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.

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.

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.  

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.  

"Should I Stay Or Should I Go"

Did you ever hear that Clash song "Should I stay or should I go"....
apparently some patients in the emergency room live by this.

They call 911 for an ambulance for something that has been bothering them for years.  They don't agree that triage is an appropriate way to manage care, it should be whoever comes in the ambulance goes to the head of the line.  When they are seen they aren't happy that the narcotics prescribed don't quite meet up with the narcotics they use from the street, so they opt to elope.  An hour after leaving without signing out they call 911 again get a free ride to the ER...  PS sucker you are now going back to the waiting room and have to be triaged again!