People are nuts

On the whole,  people are just nuts.   I have worked with the public for many years and this is true more often than not.  I have a dying patient, comatose now, and the family is grieving.   Now I know everyone gets to grieve in their own way but sometimes their way is crazy.   This was crazy on a whole different level.  The mom is repeatedly kissing the woman's lips despite the breathing tube and NG tube and the stench of old mucus,  the brother sneaks in alcohol and gets so drink off his ass he had to be escorted out by security,  the step mom is praising Jesus with increasing volume over and over and over, and the husband is repeatedly kissing his wife's TOES- yes her Toes!  while loudly proclaiming he will not apologize for it.

Only the Dad sits in the corner quietly, tears in his eyes, looking miserable and broken.  I think his sorrow is for the daugher he is losing, but then again, it might also be for the life he has lived with these nutsos.

Maybe I should be a pooper scooper.

Why in the hell do we let patients dictate their own care? Why is a patient allowed to tell me what they want or don't want?  When they want the lifesaving Bipap taken off or when they should be allowed to stay on the vent and not breath on their own because they need to rest?  Yes this is real.  I have trach patients who do not want to come off the vent during the day because it is so much easier to let the vent breath for them and not have to exert an ounce of energy in their own behalf.  We put them on a vent at night to theoretically rest them.  And who needs to rest from breathing anyway?

I have patients that order water or coke , knowing full well they aspirate everything into their lungs.  I have patients that refuse their breathing treatment because they need to take this phone call.  Or patients that won't do th therapy ordered to combat the illness which brought them into the hospital in the first place.

I absolutely detest when patients start ordering their care as if they were at Burger King.  I want to ask them, "Could you take care of this at home? Oh you couldn't? that's why you're here? Then lay back, shut up, do what we ask, and let us do what we do very well. If you can take care of this feel free to go home. Wouldn't hurt our feelings at all. "

On another note.,,, we have this room we should call the PITA room. Nearly every single patient we put in there becomes the biggest pain in the ass. And it doesn't matter the diagnosis.  Every patient assigned this room start a running chant of "I need pain meds, I need a drink, I can't breath, I need pain meds, I need a drink, Where is my pain meds, I can't breath.",  and it goes on and on and on and on, all day and all night, until some nurse gets fed up and narcs their ass.

And of course every single patient that goes into this room has some gnarly infection for which we have to glove, gown, mask, and sometimes put booties on. And each and every one refuses to tell you what they want until you get all protected up and go into the room. Then and they launch into the chant ... "I need pain meds, I need drink, I can't breath, I need pain meds.......... and of course it'snot time for pain meds, they are on a vent or a bipap so they CAN breath and no they can't have a drink. Thus, you have wasted all that time and energy to come in the damn room and repeat what the nurse had told them not five minutes before!

Maybe I should go scoop dog poop for a living. You still have to deal with shit but it's at least quiet and just lays there. 

Staff Meeting - the reason I'm on Prilosec

Can I just say how much I HATE staff meeting. Maybe "hate" is not the right word.... ummm detest, loathe, abhor. I have never yet come out of a staff meeting feeling like management thinks any of us are competent. It is two hours of either a new process that is going to make my life hard, new paperwork that is going to make my life hard, new device we are not really going to get trained on but expected to use - which makes my life hard, or why aren't you guys doing anything right????? All this by management that is not even remotely clinical.

So we are trying to up our satisfaction score. Apparantly reimburesement is tied to this - thank you Obama. There is a desperate attempt to make every single patient happy. The underlying problem is that I am an RT. I don't do one single thing that isn't uncomfortable or downright painful. I suck snot out of your lungs, I shove tubes up your nose, I stick needles in your arm, I make you cough and deep breath with an abdominial incision.

So I listen to the staff meeting spiels - the first speaker is a complete idiot I have absolutely no respect for so I blow that one off. The second was interesting and although I don't agree with their basic premise I do think that okay I probably could work a little harder at a pleasant deamanor, calling people by "Mr. or Ms." etc.

First patient of the day. I am set. I have worked thouroghly on my attitude. I am going to help this gentleman today. I am going to get high scores. I am going to go out of my way to be pleasant. He tells me to "fuck off".

Looks like our remiburesement is going to suck.

600 pounds of lovin! No kidding 300+ kilos. I have never seen a human this wide. Her neck is bigger than my butt. (And that is saying something!)

I am standing in the room as the dietician goes over her diet. Nice little dietician says ,"Is there any foods you dislike that we should not bring you?" I am thinking "does she look like there is anything Orca doesn't eat ?" And Orca pipes up "I don't eat celery - it's a personal choice."

The laugh through my nose came out as a snort. The only food known to man that takes more calories to digest than there are in eat and that's the one she WON'T eat !

you know it's a bad day when....

your first report is...
"40ish female came into the ED with OD, lying naked on a stretcher, pulled a bottle of pills from her VAGINA and proceeded to take them all."......

....so is this diagnosis called a vaginal OD?

Ah another day at Mercy Medical. (Yeah that's a made up name). Had the nicest little old lady. She's dying. She knows it. I was trying to pamper her. Got her a warm blankie, some juice, did her treatment. I was leaving and told her thank you very much. She looked at me and said "Be good to yourself today." Now I don't know why she said that but it did make me think. Am I good to myself? Do I take care of myself? Hmmmm. Probably not as much as I ought. So I am going to go buy chocolate. :)

57 Female. 3rd admission. Positive for opiates, barbituates, and benzoids. Doc can't figure out wahy she isn't waking up and insists on a head CT, and MRI, carotid artery studies, CT angio to rule out pe, and DVT studies. I ask him - um could it be the opiates barbituates and benzoids? Since she was in here a month ago - same problem. He patiently explains that she has an infiltrate in her right lower lung. Uh-huh - could she maybe have aspirated??????????
Well - he says it COULD be a PE so we have to rule it out.

Family is asking doc if this is stoke? Bleed? Infection? Why does this keep happening to mama and why can't we figure out what is wrong?

I want to scream "BECAUSE MAMA IS A BIG TIME FREAKIN' DRUGGIE AND YOUR DOC IS A JACKASS !!!!!!!!!!!!!!!!!!!!!!!!



Really really glad I am in a different unit today.

Make SURE the versed is still on board!

So my buddy (an RN) is not real tolerant of drug od's. After dealing with the same stupid chick THREE times he has had enough. She comes out of her od stupor and ...of course... is a belligerant, foul mouthed little freak.

After f'ing him this and calling him an f'ing bastard he had enough and puts down her meds and begins to walk out of the room. She yells at him, "you just don't care do you?" That was the final blow. He turns around, looks at her, and clamly says "You're right. I don't care. I think we should have let you die." Turns back around and exits the room.

Dammit the versed had worn off and she remembered

every

single

word.



I gave him some advice after he met with his manager and the HR department.

Dude no matter what - you can't tell them what you really think.

management - got to love 'em ... or laugh at 'em

So about nine months ago we were told two things in staff meeting.

#1 Everybody is working mandatory overtime and we are not paying as much for it as we used too

and

#2 oh, and here is a survey the corporation would like you to fill out concerning our management style.

Now you would think they would separate these two things by, say, a month or two. But our management does not necessarily see the connection of things. Needles to say our department came in rock bottom of the whole damn corporation. Rock bottom.

Einsteins that they are decided the problem was that we, as therapists, didn't feel recognized enough. So how to solve this? Of course! Send out another survey.

Low and behold in my box this morning is the survey. The very first question is something like "what does recognition look like to you?"
I put down, "a really big banner, a 14 and1/2 inch trophy, confetti, and possibly a parade."

Hope it puts an end to idiot surveys. Yeah - I know - wishful thinking.

I hate my job.

Okay not really the job. I hate this hospital and all the f%$#$% PA's who think they are God and don't want to listen to a damn thing any of us have to say.

So here's the scenario. Big freaking fat guy. 400 pounds. (Okay I exaggerate he's only 395). We have to do a lumbar puncture and the PA wants him prone. I strongly suggest that's a bad idea. PA argues with me. I say, "What I'm telling you is he is a big guy and he can't breath proned". I am totally ignored. So we prone the guy. Yeah I know damn stupid of us. I know better. Within seconds dudes blood pressure is 200 over something - he's tachying along at 160, spo2 67 and cyanotic as hell. PA wants to "give him a minute". RN says we have to flip him now! We overrule the PA because how you going to run a code on a prone guy????????

He did recover. But man it pissed me off so bad. I knew it was a bad idea. I told him it was a bad idea. Rn agreed it was a bad idea but no- stupid ass PA has to play big shot and damn near coded this guy.

I hate this job.

My brother loves these hunting / fishing shows. He watches them for hours. I think I could watch them if they were more like this guy....


www.youtube.com/watch?v=KUowyTE-X10

funny stuff this.

still not in Kansas

Weird. Still out of my comfort zone. Getting more comfortable though. Still in the Trauma unit. Weird. so many people WANT to work in this unit. They see it as th pinnacle of their career. Okay maybe flying on the chopper is a smidge higher - and they get cool uniforms. But for most folks working the Trauma unit means you have arrived.
Me. I just don't care. You can have the trauma unit. WAAAAYYY to many egos for my taste. And Heaven forbid a doc actually writes an order in the chart. They discuss things amongst themselves, sometimes letting the nursing staff in on whats going on.... sometimes not. And if I'm lucky - I catch wind of it. I asked someone about this odd thing about not writing orders. I was told trauma surgeons are "too busy to write orders".

Reminds me of a joke. What's the difference between a doctor and god? God doesn't think he's a doctor.

Were not in Kansas anymore....

Well I was pulled from my usual comfortable routine and sent to the trauma unit. Not usually a big deal. But today was travel day. Let me correct that... travel without any notice day. I walk into my first room for my first vent check and the there is an anesthesiologist, a transport tech and several other people. I know I'm going to look dumb but still I had to ask, "Are we going some where?". "yes the OR... now" Okay, okay I stuff my pockets full of all the crap I might ever possibly need and off we go. I leave them in the OR and come back to the unit. Walk through the doors and a nurse assails me, "Are your ready?" Me (looking dumb yet again) "Er, ready for what?" "We are taking bed four to the cath lab... now" Damn. Lucky though, I still have pockets full of all crap I may need. I never really get caught up... but you know eventually you get so behind your on schedule again! The afternoon was a repeat performance. Another transport ... which I actually got told about. And then I am doing my vent check and two nurses are talking "... and when you get back we will..." One more time I look dumb, "Are we going somewhere? " "Yes, CT ... now". You know I should have just walked out and not said a word and when they were ready to roll out the door and realized the guy is connected to a ventilator THEN maybe they would think about giving the RT a heads up!!

But then again. They might not have noticed and extubated the guy.

What do you need ....a banner that says hey I'm dead!!!

So after three apnea tests (all verifying brain death), the cholinergic tests (all verifying brain death), several eeg's (all verifying for brain death) the doc refuses to declare the patient brain dead becasue he may or may not have seen some minute possible, (most likely imagined) millimeter of eye movement. No shit. So we keep the dead guy alive on a vent, all the while giving the wife false hope, and at the same time maxing out her Visa.

We here in Neuro icky u hate this. We begin to hate the paitent. We totally hate the doc. And no one has the balls to over rule the doc and walk in to the wife and say "dammit, man's dead - pull the frggin' plug." For twenty seven days we play this hellish game - only to finally transfer him today to a long term care unit. Can you believe that?

Wht the hell does the doc need to verify brain death??? A friggin banner over the guys head? Does he need the patients ghost to come tap him on the shoulder? Does God himself need to come down and tell him to knock it off?

And what is really chilling is this is a new doc, now working in Neuro a lot (where, by the way there is a LOT of death and end of life decision making) - and apparantly a psycho doc who has end of life issues . God help all his patients from now on.

What happened to personal responsibility?

I was watching a tv the other night. Some documentary on how the health care system fails the "average person". They showed this man ... this whale of a man - 450 pounds I think they said. He was uninsurable (they didn't say why he was uninsurable, just suggested that the wicked evil no good greedy insurance companies wouldn't insure him.) He had diabetes, a bad heart, cellulitis, gangrene in his foot, hypertension, and every other malady that comes along with morbid obesity. My question is this? Why the hell is he 450 pounds and whose fault is that? If he chose to be 450 pounds (which apparently he did) then isn't his health his problem? Why should insurance companies insure you if you have a lifestyle that will inevitably cost them money? And who ultimately pays for that? You and I jack - in one form or another. Either we pay higher premiums to compensate or higher taxes for federally subsidized programs

I had a patient bragging about how good her health insurance is. "They paid for my glasses, They paid to get all my teeth fixed. I only pay 3 bucks for a prescription and only a max of twenty bucks a year. I don't pay nothing for the emergency room or the hospital...." Perplexed I say "wow - what insurance do you have?" She replies "I'm on Medicaid!" I had to bite my tongue because I wanted to scream. So because she has smoked like a chimney and now has advanced COPD at the ripe old age of 40, she is on disability (which we pay for), she gets to sit at home and smoke more while I work my ass off, and they ravage my check to pay for her health insurance to pay for her health problems that SHE caused AND I pay a shitload for my own health care insurance AND she gets better benefits than I do!!!

That is what's wrong with government running health care.

There is no responsibility factor. There is absolutely no incentive to work, stay healthy, or not visit the ER unless it's a real emergency. There are no co pays, and only minimal prescription prices. There is nothing that curbs massive widespread use and abuse.

I don't have any solutions. I just feel used.

This is what I WISH I rode. I really ride something much smaller. And older. But it's still a ride and I LOVE IT! I know I know I'm gonna' end up in the trauma unit - or quad - or something. I do wear all the protective gear and I have taken all the safety classes and I don't go on the freeway. Of course I don't go on the freeway because my 250 won't go fast enough that I'm comfortable - not that I wouldn't go on the freeway if I had the above beautiful machine!

Princess

So I began my shift full of empathy and compassion and a pretty little 18 y/o female who was in an MVA. I thought how much it would suck to have your pretty body disfigured by a four inch long scar along her swan like neck and the smaller incision in her side for the chest tube. She had been in pain with a broken elbow that was going to require surgery. It somehow got to me that someone so young was facing so much.

Then she woke up. Turns out she is quite the little dictator. She ran the nurse damn near ragged by 1000. She ran the cna ragged by 0930. She had the charge nurse pissed by 1030. She wanted what she wanted RIGHT NOW !!! She refused all respiratory therapy (not that I cared) because she was tired, text messaging, hurting, talking to the endless parade of friends that came in, uncomfortable, talking on her cell, texting, talking, phoning, texting, etc etc

Turns out "Princess" did this to herself too! Got drunk off her ass and drove her car (unbelted of course) into a wall.

The second time she snapped at me that she was too busy to do her IS and she didn't need "that piece of shit anyway" my empathy went right out the window.

I love this guy!

Sorry - I can't get it to embed. Working on it. For now cut and paste it into the addresss bar

http://www.youtube.com/watch?v=k9m2FLHlEwA

Not much changes

I had six days off. Lovely! As I was getting ready to come to work this morning it occured to me that I haven't missed this place one damn bit. Haven't missed coworkers, or patients, or the bureaucracy or anything!

So my morning started with a bang. My first pt. is totally crazy. He murmured some incredibly long story through his alcoholic encephalapathic stupor about "dinner....sissssteeer....i feel fine...mumble mumble....driving.... murmur mumble....what the hell is wrong with you people?" I actually don't mind the crazies too much. They amuse me.

I had an 80 year old I gave a nebulizer to. We chatted about the weather, the summer, etc. I asked if there was anything she needed before I left. she said "Yes, will you ask the nurse to bring in my baby?" I did a double take my brain saying what? WHAT? she said "Yes I gave birth to the sweetest baby girl yesterday. I think I will name her Susan".

Freaks me out when I didn't know they were crazy.

Not my best day.

Do you ever have days when you feel like your life is one long spiral downward? And no matter how hard you fight you are just getting sucked down. Maybe it will be almost a relief to be sucked to the bottom - it's got to end there - right?

Okay I get really down when I work in rehab too much. I mean waaay down. I see all these lives shredded. A young man with a 1 year old baby. He's girlfriend is going to take care of him. Yep that's what she says. His dad tells us on the side - he is pretty sure that is not going to happen. Dad was right. Girlfriend had no idea what is involved in taking care of a quad. She cannot raise a one year old and take care of the quad too. She is gone now.

Another young man. Drunk off his ass and tried to drive home. Ended up eating dirt with his face out the window. His young sweet wife (also with a small child at home) is way past the "Please God let him live" part. He lived he is a quad as well. Now she is in the anger "why did you F*#@! up our life?" It's not just h is life that is fubar. So is hers and the her kids'. You have got to give her credit. She is sticking around. But there is all this tension in the room. She knows what she is facing. But how can you get pissed at a quad?

Then you get the 40 female with anoxia, the 35 year old stroke who will never walk, the 20 something paraplegic who will never again feel what it's like to make love.

Dante should have seen this before he wrote his masterpiece. This is several different types of hell.