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.