si/hi etoh come one come all, we will make sure you leave medicated and a little crazier

I suppose we are lucky that we are one of the few EDs with a separate psychiatric unit. The unlucky being the employees who work there. Management is pretty good about rotating nurses and techs through the pink zone. Those in the dog house sometimes find themselves marooned there for multiple shifts. 

On any given night you can find the clinically insane, suicidal, homicidal, pyros, fakers, addicts, cutters, slashers, mumbling nanas, TBIs, ODs, glue sniffers, panty sniffers, homeless etoh, college aged etoh, yuppie etoh and last but not least combative, can't protect my airway and, I'm the best man in my brothers wedding in four hours etoh.

I think the most unfortunate are those who lack good insurance.  All is well with the BEST team but don't let them find out your crazy bipolar ass is self-pay cuz then it's all over. These are the forgotten souls of society. These poor mental train wrecks end up boarding in the ED for a few days until they are quitely shuffled out the door. I have seen section 35 quacks get released back into the streets because the SW dug up some 3 week old papers saying that PT is clinically sane and able to operate heavy machinery and large caliber weapons. 

Hey if you have some nice Blue Cross Cadillac insurance feel free to jerk the fuck out! Go out and pee on someone, Beat up a police cruiser, Get really drunk and pass out on the steps of the State House,  Eat bottles and bottles of Tylnol PM and call 911 for fun.  Whatever you do just remember to glue that shiny insurance card to your forehead. 

Don't get me wrong, the ED staff will stabilize you regardless of you economic stature. 

The card is what buys you the luxury of a top notch private institution. A month off from the fast pace of reality to think about what you did wrong. Who knows maybe you will master leather work or pottery glazing during your 30 day evaluation.

And when your all done and have recieved your endless prescriptions...................Feel free to do it all over again!!

The ED will still be here for your next episode and, after you gain frequent flyer status we will even let you hang in triage and entertain EMT crews and horrified PTs for hours and hours.

As the great Apu would say- Thank you! Pleaseeee come again.

Welcome To The Workplace Part 1

The Tech- Mostly misunderstood, the tech dwells at the near bottom of the ED food chain hanging by a rung over patient observers and support services. We answer to the new travelers nervous overhead pages, we are beckoned by grim faced residents wearing precaution masks  peeking from behind closed curtains. We are usually the only person left in the department to answer trigger finger call bell PTs twentieth ring. We share sweat with cardiac arrest PTs as we pound away on their chests like machines waiting for the stop compressions call from the attending.

We share the gallows humor with the veteran nurses and attendings as another rotation of fresh residents gap in horror at our running commentary. Not all of us in the ranks are the same though. Many different ages and personalities fill the dichotomy of the Department.

Although I can't classify everyone I can put most of us into these categories-

1.) The Lifer Tech- This breed is far and few between. These die hard techs are here to stay and when I say lifer I mean 5+ years. They mostly come from other hospital departments or like one of ours an orderly from a lock down unit for juvenile violent offenders. The pros of Lifer tech is that they can tell you were to find anything under the sun that has the hospitals serial numbers on it. They can also find veins on the difficult sticks everyone has given up on. Lifer tech is often accused of being lazy. Although Lifer tech will seldom do tasks outside of their scope of responsibility, their experience makes up for it when you need them in a pinch. Or as one of our gayer than Christmas SWs likes to say "a sticky situation"

2.) The Aspiring Doctor Tech (ADT)- This type of tech is painful for all involved. ADT can be found at shift change with docs on rounds, sometimes even volunteering their diagnosis and input. ADT loves to research med schools online while ignoring nurses requests and fellow techs calls for help. ADT has even been spotted checking tube placement with a mini stethoscope. Whenever ADT needs shift coverage for a med school interview they make sure the department wide email includes the name of whatever prestigious school they are interviewing with. But ADTs worst trait is telling PTs their diagnosis. This usually sends at least one shocked PT into a frenzy now needing a real MD to calm them down and explain in even longer words what the issue really is. There are no redeeming qualities abut ADT tech.

3.) The Workhorse Tech- Every nurses best friend. This Tech is usually one of two demographics- The first being the PA/Nursing student tech. This tech keeps their head down and gets the job done grateful for the minimal impact clinical skills. They're also always looking for something to do when docs need assistance in not so sterile procedure. The other type of Workhorse tech is the transient tech. This tech is usually an EMT sick of riding, veteran, college dropout, some guy that used to work in a pizza shop, etc that is looking for the next adventure. Some stay on becoming Lifer tech. The downside of this second type of tech is that they have a tendency to up and disappear.

A good department will have a nice mix of 1 and 3. All EDs will always suffer at least one ADT. The good thing is that they usually don't survive that long once they cross paths with the wrong senior nurse. 

Stay tuned next time for Welcome To The Workplace Part 2: The Seven Nurses

Friday Night Fights

Another Friday down the tubes. It wasn't that bad, we didn't get our first trauma basic until 0130. 20 something male with a nice deep stab wound to the chest. He was brought via EMS by some kick ass veteran basics who couldn't have done a better job packaging this ETOH induced ass clown for his arrival to the land of chest tubes and copious amounts of blood transfusions. They had successfully stopped the bleeding and applied a text book sucking chest wound dressing. From what the cops were saying it was a pretty hectic crime scene with party goers hurling bottles at the ambulance before the police finally showed up on scene. They rolled him into the trauma bay gave report and left. Thank you please come again. He was very combative at first yelling at us thrashing around refusing medical attention. It is amazing how cooperative a pt can be once they become hypovolemic. The attending cracked me up a little. First she told the trauma/surg team to get their shit together and pick up there sharps from the discarded  chest tube kits on the floor then she turned to myself and the recording nurse and stated "I've never met a stab vic that i liked."

Of course in the middle of this trauma in came our second call, a drunken 19 y.o. female college student who was grazed by a cab. "OMG am i gonna die?!?!" No princess you got lucky. of course she refused to allow us to cut her favorite jeans off despite clear evidence of multiple right sided trauma. Whatever!  She was gonna walk away from the ED in the morning with probably some minor injuries. 

I walked out to the waiting room to find stab vics family after he was rushed up to the OR. There was his Mom and sister sitting there waiting looking pretty stoic. Standing next to them was college girls 3 friends all freaking out on cell phones about Princess. One of them saw me walking towards them. "OMG is Princess gonna die?!?!?" 

Yup another Friday, another fight, another night.