"Now there is some blood involved."

This week I'm working for the first time in the part of the ER where the true emergency patients are seen, like serious car accidents, overdoses, or acute heart problems. Wisely, new staff don't get to work there right away as it can be fast-paced and procedures are a bit more complicated. Also, the bosses don't want you fainting when somebody comes in bloody and missing a bit of their calf from, oh say, a boat propellor slicing it off.

Thankfully, that's not a problem for me. One time I was registering a patient who'd fallen and lacerated his scalp. Head wounds bleed copiously, even when they're not that serious, and this guy's face and hands were covered in dried blood. He was in good spirits and as he signed forms, all I could think about was how special effects guys would kill for that level of garish realism.

It's not for everyone, but I enjoy seeking the variety of patients that come in and am intensely curious to see how treatment is done in the various cases. I'd be totally bummed if my plans to be a trauma/ER nurse were derailed because I was paralyzed by the sight of a close-range gunshot wound rather than galvanized into action.

I've never considered myself an adrenaline junky. I'm not into extreme sports, I don't drive fast, and I've never taunted a large predator with a chair or my buttocks. Now I realize I've just gone a nerdier route to that high. Consuming large amounts of caffeine, rapid-fire high school debate, low-stakes poker, public speaking, spazzing out to a great band, political campaigns, and now, the ER.

Despite my age (we won't get into details, but I'm significantly older than my classmates), I feel like young whippersnapper when I get excited about something, as my friends will agree (with a sigh and a rolling of eyes). I'm pleased that I get that "aw yeah!" feeling about my future vocation.

Speaking of getting the juices flowing, today I saw a Liston bone cutter, though not in action.



Guys, doesn't that make your balls suck up into your body cavity a little bit? Ladies, I have no idea what the correlative experience is, please enlighten me.


Technorati tags: blood, adrenaline, bone cutter

A study in contrasts

Pulled another loooong shift at the hospital. First time on a Friday night though. Very tired now.

Huge contrast tonight between two particular patients. One was an incredibly good-looking man, one was the worst-smelling person I've ever encountered.

Chesty McProud kept his upper body bare for the entire evening to the delight of certain staff members. Stanky Von Greazy's foul odor seeped out of his room to the horror of all who walked by.

Chesty apparently takes the time to shave his entire body. Stubble was noted on his chest, foot, and the backs of fingers. Stanky can't be bothered with even rudimentary washing up. His blue jeans were in fact brown and shiny from dirt and body oil.

Chesty was a little flirtacious once the pain meds kicked in. Stanky, not mentally ill, thought his lack of hygiene was funny.

Chesty would be paid well as a model. Stanky could be well-compensated by the smelling salts industry if he could figure out how to bottle his odor, particularly the vile reek of his feet. Seriously y'all, like a vat of warm cat shit.

Out of the mouths of prisoners

Occasionally at the hospital, we get people under arrest as patients. Sometimes they get hurt fighting, sometimes they suddenly get sick when the cuffs go on, and sometimes they're just drunk off their ass.

Regardless of the situation, by and large, they are an uncoopertive lot. This often amuses the hell out of me as the medical staff and police officers have a withering "seen it, not impressed" attitude with regards to the more surly of these patients. A few examples:

As part of my job, I put ID bands on patients. When I put one on this particular patient already in handcuffs, he turns to the arresting officer and says, "Now that's what I call loose."



Another part of my job is having patients sign paperwork. An intoxicated gentleman handcuffed to a gurney gamefully provides his info as he munches on a sandwich but when it comes time to sign, he balks, complaining about being cuffed to the bed. I have better things to do than argue with him (whether he signs or not, he's going to be treated and charged for it), so I leave. As I walk down the hall, I hear the arresting officer's voice fading out, "Why did you have to be so mean? These people are trying to help you and you just..."

It cracked me up because I knew the officer was just messing with the guy.



A nurse is asking a patient whose just been picked up on a warrant about his medical history.
"Do you have a history of heart disease?"
"Yes."
"Diabetes?"
"Yes."
"Asthma?"
"Yes."
"You have all these things?" the nurse asks, incredulous.
"Yes, I'm very sick," the patient says calmly.
"Do you have gout?"
"Yes."
"What is it then?
Pause. "I don't know, but I got it!"



A young, trying-to-be-tough guy is sitting on a gurney waiting for his head to get stitched up. He's been monosyllabic and surly the whole time, and now an officer is quietly talking to him. In the course of my work, I walk by the bed many times and I notice the kid's ducking his head down. After a while, I walk by again and he's clearly been crying.

I never heard what the officer said, but from the look on his face, I like to think that he was doing his best to show the kid the error of his ways and the benefit of non-criminal behavior. Though, maybe he was scaring the hell out of him with tales of prison rape.



A ER tech that clearly works out often was having a disagreement with a substance abusing patient who offered this gem, "I might do crack, you big asshole, but you do steroids."

That's not a spider bite

From the number of complaints, one would think that the spiders of Texas have begun a guerilla war against humanity. At least once a week there's someone in the ER pointing at a swollen, red bump as evidence of a spider bite. The thing is, it's not a spider bite. It's an abscess, a localized accumulation of pus due to infection, most commonly by Staphylococcus aureus (sometimes called golden staph).


At any time, about a quarter of the population has it on their skin. Fortunately, skin is a good barrier to infection. In people with an abscess, they had a cut or puncture, didn't keep it clean, and an infection developed. Often breaking the skin is accidental. Sometimes it's on purpose. For instance, skin-popping heroin with a dirty needle.

The abscess is actually beneficial in that it walls off the infection, slowing its spread. Still, it's rather nasty. Thankfully the infection usually responds well to first-line antibiotics. I say usually because strains of antibiotic-resistant Staphylococcus aureus that previously were seen almost exclusively in hospitals and nursing homes among the already ill are showing up in the otherwise healthy general population. Called community-associated methicillin-resistant staphylococcus aureus (CA-MRSA), it's a growing problem (geez that's a terrible pun). Articles about CA-MRSA can be found here and here. The Centers for Disease Control has an information page as well.

Now that we have the public health lesson out the way, let's move on to an admittedly extreme case of mistaken "spider bite" self-diagnosis.

A woman I'll call Carla came in saying she had been bitten on the ass by a brown recluse. Brown recluses do live in Texas, but they rarely bite people, and their bite doesn't look like what Carla described (and presumably what the triage nurse saw). For the curious, here's a description of a real bite.

What Carla actually had was an abscess. When she found out she wouldn't be immediately whisked in to see a doctor, out came the attitude,

"But I was bitten by a brown recluse spider. That's serious."

How she felt qualified to make such a specific diagnosis is beyond me. She sure didn't give the impression of being an arachnologist. Truth be told, ER docs often misdiagnose brown recluse bites as well, but at least they went to medical school.

After enduring a third round of complaints about her "dangerous" condition, the terrible pain when she sat down, and that *gasp* other people were being seen before her, I longed to say,

"Sweetie, you weren't bitten by a brown recluse or any other kind of spider. You have a local bacterial infection. It's not an emergency. Sit, stand, whatever. You're going to have to wait like all the other non-emergency patients. Next time, wash your ass better."

Of course what I actually said was, "Mmm. Unfortunately there is a wait."

The lesson here is that if you somehow break the skin, wash the area well with soap and water, bandage it, and keep it clean. For all my IV drug-using readers, here's some valuable information. For the rest of you, here's a bizarre little illustration from the Tacoma/Pierce County Health Department that accompanies their page on CA-MRSA.



Technorati tags: spider bite, abscess, MRSA

No Red Cross for me

You may recall what the back of my head looked like for a couple weeks in March. Well now I'm rather peeved at the Red Cross.

The policy has been in place for a couple years now, but I just became aware that they require both employees and volunteers to sign confidentiality agreements that also state that Red Cross owns the intellectual property produced by employees and volunteers during their time of service and for a year afterwards. So if I volunteered for them and wrote about any element of my experience, Red Cross would own it.

Guess I won't be volunteering for them.


Technorati tags: Red Cross, intellectual property

Hey, let's get the police involved

Steadily busy evening at work. I missed the excitement earlier in the day when a patient had to be subdued by something like eight people, security and medical staff. The patient apologized later. How decent of them.

Right before I left, I heard a visiting cop citing examples of the incredibly silly things he's "investigated". For instance, the time he responded to a call at a house and arrived to find a large group of people watching TV, eating, just generally hanging out. The officer couldn't indentify who had called or exactly what the call was about. Finally, a woman pulled him aside and said she had called because, "That guy over there keeps looking at me."

The best story though was the time he responded to a domestic disturbance call. When he arrived at the house, the "disturbance" was an 18-month-old crying. The kid's parents had called 911 because their child was crying non-stop and upsetting them. Your tax dollars at work.


Technorati tags: domestic disturbance

What choo readin' for?

Excuse me while I descend into a bit of here's-what-I-did blah blah and some bitching (also known as angry whining). Skip this entry if you find that unpalatable, which I totally understand.

I went to Half Price Books on Sunday to look for a copy of The Hitchhiker's Guide to the Galaxy, having just seen the movie. It's been a decade or more since I read the series and wanted to delve back into it. The movie was okay, not bad, not great. My enjoyment of it was compromised somewhat by the man beside me about whom I almost wrote a blog entry entitled: Open letter to the man next to me at the movie theater who paid $6 to see The Hitchhiker's Guide to the Galaxy and then slept through most of it occasionally snoring.

I didn't find a copy of the book at Half Price, but I did get a several other items, an inevitable occurence whenever I go there. The real find was a first printing of Steel Beach that is signed and not personalized. Steel Beach is one of my favorite novels, science fiction or otherwise, so I was/am very happy about scoring it for a decent price.

I also picked up a paperback copy of Carrion Comfort, an epic horror novel that I've been wanting to re-read (I've been on a re-reading kick of late). Yesterday I brought it to work to read during my lunch break and accidentally left it under the desk when I rushed off to see a midnight screening of Batman Begins, which was ultimately disappointing. The acting and production design are nifty, but it has problems with pacing and a third act that devolves into lazy action movie cliches. The last half hour bored the hell out of me. I'm sure there will be many complaints about the "slow start", but I found these scenes explaining the origin of Batman to be the best part of the movie.

Got a little off-track there. Anyway, I left my book at work last night and when I went back today, couldn't find it. I looked under the desk, in the waiting room, and checked the lending library in the break room. Nothing. Polled my co-workers, nobody had seen it. Then I asked someone on the shift after mine. The conversation went something like this,

Me: Hey ___, did you see a paperback book last night? I left it under the desk.

Inconsiderate Cretin: Oh, I think I threw that away.

Me: (stunned silence)

Inconsiderate Cretin: (blank expression)

Those who know me would unanimously agree that I am rarely at a loss for words, but there I was, speechless. The IC walked away and I stood there for a moment trying to wrap my head around this turn of events.

The book was in decent condition. It had a receipt from two days before as a bookmark. We have lots of donated books in the waiting room and employee lending library. To quote a considerate, non-cretinous co-worker, "Who throws a book away?"

Apparently inconsiderate cretins do.

Often, the IC asks me if I'm going to stay after my shift and work overtime. When I do, it makes the IC's job easier. The IC did not ask me tonight, probably clued in to how truly peeved I was by other employees. If the IC ever asks me again to help the IC out, I will say, "Yeah, let's get to work tossing all those books and magazines piling up in the waiting room. Tsk. Reading. What's up with that?"

Oh Inconsiderate Cretin, you are officially on my shit list.

P.S. Thankfully, I found a dirt-cheap copy of the book on half.com and will be seeking renumeration from the IC.

Technorati tags: cretin, books, Batman Begins

How I should deal with cavemen

Ya know what urks me? When a guy I just met tries to "bond" with me by making lewd comments about women in the vicinity. First of all, how very lame, desperate, and (literally) sophomoric. Secondly, I'm rather gay.

Next time it happens, instead of the please-stop-grunt-and-glare I typically use, I'm going to say, "Totally dude, and check out that humpy paramedic. I'd sure like to ride his ass. Now let's spit and bump chests."

Slightly unsettling

So, out of nowhere, my post Our heroes will inevitably disappoint us was included in a blogscan compendium of disappointment. I feel distinctly odd about it. Not sure why.

Childbirth, vile fluids, and hookers

I worked another long "day" yesterday, 14 hours this time. Maybe I should take more time to see friends, the sun, and my laundry room, but then money I'm making now will allow me to afford tuition, books, rent, and food for the next two semesters of school.

We were short-staffed again, so I stayed at the triage check-in desk and saw nine L&Ds (ladies in labor) in five hours. That's rather higher than usual. The tsk-tsk award of the night went to the soon-to-be-mom who'd had zero pre-natal care, which is free in Austin. Sigh.

The best part of the night was when the waiting room had been cleared out and some nurses were trading stories with an EMS guy. The subject of chest tubes came up. The EMS guy was saying how he had thought that inserting them was a delicate process, but then he saw a doctor jamming one in. One of the nurses confirmed that it was indeed a quick-and-dirty affair before telling us about the time she saw a late-stage cancer patient get one. When it was inserted, voluminous pus spewed out and it did not smell good. The EMS guy came right back with the time his partner had put a gastric tube down a guy and chili shot out all over the inside of their ambulance.

Then I starting eating my tuna sandwich. Yet more evidence that the ER is a great fit for me. Discussion of foul liquids and I can still eat heartily.

Sometime around 3 AM, I was talking with one of the police officers who moonlight as security for the ER. We were talking about bullet wounds and he showed me the bullets that the APD uses. They're designed to mushroom on impact so that they'll damage the person they hit, but won't go through them and hit someone else. Just talking about it made me antsy. I'm more suited to fixing gunshot wounds than causing them.

Finally, the quote of the evening was from the same police officer re: the quality of Austin prostitutes, "If she's a healthy ho, she's an undercover cop."

Technorati tags: chest tubes, hos

A 14.5 hour workday, in three parts

I didn't intend to, but I just finished a 14 and 1/2 hour shift. My day-and-night can be broken up into three sections with wildly different moods.

Part I: 3 to 11 PM

I worked the triage desk where you see it all. I generally try to maintain a friendly and helpful manner, but today was supa-busy and I was a hard-ass. After essentially hearing, "Did they call my name? I was wandering around even though I am supposedly in pain," for the fifth time, my response became, "You need to listen for your name, we can't chase you down."

The wait time was long and wasn't helped by the number of people coming in by ambulance who bumped everyone in the waiting room down. Overall there wasn't anything that remarkable in terms of complaints, mostly the usual top five: abdominal pain, vomiting, laceration, abscess, vaginal bleeding.

Near 11, a man comes into the ER saying there's someone outside who may not be breathing. The nurses hustle outside with Security and they bring in the patient on a gurney. Wow, excitement!

Turns out she's breathing fine and faking being unconscious. Here's a hint, to pull that off you need to keep your legs still. A nurse waves an ammonia capsule under her nose for a good 20 seconds and the patient does an admirable job of pretending not to smell it. Finally gets to her though and she rears up coughing. Turns out she's likely having a self-induced anxiety attack. It's actually quite easy to make your body freak out. Hyperventilating on purpose will do the trick nicely.

A nurse sits in a waiting room chair with a paper bag to breathe into (yes, that actually works), but as soon as the nurse walks off, she stops holding it tightly to her face and speeds up her breathing. When the patient sees that we're watching her, she starts coughing. After the third such performance, one of the Security guys holds up a piece of paper so only we at the desk can read it. It says 3.50.

I know all that sounds rather callous, but we really have better things to do. Like, oh I don't know, helping people with real problems? I'm fairly green about these things and so followed the lead of the experienced staff.

Part II: 11 PM to 2 AM

I stayed late to help out since we were shorthanded and switched over to working the pediatric ER. It was enjoyably slow and I only registered a few patients. Even when they're sick, the kids can be unbearably cute.

One of my co-workers was sick and I convinced her to go home since we were so slow. Then I read most of a Calvin and Hobbes book. Time crawled on.

Part III: 2 AM to 4:30 AM

Three kids came into the ER. One was sick. One had attempted suicide. One had been sexually assaulted.


That was my 14.5 hour day. I should get to sleep. Got to be back at work at three today, but I don't think sleep is going to come soon.

Director's Cut of Got my freak on, got my geek on

After a decent amount of sleep and no longer sore gluteus maximi, I can give a more complete and rational recollection of my Saturday-into-Sunday activities.

Several weeks ago, JenK alerted me and a number of our friends that the Alamo Drafthouse would be hosting a Freaks and Geeks marathon with cast members in attendance. The Alamo has done things similar to this before and I'd always passed on going. After a successful garage sale, JenK, John, Tina, and I were flush with cash and dreams of meeting Bill. Tickets were bought and anticipation grew.

Starting at noon Saturday and going till 5 AM Sunday, we were awash in that rare substance, television goodness. And I got thrill every time "Bad Reputation" kicked in.

Watching hours of a really good show does something to me. I care more deeply about the characters than I did when I only saw them once a week. Combine that with sleep deprivation and I got practically weepy by the end of it all. Damn but it's a good show and anyone who scoffs at the idea that a television show can be art is dumb and mean and I don't like them.

After eight or so hours, we broke off watching episodes for the Q&A. In attendance were Martin Starr (Bill Haverchuck), Sarah Hagan (Millie), Steve Bannos (Mr. Kowchevski), Stephen Lea Sheppard (Harris), and Dave 'Gruber' Allen (Mr. Rosso). Messrs. Bannos and Allen were the most effusive and excited which I chalk up to them being older and more appreciative. Bannos was also a writer on the show so he had more insight. Only two questions in and we were heard the terrible news of how the show was cancelled soon after creator Paul Feig's mother died. What a double gut punch that must have been.

It was an odd Q&A in that the answers were a mixture of interesting stories, professional struggles, wistfulness, and honesty. These are not actors that have been coached by handlers and there were consequent uncomfortable moments that, now that I think about it, perfectly complement a show full of such moments. Just a few totally obsessive tidbits that aren't in the extensive DVD features:

- If an actor made a mistake like bumping into something or dropping a prop, that's the take that inevitably was used

- Lea Sheppard (Harris) went to an audition just to accompany a friend and after being encouraged to audition, Paul Feig wrote a new part just for him

- Sarah Hagan (Millie) actually learned how to play "Jesus Is Just Alright With Me" on the piano for the "Beers and Weirs" episode, but for the filming they muted the piano and had a professional playing it off-camera

- Martin Starr (Bill Haverchuck) aspires to being a poet and treated us to a pretty decent flow

After the Q&A they signed autographs and chatted with the fans, which was nice. I was wearing my Devo t-shirt and it turns out that Steve Bannos is an acquaintance of Mark Mothersbaugh. Cool. Also, Martin Starr didn't know who Devo was and so wrote a note to himself which read "Listen to DEVO". Double cool. Then, weirdly, Sarah Hagan told me that she'd just played a character on Grey's Anatomy named Devo Friedman. Huh.

After the Q&A, the audience shrank somewhat and we watched on. We'd break every three or hours and by the end, only a quarter of the audience was left and I was sad that it was over and happy that even existed. My butt was sore, I had consumed the meat of three kinds of animal, and had spent much hard-earned money on food and drink, but I was elated as Tina, John, and I walked out into the still-dark morning. Sure, aside from the actors, I could have hosted a marathon at my house, but there was something special about watching it in a theater with an audience of fellow freaks and geeks.

UPDATE:

Here's a review of sorts printed in The Austin Chronicle.

Donorcycle weekend

This weekend is the R.O.T. rally which means lots of Harleys in town and lots of ER visits for stoopid bikers mostly without helmets (hence organ donors). I worked a 12.5 hour shift last night/this morning and we had two already. Tomorrow night will likely be worse.

Really wish I could blow up a picture of a biker with a caved-in skull and parade that up and down Congress Ave this weekend. Probably wouldn't do any good.

Are you sure that's what's wrong with you?

Sparked by an incident that happened tonight, I polled some of my co-workers and found that sometimes patients don't exactly tell the truth when the ER triage nurse asks them what's wrong. Later, when the doctor sees them, they confess the real problem. So, back pain becomes rectal bleeding, headache becomes viscous fluid dripping from the penis, and the one that started this whole exploration, rapid weight loss becomes cocaine indulgence.

Sometimes though, they never fess up to what's wrong with them. Say for instance when they get arrested and a cop brings them in because their pulse is sky high. Handcuffed to the gurney, they'll deny any illegal drug use because the arresting officer is standing there. Asshat, the tox screen is going to be positive for coke or meth or whatever, quit dicking around and tell the doctor what you did so s/he can make sure you don't die. That happened twice tonight.

One of the guys loudly complained that his rights were being violated and he wanted his lawyer until a nurse told him, "Sir, this is a hospital and there are sick people here who don't want to hear about your personal problems." He continued to complain, but at a more reasonable volume. Then a clinical assistant needed to get his temperature. The patient wasn't cooperating so the CA says, "I'm going to take your temperature, orally or rectally. Your choice." Patient's mouth pops open. I almost sniggered.

Clearly he wasn't going to answer my registration questions so I left about the time he started promising lawsuits against the police, doctors, nurses, really anyone in visual range.

Interesting sidenote, if you're arrested for public intoxication and the cops bring you to the hospital, you can't refuse treatment.

The ski accident thing

Tonight a guy came in who was hit in the face with a waterski which split his upper lip completely open from the nose down. Being around the medical staff as they were treating him made me realize that I'm on the right track, I really do want to work in Trauma/ER. And yes, he'll be fine.

The stem cell thing

I want every person who is against the use of stem cells in research to sign a binding pledge that they will never take advantage of any benefits that result from such study and if they do, they have to go on national television and admit that they are gigantic hypocrites who will now and forever more stop imposing their supposed superior morality on everyone around them. Hmph.

The Deepthroat thing

Here's my poorly thought out immediate reaction:

Felt was passed over by Nixon for the FBI directorship. If he had been appointed for the position, would he have leaked the information?

Also, this guy was convicted in the '70s for authorizing illegal break-ins to the homes of people suspected of supporting the Weather Underground. Then Reagan pardoned him.

Whoo-hoo, what a "hero".

She probably just wanted a ride to Austin

Tonight I started to register a patient that might have had tuberculosis, or maybe just asthma. "Nancy" had come from Lockhart on an ambulance and a paramedic began to doubt her motives when she hopped out of the ambulance when it arrived at the hospital and began walking away. Guided inside, she was apparently a bit surly. After getting her into the system, but before going through the complete registration process, I guess Nancy decided to get aggressive with a nurse and walked out. The staff called security and the resolution is that I didn't have to be possibly exposed to TB.

Yay! No consumption for St. Murse.