It can be only assumed that said pt watched the NASCAR race soon afterwards. Seeing this first hand I have to say that this little scene was UNREAL!!!
Pt Left hospital AMA never saw this person again!
Friday, December 26, 2014
The BIG 45
You MIGHT be a red neck if you walk out on a cardiac cath to go watch a NASCAR race on local cable. this patient has had an extensive cardiac history with open heart surgery with 5 count 'em FIVE STENTS ! This patient is quite adamant about leaving to watch this race. Pt signs out and leaves AMA despite a cardiac attending and fellow BEGGING him to stay.
It can be only assumed that said pt watched the NASCAR race soon afterwards. Seeing this first hand I have to say that this little scene was UNREAL!!!
Pt Left hospital AMA never saw this person again!
It can be only assumed that said pt watched the NASCAR race soon afterwards. Seeing this first hand I have to say that this little scene was UNREAL!!!
Pt Left hospital AMA never saw this person again!
Saturday, December 13, 2014
Fourty Four
Pt who is a mid-30's male is found unresponsive at local recreation center. Bystanders call 911 while others begin chest compressions. While waiting on ambulance arrive by standers attach AED to this unresponsive seemingly healthy male. The AED orders "NO SHOCK" no shock is given and bystanders continue chest compressions.
Ambulance crew arrives (along with a fire engine a supervisor and a few police officers) pt is scooped up and placed into ambulance. Then the pt is assessed further by EMS crew. Pt is found to have a pulse with a GCS of 3 as reported by crew pt is breathing on his own. this patient is transported to us at BCH.
When the ambulance gets to the hospital (a very short trip from said rec center) the pt now has a GCS of 10. As pt comes into the critical care area of the ER the patient becomes more and more alert to the point of by the time we get him on the monitor we find out that the patient is deaf. When he does not want to talk to us any more he has another "syncopal" episode.
No one knows ASL in the ER. BCH has many many resources so in rolls a computer on wheels with a web cam on it. We dial up the ASL interpreter who pops right up on the screen and sees a room full of people around a patient who is now "unresponsive" the ASL interpreter is unaware her mike is on and the volume is on full blast on our end and she says:
"HOLY CRAP"
The room erupts in laughter.
The pt. arouses on his own again and begins signing with the interpreter. It begins a very circular conversation which frustrated the hell out of everyone. The patient was a poor historian. The only real complaint we get is the patient is having chest pain. Which figures because bystanders were doing chest compressions on him for a few minutes before the EMS response. Trust me if the AED did not stop the bystanders from shocking him he woulda gotten a 360 joules wake up call.
The patient was rapidly moved out of the critical care area into a regular room. Never did find out why he passed out and was unresponsive. With intermittent episodes of responsiveness and unresponsiveness who knows what was going on. The patient of course got the million dollar work up. What can you do with these situations?
At least the system worked seemingly flawlessly and kudos to the bystanders:
Soon more mysteries of modern ER care in the dynamic urban environment will be revealed. I am just an old Crusty ER Tech trying to make it to the end of shift.
Wednesday, November 26, 2014
Forty Three
As we get on into the colder months the shelters fill up and we start to have our urban outdoors people begin to appear with more frequency, often in the damnedest places. Yes, yes we do get our fair share that come in complaining of chest pain or homicidal or suicidal thoughts. Which comes a small rub with me and some of my fellow tech and often nurses. I know it gets damn cold on the streets and shit the shelters are only moderately better (they're warmer).
My thought is that if you're in a bad way and homeless and come up to us and say that you're just homeless and need a place to crash til the bad weather passes then hey we are in the caring business, we'll find you a place to crash for the coldest part of the day or night. Just don't expect us to cater to your every need, be quiet in the corner and that will be that. It's happened once or twice and it happens once or twice per winter season. Just don't make a habit of it and by all means get to those shelters early.
One thing is that many don't know or really care that when they come in with the right verbiage that they will get the million dollar work up. Then since they are indigent and cannot pay the taxpayers of the city, county and state flip the bill or the hospital eats it which cuts into our operating budget which keeps us from upgrading from the monitors that are over 20 years old in some cases. It gets frustrating sometimes and sometimes it gets plain funny.
Awhile back I was in the habit of running stairs after shift not on one of those stair masters in one of the many stair wells of the high rise hospital I work at. I'm about on say 10th floor (which is about halfway to the top) and there is a "half" floor there which is only accessible to the facilities guys it's a crawl space where they can get to pipes and wires and such. this half floor con only be reached by stairs. The crawl space is locked with several locks and alarmed. The small 4-6 stair landing is super warm though.
That's where at around 0800 one morning I stepped on a homeless guy. I was in a half daze after working a long shift and wheezing my lungs out from doing stairs. He was surprised that I stepped on his outstretched arm and let out a yelp. I was surprised and let out a very undignified girly scream. At which time I ran up to the next floor and called our (seriously) crack security staff and they handled the situation. Story went that dude got discharged walked out the doors then walked in another set of doors and wandered around til he found a stairwell. He went up until he found a spot where noone really was and crashed.
Then there was the running gag for a run of shifts where a code would get called once a day by someone who could not wake up a homeless woman who was sleeping in the hospital. In a large urban hospital such as BCH if you are savvy enough you can hang out in our many waiting rooms for various clinics, watch TV, be warm and sometimes even get fed all without seeing a doctor. This particular woman just did not do that. She'd just fall asleep anywhere. In a hallway next to the freight elevators in a corner of the gift shop etc. Our hospital is divided up for codes the ER covers certain floors including the ground floor which is where this woman decided to fall asleep for this run of shifts. It's a total pain in the ass to go running with a monitor and drug box to a woman who is just being stubborn and playing asleep hoping to get left alone so she can return to her nap. It reminded me of the same phenomenon on the ambulance a commuter sees a homeless person sleeping on the side of the road and calls 911 which brings a crew out to wake up said homeless person. People mean well it's just that after awhile you wanna just well...scream. This woman got referred to social services and sent on her way. Never saw her again.
So begin the late fall and early winter months.
My thought is that if you're in a bad way and homeless and come up to us and say that you're just homeless and need a place to crash til the bad weather passes then hey we are in the caring business, we'll find you a place to crash for the coldest part of the day or night. Just don't expect us to cater to your every need, be quiet in the corner and that will be that. It's happened once or twice and it happens once or twice per winter season. Just don't make a habit of it and by all means get to those shelters early.
One thing is that many don't know or really care that when they come in with the right verbiage that they will get the million dollar work up. Then since they are indigent and cannot pay the taxpayers of the city, county and state flip the bill or the hospital eats it which cuts into our operating budget which keeps us from upgrading from the monitors that are over 20 years old in some cases. It gets frustrating sometimes and sometimes it gets plain funny.
Awhile back I was in the habit of running stairs after shift not on one of those stair masters in one of the many stair wells of the high rise hospital I work at. I'm about on say 10th floor (which is about halfway to the top) and there is a "half" floor there which is only accessible to the facilities guys it's a crawl space where they can get to pipes and wires and such. this half floor con only be reached by stairs. The crawl space is locked with several locks and alarmed. The small 4-6 stair landing is super warm though.
That's where at around 0800 one morning I stepped on a homeless guy. I was in a half daze after working a long shift and wheezing my lungs out from doing stairs. He was surprised that I stepped on his outstretched arm and let out a yelp. I was surprised and let out a very undignified girly scream. At which time I ran up to the next floor and called our (seriously) crack security staff and they handled the situation. Story went that dude got discharged walked out the doors then walked in another set of doors and wandered around til he found a stairwell. He went up until he found a spot where noone really was and crashed.
Then there was the running gag for a run of shifts where a code would get called once a day by someone who could not wake up a homeless woman who was sleeping in the hospital. In a large urban hospital such as BCH if you are savvy enough you can hang out in our many waiting rooms for various clinics, watch TV, be warm and sometimes even get fed all without seeing a doctor. This particular woman just did not do that. She'd just fall asleep anywhere. In a hallway next to the freight elevators in a corner of the gift shop etc. Our hospital is divided up for codes the ER covers certain floors including the ground floor which is where this woman decided to fall asleep for this run of shifts. It's a total pain in the ass to go running with a monitor and drug box to a woman who is just being stubborn and playing asleep hoping to get left alone so she can return to her nap. It reminded me of the same phenomenon on the ambulance a commuter sees a homeless person sleeping on the side of the road and calls 911 which brings a crew out to wake up said homeless person. People mean well it's just that after awhile you wanna just well...scream. This woman got referred to social services and sent on her way. Never saw her again.
So begin the late fall and early winter months.
Monday, November 17, 2014
Forty Two
We've been getting a lot of EMT students through BCH as of late. For the most part they have been wall flowers with a sprinkling of capable ones and the occasional "I'm getting ready for med school and thought this would help me prepare" types. No one listens when I tell them that being an assistant manager or manager at a subway would pay more and that you'd only receive only about half of the abuse.
Alas my pleas for career change fall onto deaf ears of the phalanx of EMT students we see now. The wall flowers make me wonder how they get trained then I saw this video and I think I get it.
Not saying that my particular training was magnificent. My instructor got fired at the 11th hour because he made a racy banana joke to the wrong student. Fear not as long as I am the Crusty ER tech BBCOD will live on. That was a damn long time ago in a land far far away from where I am now.
If you're reading this and you're just starting out take the classes seriously. Also keep in mind to have some damn fun. The job is tough enough even with the humor.
In case you CNA or nursing types are in here looking I'll answer your question with a YES this is how EXACTLY how EMTs and Paramedics are trained. And if you believe that then I got a certain bridge or some beach front property in a land locked state that I can sell you.
Seriously consider working at subway. I hear that employees only pay 10% of the actual cost of a sandwich.
Sunday, September 21, 2014
Forty One
Crusty has come out of his nursing school stupor (OB oy vey!) long enough to flip through the old blog. I decided to read some of the search criteria and this is what I got:
how to be a great er tech & helpful things for (an) er tech
Totally legit questions. Which are not simple questions to answer. I'll try to answer both at the same time. I'll only do 5 cause that's all I got time for.
1) Know your shit aka "educate yourself". Always work to educate yourself further don't get sucked into the "Well I don't need to know this cause it ain't in my scope of practice." thought process. Don't understand something and wanna know more? Write that shit down and look it up when you are not busy, better yet ask. Take classes ask to go on trauma, cardiac, ICU rounds or sit in on a M&M. You'll learn tons.
2) Know those mother fuckers aka "build relationships". Especially with the Paramedics, EMTs and Flight Medics & Flight Nurses. Most of us came from the field and need to remember it can really suck out there under a car in the snow and or rain. besides they can draw an excellent picture of what was going on with a very sick or injured pt. It can be tough as the tech you often go to places in the hospital and deal with the people in the hospitals that nurses and docs don't deal with. Getting in good with the CT techs can get a pt on the table a little faster or or have the XR techs run over for a muy importante CXR. The EKG tech can show you how to pull up serial EKGs when they ain't around. Go out of your way for central sterile techs cause they're the ones you'll need once in a blue moon and when you need what they have you're REALLY going to need it, like for instance a set of rib spreaders:
Alrighty back to the "reality" of school for the Ol' Crusty ER Tech.
how to be a great er tech & helpful things for (an) er tech
Totally legit questions. Which are not simple questions to answer. I'll try to answer both at the same time. I'll only do 5 cause that's all I got time for.
1) Know your shit aka "educate yourself". Always work to educate yourself further don't get sucked into the "Well I don't need to know this cause it ain't in my scope of practice." thought process. Don't understand something and wanna know more? Write that shit down and look it up when you are not busy, better yet ask. Take classes ask to go on trauma, cardiac, ICU rounds or sit in on a M&M. You'll learn tons.
2) Know those mother fuckers aka "build relationships". Especially with the Paramedics, EMTs and Flight Medics & Flight Nurses. Most of us came from the field and need to remember it can really suck out there under a car in the snow and or rain. besides they can draw an excellent picture of what was going on with a very sick or injured pt. It can be tough as the tech you often go to places in the hospital and deal with the people in the hospitals that nurses and docs don't deal with. Getting in good with the CT techs can get a pt on the table a little faster or or have the XR techs run over for a muy importante CXR. The EKG tech can show you how to pull up serial EKGs when they ain't around. Go out of your way for central sterile techs cause they're the ones you'll need once in a blue moon and when you need what they have you're REALLY going to need it, like for instance a set of rib spreaders:
Needing rib spreaders and not having them is a monumentally BAD thing. That's a whole other story for another time.
3) Know how shit works. You are the "Tech" short for technician. Following that train of thought you NEED to know how pieces of equipment in your prospective ER works. Great example is the traction splint for a closed mid shaft femur fracture. I can't count how many times I have been pulled out of triage or from another area because I was the only tech around who knew how to use this simple piece of equipment. Also be familiar with more complicated pieces of equipment like the ultra sound and the I-stats if you have them. Know how to operate the level 1 infuser in your sleep.
4) This should go under building relationships it's just separate. Get to know the docs and nurses real well. I'm not talking on a social level either. That way you can anticipate what is going to be needed and get on it. Then when you have a moment ask what's going on with an interesting pt and why certain things are being done. That way you are building your knowledge and looking like a true professional that you are. I guarantee you if you do this long enough you'll have docs, nurses and everyone else wanting to teach you something every shift.
5) Last but not least don't be a goddamned social butterfly. Remember we are in the ER to take care of patients and not further our social agendas. In my book patients come first way before that stupid pot luck, what a really hot nurse is into this week or what happened on the reality show of your choice. Save that shit for lunch or break if you get one. Take care of the patients first!
Monday, August 11, 2014
Forty
The tale of Nurse No.
Many entries ago I promised I would write the story of Nurse No. Well the time has come to put one of my fave stories of floor nurse idiocy down for the ages. After many years as an ER tech working west of the Mississippi I moved to the east and started working in BCH. I had cleared "orientation" and just started working the night weekend shifts. I was liking it so far, constantly busy with interesting cases. We were still using paper charts at the time which in hind sight was a horrific way for ANY big city hospital to have to operate.
I was asked to take a pneumonia pt up to the floor. The pt did not have any kind of funky PCP or TB for that matter, just a plain old case of pneumonia. The pt was a middle aged woman, she was one of the sweetest ladies ever no deficits, no drugs or etoh. Just one of those rare times in the ER where we treated a normal person. Her family and I chatted as I got her belongings together to transport her upstairs. They were all nice folks. After they saw that I was taking her upstairs they all left confident in the fact that she would be well taken care of by the nurses on the floor. This is around 0100 in the morning.
Heavens if they only knew.
I get the pt upstairs drop off the chart to the ward clerk and push the pt to her room at the end of the hall way. It's a semi private room and she has the bed closest to the door. I walk her inside get her settled, tell her I hope she feels better. I grab the stretcher roll back past the nurses station and head to the elevators. Naturally at BCH even on a weekend night halfway through the shift the elevators are slow. So I'm waiting and waiting then all of the sudden I hear feet running down the hall and the door bursts open and a very irate nurse says to me "You have to take that pt you just brought up back down to the ER!"
Clearly something has gone awry.
One thing the Ol' Crusty ER tech has learned in his ER tech career is that you NEVER take pts back down to the ER. The reasons are many:
1) The room or spot they were in is usually occupied by another pt.
2) The pt is no longer under the care of the ER doc they have been signed out and have orders written by a floor doc. The care of the pt is going forward by going to the floor.
3) The nurse caring for the pt previously does not want nor do they need an extra pt. especially one that JUST got admitted
4) It frustrates the HELL out of the patient. "Why am I going back to the ER?!"
5) Lastly and most importantly it REALLY pisses off a charge nurse.
Unless the floor nurses put a gun to my head there was NO WAY I was taking this pt back down to the ER.
I walk back inside the med/surg unit with my stretcher to discover and even more irate med/surg charge nurse. This male nurse immediately jumps up from his chair once he sees me and begins to scream at me (keep in mind this is at 0100) because I am the complete idiot who brought up an active TB pt to floor unmasked to an occupied semi-private room. I'm non-plussed, I looked at the chart and talked to the nurse before coming up, this is a simple pneumonia plain and simple I says. While I was waiting on the slow ass elevators the admit docs (a couple of first year and second year residents) tubed up the rest of the admit orders in which one of the boxes checked said this was an active TB pt.
This charge nurse is waving this chart all in my face and is demanding I walk down to the room and get this pt. At one point during this dressing down of my professionalism, intelligence and genetic back ground he grabbed my arm to encourage me along. I asked nicely that he release my arm while I call my charge nurse. He came to his senses for half a second and I was able to call from that nurses station. As soon as the ER charge nurse answered the phone the floor charge nurse got all riled up again. I could not even tell my charge nurse what was going on. I told the ER charge nurse I'd call back in a second.
At this time I made a point to show this floor charge nurse my badge "My name is 'Crusty ER Tech' I am trying to solve this problem, it's not my fault there the chart is screwed up. If you don't quit screaming at me and leave me the hell alone this problem won't get solved. I'm going to the other side of the nurses station and call my charge nurse again, please this time sir don't scream at me while I am on the phone." I said it in the nicest tone possible, I wanted to explode. Getting into a screaming match on the floor with another co-worker is a sure fire ticket to get paper on you especially when you are not on your home floor, it's an easy way to stand before the man.
I was able to call down stairs to the ER charge nurse and I explain the situation. That I got this male charge nurse going bat shit over the situation and trying to intimidate to get me to bring a pt back down which I know is a total no-go. I don't go into detail, it's clear I'm in a jam. The ER charge nurse says alright stay RIGHT there at that phone, she KNOWS this is not an active TB pt just in any case she'll get an isolation room on another floor so things can go forward and whatever I do, DO NOT BRING THAT PT BACK DOWN. She says she'll call back in less than five. I hang up the phone quickly because the floor charge nurse is running over and I'm thinking he's going to jump into my ass again and this time I won't be so pleasant.
The floor charge nurse demands to hear what she had to say. I'm to the point I tell him we are getting another room on another floor, that I'm camping on this phone for the next five minutes. Naturally he does not believe me and wants to talk to the ER charge nurse. No problem says I. I look on my badge and give him the number to the laundry, a phone I know that won't be answered at 0130 in the morning. I do this because he needs to be occupied with something other than leaping into another temper tantrum. I'm confident that situation will be handled. In the mean time ALL the floor nurses are glaring at me like I just kicked a puppy or some shit.
Less than 5 minutes later I get a call back. ER charge nurse says take the pt to such and such isolation room on another floor. Now is when things get REAL interesting.
I walk back down to the room with the chart and stretcher, walk inside to see that the pt is not in her bed. I do see that a nurse (Nurse No) is bracing herself in front of the room's bathroom door like she is trying to keep a ferocious zombie at bay. I ask Nurse No "Where is the pt?" and she says in her broken english (turns out she is from china) that the pt is being isolated in the bathroom because she is infectious. "You no take pt out of rest room." I tell her that the bathrooms in this hospital are not negative air pressure, and even if the pt was and active TB'er that you Nurse No are not wearing a mask, now let me get this pt to a floor where there isn't crazy dripping from every surface. Nurse No reluctantly unblocks and opens the bathroom door.
I find this sweet normal female pt sitting on the toilet with her knees drawn up to her chest.Oh and since the floor thought she was an active TB'er they did not put a mask on her, obviously keeping her trapped in a bathroom was the best choice. It was a pitiful sight, she then asked me "Am I contagious?" I assured her that she was not and that there was a mistake with some admitting paperwork. I further explained that she lucked out and gets her own private room up on a floor where it is nice and quiet.
I get her back on the stretcher and head back out to go to another floor without incident. I was rather surprised by that. I get the patient up to her new room get her settled and it's all good. the nurses on this floor are much less crazy that the other ones I just dealt with. I head back to the ER sure that I was going to have to deal with another irate charge nurse this time though it was going to be my boss. I was sure I was going to have paper on me cause this whole episode from beginning to end took over an hour. Naturally I get stuck on the shitty elevator for 10-15 minutes.
I get back to the ER and find the charge nurse. I ask her if everything is cool. She looks at me strangely and asks "What happened up there?" I tell her in vivid detail of my life of the past hour. When I get to the part about Nurse No trapping the pt in the bath room I get a face palm reaction and hear "Oh no they didn't!" The charge nurse then finds the admit residents and asks WTF? They reply "Ooops oh my we made a mistake she is just a regular pneumonia pt." This gets a face palm from me and the ER charge nurse gets visibly angry calls those residents into the med room "talks" with them about their error and storms out of the department.
The ER charge nurse walks back into the ER about 15 minutes later. With a rather smug look on her face, turns out she went up to the med/surg floor and raised all kinds of hell. She even came back with a list of names. She assured me that I did the right thing and that those people up there are all sorts of out of control. I fully expected a follow up to this episode. Nothing came of it.
About one year later.
I see an orienting group of nurses for our department and who do I spy with my little eye. Nurse No. I immediately grab a N-95 mask and hand it to her and walk away without a word. I doubt she got the joke or refrence. Somehow the word quickly spreads about Nurse No's unique form of isolation. Nurse No to her credit stayed on in the BCH ER for around a year and then left for greener pastures I imagine.
And dear readers was just one night and one patient. Sheesh.
Many entries ago I promised I would write the story of Nurse No. Well the time has come to put one of my fave stories of floor nurse idiocy down for the ages. After many years as an ER tech working west of the Mississippi I moved to the east and started working in BCH. I had cleared "orientation" and just started working the night weekend shifts. I was liking it so far, constantly busy with interesting cases. We were still using paper charts at the time which in hind sight was a horrific way for ANY big city hospital to have to operate.
I was asked to take a pneumonia pt up to the floor. The pt did not have any kind of funky PCP or TB for that matter, just a plain old case of pneumonia. The pt was a middle aged woman, she was one of the sweetest ladies ever no deficits, no drugs or etoh. Just one of those rare times in the ER where we treated a normal person. Her family and I chatted as I got her belongings together to transport her upstairs. They were all nice folks. After they saw that I was taking her upstairs they all left confident in the fact that she would be well taken care of by the nurses on the floor. This is around 0100 in the morning.
Heavens if they only knew.
I get the pt upstairs drop off the chart to the ward clerk and push the pt to her room at the end of the hall way. It's a semi private room and she has the bed closest to the door. I walk her inside get her settled, tell her I hope she feels better. I grab the stretcher roll back past the nurses station and head to the elevators. Naturally at BCH even on a weekend night halfway through the shift the elevators are slow. So I'm waiting and waiting then all of the sudden I hear feet running down the hall and the door bursts open and a very irate nurse says to me "You have to take that pt you just brought up back down to the ER!"
Clearly something has gone awry.
One thing the Ol' Crusty ER tech has learned in his ER tech career is that you NEVER take pts back down to the ER. The reasons are many:
1) The room or spot they were in is usually occupied by another pt.
2) The pt is no longer under the care of the ER doc they have been signed out and have orders written by a floor doc. The care of the pt is going forward by going to the floor.
3) The nurse caring for the pt previously does not want nor do they need an extra pt. especially one that JUST got admitted
4) It frustrates the HELL out of the patient. "Why am I going back to the ER?!"
5) Lastly and most importantly it REALLY pisses off a charge nurse.
Unless the floor nurses put a gun to my head there was NO WAY I was taking this pt back down to the ER.
I walk back inside the med/surg unit with my stretcher to discover and even more irate med/surg charge nurse. This male nurse immediately jumps up from his chair once he sees me and begins to scream at me (keep in mind this is at 0100) because I am the complete idiot who brought up an active TB pt to floor unmasked to an occupied semi-private room. I'm non-plussed, I looked at the chart and talked to the nurse before coming up, this is a simple pneumonia plain and simple I says. While I was waiting on the slow ass elevators the admit docs (a couple of first year and second year residents) tubed up the rest of the admit orders in which one of the boxes checked said this was an active TB pt.
This charge nurse is waving this chart all in my face and is demanding I walk down to the room and get this pt. At one point during this dressing down of my professionalism, intelligence and genetic back ground he grabbed my arm to encourage me along. I asked nicely that he release my arm while I call my charge nurse. He came to his senses for half a second and I was able to call from that nurses station. As soon as the ER charge nurse answered the phone the floor charge nurse got all riled up again. I could not even tell my charge nurse what was going on. I told the ER charge nurse I'd call back in a second.
At this time I made a point to show this floor charge nurse my badge "My name is 'Crusty ER Tech' I am trying to solve this problem, it's not my fault there the chart is screwed up. If you don't quit screaming at me and leave me the hell alone this problem won't get solved. I'm going to the other side of the nurses station and call my charge nurse again, please this time sir don't scream at me while I am on the phone." I said it in the nicest tone possible, I wanted to explode. Getting into a screaming match on the floor with another co-worker is a sure fire ticket to get paper on you especially when you are not on your home floor, it's an easy way to stand before the man.
I was able to call down stairs to the ER charge nurse and I explain the situation. That I got this male charge nurse going bat shit over the situation and trying to intimidate to get me to bring a pt back down which I know is a total no-go. I don't go into detail, it's clear I'm in a jam. The ER charge nurse says alright stay RIGHT there at that phone, she KNOWS this is not an active TB pt just in any case she'll get an isolation room on another floor so things can go forward and whatever I do, DO NOT BRING THAT PT BACK DOWN. She says she'll call back in less than five. I hang up the phone quickly because the floor charge nurse is running over and I'm thinking he's going to jump into my ass again and this time I won't be so pleasant.
The floor charge nurse demands to hear what she had to say. I'm to the point I tell him we are getting another room on another floor, that I'm camping on this phone for the next five minutes. Naturally he does not believe me and wants to talk to the ER charge nurse. No problem says I. I look on my badge and give him the number to the laundry, a phone I know that won't be answered at 0130 in the morning. I do this because he needs to be occupied with something other than leaping into another temper tantrum. I'm confident that situation will be handled. In the mean time ALL the floor nurses are glaring at me like I just kicked a puppy or some shit.
Less than 5 minutes later I get a call back. ER charge nurse says take the pt to such and such isolation room on another floor. Now is when things get REAL interesting.
I walk back down to the room with the chart and stretcher, walk inside to see that the pt is not in her bed. I do see that a nurse (Nurse No) is bracing herself in front of the room's bathroom door like she is trying to keep a ferocious zombie at bay. I ask Nurse No "Where is the pt?" and she says in her broken english (turns out she is from china) that the pt is being isolated in the bathroom because she is infectious. "You no take pt out of rest room." I tell her that the bathrooms in this hospital are not negative air pressure, and even if the pt was and active TB'er that you Nurse No are not wearing a mask, now let me get this pt to a floor where there isn't crazy dripping from every surface. Nurse No reluctantly unblocks and opens the bathroom door.
I find this sweet normal female pt sitting on the toilet with her knees drawn up to her chest.Oh and since the floor thought she was an active TB'er they did not put a mask on her, obviously keeping her trapped in a bathroom was the best choice. It was a pitiful sight, she then asked me "Am I contagious?" I assured her that she was not and that there was a mistake with some admitting paperwork. I further explained that she lucked out and gets her own private room up on a floor where it is nice and quiet.
I get her back on the stretcher and head back out to go to another floor without incident. I was rather surprised by that. I get the patient up to her new room get her settled and it's all good. the nurses on this floor are much less crazy that the other ones I just dealt with. I head back to the ER sure that I was going to have to deal with another irate charge nurse this time though it was going to be my boss. I was sure I was going to have paper on me cause this whole episode from beginning to end took over an hour. Naturally I get stuck on the shitty elevator for 10-15 minutes.
I get back to the ER and find the charge nurse. I ask her if everything is cool. She looks at me strangely and asks "What happened up there?" I tell her in vivid detail of my life of the past hour. When I get to the part about Nurse No trapping the pt in the bath room I get a face palm reaction and hear "Oh no they didn't!" The charge nurse then finds the admit residents and asks WTF? They reply "Ooops oh my we made a mistake she is just a regular pneumonia pt." This gets a face palm from me and the ER charge nurse gets visibly angry calls those residents into the med room "talks" with them about their error and storms out of the department.
The ER charge nurse walks back into the ER about 15 minutes later. With a rather smug look on her face, turns out she went up to the med/surg floor and raised all kinds of hell. She even came back with a list of names. She assured me that I did the right thing and that those people up there are all sorts of out of control. I fully expected a follow up to this episode. Nothing came of it.
About one year later.
I see an orienting group of nurses for our department and who do I spy with my little eye. Nurse No. I immediately grab a N-95 mask and hand it to her and walk away without a word. I doubt she got the joke or refrence. Somehow the word quickly spreads about Nurse No's unique form of isolation. Nurse No to her credit stayed on in the BCH ER for around a year and then left for greener pastures I imagine.
And dear readers was just one night and one patient. Sheesh.
Tuesday, July 22, 2014
Thirty Nine
E.R. Tech week
Well it gets remembered once every couple of years that's ER tech week. This is the poor cousin to EMS week and Nurses week. This is when ER techs are suppose to be thanked for all the hard work they do in their prospective ERs. For the cynical Crusty ER tech it's more about the free food (usually pizza) that everyone else gets to scarf down leaving me with 2 cold slices of black olive and jalapeno. (who eats that shit anyways?)
The clincher was this said at the beginning of shift by the charge nurse:
"There are gifts for you ER techs, no I don't know what they are, they will be unavailable until next week and in limited supply all of you probably won't get one."
On the other hand there was a surplus of really nice bags during nurses week:
"It looks like we have too many bags for nurses week. NURSES if you want a second bag just come by and see the me (the charge nurse)"
I never did find out what the ER techs got for ER Tech week. I took some time off the following week and never got my gift. The gifts for other "Tech weeks" over the years are of note:
1) A zippy badge holder with hospital's name on it that broke halfway in shift.
2) A leaky snow globe of the hospital I was working at.
3) A pen that quit writing after 2 shifts. It was not only me every other techs pen too.
4) A ten dollar gift certificate to the grocery store down the block.
5) A handful of old stale chocolate candy that was under the unit secretary's desk. Seriously that's all we got one year.
That's the shit I could remember. I think somethings were left over from nurses week's of years prior and got found in some store room or in a back office cabinet. Gifts that would be appreciated would be:
1) Pens that work
2) Coffee shop gift cards of 10 dollars.
3) Trauma shears
4) Cool nalgene or aluminum bottles.
5) A raffle for the techs only for an electronic device of some sort like a small tablet of some sort loaded with medical apps.
That friends would take foresight, imagination and a budget. Most places I work have none of those things. Usually tech week is usually an afterthought and coincides with Nursing assistant week. I have been told in the past "Well you guys are paramedics and EMT's so you're included in on EMS week." Thing is that EMS week is for the ambulance crews. I know when I was on the ambulance I would have killed someone from the hospital for stepping into my "week"
That's how another "ER tech week" went. So it goes.
Well it gets remembered once every couple of years that's ER tech week. This is the poor cousin to EMS week and Nurses week. This is when ER techs are suppose to be thanked for all the hard work they do in their prospective ERs. For the cynical Crusty ER tech it's more about the free food (usually pizza) that everyone else gets to scarf down leaving me with 2 cold slices of black olive and jalapeno. (who eats that shit anyways?)
The clincher was this said at the beginning of shift by the charge nurse:
"There are gifts for you ER techs, no I don't know what they are, they will be unavailable until next week and in limited supply all of you probably won't get one."
On the other hand there was a surplus of really nice bags during nurses week:
"It looks like we have too many bags for nurses week. NURSES if you want a second bag just come by and see the me (the charge nurse)"
I never did find out what the ER techs got for ER Tech week. I took some time off the following week and never got my gift. The gifts for other "Tech weeks" over the years are of note:
1) A zippy badge holder with hospital's name on it that broke halfway in shift.
2) A leaky snow globe of the hospital I was working at.
3) A pen that quit writing after 2 shifts. It was not only me every other techs pen too.
4) A ten dollar gift certificate to the grocery store down the block.
5) A handful of old stale chocolate candy that was under the unit secretary's desk. Seriously that's all we got one year.
That's the shit I could remember. I think somethings were left over from nurses week's of years prior and got found in some store room or in a back office cabinet. Gifts that would be appreciated would be:
1) Pens that work
2) Coffee shop gift cards of 10 dollars.
3) Trauma shears
4) Cool nalgene or aluminum bottles.
5) A raffle for the techs only for an electronic device of some sort like a small tablet of some sort loaded with medical apps.
That friends would take foresight, imagination and a budget. Most places I work have none of those things. Usually tech week is usually an afterthought and coincides with Nursing assistant week. I have been told in the past "Well you guys are paramedics and EMT's so you're included in on EMS week." Thing is that EMS week is for the ambulance crews. I know when I was on the ambulance I would have killed someone from the hospital for stepping into my "week"
That's how another "ER tech week" went. So it goes.
Thursday, July 17, 2014
Thirty eight.
Been awhile since Ive written, Here is a little bit of advice, When you pull out your trauma shears to cut clothes off a pt watch what the fuck you're doing, Cause goddmanit you are gonna cut the pressor that is keeping the patient alive. Fucking heads up. The damn pt coded does not need to be a nutso situation. Pt coded and coded again up in the ICU,
Go figure.
Don't get so fucking so scissor happy. Chill the fuck out for christ sakes.
Go figure.
Don't get so fucking so scissor happy. Chill the fuck out for christ sakes.
Monday, June 16, 2014
Thirty Seven
Birth is disgusting
Now I have not posted in a bit because frankly I have had other things to do. As promised Crusty ER Tech has been chasing skirts and drinking cold microbrews. That explains the lack of posts lately.
One thing I have had trouble with in the past is birth. I know some females bristle at the fact that I say that birth is disgusting, it is hands down the smells and texture and although a vagina is made to strech that way does not mean that I take pleasure in seeing it warped to produce another human being for that matter. Yeah yeah I get it it's an entrance and an exit and those of you out there who say birth is a miracle and beautiful, I won't attempt to take that away from you for me birth is disgusting.
Crusty ER tech avoids birth as much as possible.
I have had to help deliver my fair share of babies in the past which has made me nauseous and weak in the knees. I can deal with any number of heinous things the human body does from maggot infested feet (yes feet) to oozing pustules. Birth for the longest time has been my kryptonite.
With that said it has been years since I have had to deal with birth directly for one reason or another. Well my luck finally ran out in spades here recently. I was sitting in triage with the triage nurse and in RUNS a mid 20's white female who proceeds to grab a locked stretcher and does a rather funny dance (very similar to the "oh fuck" dance we all do in the ER when we KNOW something bad is happening).
The dance was on the tippy toes and she was screaming "I DON'T KNOW WHY YOU ARE SITTING AROUND SHE'S HAVING A BABY!!!"
This being the first time we have heard a baby was being born in the last few minutes we jumped up and asked the next logical question
"Where?!"
Without another word the hysterical woman dances the "Oh fuck" dance some more then sprints outside to the car port drop off. We run after her with me grabbing the stretcher to hopefully put the preggers female onto it and rush her inside before things get too gooey. No such luck.
By the time we get the door open the woman says she's having the baby in her pants. Thankfully one of the registration folks ran and got a doc who appeared out of nowhere. We threw up a sheet and he delivered the baby right there in the turn out.
It was FAST! Fastest delivery I ever saw or heard of. I got my reason why later. This was this woman's 8th (yes eighth!) baby. Mom and baby made their way up to the labor deck eventually. On a side note I did not get nauseous then or later and am happy to report that seeing a vagina stretched that way did not revulse me enough to stay away from women altogether for the next month like in the past. I did have a solid 3 fingers of whiskey neat that night once I got back to the Crusty Lair.
I guess my birthing jitters are gone finally:
Now I have not posted in a bit because frankly I have had other things to do. As promised Crusty ER Tech has been chasing skirts and drinking cold microbrews. That explains the lack of posts lately.
One thing I have had trouble with in the past is birth. I know some females bristle at the fact that I say that birth is disgusting, it is hands down the smells and texture and although a vagina is made to strech that way does not mean that I take pleasure in seeing it warped to produce another human being for that matter. Yeah yeah I get it it's an entrance and an exit and those of you out there who say birth is a miracle and beautiful, I won't attempt to take that away from you for me birth is disgusting.
Crusty ER tech avoids birth as much as possible.
I have had to help deliver my fair share of babies in the past which has made me nauseous and weak in the knees. I can deal with any number of heinous things the human body does from maggot infested feet (yes feet) to oozing pustules. Birth for the longest time has been my kryptonite.
With that said it has been years since I have had to deal with birth directly for one reason or another. Well my luck finally ran out in spades here recently. I was sitting in triage with the triage nurse and in RUNS a mid 20's white female who proceeds to grab a locked stretcher and does a rather funny dance (very similar to the "oh fuck" dance we all do in the ER when we KNOW something bad is happening).
The dance was on the tippy toes and she was screaming "I DON'T KNOW WHY YOU ARE SITTING AROUND SHE'S HAVING A BABY!!!"
This being the first time we have heard a baby was being born in the last few minutes we jumped up and asked the next logical question
"Where?!"
Without another word the hysterical woman dances the "Oh fuck" dance some more then sprints outside to the car port drop off. We run after her with me grabbing the stretcher to hopefully put the preggers female onto it and rush her inside before things get too gooey. No such luck.
By the time we get the door open the woman says she's having the baby in her pants. Thankfully one of the registration folks ran and got a doc who appeared out of nowhere. We threw up a sheet and he delivered the baby right there in the turn out.
It was FAST! Fastest delivery I ever saw or heard of. I got my reason why later. This was this woman's 8th (yes eighth!) baby. Mom and baby made their way up to the labor deck eventually. On a side note I did not get nauseous then or later and am happy to report that seeing a vagina stretched that way did not revulse me enough to stay away from women altogether for the next month like in the past. I did have a solid 3 fingers of whiskey neat that night once I got back to the Crusty Lair.
I guess my birthing jitters are gone finally:
Friday, June 6, 2014
Thirty six
Dunno if this is the line of the day/week/month/year or career.
Said by me because a few ambulance crews were waiting on me to lift a 800 + pound patient out of the floor of an ambulance (the city I currently live in does not have bariatric ambulances) I was getting the bariatric bed from the basement.
"Ah shit, I sure as hell am sorry for making you guys wait, I had to chase a naked bipolar violent homicidal transgender patient down the hall."
Some days my job is completely surreal. So goes life in the big city trauma center on an extraordinarily busy shift.
Said by me because a few ambulance crews were waiting on me to lift a 800 + pound patient out of the floor of an ambulance (the city I currently live in does not have bariatric ambulances) I was getting the bariatric bed from the basement.
"Ah shit, I sure as hell am sorry for making you guys wait, I had to chase a naked bipolar violent homicidal transgender patient down the hall."
Some days my job is completely surreal. So goes life in the big city trauma center on an extraordinarily busy shift.
Thursday, May 29, 2014
Thirty Five
Nurse Threepeat
Or as I think of him The ER equivalent of Foghorn Leghorn:
I call him Nurse Threepeat because he says everything three times, I say three times, three times I said. The man truly does not know when to shut up. I've pointed this out to fellow co-workers and we are all stunned at the similarities between Nurse Threepeat and Foghorn Leghorn.
Saying the exact same thing three times although quirky and borderline annoying is one thing being a hardheaded lout is another. Nurse 3P (threepeat) is never wrong there is no give and take with the man, you cannot get your point across even if you think it's right or even a teensy bit better because he never ever shuts up. You throw up your hand in frustration just to get away from him. The other thing is that the dude cannot make a decision. He is now a charge nurse and has been for awhile. This goes along with the long standing tradition at any hospital I have worked at. Which is to promote the incompetent. I gather from reading other posts that this is a standard practice at most any hospital in America.
Waiting for an assignment at the beginning of shift. Well fellow BCH co-workers we'll keep on a waiting. With the previous shift getting more and more upset cause hey they wanna go home and sleep. Nurse Leghorn is busy flirting with the Ukrainian nurse or the newly divorced European nurse. Trouble is that he's married and oh so is the Ukrainian nurse. It's a regular "As the bowel churns" soap opera before shift at times.
Another frustration aspect of Nurse 3p (and there are quite a few) is his wanderlust. When he was a nurse who carried patients the man would wander all the time, shit he still does and he's a full time charge nurse now. Why you ask, well he is how he puts it "making time" he's chasing women. Now Crusty does not fault any guy for being a swordsman in fact I give a nod to such behavior thing is that well that whole married thing and he'll hit on anything with a heartbeat and a vagina. ladies whether you have a ring on your finger or not you will be an object of his poonhoundery. Need a decision made on where to move a pt when he is in charge? Well try to do that and get chewed out if you make a decision in his absence. If you don't then get chewed out for NOT making a decision in his absence.
Nurse 3p is on rails when he's working if you do anything outside the lines (which often happens in an dynamic environment known as the BCH ED) color outside the lines and well, he gets his all flustered. Triage nurse order stroke labs on a Pt they are sending back with signs of a CVA? Not with 3P. As with all of us he gets his job done, often slowly agonizingly done. So the bowels churn.
Or as I think of him The ER equivalent of Foghorn Leghorn:
I call him Nurse Threepeat because he says everything three times, I say three times, three times I said. The man truly does not know when to shut up. I've pointed this out to fellow co-workers and we are all stunned at the similarities between Nurse Threepeat and Foghorn Leghorn.
Saying the exact same thing three times although quirky and borderline annoying is one thing being a hardheaded lout is another. Nurse 3P (threepeat) is never wrong there is no give and take with the man, you cannot get your point across even if you think it's right or even a teensy bit better because he never ever shuts up. You throw up your hand in frustration just to get away from him. The other thing is that the dude cannot make a decision. He is now a charge nurse and has been for awhile. This goes along with the long standing tradition at any hospital I have worked at. Which is to promote the incompetent. I gather from reading other posts that this is a standard practice at most any hospital in America.
Waiting for an assignment at the beginning of shift. Well fellow BCH co-workers we'll keep on a waiting. With the previous shift getting more and more upset cause hey they wanna go home and sleep. Nurse Leghorn is busy flirting with the Ukrainian nurse or the newly divorced European nurse. Trouble is that he's married and oh so is the Ukrainian nurse. It's a regular "As the bowel churns" soap opera before shift at times.
Another frustration aspect of Nurse 3p (and there are quite a few) is his wanderlust. When he was a nurse who carried patients the man would wander all the time, shit he still does and he's a full time charge nurse now. Why you ask, well he is how he puts it "making time" he's chasing women. Now Crusty does not fault any guy for being a swordsman in fact I give a nod to such behavior thing is that well that whole married thing and he'll hit on anything with a heartbeat and a vagina. ladies whether you have a ring on your finger or not you will be an object of his poonhoundery. Need a decision made on where to move a pt when he is in charge? Well try to do that and get chewed out if you make a decision in his absence. If you don't then get chewed out for NOT making a decision in his absence.
Nurse 3p is on rails when he's working if you do anything outside the lines (which often happens in an dynamic environment known as the BCH ED) color outside the lines and well, he gets his all flustered. Triage nurse order stroke labs on a Pt they are sending back with signs of a CVA? Not with 3P. As with all of us he gets his job done, often slowly agonizingly done. So the bowels churn.
Wednesday, May 28, 2014
Thirty Four
Mostly fiction:
Nurses, Mid-levels, Residents and Attendings are treated in accordance with this hospital's "Licensed staff care and use guidelines" and in compliance with this institution's protocols as stated by the human resources department in sections 601.5 B to 804.T. The "certified staff/techs" (Paramedics and EMT's) however are treated terribly and paid very little. In fact we work them pretty hard. This was done in accordance with the fact that they kept showing up to work so why not.
Nurses, Mid-levels, Residents and Attendings are treated in accordance with this hospital's "Licensed staff care and use guidelines" and in compliance with this institution's protocols as stated by the human resources department in sections 601.5 B to 804.T. The "certified staff/techs" (Paramedics and EMT's) however are treated terribly and paid very little. In fact we work them pretty hard. This was done in accordance with the fact that they kept showing up to work so why not.
Tuesday, May 27, 2014
Thirty three
No peace on the shitter.
Fairly often as an ER tech you get hassled about everything "Where are my VS?" "Did you do my IV in rm 19?" "where is my coffee?" "Why didn't you replace the water in the water cooler?" Usually this stuff is already done or in the process of being done and the asking party just does not realize that the task has been completed. I have found and said in this here blog the ONE thing I have never been hassled about doing this job is when I have to take a dump. When my high bran breakfast hits my bowels. BOOM! It's time to go. It's nice and quiet in there because maintenance screwed up and never attached the speakers after a pipe busted in there to the overhead paging system. Unless a person gets thrown into a wall on the other side of the door you don't hear anything.
I had to take a dump. I had been holding it for close to two hours my bowels were cramping and I was starting to get the walking farts. It's a sure way of my body telling me that "Dude, really get to a toilet soon or you're gonna shit yourself." I finished up my latest task at hand and went to the shitter. Without giving out TMI let's just say holding back a bowel movement for that long makes for a long visit in the toilet.
I was not worried because I've never been hassled about taking a dump, no where....ever. Not even when I was in the Army, the shitter is sacred in a sense. When asked I'm honest "Hey, I was in the shitter." Then it's a curt "Oh ok" and we move on. Also I was on shift with the Rockin' Redhead charge nurse. A veteran nurse who is very competent, super cool and honestly not bad to look at. She's been at BCH for a long while and knows how it goes. She's great. Well unbeknownst to me she went to a meeting of some sort and one of the middle-upper managements fell out of their office long enough to cover the area Rockin Redhead was charging that day.
Who is doing the charge duties you may ask. Well this character is a recent addition to the blog "The condescending nurse" I had a recent run in with her in the last few weeks. There is one or maybe actually several like her in every department. They usually rear their ugly heads when a new person is in the department or if they have to deal with staff members who are not licensed or if they are dealing with nurses who have not been in the trenches for as long as them heavens help you if you have only been a nurse for 20 years and she has been one for 21 years. naturally as a tech I feel I get the brunt of this kind of haughty behavior. I've dealt with them in many ways usually letting them drown or telling them to FOAD maybe both depending on the mood.
I come back into the area I get rolled up by the condescending nurse who is upper mid-level management type. One thing that is known that I am (despite what I say here) a very hard worker. I'm always proactive and on task. First thing out of her mouth "Where have you been I have been paging you?" Which meh, it happens so I answer honestly "I was using the bathroom" Choosing not to speak bluntly with the condescending nurse because this is not the time for it. I'm honestly expecting the "Oh..ok". She looks at me and says again "Well I was paging you, you need to be in the department." Which really takes me aback. She is clearly implying I had wandered off someplace. I tell her "I was in the department, I was on the toilet." CN then says "I was in the department too and I was paging you."
I'm puzzled by this I have clearly stated that I was in the toilet perhaps she needs some clarification. "Hey, if you must know I was having a massive bowel movement" By giving TMI I was hoping to back her off and avoid a write up of some sort. Nope, she's squarely letting me know that I am not getting away with literally shit. I change gears, "Ok I'm here now what can I do to help?" hoping that this would change the tone of the conversation. She says "It's too late now, I did it myself already." She is not interested in changing any tone. Obviously she is showing me that she is in charge and she thinks I am slacking off and by slacking off I have made this nurse of "29 years of experience " do some work besides shuffle papers. I have not given up yet because this is the kind of thing that can haunt you later "CN all I can say is that I was here, I was in the bathroom having a massive bowel movement I had held for almost 2 hours, we can't hear pages in the men's bathroom, if there is something you need done let me know." Not letting me have the last word in the conversation she says "I am in the department too and I am in charge, when I page you, you need to respond."
I face palm as she walks off, she never heard a word I said. Which again is common for the ER tech Crusty or not. By not seeing me as a person of even minimal importance she does not even regard my very word. I never learned what this important task was. I did find out that Rockin' Redhead got me out of getting paper put on me (which would have been a very ugly experience for all concerned) RR told me that she was cautioned to "Keep an eye Crusty ER Tech" for the rest of the day.
What could be learned from this. Well I could just shit myself, which would cement my reputation as a world class nut job. I could ask permission to use the bathroom, which reminds me of what prisoners have to do. I could suggest that if it's so important that you get in touch with techs that hey, buy radios or tag us like they did in other hospitals. The thing is that I am an adult and really I should never have to ask to use the bathroom.
I hate to say this, I think Condescending Nurse 29 (for 29 years experience) and I will have other conversations later down the line that are similar to this one. Perhaps I'll just shrug my shoulders and state "I have nothing to say because you don't hear what I am saying." which will serve to piss her off, decisions...decisions...
Well I better get my skates on, it's a Tuesday after a long holiday weekend.
Fairly often as an ER tech you get hassled about everything "Where are my VS?" "Did you do my IV in rm 19?" "where is my coffee?" "Why didn't you replace the water in the water cooler?" Usually this stuff is already done or in the process of being done and the asking party just does not realize that the task has been completed. I have found and said in this here blog the ONE thing I have never been hassled about doing this job is when I have to take a dump. When my high bran breakfast hits my bowels. BOOM! It's time to go. It's nice and quiet in there because maintenance screwed up and never attached the speakers after a pipe busted in there to the overhead paging system. Unless a person gets thrown into a wall on the other side of the door you don't hear anything.
I had to take a dump. I had been holding it for close to two hours my bowels were cramping and I was starting to get the walking farts. It's a sure way of my body telling me that "Dude, really get to a toilet soon or you're gonna shit yourself." I finished up my latest task at hand and went to the shitter. Without giving out TMI let's just say holding back a bowel movement for that long makes for a long visit in the toilet.
I was not worried because I've never been hassled about taking a dump, no where....ever. Not even when I was in the Army, the shitter is sacred in a sense. When asked I'm honest "Hey, I was in the shitter." Then it's a curt "Oh ok" and we move on. Also I was on shift with the Rockin' Redhead charge nurse. A veteran nurse who is very competent, super cool and honestly not bad to look at. She's been at BCH for a long while and knows how it goes. She's great. Well unbeknownst to me she went to a meeting of some sort and one of the middle-upper managements fell out of their office long enough to cover the area Rockin Redhead was charging that day.
Who is doing the charge duties you may ask. Well this character is a recent addition to the blog "The condescending nurse" I had a recent run in with her in the last few weeks. There is one or maybe actually several like her in every department. They usually rear their ugly heads when a new person is in the department or if they have to deal with staff members who are not licensed or if they are dealing with nurses who have not been in the trenches for as long as them heavens help you if you have only been a nurse for 20 years and she has been one for 21 years. naturally as a tech I feel I get the brunt of this kind of haughty behavior. I've dealt with them in many ways usually letting them drown or telling them to FOAD maybe both depending on the mood.
I come back into the area I get rolled up by the condescending nurse who is upper mid-level management type. One thing that is known that I am (despite what I say here) a very hard worker. I'm always proactive and on task. First thing out of her mouth "Where have you been I have been paging you?" Which meh, it happens so I answer honestly "I was using the bathroom" Choosing not to speak bluntly with the condescending nurse because this is not the time for it. I'm honestly expecting the "Oh..ok". She looks at me and says again "Well I was paging you, you need to be in the department." Which really takes me aback. She is clearly implying I had wandered off someplace. I tell her "I was in the department, I was on the toilet." CN then says "I was in the department too and I was paging you."
I'm puzzled by this I have clearly stated that I was in the toilet perhaps she needs some clarification. "Hey, if you must know I was having a massive bowel movement" By giving TMI I was hoping to back her off and avoid a write up of some sort. Nope, she's squarely letting me know that I am not getting away with literally shit. I change gears, "Ok I'm here now what can I do to help?" hoping that this would change the tone of the conversation. She says "It's too late now, I did it myself already." She is not interested in changing any tone. Obviously she is showing me that she is in charge and she thinks I am slacking off and by slacking off I have made this nurse of "29 years of experience " do some work besides shuffle papers. I have not given up yet because this is the kind of thing that can haunt you later "CN all I can say is that I was here, I was in the bathroom having a massive bowel movement I had held for almost 2 hours, we can't hear pages in the men's bathroom, if there is something you need done let me know." Not letting me have the last word in the conversation she says "I am in the department too and I am in charge, when I page you, you need to respond."
I face palm as she walks off, she never heard a word I said. Which again is common for the ER tech Crusty or not. By not seeing me as a person of even minimal importance she does not even regard my very word. I never learned what this important task was. I did find out that Rockin' Redhead got me out of getting paper put on me (which would have been a very ugly experience for all concerned) RR told me that she was cautioned to "Keep an eye Crusty ER Tech" for the rest of the day.
What could be learned from this. Well I could just shit myself, which would cement my reputation as a world class nut job. I could ask permission to use the bathroom, which reminds me of what prisoners have to do. I could suggest that if it's so important that you get in touch with techs that hey, buy radios or tag us like they did in other hospitals. The thing is that I am an adult and really I should never have to ask to use the bathroom.
I hate to say this, I think Condescending Nurse 29 (for 29 years experience) and I will have other conversations later down the line that are similar to this one. Perhaps I'll just shrug my shoulders and state "I have nothing to say because you don't hear what I am saying." which will serve to piss her off, decisions...decisions...
Well I better get my skates on, it's a Tuesday after a long holiday weekend.
Wednesday, May 14, 2014
Thirty Two
The more shit changes the more it fuckin' stays the same.
It's that time of year folks where our education department screws it's collective heads on long enough to take a crack at getting everyone through their annual competencies. Usually most places I have worked it's a day or two of doing skills and a test or two maybe a mock code on a life like automated mannequin, nothing big. For the last few years that I have been at big inner city hospital the process is more shall we say convoluted. The only thing that stays the same is that you have to do a certain set of skills. Then there is the computer learning modules which it seems like someone decides to change providers for each year. So you need new logins and passwords different than your regular ones.
One year they opened up the computer modules a month in advance for us to get everything done before getting skills done. As a tech we don't have much to do, the nurses though have got a shit ton. This ain't about nurses it's an ER tech blog so we talk about medicine's equivalent to sherpas. Any how, I suppose that idea of opening up the modules a month early was a bit too smart. So education decided to only open it up AFTER you talked to them on the day you wanted to get your skills done. Hell, they even gave us 4 non-productive hours to get it all done, awesome. Seriously Crusty ER Tech will roll with the punches to a point. I guess their idea was that folks would come in early get their shit done early and not dog pile in on the last day of annual skills. I'm following the thinking, fuckin' A. It was a good idea until it wasn't.
Case in point my experience of getting annuals done. Lately I have drunk the kool-aid and started to believe that hey as an employee I am being treated better and that I am valued as a team member. Sure there have been minor head aches it's part of the job. I thought that for once I'll get ahead of the herd and take advantage of the annuals being done in the ER for once (instead of in the secret hall on the other side of the hospital up on the 10th floor.) and I'd be smart and take advantage of these stations being open for two full weeks instead of one. The ol' Crusty ER Tech has really been using his noggin since he started nursing school. We were assured in our morning meetings that this area would be staffed the entire time M-F 0800-1700. Fantastic!
I show up and sure as shit no other techs are around and there is one nurse who is there to check off my lowly ER tech skills. There is a slight problem, I have to do my modules first and the head educator has to unlock my access. I'm here on my off day and I get 4 non-productive hours for it, remember ol' Crusty can roll with the punches. I go over to the head educator (gasp she is in her office) and she unlocks my access. I tell her that I'm gonna knock all this out and get everything done today, hell I even wrote her to say I was coming in on an off day. No problem she says. I get the modules done pretty quick despite another third party educational module provider and slow computers. Right when I am printing my completions up the nurse that was at the check off area walks up and says. hey Crusty my time is up over there but the head educator will get you checked off lickety split.
No problemo Crusty ER tech will go with it. I am a valued team member, which I am up until the moment I need something. I go find the head educator She is gone and one of her minions tells me that she'll be back "in the late afternoon" I ask how late and i get told "I dunno...LATE." No prob the old CERT will adapt. I walk over to the check off area thinking that the head educator would not leave me hanging because I am a valued team member, certainly she'd have someone over there waiting and not waste my time.
No one is there. Alrighty, the charge nurse will help me out it's slow and she's sitting in the office on her ass. I ask Condescending charge nurse for some help I get told "That's not my responsibility or job.' said of course in her usual condescending tone. Which is fine because I expected that. She's a useless bag of flesh anyways. So I do what they have told us to do use the chain of command, if someone won't help you go up the chain. So I go to her bosses, which no surprise at all they are in their office. I walk in and ask for help with my situation. I get asked very rudely "And who are you?" I'm close to the boiling point now.
Some one in the office says "that's Crusty ER tech, he's been around forever." These two birds I am talking to are new managerial types that were hired from outside the department, double ugh. They give each other a look shuffle some papers around and say "we can't help you" then turn their backs on me.Now I simmer out of my pot for a bit. "Hey, I've been here for awhile and you know what drives us employees crazy, this kind of thing right here, I come in on my day off get everything done to avoid the last day rush and get blown off by everyone. I learned my lesson, I'll show up on the last day that way at least there will be someone around to sign me off." With that I calmly walk out the door and straight to an open computer to email their boss.
In the old days of this urban ER that was unheard of speaking out because there was a price to be paid if you said anything that would be considered criticism of any manager type. You'd get written up or given assignments that sucked the life out of you. Trust me I know it happened to me a lot in the old days of this urban ER. After awhile I learned to keep my fucking mouth shut and bear the often idiotic leadership we had to put up with.
Now with a new corporate management team upstairs we have been told that those days are over, just use the chain of command. I use it and email their boss and vent my spleen about nearly everything. lo and behold the I get an email from my immediate supervisor (well I guess she is because they swap us around like horses between supervisors) I get told that my problems will be solved but only in a cursory kind of way. I'm still pissed, so I email their bosses boss again to say in essence, ya know how you guys said things have changed, well nothing has changed you guys just added another level of management it's the same old managerial style in the old inner city urban ER. I also said that since that has not changed that I fully expect some sort of disciplinary action or retribution for me saying something, just like 2 managers ago or shit was it 3 hell I forget.
Well old Crusty ER Tech shot his mouth off and again will pay the price, my next shift is tomorrow. Time will tell if anyone there gives a shit enough bout the old Crusty one to make amends. I doubt it because after all Crusty ER Tech is only a pawn in the game of life:
It's that time of year folks where our education department screws it's collective heads on long enough to take a crack at getting everyone through their annual competencies. Usually most places I have worked it's a day or two of doing skills and a test or two maybe a mock code on a life like automated mannequin, nothing big. For the last few years that I have been at big inner city hospital the process is more shall we say convoluted. The only thing that stays the same is that you have to do a certain set of skills. Then there is the computer learning modules which it seems like someone decides to change providers for each year. So you need new logins and passwords different than your regular ones.
One year they opened up the computer modules a month in advance for us to get everything done before getting skills done. As a tech we don't have much to do, the nurses though have got a shit ton. This ain't about nurses it's an ER tech blog so we talk about medicine's equivalent to sherpas. Any how, I suppose that idea of opening up the modules a month early was a bit too smart. So education decided to only open it up AFTER you talked to them on the day you wanted to get your skills done. Hell, they even gave us 4 non-productive hours to get it all done, awesome. Seriously Crusty ER Tech will roll with the punches to a point. I guess their idea was that folks would come in early get their shit done early and not dog pile in on the last day of annual skills. I'm following the thinking, fuckin' A. It was a good idea until it wasn't.
Case in point my experience of getting annuals done. Lately I have drunk the kool-aid and started to believe that hey as an employee I am being treated better and that I am valued as a team member. Sure there have been minor head aches it's part of the job. I thought that for once I'll get ahead of the herd and take advantage of the annuals being done in the ER for once (instead of in the secret hall on the other side of the hospital up on the 10th floor.) and I'd be smart and take advantage of these stations being open for two full weeks instead of one. The ol' Crusty ER Tech has really been using his noggin since he started nursing school. We were assured in our morning meetings that this area would be staffed the entire time M-F 0800-1700. Fantastic!
I show up and sure as shit no other techs are around and there is one nurse who is there to check off my lowly ER tech skills. There is a slight problem, I have to do my modules first and the head educator has to unlock my access. I'm here on my off day and I get 4 non-productive hours for it, remember ol' Crusty can roll with the punches. I go over to the head educator (gasp she is in her office) and she unlocks my access. I tell her that I'm gonna knock all this out and get everything done today, hell I even wrote her to say I was coming in on an off day. No problem she says. I get the modules done pretty quick despite another third party educational module provider and slow computers. Right when I am printing my completions up the nurse that was at the check off area walks up and says. hey Crusty my time is up over there but the head educator will get you checked off lickety split.
No problemo Crusty ER tech will go with it. I am a valued team member, which I am up until the moment I need something. I go find the head educator She is gone and one of her minions tells me that she'll be back "in the late afternoon" I ask how late and i get told "I dunno...LATE." No prob the old CERT will adapt. I walk over to the check off area thinking that the head educator would not leave me hanging because I am a valued team member, certainly she'd have someone over there waiting and not waste my time.
No one is there. Alrighty, the charge nurse will help me out it's slow and she's sitting in the office on her ass. I ask Condescending charge nurse for some help I get told "That's not my responsibility or job.' said of course in her usual condescending tone. Which is fine because I expected that. She's a useless bag of flesh anyways. So I do what they have told us to do use the chain of command, if someone won't help you go up the chain. So I go to her bosses, which no surprise at all they are in their office. I walk in and ask for help with my situation. I get asked very rudely "And who are you?" I'm close to the boiling point now.
Some one in the office says "that's Crusty ER tech, he's been around forever." These two birds I am talking to are new managerial types that were hired from outside the department, double ugh. They give each other a look shuffle some papers around and say "we can't help you" then turn their backs on me.Now I simmer out of my pot for a bit. "Hey, I've been here for awhile and you know what drives us employees crazy, this kind of thing right here, I come in on my day off get everything done to avoid the last day rush and get blown off by everyone. I learned my lesson, I'll show up on the last day that way at least there will be someone around to sign me off." With that I calmly walk out the door and straight to an open computer to email their boss.
In the old days of this urban ER that was unheard of speaking out because there was a price to be paid if you said anything that would be considered criticism of any manager type. You'd get written up or given assignments that sucked the life out of you. Trust me I know it happened to me a lot in the old days of this urban ER. After awhile I learned to keep my fucking mouth shut and bear the often idiotic leadership we had to put up with.
Now with a new corporate management team upstairs we have been told that those days are over, just use the chain of command. I use it and email their boss and vent my spleen about nearly everything. lo and behold the I get an email from my immediate supervisor (well I guess she is because they swap us around like horses between supervisors) I get told that my problems will be solved but only in a cursory kind of way. I'm still pissed, so I email their bosses boss again to say in essence, ya know how you guys said things have changed, well nothing has changed you guys just added another level of management it's the same old managerial style in the old inner city urban ER. I also said that since that has not changed that I fully expect some sort of disciplinary action or retribution for me saying something, just like 2 managers ago or shit was it 3 hell I forget.
Well old Crusty ER Tech shot his mouth off and again will pay the price, my next shift is tomorrow. Time will tell if anyone there gives a shit enough bout the old Crusty one to make amends. I doubt it because after all Crusty ER Tech is only a pawn in the game of life:
Tuesday, May 6, 2014
Thrity One
Crusty ER tech's first cor-0/code.
Since the current semester for nursing school is over (and fuck you very much I made it to the next semester) and I don't need to study and concentrate on the nursing process , I decided to finally sit down many years later and write about my first "code blue" or "cor-zero/0" ever.
I had made it through EMT school with out having to work a code ever during my rotations. I got hired on with a small private ambulance service who held the 911 contract with a couple of counties of the state I lived in at the time. We were working out of a voly fire fighter station #42 at the time which was where we were posted at a majority of the time. I was still being precepted at the time so in essence I was a third rider.
It was snowing big wet flakes, it was a pretty quiet night until as usual we got toned at O dark thirty. The service I worked for at the time worked a primarily industrial county on the east side of the city which I lived in at the time. It was a split truck, I was working with a EMT and Paramedic. It was the Paramedic's job to pecept me and sign me off medically (back of the Ambu) and the EMT to make sure I could drive and find my way around on a map (before GPS) We boogied on over to a ramshackle Mom & Pop diner off a major highway.
It was toned as a "party down" so we went in expecting the worst. It was in the sense that the person was just DRT (dead right there). It was the cook of the establishment, one second she was frying up a late night dinner for a trucker the next she collapsed, faster than what I just typed. I vividly remember the toast on the grill and the smell of burning eggs. She had false teeth, I pulled them out while the medic set up to intubate the patient. I put the teeth in my cargo pocket simply because I thought the woman would live and want her teeth back.
We get her loaded up and a voly FF shows up to help out with compressions. It takes forever to get to the closest hospital because the winter storm has gotten worse. It's a sweat box in the back of the Ambu because four people are back there. The Paramedic is at the head doing his thing and the voly ff and I are doing compressions. Plus I am doing everything else when I am not doing compressions like getting a second line and stripping the pt down more. What was usually a 10 minute trip took nearly 40 because of the weather.
We get to the old university hospital and roll her into the very ancient resuscitation room. Which was small, cramped and was around 120 degrees (steam radiators...yes radiators!) with all parties in the room. We drop her off the Paramedic gives a quick report and out the room we walk. We're out in the Ambu bay we start cleaning up the Ambu. In the middle of this I remember the patient's teeth are in my pocket. I drop what I am doing, run (yes, literally run) back into the resuscitation room with teeth in gloved hand. I arrive just in time to have them call the patient right when I come tumbling into the room.
Everyone files out of the room except the lone ER nurse who was responsible for the resuscitation room that night. I am really surprised that the patient died. Simply because as far as I knew we did everything right. I catch the nurses attention and say "Ummm here is her teeth" The ER nurse laughs sticks the false teeth into a lab bag and places them onto the patient's chest. The ER nurse says a clipped "thank you" and goes back to wrapping up her charting.
I walk back out to the ambu, I can't believe the patient died. I tell the rest of the crew and they just shrug their shoulders. The paramedic knowing this is my first code ever tells me while we are cleaning up the ambu and doing paper work that really more often than not the patient dies for whatever reason. It's a long quiet ride back to station 42 and I just think about the previous run. I wonder if I could have anything differently to save the patient. We get back to the station, the voly FF goes home. My fellow Ambu crew members fall asleep at once. I stay up the rest of the night staring at the TV wondering if I somehow fucked up and killed a patient.
I did'nt
I learn in the coming weeks what they told us in EMT school, although I never learned it. That you can do everything right and the patient still dies for whatever reason. I learn to deal with codes as an Ambu EMT and do quite well with them. I move onto the hospital and learn even more. To the point that I can only remember my very first code/cor-0 as an EMT. I cannot tell you anything about the 2nd one up to the last current one I just assisted with. I cannot and will not speak for anyone else, it just gets to a point whether you like it or not you become use to people dying. Yes there are things that stick with me, that I remember for no reason, often though I cannot put a face to a barely (if at all) remembered name.
That's the story of my first code as well as I can remember it after a few beers on a warm May night.
Since the current semester for nursing school is over (and fuck you very much I made it to the next semester) and I don't need to study and concentrate on the nursing process , I decided to finally sit down many years later and write about my first "code blue" or "cor-zero/0" ever.
I had made it through EMT school with out having to work a code ever during my rotations. I got hired on with a small private ambulance service who held the 911 contract with a couple of counties of the state I lived in at the time. We were working out of a voly fire fighter station #42 at the time which was where we were posted at a majority of the time. I was still being precepted at the time so in essence I was a third rider.
It was snowing big wet flakes, it was a pretty quiet night until as usual we got toned at O dark thirty. The service I worked for at the time worked a primarily industrial county on the east side of the city which I lived in at the time. It was a split truck, I was working with a EMT and Paramedic. It was the Paramedic's job to pecept me and sign me off medically (back of the Ambu) and the EMT to make sure I could drive and find my way around on a map (before GPS) We boogied on over to a ramshackle Mom & Pop diner off a major highway.
It was toned as a "party down" so we went in expecting the worst. It was in the sense that the person was just DRT (dead right there). It was the cook of the establishment, one second she was frying up a late night dinner for a trucker the next she collapsed, faster than what I just typed. I vividly remember the toast on the grill and the smell of burning eggs. She had false teeth, I pulled them out while the medic set up to intubate the patient. I put the teeth in my cargo pocket simply because I thought the woman would live and want her teeth back.
We get her loaded up and a voly FF shows up to help out with compressions. It takes forever to get to the closest hospital because the winter storm has gotten worse. It's a sweat box in the back of the Ambu because four people are back there. The Paramedic is at the head doing his thing and the voly ff and I are doing compressions. Plus I am doing everything else when I am not doing compressions like getting a second line and stripping the pt down more. What was usually a 10 minute trip took nearly 40 because of the weather.
We get to the old university hospital and roll her into the very ancient resuscitation room. Which was small, cramped and was around 120 degrees (steam radiators...yes radiators!) with all parties in the room. We drop her off the Paramedic gives a quick report and out the room we walk. We're out in the Ambu bay we start cleaning up the Ambu. In the middle of this I remember the patient's teeth are in my pocket. I drop what I am doing, run (yes, literally run) back into the resuscitation room with teeth in gloved hand. I arrive just in time to have them call the patient right when I come tumbling into the room.
Everyone files out of the room except the lone ER nurse who was responsible for the resuscitation room that night. I am really surprised that the patient died. Simply because as far as I knew we did everything right. I catch the nurses attention and say "Ummm here is her teeth" The ER nurse laughs sticks the false teeth into a lab bag and places them onto the patient's chest. The ER nurse says a clipped "thank you" and goes back to wrapping up her charting.
I walk back out to the ambu, I can't believe the patient died. I tell the rest of the crew and they just shrug their shoulders. The paramedic knowing this is my first code ever tells me while we are cleaning up the ambu and doing paper work that really more often than not the patient dies for whatever reason. It's a long quiet ride back to station 42 and I just think about the previous run. I wonder if I could have anything differently to save the patient. We get back to the station, the voly FF goes home. My fellow Ambu crew members fall asleep at once. I stay up the rest of the night staring at the TV wondering if I somehow fucked up and killed a patient.
I did'nt
I learn in the coming weeks what they told us in EMT school, although I never learned it. That you can do everything right and the patient still dies for whatever reason. I learn to deal with codes as an Ambu EMT and do quite well with them. I move onto the hospital and learn even more. To the point that I can only remember my very first code/cor-0 as an EMT. I cannot tell you anything about the 2nd one up to the last current one I just assisted with. I cannot and will not speak for anyone else, it just gets to a point whether you like it or not you become use to people dying. Yes there are things that stick with me, that I remember for no reason, often though I cannot put a face to a barely (if at all) remembered name.
That's the story of my first code as well as I can remember it after a few beers on a warm May night.
Monday, April 21, 2014
Dirty Thirty
This is number thirty of my blog entries out there to the ol' interwebs. It's all about busting cherries so I'll call this one the "Dirty Thirty"
Not so long a go in a hospital emergency room not so far away there was a scared and rather timid new EMT student. It was her first clinical rotation and first experience with a large hospital like BCH. Never an ambulance ride before it was truly her first day in nearly way shape and form. It was a rather slow morning and early afternoon at BCH nothing too exciting was going on and then we got a code into the resuscitation room. Hearing the page overhead I crawled out of my unchallenged stupor to shuffle into the resuscitation room to see if I could help. EMT student was plastered on the wall.
It was the usual code stuff and we "saved" the patient while waiting for ICU to accept report the EMT student and I (who I was not precepting the nurse who was pushed her into the room to "watch") were talking about her school and training so far. I was doing my usual thing which we all do after awhile, talking to someone while watching the monitor. The pt HR was going down down down and her pressure cycled and it was shit. While this was going on I told the EMT student "You up for some CPR?" I was feeling for a pulse (there was none) then waving at the nurse, 3rd year and attending and said "Guys she ain't got no pulse...check the monitor and check me." Meanwhile the EMT student says "I've never done CPR before." Which was very honest, then a great thing happened. Everyone in the room says to the EMT student "Get on the stool and start compressions" It was one of those "teaching moments" where everyone coached her on proper technique and was encouraging her.
The EMT student showed some gumption and got into it doing her compressions like an old pro in no time. When she stepped down for a pulse check she had a big smile on her face. She was hooked and came out of her shell. It ended up being a long nasty code where the pt would come back with a round of epi we'd hang pressors and do a procedure and then it was back to chest compressions. We had the EMT student do more chest compressions bag the pt with a BVM, help roll the pt to get the pt off of the back board all sorts of "cool" things EMT students love to brag about in class. This I know because I was new once too. I never worked a code until I was a "certimified" EMT and hired on the ambu (which is another story for another day) I was telling her the whole time "You're gonna be a rock star when your class meets again." When she looked scared one of the nurses would come over to her and pat her on the shoulder for a second and then go do something all nursey and shit.
The student got to see things they had only peripherally discussed in class. We all explained what we could when we could about what was going on with the pt. The pharmacist would explain the drugs, the second and third years would explain a procedure or the pathophys of what was going on inside the pt. I'd fill in the spaces as best I could when I was not looking for equipment, taking my turn at compressions or otherwise occupied. In all it was a team effort not only to save the patient over and over again but to ease the EMT student into the often jarring world of modern medicine. It's a mind searing event and one you'll never forget. Whether you're having sex or doing CPR for the first time. I guarantee you'll never forget it. Yes, it can get rough during codes and trauma activations we all made the effort to make the student feel as welcome as we could under the circumstances.
Finally we got the patient as stable as we were gonna get her and made a dash for the ICU. Naturally on the way up there we lost her pulse while we were waiting on the elevator. Fortunately the ICU charge and an ICU nurse met us at the elevators and helped out tons. As soon as we got to the appropriate floor The ICU charge nurse sprints out of the elevator and runs into the ICU pod and calls a code and literally the entire ICU drops what they are doing and helps us out. Man we were running down the hall with this pt. Which is something I had not done in a long while. After another long bit (more epi & more chest compressions) we get the pt into the ICU bed and we leave. Which is when the EMT student said the line of the month:
"That was the coolest thing...ever!"
The ER nurse and I started laughing because we have both been there and yeah it's pretty awesome running down the hall doing CPR on a pt. Besides the ER nurse was and old EMT and knows what it's like to be a exposed to this for the first time. The EMT student is totally hooked. I made it a point to tell her this was a rarity and it does not happen every shift or call. Learn from the experience of course but also enjoy the moment.While I was doing my final checks in on everyone for the day the EMT student gave me a big hug around the neck and just profusely thanked me for pushing her to do more during the code.
When I precepted EMT students years ago that's how I could tell who wanted to do the job and who just wanted to just slide by. Sure it would have been easy for her to walk out of the room and no one would have had a second thought or blamed her. She stuck with it and that's a telling sign in and of itself. I told her to make sure she thanked everyone else too. She did, she practically floated out of the department on that big smile and adrenaline.
For all the horseshit I (really all of us) have to deal with those moments are what makes the job worth while and I am thankful for the opportunity.
Not so long a go in a hospital emergency room not so far away there was a scared and rather timid new EMT student. It was her first clinical rotation and first experience with a large hospital like BCH. Never an ambulance ride before it was truly her first day in nearly way shape and form. It was a rather slow morning and early afternoon at BCH nothing too exciting was going on and then we got a code into the resuscitation room. Hearing the page overhead I crawled out of my unchallenged stupor to shuffle into the resuscitation room to see if I could help. EMT student was plastered on the wall.
It was the usual code stuff and we "saved" the patient while waiting for ICU to accept report the EMT student and I (who I was not precepting the nurse who was pushed her into the room to "watch") were talking about her school and training so far. I was doing my usual thing which we all do after awhile, talking to someone while watching the monitor. The pt HR was going down down down and her pressure cycled and it was shit. While this was going on I told the EMT student "You up for some CPR?" I was feeling for a pulse (there was none) then waving at the nurse, 3rd year and attending and said "Guys she ain't got no pulse...check the monitor and check me." Meanwhile the EMT student says "I've never done CPR before." Which was very honest, then a great thing happened. Everyone in the room says to the EMT student "Get on the stool and start compressions" It was one of those "teaching moments" where everyone coached her on proper technique and was encouraging her.
The EMT student showed some gumption and got into it doing her compressions like an old pro in no time. When she stepped down for a pulse check she had a big smile on her face. She was hooked and came out of her shell. It ended up being a long nasty code where the pt would come back with a round of epi we'd hang pressors and do a procedure and then it was back to chest compressions. We had the EMT student do more chest compressions bag the pt with a BVM, help roll the pt to get the pt off of the back board all sorts of "cool" things EMT students love to brag about in class. This I know because I was new once too. I never worked a code until I was a "certimified" EMT and hired on the ambu (which is another story for another day) I was telling her the whole time "You're gonna be a rock star when your class meets again." When she looked scared one of the nurses would come over to her and pat her on the shoulder for a second and then go do something all nursey and shit.
The student got to see things they had only peripherally discussed in class. We all explained what we could when we could about what was going on with the pt. The pharmacist would explain the drugs, the second and third years would explain a procedure or the pathophys of what was going on inside the pt. I'd fill in the spaces as best I could when I was not looking for equipment, taking my turn at compressions or otherwise occupied. In all it was a team effort not only to save the patient over and over again but to ease the EMT student into the often jarring world of modern medicine. It's a mind searing event and one you'll never forget. Whether you're having sex or doing CPR for the first time. I guarantee you'll never forget it. Yes, it can get rough during codes and trauma activations we all made the effort to make the student feel as welcome as we could under the circumstances.
Finally we got the patient as stable as we were gonna get her and made a dash for the ICU. Naturally on the way up there we lost her pulse while we were waiting on the elevator. Fortunately the ICU charge and an ICU nurse met us at the elevators and helped out tons. As soon as we got to the appropriate floor The ICU charge nurse sprints out of the elevator and runs into the ICU pod and calls a code and literally the entire ICU drops what they are doing and helps us out. Man we were running down the hall with this pt. Which is something I had not done in a long while. After another long bit (more epi & more chest compressions) we get the pt into the ICU bed and we leave. Which is when the EMT student said the line of the month:
"That was the coolest thing...ever!"
The ER nurse and I started laughing because we have both been there and yeah it's pretty awesome running down the hall doing CPR on a pt. Besides the ER nurse was and old EMT and knows what it's like to be a exposed to this for the first time. The EMT student is totally hooked. I made it a point to tell her this was a rarity and it does not happen every shift or call. Learn from the experience of course but also enjoy the moment.While I was doing my final checks in on everyone for the day the EMT student gave me a big hug around the neck and just profusely thanked me for pushing her to do more during the code.
When I precepted EMT students years ago that's how I could tell who wanted to do the job and who just wanted to just slide by. Sure it would have been easy for her to walk out of the room and no one would have had a second thought or blamed her. She stuck with it and that's a telling sign in and of itself. I told her to make sure she thanked everyone else too. She did, she practically floated out of the department on that big smile and adrenaline.
For all the horseshit I (really all of us) have to deal with those moments are what makes the job worth while and I am thankful for the opportunity.
Monday, March 24, 2014
Twenty Nine
I'm a little behind in somethings, ok a lot of things this is a video that was shared during my recert. I thought it was funky and pretty cool:
One of these days when I ain't busy with school, work and life stuff, I'll post about my first code/cor-0 which was not in an ER but back when I was a baby EMT working on an ambulance on a dark and snowy night. We were doing chest compressions to mariachi music though, that's a whole other story for another time
One of these days when I ain't busy with school, work and life stuff, I'll post about my first code/cor-0 which was not in an ER but back when I was a baby EMT working on an ambulance on a dark and snowy night. We were doing chest compressions to mariachi music though, that's a whole other story for another time
Tuesday, March 18, 2014
Twenty eight
Been busy these last several weeks with things outside the realm of the ER.
Last shift was a doozy and another rare "first" for me. We had so many heroin overdoses that we ran out of narcan and had to call to the main pharmacy and get more.
For laypeople narcan is simply the reversal agent for opiods (narcotics) :
you give narcan/naloxone and USUALLY the OD pt comes out of their self induced near dirt nap. I've done this for a while and was quite frankly amazed that we had this many in a single shift. One or two sure it's expected in the urban environment but several in a span of a couple of hours?
Whoa take it down a notch...'kay?
On a separate note Crusty has once again recerted. Here is to another few years of serving the public. At least I did not have to work St. Patty's day.
Last shift was a doozy and another rare "first" for me. We had so many heroin overdoses that we ran out of narcan and had to call to the main pharmacy and get more.
For laypeople narcan is simply the reversal agent for opiods (narcotics) :
you give narcan/naloxone and USUALLY the OD pt comes out of their self induced near dirt nap. I've done this for a while and was quite frankly amazed that we had this many in a single shift. One or two sure it's expected in the urban environment but several in a span of a couple of hours?
Whoa take it down a notch...'kay?
On a separate note Crusty has once again recerted. Here is to another few years of serving the public. At least I did not have to work St. Patty's day.
Tuesday, February 25, 2014
Twenty Seven
Way busy with school just wanted to comment on why when you're a new employee in an ER that hardly anyone will talk to you. I had this discussion with a friend and we determined that:
The unwritten rule is that a new person isn’t worth as much because they have not put their time in yet and it is said if you are gonna quit or get fired in the ER it’s better to get it in the first few weeks, the logic being you don’t suffer that much, I can believe that.
A small nod to "Platoon" for the inspiration.
The unwritten rule is that a new person isn’t worth as much because they have not put their time in yet and it is said if you are gonna quit or get fired in the ER it’s better to get it in the first few weeks, the logic being you don’t suffer that much, I can believe that.
A small nod to "Platoon" for the inspiration.
It's callous and real unforgiving, it's my reality.
Sunday, February 16, 2014
Twenty Six
The crusty one is busy with school shit so he won't have to be an ER tech until he drops over dead. In the interim I decided to give you an eyeful:
Why did they not have ambulances like this...ever?
Why did they not have ambulances like this...ever?
Friday, February 7, 2014
Twenty Five
Random hilarity.
I was having a conversation with a relative about of all things gladiator movies. Now not the Russell Crowe one but the real cheezy Italian ones from the 70's. It was a discussion about how a certain in law has truly awful tastes in movies. If this relative likes the movie then it's guaranteed loser.
This conversation got me to thinking about this great PA I used to work with. This dude was at the top of his game constantly and was often better than some of the docs who had to sign off on his orders actually a majority of the docs in the group he belonged to trusted him so much they consulted him on really strange cases. This PA was an old special forces medic who was the epitome of being a true professional.
He has a wicked sense of humor and could be VERY random. I witnessed him time and time again walk into a drunk patients room and ask them "So, what's this fascination you have with gladiator movies?" He'd never repeat the question but it always cracked me up. The dk pt would always say "Wha?" and he'd just say "Oh never mind" he did this shit for the entire time I was at west of the Mississippi po-dunk level 3. One of the few bright spots there.
I finally asked him what the hell this line was all about and he reminded me of the line from Airplane:
Plus he said it was a way of really loosening the staff up. I could not think of any tech or nurse there who would not bend over backwards or take a punch for SF Medic/PA. He had a great insight about people in fact he was one of the few people who I could say who is a true leader of staff. SF Medic/PA was one of the reasons I sat on the fence for so long about deciding between PA & Nursing school because he said and I quote "PA school? PFFFTTTT I had a blast I'd do it again in a heartbeat." If I thought I could be a 1/10th of the PA this guy is I'd give PA school a shot.
You also have to consider that PA school to him was probably a cake walk compared to all the other schools and training he had to do over his military career.
Anyways, that was years ago. I have no doubt that he's still working in an ER someplace out west asking every drunk patient he signs up for "So...what's this fascination you have for gladiator movies?"
Hilarious.
I was having a conversation with a relative about of all things gladiator movies. Now not the Russell Crowe one but the real cheezy Italian ones from the 70's. It was a discussion about how a certain in law has truly awful tastes in movies. If this relative likes the movie then it's guaranteed loser.
This conversation got me to thinking about this great PA I used to work with. This dude was at the top of his game constantly and was often better than some of the docs who had to sign off on his orders actually a majority of the docs in the group he belonged to trusted him so much they consulted him on really strange cases. This PA was an old special forces medic who was the epitome of being a true professional.
He has a wicked sense of humor and could be VERY random. I witnessed him time and time again walk into a drunk patients room and ask them "So, what's this fascination you have with gladiator movies?" He'd never repeat the question but it always cracked me up. The dk pt would always say "Wha?" and he'd just say "Oh never mind" he did this shit for the entire time I was at west of the Mississippi po-dunk level 3. One of the few bright spots there.
I finally asked him what the hell this line was all about and he reminded me of the line from Airplane:
Plus he said it was a way of really loosening the staff up. I could not think of any tech or nurse there who would not bend over backwards or take a punch for SF Medic/PA. He had a great insight about people in fact he was one of the few people who I could say who is a true leader of staff. SF Medic/PA was one of the reasons I sat on the fence for so long about deciding between PA & Nursing school because he said and I quote "PA school? PFFFTTTT I had a blast I'd do it again in a heartbeat." If I thought I could be a 1/10th of the PA this guy is I'd give PA school a shot.
You also have to consider that PA school to him was probably a cake walk compared to all the other schools and training he had to do over his military career.
Anyways, that was years ago. I have no doubt that he's still working in an ER someplace out west asking every drunk patient he signs up for "So...what's this fascination you have for gladiator movies?"
Hilarious.
Sunday, February 2, 2014
Twenty Four
Or how the NFL does it:
XXIV
It's stuporbowl sunday or stupid bowl sunday as we called it when I had to work on this day in the past (Today I am studying) It's one of the rookie nights of the year as well. And although I have an attachment to one team over the other I won't be watching the game, I honestly need to hit the books.
I have not forgotten what day it is though. So if you can stay home drink yer beers and have a blast watching the game. Because I have not posted one since the holidays here is some superbowl sunday sweetness for us guys out there:
In case you're wondering her name is Sarah Frechette. Stay tuned more hair greying stories to come from the CERT.
XXIV
It's stuporbowl sunday or stupid bowl sunday as we called it when I had to work on this day in the past (Today I am studying) It's one of the rookie nights of the year as well. And although I have an attachment to one team over the other I won't be watching the game, I honestly need to hit the books.
I have not forgotten what day it is though. So if you can stay home drink yer beers and have a blast watching the game. Because I have not posted one since the holidays here is some superbowl sunday sweetness for us guys out there:
In case you're wondering her name is Sarah Frechette. Stay tuned more hair greying stories to come from the CERT.
Thursday, January 30, 2014
Twenty Three
Twice in one career is enough.
I mentioned back in entry twenty one what I thought was a once in a lifetime/career occurrence. Female pt openly urinating in the middle of the hall in front of anyone who cared to see or not see. I honestly thought I would never see this type of thing ever again.
As in many things in my life I was wrong about that too. Lightening can strike in the same place twice.
Female mental health pt waiting for transport to the psych unit needs to urinate. I happily escort her to bathroom. Unfortunately in urban ER this bathroom is out of order. So we walk to the next bathroom about 20 feet away. This being an urban ER it too is out of order. So I say "Hey, there is another bathroom around the corner about 30 feet away, I think we can make it." By now this pt has gotten irritated over this inconvenience and screams "I AIN'T GONNA WALK NO WHERE ELSE I AM GONNA PISS RIGHT HERE!"
And she did.
This got a "Awww.... you gotta be kidding me." from the the ol' CERT (Crusty ER Tech) and then the comment "So do you need toilet paper to wipe with, you know you should wash your hands."
Folks were mortified. Instead of face palming I chose to bridge pinch.
I just walked her ass back on the stretcher and made the appropriate note with the above details in her chart. At least after she pissed in the middle of the hallway in front of everyone she was in a better mood.
So goes another shift for the Crusty ER Tech.
I mentioned back in entry twenty one what I thought was a once in a lifetime/career occurrence. Female pt openly urinating in the middle of the hall in front of anyone who cared to see or not see. I honestly thought I would never see this type of thing ever again.
As in many things in my life I was wrong about that too. Lightening can strike in the same place twice.
Female mental health pt waiting for transport to the psych unit needs to urinate. I happily escort her to bathroom. Unfortunately in urban ER this bathroom is out of order. So we walk to the next bathroom about 20 feet away. This being an urban ER it too is out of order. So I say "Hey, there is another bathroom around the corner about 30 feet away, I think we can make it." By now this pt has gotten irritated over this inconvenience and screams "I AIN'T GONNA WALK NO WHERE ELSE I AM GONNA PISS RIGHT HERE!"
And she did.
This got a "Awww.... you gotta be kidding me." from the the ol' CERT (Crusty ER Tech) and then the comment "So do you need toilet paper to wipe with, you know you should wash your hands."
Folks were mortified. Instead of face palming I chose to bridge pinch.
I just walked her ass back on the stretcher and made the appropriate note with the above details in her chart. At least after she pissed in the middle of the hallway in front of everyone she was in a better mood.
So goes another shift for the Crusty ER Tech.
Saturday, January 18, 2014
Twenty two
The ol' double duce!
I'm trying to wrap up my online refresher right now I just can't seem to get the dates coordinated though. Here is a blast from a past refresher course for you nurses out there wondering what they teach us EMS types turned ER techs:
And that was my first day of orientation years ago.
I'm trying to wrap up my online refresher right now I just can't seem to get the dates coordinated though. Here is a blast from a past refresher course for you nurses out there wondering what they teach us EMS types turned ER techs:
And that was my first day of orientation years ago.
Monday, January 6, 2014
Twenty One
New years eve...
Yeah yeah I realize I'm a little behind on the holidays. Here are my top five reasons I will try with all my power to never work another night shift NYE again. These have been accumulated over the years.
5) Party girl with a standing drunk fall from some tall heels, who decides that she cannot wait to go to the bath room and hikes up her skirt and urinates in the hallway 10 feet from the bathroom. No fractures from xr.
4) One year we ran out of geodon and haldol.
3) Co-workers who disappear at midnight to run out to the chopper pad to watch fire works despite trauma activations coming in through the ambulance bay.
2) It's one of the 3 acknowledged "rookie nights" of the year. The others being the Super bowl and St. Patty's day.
1) At the end of shift every patient on the board has ETOH level of at least 0.15.
I have been fortunate that my schedule has allowed me to miss NYE of the last few years. you can only be so lucky with the schedule for so long.
Yeah yeah I realize I'm a little behind on the holidays. Here are my top five reasons I will try with all my power to never work another night shift NYE again. These have been accumulated over the years.
5) Party girl with a standing drunk fall from some tall heels, who decides that she cannot wait to go to the bath room and hikes up her skirt and urinates in the hallway 10 feet from the bathroom. No fractures from xr.
4) One year we ran out of geodon and haldol.
3) Co-workers who disappear at midnight to run out to the chopper pad to watch fire works despite trauma activations coming in through the ambulance bay.
2) It's one of the 3 acknowledged "rookie nights" of the year. The others being the Super bowl and St. Patty's day.
1) At the end of shift every patient on the board has ETOH level of at least 0.15.
I have been fortunate that my schedule has allowed me to miss NYE of the last few years. you can only be so lucky with the schedule for so long.
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