Number 12

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

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

No pulse.

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

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

It does happen that quickly. No shit.

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

Number Eleven

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

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

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

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

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

Thanks for the hard bowel movement later on.

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

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

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

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

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

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

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

-Stale food and cold coffee is pointed out.

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

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

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

 

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

Number Ten

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

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

Number Nine

A waste of training, time and talent.

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

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

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

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

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

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

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

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

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

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

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

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

Number Eight

Screaming female patient is brought in via ambulance after an altercation with police. Well not so much an altercation, the police just did not want to deal with her. The patient is a middle aged female wheel chair bound schizophrenic. This woman went off her meds and smoked crack the entire night before. She then deteriorated into a true menace to her neighborhood. Menace is probably the wrong word to describe this woman but the only one my small tech mind can think of at the moment.

In just a few hours of the early morning this woman said she saw UFOs flying in the sky and she needed to shoot them down. She fired several shots in the air and shot one of these UFOs down (and no I do not know the type of gun or the caliber of the gun.)  She then claimed to have seen this UFO crash land in a neighbor’s back yard where the unscathed alien escaped the wrecked UFO and went into a neighbor’s house. The wheelchair woman seeing this decided to confront the neighbor about them harboring an alien from outer space. Naturally the neighbor would not answer the door when they saw and heard the wheelchair bound woman screaming at them and waving a gun around.

The wheelchair bound woman now is determined to finish this alien off whom she shot down.  No one will come out so she decides in the interest of saving us humans that she should burn the neighbor’s house down.  She somehow procures some sort of flammable fluid and sets fire to the house which has the outer space alien in it. As the house begins to really catch fire the police arrive and call the fire department. Fortunately the woman ran out of ammo shooting at the UFO’s earlier and decided to as a last resort after confronting the neighbor throw her gun at the then burning house.

The neighbor’s house sustains minor damage; no one is injured during this incident. The woman is brought to the urban city hospital where she is removed from the wheel chair and placed on a bed and proceeds to scream at everyone for the next hour until the attending decides that yes, this woman needs to be chemically restrained, only after she has torn everything off her bed and is close to tipping this bed over from her violent rocking of the bed back and forth.

The alien from outer space was never found nor was the UFO.

Number Seven

Something I said stuck.

I had a shift recently where a fairly new nurse told me something I said once stuck. It was about working in an emergency department and continually getting the worst assignments. She told me one shift that she thought it was not "Fair or right" that she got stuck in a crap assignment and that she "deserved" to be in a better assignment so she could learn more.

She's been a nurse for about 18 months now, all at this particular large urban ED.

I told her that fair, right or deserve has nothing to do with it. I told her that even the most experienced people get the shit end of the stick, that's the way it is. Trust me I know. I myself just hope one day to be out of this dead end tech job and move onto something better once I get my nursing degree.

Remember folks you can have a shit ton of experience, education be the smartest person on shift but if for some reason the supervisors wanna shit on you because they don't know or like you there is little you can do. Suck it up and do your job as best you can.

To quote William Munny from "Unforgiven"

"Deserve's got nothing to do with it."

It's so very true in the ER whether you are the victim of an accident or the tech doing your 7-8th code brown of the night.

Number Six

The Haunting of the Ghost Tech.

This is quite the read so use the bathroom and grab the beverage of your choice while you're up. The story will be here for awhile.

The Ghost Tech as many of the veteran nurses know are often the source of frustration on their part because they cannot find that tech to give them a hand. If the nurses are frustrated with ghost tech then well his/her fellow techs are just below openly knee capping ghost tech in front of the entire medical staff because the ghost techs “vanishings” aka hiding causes more work for the techs who stay at home.  The nurses and docs can find the stay at home tech and like the reliability of the stay at home tech. So the tech that sticks around tends to get more work thrown on them because Ghost tech never manifests themselves long enough to do trivial much needed tasks like helping out with a code, helping a patient to the bath room or *gasp* getting discharge vitals.

The ghost tech I am talking about are actually two separate people from two separate hospitals but both had very similar personalities, one could call it spooky how similar they were.  Both as I observed got their come uppance eventually. Both wanted to go on and be docs, seriously.  I have no idea if either did though.

Ghost tech 1 aka GT1 I had the displeasure of knowing first knew first. He actually had the nerve to use me as a reference to come up from the central sterilization, yeah I knew him in passing but I NEVER said he could use me as a reference to move up from there, trust me he knew right off that was a wrong move on his part.  Meh, not that it mattered. Somewhere along the way GT1 got his EMT but never worked the ambulance, so he had no skills at all. We had to teach him everything.  This tried all the techs patience but also drove the nurses and docs nuts. Since GT1 wanted to be a doc, he was up the docs asses ALL the time some docs loved that shit like Dr. Cause the majority after awhile grew tired of it. In one case Dr. Mke at this particular hospital told him “GT1 remove yourself from our office and please get out of my ass!” GT1 wanted to be an ER doc or Cardiologist he just was not sure. GT1 was taking a break from school but was a former ECHL hockey player which at first was neat then we quickly saw why he was cut. No work ethic.

Ghost tech 2 aka GT2 was a similar case no ambulance experience. By the time I made it to that suburban level whatever ER he was trained up and had an “entire year” of experience in that ER. He was actively going to school at a second tier college and playing football for them as a walk on. Another words he was a walking tackling dummy for the practice squad. He also bragged that he tried out for the local arena FB team.  GT2 clearly knew what kind of practice he wanted as a doc and he had the build for it, orthopedics.  GT2 would mysteriously materialize whenever there was an orthopod in the department and a reduction to be done. I had it down to a science with him. The orthopod would show up, while you were gathering supplies for a cast or splint or even a simple sling, GT2 would slither into the room without you knowing. Then he would say “I got this” and with no mercy or pride crawl up said orthopods ass, it was embarrassing. I gave him enough rope to hang himself and eventually a very tired orthopod got sick of his shenanigans and ignorance then threw him out of the room along with his shitty three way splint.  But need him to take up a patient for you or help out with a rough code brown, he’d “ghost” on ya. GT2 also had a side kick aka lap dog known as Shadow tech who will get discussed at a later time, needless to say where ever GT2 was shadow tech was never far behind. They never worked the same assignments but somehow always ended up together, you could say they had a bromance that bordered on dating. It was felt by several people that they were dating, not that there is anything wrong with that. Both vehemently denied any romantic inclinations on their part.

At both hospitals the staff was well aware of these respective Ghost techs ummm ‘quirks’. Hardly a word was said by nursing staff or techs at either hospital to management. Because of a few reasons one of their let’s say “attributes” as athletic somewhat attractive males they got away with it for a period of time, female nurses like eye candy too! Another was in GT2’s case the department was so dysfunctional no one was really in charge for well over 18 months. In GT1’s case it was felt that the charge nurses would get him eventually. Both got what they deserved in the end.

GT1’s down fall began when he decided to replace nurse GK’s liter bottle of ice water with iced saline solution. Nurse GK is a fantastic guy and a hullva nurse, a total professional. By quietly doing his job Nurse GK garnered respect from the entire staff of the ED. Nurse GK did not say much but when he did folks listened.  Nurse GK had a busy night and was juggling two pretty sick patients. He hardly had time to breathe much less drink water. When he did it was ALL normal saline and he spit it out. Nurse GK did not appreciate this and when GT1 was laughing in his face, nurse GK got that twitchy eye look. Nurse GK began to pull strings but that was the long fuse.  Nurse GK at the time was a relief charge nurse on occasion.

Another long fuse was fitness model/paramedic/fire fighter/goddess nurse. FMPFFG nurse is the and now pardon the pun ‘model’ of the nurse any hospital wants. I’ll get into detail about her another time. She has a work ethic that would make you stand up and cheer, smarts that rivaled many of our docs and looks that would make many a fire fighter and male patient swoon. She carried it off well too. FMPFFG nurse worked with GT1 many times and TRIED with him. Finally she had enough and asked him openly one day “You came from money right?” To which GT1 replied “Yes!” obviously thinking he was getting in good with this angel sent from heaven. “Well..” FMPFFG nurse said giving him the finger “…that explains your work ethic.”  From then on there was no bigger fan (and still am) of FMPFFG nurse than the old crusty ER tech. FMPFFG nurse was a relief charge for a while then got her stripes as a charge nurse. She is one of the few nurses I call “super charge/charged” she was/is that damn good.

The short fuse was Dr. Mke.  Dr. Mke had no love lost for GT1, and when presented with a chance to hammer him into the ground he did so in a convincing manner then stepped on him hard to be sure. GT1 decided to start an IV on a sick transport tech one day. Now I will say I have started IV’s on co-workers before for hangovers and the flu. Just normal saline in nothing bigger than a 20G with a normal drip set. GT1 went WAY beyond that. He grabbed D5 half normal saline a 16G IV needle and a ‘Y’ IV set with a blood pump then put this transport tech in a room that was not being used and loaded her up. He infused that D5 ½ NS in under 10 minutes. The outcome sent this willowy transport tech to the step down ICU for a few days because she got chest pain and a PE from the episode. EVERYONE heard about this and unfortunately for GT1 Dr. Mke was there that day.

Dr. Mke from went ballistic and rightly so. GT1 was shit canned right then and there. Word was that Dr. Mke was also going after GT1’s EMT cert for this gross negligence and stepping WAY over protocols and his scope of practice. I would not be surprised if Dr. Mke did because he’s a real pit bull. I think if Dr. Mke coulda done so he would have physically thrown GT1 out of the ER himself. Dr. Mke was a former orderly in the old…old days. Ya know when Johnny and Roy were running calls.

GT2’s demise was much less dramatic. At suburban level whatever hospital he got away with long lunches being, hours late to work leaving the hospital’s campus etc. But remember this was during the reign of Gerald everything was fucked up. Up was down, black was white, frogs rained from the ceiling there from time to time.  When we got an actual ER manager and her minion Nurse Blabber mouth, GT2 was not safe for long. Actual ER manager tightened things up and got rid of dead weight another words she cut costs. One of the dead weights was GT2. He got warned when she looked at the clocking system records of the past several months and was told all is forgiven but we’re watching you.

If you guessed he got shit canned because of tardiness then you guessed correctly.

One day he was there and got called into the nursing office. The next thing we know the charge nurse is dividing up the techs assignments because we are “minus one” that night and GT2’s name is off the schedule.  Shadow tech was lost after that.

As you can see in these cases these Ghost techs made their beds and were forced to lie in them. These are just two extreme examples of Ghost techs I use them because they were SO similar in many ways.  I have experienced other degrees of Ghost ER tech. They disappear and manifest at the charge nurses elbow for lunches and breaks then fade into a fine mist until end of shift to clock out or when food appears. It’s maddening and frustrating and makes the entire team work harder. I say tolerate these shit heads but watch them though. As you have seen here they get theirs eventually.

So ends the Haunting of the Ghost Tech.