Tuesday, July 22, 2008

As Seen on T.V (and just as glamorous)

Last night was hellishly busy. I had a really heavy (but overall pleasant) patient load. On top of the usual belly pains, IV antibiotics, sore throats, vomiting x 2h, "sore ears", and back pains, I had two admitted LOL's* who both had anemia from G.I bleeds. Both had diarrhea (one of them several times--those were good times) and I was running blood transfusions on both of them all night.

Transfusions are a major pain in the derrière as you have to take vital signs on pt every 5, 15, 15, 15, 15, 30, 30, 30...etc. mins. And when you've got two at the same time it means a lot of running around. Plus each lost an IV site which had to be restarted. One of them had nothing for veins and was needed three separate lines so I was running out of options. It's good that I have no pride in terms of gauge size because I put a weensy one in for the potassium and left the garden hoses for the blood and pantaloc.

I also had a raging ETOH'er who was detoxing and needed regular full bedding changes from his soaking sweats and sedation to keep off the potentially life threating delirium tremems he was going through. Nice guy actually, from Egypt. Was dismayed to find out he had cocaine on his tox screen and assured me he had never done the stuff. We brainstormed a few ways that he had ingested it, then he figured it was some guy from Florida that gave him some cigarettes that made him feel "funny". Those guys from Florida. Gotta watch 'em.

My LOL's were cool too. One of them was a 96 year old who told me when she got out she was planning to start training for the Olympics because she wanted to go to Whistler. She also referred to the IV pole with several heavy hanging IV bags and blood units as her "Christmas tree" and her arm all taped and attached as her "decorations".

The only heinous patient was this dude who had MRSA in his lungs and was adamant that his isolation precautions were "bullshit" and that he knew all about "SARS" and that it could only be transmitted by blood. I attempted to explain that it was MRSA that he had, that he was putting others at risk, and that it was highly contagious through droplet transmission. Anyway he ensured that we all knew his stance on the matter by using the patient phone all night, leaning over the nursing desk, leafing through the magazines, and going outside for several cigarettes to "loosen up his chest". I tell ya, if I was the MD that guy would have been packing his little patient belongings plastic bag and on his wee way out the door before you could say "superbug"**. But no. I was not the doc, I was the one getting blood and poo all over me all night.

Which brings me to the funny part of the day. After work I was on my way to Save on Foods (I know, I know....it's just not right to go to a grocery store after working in an ER all night) and was walking towards the double doors when I looked down and realised I had dried blood down the front of my leg and all over my shoes. It was also at this point the wind changed and I realised that I smelled like melena and truly was a threat to society. So I turned around and walked back to my car laughing to myself at how ridiculous this job can be sometimes, drove home, had a shower, changed, then went back.

Got home and fell into bed, did my usual daily C.S. Lewis read, and attempted to sleep. The lyrics to a Gillian Welch song called "Bar Room Girls" pops into my head. It could be called "Night Shift Girls" and ring just as true...

"Well she tosses and turns, 'cuz the sun is unkind
and the heat of the day
is comin' in through the blinds...
leave all the blue sky
to the rest of the world
'cuz the neon shines
for the bar room girls"

*Little old ladies.
** After 6 days of contaminating our already MRSA friendly ER the pt was finally discharged home. Why he was there that long is a mystery to me. He refused to wear oxygen, refused nebs, and was simply taking his meds from home anyway. So what were we doing for him? Well, other than bringing him hot water, juice, sandwiches (and following him around with the most potent cleaning supplies known to man).


Rogue Medic said...

My feelings on people with contagion is that they should be prevented from spreading it - if they make no reasonable attempt to contain the spread on their own. The permissive attitude toward this, whether it is Typhoid Mary, someone spitting blood and claiming to be HIV+, or someone with respiratory MRSA and criminal illiteracy, is completely wrong. Endangering the other patients and the staff, just to appease some idiot, is bad medicine.

Of course, there are ways to explain this to the person, that they may understand. Sometimes it just takes more than one lesson.

Albinoblackbear said...

I couldn't agree more RM. There are currently 2 nurses from the department off with MRSA related issues. As we've talked about before, precautions with known contaminated cases are laughable in ER settings (and totally unreasonable with the amount of time it takes to do simple tasks).

Last night another pt had VRE colonized from his urine but was not put on precautions because he was the father of a staff member.

I'm sorry, what???

Soon everyone will have MRSA-VRE and I suppose we won't have to worry! :)

Rogue Medic said...

There was an article on the internet years ago - VIP medicine or executive medicine - it was by a flight surgeon and examined the effect of medical decisions made to accomodate VIPs. Sometimes at the request of the VIP, sometimes because it was believed that it would be undignified to treat the VIP as if they were a patient of the same species.

One general was essentially killed in this way, being spared the insult of a prostate exam after symptoms that would have indicated one. By the time the general followed up with another doctor, it was metastatic. President Lincoln might have survived being shot in the head, severely impaired but alive. The senior medical staff, unfamiliar with battlefield medicine kept poking and prodding in his brain with probes. Presidents Garfield and McKinley were also probably hastened on their way to the grave by out of practice, but distinguished doctors, because the president deserves the very best.

Reagan was smart enough to tell his doctors to treat him just as they would anyone else. Being shot and going to a trauma center then meant a rectal exam. It is not mandatory in trauma any more, but was part of the standard of care, back then. I believe that he received the same care anyone else would have, which would include that unpresidential exam.

When we make exceptions to rules for political, social, or other reasons that are not medical, we endanger the patient, and/or other patients, and/or staff.

Ryan said...

"...walked back to my car"... Wait a minute, don't you have OUR car right now??????????????
Maybe it's time for that trade in.

Albinoblackbear said...

hee hee

No that was the day before we swapped...which means you're already too late...what do you think the wipes in the glove box are for??


Just trying to toughen you guys up!