Little Darling

Last Friday was homecoming and the local high school had a big dance after the game. The only thing worse than Homecoming is Prom, why? Because we can be guaranteed to get one or more drunken, spoiled brats from the party.

Last week was no disappointment. Our guest was a 16 year old female with a BAC of .24 - a respectably high number for a teenager, I would guess that it was not her first rodeo as she was still conscious and screaming, kicking and spitting at all and sundry. Her lovely dress was covered in vomit and her carefully applied makeup was streaked down her face, carefully covered by the medics with a spit hood. I might have been a little more sympathetic if she hadn't managed to kick me in the hip while we were restraining her, and if she hadn't called me a "motherfucking, cocksucking bitch" every time I entered the room.

I could have put up with all that easily, after all it is pretty run of the mill for us - a little verbal and physical abuse is part of the territory, right? That was until her mother showed up. As soon as she came in she went running into the room screaming "MY BABY !!!!!!!!! WHAT HAVE YOU DONE TO MY BABY!!!!!!!!"

What have I done to your baby? Puhleeze.

She then proceeded to sit at the side of the bed stroking her daughter's arm and saying "oh you know mommy loves you, it's OK."

Uh, no it is NOT OK. Your underage daughter drank enough that she could have suffered serious harm. She has a tolerance which means she is drinking regularly. She assaulted a health care worker and worst of all.....she is a brat.

The mom then starts to scream at and verbally abuse the doctor and myself for the horrible way we have treated her little darling. She demands to have the restraints taken off which we refuse to do as the patient has become more and more agitated since mom arrived. Enraged by our refusal and subsequent offer to have her removed by the off-duty police officer she grabs the ankle restraint and unbuckles it at which point her daughter kicks out and connects with mom's mouth, knocking out two of her front teeth and splitting her lip and chin open.

Some days it is really hard not to believe in karma.

Bet mom doesn't think her kid is such a little darling now.

Tax and Spend

For all of you thinking of voting for Obama:

Redistribution of wealth is just a fancy way of saying "tax the ones that work and give it to the ones that don't"

Take money from the middle class and give it to the entitlement crowd. Tax and spend, just what the democrats do best.

Excuse me if I don't participate.

Random things that are bugging me today

How can one dog shed so much? My rug looks like a brown mohair sweater. Unfortunately it's real color is beige.

How can a patient that came in for a wart possibly think they need to be seen before a person getting CPR? And why would they, or anyone for that matter, think it is okay to walk into another patient's room - where CPR is in progress - to ask how much longer they are going to have to wait?

Why don't administrators realize that the department that admits more than half of the patients is an IMPORTANT part of the hospital? How many of you ER people think your department is treated like the red-headed step-child?

How many of you think that the people that are using the bail-out money to give bonuses to executives should be burned at the stake?

how can one thirty year old male vomit his body weight in two hours? And why do young adult males need to make so much NOISE when they vomit?

Why does it take one doctor to take 7.25 hours to decide the patient needs to be admitted when everyone else knew as soon as the patient was put in the room?

If the schizophrenics are crazy......why do so many of them have the same delusions?

How can gas be $2.78 today and $5.69 in July?

46 year old male who's uncontrolled hypertension lead to kidney failure at the age of 42. Medicaid is paying for his thrice-weekly dialysis. Unfortunately he doesn't go very often as the three hour treatments interfere with his crack smoking. After two or three missed dialysis treatments he will come to the ER with chest pain. His blood pressure is usually around 280/190. He receives a full ER work up for chest pain and an admit to the ICU on a Nipride drip about twice a month. Each of those visits run around twenty or thirty thousand dollars. After a couple days he will elope from the hospital and go back to the 'hood to score some crack.

This one patient costs the system untold thousands of dollars every year. Where should we draw the line?

How do we know it's fall? All the nurses are quitting

Every September after school starts our census drops and the ER is slow. This often continues through October and then, reliably, the flu and pneumonia season starts and the hospital is hopping.

Every year without fail the same thing happens - census is down so nurses are called off and forced to use their vacation time. After a couple months of this the nurses start leaving in droves. Every year the same thing.

Then the flu and pneumonia season starts, surgeons stop taking vacations and start doing more surgeries and the hospital is full to bursting. The problem? Now there are no nurses to take care of the patients. The ER has to hold admits for hours or days, reducing the amount of patients they can process through the available beds. The recovery room is backed up because there are no nurses to take their patients.

Every year without fail the nurses that are left work a lot of OT to help pick up the slack. This causes increased stress, illnesses and on the job injuries. The hospital ends up bringing in traveling nurses - which are very expensive to use- to deal with the increased patient census.

Now granted, I don't have a MBA but I can see how stupid, inefficient and ultimately cost-ineffective this is.

First of all, new employees represent a significant cost to the institution. It takes several weeks of orientation until they are up and running independently. Why would you want to risk losing the trained nurses and have to hire a whole new group every year?

Are the increased payouts for sick time and medical leave really offset by the savings made by forcing nurses to take days off for two months? I seriously doubt it.

Is it better to have to bring in a nurse that gets one or two days of orientation or to have your own staff who are thoroughly familiar with your facility and it's policies and procedures?

My question is, how can people that have Master's degrees in business administration be so damned stupid?

I got my flu shot, did you?

Every year over 100 kids die from the 'flu and an average of 20,000 kids under 5 are hospitalized from 'flu complications. Here's a short video made from interviews of parent's that have lost children to the 'flu, please take a few minutes and watch it

In 1918 and 1919 a terrible epidemic of influenza ravaged the earth, killing and estimated 20 to 40 million people - about 1 million of those were Americans. Think it can't happen now? Guess again - last years strain of 'flu overloaded ER's - my ER saw close to 30% more visits a day when the flu was at it's peak and our hospital beds were full to bursting. Add to that the 10% of staff that were out sick on any given day and you begin to see what would happen if a full scale pandemic were to occur.

So I lined up today and got my 'flu shot, just like I do every year. I urge you to do the same. In addition please wash your hands frequently, cover your mouth and nose when you sneeze and cough and FOR GOD'S SAKE stay home when you are sick - no one is so important that they need to be out infecting others - like the children in the video.

"I've fallen and I can't get up."

One of the things I find most heartbreaking is when we get an elderly person who lives alone and has fallen and laid on the floor for hours or days. Unable to get up, reach a phone they lay there alone, cold, scared. Unable to get up they are eventually force to urinate or defecate where they are - their soiled skin burns. Unable to get up they grow hungry and thirsty. The pressure of the hard floor causes their skin to break down into bed sores. The pressure of the floor causes their muscles to break down, the molecules from their broken down muscles clog up their kidneys causing them to fail. Once they are found and brought to the ER they are usually critically ill, partially from a broken spirit I suspect.

Imagine how it must feel to lay on your own floor cold, thirsty and hungry - lying in your own bodily wastes wondering how long it will take you to die.

All alone.

If you have an elderly neighbor that lives alone take the time to befriend them - check on them regularly, keep this from happening. It's a very simple, very human thing to do. The rewards you get in return might surprise you.

Another Voice on Vaccination

From a previous post on vaccination I received this comment:

"Anyone doubting the value of vaccination should be living with us right at the moment. My (stupid) son and daughter in law did the "homeopathic innoculation" despite many prompts from us to follow the regular vaccination regime. At just 1, my granddaughter has contracted whooping cough and has been hospitalized twice - a week in intensive care in one case and 3 nights the second time around. They are now living at our place (big city, good facilities etc as opposed to their out in the bush hippy place!) and to listen to the poor little poppet whooping away and occasionally going blue in the face is absolutely scary in the extreme. We have hired Oxygen with the paediatrician's support and take it everywhere with us now. The DIL said last night that vaccination looks like a good idea - duh!"

I cannot stress enough how stupid it is not to vaccinate your child - allowing a child to suffer and die from an easily preventable illness is CRIMINAL. Despite all the anti-vaccinationist propaganda the is NO scientific evidence to show any vaccine/autism link.

the Difference a Doctor Makes in ER Flow

Two patients both in their 40's. Both present with similar symptoms of burning chest pain. Both have negative histories. Both have normal EKGs and normal VS.

Patient number one is seen by doctor A - gets cardiac labs which are normal and a GI cocktail which completely relieved the pain. Discharged home after 1 1/2 hours with a prescription for Protonix.

Patient number two is seen by doctor B - cardiac labs, IV, EKG, Sublingual nitro x 3 followed by a nitro drip, IV lopressor q 5mins x 3, chest xray which was normal oh, I almost forgot - a slightly elevated d-dimer so the patient had to go for a chest CT to r/o PE. Discharged after 7 hours when the hospitalist refused to admit the patient.

Guess which doctor managed to see all of my patients today?

Please pass the wine.