Friday, July 29, 2005

Night of Lacerations

We had a Night of Lacerations recently in the ER. I was working in the Pediatric area. It's a bit more complicated when the kids come in because they have a hard reconciling "sewing your head closed is a good thing" with "AAGH! Needle in my head!!" Sometimes the kids are really good and just sit there with wide eyes. Other times they scream their little heads off.

One night there was a boy about eight who was quite accomplished at delaying the proceedings. After the doctor calmly explained that she was going to deaden the area, he had lots of questions. Why was this necessary again? Are you absolutely sure that needles must be involved? What are your qualifications to make this judgement?

Despite his tactics, the needle eventually went in and he was stitched up. There was some shrieking, though he saved the best for last. Afterwards, when the doctor asked him how he was, he narrowed his eyes, shot her a look of pure hate, and tossed his head contemptuously.

Another time, a kid of about six had a nice gash between her eyes. It was deep, so the plastics doctor was called in to do it. They did a conscious sedation on the little girl. The patient is still able to communicate, but there's no pain and often no memory of the procedure.

I had it when my wisdom teeth were removed. I have only one brief memory, "waking up" and seeing spatters of blood on the face guards of the people around me. I distinctly remember thinking, "Oh. Not done yet. Okay, back to sleep," before sinking back into amnesia. I'd love a videotape of the procedure. My teeth were still mostly covered by my gums so I presume they had lots of cutting and teeth cracking to remove them. I do have two polaroids of myself spitting out a mouthful of blood when I got home. So there's that.

Anyway, when kids are likely to fight back (something that can still happen with conscious sedation), they get strapped down. The door to her treatment room was closed, but you could hear her screaming all the way down the hall. Seriously, you'd think they were torturing her in there.

The mom had to leave and sat in the hall with tears in her eyes. I and a fellow employee felt much worse for the mom. The kid was just scared and being ornery; she was pain-free and likely to forget the whole experience. The mom had to see and listen to her daughter freaking out.

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Wednesday, July 27, 2005

Vacation, all I ever wanted

Yesterday I put in my notice at work that I would be going PRN in a few weeks. PRN is is an acronym for pro re nata, or "as needed." Rather than work a fixed schedule, I'll sign up for shifts that need more staff. As the school semester starts in late August and there isn't any benefit to me working a fixed part-time schedule, it just makes sense. It does mean that I won't be putting in anywhere near the hours I did this summer, hence less stories to share in this space. Luckily, I have a backlog. The well is far from dry.

My boss hasn't actually acknowledged my notice, which certainly could get awkward in a few weeks when I stop showing up for work. We'll see about that today. All my work friends know and are generally supportive, though there is the requisite whining about losing a person who does the work quickly and correctly. To which I say, "Suck it bitchbags!" No, I like my work friends and am a little sad that I won't see them as much.

The decision to sort-of quit has been brewing for a couple weeks now. Some of the managerial boneheadedness was beginning to chafe, as it always does several months into a new job. I need to have a summer vacation before I hit the books again, so it's Devo in New York, my Dad's home town, The Shockwave, and Boogie Bahn for me.

Oh, and here's a great quote from a patient,

"I'm not usually a paranoid person when I do drugs. Maybe they're putting something in the drugs."

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Wednesday, July 20, 2005

Well that took a turn for the bittersweet

Monday and Tuesday were again hella-busy. Is hella old enough to be nostalgic for? Probably not.

As opposed to last Monday, this week I was well-rested and maintained a chipper, can-do attitude despite the constant stream of incoming ambulances to the "crash" area of the ER. I kept my head above water with my work and managed to stay out of the medical staff's way. My co-workers are happy to leave me to it and I really enjoy handling all the details. Nothing unusual so far this week, a few ODs, several car or motorcycle accidents, and lots of chest pain.

The one great bit tonight was the long conversation I had with a patient who'd recently moved to Austin from Chicago. She was disappointed in Austin so far. The night she went to see the bats fly out, they stayed underneath the bridge. A restaurant that was recommended to her turned out to be terrible. Then there's the oppressive summer heat.

Of course I defended my hometown. The bats won't come out if rain is a strong possibility since the bugs they eat won't be out either. There are lots of great places to eat, and the restaurant she went to isn't one of them. As for the heat, well that's what A/C and Barton Springs is for.

It was a fortuitous meeting since I currently plan to move to Chicago a few months after I graduate school. One of the reasons I'm becoming a nurse is so I can move about the country and world experiencing life in different places. Chicago is at the top of my list because I already have friends there, there's lots to do, and I think the professional experience will be gratifying. The harsh winters will just have to be endured. After that there will be Hawaii, Toronto, London, New Zealand, China, Ecuador, New York, et cetera.

In a way, it seems ludicrous that I would leave Austin. I have it so good here; lots of friends and family, relatively cheap entertainment, a socially progressive populace, and a profound sense of comfort. It's incredibly easy to get stuck in the velvet rut that is Austin, just contentedly drifting along.

Austin will always be where my heart lives and I'll come back to visit often, but by the time I get out of school, it will be time to move on.

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Sunday, July 17, 2005

A few short quotes to amuse and edify

Drunk guy, "I've been blacking out for years, but right now I'm off my anti-blacking-out medication."

Psychiatric patient, "Go ahead and take my blood. It's as pure as white cake!"

Patient with back pain, "Can I have something to eat? Like a pain killer?"

Thursday, July 14, 2005

Open letter to a father who brought his son to the ER

Dear Sir,

I'm trying to imagine the circumstances under which your 10-year-old received multiple ant bites on his penis. Enlighten me.

Thanks so much,
St. Murse

Tuesday, July 12, 2005

Come one, come all. Apparently by ambulance.

Last night, work was ugly. Not only was I tired going in, but we were slammed. Last week Austin-area hospitals ended the long-standing practice of going on diversion, which meant that when they were close to being full, ambulances were diverted to other hospitals. EMS hated it because it made for longer rides, less availability, and patient's directives on where they wanted to be treated were often overruled.

Starting last Tuesday, the hospitals agreed to accept all ambulance traffic unless they have some sort of major internal problem. Practically it means that the hospitals have to quickly treat and discharge those patients who aren't serious, and make room for those who are.

As I've noted before, many people come to the ER for fairly minor problems that should be seen by a primary-care doctor or community clinic. Unfortunately, the medical system in the US is not set up to adequately care for us all, so these people come to the emergency room.

Like many hosptials throughout the country, we have a fast track area where patients are seen quickly, often by a nurse practitioner or physician's assistant rather than a doctor, for minor problems. These are the people for whom the phrase "treat 'em and street 'em" was coined. Last night, in our crush of business, the wait for even the fast-track area was roughly five hours.

In light of the volume of patients, the medical staff were pushing hard. Not only were fast track patients were being shuttled through quickly, but the regular treatment areas were on overdrive, meaning that I and the rest of the registration staff had to step it up as well. Pair being understaffed with more ambulance-delivered patients than I've ever seen, and it made for an exhausting evening.

I could go on about an incident of childish behavior by a manager of my department, but I'll spare you the ugly, yet mundane details. Suffice to say, due to my growing annoyance at occurrences, I may be going part-time sooner than I had planned.

Mondays are always the busiest day of my week and it's likely to improve, so I will endeavor to regain my usual attitude; sunny, yet archly cynical. Maybe I should stop listening to The Sundays right now and switch to Banarama's "Cruel Summer" which is also sunny, yet archly cynical.

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Saturday, July 09, 2005

Demetri Martin is a funny, funny man

Demetri Martin had a great show last night at Emo's at a taping for his first comedy album. About a third of the material I've heard before on his talk show appearances and Comedy Central special, but funny is funny and he killed. Demetri is a former writer on Late Night with Conan O'Brien and a great comedian.

I was surprised by the turnout, the inside room at Emo's was packed. I guess the postcard marketing and/or word-of-mouth worked. Less surprising was the largely hipster crowd, in particular the two Demetri-clones. Seriously, same "gay Beatle" haircut (as Demetri calls it), same lanky build.

The show was marred only by Annoying Forced Laugh Guy who clearly was trying to make an indelible impression for the recording.

My favorite joke of the night was one that bombed. It's a bit of a sleeper.
"There's not much difference between saying I'm sorry and saying I apologize. Unless you're at a funeral. Worse still, my bad."

There are several more tapings in Seattle and San Francisco. I hope the CD comes out well. Here's an NPR profile of him with a link to a few of his jokes.

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Friday, July 08, 2005

Quasi-obligatory post about the Real World

I've instituted a policy when it comes to watching The Real World Austin. I'll Tivo it, but I'm fast-forwarding through all scenes in the house. That way, I won't have to watch all the "drama", yet and I can still see where they go in Austin. So far, they haven't ventured more than a mile from their converted warehouse except when they were introduced to their job: making a music documentary about South By Southwest.

It was quite odd to see them sitting in a meeting on the UT Campus with film professor Paul Stekler. I never had him while I was at UT the first time, but I've met him several times since and was interviewed on camera once for a political doc he was making. Thankfully, I didn't end up in the film. The real surprise was when Stekler introduced the cast to their sound tutor Jen Garrison, with whom I worked extensively many years ago at the campus radio station.

During SXSW, I saw the RW kids shooting at the convention center and at a few clubs. At the time, I couldn't imagine why they were taping Enon. I mean, I like them, but they're not what I think of as an MTV hype band. The Real World's first episode did show a bit of footage from the night the cast was at the Enon show so we'll see what ends up in their doc.

Anyway, I was intrigued from a medical standpoint when in the first episode, RWer Danny was punched hard enough to break his cheekbone and cave it in. I just watched the episode where he gets surgery to repair the injury and there was a quick shot of the name of the facility, Surgical Hospital of Austin. It's not a full-service hospital and not one with which I'm familiar.

With minimal effort, I found webpages for Danny's plastic surgeons Dr. Scott Haydon and Dr. Todd Shepler. Despite the surgery, he apparently still has blurry vision in one eye and is suing the guy who punched him.

In addition to that bit of news, The Austin Chronicle published this rather unsubstantial piece today. Not noted was the big No Trepassing signs posted all over the outside of the RW house while the cast was living there. The alley behind the house was closed off as well the few times I passed it.

Why am I expending energy writing about the frickin' Real World? Insomnia baby.

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What's funny when you work in an ER

A few co-workers and I were discussing a patient that had apparently taken off before being discharged. She's a regular in the ER, either as a patient herself or accompanying one of her fellow homeless, drug-using friends. We were talking about how to handle her registration when a nurse well-acquainted with this patient stuck his head in, listened for a moment, and said,

"If she's the last woman on Earth and I'm the last man, that's it. History is over. I'm playing with myself until I die."

Then we all laughed and laughed and laughed. Have I mentioned that a dark sense of humor is practically obligatory when working in an ER?

One time the med staff and I were waiting for EMS to come in with a kid who'd fallen off his skateboard and hit his head. Of course he wasn't wearing a helmet. We were just standing around when one of the Spanish translators came in saying,

"Somebody call me?"

To which the doctor replied, "No, but we might need someone who speaks head trauma a little later."

Then we all laughed and laughed and laughed. Yeah, we're sick bastards.

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Thursday, July 07, 2005

Loud sounds from near quarters

The other night I experienced an incredible sensation, a mixture of delight and pain the memory of which still makes me smile and wince simultaneously. It was this, an adorable baby shrieking happily. Sure, you've seen cute kids and heard they're high-pitched yelps, but this child and the noises she made are several orders of magnitude greater than I have previously experienced.

Imagine a cherubic face, bright eyes, and a smile that could conceivably turn Karl Rove away from the dark side. This baby was cuter than that. Now imagine a pterodactyl loosing a vicious cry as it drives off a rival suitor. This baby's voice was more ear-piercingly painful. Clearly the child was exhibiting early signs of being a mutant with superpowers.

Another night we were treated to the periodic, stentorian exhortations of a woman off her psychiatric meds. Despite being in a room with a closed door, you could hear her throughout most of the ER. She would go on for 15 minutes or so, then quiet down for a bit before going on another tirade, the main topics of which were God, people bothering her, and the fact that the door to her room was closed. All reasonable topics that could be argued coherently. However, she sounded like this:

"Gaw blah hibba! God friltcha said the door is closed! Abba. Aieeeeee!"

She was also rather uncooperative with the medical staff. When asked to drink some Gatordade, she had been shouting on and off for 6 hours after all, she said in a scandalized voice, "I'm a Christian!" Turns out this was her response to most requests.

I feel for the medical staff. When I have to register a patient like this, I can just write, "Patient is altered, unable to answer questions or sign paperwork," and my work is practically done. The med staff have to persevere in communicating with the patient and treating them. I don't look forward to this part of the job.

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Tuesday, July 05, 2005

What passes for a July 4th post around here

Over the weekend, I dreaded going to work on Independence Day because of the large potential for fireworks injuries and drunken car accidents. I'm happy to report that July 4th ended with only one minor fireworks-related incident and one drunken assault. Of course there were people who fell off things, had seizures, or didn't take their meds/took an excess of meds to make up for it.

So really, it was a typical day aside from the plethora of flag-themed scrubs on the med staff. Like this:

From a purely design persective, red, white, and blue is an ugly grouping of colors to use in clothing fabric and, consequently, Tommy Hilfiger is vile.

Speaking of vile and flags, if the perennial flag-burning amendment (otherwise known as "bread and circuses while Rome burns") gets out of Congress and goes to the states for ratification, there will be a great market for faux-flags. Completely legal and ready to burn. John Scalzi says and demonstrates the concept better than I ever could.

Can't quite get my head around what is essentially an edit of the First Amendment. "Freedom of Speech. Yes, good idea. Wait, no, but not burning a symbol of that freedom. No, that's so awful that we must take time out to specifically try to prevent it, but ultimately fail because people can just burn reasonable facsimiles thereof." Then again, I'm a bit out of step with a third of the young people who think the First Amendment goes too far. Sigh.

As far as flags-as-a-print-for-scrubs, I prefer the Canadian flag. Simple, immediately recognizable, and just a bit (serrated) edgy. I tried to find a picture of the scrub top sported by one of the Canadian med staff, but Google failed to offer it. Though it did find this and this. Oh Internets, you are so fickle.

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