An ER Christmas

Today some of the nurses put up Christmas decorations around the Triage area.
Lights around the main desk window, tinsel around the triage desks; very festive!
It was a little off putting though, when a patient came in a threw up blood all over the Santa ornament, and then defecated in her pants, so you had to smell feces while walking past the Christmas cookies.
Hazard of the season, I suppose.

Strangest Customer Of The Night

He sat down at my window. Immediately I knew something was not right.

Although on his nursing notes said presenting complaint was "unsteady on feet", I knew there had to be psych component to this patient.

He was twitching slightly, hands trembling as he clutched his bag close to his body. He reminded me of a trapped rabbit, his whole body quivering with nervous energy.

I proceeded with the registration, all went well until I picked up my computer mouse slightly to readjust it on my mouse pad. He shrieked, startled I looked up at him; without looking at me he asked if i could,

"Not pick up the mouse, as the red laser under it is blinding me and causing me to die".

Now it is true, I have a small red light under the mouse (I am not sure why it is there), actually his commenting on it was the first time I had even ever noticed it; and this was definitely the first time anyone had complained that it was causing them to go blind, or expire!

Unsure of what to say, I completed the registration, and proceeded to put an ID bracelet on his wrist.

As I did this he asked"Can Ellen be my nurse?"

"Is Ellen a nurse that works in Emergency?" I questioned.

"No" he stated, "She is my dead aunt who use to be a nurse, she died of kidney failure...I was wondering if you could call up her ghost so she can treat me, you can do that, right?"

Baffled, I muttered "I'll see what I can do" under my breath as I sent him back into the waiting room.

Sitting at my now (thankfully) empty desk, I tried to think of what my costume would look like...Surely being able to blind people, and being able to summon the dead, warrants at least minor league superhero status?

I am thinking purple and gold leggings....

Mes Cher Amis..

Dearest Nurses:

Please do not come and yell at me when you cannot find a patient's chart.
After assembling it, I put it in one of two places:

1) The triage desk
2) The acute chart bin

That's it. After placing it in one of these, I no longer have any contact with said chart.

That way it will save you time, because, you will not have to come back and apologize when you realize that the medical student was the one who walked off with it.

Dearest Medical Residents:

Please do not walk off with patients before they have been registered in the system, and then come down and yell at me, that you can't order tests because they are not in the computer. You only have yourself to blame.
It will also save me ( and my vocal chords) from continuously having to trek out to the wait room, and holler that patients name, in hopes of finding them to register.

No Words of Comfort

The stretcher curtains open to reveal a young, thin, First Nations lady. Blood surrounds her head, staining the white pillow in geometric shapes; her large fawn-brown eyes stare up at me as I ask her questions.

Half way through asking her about who her family doctor is, she begins crying; her frail shoulders shaking violently. Taken aback, I watch her dark, stringy hair shadowing her bent face, while reaching for the generic floral pattern box of cheap Kleenex kept at every bedside. As I place the box in her crumpled lap, her tiny hand reaches out and grasps my arm, tightly whispering

"I'm going through a hard time..."

Before I have a chance to respond, she launches into her story, breathless, panicked;

"I was living with a guy for 6 months when yesterday morning I woke up and he wasn't there, I opened a note on the table that said he was HIV+, and that he was sorry for not telling me."

"What am I going to tell me children?"

Her tear-stained words hung in the air.

I stood by her bed and held her hand, until she finally cried herself to sleep, watching her small exhausted body rise and fall; giving way to the steady rhythm of sleep.

There was nothing I could say that would make it alright.

Curse of the Computer

I always forget how much I rely on computers until they break! Already within the past couple of months I have had the hard-drive on my personal computer fizzle; and dislodged the hard-drive on my boyfriend's one after knocking it over.

Today it happened right when I started my shift and attempted to log on, my screen froze and would not let me proceed; not matter how many times I manually re-booted.

Finally I called the hospital computer help-desk, the poor guy upstairs was just as baffled as I was, and had to come all the way down to Emerg to see what he could do. I spent the next 3 hours waiting while him and a colleague completely replaced my whole computer.

After the new one was installed, and the old one carted away, I gingerly re-booted and all seemed to be hunky-dory until....I tried to log in to the program we use to register patients, and I could not see any patients on my screen, even though the ER was full. It took another 2 hours for them to fix THAT problem. Finally, by 8 pm, with over half my shift having gone by, my computer was up an running. Luckily it was a pretty mellow night (even though we did have a depressed psych patient somehow break loose from her four-point restraints and go AWOL)

I have a love/hate relationship with technology.
I love it until it breaks/ then I hate its guts!!

Knight In Shining Armour

I was having one of those crazy busy nights; all us clerks were run off our feet, when a motor-vehicle accident was brought in.

The EHS (paramedics) have their forms in triplicate, they keep the white one, the yellow goes to the nurses, and the pink goes to us admitting clerks. Some EHS are awesome at filling out the forms, getting ALL the details they can, which is such a big help; others couldn't care less, which makes life more difficult for us with STAT registrations. Of course there are just some times that the patient is so critical that they do not have time to fill anything out other than the patients name and birthday which is totally fine; this was one of those times.

After finding the patient in our database, and running off all the paperwork, I went to drop it off in the Trauma Bay. I have a section in my database where I need to fill out the accident details ( time, location, mechanism of injury ) the best way to find that out accident info if a patient is in trauma bay and surrounded by doctors and nurses is to see if I can catch one of the EHS and ask then as they are re-stocking their gurneys.

Just as there are nice people, and jerks in every profession, it is the same with paramedics. Some are understanding and helpful, others act like I am a fly on the windshield of their existence! I had the misfortune of dealing with one of the latter. This gentleman acted like I was the biggest hassle he had encountered all day...all questions I asked him were answered with one word answers, grunts or "I dunno, my partner might know".

Right before I was about the slink away feeling the size of a termite; one of the other paramedics spoke up. My knight in shinning armour was one of the veteran paramedics, who I hadn't seen leaning against the wall. He turned the jerk paradmedic and said

" Hey buddy, you be nice to the little admitting clerk, she is only trying to do her job", the other paramedic looking very shame-faced turned to me and said "I can go see if my partner has the sheet with all the info" to which I promptly replied with a smile " thats ok I can get it myself."

The veteran paramedic gave me a thumbs-up as I walked by toward trauma bay. So often us clerks are viewed as the pee-ons of the ER; people often forget that we have an important job to. We are the ones who get the correct patient in the census so tests can be ordered, and medical histories can be viewed. Not life-saving I know in the big scheme of things, yet important none the less; and the fact that someone recognized, and stood up for me that evening, left a grin on my face until I left for home that evening.

Dignity.

Seeing as the gentleman featured in this post shuffled off this mortal coil yesterday evening; let us take a minute to observe the passing of a fellow soul. That being said....

How to be assured that when you die the ER staff will not talk about you for weeks to come:
1) Do not meet a strange man over the internet, and after a few weeks of casual emailing decide to meet up for sex.

2) Do not invite him over to your basement sex "dungeon", complete with a comprehensive array of sex paraphernalia.

3) Do not start the evening off by smoking a joint, proceed to drink an *unknown amount beer, ingesting ecstasy, and topped off by stuffing cocaine and ketamine in your rectum.

4) Do not stop breathing while you are tied up in full bondage gear in the middle sex.

5) Do not have your new found *friend* fail to preform CPR for 18min while awaiting EHS because he is freaking out. Also, do not have him forget to untie you from your bondage restraints, so you are brought into the ER still all trussed up.

6) Do not pass away from Cardiac Arrest, looking like the most peaceful and happy corpse we have seen in awhile.

~ Just a friendly public service announcement~

Nonstop Night.

Crazy busy night tonight. It was STAT reg, after STAT reg.

We had some poor 20-yr-old kid brought in who was trying to repair his gas heater when it blew up in his face; he was brought in by EHS,intubated with 70% burns.
Charred flesh has a very distinct smell.
Although, on the news they had him as a 39-yr-old male; it is funny how often they get their facts wrong.

Right before I left we also had some sweet 95-yr-old lady GCS <9, brought in from a care home, who had been given an incorrect dosage of meds; poor gal.

Luckily we were fully staffed, so the load was manageable. Off to bed, so I can do it all over again tomorrow!

A Memorable Night.

Last night in the wait room together were patient's, doctors, nurses, paramedics, all watching in hushed silence Barack Obama's acceptance speech. A sense of history in the making was in the air.

Of course, as soon as it was over, the channel immediately got switched over to the hockey game. I love Canada...and I proceed to go back and deal with our favourite drug-seeking, smelly, belligerent homeless guy, whose last name "Swampy" I find very fitting.

Working the Nighshift

16 hours is a long shift, especially if working overnight.

Last Saturday, I worked my first ever night shift. I got the call from work, as I was heading out the door, that the night clerk was sick and they needed me to extend my shift, although I was hesitant I knew my bank account would thank me, so I accepted.

I came to work prepared with a large cup of tea, and a Red Bull. Everything was as per usual for my regular 3 pm to 11 pm shift. I have to admit it was sad seeing my regular collegues leave to go home at 11pm, knowing I still had another 9 hrs ahead of me, being the lone admitting clerk.

Of course I had to accept to work a shift during the daylight savings time change...so I didn't work 8 extra hours, I worked 9. There is something very depressing about watching a whole hour of work vanish right before your eyes!

For my first ever night shift, it wasn't that terrible. I like the atmosphere on nights, things usualy die down around 3 am, so you get to sit around and talk to the nurses and doctors; also time goes by fast because I always had someone to admit ( being the only clerk). I caught a quick snooze from 2-3 am, on the couches in the hallway outside of CT scan. I had first tried to sleep in the nurses lounge, but a few of them were watching "The Mummy".

By the time it reached 5 am, 7 am could not come soon enough! I was feeling very gruby ( even though I had already brushed my teeth once during the night ). My mascara was smuged, and my hair was doing its own thing, after being slept on!!

Luckily we were fairly busy from 5-7 am. I have never been so happy to see the 7 am shift relief in my life!! I called a taxi home ( there was no way I was taking a bus...I was too afraid of falling asleep and missing my stop).

My delightful boyfriend has woken up early to cook my a hearty breakfast of eggs bacon and toast, which I wolffed down, showered and then promptly fell asleep.

It was nice to know that I am capable of working 16 hours overnight with becoming a total mess, but it is not something I plan on making a routine.

My First Death

I had only worked in the ER for around a week, when I was sitting at my desk, and the triage nurse came over and told me that a "post-arrest" was on its way in, and that we had no info on them.
I felt a surge of excitement run through me, this was to be my first major "trauma" that I would deal with all on my own. About ten minutes later I heard the "CTAS 1 to A2" go out over the loud speaker, and saw the blur of the EHS gurney zoom past.

The unknown patient popped up on my computer screen and I ran all the paperwork off as a "stat reg"; meaning, I ran it through with no personal demographic details, and gave a new medical record number to the patient. As soon as I had finished running it off, the social worker came by with a wallet. It was the patients, she told me to go through it to see if I could find any relevant information, and to now change the "unknown" patients name, to the name on his drivers license.

It is always strange going through a strangers wallet. He was an 82-year-old, English gentleman. In his wallet he had pictures of his family, and a very dashing picture of himself as a young servicemen during World War Two. I proceeded to update all of his demographic details, and re- ran off all the paperwork.

I dropped off all the forms with the unit clerk, and hustled into the trauma bay, with the patients wallet. Right when I walked in the doors is when they shocked him. I had seen it done on TV shows before, but nothing really prepares you for watching it in person. The patients arms and upper body flew up and crashed back down, violently. The nurse then went up and suctioned out his mouth, while they gave another shot of Epi. This happened 2 more times as I stood in the crowd of residents, EHS crew, and firemen; with my mouth agape. This was my first realization that death is neither romantic nor beautiful,no matter how it happens, it is never pretty.

Five minutes afterwards they decided to call it. I don't remember the exact time of death, but I do remember the trauma nurses taking a white sheet and covering him, while the whole trauma bay went silent. The silence was deafening, compared the the hustle and bustle that going on only moments before trying to save a life.

I walked back to my desk in a daze. I had applied to work in emerg, to get to participate in saving lives, dealing with death, feeling that rush of adrenaline, and now I had truly experienced what it means to work here.

A half hour later, I walked past the trauma bay, and saw the man's son holding his hand and saying goodbye.

I will never forget that day.

The Deluge.

Tonight was completely nuts!

I came on to a shift, where half the computers were not functioning at full capacity, we were down two clerks; and to top it all off I had the fact that I was training a new girl thrown at me, right when I walked in the front door.

As a clerk in Emerg, you either sink or you swim. You are either the kind of person who can deal with a fast-paced, multi-tasking, sanity-depleting enviroment or can't. I usualy can tell within the first 20 minutes of training someone whether they are up for the task,. Luckily she was. Thank goodness.

It was all quiet on the homefront until around 8:30 pm. As I said we were down two clerks; a preferred acommodation clerk ( who goes around to the patient's bedsides to see if they want private or semi private rooms )...this clerk also will come out front if the regular clerking staff needs a helping hand; and we were short a treament clerk, who does all the non acute patients. So basically it was up to my collegue and I do admit all the patient's in the largest hospital in the city. Good times.

So, like I mentioned it was fairly laid back, until the floodgates opened at 8:30pm. All of a sudden we had 6 EHS crews pull up. One with a CTAS 1, intubated, 19-year-0ld overdose, the rest with abdo pains, and general weakness; along with 7 more treamtent patients.

Manuevering around the triage area when there are so many crews and people clogging it up can be a real health hazard. I have been endowed with a few lovely violet bruises on my leg from running into EHS gurneys in my hunt to find patients needing wrist bands.

Needless to say we were running around trying to get everyone registered and in to the proper wait rooms, on top of that I had to talk to the overdose victims family.

I walked into the trauma bay to find the victims father standing by her bedside. He was a wreck. I will never get use to the terrified look in victims families eyes, looking so lost and helpless; and you know that there is nothing you can say that can help. He kept telling me how she had enrolled in school to finish her highschool degree, and how she was doing "so much better". The worse part is when she start waking up and thrasing against her restraints in the bed. That is never a pretty sight.

Anyways, now I am at home in bed, and can't sleep...still trying to decompress from my shift; listening to the Bloc Party and watching time tick on by.

Metamorphosis.

The Emergency Room has a way of insidiously weaseling itself into your life; until one day you look at yourself in the mirror and suddenly realize that you have become a callous, iron-stomached bastard; and you can't even be bothered to care.

Don't get me wrong I love my job, I love the adrenalin rush, the people I work with,and the fact that you never truly know what is going to come bursting through the door; but I have to admit, it has changed me:

-I can now finish eating my sandwich I brought for lunch as you puke into your little red bag in front of me.

- Play "rock paper scissors" to see who gets to deal with the psychotic patient strapped down to her gurney, yelling " I DEMAND JUSTICE AND LAW" at the top of her lungs.

- Ask to see the care card of a man who has been beaten with a lead pipe, and whose eye in dangling out of his socket..without, pardon the pun: batting an eye.

-Have come to the conclusion that you are not truly sick unless you are vomiting blood, missing limbs, or have damaged vital organs.

-Believe all people coming in to the ER with the chief complaint of: "I feel unwell", should be thrown into a dark cellar, and fed only bread & water, and made to think about their response until they can come up with a real complaint..( I'll show you the meaning of unwell %^&^$...)

- Believe that "shallow end of the gene pool" should be a recognized diagnosis.

-Watch maggots crawl out of a necrotic gangrenous foot while deciding what I want to eat for dinner.

- Believe that we should be able to tell patients ( in the immortal words of Chopper Reid) to "Harden the Fuck up".

This the person I have now become.

Get It Together

20-year-old female brought in to Emergency; weepy and slightly dishevelled.

Presenting compaint: Palpitations.

She looked scared, and stressed out. I was feeling sorry for her until I read her EHS form:

" PT DRINKING LAST NIGHT UNTIL 1200. USED COCAINE & ALCOHOL UNTIL 1600 TODAY. PT LEFT DOWNTOWN, ARRIVED AT FRIEND'S HOUSE, LAID DOWN ON COUCH AND THOUGHT SHE WAS GOING TO DIE. HAS HEADACHE AND PALPITATIONS".

You think?

Maybe 14 hours of cocaine use isn't that great for you...who knew?

Go home and sleep it off (if you can sleep).. and if you can't sleep contemplate the choices you have made over the past 20 hours. Seriously.

Halloween Mortification

Last night I had a 39-year-old lady come in dressed in a pink bunny costume, who had decided to imbibe a 2 litre bottle of liquid marijuana ( which I have actually never heard of before) mix with Bacardi Breezer.

Needless to say she was completely out of it, drooling, head lolling about, with a lovely dose of vomit all over the place. Her poor friend who was with was completely embarrassed ( turns out, she is a nurse at another local hospital, and she was the one who called the ambulance). I guess if you are going to be doing things like mixing your vices and dressing up like a bunny; it would be a good call to be friends with a nurse!

Last night did seem to be the evening for mortified friends.

Later on, there was a gentleman in his mid-twenties brought in by ambulance, who also had decided to partake ( heavily ) in pre-Halloween celebrating. Him and a bunch of his office buddies had been out enjoying our local "Night of Lost Souls" parade and had tripped, fallen forward and hit his head on a bus stop bench.

He was a disaster; didn't want to keep his c-spine collar on, wanted to fight the ambulance crew and kept yelling about how afraid of needles he was. His poor ( more sober ) friend, kept apologizing profusely to all the staff, on his behalf; and kept repeating over and over "please tell me you have seen worse than this, man I'm sorry".

Although I am not working Halloween evening, I look forward to all the stories my fellow staff members will tell me. Although this is my first Halloween in emerg, I am told it is always an interesting night!

Mushrooms

Public Service Announcement:

Although mushroom season is here, please resist the urge to go into you backyard and pick a bunch of the little guys to fry up in a dash of olive oil and eat. Then later, when you end up feeling violently ill, do not try and cure your ills by concocting and self administering a dish soap enema.

That is just adding insult to injury, and needless to say you will end up here drinking charcoal, an experience probably equal to dish soap up your rear end.
FYI.

Definition of Emergency

I see it day in and day out. People who come in to the ER for minor complaints that are much better suited to a walk-in clinic than a hospital Emergency Room!

Not only is this a nuisance for the staff, it creates backlog for the people who are truly ill and require immediate medical attention.

So if you have injured yourself/ are feeling ill and are debating whether or not to go the ER, here are some tips on what ARE NOT emergencies ( please note: all examples taken from real life )

1) You have minor blisters on your feet, because your shoes are too tight

2)You have a headache, which you have not yet tried to treat with Tylenol or Ibuprofen ( side note: when you get to the ER, that is the first thing the nurse will give you, anyways).
.
3)The skin has grown over the back of your large rhinestone earring

4) You are depressed, with no suicidal ideation. (You will just have to wait for hours to see the doctor, waiting down a hallway with other psych patients, wearing brown pj's, which is bound to make you even more depressed).

5)You have a minor cough/sniffles. Go to a clinic. Seriously.

6) You and your entire family are completely asymptomatic, but it is your belief that you all have parasites.

7) You've smoked pot for the first time with a bunch of friends, and now you are anxious and believe you are dying.

8) You have a paper cut on your finger.

9) You are not allergic to bees, and you were stung. On the arm. Once.

10) You have run out of birth control, and want to renew your prescription.

All these things are not emergent, and do not require your presence in your local emergency room. Please use your local walk-in clinic or family doctor as your first line of defense. If you truly do need to visit the ER for any of the above conditions, your doctor will let you know.

Now off to another day at the office....

Identify Yourself.

Just a quick note:

This is a plea from the bottom of my (tiny, wizened) heart, that goes out to every person across the wide planet:

Please please please, carry a piece of ID on you AT ALL TIMES.

At the very least, anything that has your name and birthday on it. I don't care if it is a crumpled sticky-note you cram into your wallet behind your Cosco card, if need be!

Your name and birthday/photo are the way that we identify you in the ER, confirm your demographics/ contacts and pull up past charts ( if you have been here before). This is important if you have underlying medical conditions or allergies we need to know about before treating you.

Now, this is all fine and dandy in a pinch,if you are able to converse with us and let us know...but what if (heaven forbid) you have been hit by a car, and are unconscious....how are we going to know who you are?? I can tell you it is pretty stressful trying to treat someone, and not knowing their medical history or an emergency contact. Wouldn't you want your family to know if you were in an accident?

Also, if you are Canadian, please carry your Care Card around with you as well as photo ID, easy right? Just shove it in the back of your wallet, and forget about it until you need it.

You would not believe the number of people who come walking into the Emergency with a finger laceration, requiring stitches...and no ID. They just expect us to take them at their word that they are who they say they are! They could walk in and say "I'm Tom Cruise" and I would have to take them at their word. Silly and annoying; not to mention time consuming, as we try and search through our databases trying to find you, and confirmation that you are who you say you are.

So, if you would like to endear yourself to Emergency Room workers everywhere, please for the love of all that is good in this world, carry some form of ID on you at all times.

Thank you for your time, and understanding.