You thought your Mondays SUCK!

This past week was on of those ones that I hope I don't get to experience any time soon. It all started around 1900 Monday.

Another night on diversion! 

One of our many senior nurse managers followed by the very angry chief attending called the resource nurse less than 30 seconds after our request went to CMED. They wanted to know why he was requesting diversion if we still had beds available in the hospital. 

I was in the 7 bed trauma section where the two hardcore rock star nurses I was working with  were pretty much one to one with two very sick PTs while their other PTs harassed me with every request from doctors and doses of pain meds to the Russian looking for her seafood salad sandwich. 

The department as a whole was drowning in a sea of level 1-2s. ICH, Stemi, Acute GI bleed, three tubed ICU players, Sepsis, yup we had em all. It was an acuity party and the ED was the only department invited. Consult teams and floor nurses were avoiding our calls and pages like a resident avoids a call bell. A particularly ugly Monday meltdown.

And then the dreaded radio call arrival alarm went off. Several nurses and doctors cursed aloud. 

Medical Student (b) speculates " I thought we were on diversion"

 The double doors from triage opened and in rolled two cops and two paramedics with a stretcher.

 Pedestrian struck around the corner from the hospital on a busy four lane parkway.  This guy is in rough shape delta O2 and BP. The recording nurse makes a second overhead call for nurses to the trauma bay, The PT goes into cardiac arrest, intubation turns into a 5 minute ordeal for the senior resident. Despite everything the PT is revived and stabilized enough to be rushed to CT. The Trauma team wants the PT to go directly to SICU to be prepped and further stabilized for the OR. As they leave with the PT in a giant gaggle of equipment, RT and, trauma team the nurse shouts to me to call the SICU and inform them of whats going on and to have them call her in the CT control room for report. 

I pick up the phone and dial the SICU and explain to the nurse on the other end what is going on. She bitches to me that we should have given the SICU a little more notice than this. The PT has now been on the property for just over 15 minutes. 

Rock star nurse calls from CT she needs two bags of blood and more sedation meds "Please hurry!" she pleads. I tell her I am all over it like white on rice. as I move down the hallway I poke my head in her other PTs room to see why the alarms are chiming the monitor reads 68/- and HR hovering around 30. I overhead the attending to the room.

It is true Mondays really do suck!

The following week the resource nurse who was on duty that night is sat down for a formal Inquisition by a panel of senior management to explain why diversion was requested. 

The Art of ED techery

I think most people out there would agree that the emergency department (ED) is the official gateway to the hospital for all people whether they are there for something minor or, beginning the confusing time consuming transition to becoming an inpatient. Some patients will even find themselves spending days in the ED on a gurney before they see the inside of a hospital room due to no available beds or shitty insurance issues.



Your friendly ED tech is the first face and usually the last one that most patients see during their emergent visit. We take their vitals and chief complaint at triage. Once in the department we draw blood, start IVs, perform ECGs, flush wounds, splint, dispense crutches and turkey sandwiches. All this and the usual gofor duties. Plus how could I not include all things R. Kelly i.e. foley caths, UhCGs, U/As, Utoxs, and the good old code brown in all its glory and different forms.

We are the trench dwellers. The human insulation between nervous internal medicine residents and their unsuspecting victims. I listen to patients introduce themselves to me "You ain't the Docta!". After three or four hours waiting for the "Docta" I am now their only answer to the call bell.

"Whats takin so long?" call bell happy PT
"well two things, You need to pee in that cup for me and...."
PT cutting me off "Whatcha mean right here?!?!"
"No we have a bathroom down the hall for that" I reply
"You also got to finish that PO contrast so we can get you to CT." I continue
"It taste like shit. Gimme sumthin to eat!" PT exclaims hitting the call bell again. I reset it again.
"Miss, you can't eat anything just yet your here for severe abdominal pain and you said you haven't had a bowel movement in eight days........"

call bell going off again I reset it in seconds.
PT again cutting me off "Its startin to hurt more cuz I ain't got nothing in it."

Even though I get more of this shit than I do quiet and obedient grateful PTs I'll still advocate for them. One night recently I was going to the mother room to restock and a hallway player grabbed my arm and complained about nobody talking to him in hours and all he wanted was a glass of water and some pain meds. Of course I was automatically judgemental as we all know which stereotype is usually uttering this request. The patient wasn't in my section but I went to find his nurse to see what his NPO status was. It must have been someones lucky day because as it turned out the triage tech had fucked up royally and hadn't placed the PT's chart in the to be seen rack when they brought him back. What was initially triaged as a level 5 chief complaint ended up being two fractured ribs and a ruptured spleen requiring surgical intervention. Incidents like that always put the job back into perspective for me. Because at the end of the day if you forget that it really is all about the patient than you might as well go dwell in a cubical somewhere instead of potentially contributing to a PT fatality!