Posted on 10/26/2008 5:34:19 AM PDT by 60Gunner
Okay, I know this is a bit of a chronological jump, considering I was last writing about my recent odyssey. I'll get back to that soon.
I am back at work now, and since returning I have encountered an unusually-long parade of ER patients who have displayed, shall we say, less-than-sound judgment with regard to the way they chose to conduct themselves in ER Triage.
I am a man of great forbearance and restraint. I have never told any patient that he/she was a slack-jawed, mouth-breathing idiot before- even when the patient's actions clearly proved such to be the case. But some people make it very difficult to restrain the urge. Happily, only a rare few have ever caused me to fervently wish that dope-slapping was approved as a therapeutic nursing intervention.
For the sake of brevity, I'll cut to the chase:
To all of the exasperation-inducing patients described in Paragraph Two of this entry, and to all potentially-exasperating patients, I offer the following pearls of advice. If you follow these maxims, I guarantee that your name and the word "idiot" will never be uttered in the same sentence when you are mentioned in verbal handoff report by your Triage Nurse.
1: Do not come into the ER with a chief complaint of "high blood sugar" and then sit, in full view of the Triage Nurse, gulping down a can of Coca Cola and eating a candy bar.
2: Do not use "I have (insert disease name here)," "Googled," and "My symptoms" in the same sentence.
3: Do not sprint full-tilt boogie into the ER from the parking lot (having been observed by the Triage Nurse for the entire 100 feet of your medal-winning dash), burst into the waiting area, and yell at the registration clerk in a full sentence that you are having a heart attack and need morphine.
4: Do not ask the Triage Nurse for any sample packets of Tylenol, Ibuprofen, antibiotics, the "Morning After Pill," Valium, Ativan, Zanax, Methodone, Oxycontin, Surgi-Lube, or medicinal marijuana.
5: Do not tell the Triage Nurse that you don't want to see a doctor but just want to have your blood pressure, blood glucose, lung sounds, or that "icky lump" in your bikini area (I am not kidding) checked by the Triage Nurse. You have to be registered before the Triage Nurse will listen to you say anything about that "icky lump" in your bikini area. Otherwise, go to the fire station or your clinic. And wash your "icky" frigging hands.
6: Do not get out of your car, walk ten feet to the wheelchair your relative provides for you, sit down in the wheelchair, and then go limp and pretend to be unconscious the remaining twenty feet to the Triage Desk. (Yes, I did see you peeking, you rascal!)
7: Do not ask for a five-gallon barf bag, be given one, pull your face out of it to spew all over the Triage Room, Triage Computer, Triage Floor, Triage Tech, and Triage Nurse- and then say, "Sorry, I missed."
8: Do not refuse to wear a mask if you are coughing or sneezing. If you do refuse, then do not take offense when you are thus held in that special regard reserved for all mindless, disease-carrying vermin.
9: Do not talk on your cell phone while being triaged and tell the Triage Nurse to "shush!" for interrupting when you are asked about your migraine. And do not get angry when you are ushered out of Triage to finish your phone call and the Triage Nurse moves on to the asthmatic 3-year-old who just came through the door.
10: Do not walk in and tell the Triage Nurse you were involved in a rollover motor vehicle crash an hour ago when all you are really looking for are narcotics. You will be slapped into a cervical collar and duct-taped onto a very uncomfortable backboard faster than you can say "I'm never using this frigging story again." Just tell the truth. Honesty serves two purposes: 1) We can deny your request for narcotics without you having to go through all that unnecessary discomfort, and 2) You can haul your drug-seeking carcass over to the neighboring ER without any telltale patches of tape-induced depiliation on your head.
11: Please be sure to leave the ID bracelet from the neighboring ER that you just left on your wrist when you arrive at our Triage. This enables us to contact that ER and find out why you were dissatisfied with the service they provided and which medication they refused to give you.
There you go. Have a safe Halloween, think before you drink, avoid anyone who says "Hey, watch this!," and stay inside any moving automobiles.
ROTFL...this is great. I’m going to print this out for my instructors.
omg you poor things people are such losers
the only times I’ve gone in are with my kids for broken things and once for myself when I fell over while seated in a lawn chair at my kid’s ball game holding a newborn and a baseball headed right for us so I jerked us out of the way, used my arms to protect the baby and injured my elbow
Very cute! :-)
Funny, funny! Thanks for posting that!
Do you always whine this much?
I was in the ER triage after getting about a gallon of JP-4 (jet fuel) spilled over my head and in my eyes. After waiting about 25 minutes, the nurse walks in and looks at the chart and says “Fuel spill? Was it hydrazine (a very dangerous rocket fuel that we used for Emergency Power Units on the F-16)?”
I answered, “No, it was just JP-4.”
When she answered “Oh, “just JP-4...aren’t we being macho!”
Was I wrong in cussing her out? :)
I am so guilty of saying that. Never to a triage nurse, but to an ophthalmologist.
10: Do not walk in and tell the Triage Nurse you were involved in a rollover motor vehicle crash an hour ago when all you are really looking for are narcotics. You will be slapped into a cervical collar and duct-taped onto a very uncomfortable backboard faster than you can say "I'm never using this frigging story again." Just tell the truth.
I was hit, by a jackass in a truck, while riding a bike when I was a kid. I remember being strapped to one of those boards. Ugh. Not fun. I kept trying to tell everyone it hurt and I didn't need it.
avoid anyone who says "Hey, watch this!,"
But what if it's really cool? ;)
ER Nursing Stories Ping.
If you have been in a motor vehicle accident, make sure that you are actually injured before you listen to your lawyer and call 911. He doesn't care about your condition, he's just trying to get rid of you.
When the emergency services professionals arrive and observe a thumb sized scrape on your bumper, they will know that you are faking an insurance claim. Don't act surprised when they strap you to a backboard and leave you there all day. You asked for it.
If your cell phone is impaled in the side of your head because you turned sideways just before impact, expect the emergency services professionals to take an interest. If the phone is still working and you are still talking to your friend while they cut the doors and roof off of your car, expect the professionals to be very interested. They will want to know what kind of phone could survive such an impact because they will want to get one. Emergency service is rough work. They need good, quality cell phones.
If you collide with another object and are visited by the emergency services professionals a second time, try some friendly banter to ease the tension when they recognize you. Look and see if any of them are carrying the same brand phone that you have. If they are, remind them that you told them it was a good phone. They will still chop your car into little pieces, but they will be nice to you.
Don’t make out with your boyfriend in the waiting room.
Don’t copulate in the exam room, your wait will not be that long.
Don’t threaten the triage nurse with calling the police and having them arrested. The triage nurse has their own policeman and he is bored.
Don’t deficate in the UA cup.
And my personal favorite is, if you are faking a seizure, the triage nurse is only testing you by saying “if it were a real seizure, they’d wet themselves” At this point urinating in your pants will get you nowhere.
I had one where I limped into an ER. I told them I had fell and struck my leg on a concrete edge, and I thought I just needed some motrin.
The nurse took one look at my left leg and saw it was literally twice the size of my right leg.
I was in a bed so fast my head was spinning.
From the other side - treat your patients and get them out. Four years ago it took 8 hours to diagnose my son with appendicitis. My husband threatened everyone in sight to get him some pain medication. That hospital is closing this year. The surgeon actually taught the doctor how to press in the right place to do the old pain test for appendicitis AFTER the CT scan.
In August my son was at another ER after a car crash. $23,000 for four hours which included a tetanus shot, pain pill,urine test for sugar levels and total spine CT. I was there, I know. If he had Medicare or employee based insurance there would have been a HUGE write off. Instead he owes $13,000. I was office manager for a group in 1980 who raised their prices to increase Medicare reimbursements for the future.
The ER culture of making people wait when they get into one of those little rooms in the back is so wrong, I would love to see them run with a little efficiency and sense.
You have just listed 11 of the 20 reasons I will not go to the ER unless I have visible blood loss or an appendage unintentionally disconnected from the rest of my body (i.e., techniques to bypass the triage nurse as quickly as possible)
This is really informative! I haven’t had to go to an emergency room since “critical care” clinics were invented, thank God. They can put a baby with croup to the head of the line, while a real ER has accident victims, gunshot wounds, and drug addicts looking for a fix.
My son is an E.R. Doc. I think he wrote this thing. LOL I will pass it on. Thanks
These are all good. But, please tell me, how does one really get taken care of by the triage team. I went in with a body temp that went up and down, pain in my abdomen, nausea, headache and weakness. I was obviously cold. In August in Alabama I walked in wrapped in a quilt! I was not sitting up, but did everything I could to lay down. It was 21 HOURS LATER before the ER began diagnosing me.
It turns out I had a serious kidney infection with possible appendicitis. I was finally admitted for 48 hours.
How can I communicate to the triage nurse that I was really sick? Obviously I said something wrong.
On the happy side- in a country with socialized medicine, a patient with appendicitis would have to wait a much, much longer period of time- days, even- just to get into a room, much less be treated. You may fault American ER care all you wish- but I have been to multiple countries to study emergency care and I would still take my kid to an American ER first, bar none.
Regarding waiting after being taken back: the pace of the ER treatment is driven to a very large extent by the pace at which the diagnostic studies go. It's frustrating as a nurse as well to have to wait for the lab to process a blood test, or for the Radiologist to get around to posting his findings, or for a room to open up on a patient care unit. We can't change that. But any nurse/MD worth his/her salt will do everything possible to keep the patient/family informed and comfortable.
I cannot really say any fairer than that. I am sorry that your experiences were unpleasant ones.
I’m a pathologist now but in my ER days the thing that would annoy me the most were the people coming to the ER complaining about back pain they’ve had for years. Sometimes they would show up at 3 AM. When I’d ask them what there was about the pain that prompted them to come in now they’d say “It hurts”. Not that it hurt any worse, just that it hurts.
I had an experience like that. I took my then-six months pregnant wife into an ER with side pains. Seven hours in the ER later she was getting an “emergency” appendectomy.
For any of you that think this job is easy here is one. Lady comes into the E.R and complains of stomach pains. The E.R. Doc does a complete work up including a pelvic. Now mind you there are other people that need him in the E.R. But if he does not he get sued. Upon finding nothing out including the fact she is not pregnant he asks her, “Did you just come in here for a pregnancy test?” She says, “Well yes” He says, why didn’t you just buy a home kit and do it yourself?” She says, “Well this is FREE!” Of course you can NOT ask legal status either.
PING
Thanks for the bump. Interesting as always.
Ask your son to talk to me. I was really sick. But it was 36 hours before I got any pain and nausea meds. How could I have gotten better service?
We get parents calling for an appointment for their kid for vomiting. Of course, they can’t come in that day, and when they DO come in the next day, their puking child is sucking down a McDonald’s Happy Meal.
And I also love those drug seekers who come in wearing their sunglasses inside for their “migraine”, but take them off as soon as they get their Demoral and Phenergan; miraculously cured before the drugs have time to take effect.
I’d like to know this too.
I don’t go to the ER unless I’m worried about losing a body part or passing out.
This summer, I dropped a piano on my toe. It was the worst toe injury the attending had ever seen (when he finally saw me). Hurt myself at 7:30, was at the ER by 8:00. I finally got some pain meds at 1:00am and was admitted at 3:00am. Ended up with a fracture, serious laceration, and exposure of the bone requiring a podiatric surgeon (who was awesome). At one point, the discussion of amputation possibility certainly got my attention.
Part of the reason for the delay was that the nurses put me back into one of those little rooms in back instead of the waiting room. They would page Xray. Xray would go out to the waiting room and call for me. I wasn’t there. They figured I left.
Half an hour later, ER would page Xray. Xray would go to the waiting room. I still wasn’t there.
You get the picture. Four hours of this before a nurse had the presence of mind to figure out what was happening.
Truly, I can’t fault any of the nurses or doctors there. The problem was systemic, and made worse by the gaggle of illegals with no visible problems or symptoms mooching off this service that is supposed to be for those in real need.
From my observation, the biggest problem in ER is that there isn’t a single person who is responsible for a patient. Everything is handed off to other people/departments. If they fall short, nobody knows and you just drift. Its worse if you’re there long enough for a shift change.
BTW, I have insurance, and even though this hospital was out of network, they negotiated between themselves and I paid nothing, even though it should have cost me 10%, or about $1700.
Yep, the lady was spanish speaking with an interpreter. Every the time the nurse would look her way, she would start skaking. The nurse made the comment, the interpreter hesitated for a minute then repeated it in spanish. About a minute later she proceded to urinate in the waiting room.
And yes to the coitus, a very nasty looking couple. I felt like I needed to wash my eyes with isopropyl.
I thought I had the flu, and in fact, may have had. It started on a Friday, by Sunday night I was so dehydrated I was in agony. My daughter took me to the ER, we called my dr ahead of time. When I got there, they said 4-6 hours before I’d be seen. I joked, “What if I said I had chest pain?” Still 4-6 hours they said, ha-ha.
I checked out, and went to another ER after calling my dr again and telling her the situation. This time, I walked in, said I had chest pain, and nausea. I was on my way via ambulance in 15 minutes to the nearest big cardiac hospital (too fohgy to take a helicopter).
Upshot is, I had a lulu of a heart attack. Also, no chest pain. If I’d stayed in the first ER, I’d be dead.
I’m a nurse (retired). Did not have a clue I was having a heart attack. No chest pain. Just vomiting. I knew I was dehydrated, and that I needed an IV so bad I was nearly hallucinating.
10 days later, discharge ejection fraction was 50%, also found a little aortic aneurysm that I will likely get repaired later. Some dead heart tissue, but nothing serious apparently. I asked about a stent, cardio man said, all we’ll get with a stent is pink scar tissue, instead of white scar tissue, no need for that. Plus I’m allergic to the stent material he likes to use.
This is the only ER visit of my entire life.
I’m glad you are still with us.
Hmmmm...around here the wait can be so long that you can watch the anchor baby growing in the teenage girl across the waiting room.
I understand your frustration, I’ve had to go to the ER with family a few times. I don’t work in a hospital, but I am a medical professional and understand why it takes so long at an ER. They aren’t going to treat until they rule everything out. They need documentation so they order test, scans, etc. Everyone, including the doctors, wait for the various departments to have someone available to run the test, then they can properly diagnose.
One of the big problems is people without a family doctor use ER’s for general medicine.
BTW the one I love is the person that calls at 5:10 on Friday afternoon and thinks they may have xxxx. They’ve felt bad since noon on Wed, but just decided it might need attention.
Are you always an arse-whole?
The triage nurse at the first ER basically suggested it.
Good nurse. How are you feeling now?
Good stuff. Sent to my uncle who is finishing up nursing school right now, and worked in an ER over the Summer.
Tired. On the road to recovery. Enjoying the hospitality of my son, his dear wife, and the family.
Still no chest pain. :D
I mis-read that as:
Hmmmm...around here the wait can be so long that you can watch the anchor baby growing into a teenage girl across the waiting room.
And thought it should be:
Hmmmm...around here the wait can be so long that you can watch the anchor baby growing up into a pregnant teenage girl across the waiting room.
I’m glad to hear it. :)
My son’s girlfriend had them waiting for her at the door. We just called in and said that she had been bitten by a rattlesnake.
My 85 yr old MIL was very sick Christmas day and they told her it would be at least 4 hrs to be seen. She’s probably been to the doctor less in her lifetime than 25% of the people see one in a year and when she wants to go to the emergency room, you take her.
My husband just brought her home to me and I made her some pedialite stuff and made her drink it but she probably would have recovered faster with an IV and some medication.
You are smart. Giving her fluids was probably the best thing you could have done for her.
It did occur to me to say I was having chest pains, but ... I won’t lie like that. When I’m sick I want a good diagnosis and don’t want them wading through misdirection.
I don’t really have any answers at this point. If there was some way I could have moved to higher spot on the triage list I would have.
I was fortunate. I lived.
Holy Moly, I’m sure glad you’re okay.
Oh, c'mon, no road surfing on the top of the pickup?
In all seriousness though, If I ever pulled any of this stuff I would be ashamed to look at myself in the mirror.
Short of a severed part of the body or a broken bone I can't imagine why anyone would WANT to go to the ER.
First, as I stated in my first reply to you, many variables may have been in play on the day you visited the ER: size of the ER, staffing, how sick the patients in the beds were at the time you visited, how crowded the waiting area was, etc.
I cannot answer for that ER or its staff. I also will not minimize your suffering. Kidney infections just plain hurt. It may have been a combination of factors.
I know you have already shared a great deal of your experiences. If you like, you can share more via personal message. I am very interested in your insight. I cannot promise that my answer will perfectly match your questions, but I do promise to answer them to the best of my knowledge and ability. Are you alright with this? I look forward to hearing from you. With warmest regard, Gunner
Thanks for listening. I gave you a few more details via freepmail. Again, I don’t have any answers. There are so many abusing the system that they make for worse service for those of us who don’t.
Is 8 hours good of bad? Cause it took my doctor and various specialists over 3 months to diagnose me (properly) when I had appendicitis. I avoided the ER, though, because I had been sick with something nobody could figure out for three months, then on a road trip to NYC I started throwing up and was in so much pain I could hardly move. I took a lot of painkillers, and when I got back (on a Saturday morning) I called the doctor. The whole ‘pain test’ didn’t work, as my doctor decided it was probably a kidney stone, maybe a kidney infection, maybe female issues, and a slim chance of appendicitis. However, when the CAT scan showed nothing, someone finally figured that since everything else was eliminated, it must be my appendix, and it turned out that was true when they went ahead and did the surgery.
Then, a couple weeks later, I had kidney stones. But, when I had come in complaining of intense pain where I recently had intenstinal surgery, nausea, vomiting, and fever, I guess the nurse assumed the surgery site had become infected, so I got in and got some pain meds within 30 minutes. So, I spent from 9 PM to 3 AM in the ER on a saturday night, which was quite the educational and somewhat amusing - probably due to aforementioned pain meds - experience. There were definitely people in there who were fishing for drugs, including a loud, crude lesbian couple, one of whom needed ‘stronger’ pain meds than she was already on for her back pain, and two separate family groups who both brought all of their hyperactive children because one of those children ‘had a toothache and needed vicodin’.
Your list cracks me up, because I know every one of those is true.
We have a problem with ER abuse here as well. It gripes me to watch illegal aliens sitting there using it for general medical care, knowing that they will not be paying for their visits, while my daughter, who has no insurance since she is an hourly worker will be.
(sigh) I’m not sure what can be done about it either, since the local government is not working too hard at getting rid of the illegals.
On a brighter note, the only time I ever went to the ER I was in a room and being examined in less than 2 minutes, diagnosed and transferred to another hospital (because there was a specialist there) within hours. I could not have received better care.
I admire your professionalism and restraint.
Some of these folks sound only good for field goal practice, as in “That one cleared the streetlight—woweee!”
I saw one of those folks coming to my local ER trying for the Oscar. Had to go with a friend who cut her hand. We watched the guy walk jauntily toward the doors to the waiting room, glass doors, mind, top to bottom. He comes through the door, didn’t hit into it or anything, and all of a sudden he can hardly walk and falls down on the floor rolling around in “pain.” There were a lot of folks sitting there, and we all laughed our tushes off!
I look forward to these, 60Gunner, and can’t wait til you post the next installment to your trip.
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