) Many apologies to those of you who work OR who know what is going on.
6) I am terrified of surgery...did I say that already?! That is whether it's being done on me or not.
7) PLEASE understand I am talking out of my ass and way out of my comfort zone here.
So I do my inventory and find that for the night and for all our trauma beds I have exactly ONE thoracotomy tray on hand which perplexes me but I am told that "it's a week night nothing REALLY happens on weeknights' Cue foreshadowing music. I am working at a poor hospital and really we are lucky to have this tray on hand usually we have to beg one from the OR.
Now up until this point I've seen a few chests cracked. Been there when we needed to internally defib a patient and not have the paddles on hand. (how do you fix that? well open up another tray or grab a spare set if you are in a well funded hospital) So I know a little bit which is to say when the surgical team decides to crack a chest in a trauma room the pucker factor goes up a shit ton and the shit has hit the fan in a very major way. Which is to say when I hear the surgical types say "We're cracking a chest" I need to know where everything is at and then where to find things if shit ain't there another words when old murphy of murphy's law makes a very unwanted appearance.
Long story short and you dear readers saw it coming that night we crack a chest.
The tray is opened and lo and behold the tray has everything we need except for:
THE FUCKING RIB SPREADERS
For those of you not in the know rib spreaders (eg, Finochietto) are one of those essential pieces of equipment you cannot get to the heart without them. This vital piece of equipment opens the rib cage enough for the surgeon to reach their hands in to do repairs to very vital organs, defib a patient or do a heart massage. These like most parts of this particular tray are important. Unlike most everything else in an ER you cannot just cobble together something that works you gotta have THAT piece of equipment.
Now I am sure there are folks out there way smarter than ol' crusty ER tech who know how to do shit like this. To them i will say in a situation like this I am by far the dumbest person in the room. I am not a trained surgical type. I will say that even surgical folks may not know how to over come this deficit of essential surgical equipment. I don't know I do not work in an OR.
So there are no rib spreaders. Since I slapped the tray down on the table and i'm standing there and fuck there are no rib spreaders all eyes rest on me. Now double fuck me. I should have insisted earlier on getting a second tray up ther just in case but i was waved off that thought for what ever reason. At that point the surgeon says "Fuck open another tray" Which the charge nurse and trauma nurse say "That's all we got" A silence falls over the room. We all know the surgeon wants to crack the chest in fact in the hurry to do it the rest of his team has already cut into the appropriate land marks and fuck blood is pouring out. The level one is going and suction canisters are filling up. Lots of blood in the chest cavity.
I look up and say "I'm going to run over to sterile supply and get another tray" I get told more than once before i leave the room to "Hurry the fuck up"
I am sprinting down the hall way. I am confident in those moments that the charge nurse is on the phone to sterile supply telling them someone is headed over there to pick up another tray. I know there is probably a resident calling the OR telling them of our predicament. Sterile supply is closer in a round trip than OR is one way. So I know if it's no dice at sterile supply I gotta call the ER and let them know I got fuck all. It's a monumental cluster fuck.
I make it to sterile supply, instead of seeing a rattled person standing outside the doors with the tray in hand I arrive at the door hearing their phone ringing. I start pounding on the doors with both fists screaming. I am having a controlled shit fit. The doors fling open and there stand a bewildered sterile tech looking at me all pissed off.
This is understandable. I can imagine the life of a night shift sterile tech being almost zen like. Night in and night out you listen to your music and clean surgical tools. You do the same thing night in and night out you may think "this is awesome, I'm all by myself and I don't have anyone hardly ever bothering me." Again I don't know I am not a sterile tech I can only guess.
I have disturbed this dude's zen and fuck now the damn phone is ringing off the hook, shit every line is ringing off the hook. I would guess that this dude has never seen this much action going on at his job ever. He's answering the door & picking up the phone. He's got me screaming at him for a thoracotomy tray and some other person on the other end of the line screaming for the same thing. This dude is in the eye of a horrible shit storm and he ain't use to it. I know it's the charge nurse asking for what i'm asking for because she ain't leaving anything to chance cause I could have dropped over dead running over to get the thoracotomy tray. In fact i'm a little surprised a surgical resident or another tech is not running up right after me.
Needless to say I am sweaty and wild eyed.
The sterile tech is able to focus enough through this abrupt cacophony of noise that I need a thoracotomy tray. He has no clue I need it NOW!!! He tells me all our thoracotomy trays are being cleaned at the moment, that we'll have to wait until later to get them.
Clearly there is a misunderstanding here.
To his credit he hangs up the phone before I speak. The phone begins to ring again. He looks annoyed. I am one breath from pushing him aside and just grabbing whatever i need which would be a mistake since i have no clue where anything is in the sterile cleaning area. I calm down enough to tell him that we are cracking a chest up in the ER and that I need a thoracotomy tray ASAP, Yesterday, NOW!!!! If I ask for rib spreaders alone it will be a fuck up. Better to ask for the tray in fact in my paranoia I ask for two thoracotomy trays. He snatches up two quick that belong to the OR . I tell him if I have to come back for another tray that physical violence will occur. I mean it because what we need aint on these trays then I am fired, he is fired and other people are fired so why not kick someone's ass over this damn mess. I'll take the charge fuck it.
I make it back to the ER in just a few minutes (literally, yes LITERALLY!!!) The chest is cracked the rest of the way and surgical things happen. I won't go past that.
I don't know who fucked up the thoracotomy tray so badly that there were no rib spreaders in it. I was told rather sternly that I knew better and to have a back up tray in the future. I learned a powerful lesson there. The charge and trauma nurses were told the same thing. We all got angry glares from the surgical teams for months after that. A lot of memos and emails were exchanged over this very gross oversite. For as long as I was at this hospital that never happened again.
I had a triple extra large whiskey after that shift. It makes for a nice story but I've had a lot of sleepless nights over that one. So goes the life of the ol' crusty one.
Since this small dysfunctional corner of the internet has made it to sixty that's right folks 60 entries I decided to relate one story of a distant past. Plus crusty is a few strong beers in on a late weekend night. Forgive the typos and hold on to the popcorn cause this folks is a true doozy.
I was working a trauma shift in one of the trauma centers I had worked in my past. One of the responsibilities of this area that night was taking inventory of the equipment on hand vs needed for the night. The preference is for every trauma bed that there be a thoracotomy tray.
Before I go any further let me state a few things:
1) I know precious little about surgery
2) Although exciting it still to this day well over a decade later as a dumbass ER tech that surgery on a major scale terrifies me.
3) I have a LARGE amount of respect for anyone who takes knife to skin in hopes of healing
4) I am NOT an OR tech nor do I have any OR experience. I could not tell you the components of a thoracotomy tray but I can tell you once you get to that point that GODDAMN EVERYTHING IS IMPORTANT. I am an old EMS type who has seen a thing or two with a keen sense for shit really going sideways and figurung (drinking here remember) out how to dig out of the proverbial hole.
5) Many apologies to those of you who work OR who know what is going on.
6) I am terrified of surgery...did I say that already?! That is whether it's being done on me or not.
7) PLEASE understand I am talking out of my ass and way out of my comfort zone here.
So I do my inventory and find that for the night and for all our trauma beds I have exactly ONE thoracotomy tray on hand which perplexes me but I am told that "it's a week night nothing REALLY happens on weeknights' Cue foreshadowing music. I am working at a poor hospital and really we are lucky to have this tray on hand usually we have to beg one from the OR.
Now up until this point I've seen a few chests cracked. Been there when we needed to internally defib a patient and not have the paddles on hand. (how do you fix that? well open up another tray or grab a spare set if you are in a well funded hospital) So I know a little bit which is to say when the surgical team decides to crack a chest in a trauma room the pucker factor goes up a shit ton and the shit has hit the fan in a very major way. Which is to say when I hear the surgical types say "We're cracking a chest" I need to know where everything is at and then where to find things if shit ain't there another words when old murphy of murphy's law makes a very unwanted appearance.
Long story short and you dear readers saw it coming that night we crack a chest.
The tray is opened and lo and behold the tray has everything we need except for:
THE FUCKING RIB SPREADERS
For those of you not in the know rib spreaders (eg, Finochietto) are one of those essential pieces of equipment you cannot get to the heart without them. This vital piece of equipment opens the rib cage enough for the surgeon to reach their hands in to do repairs to very vital organs, defib a patient or do a heart massage. These like most parts of this particular tray are important. Unlike most everything else in an ER you cannot just cobble together something that works you gotta have THAT piece of equipment.
Now I am sure there are folks out there way smarter than ol' crusty ER tech who know how to do shit like this. To them i will say in a situation like this I am by far the dumbest person in the room. I am not a trained surgical type. I will say that even surgical folks may not know how to over come this deficit of essential surgical equipment. I don't know I do not work in an OR.
So there are no rib spreaders. Since I slapped the tray down on the table and i'm standing there and fuck there are no rib spreaders all eyes rest on me. Now double fuck me. I should have insisted earlier on getting a second tray up ther just in case but i was waved off that thought for what ever reason. At that point the surgeon says "Fuck open another tray" Which the charge nurse and trauma nurse say "That's all we got" A silence falls over the room. We all know the surgeon wants to crack the chest in fact in the hurry to do it the rest of his team has already cut into the appropriate land marks and fuck blood is pouring out. The level one is going and suction canisters are filling up. Lots of blood in the chest cavity.
I look up and say "I'm going to run over to sterile supply and get another tray" I get told more than once before i leave the room to "Hurry the fuck up"
I am sprinting down the hall way. I am confident in those moments that the charge nurse is on the phone to sterile supply telling them someone is headed over there to pick up another tray. I know there is probably a resident calling the OR telling them of our predicament. Sterile supply is closer in a round trip than OR is one way. So I know if it's no dice at sterile supply I gotta call the ER and let them know I got fuck all. It's a monumental cluster fuck.
I make it to sterile supply, instead of seeing a rattled person standing outside the doors with the tray in hand I arrive at the door hearing their phone ringing. I start pounding on the doors with both fists screaming. I am having a controlled shit fit. The doors fling open and there stand a bewildered sterile tech looking at me all pissed off.
This is understandable. I can imagine the life of a night shift sterile tech being almost zen like. Night in and night out you listen to your music and clean surgical tools. You do the same thing night in and night out you may think "this is awesome, I'm all by myself and I don't have anyone hardly ever bothering me." Again I don't know I am not a sterile tech I can only guess.
I have disturbed this dude's zen and fuck now the damn phone is ringing off the hook, shit every line is ringing off the hook. I would guess that this dude has never seen this much action going on at his job ever. He's answering the door & picking up the phone. He's got me screaming at him for a thoracotomy tray and some other person on the other end of the line screaming for the same thing. This dude is in the eye of a horrible shit storm and he ain't use to it. I know it's the charge nurse asking for what i'm asking for because she ain't leaving anything to chance cause I could have dropped over dead running over to get the thoracotomy tray. In fact i'm a little surprised a surgical resident or another tech is not running up right after me.
Needless to say I am sweaty and wild eyed.
The sterile tech is able to focus enough through this abrupt cacophony of noise that I need a thoracotomy tray. He has no clue I need it NOW!!! He tells me all our thoracotomy trays are being cleaned at the moment, that we'll have to wait until later to get them.
Clearly there is a misunderstanding here.
To his credit he hangs up the phone before I speak. The phone begins to ring again. He looks annoyed. I am one breath from pushing him aside and just grabbing whatever i need which would be a mistake since i have no clue where anything is in the sterile cleaning area. I calm down enough to tell him that we are cracking a chest up in the ER and that I need a thoracotomy tray ASAP, Yesterday, NOW!!!! If I ask for rib spreaders alone it will be a fuck up. Better to ask for the tray in fact in my paranoia I ask for two thoracotomy trays. He snatches up two quick that belong to the OR . I tell him if I have to come back for another tray that physical violence will occur. I mean it because what we need aint on these trays then I am fired, he is fired and other people are fired so why not kick someone's ass over this damn mess. I'll take the charge fuck it.
I make it back to the ER in just a few minutes (literally, yes LITERALLY!!!) The chest is cracked the rest of the way and surgical things happen. I won't go past that.
I don't know who fucked up the thoracotomy tray so badly that there were no rib spreaders in it. I was told rather sternly that I knew better and to have a back up tray in the future. I learned a powerful lesson there. The charge and trauma nurses were told the same thing. We all got angry glares from the surgical teams for months after that. A lot of memos and emails were exchanged over this very gross oversite. For as long as I was at this hospital that never happened again.
I had a triple extra large whiskey after that shift. It makes for a nice story but I've had a lot of sleepless nights over that one. So goes the life of the ol' crusty one.
Tuesday, January 5, 2016
Fifty Nine
"Don't do it."
A few years back a friend outside of my circle of EMS and ER circles approached me after he graduated college with a bachelors of some sort of science from a major private university then med school. He had worked as a ER clerk to pay the bills that scholarships did not cover.
ER clerks in the old days really had a tough job and were often the center of the universe in the ER. When we had paper charts they'd collate them track them make calls to any number of people and get calls from the same. Biggest part of the job was answering the near constant ringing phone. Very important because ER docs call other docs to consult with and vise versa. Depending on the hospital they ordered tests and arranged transport to other parts of the hospital or at least helped in it. Aside from looking at the old white boards the ER clerk is the person who you told everything to because they were the one constant in the ER. Since we have computer boards and pt charts are computerized as well the role of the ER clerk has greatly diminished. It's an easy way to work in an ER without getting involved with patient care. An ER clerks job is to stay behind a desk period. I give the old ER clerks mad respect.
I digress
So I got this friend who wants to be a doc they have gone through med school and is looking to specialize. He his wife and I talk about this over dinner one night and I'm asked since I am an EMS type and work in an ER what I think of emergency medicine as a specialty for him. This friends is a really loaded question. If you already asking this question you've already decided and human nature being what it is you are looking for confirmation that it is a good decision. I'm known for being blunt to the point of painful even more so when it comes to the job.
I've known some great ER docs and some real shit bag ER docs. Some are truly great human beings and sometimes the smartest people in the room hands down. Others just need to be strangled where they stand because of their sheer incompetence and lack of any social skills what so ever (I'm talking to you Dr. Klaus).
I said that and also told him this exactly:
"Don't do it."
I was asked why and I followed up with many things. Emergency medicine is constantly changing and it seems to me that the higher your education the less time you spend at the bedside with the patient. A lot of what we all do not is sitting behind a computer and checking boxes. Liability and responsibility is tremendous for the ER doc. They are the generals in the ER what they say goes and they have to be leaders. It can be rewarding but also more often than not is total drudgery. Which goes for most any job anywhere. There is a shit ton that goes on behind closed doors that the ER docs do that I don't know about. There is a ton of politics played in the private groups in hospitals. When I worked at a private hospital with a small ER group I saw it fairly close up. You can be a fantastic doc and still get shit out the other end because you were on the wrong side of an argument with administration. I saw it happen a few times and it was always sad. ER docs have a lot of power but not as much as you think. ER docs are in essence the middle man, the jack of all trades and master of a few. They treat a patient and if the patient is seeing another doc they gotta call them and see what their doc wants to do. Waiting on that call back can be an aggravating experience for everyone concerned in the ER. I've seen docs do nerve blocks for a patient with a tooth ache and turn right around and read a vastly complicated EKG and decide on definitive care for another totally separate patient.
Let me dig myself in deeper because I'm too stupid to shut the fuck up. To me it seems like the financial crush of loans and the way over the top commitment to become a doc before you specialize is an astonishing achievement, truly a pinnacle. With that said why waste that on working in a ER. I told him do any other specialty get stupid rich and do cardiology, neurology or open your own colonoscopy clinic. That way you are not at the mercy of a hospital administrator or senior members of a large ER group. Do something with your doctorate in medicine where you can have nights and weekends off and be able to send your kids to a great liberal arts private school and college. Not do something where your life is put in danger every shift or where you get nightmares from what you've experienced as a doc in the ER. Don't do the job because you'll get pushed around by every other specialty and get shit on from down below and from a great height.
I told him doing any kind of patient care in a ER will change you and in my experience not in a good way. Its a whole different universe from ER clerk to ER doc. He's a great guy and honestly I did not want to see him change or be hurt from the crush of what I know about working in a ER especially going through residency in the hospital I work at, oh man oh man it can be awful. In short I wanted to protect my friend.
I had one ER doc tell em that his dad who was an ER doc as well told him not to be an ER doc. In fact his dad was pleased as punch because his son was an artist. Well the son felt the pull of ER medicine and went through the whole pipeline to be a ER doc. When he got his residency his father told him that he was proud his son got his doctorate but that he was a total idiot for being an ER doc now.
I guess I did not get my point across well or explain it clearly enough. He applied for residency and got it at a major hospital in another state. We stayed in touch as much as possible due to the constraints of being a resident. Towards the end of his residency we crossed paths and had a lunch he his wife and I. He excused himself to go to the bathroom during our lunch. While he was gone his wife became very somber which is not her personality at all. She told me "Everything you said came true" she was going to stick with him and support him but there are easier gigs as a doc than working in an ER, they both knew that now. I didn't ask for specifics, i could see the change in my friend too and it made me sad.
I knew one ER doc who was fucking excellent. She was amazing with the patients, staff all the way down to the housekeepers and kitchen personnel. It was a fair sized hospital and everyone it seemed knew her. Plus she was a great doc to boot. We loved her, she got tired of the grind of being an ER doc and one day came in told the group she was working with that she was done and left to do public health in Africa. She sent us an email a year or so later telling us it was the best decision she ever made.
I'm probably sticking my foot into my own mouth rattling off about this but really there is an easier way to make a living with an advanced degree, I'm sure of it. For the most part everyone who works in an ER intentions are well, they have a good heart. There are a lot of lost souls who work in an ER and I'm always a little depressed when I see a new crop of ER residents or new grad nurses come into the department.There is a high mental price to be paid in order to do it though.
For those of us who were lucky to get through high school and go on to work on an ambulance after a few years it's all you know. Your career options are limited dragging drunks and junkies out of flea bag motels and out of the gutter makes for great stories but hardly pays the bills. Ambulances and hospitals are not happy places in general. What I am saying in my off kilter way is:
Don't do it.
What do I know, I'm just Crusty ER Tech.
A few years back a friend outside of my circle of EMS and ER circles approached me after he graduated college with a bachelors of some sort of science from a major private university then med school. He had worked as a ER clerk to pay the bills that scholarships did not cover.
ER clerks in the old days really had a tough job and were often the center of the universe in the ER. When we had paper charts they'd collate them track them make calls to any number of people and get calls from the same. Biggest part of the job was answering the near constant ringing phone. Very important because ER docs call other docs to consult with and vise versa. Depending on the hospital they ordered tests and arranged transport to other parts of the hospital or at least helped in it. Aside from looking at the old white boards the ER clerk is the person who you told everything to because they were the one constant in the ER. Since we have computer boards and pt charts are computerized as well the role of the ER clerk has greatly diminished. It's an easy way to work in an ER without getting involved with patient care. An ER clerks job is to stay behind a desk period. I give the old ER clerks mad respect.
I digress
So I got this friend who wants to be a doc they have gone through med school and is looking to specialize. He his wife and I talk about this over dinner one night and I'm asked since I am an EMS type and work in an ER what I think of emergency medicine as a specialty for him. This friends is a really loaded question. If you already asking this question you've already decided and human nature being what it is you are looking for confirmation that it is a good decision. I'm known for being blunt to the point of painful even more so when it comes to the job.
I've known some great ER docs and some real shit bag ER docs. Some are truly great human beings and sometimes the smartest people in the room hands down. Others just need to be strangled where they stand because of their sheer incompetence and lack of any social skills what so ever (I'm talking to you Dr. Klaus).
I said that and also told him this exactly:
"Don't do it."
I was asked why and I followed up with many things. Emergency medicine is constantly changing and it seems to me that the higher your education the less time you spend at the bedside with the patient. A lot of what we all do not is sitting behind a computer and checking boxes. Liability and responsibility is tremendous for the ER doc. They are the generals in the ER what they say goes and they have to be leaders. It can be rewarding but also more often than not is total drudgery. Which goes for most any job anywhere. There is a shit ton that goes on behind closed doors that the ER docs do that I don't know about. There is a ton of politics played in the private groups in hospitals. When I worked at a private hospital with a small ER group I saw it fairly close up. You can be a fantastic doc and still get shit out the other end because you were on the wrong side of an argument with administration. I saw it happen a few times and it was always sad. ER docs have a lot of power but not as much as you think. ER docs are in essence the middle man, the jack of all trades and master of a few. They treat a patient and if the patient is seeing another doc they gotta call them and see what their doc wants to do. Waiting on that call back can be an aggravating experience for everyone concerned in the ER. I've seen docs do nerve blocks for a patient with a tooth ache and turn right around and read a vastly complicated EKG and decide on definitive care for another totally separate patient.
Let me dig myself in deeper because I'm too stupid to shut the fuck up. To me it seems like the financial crush of loans and the way over the top commitment to become a doc before you specialize is an astonishing achievement, truly a pinnacle. With that said why waste that on working in a ER. I told him do any other specialty get stupid rich and do cardiology, neurology or open your own colonoscopy clinic. That way you are not at the mercy of a hospital administrator or senior members of a large ER group. Do something with your doctorate in medicine where you can have nights and weekends off and be able to send your kids to a great liberal arts private school and college. Not do something where your life is put in danger every shift or where you get nightmares from what you've experienced as a doc in the ER. Don't do the job because you'll get pushed around by every other specialty and get shit on from down below and from a great height.
I told him doing any kind of patient care in a ER will change you and in my experience not in a good way. Its a whole different universe from ER clerk to ER doc. He's a great guy and honestly I did not want to see him change or be hurt from the crush of what I know about working in a ER especially going through residency in the hospital I work at, oh man oh man it can be awful. In short I wanted to protect my friend.
I had one ER doc tell em that his dad who was an ER doc as well told him not to be an ER doc. In fact his dad was pleased as punch because his son was an artist. Well the son felt the pull of ER medicine and went through the whole pipeline to be a ER doc. When he got his residency his father told him that he was proud his son got his doctorate but that he was a total idiot for being an ER doc now.
I guess I did not get my point across well or explain it clearly enough. He applied for residency and got it at a major hospital in another state. We stayed in touch as much as possible due to the constraints of being a resident. Towards the end of his residency we crossed paths and had a lunch he his wife and I. He excused himself to go to the bathroom during our lunch. While he was gone his wife became very somber which is not her personality at all. She told me "Everything you said came true" she was going to stick with him and support him but there are easier gigs as a doc than working in an ER, they both knew that now. I didn't ask for specifics, i could see the change in my friend too and it made me sad.
I knew one ER doc who was fucking excellent. She was amazing with the patients, staff all the way down to the housekeepers and kitchen personnel. It was a fair sized hospital and everyone it seemed knew her. Plus she was a great doc to boot. We loved her, she got tired of the grind of being an ER doc and one day came in told the group she was working with that she was done and left to do public health in Africa. She sent us an email a year or so later telling us it was the best decision she ever made.
I'm probably sticking my foot into my own mouth rattling off about this but really there is an easier way to make a living with an advanced degree, I'm sure of it. For the most part everyone who works in an ER intentions are well, they have a good heart. There are a lot of lost souls who work in an ER and I'm always a little depressed when I see a new crop of ER residents or new grad nurses come into the department.There is a high mental price to be paid in order to do it though.
For those of us who were lucky to get through high school and go on to work on an ambulance after a few years it's all you know. Your career options are limited dragging drunks and junkies out of flea bag motels and out of the gutter makes for great stories but hardly pays the bills. Ambulances and hospitals are not happy places in general. What I am saying in my off kilter way is:
Don't do it.
What do I know, I'm just Crusty ER Tech.
Monday, January 4, 2016
Fifty eight
Nurse Bass strikes again.
Working triage and responsible for EKG. My job is simple stupid. Do EKGs and be damn sure I am available for "Cardiac Alert" EKGs. Do the EKG tell pt to stay put, find attending and have them sign off on the 12 lead. It is a new point of pride at this hospital we have this cardiac program and whiz bang awesome cardiac cath lab which is a sure money maker like colonoscopies, it rakes in the money and lordy the prestige esp with cardiac caths (see The Rape of Emergency Medicine). If you have read my previous posts then you know all the way down to my level that this is something you DO NOT fuck with. Especially if we can catch an MI early and get the pt cathed and save a life. I take this seriously it gets my undivided attention. It saves lives, can get ol' Crusty ER Tech in a shit ton of trouble and makes the hospital money. It seriously has my attention esp when it comes to saving lives and staying out of trouble that I can avoid.
Seriously, full stop.
I make sure I stay in the area and hate to wander away from the EKG bay. Most of the time we have an EKG tech but on weekends and holidays we do not. Also when the EKG tech wanders off to do whatever we have to cover them. It happens.
Enter Nurse Bass. I have my head down doing EKG in the bay for a variety of patients. I'm plugging away and catching every EKG I can find in the system because I am VERY afraid of missing one. We have a different system of triage from every other place I worked it works well you just gotta pay attention to some small details and our system for ordering normal EKG and "Cardiac Alert" EKGS are very hit or miss. Basically if a "Cardiac Alert" EKG comes down a triage nurse who orders the test is suppose to tell me and have the patient there on hand. It rarely works like that. So I am constantly refreshing the computer and looking for new EKG orders.
Nurse Bass is charge nurse that day. Nurse Bass LOVES to delegate and is happy sitting in a chair behind the desk "managing" the area. By managing I mean looking at wedding and baby shower websites. I got my head down and have only left for five minutes to use the bath room I was gone for maybe five minutes. About 2 hours in the shift Nurse Bass spots me sitting in the EKG bay "surfing the internet" which is not true because the computer I am on has been blocked from internet access I was checking for EKG orders again, again and again. I had just finished up an EKG for a dialysis patient and directed the patient to the appropriate area a few minutes before.
Nurse Bass tells me that I don't need to be "sitting around" and I need to help her clean rooms and help her with her duties. I inform her of the policy which states that I need to stay in the area and be readily available for the triage nurse. She ignores me then proceeds to get cross with me and restates what she just said. I have no recourse.
As the fates have it a bunch of EKGs are given to me over the next 45 min to an hour. I'm plugging away doing what I am suppose to be doing. Then Nurse Bass reappears and talks to the triage nurse. Either Nurse Bass does not see me or is being passive aggressive and says...
"Have you seen Crusty ER Tech? I have not seen him in an hour, he's probably wandering off some place or hiding, I'm so sick of his shit." this is a direct quote folks.
I'm actually hurt by this statement because I am a stay at home type of tech assign me to an area and you can find me there. Again ESPECIALLY when it comes to EKG stuff.
Nurse Bass is standing right in front of me when she says this. I'm behind the EKG machine and look up at her in all her girth and glory and I say "Nurse Bass I'm right here and have been for nearly an hour doing one EKG after another for just as long like I am suppose to. If you do not belive me ask the Triage nurse and check the log on this EKG machine."
Nurse Bass is unhappy with my response, I think part of it was because she was talking shit and did not see me sitting there. She tells me I am suppose to help her clean rooms. I say we have house keeping for that and if a nurse cannot wipe a bed and pull a film of paper down over a exam table then something is wrong. The bays in the triage area are not getting trashed because we turn them over quickly. Nurse Bass is not hearing any of this, she tells me that I need to help her clean rooms and do as she directs (meaning I need to clean rooms). I ask her about doing "Cardiac Alert" EKGs and other EKG as directed by the docs. She says "we'll cross that bridge when we come to it"
Another words I'll be thrown right under the bus for missing EKGs while I am out doing her bidding. I have no recourse and we are having this discussion in a patient care area. I look to the triage nurse for support who is usually supportive she shrugs her shoulders and says "She's charge"
I throw up my hands and have no choice "Nurse Bass believe what you like I could care less, I'll do whatever." at which point she turns on her heel, walks over to the desk and looks at the board (by board I mean a baby shower planning website)
For the rest of the day I am furiously running around like a maniac trying to do the "whatever" while trying to stay on top of EKGs. I'm doubly cranky and mentally exhausted by the end of the day. The day ends with a line from Nurse Bass:
"Well night shift is here, I want to thank all the docs and mid-levels (PA's and NP's) for their hard work today." At this point the triage nurse says "What about the nurses and Techs?"
Nurse Bass pretends she did not hear the triage nurse sitting beside her.
So ends another shitty day for Crusty ER Tech. I gotta find another line of work.
Working triage and responsible for EKG. My job is simple stupid. Do EKGs and be damn sure I am available for "Cardiac Alert" EKGs. Do the EKG tell pt to stay put, find attending and have them sign off on the 12 lead. It is a new point of pride at this hospital we have this cardiac program and whiz bang awesome cardiac cath lab which is a sure money maker like colonoscopies, it rakes in the money and lordy the prestige esp with cardiac caths (see The Rape of Emergency Medicine). If you have read my previous posts then you know all the way down to my level that this is something you DO NOT fuck with. Especially if we can catch an MI early and get the pt cathed and save a life. I take this seriously it gets my undivided attention. It saves lives, can get ol' Crusty ER Tech in a shit ton of trouble and makes the hospital money. It seriously has my attention esp when it comes to saving lives and staying out of trouble that I can avoid.
Seriously, full stop.
I make sure I stay in the area and hate to wander away from the EKG bay. Most of the time we have an EKG tech but on weekends and holidays we do not. Also when the EKG tech wanders off to do whatever we have to cover them. It happens.
Enter Nurse Bass. I have my head down doing EKG in the bay for a variety of patients. I'm plugging away and catching every EKG I can find in the system because I am VERY afraid of missing one. We have a different system of triage from every other place I worked it works well you just gotta pay attention to some small details and our system for ordering normal EKG and "Cardiac Alert" EKGS are very hit or miss. Basically if a "Cardiac Alert" EKG comes down a triage nurse who orders the test is suppose to tell me and have the patient there on hand. It rarely works like that. So I am constantly refreshing the computer and looking for new EKG orders.
Nurse Bass is charge nurse that day. Nurse Bass LOVES to delegate and is happy sitting in a chair behind the desk "managing" the area. By managing I mean looking at wedding and baby shower websites. I got my head down and have only left for five minutes to use the bath room I was gone for maybe five minutes. About 2 hours in the shift Nurse Bass spots me sitting in the EKG bay "surfing the internet" which is not true because the computer I am on has been blocked from internet access I was checking for EKG orders again, again and again. I had just finished up an EKG for a dialysis patient and directed the patient to the appropriate area a few minutes before.
Nurse Bass tells me that I don't need to be "sitting around" and I need to help her clean rooms and help her with her duties. I inform her of the policy which states that I need to stay in the area and be readily available for the triage nurse. She ignores me then proceeds to get cross with me and restates what she just said. I have no recourse.
As the fates have it a bunch of EKGs are given to me over the next 45 min to an hour. I'm plugging away doing what I am suppose to be doing. Then Nurse Bass reappears and talks to the triage nurse. Either Nurse Bass does not see me or is being passive aggressive and says...
"Have you seen Crusty ER Tech? I have not seen him in an hour, he's probably wandering off some place or hiding, I'm so sick of his shit." this is a direct quote folks.
I'm actually hurt by this statement because I am a stay at home type of tech assign me to an area and you can find me there. Again ESPECIALLY when it comes to EKG stuff.
Nurse Bass is standing right in front of me when she says this. I'm behind the EKG machine and look up at her in all her girth and glory and I say "Nurse Bass I'm right here and have been for nearly an hour doing one EKG after another for just as long like I am suppose to. If you do not belive me ask the Triage nurse and check the log on this EKG machine."
Nurse Bass is unhappy with my response, I think part of it was because she was talking shit and did not see me sitting there. She tells me I am suppose to help her clean rooms. I say we have house keeping for that and if a nurse cannot wipe a bed and pull a film of paper down over a exam table then something is wrong. The bays in the triage area are not getting trashed because we turn them over quickly. Nurse Bass is not hearing any of this, she tells me that I need to help her clean rooms and do as she directs (meaning I need to clean rooms). I ask her about doing "Cardiac Alert" EKGs and other EKG as directed by the docs. She says "we'll cross that bridge when we come to it"
Another words I'll be thrown right under the bus for missing EKGs while I am out doing her bidding. I have no recourse and we are having this discussion in a patient care area. I look to the triage nurse for support who is usually supportive she shrugs her shoulders and says "She's charge"
I throw up my hands and have no choice "Nurse Bass believe what you like I could care less, I'll do whatever." at which point she turns on her heel, walks over to the desk and looks at the board (by board I mean a baby shower planning website)
For the rest of the day I am furiously running around like a maniac trying to do the "whatever" while trying to stay on top of EKGs. I'm doubly cranky and mentally exhausted by the end of the day. The day ends with a line from Nurse Bass:
"Well night shift is here, I want to thank all the docs and mid-levels (PA's and NP's) for their hard work today." At this point the triage nurse says "What about the nurses and Techs?"
Nurse Bass pretends she did not hear the triage nurse sitting beside her.
So ends another shitty day for Crusty ER Tech. I gotta find another line of work.
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