Me

Quiet

I’ve been quiet for a few days. The old saying that you can’t fill someone else’s cup if your own well is dry has been true for me this week. Let me explain:

As you all know, I work three days a week. Day one, I had four rooms and a parade of really sick patients in them. One of my patients had leukemia and didn’t know. The doctor and I had to tell her. Still other patients had a host of problems- one guy had a 100% blockage in two cardiac arteries, another had lost so many fluids from a week of diarrhea that his blood pressure was only 70/42. A long day.

The second day saw me treat two coworkers: one a doctor who had a seizure at work. The second, a fellow nurse with SVT and a heart rate of over 200.

The third day was by far the worst. We had a critical incident. Let me explain. EMS brought in a woman who was in cardiac arrest. She was also 38 weeks pregnant, and had been down for about 40 minutes when she came in. I was the team leader.

When you work a cardiac arrest in the emergency department, what we call a “Code,” there are numerous jobs.

  • There is the recorder, whose job it is to write down every single lifesaving act we take, drugs given, etc. That person also is the time keeper. Things like “Two minutes to the next pulse check, three minutes to the next dose of epi,” things like that. This is always an RN.
  • There is at least two compressors. Their job is to perform chest compressions, and there are two so they can switch places when they get tired. Literally anyone who works in the ED can do this job.
  • A Respiratory therapist, who is in charge of ventilating the patient and maintaining the patient’s patent airway.
  • One nurse or paramedic who is in charge of IV access.
  • A doctor, who is in charge of making all decisions.
  • The team leader, who runs the defibrillator and handles all of the drugs. This is always an RN, and usually a well experienced, senior one. They work with the doctor to ensure that the patient gets the proper treatment.

One of the sights that I will never forget is what that lifeless baby looked like when they cut her mother open to rescue her. Another sight that I won’t forget is looking across the patient and seeing the nurse who was the compressor continuing to do her job as tears poured down her face. It was heart wrenching.

In total, we worked on that mother and her baby for over an hour.

We wound up getting mom’s pulse back. We lost the baby. We still had six more hours to go in our shift, and we still had patients to take care of. The most jarring thing about it was that you would walk out of a room where you just spent an hour trying to save a dead baby, only to hear your patient demand a turkey sandwich. Codes involving the death of a child are always hard. In fact, it was one such call years ago that had me seeing a shrink for a couple of years.

Emergency nurses are some of the most jaded people I have ever known. They are used to seeing tragedy on a daily basis. It isn’t unusual for us to work several codes in a shift. What is unusual is to work a code on a child or on a pregnant mother. In fact, we only do that once or twice a year. Add to that, many of our nurses are recent or expecting mothers. Adults dying? That hasn’t bothered me in years, but when a child dies, it’s like a little piece of you dies with them. It’s heart wrenching and it takes weeks to get over it.

For the rest of the day, you would enter a medication room or a storage closet to find a nurse in there crying. Two of the nurses were doing so poorly that they had to be sent home for the day.

Me, I did OK for the remainder of the shift, even though I was on the verge of tears. I held it together and went home. As soon as I saw my wife, that was when it hit me. I sobbed like it was my own child that I had lost, and did so for about 20 minutes. Then I drank some booze and went to bed. I didn’t speak very much to my wife for a couple of days. I didn’t blog, except to post some posts that I had already written and was saving for later. I ate very little.

I feel better now, but you can’t imagine how hard it is to hold a dead baby. I still see that child’s face at night. The only thing that enables me to sleep is the knowledge that we did our job well, and managed to save the mother. I can’t think of a single thing we could have done differently that would have made a difference, and that is what will enable me to go back to work.

By Divemedic, ago

Lame

The training was stupid, and the instructor actually admitted that it was designed to absolve the hospital of any liability of a patient were to attack a nurse, because now we can’t sue the hospital for not providing us with training. If a violent event happens, it must be the nurse’s fault for not properly de-escalating the patient’s behavior.

Today’s class was 8 hours long. The first four hours was on how to redirect the patient’s behavior. The training said that all behavior is a form of communication, and the patient is simply trying to tell you that there is some sort of problem that the health care provider needs to address, but doesn’t have the words to be able to express it, so this manifests as “Risk Behavior.” The only proper reply to this “risk behavior” is to safely, and in a non-confrontational way, control and redirect the patient until the patient can realize that what he is doing isn’t productive. It’s called nonviolent crisis intervention, and I think it is bullshit that is designed to cover the employer’s legal ass, and who cares if employees get hurt? Healthcare systems hide behind the workers’ compensation immunity shield, so you can’t sue them if they trained you to avoid violence. They can, however be sued if one of their employees defends themselves from a violent attack using a violent response.

The next hour was all about how employees need to remain detached and not allow the patient that is in crisis to goad or bait you into engaging them.

Then we broke for lunch before returning to learn the practical skills. The first step to each one is to “take a non-threatening stance that is designed to not provoke the patient into engaging in risky behavior.” Then, if the patient tries to hit, grab, bite, or shove you, how to break free and escape to run away and call for help. The key is for the employee to avoid violence.

I was the only male there, so I got to be the one that the instructor kept using for demonstrations. One of the scenarios was how to escape a front chokehold where the patient is facing you and attempts to grab you by the throat. The instructor, was roughly my size, had us watch a 1 minute video on how to escape this and said let me demonstrate, then spun around and grabbed me by the collarbones with both hands. I swear with all of my being that I didn’t do it on purpose. He caught me by surprise because I was zoned out and not really paying attention. What happened was reflex.

I brought both hands up through the middle of his arms, then palmed his face with my left, causing him to lean backwards slightly. Once he was off balance, I stepped into him, put my right leg behind him and shoved. He landed on his ass. The entire class got to hear about how what I did was a violent response, and would get you in a discipline issue of we were ever to do that to a patient.

I don’t give a shit. I will not allow myself to be some crackhead’s punching bag and spend the rest of my life eating through a straw from my wheelchair. A couple of events from Florida this year drive that point home:

A nurse for Palms West Hospital had every bone in her face broken by a patient who attacked her. It was two months before she could walk well enough to go to a rehab center. She is still there, and hasn’t yet returned home, as far as I know. The hospital responded by designating a desk in the ED for the use of a sheriff deputy, to encourage them to hang out there. Also, that makes them a substation, which many hospitals use to declare that they are a police station, so concealed carry is off limits. Most hospitals only use unarmed security, and many times those security guards are unarmed women and old men.

A pair of nurses in Port Charlotte, FL were attacked in March. No one was arrested.

By Divemedic, ago

De-escalation

I am having to take de-escalation courses for my employer this week. There is an online component and a classroom component on how to handle patients in a crisis. The online is supposed to take 2 hours and the in-person class is another 8. Sure, I will take 10 hours of overtime. The online class consists of videos that constantly ask for interaction, so you can’t just hit play and walk away. Things like

  • “Click next to continue”
  • Click on each image to read more. You have to click on all of them, or the class won’t go on.
  • and quiz questions on the material to test if you are listening. If you get any of them wrong, you have to start that section over.
  • If the video isn’t the only window open, it stops playing.

So I am sitting here having to let the video play on a laptop while I type this on my desktop.

The way online training works is they tell you how long it should take. In this case, 2 hours. That’s all they will pay you for. I have stopped doing the training, since they aren’t paying me for it. I got talked to last week for that. It seems that they are not happy that I am not completing the required training. I told them that I only do the training that I am paid for.

Back to today: I have been watching this video for an hour and 15 minutes. I haven’t failed one of the 4 built in quizzes that I have taken so far, so I haven’t had to repeat any sections. According to the progress bar, I am only 19% complete. At this rate, it will take me 6 and a half hours to finish. Remember, they will only pay me for 2. For that reason, I am stopping at 2 hours.

I dare them to try to tell me that I need to do more.

I know that many of you are saying that I should just get a different job. The issue is that this is how every health care job that I have ever had is. They demand as much as they can get away with, which is why, in my opinion, there is a shortage of nurses. So I just set clear limits and refuse to do work unless I am paid to do it. I also make sure that I put it off so I can do as much training in a single week as I can get away with, as well as doing it on a weekend. That way as much of it as possible is at time and half and with a weekend differential. If you are going to make me do it, I am going to maximize my pay for doing it.

By Divemedic, ago

I Miss

As I write this, I am enjoying the first really cool day that we have had in Central Florida in quite a few months. The windows are open, there is a nice breeze, and a misty sort of rain is falling from a cloudy sky. The temperature is 69 degrees outside, and it’s official: Florida Fall is here. This is the time of year when I put on Youtube videos like this.

A nice, calming sound to play in the background as I do whatever around the house. My memories drift back to when I was a child, the weather the same as it is today, and I watched my mother hang fall decorations like these.

It makes me a bit nostalgic. Now my mother is gone. My father is gone. My innocence is gone, as is my childhood. So is the country that I grew up in.

I miss all of those things. It seems that all is left is an aging guy who is about to become an old man, and a country that seems to be disintegrating. We aren’t coming back from this, are we?

By Divemedic, ago

News from the ED

During the past week or two, I had a few notable incidents:

Of the more than 100 nurses who work in my hospital’s Emergency Department, only 9 of them are board certified in Emergency Medicine. Only three of us are board certified in a second specialty. For that reason, I now spend most of my days in the critical care zone.

For starters, this being the tail end of summer/start of fall, there are almost zero cases of Flu/COVID/RSV coming into the ED, but there are quite a few cases of pneumonia and sepsis, mostly in our older population. Of our patients, I would say that the biggest reasons for visits are people who are sick because they are old, abusing intoxicants, homeless, having a mental health crisis, or a combination of those.

One of my patients had come in having some mild stroke symptoms. He had my undivided attention for the first 30 minutes he was there. It turned out, no stroke. It was a complicated migraine. So while we were waiting for further testing and for the migraine cocktail to kick in, we suddenly were inundated with some very sick patients. Four cardiac arrests, and 3 other patients who required intubation in less than a two hour timespan. It happens like that sometimes- things are calm, then it is like a bus full of sick people pulls up. As the only nurse in the critical care zone who is certified to insert IV lines by ultrasound that day, I was busy for that two hours. One case in particular, I had to start an ultrasound line, then stick around to give Etomidate and Succinylcholine for the rapid sequence intubation. After that, I was in a cardiac arrest for another 30 minutes.

In the middle of all of this, the patient with the migraine had pushed his nurse call button. When I was finally able to get to him, he was indignant: “I pushed this button 20 minutes ago. This is ridiculous.”

Me: “I’m sorry for the delay, sir. I was busy with some very sick people. I’m sure that you understand, it’s just how things work in the Emergency room sometimes.”

Him: “Where were you? Are you really that incompetent?”

Me: “Sir, I am sure you heard the announcements. I was literally doing CPR on someone for the past half an hour.”

Him: “I don’t care about that, I called for you and you should come. I am never coming to this shitty hospital again. I want to see your boss, you should be fired.”

My charge nurse enters the room, and the man goes on a rant. The charge tells him what happened, and he still keeps complaining.

All of that. Do you know what he wanted? Some water and a warm blanket.

Working in emergency medicine has convinced me that far too many people have Main character syndrome.

Later, I had another 34 year old patient come in complaining of a severe headache and nausea. He reeked of weed. When I asked him about that, he said “Oh, I have a weed card. It’s medicinal.” He then told me that he smokes 6 or 7 joints a day. We tested him fully, finding nothing. Did I mention that he was covered in tattoos, had green hair, a septum ring, and two lip piercings? He was telling me how he is too poor to afford a ride home, and wanted the hospital to make arrangements to get him home. Uh, you can afford all of that ink, those piercings, and weed, but you can’t afford an Uber? Medical marijuana is bullshit 99% of the time, by the way. It isn’t for medical reasons, they just want to get high. If it were medicinal, wouldn’t there be a prescribed dose and schedule, like with every other medication? What other medication says “take however much you want, as often as you want?”

Anyhow, I now have a few days off.

By Divemedic, ago

Damned Squirrels

We were hearing scampering feed over our heads, then the drains and toilets started gurgling when someone was in the shower. I didn’t make the connection until we saw a dead squirrel hanging out of the soffit, with his head stuck.

The pest control guy I called found 12 places where our builder didn’t seal the attic properly against squirrels. He said that most builders don’t, because the code doesn’t require it. The repairs to seal the attic and replace the damage they did is $3 grand. The guy said we are getting off cheap because we caught the infestation early.

That doesn’t feel cheap, but I guess it could have been much worse. Little bastards.

By Divemedic, ago

Problems

I am aware that some of you have tried to setup accounts here. I will look into it when I get a bit of spare time. I am trying to migrate another blogger to my server, take care of honey-do lists, complete MBA courses, blog, and somehow find time to work, sleep, and take a crap, so it might be awhile.

I used to enjoy playing Falcon years ago. I decided to play DCS in the near future, or at least when my MBA is done. I dropped $2700 on a new computer, but I won’t have time to try out the game for a few months yet. Still, for you computer nerds:

  • AMD Ryzen 7 7800X3D 4.2GHz (5.0GHz Turbo Boost) CPU
  • 1TB Gen4 NVMe M.2 SSD
  • 2TB Gen4 NVMe m.2 SSD
  • 360mm AIO Liquid CPU Cooler
  • NVIDIA Geforce RTX 5060 Ti 16GB GDDR7 Graphics Card
  • 64GB DDR5 RAM 6000 RGB Gaming Memory
  • 32 inch 4K monitor
  • WinWing Orion 2 HOTAS and Rudder Pedals

By Divemedic, ago

How I Became Homeless, Then Not

Yesterday, I talked about struggles and how we overcome them. I have had mine, and most of them were caused by my poor selection of female partners. This is the story of my journey from divorce, homelessness, on to success. Maybe it can inspire someone who is struggling.

I’m going to mention a song today. It’s a song from a genre that I typically don’t like- rap. This particular song was popular while I was in the military, and the reason why I mention it is related directly to a period in my life when I was really struggling: the summer of 1999. Most rap “music” is simply someone talking over music while loosely rhyming. Typically, they are talking about their genitals, drugs, gang violence, or some other antisocial drivel. However, every once in awhile, one of them displays a level of societal truth, proving that they are the exception to the rule of rap being an annoying waste of time.

I had just gotten divorced, and things were financially rough for me. I was making $8.25 an hour as a firefighter/EMT. As a firefighter, you work a 24 on/48 off schedule, and this results in three different sized paychecks:

  • The large paycheck has 106 hours of straight pay and 14 hours of overtime.
  • The medium paycheck has 106 hours of straight pay and 6 hours of overtime.
  • The small paycheck has 104 hours of straight pay.

The divorce was punishing. The judge gave her the car, the kids, child support, and I got all of the debts. Those debts would be taken out of my paycheck before I even saw it. By the time all of my deductions were taken out (including child support) I wound up making an average of about $525 per two week paycheck. Since the rent on my apartment was $535 a month, it wasn’t long before I was homeless. I just couldn’t afford rent, utilities, and all of the other expenses that went with living in an apartment.

I was sleeping on the couches of friends until I could save enough for a buy here/pay here car, then I began living in my car. This was probably the worst time of my life. It took more than 3 months to save enough for a down payment on a 10 year old Ford Tempo. I would go several days at a time without eating. At work as a firefighter, I would eat everyone’s leftover food, and for that reason, they started calling me catfish, because I was a bottom feeder (from the bottom of the pot, you see). I lost 25 pounds in three months. Finally, after 3 months, I was able to come up with the $1200 I needed for a down payment and for the first 6 months’ insurance.

That’s when the song came into play. It was “Bust a Move.” Here are the lyrics that really struck home with me:

Girls are fakin’, goodness sakin’
They want a man who brings home the bacon
Got no money and you got no car
Then you got no woman and there you are
Some girls are sophistic, materialistic
Looking for a man makes them opportunistic
They’re lyin’ on the beach perpetratin’ a tan
So that a brother with money can be their man

So there I was: homeless, broke, and living in my car. I was alone, and couldn’t even have my kids over for visitation, because I had no place to bring them. I was alone: no friends, no money, no place to live. Every day was a search for ways to make a better living. I got a second job, working as a janitor in a theme park. I had to keep that second job a secret from my ex-wife, so she wouldn’t take me back to court to have that extra income be used to calculate a higher child support amount. Things were a bit better, because the extra income from the janitorial work nearly doubled my take home pay. Things were hard, but I knew that I could make it.

I lived in my car for about six months, parking it in various places so I wouldn’t have the cops called on me. I showered at work: once when I got there, then again when I left. On the third day, I was able to shower at the city’s owned gym, because city employees got a free membership.

That lasted until I found a woman willing to rent me a room. She was s supervisor at the theme park where I worked who found out how much I was struggling and decided to help me out by letting me rent her spare bedroom for $200 a month. I lived there for about three months, until she moved to Montana. Now here I was, just over a year after my divorce, and had to find another roommate.

That brings us to the summer of 2000.

The place I was living wasn’t great- it was in the middle of one of the most dangerous, most crime filled neighborhoods in Orlando, but it was cheap, and it was all that I could afford. If I remember correctly, my share of the rent and expenses was around $400 a month, my car was another $300 a month, and by the time I was done with the “must have” expenses like gas, insurance, and the like, I had $200 a month left over for food and other things. While still rough, things were much better than they had been just a few months before. Sometimes, I would only have $30 to last from one payday to the next, and $15 of that went to gas to get me to work.

Meanwhile, I didn’t stop working to get myself out of the situation I was in. I was working two jobs and began going to school at the same time. I spent the next year getting my Paramedic license, and along with it, an AS in Emergency Medicine. That was a miracle for my monetary situation.

It was now the summer of 2001.

My pay in the fire department was so much better at that point. As a Paramedic, I was finally making $10.65 an hour. On the days that I was acting engineer, I got an extra 75 cents an hour. It was during this time that I moved out of my ghetto apartment, and moved into an apartment in a better neighborhood. I had two roommates in this new place, a woman and a man. It was a good arrangement for them, because my now three jobs meant that I only slept there one night out of every three. It was good for me because it was half a mile from my fire station, and I could have my kids over for visitation. I was still living there on 9/11. Yeah, that 9/11.

It was that experience that gave me a unique perspective on needs versus wants, as well as how to make your money stretch. I know what it means to struggle, I know what it means to know that your next meal is likely days away.

That’s why I become so offended when the current generation complains that the generations that came before had it easy, while complaining that they can’t buy a house. Bull crap, they just don’t have any idea what the difference is between a need and a want.

The world doesn’t owe you a thing. You can have the lifestyle you want, but you can’t expect others to give it to you, you have to earn it. Doing so requires hard work and consistently making good decisions. One of those decisions, perhaps the most important of them, is the person you choose to partner with. That is the decision that I have struggled with more than any other, and I am glad that I finally got that one right.

By Divemedic, ago

Wage Theft

The hospital where I work has a money issue. That is, our department was more than a thousand hours over budget on staffing. As a result, the ED director was fired last year, and the new director has been swinging the budget axe. She laid off 25 nurses as her first official act a year ago, and we have been running understaff since. They took us from 3:1 patient to nurse ratios to 4:1. They also eliminated most of the nurse assistant positions. As a result, we usually don’t get lunches on our shift, nor do we get off work on time. This results in a 12 hour shift usually stretching out to 13 or 14.

Still, our department saw more than 150,000 patients last year, so we are raking in the money. My recent visit to the emergency room was billed at over $40,000, so do the math. Even if they only collect a quarter of what they are charging, they made billions from the ED alone.

On top of all of this, they don’t let us do required trainings during our shift, we are required to do them on our days off. This training is required by our employer, and is over and above the continuing education that we do on our own to maintain licensure. They tell you that annual NIH stroke scale certification is required, and you are subject to discipline if it isn’t completed, for example. So you do it on your days off.

In the past year, more than a quarter of our nurses have left. They are desperately trying to hire replacements, but the word has gotten out, and the only nurses applying for jobs are brand new ones out of school with no experience, because they are hungry for a job that isn’t med-surg.

Admin then tells you that they will pay for a maximum of 2 hours per week of training. The only problem is that they assign far more than that. This two week pay period alone, I have done 8 hours of mandatory training on my days off: a 3 hour class on NIH stroke scale, a 3 hour class on IV insulin, and a 2 hour class on ESI triage policy.

They are only going to pay for 4 hours of it, if they keep up their policy. In the past year, they have denied paying me for about 100 hours of mandatory training. I’m tired of it. I have screen shots of emails telling me the training is mandatory, screenshots of my online time card, and emails of the policy saying they will only pay for 2 hours per week.

I am turning them in to the state department of labor. I’m going to get my money. If they take any action against me, that is illegal and I will sue their ass. I am tired of being made to work for free because they have a “budget.” Well, I have a budget, too, and I expect to be paid for my work so I can make my budget.

By Divemedic, ago