Chief Complaint

I suppose I should clarify what I do at Kadlec. I am a nursing student, not a nurse. I suppose I am a nurse-in-training, but I do not interact with the patients. In all reality, I do, jokingly, once the doctor has done so and it is apporpriate for me to do it as well. Let's say that I have not left a patient's room with the doctor telling me to knock it off. Yeah, I am surprised too. I am a scribe. Not the quiver-n-bow type scribe, but a medical scribe. I make paper. Well, electronic paper. I chart while the physician examines the patient. I track lab results and diagnostic tests for the doctor and prompt him or her to read them, interpret them and I will transcribe these verbal findings onto the chart.

Now, as mundane as that might sound, I love doing it. I love seeing the interaction that the docs have with patients. I love seeing their minds work and asking questions about the process. It is a trememndous learning experience, just as I thought it would be when I first applied. All the doctors are amazing clinicians and I know that when I am done with school I will owe them a debt of gratitude for both teaching me and tolerating me. However, I have seen some really, REALLY stupid things roll into the emergency room. Things that do not require emergent care and things that are referred from doc-in-the-box type clinics for further evaluation. The list of things that should not come into the emergency room is in my head, which, as we all know, can be a very insane place to hang.

A "chief complaint" is the complaint that the patient complains the most about. For example, often times a patient has so many complaints in triage that the nurse has to narrow it down to one. Often times, even that one is bullshit. However, since people come into the emergency room, the deserve proper, adequate care to relive this complaint. The list of interesting chief complaints is somewhat comical since what their diagnosis ends up being often has nothing directly to do with their chief complaint. For the uneducated, however, here is a list of things that do not require EMERGENT CARE...since that is what is done at the EMERGENCY ROOM.

1. Bug Bites - not brown recluse bites or black widow bites, or numerous wasp stings, but just 5-6 mosquito bites, none of which are infected. Simple treatment would include over the counter Benadryl (antihistamine to relieve itching) or Calamine lotion (topical ointment to relieve itching), both of which were not administered prior to arrival. When asked why they came to the emergency room, the parents of this 9-year old indicated that their child was itching these "huge bites," the biggest of which was about the size of a grain of rice. Diagnosis : bug bites, multiple. Prescription: OTC (over the counter) Benadryl. That will be $400 please.

2. Nausea - no vomiting, no diarrhea, just a stomach ache. When asked to grade the pain on a scale of 0-10, with 10 being someone smashing your legs with a sledgehammer, the patient graded it a 9, remote control in hand switching it to the NBA playoffs, feet crossed over each other, bed reclined, ala home recliner comfort. No abdominal tenderness to palpation, no fever, no real illness. I think this guy was tired of dealing with wife and kids while the game was on. A CT scan later to rule out any acute injury, $1000 or so, and off he went. Be sure to drink lots of fluids.

3. "My pee smells really bad..." - Sounds like it could be a urinary tract infection? Sounds serious enough, right? I mean we have all been taught that stinky anything is indicative of an infection, right? If that were the case I have had an ass infection my whole life. While being questioned about recent food, drink or antibiotic use, patient indicated that he had ingested some asparagus prior to arrival. End of exam. Diagnosis - normal exam. Prescription - car keys.

4. Abdominal pain/pelvic pain - I cannot fathom menstrual cramp pain, at least directly. However, every 28 days I do get an indirect idea of how these feel. Ouch. I get it. But when asked if these cramps are different from previous menstrual cramps, the patient indicated these are the same. No abnormal or excessive bleeding. WHY ARE YOU HERE? "I am out of Motrin." Wow....really? This will be some expensive Motrin. Next.

5. "My skin hurts." - Can you describe the type of pain you feel? "No not really." Is it like an itcing or burning pain? "yes, its like that." Is it also like a cramping pain? "yes EXACTLY like that. My skin feels very crampy." Can you tell me one spot that hurts worse that anywhere else? "Right about here (motions hands over his whole body; head to toe)." Have you taken anything for the pain? "I took some Benadryl and Motrin." Did you have any relief? "No, that made it worse." Are you allergic to any medications? "Ibuprofen and Benadryl." Did you know you were allergic to ibuprofen before you took it? "I didn't take ibuprofen, I took Motrin." That's ibuprofen...they're the same thing. "Oh...well, why is it worse?" Because you are having an allergic reaction to the medication you took. "Oh...can I get a shot of Dilaudid then?" I'm sorry, according to your care plan, I cannot administer any narcotics during your visit to the Emergency Room. "Oh ok, well I am feeling much better now. Can I just leave?" This happens quite often...more than you know.

There are many, many more I could illustrate but I don't want to bore you any further. From a student perspective, it is a great opportunity to listen to patients talk and be able to filter out the bullshit. My filter was not as keen as it was before I started. I am a tad cynical when my kids come complaining about certain ailments. When my wife took Peyton, now 8 years old, to the emergency room as a two-year old (see previous blog post from 2005), I laughed before she left, as did the docs at the ER I am sure. Diagnosis, diaper rash. Prescription: diaper rash ointment. I think that visits was about $300. Should have framed the bill. Unless they are bleeding from their numerous orifices profusely, or have dangling limbs bending in ways that God did not intend, they can wait to see a doc-in-the-box.

I don't want my kids to be someone else's blog fodder. They are for mine.

Coupons? Seriously?

My disclaimer for this post is this: I know nothing about it. My anger stems from others who use it while I am shopping and know nothing about it. Just because TLC does a show about it doesn't make it an acceptable practice. I believe Sister Wives is a TLC program.

I rest my case.

Coupon shoppers annoy me. It isn't that they are being proactive and wanting to save a ton of money. To me, at least from what I have witnessed, it is an excuse to hoard. Who needs 12 boxes of saltine crackers and 22 bottles BBQ sauce? It seems to me that what you save in money you lose in living space. I am sure its awesome to never have to run out of water, bread, Hershey bars, laundry soap or thumbtacks. That's awesome for you. You saved $50 on a $200 bill? That's efficient and news worthy. It burns when I pee. But I don't go shari...err....you know what I mean? I don't care. You are better than me. I get it. That's fine with me. Just know that when I open my linen closet, there is linen in there, not 38 boxes of Rice mix, 14 jars of Jif and 33 Power Bars and 4 jars of shoe polish. It's hoarding.

The express line is just that...an express line...express, meaning hurry the fuck up and all 3-ring binders are to be kept in your back back. It's not impressive to pull out a binder that has more earmarks than Obamacare. It's kind of annoying. It causes eyes to roll. Then, you apologize which acknowledges the fact that what you are doing is inconvenient to others behind you.

Checker - Ma'am that will be $39.97 (I say ma'am because its a woman doing this. Guys won't coupon shop...too much work. Besides they don't have coupons for beer.)

Coupon magnate - Wait....I have coupons

Checker - you need to present those before you are rung up. Do you see the sign? (points to sign that says present coupons prior to checkout, fuckchop)

Coupon - I just need to get them out (takes out laptop, can of tennis balls, earmuffs, 22 inches of heavy chain link, one sock, a tube top that says 'OK-95,' 18 chapsticks and a swiss army spoon)...here you go

Checker - .50 cents off Depends? You don't even have Depends in your items?

Coupon - Oh sorry not that one....this one.

Checker - Buy one Trident, get the 2nd one at the same price, must buy 400 Tridents? This one? You realize this is a 15 item or less line right?

About this time there are 8 people with 12 items between them about ready to gang rape this woman. Why? She watches TLC and wants to save a buck. In all reality, to each their own. For the record, I don't care it works for you. I don't care to learn about it. I'm not mad that someone else does it and I don't. It doesn't bother me if you know what the hell you are doing. But if you don't, pardon me if I punch you in the vagina. I just need this milk...this one jug of milk so I can be on my way.

Asshole.

Parent First, Friend Last

First and foremost, parenting styles are different. I get that. However, I believe there is a constant that all parents should share but seemingly few do. That constant is that as a parent, you are a parent first and a friend later. Period. End of story. I believe there is a generation of kids being raised that have little knowledge of right and wrong. Isn't that the job of the parent? If you are right, you get to stay here one more day. If you are wrong, I'll help you pack. I can't remember a time when I mistook my parents for my friends. Thank God or else I could describe a jail cell down to the dots on the cinder blocks.

I love all my kids. However, if they "hate me" because I won't let them do everything they want, so be it. I will get over it long before they will. It's the nature of the beast. I provide food, shelter, clothing, a sense of well-being and moral support...maybe some assistance with homework and a ride or two. Beyond that, let the molding begin. I have heard too many times that "my parents were strict and I hated it, so I am trying to be my kid's friend first," and every time I hear that I want to open up a sterilization clinic. That's not your job. Your job is to provide the knowledge and skills that are required to function in society, not to make sure your child's friends like you. My house is a gathering point for the socially inept when school gets out. I'm glad my kids have friends. Is it wrong that I want to make sure that their friends aren't going to kill a porcupine and hang it from a door knob? I don't think so, and even if it doesn't sit well with my kids, I don't really care and to the parent's who question why I won't let your kids play with mine after school, go fuck yourselves. I'm not a day care center. Spend time with your kids after school. Ask about their day. Don't send them to my house. Example:

(knock at the door, door opens) Hi, I live across the street and my daughter said that you told her she couldn't play with your kids

Me - Correct

Neighbor - Can I ask why?

Me - No

Neighbor - Excuse me?

Me - Which one of the single words did you not understand?

Neighbor - Why can't my kids play with yours?

Me - For starters, hepatitis. But if you want a complete list of reasons, lice, numerous blood borne diseases...ummmm....I am afraid your kids will dumb mine down, tuberculosis, cellulitis, sinusitis and gastroenteritis. Most important however, your kids need YOU, believe it or not. Go help your kids with simple math. If you can't handle that, Google it.

I have heard from my kid's how they hate it at home. I have offered to help them pack and offered to crack their piggy bank for some spending money. It never really goes very far, but honestly, if I didn't love them, I would let them be assholes. My job isn't to be friends and make them happy by fulfilling every request. That's not realistic. McDonald's management won't do that, so why should I? I need to prepare them for reality. Only way that will happen is by P-A-R-E-N-T-I-N-G. It requires a sense of realism. Parenting now, while they are young allows for friendship later. I have grown up always loving my parents, but have found a certain level of respect of their parenting style now that I have kids. Being a pain in the ass early in life has allowed us to become very good friends. I love them for that. I have no doubt my kids will be the same way as they get older. History has proven it.