"Charts"

The hardest part about being a nurse are the charts - not even the amount of them or the constant lawsuit looming over you. No, it's the fact that we have to put into words what we see - the incompetence, the neglect, the stupidity, the failure of a system (bodily as well as social) & the "mistakes" people claim to make.  Within seconds we have to recognize all the presenting ailments & conditions & put them into words that the healthcare team will understand and react appropriately based on the severity.  A bathtub too hot becomes an emergent circumferential burn requiring specialized transfer, a five hour delay to seek care because of fear becomes a call to child protective services, mac & cheese for dinner for a child with a milk allergy becomes an anaphylactic reaction nearly requiring resuscitation, a bottle of Tylenol results in a PICU admission, a croupy toddler weakly crying “I’m sorry mommy, I’m sorry” while an IV is started is instantly classified as delirious with air-hunger.

Putting it all in words gives it reality, gives it strength, gives it power. It has the power to consume you, to destroy you, to bring you down to your knees and break you down. The key is to learn how to be able to type “3 y/o with 2^nd degree circumferential burn to the R foot with significant blistering & serous drainage” and not feel it.  We seems insensitive when we say “the foot pain in 15A” but really we’re trying to distance ourselves so that we can do this all over again tomorrow night, and the night after that, and the night after that.

"Credibility"

Some sound advice from my perspective of your dire emergency:

If you chief complaint involves anything in the belly (nausea, vomiting, diarrhea, or pain) DO NOT show up in the waiting room with a piping hot bag of McDonalds takeout.  Your credibility for this complaint and all others just went out the window.  Likewise, do not let your vomiting children eat in the waiting room, because you will see how food exponentially expands in the stomach just prior to being vomited; suddenly just one French fry becomes 2 gallons of vomit on the floor.

In fact, if you or your companion had time to stop for any kind of food on the way over here, it can’t be that big of an emergency, so please don’t badger me and ask me how much longer it will be.  I will eventually stop being nice and simple say “people are seen in order of acuity/severity, not in the order that they arrive” which in my head means your complaint is bogus and you will wait until all the truly sick people are seen.

Don’t tell me that you came to the emergency room because it’s closer or more convenient than your primary care doctor.  It’s like me parking in your drive-way in the wintertime because it’s more convenient for me to have you shovel out my truck.

If you take medication, chances are you have a history of medical problems.  An antihypertensive does not cure your high blood pressure, it simply helps you manage it so that your head doesn’t explode.  Insulin doesn’t cure your diabetes, it simply helps you manage it so that your blood isn’t the consistency of cake icing.  So please, when I ask you if you have any medical problems, do not say “no” if you’re going to rattle off a laundry list of meds after that.  And please don’t answer “not really” when I ask about medical problems, surgeries or allergies; you can’t be “a little bit pregnant”, you either are or you’re not.

Everyone from a secretary to the brain surgeon will instantly assume that if you say you’re here in pain and allergic to Ibuprofen, Tylenol, Toradol, Naproxen, & Dolobid you’re drug seeking.  That’s just how it is, so you better start coming up with something more creative than that.  ER hopping (like bar-hopping) in one day doesn’t work either, everybody knows everybody in this field.  And we are far, far too immune to the “my doctor is out of town and my prescription was stolen last night” excuse, that’s just comical.

If you say you or your child has a fever, to avoid looking like a moron, measure the actual temp so that you have an answer when I ask how high it is.  “Baby feels hot” is not a quantifiable fever, whereas 103.2 rectally is.  For further reference, 99.9 is not a fever either.  And for Pete’s sake, medicate! Under 6 months it’s Tylenol, over 6 months you can give Motrin or Tylenol, or even both together.  Yes, yes I am well aware that Tylenol has been recalled, but there are generic options.  What are generic options, you ask – well it’s like GAP jeans & Target jeans, you’re looking for the Target ones; yes a mother really did ask me what “generic” means and that was the exact analogy I used.

If you scream in my face that you can’t breathe, I will point out the opposite to you – you are moving enough air to scream, you can breathe.

Just because you come by ambulance doesn’t mean you will be seen first, or even second.  End of story.

"Peds Code Room"

Morning’s slowing down, I guess I’ll go put away the cardiac monitor cables.  God what a fucking mess in here, how hard is it to things away neatly?! 

“Peds Code?!”

“What?”

“We’re looking for the peds code room,” the medics blurt out rolling in with a patient with CPR in progress.

“Right here, you’re in the right room.”

“12-year old male, unknown downtime, found face-down in the bathtub.”

My heart sinks, he’s already cool to the touch and mottled.

I take over compressions as the nurse pushes the 4^th Epi.

“Let me see what we have,” the physician asks me to pause – the monitor flatlines.  He asks the medics, “did you have anything in the field?”

“No, nothing, asystole since we found him.”

The doc intubates with difficulty, the jaw is already becoming slightly stiff; the ET tube gurgles from the fluid in the lungs.

It’s hopeless and everyone knows it but no one wants to call it on a kid. 

Time of death is called, we quickly clean up the body & set up some chairs for the family.

The sleepy, morning calm of the ER is shattered by a mother’s devastating screams. 

Next begins the self preservation – we ask others how they’re doing in order to ignore our own emotional turmoil, we tend to the survivors’ tears to suppress our own, those new in the field try to make sense of what’s happened, the experienced ones deal with it in their own ways.  We decompress, we move on, we act distant, we bottle it up, we drink, we smoke, we work out, we cheat on our spouses, we get out the emergency stash of chocolate (for some too far gone, the stash of Xanax or Fentanyl).  No matter what we do we know this evil is here to stay, and some days are good and the Grim Reaper loses, some days not so good, and always, we are left to bear witness and help a family pick up the pieces.