I am all for providing care for the ill, even the chronically ill. My disclaimer is my oath. If a patient comes to the Emergency Room, they will get equal care from me, even if their chief complaint is as annoying as being kicked in the balls repeatedly by a mule. That being said...I gots some problems with some people's definition of "emergency." I may have posted something about it before, at least the definition problem. Every day I work, however, shows me that what I think is an emergency, is not always the case.
For example, if you have to take a taxi to the emergency room...is it really an emergency? I know, you don't have a car. I get it. That's why they have ambulances so you can be transported for care. On the flip side, calling 911 to have an ambulance bring you to the Emergency Room to avoid waiting for an hour in triage, depending on your condition, will most likely put you in triage to wait just like everyone else.
Most ER visits are long. Staff will do their best to make sure that your ER wait is as short as possible, but like a walk-in clinic, you are seen based on accuity and arrival. Both factor into the length of stay. A finger laceration, as painful as it may be to you, is often trumped by someone experiencing chest pain, or stroke symptoms. Common sense. Don't get mad when someone who just got there goes back before you do. Oh, and it has nothing to do with race...FYI.
If you have been diagnosed with antibiotics less than 24 hours prior to your ER visit for similar symptoms, and you haven't filled the prescription from yesterday's visit, don't be surprised if your visits with the doctor is very, VERY short. At the same time, if you HAVE filled the prescription, and HAVE started the medication...YESTERDAY...and still have, let's say, sinusitis...give it time. It's like a cell phone taking a little while to load. The signal has to go to space and back. Great technology. Show some patience. Antibiotics need to build in the system before your problem gets better. Save $500 and wait.
If you chipped a tooth, see a dentist. Especially if it was chipped 3 weeks ago and your face is swollen. Not knowing why your face is swollen is a sign that you should be a ward of the state. The is not a whole lot the emergency room can do for you. We are more prepped to handle....emergencies. Heart attacks, strokes, gunshot wounds, stabbings, motor vehicle accidents. We have specialists on-call that can assist us with those types of...emergencies. Hard to believe we don't have a dentist or a podiatrist on-call, I know, but we don't. We try our best to provide the care you desire. Often times, its a dental block to let you sleep and...go to a DENTIST. If this becomes an on going problem, and this is your 12th visit in 6 months for the same dental pain, all of which have been the same with instructions to go to a dentist, not much will change in the approach to the care that will be given. 2mg of Dilaudid given IV is not the protocol for a chipped tooth, nor is it lawful in the State of Washington. I accept the fact I will not be getting a Christmas card from you. I apologize.
The emergency room is not a spa. Coordination of care is directed by professionals that went to school for a long time to get you in and out the door. There are standards and protocols in place to make sure that you are given care in a timely manner. There is no other way to say it nicely than....go home. There is nothing EMERGENT that can be done with your abscess. It has been incised and drained, cleaned and dressed and the prescription is in your hand. ESPN is on pretty much everywhere. Sportscenter repeats every hour after 10 P.M. You aren't missing much. The are limits to what we can do for you. No offense, but there are people that are waiting for the room. No we cannot admit you for a food tray because there is no reason to admit you. Subway, however, is open.
When entering the emergency room, do not walk from your car, briskly, enter the doors and plop down in a wheelchair and adopt the facial grimace from hell. Funny thing about windows...triage nurses can see through them. You lose credibility when you come for shortness of breath upon exertion and you were seen smoking while you skipped to the door, laughing and talking on your cell phone. Morphing into the wheeze monster who spews sentence fragments while speaking to the triage nurse doesn't fool anyone, especially when your oxygen saturation is at 99%. Notice the signs strategically placed throughout..."It is against Washington State law to dispense prescriptions for narcotic pain medication for chronic pain conditions. You will need to get your narcotics from one physician, typically your primary care doctor." Funny thing about records...we keep them. Today, shortness of breath, the previous 55 visits...back pain. We'll do what we can to get your saturation level from 99% to 100%, but unless your trachea deviates to one side of you have a lung mass...don't be mad when you are sent home with Albuterol instead of 20 Lortab.
I love my job. I love that one day, I will be a practicing nurse. But I love common sense even more. I wish someone could prescribe that...
Wednesday, October 12, 2011
Tuesday, October 04, 2011
Realistic Consequences are Best
My 8-year old has a hard time with choices. I believe that it is important to direct children to making good choices now because poor choices are a gateway to SERIOUSLY poor choices that hold more severe consequences later in life. Peyton feels that we hate her. No matter how I try to tell her if that were the case I would help her pack, she still believes that living under my roof is like having her legs broken ala Kathryn Bates in 'Misery.'
"Peyton, can you please go put your clothes away that are in your room?" - WAHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHH....whhhyyyyyyyyyy do you do this toooooo meeeeeeee???!?!?!?!??"
"Peyton, please finish your milk and put your dishes in the sink?" - YOOOOUUUUU HAAAATTTEEEEEEE MEEEEEEEEEEEEEEEE!!!!!!!
"Peyton, could you not play in the dirt before you go to school? You will get your clothes dirty." - RAPPPPPEEEEEEEEEEEEEEEE!!!!!!!!!!!!!
It doesn't matter the request. There is always bartering and banter that comes with it. The above are reactions that depict, somewhat, the typical reaction. The atypical reaction is the request is fulfilled without resistance. However, that is about as popular as a Centaur feeding in my lawn. It never happens. It's really hard to come up with a consequence I can actually follow through with. For example, as she is eating a meal she has eaten in the past, I watch her face at the table wrythe and contort into every possible shape to convey to me, non-verbally, that she is eating glass. It's hard for me to watch her behave this way, knowing that there are people, RIGHT NOW, cupping handfuls of urine to satisfy extreme thirst somewhere in the world, and NOT want to throw her through a wall. Instead of saying something reasonable like, "Peyton, if you don't finish your food, you will need to go to bed," I say something like "Peyton, eat...because if you don't I will let loose 100,000 black widows in your room and break your light bulb and lock the door." I can't possibly do that. I hate spiders. I can't handle ONE let alone 100,000. Pfffft...makes no sense.
That's just food. If you want to talk about clothes for school that day, that is an entirely different story. Before she goes to bed, she picks out what she will wear the next day. Seems legit. Until the sun comes up and all bets are off. Setting them out the night before saves time. However, when you have a multiple personality pseudo-disorder, as AM Peyton and PM Peyton are different in ways I cannot convey in words, this is a chore. She has learned that the more resistant she is, the more she will simply get her way as to avoid an adult aneurysm. My bad. I have evolved. So has Mom. Now, what she picks out at night will be what she wears in the morning. If she chooses not to, she will need to go to school naked....because that is realistic. Ok, not so much. I have also threatened to burn her clothes and went so far as to grab the flick lighter and hold her clothes a few inches from it...and thought better of demonstrating pyrotechnic behavior to my son who is sucking this all in. I figure, let her wear fuschia pink shirts with a denim skirt and green and navy blue leggings. The playground police will fix this for me. She will become socially irrelevant, and then she might listen.
As far as she is concerned, her Mother and I know absolutely nothing. Funny how I was the same way. My parents attempted ther whole lives to teach me right from wrong. It wasn't until I was older, maybe wiser, and a parent that I realized that I was wrong. My parents knew everything. Maybe I will dig a grave in the back yard with a blank name plate and tell my kids that that hole is for the first one to give Mom flack?
But that's not realistic....or is it?
"Peyton, can you please go put your clothes away that are in your room?" - WAHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHH....whhhyyyyyyyyyy do you do this toooooo meeeeeeee???!?!?!?!??"
"Peyton, please finish your milk and put your dishes in the sink?" - YOOOOUUUUU HAAAATTTEEEEEEE MEEEEEEEEEEEEEEEE!!!!!!!
"Peyton, could you not play in the dirt before you go to school? You will get your clothes dirty." - RAPPPPPEEEEEEEEEEEEEEEE!!!!!!!!!!!!!
It doesn't matter the request. There is always bartering and banter that comes with it. The above are reactions that depict, somewhat, the typical reaction. The atypical reaction is the request is fulfilled without resistance. However, that is about as popular as a Centaur feeding in my lawn. It never happens. It's really hard to come up with a consequence I can actually follow through with. For example, as she is eating a meal she has eaten in the past, I watch her face at the table wrythe and contort into every possible shape to convey to me, non-verbally, that she is eating glass. It's hard for me to watch her behave this way, knowing that there are people, RIGHT NOW, cupping handfuls of urine to satisfy extreme thirst somewhere in the world, and NOT want to throw her through a wall. Instead of saying something reasonable like, "Peyton, if you don't finish your food, you will need to go to bed," I say something like "Peyton, eat...because if you don't I will let loose 100,000 black widows in your room and break your light bulb and lock the door." I can't possibly do that. I hate spiders. I can't handle ONE let alone 100,000. Pfffft...makes no sense.
That's just food. If you want to talk about clothes for school that day, that is an entirely different story. Before she goes to bed, she picks out what she will wear the next day. Seems legit. Until the sun comes up and all bets are off. Setting them out the night before saves time. However, when you have a multiple personality pseudo-disorder, as AM Peyton and PM Peyton are different in ways I cannot convey in words, this is a chore. She has learned that the more resistant she is, the more she will simply get her way as to avoid an adult aneurysm. My bad. I have evolved. So has Mom. Now, what she picks out at night will be what she wears in the morning. If she chooses not to, she will need to go to school naked....because that is realistic. Ok, not so much. I have also threatened to burn her clothes and went so far as to grab the flick lighter and hold her clothes a few inches from it...and thought better of demonstrating pyrotechnic behavior to my son who is sucking this all in. I figure, let her wear fuschia pink shirts with a denim skirt and green and navy blue leggings. The playground police will fix this for me. She will become socially irrelevant, and then she might listen.
As far as she is concerned, her Mother and I know absolutely nothing. Funny how I was the same way. My parents attempted ther whole lives to teach me right from wrong. It wasn't until I was older, maybe wiser, and a parent that I realized that I was wrong. My parents knew everything. Maybe I will dig a grave in the back yard with a blank name plate and tell my kids that that hole is for the first one to give Mom flack?
But that's not realistic....or is it?
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