50 Year Old Stripper

Our ER has a special place for the party people in da house.  It's the drunk hall.  Forrest Gump's line of "Life is like a box of chocolates, you never know what you're gunna get" totally describes it perfectly.  Work is nothing less than an adventure when you're working that assignment.

On one particular night I was greeted by some very happy EMTs.  "What are you'll smiling at", I asked.
"You'll see", they replied.
"Can you give me a hint", I ask.
"Drunken stripper", the respond while laughing.

As I walk down the hall to meet Jane Doe Drunken Stripper, she hops off the stretcher naked as the day she came into this world and sacheyed over to another stretcher and began her bump and grind.  Wow, the boys who dropped her off weren't kidding, this chic had moves.

A very nice security guard looked at me while he was putting on his gloves and says, " I guess we won't be fighting this one to get her cloths off."  When folks come back to the drunk hall we change them into gowns, so if they try to wander out the door they can be easily identified.  This practice also helps  us reduces the fragrence in the ER.

We start to approach our naked patient.  She takes a look at the security guard and turns her attention to him.  He's a big guy and hard to miss.  As she begins her floor routine  a crowd of young surgical inters find themselves captive behind her, they look scared, they didn't know where to go, so they just froze.  Stripper lady continued shaking her money maker and then did something that stunned everyone, a gymnast type move, she stretched her leg straight up to the side of her head, the poor residents looked mortified. I was a little jealous I couldn't do that myself after years of yoga, and the security guard just shook his head uttering, "I didn't need to see that".

We managed to get her into gown number 1 out of 8 for the night, and she was moved back to the stretcher.

Throughout the evening she would get her gown off and then slide herself off the stretcher and start her routine.  At one point she started a lap dance on a sleeping orderly, which woke him up real quick with the look of panic on his face.  There were other times when her stretcher was her stage and she was dancing on top of it and asking for money.

A few hours into her stay she was becoming more lucid. When I asked her what her name was she gave me I can only assume was a stage name.

Eventually an older man showed up, saying he had called the ambulance for her. She worked in his strip club.  He had recently demoted her from a dancer to a bar tender because of her age, because she had turned 50.  I asked him if she was depressed about turning 50, he said, " No, she's  pissed at me because I don't want her dancing anymore, I thought I was doing her a favor".

The gentleman was kind enough to leave contact information so she had a ride home after she woke up.

Nurses Gone Wild Convention Style

There's nothing better than going to a convention to recharge your knowledge and your spirits!  Conventions are so informative.  You learn cutting edge techniques, you have a chance to network (job search), you meet nurses from different hospitals so you can get the low down info about where you might or might not want to work, but probably more important than any of that is the pure joy you having watching your co-workers, bosses and friends make total asses of themselves after drinking way too much!  Oh the power of alcohol!  Thank god for libations and lack a inhibition!  There were the intoxicated dancing assistant nurse managers, the puking educators,and the grinding granny (retired nurse).  It was a lovely 3 days!  Now it's back to the grind, but not the kind of grind granny was doing...

Love In the ER

I love a good love story.  One night a woman was rushed to the the ER by her husband because she had chest pain.  The couple were in their later 70's and had just had dinner to celebrate their 50th wedding anniversary. When I asked how the couple met the husband told me a very funny story. 

He told me that he was working in construction at an office building when her heard women screaming.  His boss thinking that the ladies saw a bug, told his worker to go in and check things out.  As the man, the patient's husband, opened the door he was greeted by a cloud of smoke.  The ceiling had collapsed in on the ladies.  When the dust cleared that's when this husband of 50 years met the love of his life.  He told me it was love at first sight. 

Like any good man he pulled pieces of plaster off of his future wife and then asked her out on a date for coffee.  A few months later they married!  

A couple of hours after arriving at the ER, the two lovebirds were on their way home.  She wasn't having an heart attack, just a case of indigestion!  

Hello Gonorrhea Welcome Back- Antibiotic Resistant STDs

A young lady came to the ER complaining of "stankness" from her vajayjay and some abdominal pain. I asked her for a urine sample to do the pregnancy test and send off the standard urine testing.  In the mean time her and her mother settled into the GYN exam room.   When I returned to the room she was already changed.  She asked me the results of her pregnancy test which was negative.  Her mother nodded approvingly.  I asked the patient if she wanted to have her mom wait in the waiting room until after the exam was complete, she declined, and said her mom could stay.  

A resident came and introduced himself.  He asked her about her history which she offered up including dates of treatments and course of treatment. 

After the exam was done and the culture obtained the patient sat up.  The doctor told her she probably had gonorrhea.  Out of the corner of my eye I caught a glimpse of her mom... she didn't look shocked.  I was expecting shocked.  

Her mom looked at the doc and says, "You better giver her something stronger this time. She had this a month ago and the medicine didn't work."

The doctor then asks the patient, "So you had this last month, did you finish the prescription?"

She responded, "Yeh, I did but I don't think it worked, because it came back again."

The doctor went on to explain that she had to abstain from sex and that her partner would need to be tested and treated.  The patient responded that she understood.  When asked about the kind of birth control she was using, she replied that she wasn't using any.  Concerned the doctor explained the risk of other STDs and the increased chances of fertility problems down the road.  The patient then explained that the only person she has unprotected sex with is her boyfriend, and that the other guys have to wear condoms.  

Again out of the corner of my eye I look at the mother's response, still no shock.  

That's when the mother says, "Well I just think that stuff she has mutated."

While my thinking is that it might have had to do with the multiple sex partners and no protection her mother might be on to something.  

Just when you thought that gonorrhea was bad now we do in fact have antibiotic strains.  

http://www.cdc.gov/std/Gonorrhea/arg/basic.htm

Maggots! I have a love hate relationship with them

Some things are not uncommon where I work.  Up to 40% of the patient population I deal with has diabetes and vascular issues. The smell of rotting flesh goes with the territory.  Here is where the poor folks live. They have very limited access to good healthy food, the kind of food diabetics should be eating and with the per capita gun homicide rate of 25.4 per 100,000, people are afraid of going outside for a run or exercise.

Generations of families rely on public assistance and their health care insurance is through Medicaid and Medicare.  The city has 4 hospitals, but there are limited primary care doctors that take Medicaid, and fewer specialists participate with Medicaid.  In other cities and suburbs you see plenty of doctor offices and doctor practices near hospitals, but not in the poor areas with high gun violence, so people go without.  

One evening a woman came in.  She had the triple threat that is common in our patients: obesity, diabetes and vascular disease.  Her legs had loose dressings that looked like an abstract painting.  There were bits of green, brown, yellow,red and tan, there was no evidence of the white gauze that it started out as.  The EMTs brought her in wearing face masks, so everyone knew it was going to be bad.  But how bad could it be?

My co-worker was the lucky nurse to get this patient.  She was a newer nurse, but well skilled and truly a lovely person.  Out of the corner of my eye I see her running out of the ER towards the ambulance entrance.  I walked out after her to see what was up.  

"I'm going to puke", she said. 

She went on to describe that the woman's bandages were concealing a slew of maggots which where eating her flesh.

Now most people would right away freak out.  Maggots in a hospital.  I know it sounds bad.  Okay in this case it wasn't ideal, but the maggots really were helping.  

In other countries around the world maggots are used to treat diabetic ulcers that won't heal with conventional medicine.  Maggots only eat the rotting flesh which allows the new tissue to grow.  Of course the maggots used for treatment are generally grown under sterile conditions, so yes our ER patient's maggots weren't ideal.

How can this happen you might wonder? Well the patient said she had a nurse come take care of her.  Of course "nurse" is a broad term, read the post about the garlic in the vajayjay, she was a "nurse".  This woman was paying someone from her hood to come take care of her, not an agency, not the VNA, just some girl who she knew.  

When we told he patient about the maggots she was stunned.  See that might shock the reader, "How could she not have known?", well if you are 5 foot 1 inch and weigh 360 pounds, you can't walk, the chances are you aren't bathing everyday and you eventually get use to the smell, she also couldn't see her legs.  

Was there an abundance of flies in her house? Yes, the EMTs said that the house was a mess, but she didn't have anyone who cared.  She finally called 9-1-1 when she couldn't take the pain anymore.  

Perhaps we have the reason why no matter what time of year it is, even when it is snowing outside we still have flies buzzing around the ER.  

Nursing Bliss: A Place at the Table

Nursing Bliss: A Place at the Table: I had a chance to see the documentary "A Place at the Table", tonight after my 10 year old went to sleep. The movie opens showin...

Too Painful to Watch

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Brick to Your Head

This is going to sound really insensitive and probably tarnish the halo above my head but it was perhaps one of the funniest and most frustrating nights I ever had in the ER.

The city I work in is called the Brick City. I work in one of the larger hospitals in the town.  On a daily basis our ER is packed.  We might see 300 patients a day in the ER.  There are patients being seen in plastic chairs, there are stretches in the hallways, there are patients waiting for hours in the waiting room just waiting for a chance to get the main ER, when ambulance units arrive with stretchers patients have to be moved just so the medics can get through the hall to find an open bed.

The city has violence, it has gangs, homeless, it has a heartbeat that is uniquely it's own.  It's an energy like something I have never experienced anywhere else in the world.  Newark has that vibe.  It is crude, it is bold, and it is humbling.

One night we had a woman come into the ER with her loved one. They were from an upper middle class suburb about 45 minutes away from the Brick City.  She had come into the ER because she wanted her loved one to get clean and sober, a Friday night epiphany.  Believe me I am all for folks kicking their habits, but there were a couple of issues I had with this particular situation: 1) She was obnoxious, she felt that since she thought that she knew a doctor in the massive hospital, she was privileged.  2) we are not a detox facility and we didn't have what they needed, but we provided a referral, which she didn't think was good enough.  3) she demanded a private room, insinuating that she and her loved one were more important, although there was nothing critical about that person's condition, meanwhile there were seriously ill patients waiting for stretches, even if that was a bed in a hallway a foot away from another patient.

Our ER isn't pretty.  It doesn't smell good.  There are homeless folks in the waiting room, in the ER and waiting outside, but we are damn good at our jobs, even with nursing shortages and cutbacks.

Well on this particular night the person who came for detox was tired of waiting for a room, tired of waiting because we did not have services to offer him. After much ranting and raving from a loved one, the patient went out to smoke a cigarette.  Now leaving the ER to smoke is against our policy, but no matter what we said we, the staff, couldn't be right.  We were always wrong.  Well some might call it karma, but when this person went out to smoke after telling me to "F" myself,  he was hit in the head with a brick.

Welcome to the Brick City!

While I don't condone violence in anyway I also do not condone patients and their loved ones treating nurses like crap.

New Clogs vs Chest Tube

I found the perfect clogs.  They were so comfy.  Did I mention that they were perfect. Beautiful shiny black paten leather, light weight, I was in shoe heaven.  I was gracefully and comfortably gliding to the busy ER, no discomfort.  My feets were happy.

I went into check on a patient who was complaining of coughing for a few days and shortness of breath.  He had taken off his oxygen, and his oxygen saturation was looking crappy.  

Like a good nurse I chat with him for a moment and then listen to his lungs, or should I say lung.  

That's right he only had lung sounds in one lung.

I find an attending physician and alert him to the pneumothorax (collapsed lung),  but the doctor doesn't look phased, no blinking of eyes, no getting up from his chair, he didn't even send a resident over.  So I order a stat chest X-ray and beg the tech to pull it up in the ER for me.  How I love digital technology.  

My hunch was correct-- pneumothorax!  So I grab a resident, ask him to read the xray to confirm the diagnosis (because I'm a silly nurse and I can't diagnose anything).  I quickly walk over to the lazy unimpressed attending to tell him that "the patient has a pneumo."  

"How do you know", he asks.  

"I ordered a chest xray and it shows one, and there's that whole no lung sounds thing", in a slightly smart assed tone. 

He gave me the oh shit look and got up, quickly walked over to the patient and took a listen, then walked over to the computer to check the X-ray.  

So now it was time to fix the problem at hand.  

I gave the patient some pain meds, explained to him that he needed a chest tube and what a chest tube was.  I got the equipment set up.  Now we were just waiting for a doctor to show up, but I had on my comfortable new shoes.

So the resident comes bouncing over and looks thrilled.  How they love to put in chest tubes.  

So Resident A begins putting in the chest tube.  He has a medical student and an intern at the bedside with him.  He in on the bad lung side and I am on the other, holding the patient's hand and talking him through the process.  The patient is doing well, suddenly I hear the splash of fluid hitting the floor.   It's a lot of fluid.  Realizing the residents on the other side are fumbling with the pleurovac and seeing the floor covered in fluid I move over to the other side of the bed, my new clogs are splashing in the lung juice.  I  hook up the chest tube to the pleurovac.

"Thanks I owe you", the resident says.  

"Yes, you do to the tune of about $120 for a new pair of clogs".