Tuesday, October 23, 2018

That Was...Bracing

You shall be forgiven if you mistakenly thought the picture above was a still of the casualties in Atlanta in Gone With The Wind.

It was, in reality, the waiting room of Teeny Weenie ER at Shoestring General Hospital this weekend. No, really.

My personal tally: 4 strokes, 2 heart attacks, three major fractures, five automobile collision victims, a baker's dozen of abdominal pains, and about half that again of people - almost all in their 90s - suffering from Failure To Fly, leading inevitably to the dreaded FDGB: Fall Down, Go BOOM! And by some small miracle, only one(!) patient who was certifiably bat-crap crazy. My co-workers all leaned into that last pitch instead. Better them than me.

(BTW: I can reliably report that people having actual strokes and heart attacks will drive themselves to the hospital about 1 time out of 3, rather than calling the paramedics to bring the ER to their living room for a pick-up, so think about that when you decide to cut off the geezer in front of you driving a little distracted.)

There are days I should get paid for patients by the pound, and this was a triple dose of that.

If we want to switch to pay based on how sick they were, I managed to fill up all the hospital's available ICU beds two nights out of three. They're not talking my calls any more this week. I have heard mumblings that my new nickname thereabouts is "Trainwreck", in honor of the patient type with which I've been gifting them.

Despite all that, everyone who came in with a pulse (all of them, hallelujah!) left with one, and they all left in better condition than they entered. That their efforts to shuffle off their mortal coils failed was not due to any lack of trying on their parts. It also didn't hurt that everyone at Teeny Weeny ER is a team player (and there's no "F**k You" in "Team", boys and girls), without which things wouldn't have gone so well for all concerned, and also one of the reasons I like to play at this particular body shop.

Best of all, there is no "X" in the box tonight on my line of the shift schedule. For one night in a row!
As noted in my last post, my employer and my bank will both love me, but only the prospect of pizza, two or three unseen movies to watch, and no one's life to save tonight is currently making life worth living.

Then we'll have a look around and see what dipwitted f**kery our would-be overlords and random strangers have got up to in the intervening 96 hours.

Based on my own biased sample of the world since Friday afternoon, high IQs have not broken out anywhere on the planet, so the pickings should be good in due course, and serve as proof that compared to things that really matter, like sending average people home to their family rather than wrapping them in their final plastic baggie and toe tag, there's little whatsoever that Government Idiots Inc. (but I repeat myself) do that isn't anything beyond comedy relief and an object of ridicule. 

If I could but trade the Stygian Ferry 1:1, and save my patient's lives, in return for sacrificing the minions of governance and self-proclaimed cultural icons, I'd happily walk the streets of D.C., NYFC, and Hollywood, with a pillow in hand, looking for deserving fucktards to smother in trade for the gaggle of grandmothers, uncles, sons and daughters I saw in the last 4 days' time, and what's more, the republic would be improved for every trade I made with the Grim Reaper.

If only...

And sadly, I failed to score the winning billion $$ lottery ticket, so I have to keep doing this for a couple of decades more.  I kicked a coupla bucks into the community pool, so we were hoping to hit it, just to be able to text Big Boss that 57 of us were all quitting when we collectively hit the jackpot. It would have been worth it to see the looks on the faces. Perhaps another time. And Fat Cat will not be dining on crab and steak, but she's announcing that I didn't have permission to ignore her all weekend. The little furry terrorist probably found something to puke on out of spite, because that's how cats roll.

Meanwhile, there's pizza to order, discs to insert in the player, and a number of web pages and such to browse. Like a good campfire, sarcasm and mockery must be banked and fed regularly to keep them hot and useful.

I hope you all had a weekend that didn't include any time in the ER, unless you were getting paid for it.


Anonymous said...

In the last year I have been to the ER about a dozen times. Twice for myself and the rest of the time for my kids. Sounds like a lot, I know but not typical for me. Normally I go zero times a year. But the one thing that stands out is that in every ER I visited (except one) the waiting room was full of people who were suffering from lack of their drug of choice. No broken arms or heart attacks just drug users feeling like crap and trying to get a prescription. Oh, the one exception was a small hospital in Las Vegas where the waiting room and the treatment rooms were all empty.

Suz said...

Yeah!! No one died on your shifts! That is a major accomplishment!
I was on call and only received 2 phone calls (which is a minor miracle), and none after 10pm (which is a major miracle).

Folks will always try to drive themselves, or have the wife drive them, as they "don't want the neighbors to know." I always count to 10, silently, and inform them that "having the wife drive while you are crumping with chest pain and not breathing is probably not the safest situation, so I am going to call 911 right now." They grumble, and wifey always looks like she wants to hug me.
"Besides, you are telling me you can't breath. Both the fire guys, and the ambulance folks always have oxygen with them. So you will be able to breath!"
They are not very happy with me, at the time, but later, will tell me that I was right by "making them" go by ambulance. I always tell them that having dying patients today are not something I have on my to-do list today. Especially since I no longer am working Hospice or Palliative Care anymore.

The other rules are "No falling in front of the nurse." It is an hour's worth of paperwork. Use the damn walker. And "No smoking in the house with O2 in the house". Flash overs are not anything I want my patients experiencing as I lost 1 that way, years ago, which was 1 too many. Had another one burn the house to the ground, losing 2 of her herd of little ankle biters. Those statements usually shut down any argument.

Enjoy your down time! Sounds like you more than deserve it.

Anonymous said...

My 90 year old stepfather (God rest his soul) was home alone with the power tools and cut off one and a half fingers with a 50 year old table saw (no guard). Mom called and said go check on Pop, opening the garage door revealed a trail of blood leading to the kitchen. The sink was cleaned with the paper towels next to it. Ran to the local ER and he was there. He drove himself to the ER, he even turned around half way thinking he left the garage door opened. Only that generation.

Anonymous said...


Glad to hear your getting some well deserved down time. There's all kinds of dumbfuckery going on in the news deserving of your rapier attention, which I'm sure you'll get to in due course.

Go breathe some fresh air, getting that hospital smell out of your nostrils. Your faithful readers will be here when you get back.


Unknown said...

Wife is in ER as RN just outside Mpls. Just came home after 3 - 12's in a row: leave her alone best plan, and pour wine. Enjoy your writing and analysis, fact based and with little emotion, but lots of snark, just how I like it.

Old NFO said...

Thank you for what you do. And enjoy the downtime, you deserve it!

Popular Front said...

Duty done. Stand tall. Be proud. In 2005 I had chest pains all day, eventually driving myself to the ER to be checked. Thanks to the diligence of a tiny Asian lady doctor they found I had a AAA - Abdominal Aortic Aneurism - which was just about to blow. Up came the Careflight chopper to my little town hospital and then flat out for the big provincial unit, the first time I'd been back in a Huey for years. Outcome - 10 hours on the table and two cardiac arrests but here I am, feeling very good. Now, everytime I see a fundraiser for the Careflight, or our local hospital, I dig deep. All great people doing a very difficult job so I salute you sir.

Reg T said...

Why do they call them "hairballs", when they look more like long hairy turds? My Maine Coon (will the PC crowd pinch a brick for that racist name?) refuses to answer when I ask him.

When I worked graves at our ER (back before cable and satellite), we'd get customers almost every night after 2 AM or so, when there was nothing but a test pattern to watch. Dates me, I know.

Aesop said...

As noted, the problem this weekend was that most of the drop-ins and drop-offs were legitimately effing sick.

The time-wasters are why there's a P.A. here 20 hrs/day, to see the minor illness/injury, and weed out the silly sh*t.

Tactless Wookie said...

Thankfully no trips to the ER or ICU for me last weekend. I hopefully got that crap outta my system a few weeks ago after a trip (via medic unit) to the ER and ICU. Pulmonary edema being much fun!

I could not have asked for or received better care on my stay. Walking out is much better than rolling in. (Shout out to DFD and the kids at Medical City Dallas!)

So Aesop, many thanks to you and all the others that man the units and do the voodoo that you all do! Enjoy your well earned rest.

Mike_C said...

Popular Front: Glad you took the initiative to get to the ER. We're still missing a guy who tried to sleep off his MI.... Lucky about the lady doctor too. Here's a war story, though not mine.

So this buddy of mine was moonlighting in the ED at the hospital where he'd done his medical residency. (This can be awkward, because you're always "that kid" even though you're now a grown up attending.) He got the sign out from the departing doc, and was told "Oh, Mr Smith in bay 8 is a nonSTEMI*. We've got one set of enzymes, mildly elevated, two more are pending; he got his aspirin and was pain free after one nitro. He's just chilling until they open a bed up in the ICU [this was a small community hospital]. I've ordered a heparin gtt. Nothing for you to do."

Being a highly conscientious type, Buddy goes and examines Mr Smith anyway. "How long have you had a heart murmur, sir? Did any one tell you about an issue with your aortic valve?"
Smith: Huh? No one has ever told me about any heart murmur.
Buddy: Hmmm. I'm going to get a CAT scan on you, Mr Smith. Any contrast or iodine allergies? No? Okay, just hang tight, sir. [...] Nurse, please hold off on that heparin drip!

Long story slightly shorter, the CT scan showed an acute aortic dissection, from the aortic root down to almost the iliacs (i.e. one HUGE MFer]. Astonishing that none of the cranial vessels had been compromised. Anyway, the new heart murmur was the only sign on physical exam. Otherwise the provisional diagnosis of nonSTEMI was reasonable. Anyway, before they got the CT, Buddy was getting shit from the other ED attending ("that guy's all set, why are you wasting time on him") as well as Charge up in the ICU ("why are you holding up this guy?") But when they saw the CT they called lifeflight and patient was helicoptered to the Quaternary Care hospital downtown, immediately whisked into surgery which turned out to be a MANY hour procedure. But he survived.

Next morning Buddy, groggy from a bad night, gets a page from the CEO of the hospital. "Please come to my office NOW." Buddy is thinking, "Oh shit, shouldn't have gotten into those fights with ICU Charge and that ED attending. I bet one of them filed a complaint." But on presenting himself, the CEO says, "I heard about the aortic dissection case. I'm sure you saved that guy's life. And you saved us from a truly gigantic lawsuit. So thanks." Hero for five minutes, the next day it was "And how many RVUs have you generated today" again!

*Non ST-elevation myocardial infarction: this is a "less serious" heart attack where it's reasonable to delay cardiac catheterization until morning; a STEMI is the serious one where you're knocking over little old ladies and babies to get the patient into the cath lab right fucking now.

Pat H. said...

Way back in 1992, I worked a couple of days in the Alameda County Hospital, IOW, where all the gangbangers with high speed lead poison or blade injuries in Oakland, CA end up. I was in the OR, so didn't have to deal with them unless they survived long enough to come to where I was.

Before that, I was a "scrub tech" while in Nursing School at UNC-CH. I was scrubbed on a case where a youngish man had a single gun shot wound to his chest. From a .22 rimfire shot from a rifle, by the victim's father. Seems young scion took a baseball bat to daddy's truck windows and was advancing on daddy. Daddy's single shot nick sonny's aorta, just barely, which threw clots south of the nick. He had multiple organ infarcts, took him eight days to die. The giveaway right up front was both of his feet were already black.

Moral is, don't fuck with a man's truck.

Reltney McFee said...

Welcome back! Myself, I'm just concluding a spell of working full time 12 hour shifts at Job A, then, for the entertainment value, working 2-4 12 hour shifts at Mount Saint Elsewhere, 250 miles distant from the home front. As you noted: good news: fecund Rainy Day Fund. bad news: all work and no range time makes Reltney a dull boy.

So, carry on! Smart work! Thank you for the "free ice cream" that you dished out today!

Dan said...

Yep....nothing collects Trainwrecks and Troglodytes like the ER. Add in the fact that medschools are turning out fewer doctors and more proctors (doctors practice medicine, proctors just order tests.....in MASSIVE quantities) and the place is usually clogged up like the toilet at a chili festival.

Anonymous said...

Went to the ER in '08: motorcycle wreck, femur came through the front of the leg (& broke a couple of inches off itself). Nearly bled out on the pavement, until the ambulance crew controlled (mostly) the bleeding. Then a damned great surgeon named Marc Tressler saved the leg. I walk funny, but I can feel the ground through both soles.
Went again in '09: mild stroke, resulting in temporary aphasia, no long-term effects. They believed part of the bone graft broke off & caused a blockage.
I still ride. Still eat lots of bacon, too. I'm grateful for the ability to do both, or do any damned thing at all, since I really shouldn't be here. When every day is gravy, you learn a new perspective.
Thank you, and God bless you, for what you do, Aesop.
--Tennessee Budd

Moggy said...

Glad to see you back in action and to hear you mention Fat Cat...might you post a picture of your feline companion?

Aesop said...

One of these days I'll get a pic up of the furry terrorist.