Can I just say fuck whoever had the idea for hallway beds
Cus that was the single worst decision that has happened in medicine. Never should’ve been considered acceptable to treat patients in chairs and stretchers out in open hallways. Leads to bad medicine, overcrowding, tripping and fire hazards, negative patient-patient and patient-provider interactions, the list goes on. When patients started piling up in the waiting rooms, the answer should’ve been to cut a few million off the CEO’s paycheck and build more rooms and hire more staff. Instead the decision was to just jam as many patients as possible in like a clown car and tell us to pick up the slack. Now this problem will simply never be fixed, and we’ll be treating patients in the waiting room until the healthcare system finally just totally collapses. Anyways yeah it was a good shift thanks
The ones you can’t save
We all have the frequent fliers, love or hate them, they come and go until they either die or get the mental health treatment they need. My hospital had a notorious one - well known to the entire metro area, with such an extensive history one of our mid levels had been taking care of her since he’d become a nurse. She was an alcoholic, and quite young to be so sick. She had been fired/kicked out of every clinic and local hospital for drug seeking and came in nearly every day, always by ambulance, and always for belly pain & vomiting. I saw her so frequently that I recognized her from the EMS report - no need for demographics, her name and DOB were burned into my brain. She was skin and bones, and always looked 9 months pregnant due to her massive ascites. One day last winter, I rounded on her and found her obtunded. She had snuck vodka in via her fruit punch drink, and nearly drank herself to death in her room. I shook her awake, and asked “are you trying to kill yourself??” and what remained of her fragile body simply shook her head. I slowly got to know her. What she’d say, the amount of blankets needed to keep her warm, what labs to expect, where to get an IV, and what vitals I’d see. Hypotension was her baseline. Nurses and other staff would openly & blatantly say they hated her. Loudly. And arguably fairly - in the depths of her addiction she manipulated and then rejected every doctor/hospitalist/midlevel here before finally accepting that toradol, fluids, and zofran would be all she’d get from us, in the absence of acute pathology. After that she was never a “problem” patient. She just took up time and resources and taxi vouchers, her family either tired of it or living states away. Unless her potassium was a mess, and then she’d take up a hospital bed. I laid down the law with her when warranted, but otherwise didn’t mind her. While so many people were so rude to her, she was never rude to me. She got sober, and stayed that way. The damage was done though, and the visits didn’t stop. The last couple months, if I saw her, I made it a point to spend time talking to her and encouraging her. She talked about AA meetings and trying to gain some weight and said if she could stay sober for 6 months, she could be considered for a liver transplant. The last time she was my patient, maybe 4-5 weeks ago, she had showered and styled her hair and I’d never seen her like that. She was skin stretched over bones, pale and dry and peeling, but she had tried. I told her it was beautiful and she lit up. I held her hand and we talked about life. We both acknowledged the limitations of the care we could give at this juncture. I told her I was rooting for her, and she told me I was her favorite. I saw her once more after that. She was laying in a hallway bed, hyperkalemic, awaiting a room upstairs. I didn’t know she was there until I was leaving and when she saw me she begged me to stay and take care of her - I was one of the only people still nice to her. I told her I was proud of her and that we’d catch up next time. My dad passed away on June 26th. He was 67 years old. His time was cut short due to the cumulative effects of lifelong alcoholism, smoking, lung cancer, and ultimately sepsis. He was withdrawn and our relationship was strained, but I held his hand until the end. I was his next of kin. I spent the following 2 weeks picking out a casket, flowers, eulogizing him, and bringing home the remnants of his meager life. A chair I made of clothespins when I was 5 that I didn’t know he had kept. His military honors. His death packet. His folded American flag. He was an electrician, a photographer, a musician, a carpenter. I look just like him. In the midst of the 2 weeks, I turned 40, and the phone didn’t ring. I didn’t hear his voice, and didn’t have to remind him how old I was. There was never a next time. She passed away on July 8, before I returned. She was 36 years old. The tribute her family wrote included a slide show of pictures through her years. She was a CNA, a makeup artist, she loved to ride horses, and loved to cook. She once was strikingly beautiful. Her personality was infectious. These are the ones we cannot save. Nobody can save them, except themselves. Sometimes they try and it’s just too late. Other times, they accept the inevitable. The holes they leave behind are gaping and hollow, echoing with the lost promises of what could have been. The tremendous emotional suffering they must have endured haunts me, even after 7 years in this field. I hope I gave her something to smile about as she slipped away. Edit: I am blown away by the response to this. I didn’t post for the kudos and the compliments - I nearly didn’t post at all. But thank you. I just love to write, it was therapeutic to get it all out, and feel like we all need to be reminded at times of the stories and the humanity behind the faces we see far too often. The timing of her death with my father’s death makes this particular experience hit home a little bit harder.
Dr. Google has been overthrown
It finally happened today. I ask patient what brought them in today. They ignore this question and instead inform me that ChatGPT has diagnosed them with Lupus and hypermobile ehlers danlos syndrome. Mind you I have very limited education on these conditions, so I redirect to the original question and we’re right back to square one: ChatGPT diagnosis. What was particularly confusing to me was that the patient seemed to think that this WAS a diagnosis. It wasn’t like situations I’ve encountered before where a patient will come in and say “Google says X, is that true?” No, no, no. They wanted me to put it in the chart and consult with rheumatology?? I very quickly felt out of my lane and got a resident but man it was interesting.
Cardiac arrest in walk-in clinic.
I work in a walk-in/urgent care type clinic in rural, nowhere southwest. We are the only clinc in about a 30 mile area save a single primary care clinc, and are about 45 mins to nearest hospital. It's me (a PA with about 4 years experience), a new MA who is great but has been on the job for about 3 months and an administrative person to check patients in and answer the phone etc... Had a 70 something patient check in, brought in by his daughter for chest pain. Protocol is to immediately evaluate patients with certain complaints, so even though I'm with a patient I get a knock on the door informing me. I walk out to the waiting room and daughter tells me to "hold my horses" her dad is in the bathroom and I can see him when he's finished. So even though this guy has every ACS risk factor known to man based on my 30 second chart review, I wait patiently. We hear groaning though the bathroom door, so I open it up and I see a man who looks like absolute shit. He's not answering any questions. I ask his daughter who tells me this isn't normal, he's usually independent. The gentleman then projectile vomits on me and my MA as we are trying to get him into a wheel chair. He vomits 3 or 4 more times and becomes unresponsive. Covered in vomit, we move him to the ground and put him on his side. I tell our admin person to call EMS. I get screamed at by the daughter telling me not to call EMS as "she's not made of money" and "why the fuck am I not helping". Good carotid pulse and is breathing but I lose it after about 30 seconds. Agonal breathing. Start CPR and have my MA grab the AED. Have my admin assistant throw me her scissors and cut off his shirt. Then have her go outside to stop people from entering the clinic while there is active CPR in the waiting room. He's absolutely drenched in sweat and vomitus. Dry him off and apply pads. Shock advised. Shock and resume CPR. Patient starts moving after about a minute. Good carotid. Breathing on own. Throw him onto his side. Monitor closely until EMS arrives. Some time during this sequence daughter just leaves. Unable to get any additional history or timeline for EMS. EMS takes him. Looks like STEMI on monitor. Admin assistant comes back inside crying. 2 different people screamed at her for not letting them in the clinc, despite ambulance out front. MA is crying. Its her 1st time seeing a cardiac arrest and she is covered in vomit. (I've participated in codes before but never directed anyone to do anything.) I ask her to talk to the 3 patients in rooms to let them know there had been a medical emergency and they will have to wait a while. (I later realize this is a mistake, i should have done this myself but I was calling report to the hospital.) 2 are ok with it but one patient goes off on her, screaming about wait times for her "sinus infection ". Admin, surprisingly, lets me close the clinc for the rest of the day. The next day I give my MA a hug and a card with a gift card to her favorite restaurant but she ends up quitting a week later. Admin lady also quits a month or so later. I hear 2nd hand that the patient was cathed and survived. I'm sorry for the length, I just needed to get this out. This happened 3 months ago, but Im still so angry and thinking about quitting. Why not just sell solar panels or some shit. This job is hard and people just don't care. Not just one patient, even the patient's family. I don't know what I'm looking for, encouragement maybe? Someone to hear me venting? Someone who can relate? Thanks for reading everyone who made it to the end.
Asked chatgpt to do a nursing note in gen alpha slang. My kids hate me for this
https://www.reddit.com/gallery/1kr168g
I am so sorry. (Emergency support staff and how I destroyed the bathroom.)
Have you ever had to go to your own ER? I was constipated for about five days. Decided to not seek medical advice from anyone at work, despite ample opportunity. On the sixth day I gave up on my youth and bought some laxatives. Followed the instructions, drank lots of water, and went to bed. A few hours later I was woken by cramping. "Oh yay! I can finally poop!" I thought. But nooooo there was no poop to be had! Only worsening cramps. "No worries! I can ride this out!" I thought, as I sat on the toilet waiting for sweet relief. The cramps worsened. By now they felt like minor contractions... Then they got worse. Then I couldn't stand and I was crawling around the house calling for my boyfriend who was sound asleep and probably didn't want to wake up to the image of his girlfriend pants-less and crying in pain about not being able to do a poo. "WE HAVE TO GO TO THE HOSPITAL!" he declared. "No baby, please, our co-workers are there. Just take the pillow and finish me off." He loads me into the car, and by the time we get to the ER the cramping is full-on "push the baby out!" levels of cramping. Upon walking through the doors, I heroically threw up all over the floor and sat on the floor because mi legs stopped working. We get a chair, we're immediately called back. "Oh hello lovely triage nurse who I have been trying to make friends with, yes I'm sorry about the puke, I'm now going to use all of the emesis bags and attempt to chew through my own arm to stop myself from screaming. I am, however going to scream puke like a psychopath. I do not think we can be friends after this." My vitals are a bit whacky. I'm taken back right away. On the way to being wheeled back, it suddenly hits me. "QUICK I NEED THE BATHROOM!" I scream and waddle off to the toilet.... Where I promptly and throughougly don't quite make it to the toilet before the flood gates open. After lying next to my own filth for a while I feel much better. So much better in fact that I don't think I need to put myself through the embarrassment of seeing the doctor or any more co-workers. Ask boyfriend if he can track down a vitals machine, oh yes looks much better now. Then we went home. So essentially what happened was. I couldn't do a poo. Took laxatives, panicked when they worked, went to work, completely annihilated the lobby with vomit and the bathroom with shit, then went home and back to bed. 10/10 for psychotic behavior. I am so sorry.
Are "boarders" as big as problem as the the show "The Pitt" suggests?
For those who haven't seen the show, it opens with a tense exchange between our attending hero, played by Noah Wyle, and an administrator he accuses of exploiting ED staff by not hiring a full nursing staff on the wards. Boarding is referred to as "a nationwide problem," and there are references to boarders (esp mental health boarders) staying days if not weeks in the ED. How true to life is this? I mean, for those of you working in EDs where boarding is a daily reality, how many of your beds on average are occupied by boarders? Thanks
Lateral canthotomy in the ED today
Didn't think I'd ever see this procedure at work. Old lady on eliquis came in after a fall, retrobulbar hematoma, tonopen read the IOP > 60. Doc walks out of the room, says "the last time I did this was on a cadaver in medical school," watches one YouTube video, then saves this lady's eyeball while I hold it open with a paperclip. Two minutes after he was done cutting she said "oh my god I can see!" I ain't wanna see that shit ever again though, that was gnarly.
I asked ChatGPT to roast this subreddit 😂
https://i.redd.it/dc3570q77apd1.jpeg
Coded and Pronounced my Neighbor
Title. Did all we could. Literally address is 316, i’m 317. I was the ED attending in our high acuity/resus area. Came in with chest pain, got initial EKG and immediately once done went apneic/arrested 10ish min after arrival to ED. Brought back to resus, called code STEMI and shock (gets ICU cards and CT Surg for ECMO decisions), intubated, coded him for 70ish minutes, 7 Epi and various other meds like lidocaine and amio volumes even tried lytics and never got him back/stable enough to go to cath. EF on bedside US was <10%, looked like a massive left main occlusion. Was after hours and taking too long to get team in house for ECMO so tried lytics and gave another 20min. Ultimately determined to be futile to continue, brought family in, stopped efforts. I don’t feel like there was much wrong with the medical care, but what do I do about them being my neighbor? Every time I open the garage and see their house across from mine it brings it back. I literally called time of death on my direct neighbor. We know their entire family, been here 2 years and they welcomed us to the neighborhood, watch our cat sometimes when we are away, etc. Do I bring over flowers and a card? Do I say or do anything else? What if they invite me to the funeral? Do I go? At a loss. We are trained to and I can generally deal with death, but this is literally a bit too close to home. I hugged it out with the family member around my age right after, said we did all we could and lost it. I haven’t had to excuse myself from active care on shift to go cry it out in years until this.
Can I face palm any harder?
I’m just at a loss for words…. “I wondering how I manufactured symptoms of a heart attack after reading ChatGBTs response” Lawdy if only you knew what my coworkers diagnosed themselves with after learning about it
Got written up for being too friendly with a patient.
For context, I volunteer with a group that does needle exchanges and STI screenings, and have developed a friendly relationship with a sex worker I’ll call Q. Q is funny as hell, personable, and genuinely seems like they are interested in recovering and improving their circumstances. It’s always great to see Q at the exchange or in screenings and get updates from them. When I saw Q’s name in the queue last night I volunteered to take them since we have an established relationship, and I was devastated to see they had back slid and had overdosed. We got them stable and I spent some time after educating them again on the importance of safe sex, the dangers of IV drug use, and had an open dialogue with them about what may have caused this and encouraged a formal rehab program (again). When I spoke with them I admittedly did talk to them like I do outside of the ED, using casual language and street vernacular. I wasn’t ever crass, but I talked to them like I would a close friend or family member. Apparently, a patient in a hall bed overheard and made a complaint that I was too informal with my patients and how can anyone respect a doctor who goes around talking like I’m from the streets, and that I spent too long with them when I could have been seeing other patients (there were very few actual emergencies just a lot of people with the Sunday night into Monday morning “flu”). Can’t win em all I guess. We got Q a bed in rehab lined up for next week though so I’ll take it.
The lead surgeon let me choose the music and I forgot a super vulgar song (“ Deepthroat” by Cupcake) was on my playlist- dying from embarrassment.
So I'm a derm PGY4. They let me scrub in on a really cool surgery for a patient with kaposi sarcoma. Derms aren't often in the OR (most of our surgery is done outpatient)- so I was excited. He let me choose the playlist. However, I forgot on this one playlist I had a super vulgar song called “Deepthroat” by Cupcake. Now I've heard WAP played in the OR before and other trashy music, but this song is basically like a commanding narration of porn. You can listen to it or google the lyrics but these are the opening lyrics: Hump me, fuck me, daddy better make me choke (you better) Hump me, fuck me, my tunnel loves to deep throat (it do) Lick, lick, lick, lick (I lick it), I wanna eat yo' dick (I do) But I can't fuck up my nails (I can't), so l'ma pick it up with chopsticks Mouth wide open like I was at the dentist Mouth wide open, mouth wide open Put it so deep, I can't speak a sentence My fingers in it, gentle (yeah), explore this n**ga mental I'ma write my name on his dick (his dick), don't need a pen or a pencil (no, I don't) All I need is my body (my body), my pussy pink just like salami (ooh) This will never fuckin' end it won't), ballerina that dick when I spin (I do it) I fucked this n**ga so good, I ain't swallow one kid, I think I swallowed twins (ah) Anyways………… Let’s just say I died inside from embarassment. I was begging the nurse to change it but the surgeon said “No! Leave it on this song is my jam!” (He’s a really good sport and good guy.) The anesthesiologist was laughing so hard he was snorting. The surgery went well and was successful with no complications (other than the death of my dignity).
Being an RN at a fatal car wreck hits much different than in a hospital setting.
About 14 years ago I was driving with my 7 year old in the car and the vehicle right behind me got off on the shoulder, overcorrected and hit a flat bed truck head on. I saw it in my rear view mirror. I pulled into the next driveway, grabbed a handful of gloves I keep in my car, told my son not to move and ran to the car. The small, 4 door sedan had turn 180 degrees, still in the same lane. The truck flipped on its side, broke completely in half and the gas tank was pouring fuel onto the road. Two men had gotten out of thr truck, in shock but ok aside from some broken bones. The driver of the car had their head hanging out of the window, her hair stuck in the bent frame of the door. I had to rip her hair out of the frame in order to straighten her airway. I knew this was not going to turn out well. I held her head and could feel her pulse. Weak but there. I barely had room to do a sternal rub due to the steering wheel being up against her chest. All the airbags had gone off so I couldn't see if anyone else was in the car. Another RN stopped and was able to look in the car and tend to the men from the truck. A young man, first responders with nothing more than a radio and a RESCUE license plate stopped and looked like he was in shock. We told him to get the firetruck there to hose the fuels away from the smoking engines as it was still pouring onto the road. EMS arrived quickly and I maintained her head position while the smaller EMT climbed in the back seat to try and lower her seat and get an airway in. She growned once with a sternal rub. Then her pulse slowed and stopped. As they got a neck collar on her I was able to get out of their way. They began cutting the car apart with the jaws of life. Those things are impressive to see in action. They got her out and attempted CPR but her injuries were catastrophic. I went back to my car and left once the EMTs had take over so I wouldn't be in the way. About 5 minutes later I started to shake. I was sweaty, felt like I couldn't get a good, deep breath. I pulled over again and tried to calm myself. I had worked in a hospital for 11 years. I had cracked ribs doing CPR, been present for multiple deaths and had never had such a reaction. The reason this was so hard was because I was alone. No band of nurses running with me to the code. No equipment to help the patient. It was me and a pair of gloves. All I could do was hold her head, keep her airway open and talk to her. I love and appreciate EMTs/Paramedics but on that day I had a whole new respect for what they do. They don't get a chart or a full report. They roll up on the most horrendous and often gory scenes and jump in. They communicate well, work well together and get it done. I drive past the site of this wreck every single time I go to town and often think of her. How quickly a life can end. Just a couple inches off the side of the road, overcorrected and went straight head on with a truck. I realized just how important our training is, especially when you are at a crash site with nothing but a pair of gloves.
Worst mistriage near-miss you've seen?
For me, ESI 5, cc: headache, vs normal, taken to Fast Track APP pages me saying "can you see pt in room x no neuro deficits but I think something's off." So I go in repeat neuro, no deficits, start taking HPI. "How long has this headache been going on?" "Oh man life's been a headache since I was born" and then he laughed and looked at me like he was expecting me to laugh too. "I'm surprised everyone doesn't have a headache these days" and then laughed again. "No, uh, three days now." I think we've all had patients like that. Anyway this is the ED not open-mic night, into the donut of truth you go. ICH.
My favorite PCP referrals to ED this month
Most of the PCPs I’ve worked with are amazing. But a lot of them around my ED….leave much to be desired 💀 Older woman with cirrhosis on lactulose takes it nightly and keeps pooping herself trying to get to the bathroom PCP: she needs to be evaluated for fecal incontinence! Me to patient: does this happen during the day? Pt: no I have regular BMs during the day, but at night I’m woken up from sleep to get to the bathroom and don’t always make it Me: so can you take the lactulose during the day? Pt: yeah? Neuro exam intact, no cord compression symptoms. Basically PCP didn’t even try to ask about the timing of lactulose and punted her to ED 💀 Older man comes in for a rash x 3 days. Borderline fever, mildly tachycardic Pt: my PCP prescribed me steroid cream and bactroban, but it’s getting worse. But she didn’t even look at my rash! I open his shirt….and it’s necrotizing fasciitis Me: so uh…we’re gonna have to start IV abx now And my personal favorite….asymptomatic HTN!! Asymptomatic HTN everywhere. Like literally just ASK if the patient is having symptoms??? And start them on something???? Because if they’re not having symptoms I’m sending them home?????
Wacky Treatments That Work
I was reading another thread that mentioned wacky treatments that the public thinks work. It reminded me of when I was in med school in a big northeastern city and the heroin users came to believe that you could treat OD by stuffing their underwear with ice or snow. Back then they would roll the patient on their side, stuff snow in their shorts and run away because heroin and drug paraphernalia were still illegal. Consequently when EMS arrived they just had an unconscious person with no history. The snow treatment actually "worked" in that it achieved improved outcomes because it was like a calling card. EMS would see the open, soaked pants chock full of leaves, weeds and gutter trash and give Narcan immediately. What are some other wacky treatments that work like having a parent blow in a kid's mouth to pop out a foreign body?
MY MOMENT OF CLARITY
This is not meant to be political, but as a nurse in a deep blue state, the effects of SOTUS over turning ROE V Wade felt infuriating. I really didn't feel like would change anything in my ER. Two day ago I triaged a young woman who was in that tiny fraction that chemical abortion did not complete the abortion. Retained product with a high fever. Does this woman die in some states? Opened my eyes to the horror of that decision.
My patient couldn’t breathe and needed a cric
Today was pretty quiet at first, just normal stuff. Then one of my patients who came in with a bad dental infection started having a hard time breathing. At first, he seemed okay, but then his airway started closing up fast. We called anesthesia and surgery right away and tried everything to get a tube in, but it just wasn’t working because his neck was swollen and bloody. I watched the surgeon do a cric right there at the bedside, it was the first time I’ve ever seen one in real life. I wasn’t the one doing it but my hands were shaking. It felt heavy watching someone’s airway get cut open to save them. We got him stable and moved him upstairs, but I’m still thinking about it hours later. I guess you never really get used to moments like that, even after all the years working in the ER. Just had to share.
Addicts
Hey cousins. I had an interesting experience last night that was a terrific reminder to me and I think a great lesson for all of us (especially if you’ve never been on the shitshow side of addiction yourself). I had a heroin/fentanyl OD come in, had just been discharged <10 hours earlier after a several days long stay for same as well as aspiration pneumonia. His co-user narcanned him in the Popeye’s parking lot followed by EMS, and then me in the ED (RN). He puked, got admitted for more aspiration pneumonia, and (hopefully) transfer to rehab down the road a few days. This kid (21) came in with wounds all over his body. Not injection wounds (he’s a snorter not a shooter) but large scrapes and abrasions across his body as well as a black eye. EMS had some convoluted story about self-harm but they hadn’t seen him conscious so me and the MD were puzzled. After a few hours, some fluids, and me tickling a foot (rather than a sternal rub); he started opening up to me a bunch. BG: I’m an alcoholic in remission x12 years (ya I got sober THEN became a nurse. Wrong order, right?). So, he and I speak the same language and have lived a lot of the same experiences. As he opened up more, I asked him about the wounds. His wounds were indeed, all self-inflicted. While we were talking about recovery and why we do/did what we do/did to ourselves, he shared that he was harming himself out of self-hate and his disgust over his addiction. This boy was a large, powerful young man and had been a very driven HS wrestler. He started to get injured and got several Rx for norco. After a while; instead of titrating his training and performance to his health needs, he drugged himself up to get through those obstacles. This turned into dependence, we all know the rest. The thing that stuck with me was his articulate and radical honesty (this is a kid that might actually have a chance to kick this problem if he can get the right support system). As an addict myself and a member of the EM tribe, I desperately wish I could communicate to you, my colleagues, the absolutely gargantuan mountain of self-hate that is hiding inside of the addict’s brain. Yes, we’re incredible assholes. Yes, we do remarkably fucked up things. Yes, we bring bushels of scorn upon ourselves as a result of our choices. Yes, there is very little nothing anyone can do to help us until we decide to help ourselves. But: Please. Please remember, we hate ourselves. We hate what we’re doing. We despise ourselves so emphatically that it takes a high just to take some edge off of that hate. We hate ourselves more than you could ever hate us, regardless of our behaviors in the ED. I was so blessed to have had this young man show me some emotional vulnerability amongst his physical vulnerabilities and suffering. He gave me (a fellow addict) that wonderful reminder to look for the humanity behind the behaviors. It’s so hard to remember that, even for those of us who have lived it. Please, please, please; learn more about this disease. Not from conferences, journals, and textbooks but from the AA Big Book, the memoirs of people like Noah Levine, Darryl “DMC” McDaniels, Marya Hornbacher, Matthew Perry, and all the beautiful and flawed people who have and do live this disease everyday. If you’re one of those people, just like me; please know that I love you dearly and you CAN get through these challenges. You have so much value here with the rest of us.