This is part 2 of a three part series detailing a typical day for an ER department nurse. To read part 1, click here.
Since my rooms were pretty boring, I decided to discharge a patient in another room. The DC instructions had only one line, “Stop doing Methamphetamine.” Took the student into the room and quickly realized why that was the only suggested discharge instruction. There was a man, sitting on the bed, trying to tweak out the meth mites that were crawling out of his neck and arms.
“No sir, I can’t see any bugs coming out of you. They are all in your head. You are tweaking, and need to stop using meth. Yes, I’m sure you have no bugs in you. No, we can’t give you anything to kill the bugs, they will go away when you stop tweaking.”
After several minutes of trying to convince this man that he didn’t have real bugs coming out of him, I went into ‘bartender mode’ and said, “You have been discharged sir. You don’t have to go home, but you can’t stay here.”
It’s a good thing that my skin has thickened up a bit since starting my career in nursing, otherwise I might have been offended by the stream of profanities directed at me as I escorted the gentleman to the door.
That’s a new curse phrase.
Not humanly possible.
Back to yoga class.
Next up was a STAT OB triage. The new triage nurse was already busy, so I went out to see what was going on. Her water had already broken, she was having contractions, and it looked like she was about to deliver. This is NOT something I want in my ER. Sure, all of the docs have delivered babies, and I know where the OB kit is, but I can’t even spell “OB” so I made the only logical choice: I put her in a wheelchair and went running down the hall, yelling, “call OB, let them know I’m coming.” Sure, the OB room in the ER would have been closer, but when properly motivated, I can make it from central registration to OB in less than 45 seconds. I helped the patient out of the wheelchair, brought it back for house keeping to clean, and thanked God that she didn’t fill her sweat pants with a baby on the trip down there.
No pushing in here.
This is not the place for that.
Would packing gauze help?
Things then started to pick up a little bit, but it was all ditsy, primary care crap: sore throats; ear aches; and, well, baby checks because “he cries every two hours, all night long.” We ploughed through all of this and for the first time in months, we actually cleared out completely and the white board was totally blank on the big screen TV tracker board. I broke out my iPhone to take a picture of it, just so I could mail it to co-workers that had the day off, but before I could push the button, another name popped up in the waiting room.
There was a stat triage called and the ambulance line went off, all at the same time. I was closest to the ambulance line and I wanted to pick it up quickly because I’m really sick of the song it plays. Whenever an ambulance is calling in a report, instead of ringing like a phone, it plays the theme to Mission Impossible. It used to play the theme song to M*A*S*H, but it was changed a couple years ago, and it is well past due to be changed again.
The ambulance call was for an official time of death on a DOA they were called out on. I hate to say it, but DOAs are the best type of calls we can receive. There is no way that this patient will be coming into the ER later that night. Patients going to the next hospital over are a close second, but we have had enough people come to us by ambulance after the first hospital didn’t give them enough narcotics to know that we aren’t safe, even if they start off someplace else. Patients that refuse to come in by ambulance, against medical advice, aren’t too bad either, but odds are we will be seeing them later that night anyway. Therefore, dead people are the only good people. Told the doc the story, confirmed with EMS that he really was dead, and gave the official time.
Right song for the job.
“Another one bites the dust.”
Good for C.P.R.
The STAT TRIAGE was a little more interesting. Guy came in, didn’t speak a word of English, and was pointing at his head. Could see that he had a shunt running under the skin. Finally figured out that he spoke only German so we tried to get an interpreter for him. Our video interpreter on a stick via computer can do Somali, Vietnamese, and a couple other languages that we have no need for, but not German.
Tried to do the voice only connection, but she couldn’t hear us well enough because of a poor connection, so we went with the AT&T phone interpreter. Of course, the speakerphone wasn’t working, so we had to hand the headset back and forth. It turned out that he was just released from a German hospital three days ago for an infected VA shunt and the doctor told him his shunt was “kaput” and needed to be replaced.
Of course, with this information, he decided to leave the country and come to podunk Washington, where we have nothing in the way of neurology or neurosurgery. I started a line, gave him some Zofran and Dilaudid, and sent him off to CT scan.
Had the student dress a wound while he was gone and got another patient discharged with a middle ear infection, when the German came back. Pointing at his head, he said, “more medicine.” Gave him another dose of Dilaudid, and received an ambulance patient while waiting for the CT results. Call light went off, and the German stated that his head was hurting again and he would like more hydromorphone. Amazing how well he was speaking English after a couple doses of Dilaudid, but I give it to him. CT results came back totally normal with the shunt in the correct place and no signs of swelling. By this time he was sleeping, but when awakened to check another set of vital signs, his English was fluent, and he was asking for more pain medicine.
I couldn’t believe I had been scammed so well. Normally I can sniff out a narc seeker from across the department. I told the doc, who would normally be pissed off about being lied to, but he also had to admit that this was one of the best scams of the year.
How many people actually have a VA shunt and go through the effort of learning another language, not common in the area, just to score some narcotics? We had a good laugh, actually gave the guy another dose for the road, and kicked his ass out of the ER, with instructions, in English, to follow up with a neurologist if he had any other complaints regarding his shunt.
Narc seekers can win.
How do they make these stories?
They should write fiction.
After this, my student had to leave, and I was left alone with my rooms. I paid dearly for using the “Q word” earlier in the day. We got slammed with a steady stream of stat triages and some legitimately sick people, needing ICU admissions.
Kept too busy to keep a good record of the next few hours, but it involved ventilators, BiPAP machines, dopamine, central lines, and a slough of ditsy sore throats and earaches.
There’s one horrifying story left that only a Mighty Nurse could handle. Check back Thursday for a conclusion not to be missed in part 3 of “A day in the life of an ER nurse.”