Dr Less was everybodys favorite. He did the minute workups. Discharged fast, ordered practically nothing. Even on a Monday if you knew you had Dr Less on shift, it was to be a good day.
Dr Less is a golden boy. The luck god smiles down on him. He's never gone to court, never been sued.
Nurses love him for the most part but it could be a bit scary when he'd want to discharge to followup an old lady who passed out cold in church and had been witnessed bradying to 40 on the monitor. Every so often an astute nurse would advocate for admission and he'd roll his eyes and cave with a smartass but good natured comment.
Then there's Dr More. Poor Dr More.
We hated his work (massive workups on everyone) but we love the guy. He's the one you want on when you drag in your sick mom. He's kind, more than thorough and the nicest guy ever. He'd suture a patient and then tell them the next time he worked, and to stop by and not sign in, just ask for him so he could re-evaluate them or remove their sutures without a visit.
Of course bad luck follows him like the plague.
Take for instance the unit secretary whose no-good husband needed a work note. Dr More caved and wrote a note for him, because he really cares about the employees, he didn't want old Marthas husband to lose his job and cause a hardship for Martha.
Next day he gets an irate phone call from the mechanic shop manager yelling at him "Doctor More, you wrote a work note for Mr Martha but he was seen by his coworkers in a BAR every day he was absent! Did you even TREAT him? Was he even SICK? Where is your INTEGRITY, DOCTOR?"
Ouch ouch ouch. No good deed, indeed.
Then we had an older lady, visiting our town and ready to head home when she got weak and had a fall. Her daughter brought her in and he did the full workup, presented admission.
I witnessed and charted both the patients and her daughters refusal for admission. Dr More was adamant about her needing admission but they flatly refused. She wanted to go home and see her own doctor, she didn't want her daughter to have to stay in our town away from her kids, she wanted to get admitted to her own hometown hospital. He grudgingly agreed to *discharge* the patient to home, 2 hours away with her daughter driving, they said they understood his doom and gloom warnings and promised she'd follow up the next day.
An hour or so later we get a call from another hospital, the patient had fallen again, at a rest stop, and had broken her hip. The daughter hadn't told us she was a nurse and she was screaming in the background about how could her mom have been discharged, (not AMA) and how this is all Dr Mores fault.
I reassured him, telling him that I had charted the conversation I'd witnessed but he was just crestfallen, he didn't get angry and defensive or vent, he wasn't worried about his own ass, he just felt horrible.
The poor guy.
Dr Less didn't always get lucky though. One memory comes to mind of him on a slammed busy day. he was reading aloud a patients lab results over and over while scratching his head, coupling it with her presentation as her diagnosis dawned on him just a minute or two later than it had dawned on everyone else within a 2 mile radius of the ER.
"Holy shit, she's in fucking D.I.C!"
We nodded.
"What the fuck do we do?"
A particularly dry charge nurse volunteered, "You tell us! You're the doctor!"
I suggested, totally jokingly "google it!" Tee hee, as I went to the pyxis for another patients med.
Got my med and turned back around, to find Dr Less hard at work, googling.
Saturday, October 6, 2012
Triage Cassanova
I don't have to do triage anymore.
Unless I sign up for it, which, heh, why would I do that?
I do miss the triage cassanovas though.
Yes, I am technically ringless and available. Though I'd never date a patient, my own bad choices in men are a joke in itself at work (a religious cultmember, a cop who took me to a party wherein he and his cop friends shot themselves in the scrotums with bbs to prove their manhood, a white collar, a Mr Perfect, doctor-shopping Rx drug addict). Yeah, and so I get it, and I've pretty much sworn off dating.
Whenever we have a guy come in for an STD check, suicidal or homicidal ideations, ETOH intoxication or drug overdose I'll hear "but is he single? Travis needs a boyfriend" haha. So funny youse guise!
Dudes dig nurses. I hear there's a whole genre of porn dedicated to this very subject. Looking around myself on a shift I never see short white dresses with thigh high white stockings and red stillettos so I'm not sure how that porn is any different from tooth fairy fantasies. I look around and see nurses with hair falling down from pony tails, maybe scarfing some stolen peanut buttered graham crackers over a keyboard in lieu of a proper lunch break. Myself included.
I once had a patients wife refuse a foley from me. The poor guy had fallen out of a tree and had several vertebrae busted. I'm sure my cold hand shoving a big tube in his junk was NOT going to be future fantasy material for him (and a dude with a broken back is low on my prey list) but his wife tearfully demanded a man put in the catheter. She also accused me in front of the charge nurse, of stealing his wedding ring, which I reminded her she had put in her purse!
But back to the triage romeos! I'm talking about the younger men who maybe harbor some nurse fantasies. Also seem to think my ok looks fit their fantasy and my mandatory screening questions scream interested.
I've heard way more than once "and I really need to get this checked 'cause I'm a SINGLE DAD".
Too bad so sad I have no interest in raising someone elses kids.
I'll never forget one in particular. A musclebound meathead in an arm-bearing tank top.
He signed in, and wrote down his complaint in handwritten caps lock:
STAPHALACOCCALACACCULUS.
He had an abscess (boil or bunch, if you've worked in the remote areas I have) on his back.
He proceeded to tell me how at his GYM several other guys who workout in his GYM had gotten these staph imfections from the GYM EQUIPMENT.
Sigh.
Dreading the single dad mention, I forged on and asked my mandatory questions like, do you feel safe at home? Do you have any suicidal thoughts? Any history of infectious diseases?
"No! I'm careful! I always use protection. I'm not even seeing anybody right now."
He paused for a second went on "I've been watching you, you know, from the waiting room."
Heh. Oh noes. Here it comes.
"Do you work out?"
I laugh and go on with my questions.
"Do you take any medications? No, ok, do you have any allergies?"
He laughs "I've decided, I'm allergic to men! *giggle*"
I do a double take and realize. Oh. Ooooooooh.
Unless I sign up for it, which, heh, why would I do that?
I do miss the triage cassanovas though.
Yes, I am technically ringless and available. Though I'd never date a patient, my own bad choices in men are a joke in itself at work (a religious cultmember, a cop who took me to a party wherein he and his cop friends shot themselves in the scrotums with bbs to prove their manhood, a white collar, a Mr Perfect, doctor-shopping Rx drug addict). Yeah, and so I get it, and I've pretty much sworn off dating.
Whenever we have a guy come in for an STD check, suicidal or homicidal ideations, ETOH intoxication or drug overdose I'll hear "but is he single? Travis needs a boyfriend" haha. So funny youse guise!
Dudes dig nurses. I hear there's a whole genre of porn dedicated to this very subject. Looking around myself on a shift I never see short white dresses with thigh high white stockings and red stillettos so I'm not sure how that porn is any different from tooth fairy fantasies. I look around and see nurses with hair falling down from pony tails, maybe scarfing some stolen peanut buttered graham crackers over a keyboard in lieu of a proper lunch break. Myself included.
I once had a patients wife refuse a foley from me. The poor guy had fallen out of a tree and had several vertebrae busted. I'm sure my cold hand shoving a big tube in his junk was NOT going to be future fantasy material for him (and a dude with a broken back is low on my prey list) but his wife tearfully demanded a man put in the catheter. She also accused me in front of the charge nurse, of stealing his wedding ring, which I reminded her she had put in her purse!
But back to the triage romeos! I'm talking about the younger men who maybe harbor some nurse fantasies. Also seem to think my ok looks fit their fantasy and my mandatory screening questions scream interested.
I've heard way more than once "and I really need to get this checked 'cause I'm a SINGLE DAD".
Too bad so sad I have no interest in raising someone elses kids.
I'll never forget one in particular. A musclebound meathead in an arm-bearing tank top.
He signed in, and wrote down his complaint in handwritten caps lock:
STAPHALACOCCALACACCULUS.
He had an abscess (boil or bunch, if you've worked in the remote areas I have) on his back.
He proceeded to tell me how at his GYM several other guys who workout in his GYM had gotten these staph imfections from the GYM EQUIPMENT.
Sigh.
Dreading the single dad mention, I forged on and asked my mandatory questions like, do you feel safe at home? Do you have any suicidal thoughts? Any history of infectious diseases?
"No! I'm careful! I always use protection. I'm not even seeing anybody right now."
He paused for a second went on "I've been watching you, you know, from the waiting room."
Heh. Oh noes. Here it comes.
"Do you work out?"
I laugh and go on with my questions.
"Do you take any medications? No, ok, do you have any allergies?"
He laughs "I've decided, I'm allergic to men! *giggle*"
I do a double take and realize. Oh. Ooooooooh.
Perfect Timing
Little OLD man brought in EMS, status post fall with bleeding scalp.
He was adorable. Pushing 90 and fretting over his beloved wife at home, the wife he cares for.
He had been working in his garage and tripped over something, went down and hit his head on his tool bench. Just Plavix and aspirin daily. I triage the patient, asymptomatic and talkative.
I carefully removed the EMS bandages and zip! A little arterial spurter shot a stream of blood towards the other side of the bed. Luck is my lady!
I covered his geyser and Dr S came in, one of my faves to work with, a no bull but thorough doc. He wants coags, lytes, and a CBC.
Dr S garbs up in a gown and mask and I set him up to suture, then I got to spiking a bag and starting an IV. I've got 4 other patients, managing my time here, doing my thing while staying close by to gofer for Dr S.
The little old patient chattered about his lovely wife and he kept looking down at his right AC where I was starting his line. I see a large maybe 1/2 cup gelatinous blood clot slither from behind his neck, down his shoulder over his gown. Gross.
Dr S asked the patient to stop looking down as it is messing up his view.
As pt looks down again, S gives me a raised eyebrow and a sweet smile, "do you have to do that *now*?"
I give him the eyebrow right back and redirect the patient, "IVs all done, now look straight ahead!" Patient apologizes, looks ahead and finishes his sentence, more about how he can't stay because he has to get home to care for his lovely wife.
I draw the labs, hook the fluids KVO and go to set the blood on my mayo table as Dr S finishes his last suture.
I look back at the patient as he goes from talkative to quiet, from pink to dreaded GRAY in a horizontal line moving down his face and body.
His pressure is cycling and pops up: 74/36, heart rate 42.
I lay him back and release fluids wide open as Dr S whips off his gown and mask.
I squeeze the fluids for a minute or two and the patient comes back around, gives a hoarse chuckle and says "I got kind of dizzy there."
I wink at Dr S "Aren't you glad we had that IV!"
He uses an index finger to shoot a glove in my direction.
The patient ended up spending the night, I arranged for a granddaughter to spend the night with grandma.
He was adorable. Pushing 90 and fretting over his beloved wife at home, the wife he cares for.
He had been working in his garage and tripped over something, went down and hit his head on his tool bench. Just Plavix and aspirin daily. I triage the patient, asymptomatic and talkative.
I carefully removed the EMS bandages and zip! A little arterial spurter shot a stream of blood towards the other side of the bed. Luck is my lady!
I covered his geyser and Dr S came in, one of my faves to work with, a no bull but thorough doc. He wants coags, lytes, and a CBC.
Dr S garbs up in a gown and mask and I set him up to suture, then I got to spiking a bag and starting an IV. I've got 4 other patients, managing my time here, doing my thing while staying close by to gofer for Dr S.
The little old patient chattered about his lovely wife and he kept looking down at his right AC where I was starting his line. I see a large maybe 1/2 cup gelatinous blood clot slither from behind his neck, down his shoulder over his gown. Gross.
Dr S asked the patient to stop looking down as it is messing up his view.
As pt looks down again, S gives me a raised eyebrow and a sweet smile, "do you have to do that *now*?"
I give him the eyebrow right back and redirect the patient, "IVs all done, now look straight ahead!" Patient apologizes, looks ahead and finishes his sentence, more about how he can't stay because he has to get home to care for his lovely wife.
I draw the labs, hook the fluids KVO and go to set the blood on my mayo table as Dr S finishes his last suture.
I look back at the patient as he goes from talkative to quiet, from pink to dreaded GRAY in a horizontal line moving down his face and body.
His pressure is cycling and pops up: 74/36, heart rate 42.
I lay him back and release fluids wide open as Dr S whips off his gown and mask.
I squeeze the fluids for a minute or two and the patient comes back around, gives a hoarse chuckle and says "I got kind of dizzy there."
I wink at Dr S "Aren't you glad we had that IV!"
He uses an index finger to shoot a glove in my direction.
The patient ended up spending the night, I arranged for a granddaughter to spend the night with grandma.
Thursday, October 4, 2012
Dr Gorgeous
So back in my country ER days, one day Dr Gorgeous travels in from the big city. He's hot and he knows it. Mr Charismatic! He woos the patients with good looks and mile high bullshit, he woos the nurses with quick discharges and big workups only on the truly ill.
A pathetic, chronic backpainer everyone hates comes in and Dr G goes in to see him. No doc has ever gotten rid of this dude without caving into dilaudid. I overhear the whole thing.
"I see you've been here 7 times in the last 2 weeks for this back pain. You POOR bastard, you must really be in a lot of PAIN!" His voice was DRIPPING with pity.
The guy nods. I choke on my bubblegum.
Dr G switches gears "UnFORtunately I cannot treat your chronic pain here in the ER and you've already had tons of xrays so I'm going to do what I can and discharge you with a prescription for motrin. I really hope you get better soon!"
The patient didn't know what hit him and I fell in love with Dr Gorgeous as pathetic dude limped out.
Not that kind of love. Don't confuse me with the subject of Dr Gs cell phone conversation with his wife overheard later "It was JUST a FUCKING TEXT! It was a JOKE, I don't know why she'd send me that picture of herself, I was just fucking around when I asked for it."
Ahem.
So, another day Dr G is scheduled to travel in locums and we're all happy, its gonna be a good day.
We get country patient. Hugely obese, dirty, talks with a bad speech impediment, has 6 kids who also have crossed eyes and babble with retardation. Her sister comes in, she brings her shortbus kids as well but can at least communicate. Patient is writhing in the bed yelling "ow, ow, mah hed huwts!"
Line, lab, head CT. All negative. Fluids and non-narcotic migraine cocktail do the trick. She gets discharged and the whole kit and caboodle leave with a little mustached, tattooed dude who showed up at some point.
Shift change rolls around about an hour later and dear old Dr Elderly comes running in breathless, I'm holding my breath as I watch his one severley bowed leg somehow holding up for the sprint.
"There's a woman down in the parking lot! Hurry hurry, she's beside the car! She's on the ground!"
Great. I'm nearest the door, closest to the wheelchairs. All 5'4 120lbs of me and no male nurses or techs that day. I grab a wheelchair and head out by my lonesome.
I find the headache patient lying on the ground right outside the ER, beside the minivan full of slowkids, the side door is wide open and she's writhing again holding her head.
"I went! To bugga king and my hay ait come back!"
Little tattooed dude volunteers "she dinna even eat her fwies!"
Just freaking great. I gotta pick her up off the ground.
I hear a voice behind me "Whats going on here?" And it is Dr G in his long white coat, sleeves rolled up, blue eyes shining, gelled hair in perfect place.
But I'm still the nurse. Doctors don't lift patients. Back to reality. I go down to try and hoist her up and Dr G steps between us, puts a Rolex toward me with his hand gesturing me back as he bends down toward the patient.
Little tattoo dude leans over behind Dr Gs other shoulder and coughs.
Dr G shoots up to full height and spins on him "DID YOU JUST COUGH ON ME?!"
White faced, tattoo dude shakes his head no.
Dr G orders the patient to get up and get in the wheelchair and she OBEYS.
I wheel her in for Dr Elderly to take over and order dilaudid dilaudid dilaudid, she pukes up her whopper, and then she gets phenergan and discharged again.
Forever indebted to Dr G I'd send him a picture of anything, anytime.
A pathetic, chronic backpainer everyone hates comes in and Dr G goes in to see him. No doc has ever gotten rid of this dude without caving into dilaudid. I overhear the whole thing.
"I see you've been here 7 times in the last 2 weeks for this back pain. You POOR bastard, you must really be in a lot of PAIN!" His voice was DRIPPING with pity.
The guy nods. I choke on my bubblegum.
Dr G switches gears "UnFORtunately I cannot treat your chronic pain here in the ER and you've already had tons of xrays so I'm going to do what I can and discharge you with a prescription for motrin. I really hope you get better soon!"
The patient didn't know what hit him and I fell in love with Dr Gorgeous as pathetic dude limped out.
Not that kind of love. Don't confuse me with the subject of Dr Gs cell phone conversation with his wife overheard later "It was JUST a FUCKING TEXT! It was a JOKE, I don't know why she'd send me that picture of herself, I was just fucking around when I asked for it."
Ahem.
So, another day Dr G is scheduled to travel in locums and we're all happy, its gonna be a good day.
We get country patient. Hugely obese, dirty, talks with a bad speech impediment, has 6 kids who also have crossed eyes and babble with retardation. Her sister comes in, she brings her shortbus kids as well but can at least communicate. Patient is writhing in the bed yelling "ow, ow, mah hed huwts!"
Line, lab, head CT. All negative. Fluids and non-narcotic migraine cocktail do the trick. She gets discharged and the whole kit and caboodle leave with a little mustached, tattooed dude who showed up at some point.
Shift change rolls around about an hour later and dear old Dr Elderly comes running in breathless, I'm holding my breath as I watch his one severley bowed leg somehow holding up for the sprint.
"There's a woman down in the parking lot! Hurry hurry, she's beside the car! She's on the ground!"
Great. I'm nearest the door, closest to the wheelchairs. All 5'4 120lbs of me and no male nurses or techs that day. I grab a wheelchair and head out by my lonesome.
I find the headache patient lying on the ground right outside the ER, beside the minivan full of slowkids, the side door is wide open and she's writhing again holding her head.
"I went! To bugga king and my hay ait come back!"
Little tattooed dude volunteers "she dinna even eat her fwies!"
Just freaking great. I gotta pick her up off the ground.
I hear a voice behind me "Whats going on here?" And it is Dr G in his long white coat, sleeves rolled up, blue eyes shining, gelled hair in perfect place.
But I'm still the nurse. Doctors don't lift patients. Back to reality. I go down to try and hoist her up and Dr G steps between us, puts a Rolex toward me with his hand gesturing me back as he bends down toward the patient.
Little tattoo dude leans over behind Dr Gs other shoulder and coughs.
Dr G shoots up to full height and spins on him "DID YOU JUST COUGH ON ME?!"
White faced, tattoo dude shakes his head no.
Dr G orders the patient to get up and get in the wheelchair and she OBEYS.
I wheel her in for Dr Elderly to take over and order dilaudid dilaudid dilaudid, she pukes up her whopper, and then she gets phenergan and discharged again.
Forever indebted to Dr G I'd send him a picture of anything, anytime.
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