PressGaney Kiss My Ass! This Isn't the Hilton or Burger King! You Can't Have It Your Way!

The ED isn't Burger King!  You can't have it your way!  This is medicine not fast food.  You can't drive through and special order your care.  And you certainly cannot do it when you are refusing exams or testing!   So I'm sorry management if you get an unhappy customer because they refused an exam by a provider for drip from below.  I'm not sorry that we do not just give meds to people without evidence of illness....  oh wait... you changed your mind and you are now telling me to just give the patient the meds... without an exam, without the urine specimen that you told them they needed.  

Oh wait patient you're pissed off at me and calling me derogatory names and referring to our hospital as the ghetto hospital because you are upset that you didn't have faster service in the ED..  you've been here an hour.  You had a nebulizers and spent most of the time arguing about how the college educated staff doesn't care about you.  Love how you wasted your nebulizer telling me that I'm a racists because I am not the same shade of you and how I didn't provided you with anything..  I just spent 15 minutes listening to you complain and tell me how you are smart and know what you need, yet you can't tell me what you need.  Thank you for wasting my time and the time of my other patients who actually need help.

PressGaney and happy endings have two things in common--- you get jerked around a lot and in the end are you really satisfied or is it just pity service? 

Patients Please Leave Your Crazy Friends, Friends With Benefits at Home

There is nothing worse than a crazy "friend" at the bedside.  This crazy "friend" is the type of friend who doesn't want to be present for an invasive procedure-- an IV or a foley insertion, but will get in everyones' face, and I do me everyone!  They will stop you from talking to your own patient, they will stop you mid sentence with a colleague, you might not have anything to do with their "friend's" care, but they will attempt to hold you accountable as if you have the power to know every patient and every patients' health issues and the plan for care.  And if you god forbid say, "let me find the nurse caring for XXX", it turns out that that is the kiss of death.  See the friend isn't really interested in shutting the fuck up in order of the staff to try to help, he or she is there pacing the hall, obstructing the hall, hanging over other patients for attention.  They rant and rave.  They complain and refuse to leave the area, but they were never actually in the area holding the hand of the "friend".  It is truly an amazing phenomena while you are actively attempting to help the patients you can't because the "friend" just wants to argue, and for what?

What's So Hard About Doing Your Job?

I've worked in a couple of ERs over the years and I am often left wondering why people find it so hard to just do their job.  I don't mean all people, but some people.  What makes it even more frustrating is when the job is to just stay awake and keep an eye on a psych patient.  Seriously why  is it so difficult?

What is even worse is when you wake up the sleeping employee or ask them to remove their earbuds so they can hear what you have already said to them, and they get pissed.

Seriously.  I run around for 12 hours and I'm lucky if I have the time to pee...  but somebody is actually getting paid to sit and their responsibility is to really just stay awake and get the nurse is the patient needs something.

My rant is over!!!

They Came By Air

"Trauma alert by air 10 minutes.  Trauma alert by air 10 minutes".  For those of us wearing protective lead, covered head to toe in surgical attire, medical ninja garb, we are prepared to receive whatever comes our way.  We anticipate the badness that has been air lifted to our helicopter pad 24/7.  We first greet you, but you cannot see our face, just our eyes.  You are disoriented from a flight up-up and away from your disaster site, and you are carefully lowered to a small roof top that overseas a metropolis with college parties, gang violence, corporate gatherings and trials and tribulations of everyday life.  

You are here now.  I greet you with a welcome to ____ Medical Center, I'm your nurse.  You're safe now.  We are going to take great care of you.  I do my best to absorb a readers digest version of report with just the highlights from the flight crew, knowing they will repeat it when we cross the red line in the trauma bay.  I explain to my patient that we are going to move fast but we are thorough.  I explain that we will be cutting their clothing off and giving their belongings to security.  I try to prepare them because they are no longer in control.  Their control ended on impact with whatever bad thing landed them on our roof.

In those moments we look at every inch of skin, we check for holes and check existing holes.  We invade your body with needles, airway devices, caterers, tubes, hands and fingers.  We are causing you pain to end your pain and save your life.  We do this out of love for our vocation-- because it is not just a job we show up for-- it is our passion.  We like to fix things.  We are fixers. 

Somedays when they come by air the fix is easier than we thought, but the pain for the body is brutal. The emotional pain can be worse.  One lands on our roof and another- perhaps a soulmate lands on another roof hours away.  Together they became powerless, they were impacted, they became patients, but they are separated and suffering physical pain and a deep hurt not knowing if the other is still breathing or alive.  I can give you drugs to lessen the pain from your trauma, but I can do little to mend your heart.  

I rarely think about the other, because I am so focused on you and fixing you.... but then hours later on the news or in the paper or via a call you learn about the others.  I hope for the best, but know that if you landed on our roof the badness was real and the stark reality of life comes like a speeding bullet.  My patient survives, but there are others who do not.  Maybe one or maybe a couple perish.  It is sad and I selfishly hope that my patients soulmate lives on and makes a recovery, because I have seen the news and it was bad! 

Good Bye ER It's been real

I've always had a love for the ER.  In my opinion there is nothing like the ER.  It is unpredictable and things can change on a dime.  I loved getting train wrecks and working with providers to stabilize them.  Unfortunately I had to walk away from my ER job the other day.  It wasn't because of the patients.  A bad day in the ER is never in my opinion because of the patients.  A bad day in the ER is because of a broken system.  Perhaps my ideals are just not in line with the world of Emergency Nursing.  Perhaps I had too much faith and hope that ENA would advocate for better conditions for ER patients, and really start promoting leadership amongst the ranks of the staff nurses that would force nursing management to grow a spine.

On to new challenges and a new environment.  Its time to step away from the toxicity and into the unknown.

Failure Of The System

Over the past few months my ED has had a steady nurse attrition.  This is never a good thing.  At some point there needs to be an awaking to the exodus and a real discussion regarding what the heck is causing this unfortunate cycle.  Like several of my coworkers I also left the ED--- sort of.  I jumped ship to the EMS side of the house.  I didn't leave for just one reason, I left for several.  Amongst those reasons was my need for growth--- not in a management way.  I wanted to do more and learn more.

Its only been a couple of weeks but wow what a different world.  Is it all rainbows and unicorns? Probably not, but it is certainly a much different environment.

They say I'm a great nurse and a biotch! I'm okay with that

I had an interview within the hospital system for a critical care transport gig.  I've been considering getting the heck out of my ER for the past year, but really haven't done much in planning an exit.  Earlier in the month I interviewed in a trauma center in the hood, I was offered a position, but I haven't set up a start date yet.  I guess I was weighing my options.  Do I stay in my dysfunctional ER or tough it out until after the "new ER" opens and see if the new CNO makes much needed changes?  Fortunately I was approached about a critical transport opening and a CCU opening, not to mention the other ER gig.  So I have options.

I love the ER.  I think I'm a kick ass ER nurse, and my peers, patients and docs compliment me often.  Unfortunately lately I have been utterly disenchanted.  I love the work, I love the patients, I truly love working in the ER, but I am so incredibly disappointed with the quality of care that some of my peers provide and it is frustrating.  Recently one of my coworkers told me that some of the nurses on dayshift fear giving me report.  He finds it hysterical.  I find it amusing as well. When I asked him why he told me that they are always scrambling to get things done because they know if I come in and the shits not done there will be hell to pay.  I'm not sure that I would say that I would say I'm that rough on them, but I have written people up for neglecting to give meds or start IVs that were ordered hours ago.

I guess I learned the old school military way.  You treat every patient like they belong to your family, and you make sure you do your job.

If this expectation has given me the title of biotch, so be it.  I wear it well.

I am more than happy to point out when someone does a great job, but I will not coddle a lazy incompetent person!

Jackass OBs and their little friends too

I haven't spent a ton of my nursing career in labor and delivery, but I have spent enough time dealing with egotistical OBs as well as my own experience as a patient and a support team member to other moms to offer this rant:

Dear Labor and Deliver Staff:

1) Please stop saying "you're not in labor" when a mom is having palpable contractions every 6-3 minutes.
2) Please don't be the ass who asks the mom in labor with contractions every 4 minutes, "Do you have a low pain tolerance?"  --- here's a clue if the person is having repeated contractions--- of course its painful- if its their first birth chances are it's going to be very uncomfortable.  If you have a penis ask yourself how would that feel if your penis was contracting every 4 minutes!!  If you can't imagine it please come closer and I will find a way to make you uncomfortable every 4 minutes and follow it up with "do you have a low pain tolerance?".
3) Please don't tell the mom in labor that although the monitor shows a contraction of 75, it really doesn't matter, because the numbers on the monitor are only really valid when the internal transducer is in place---  moms in pain don't give a crap about that, and it doesn't reduce their pain.
4) Please don't tell moms who are having a difficult time pushing because of an epidural that they "aren't trying hard enough".
5) Please don't tell the mom who is 37 weeks, bleeding, having strong contractions every 4 minutes and was on bed rest at 22 weeks for preterm contractions and an incompetent cervix that they can go home because there are not in labor and they shouldn't be having pain because they aren't in labor because their cervix is only 3 cm dilated.
6) Please put an IV in and hydrate the mom when she has not been able to eat or drink appropriate amounts due to pain and vomiting, within 2 hours of being at the hospital, and not 10 hours later!
7) Please do not blame the dehydrated, pregnant, scared mom who is in pain with contractions for not having plump veins.
8)  Please do the right thing for dehydrated moms in pain and find the best vein for the time being--- if its an AC vein so be it-- hydrate them, manage them with an antiemetic and pain meds, find a more suitable vein in the lower arm later after they are hydrated--- don't stick the patient 7 times when you could have inserted an IV the first time!  Take care of the patient first! find the vein that suits you better later when they are comfortable!
9)  Don't ask the support team and husband to leave the room because your IV skills, and the skill of the nursing team suck!
10)  After essentially blaming the patient for "not being in labor" and taking up a bed with symptoms of labor in a high risk pregnancy, don't try to shove them off to home or an antepartum unit, re-check the patient.  And by the way you look like a complete ass when the patient dilates to 4 from the 3 they were at and now all of a sudden they are in labor!  And when you say "I've never seen this before"… you are a liar…  it happens all of the time!  Women can be slow to dilate and have close strong contractions!  It happens all of the time!
11) To the L&D staff.  A mom that is "not in labor" is no different than another patient in the hospital..   they need to be assessed and monitored!  Waiting hours to check a set of vital signs is not appropriate!  You have that ability on your fetal monitor!  Put the cuff on!
12) L&D nurses: Advocate for your patients!
13)  Don't leave narcotic pain meds drawn up in a syringe sitting for 2 hours at the bedside until the anesthesiologist can come start the AC IV---  waste or return your meds!  Bad practice!  Very bad!
14) When a mom has been pushing for 3 hours and things are not progressing, change the approach, because when that baby is born and isn't breathing, has to be placed on a vent with a cooling cap, its hell on the family and the nice ER nurse friend is now your worst enemy!
15) When you see the meconium come out when the bag was ruptured, you need to explain to the family the significance of it right then and there, not wait  hours until the very troubled birth!  Because that C-section they requested before they fully dilated might have been a better idea than the chain of events that unfolded!

Stop Bit@hing And Do Something

The ER I work in has 4 areas.  The area I was assigned to the other day is pretty detached from the main ER.  This particular part of the ER has 10 urgent care beds for the not so sick folks and then another 12 beds for level 3 and 2 patients.  The 12 bed area gets its fair share of stroke and septic patients.  Unfortunately it is a logistical nightmare.  Not only is it minimally stocked with meds, the new flavor of the month is not to have insulin stocked in a medication refrigerator because there were issues with vials not being properly labeled with "use by" dates.  Needless to say trekking through the ER to the main ER's med room is time consuming.  Upon getting to the med room and finding no insulin one might find themselves extremely annoyed… not because they walked all the way to the main ER, but because it was a complete waste of time  when they are otherwise running around cleaning up the mess from the prior shift.

Having had this issue of no insulin in the ER in the past I called the pharmacy and offered to pick up a bottle of each type of insulin in order to restock the ER!  During my conversation with the pharmacy tech I asked why when they restocked the refrigerator they didn't check to see if we had insulin.  The tech informed me that it wasn't something they did.  Knowing that they stock the refrigerator with other refrigerated meds it just seemed like a simple request…. but I wasn't getting anywhere.  The only explanation I was given was that someone must have been stealing the meds.

After hanging up the phone on of my managers said that I was "mean" for calling them as telling them that it was unacceptable that the ER didn't have insulin.  Well I do find it completely unacceptable to not have insulin stocked in an ER.  I then pointed out to the manager and the charge nurse that this was a chronic issue, which it has been, and that we needed a solution.  She quickly stated that pharmacy wouldn't perform a check and restock twice a day.  I then suggested that the charge nurse at the beginning of the shift check the refrigerator to ensure that insulin was stocked as well as checking our stock levels for vital things like liter bags of normal saline.  I was then told by the charge nurse that I "complain too much".

Maybe I do complain.  But I think that I am right to complain and offer a few suggestions on how to fix this problem we have.

Its interesting how identifying a problem and offering a solution is met with such resistance.

I have decided to turn a new leaf.  I'm not one of my apathetic coworkers, I refuse to give into that mentality.  If there is an issue I will absolutely point it out but I will now offer no less than three solutions.

Compassion and Caring

"Love and compassion are necessities, not luxuries.  Without them humanity cannot survive." ~ Dalai Lama

Compassion is something that one would thing is a given with nursing and the medical system.  Compassion is the one thing that is not delivered in a pill, an IV push in a manufactured way.  Compassion is genuine.  Compassion is ignited from within.  Compassion in the one thing that we can give of ourselves to comfort those who are suffering, as we give it, we also receive great benefits in return.

Why is it in our field there is a lack of compassion.  In order to provide compassionate care we must have received compassion. As we care for our patients and provide compassion it is equally important that we treat the members of our hospital teams with compassion.

http://www.ted.com/talks/view/lang///id/1216

Joan Halifax highlights this concept in a short Ted Talks episode.

2013 ENA President-Elect Deena Brecher speaks at 2013 ENA General Assembly

Incarceritis And New Onset Suicidal Thoughts at Time of Discharge

There is this amazing phenomenon  in the emergency room that results when a patient arrives in the ER while in custody of law enforcement with a new onset of incarceritits.  The symptoms of incarceritis include chest pain, shortness of breath and syncope.  Upon a full medical work up, which often includes lab tests, EKG and x-rays medical findings are usually negative for MI or other life threatening emergencies.  As the patient is discharged they miraculously develop new onset suicidal thoughts.  

Lucky for them they are usually handcuffed to a stretcher and have no personal belongings.  

Thankfully there is a cure for this!  Swift discharge and a bail bonds business card.  

The Waiting Room---- Why do you wait to be seen in the ER?

I have to give PBS props for airing what has to be the most honest look into life in the ER, for the patients that wait to the team that works to care for what is an endless stream of pictures.

If you haven't had a chance to view this gem, I encourage you to click on this link and give it a view!

http://video.pbs.org/video/2365092060/

While MTV shows the party life of nurses on their new show, essentially Jersey Shoring nursing, this is PBS docu is a real look, the real deal!

Who Dat?

I ran into a former manager today and it was an interesting experience.  I hadn't seen her in a while.  When I worked under her she was always well dressed, poised, professional in appearance....  when I saw her today in my former ED I hardly recognized her.  At first I thought she was one of the girls from the hood.  Then I thought she was a visitor.  Maybe it was the bad wig, the overly tight attire, the lab coat the unprofessional lab coat or the fact that she was literally hanging on some guy in the ED.  This was not the same former manager who was well dressed, professional and poised that I once knew.  I stand by my earlier post, leadership is lost!

Leadership Is A Lost Art In The Wake Of Middle Management

Many, many years ago the career field of nursing had leadership as a core value, but over the years reorganization and redefinition of management has suffocated the concept of leadership.  Gone are the days when you looked to your fellow staff nurses for mentorship.  Today's concept of nursing has ultimately killed the bond that drew us all together and it is weakening our very foundation.

When I look around at work there are very few leaders.  By leaders I don't mean managers.  In my opinion the two words have completely different meanings, although in today's hospitals nursing leadership is comprised of managers which is unfortunately an oxymoron most of the time because nursing managers rarely lead, they follow the hire up administration's agendas.  Perhaps that is why there are floors closed to accepting patients because there "isn't enough staff" which causes emergency department patients to sit waiting for hours for beds.  Lean staffing was a concept of management, certainly not nursing leadership.  What good nurse would ever want to subject patients to the hell of the dreaded hallway bed for hours?  Where is leadership advocating for the patient's safety and wellbeing?

I recently had an experience with three nursing managers.  Two of the managers were assistant nurse managers and the other a supervisor in the ED.  I had a critically ill patient who was bottoming out.  The patient's heart rate dropped to 32.  I had five patients to contend with at the time, and my neighbor, a new graduate just off orientation had five patients of her own.  Having informed the three managers who were sitting at the nurses station of the situation with my patient, and seeing how my neighbor looked a bit like a deer in the headlights, I asked my neighbor to ask one of the three manages to come over and assist me.  When my neighbor returned she informed me that they refused to help.  Wow was I blown away, well not really.  This is how our management is.  They are managers not leaders.

About an hour into pacing this patient and starting dobutamine, yes DOBUTAMINE, on this patient, one of the managers shows up.  She is eating popcorn, and coughing.  She tells me, "I'm choking on my popcorn", I shoot her a look which probably included an eye roll and I inform her that I needed her help an hour ago.

Her response to me is cold.  She lashes out that "I'm here now".  My response to her was "I needed you an hour ago".

During this hour that has transpired I had patients who were in pain, physicians trying to call in orders and other patients who had room assignments that needed report called, but I was tied up with a critically ill patient who was in dire need, yet for that hour my patients' needs, my call for assistance was less important than popcorn.

Just because one holds the title of manager does not make one a leader.  Leadership comes from within, regardless of rank, title or pay status.  Unfortunately true leadership has been left to the waste side, abandoned for some alien concept of leadership.

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.