The Silence of Words

I enter moments after the doctor leaves. There are no easy words; I see the tidal wave of emotions crash across your deep blue eyes; the shock, the fear. You are my age, you shouldn't have to process the news you've just been dealt. You try and hide the tears that are steadily coursing down your face, pooling around the faded blue neck of your hospital gown; despite your furious attempts to wipe them away with angry balled-up fists. Quick one, two jabs, a boxer fighting a terrifying new opponent. I make you laugh; some stupid joke I've used hundreds of times before to put patients at ease, but it is gratifying to see you crack a goofy lop-sided grin. You tell me how relieved you are that you paid off you two-thousand dollar health care bill the other week, or you would surely be up the creek without a paddle now; and I reply with “well, I guess everything happens for a reason.” Not sure that it does though. The paramedics brought you to the hospital because you fell from a ladder and had sharp back pain. You thought the doctors would just give you a quick once over and maybe prescribe some of the those lovely pain pills. Instead you went through a battery of tests; CT scans, blood work. Diagnosis: metastatic colorectal cancer. Bet you didn't see that coming. As I put your armband on we share a moment of silence. All the unanswered questions and fears hang thick in the air. There is nothing I can say that will make it okay, I can't cure you; but I can stand beside you in this moment. I can at least do that.

Addict

You mirror my quiet desperation with your violence; your visceral mass of aching pulsating need, bloody and vulnerable. You don't care who sees you, judges, who steps around. Your wide, gaping want, gulping and sputtering. The now now now of it, a metronome of addiction.

A Cocaine Pain

Did I force you to buy the cocaine?
Did I spend the last forty-eight hours shoving it up your nose?
Nope.
Now you say your heart is racing? Get out, really?
So, what you are saying is that you want me to spend my hard-earned tax dollars
treating you; when we could be keeping the bed open for someone who is actually sick? Not someone who spent the last two days on a bender sticking foreign substances up their nostrils.
And no, I don't care that you are wearing an Armani suit, but I'm sure the psych patient who you get to sit next to for the rest of the evening would love to have a nice long chat about that very fact.

Insider Tips

1) When presenting at the triage window have your care card or a form or picture ID ready and give ONE I repeat ONE complaint. For example; stomach pain, left foot pain, right eye swelling, chest pain. Whatever you do do not say "I feel sick" that is waaay to general. Also, do not launch into a long convoluted story. All we want is your one sentence reason for why you are in the ER, we will get a more detailed story when we get you into the booth, okay?

2) Whining, crying, moaning, yelling, fake fainting, throwing a tantrum will not, I repeat not get you seen any faster by a doctor. It will only serve to annoy the nurses and other ED staff and possibly get you thrown out. People who are in real true pain, are too sick to throw tantrums. Also, if you are speaking to me in full sentences and breathing normally, you are not in having an anaphylactic reaction; so please stop self-diagnosing.

3) Relatives. When deciding you are ill enough to warrant a visit to an Emergency Department please limit the number of family members your bring along to one to two. There is no need for you to haul the whole extended family in and take up the entire waiting room. Similarly, if an accident happens at a wedding,or gathering there is no need for the entire wedding party, all fifty of you to be in the wait room. Pick a few to stick a round, the rest of you go grab a beer. Finally, please keep all children at home, the last thing sick people want is a crying baby sitting next to them; and I'm sure the last thing the crying baby wants is a person who's vomiting sitting next to them.

4) Headaches/Nausea/Vomiting. Ok, now is the time to become adults and be proactive about your health. There are the marvelous places called pharmacies (or chemists) they dispense pretty little pills that can aid with a myriad of ills. So before coming to the ER, try taking a Tylenol or an Advil for your headache, and hanging out in a darkened room. Feeling nauseated? I suggest trying out some Gravol. These are all things we are going to try giving you when you first get here any way. So why don't you see if it works for you at home first. It will save you the trip and save us the time and beds. Also, Benadryl, works wonders for minor allergic reactions, like hives and itchy, etc.

5) Lastly, for the love of Pete, leave home with some form of identification that has your name and birthday on it. I'm not fussy, if can be a ketchup-smeared post-it note shoved it the back corner of your wallet that has never seen the light of day; just something, that so when you come in unconscious we can identify you and find your medical history. Now, ideally, I would say find your medical care card and stick in your wallet along with a little note that has an emergency contact number and any relevant allergies/medications; but that's only if you want to see me dance a little jig.

Bitches be Crazy

Lesson of the day; listen up boys this one is for you:

Be careful of the females you choose to keep company with. They may be holding secret grudges against other ladies and then when they come across them at a park one evening decide to get their brawl on. Then you laddie boy, may get caught in the middle, catch a left hook to the ribs, and get bear sprayed left eye. Let me tell you when you're no Johnny Depp to start with, it is not a pretty picture people are left starting at. You end up looking a tad more Popeye then Captain Jack. Safety first, okay?

Last Thoughts

What were you were you thinking as you heard the police on the other side of the locked door as they tried to reason with you in steady firm voices to put down the knife?

What were you thinking in that split second as they broke the door and you chose slit your throat with such force that you sliced your windpipe in half?

What were you thinking as you began to bleed out on the floor? Did you see the fuzzy images of the paramedics hovering over you?

I heard about you before I saw you. "Traumatic arrest, two minutes out." Suddenly you went rushing by on a gurney dripping with blood.

I brought your paperwork in to the trauma bay. You had been to the hospital before, schizophrenia, you were 28, you had a sister.

I heard the social worker call your sibling, heard her ask if she could please come in as soon as possible, that you had tried to hurt yourself again and it was serious. The second after she hung up I heard that you were dead. I met you then.

I saw you in the trauma bay, they were getting ready to move you to a room, so your sister could say goodbye. The nurses had cleaned off the blood, and bandaged up your wounded neck. You looked quiet, pale and restful with your short dark brown hair and goatee, eyes closed. I guess you weren't really there anymore though, it was just a body.

I did see your sister. I walked by right at the moment the police told her you were dead. I saw the shock on her face and watched her collapse onto the floor with grief.

I also saw the sadness on the faces of my colleagues; the doctors, nurses, policemen. All who had tried to save you, for a life you didn't want to live.

Seriously?

It never ceases to amaze me how stupid some patients can be; talk about swimming in the shallow end of the gene pool.

Had one today, a 28-year-old male and it was like talking to a brick wall. As a matter-of-fact I think I would have had a more meaningful and fulfilling conversation with a wall.

He didn't bring his wallet, had no ID, couldn't tell me his phone number, address (previous address), or a family members number for emergency contact. Although; he said he had a mother, father, and siblings, all with cellphones & home phones. He didn't even remember the name of the company who he worked for, or a contact number at work.

Seriously.

I felt myself losing brain cells just talking to him.

Just needed to vent.

Stuck On Repeat

One of the ER docs was humming Mambo #5 all day at work the other night, and it has been playing non-stop in my head ever since.

I have been trying to think up a suitable punishment; any suggestions? Tarring and feathering has come to mind...

Junkie Love

Love is a beautiful thing...

The other night we had two junkies brought in by separate EHS crews for minor injuries, both strung-out on heroine and meth. Greasy haired, missing teeth, barely clothed. They were positioned on adjacent stretchers at Triage and over the course of the evening decided they were madly in love, and got it into their heads to run away together.

They snuck out the paramedics entrance as a crew was leaving, and luckily one of the security guards saw them as they made their bid for freedom. He found them around the side of the building going at it like rabbits; which, I also had the pleasure of seeing as I was just coming back from my break.

It is an image of flailing arms and saggy naked bums that will be seared into my skull for the rest of my waking life, and probably in the after-life as well.

They clung to each other desperately as the security guards pulled them apart, shouting vows of eternal fidelity and loyalty as they were dragged back inside.

This time the Triage nurse was sure to position them on different stretchers; although, this didn't stop them from professing their undying love at the top of their lungs for the rest of my shift; which was oddly touching in its own way.

Love takes many forms, and far be it from me to judge. Maybe they will end up blissfully happy in a little log cabin somewhere...she will bake pies, he will chop wood for the fire, and they will have six kids whose names all start with the letter P and the whole brood will live happily ever after?

Then again, maybe that's just the romantic in me talking?

Pet Peeve

Pet peeve:

Young adults aged 18-30 who go on week-long coke binges and then come into the ER complaining of chest pain.

So annoying.

FYI. Cocaine causes the blood vessels in the body to constrict. This can decrease blood flow to the heart, causing chest pain. Which in some cases can cause heart attacks, etc. AKA cocaine isn't that great for you; who knew?

Next time before you snort that line, I recommend you rethink your life choices before going on a bender,and opt for say one evening of coke induced fun, instead of a whole week. Which will save you money, and ER staff the hassle of dealing with you.

And, PS: Stop crying, you brought this upon yourself.

(Can you tell I had a lot of those come in last night?)

So you want to go the Emergency Room?

Dearest readers,

I know having to go to the ER can be a frightening and overwhelming experience to those who do not work in the health-care industry. Here are some tips to help things go as smoothly as possible:

1) Please refer here: http://emergencynights.blogspot.com/2008/10/definition-of-emergency.html for what are NOT considered emergencies, therefore saving you a visit (and me the headache) altogether.

2) Bring this http://emergencynights.blogspot.com/2008/10/identify-yourself_21.html with you.

2) When you walk through the sliding doors, read the giant sign that you can't miss that says "Wait behind the yellow line for the Triage nurse to speak to you". This aforementioned line, being the thick neon yellow line at your feet. Sometimes the nurse is busy triaging other patients. Do not fret, she will be with you as soon as she can. Do not:
A. Over step the yellow line to bang on the glass.
B. Come over to my desk yelling that you need to be seen ASAP, because your
toe hurts; I can do nothing for you until you have been triaged and are in the
computer system.
C. Hurl abuse at the other patients waiting, bemoaning the state of the health care
system, and telling them that your injury/illness is much worse that theirs; I'm
sure they don't appreciate it.

3) When the nurse is available she/he will ask you for your ID, and what the matter is. If she is not at the window when you first arrive, perhaps you can use this time effectively to think about what it is that has brought you to the ER, so when she or he asks you, you can give a concise, to the point answer. After taking your details you will be either asked to come into the booth for a full triage, or asked to sit in the wait room. Sometimes we get busy in the emergency, so wait times can be long...yelling abuse at the ER staff will not help things go quicker, FYI.

4) After you have been triaged in one of the booths, where the nurse will ask you questions about your illness/injury, and take your BP and temperature you will sent to one of three areas:
A. The acute side
B. The treatment area
C. Back in the waiting area, until there is a bed available for you.

5) This is when you get to talk to me. I will come around to either your bed, or have you come up to my admitting window. I will ask you lots of questions, some of which may sound irrelevant and annoying, but trust me are important. Perhaps something else you can think about while you are waiting to see the nurse, is who you would like to have down as your Next Of Kin contact, preferably a family member.

Please to not tell me that you have no one to put down; I will settle for a friend or colleague in a pinch. The worst thing is when patients are brought into the ER unconscious, or very badly injured and they have no contacts on their chart, no one to notify. Please also to not act like it is a big hassle when I ask you these questions, you are the one who decided to come to the ER, and this is my job. I'm sorry asking you for your phone number is the most annoying thing on the planet, but it is my job, so deal.

6) After I have finished getting all your details, I will give you a snazzy little bracelet to wear which will have your name, date of birth, health care number, hospital number and date on it. Please keep it on at all times until you have been discharged. This wrist band is how hospital staff know they are running the right tests of the right patients; drawing bloods, doing a cardiogram etc. Do not pull it off and stuff it in your pocket, or throw it out.


After all of that, the doctor will come and assess you and things will proceed along from there. Hopefully this post has been helpful in quelling some of your fears and has given you some tricks as to how to make your trip to the emerg. run as smoothly as possible, and how not to act like a douche-bag to the staff therefore, helping ensure a high quality of patient care, and a happy home-life for those of us who have to treat you.

Thank you for your time.

Acceptance

There comes a time when you have to let your loved ones go.

I know it is hard, and that it may seem like an impossible task to face life without them.

But if your special someone is suffering from incurable pancreatic cancer, and the doctor's here have said that there are no more treatment options, and the best thing to do is to make him comfortable; do not cart him on a fourteen-hour flight to Hong Kong to try some herbal remedies.

The last thing you want to have happen is for him to become horribly ill on the flight home, and to have to go straight from the airport to the ER, and then have him die overnight from the toll the trip has taken on him.

Wouldn't it have been much nicer to have had him pass away peacefully in the palliative care unit or at home, surrounded by those he loves, then in a busy, noisy, smelly emergency room?

Just putting it out there.

ETOH

ETOH stands for ethanol. More specifically, in medical notes, drinks containing ethanol. So pretty much when the EHS crew brings you in on a stretcher and in their Chief Complaint section it says ETOH, it means you are drunk off your ass, or have done something remarkably stupid while drunk off your ass.

It seems in the past week, that all of our Medivac chopper flights have been bringing people in with ETOH related complaints.

There was the one guy who got really housed, then decided to climb a ridiculously high tree and fell off; of the guy who imbibed a little too much Jack Daniel's and then went for a ride on his off-roader which inevitably crashed, the one who fell down the stairs and broke his back...and the list goes on.

I'm just going to put it out there that this is not a ringing endorsement for people from the city to move to the country. It makes us think that it must be so boring that there is nothing else to do but get drunk, do incredibly stupid things and get flown down to the big city for treatment.

A Hunk Of Burning Love

What is it about firemen that turn usually level-headed, mature women in to giggly school girls?? Is the the big red shiny truck? The uniforms? The whole 'hero" thing?

I don't know, but today we were graced with their brawny presence, and even the 50-year-old female doctors became flirty school girls.

It all started with a hysterical 17-year-old girl at Triage. I didn't get the full story but somehow she got an incredibly small ring stuck on her finger, which was rapidly beginning to take on the colour and dimensions of a tomato.

The nurses in Treatment attempted to locate our ring-cutter but to no avail. It seems like the sneaky little gnomes in OR like to steel our cutters and not give them back. When our charge nurse called to get them back they refused to give them up. As the girl was in increasing amounts on agony, time was of the essence. After trying to locate another set which was another exercise in futility, the only other option was to contact the fire department. After calling the non-emergency line and no one picking up. The charge nurse was forced to call 911, which was pretty funny listening to her explain our situation to the operator.

About ten minutes later three of the best-looking firemen I have ever seen strolled through the door. I'm sure they must all have been featured in last year's calendar! One of them was clutching the jaws-of-life and revving it full blast saying "so ladies, where's the finger??" with a big grin on his face.

Luckily the hysterical 17-year-old was in a room, or I'm sure she would have passed-out upon seeing the contraption. For those of you who may not be aware; the jaws-of-life are used to extract people from vehicles, not cutting off tiny rings.

Five minutes later they swagger back out, having cut off two rings, the girls, and some other gentleman who just happened to need his ring cut off as well. As they stepped out the brawniest of them turned around and joked " looks like you got two for the price of one, ladies. We'd be happy to help any time, you know where to find us" Seriously, I'm not kidding that's exactly what he said.

Then our attending blushed and giggled like a 13-year-old.

And that my friends is the story of the firemen, the ring cutter; and how you get female ER staff to swoon.

"Honey, I'm home".

Hello.

I don't know if you remember me, but I use to come here sometimes and blog about my life as an ER Clerk, but then I moved to Australia and took a job as something less exciting; henceforth no blog posts, but guess what? I'm back in the ER!!! So now exciting blog posts will resume again.

You are more than welcome to come along for the ride.

Mr. Sunshine

I came up with a name for him by my second day of work, "Mr Sunshine".

He's a tall man, I would gauge him to be at least 6"4 in his late 30's. His outfit of choice is a pair of running shorts, white sneakers and any assortment of t-shirts that have seen better days. He sports a shaved head, whether that is from chemo or by choice I don't know; his face swathed in a permanent five o'clock shadow.

Every patient that comes through our doors is bound to be having a tough time; going through the kind of struggle that I can't even fathom with my cancer-free body. The surprising thing is how friendly and jovial 99% of them are, it blows me away. They come up to my desk always ready with a joke, or quip, all smiles and hellos. Mr Sunshine draws a severe contrast.

You can feel the air change when he walks through the door, his posture hunched and angry, his eyes scrunched up in a permanent squint. He slams his booking card down on the counter and grunts, avoiding all eye contact if at all possible. I am lucky if he sticks around long enough for me to give him the time for his next appointment. Any communication he has is through hoarse whispers, and finger pointing.

I figured he must have laryngeal cancer or something to that effect. The strange thing is that his wife is lovely; a petite brunette with a willing smile and caring demeanor, any of his tainted interaction with the outside world seems to roll right off her.

The other day when I was checking him in, I took a closer look at his diagnosis, I was correct in guessing laryngeal cancer, I looked over to one of the other columns on my computer screen and saw the word, palliative. I guess if I found out I had in incurable cancer and was dying I would be angry too.

I still don't relish the thought of dealing with his sunny disposition on a daily basis, but at least I understand a bit better where it is coming from.

The brain is a muscle one must exercise frequently...

Sorry...I know I promised imminent updates on the new job, unfortunately my poor under-used brain went into overload and almost crashed from all the learning!
I think I'm going to like this new job; there is a plethora of computer programs to learn, but as soon as I get on top of that, I think it will be fine.

My favourite part so far (and I think will continue to be) the patients. The majority are 60-plus, and they are really lovely, always smiling and joking. Everyone becomes a quasi-family in the department because the patients come in everyday for usually around 6 weeks for treatment, so they get to know one another and us. We were inundated with Easter chocolate given by the patients today, I left with a whole bag full!

The toughest part has to be seeing the children. Little five and nine year-olds coming in for treatment. There is one little girl, who is just adorable, short little brown ringlets and as shy as they come, such a cutie..I can't imagine how hard it would as a parent to watch your child go through that.

Anyways, this post isn't as exciting as I had hoped; I have the next four days off over Easter, so hopefully my brain will get a chance to decompress and I will get some stories up about some of the characters that I have met.

Back and better than ever..well, I'm at least back

Bonjour,

I apologize for the gap in all things blog related, I just had to go travel around NZ, and move ALL the way to Australia.

Now that I have found myself a new job as a Radiation/Oncology booking officer I shall have new fodder with which to feed you. I know it probably won't be as exciting as my daily life in the ER, but hopefully there will be enough to sustain you until I get back to my old job!

I start bright and early Monday morning....and I will let you know all the dirty details

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....