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.
14 Comments
Honk Honk · October 10, 2025 at 9:03 am
A sibling moved to the other side of the country where weed is legal.
He has stage 3 lung cancer and makes Phoenix Tears or Rick Simpson Oil.
First diagnosed ten years ago after hacking up a piece of lung, he swears by the treatments.
Smoking 6 or 7 joints is looking to get high and is that abuse if you are taking it to get high?
JimmyPx · October 10, 2025 at 9:27 am
Regarding “Mr Weed” wanting a free Uber, I have seen that crap my whole life.
For example my ex brother in law and his girlfriend called us boohooing that their electricity was cut off.
Me and my ex went over there and I asked why they didn’t pay the bill ?
Broke, they said yet they both had jobs.
I look and she has a new purse and he bought a used motorcycle recently.
I said “why did you buy those things instead of paying your electric bill” ?
Answer “I’m not wasting MY money on the damn electric bill”.
But they wanted ME to waste MY money on THEIR electric bill.
I refused and told them to sell the purse and motorcycle and pay their bills.
My ex and I had a Hell of a fight on the way home but I stood my ground.
Many people are like little kids and their paycheck money is for things THEY want not necessities like bills. So weed man has plenty of money for weed, booze, tats but Uber — I need charity.
Joe · October 10, 2025 at 10:15 am
Years ago I went to the E.R. because I had too much fun on the dirtbike. Two broken toes, later found to be three. Anyway I was waiting my turn and noticed the place filled with sobbing junkies who were probably there for a load of pain pills.
The Nurse in charge noticed my name and realized that one of my relatives was a big wig nurse at that hospital. He took me into the back room and basically let me jump to the front of the line. He confirmed my observations and told me they were doing the circuit of local hospitals to satisfy their addiction. A guy with a good lever action at the road into the hospital would have cut down on the problem.So, after x-rays saw the broken toes. I was given a walking boot and a prescription that I never filled.
I don’t know how you do it.
Mel Pinto · October 10, 2025 at 12:35 pm
Are you seeing an increase in ‘complicated migraines’? I had never heard of it until after covid. Now I am running into people that that have been in the ER with stroke symptoms, and then later being diagnosed with either complicated or hemipelgic migraines. Last I looked, hemipelgic migraines are supposed to be a genetic anomaly with maybe 10,000 total in the US.
Divemedic · October 10, 2025 at 7:28 pm
They are common enough that I see 2 or 3 per week, and have been since before COVID.
Mel Pinto · October 10, 2025 at 7:52 pm
Thanks
Jojo · October 10, 2025 at 2:36 pm
You’re a saint, Divemedic. I’m a retired clinical lab scientist and have a slight clue as to what you have to deal with. I’m sure it’s much worse than when I was working now that there are so many more homeless and weed is legal. Mr self-centered patient is just that:self centered and a jerk. Again, bless you for what you do!
random số · October 10, 2025 at 3:04 pm
Man, this ER story hits different. Main character syndrome is the real deal, apparently. One minute youre saving lives, the next youre dealing with the guy who thinks his migraines deserve immediate Uber charity. And the weed card guy? Classy. Medically necessary weed, yet he cant afford a ride home. Hypocrisy much? The weed needs to be medicinal, like, prescribed in a little bottle with a label, not take as much as you want. Anyway, keep your cool out there, fellow med folks. You cant win em all, especially with the patients whove clearly watched too much TV. Stay sharp!
Grumpy51 · October 10, 2025 at 4:41 pm
We, ER and society, did it to ourselves.
Remember JCAHO saying pain was the 5th Vital Sign and that patients “had a right to have their pain controlled?” (Which patients took as meaning “painfree”). I REFUSE to use the Likert scale (1-10), haven’t used it (or documented it) since last century. I tell my patients my goal is to make them comfortable but will not be looking at “pain-free.”
How many times do you remember admin telling us “an emergency is whatever the patient thinks it is”? BULL!! Your sniffles doesn’t trump a code. There’s a reason we call it triage.
I don’t care what your pronouns are. I base things off science. If you tell me you’re a “male”, but you’re a biological female, your peak flows will NEVER be at goal, your tidal volume will put you at risk (intubated). If you’re a “female” but a biological male, I won’t know to consider prostate cancer in my differential, I’ll waste resources checking for pregnancy. I’ve been talked to more than once for documenting “biological male.”
How many facilities quote Press-Ganey scores to us?? I don’t give a rat’s ass about it and have told admin the same. I’m ONLY concerned in giving excellence in patient care – and THAT means getting the diagnosis (or diagnoses) correct. Besides, Kaiser did a study (late 90s??) re Press-Ganey scores and patient outcomes – those patients who gave the highest scores had the worst outcomes. Why?? Because the doc did what the patient wanted and NOT what the patient NEEDED.
And yeah, I only last 3-4 years before moving on…… after 40+ years in healthcare, I’m almost done…. Never thought I’d retire but COVID changed a lot…… I feel for the folks who are in the early days of their career
Danny · October 10, 2025 at 5:58 pm
“Medical” marijuana. Yeah, sure.
Plague Monk · October 10, 2025 at 6:42 pm
When my right foot got infected and I finally decided to get it treated, my wife and me went to the doctor,who confirmed that I needed to get to the ER ASAP. She called ahead to let them know.
When we arrived, the intake area was nearly full, with mostly Hispanic families there. We figured that it would be several hours before we were seen. To our pleasant surprise, we only had to wait about 15 minutes before we were called. The intake person took our information, noting that the doctor had given the hospital a good summary of the issue.
I was told that several of the other people waiting to be seen were there for colds, earaches, and check ups, not real emergencies. There was quite a bit of resentment over my being looked at first. Apparently, I was one of only a few in the intake area that had any coverage; the others were mostly illegals with no money or insurance. I was also told that most of them were rude to the staff, but they just let the discourtesies slide.
As an aside, post op I showed the surgeon who used his chainsaw on my foot some of the drawings that I created while on my last contract, and he was boggled by the complexity of the 3D model. I told him that it was far easier than working with people.
He was able to save 3 toes, and about 3/4 of the rest of the foot. Still recovering, a year and a half later.
As Joe said above, I don’t know how you do it.
Lynn · October 10, 2025 at 9:41 pm
Yup. I was getting my mother’s prescriptions today at HEB and a guy on an store electric buggy tried to cut the line. He definitely had the syndrome.
And yes, he did not need the buggy to walk.
Dan D. · October 10, 2025 at 10:42 pm
These are my favorite posts.
Thank you for helping people when it is thankless. That is the very definition of charity.
Aesop · October 11, 2025 at 4:02 am
FWIW, my standard of care for Entitled Bastards is to pull out a 5″x 8″ mini legal pad, and chart “Okay, let me get this right: I’m incompetent because I didn’t get you water and a warm blanket for the twenty minutes we were doing CPR on a patient in full cardio-pulmonary arrest. Is there anything else you want me to write, verbatim, in your permanent medical treatment record? The one that no one can edit, and which your insurance company gets a copy of? Or would you care to amend your remarks and opinions in light of reality?”
They usually STFU about then.
If not, I flip the page, and just start quoting them fully in written notes, and then go type it all into the EMR, word for word, as a progress note.
And there’s f**k-all the hospital or the patient can do to get it out once I put it in.
“Paint a complete picture of the patient and the situation”, my nursing instructors told me when teaching about proper charting.
I have also fired patients, informing my charge nurse I’ll take a full load, but it will no longer include the offending a-hole, under any circumstances. It’s a card I rarely use, but when I do, I stick with it.
As you know, there are a myriad of ways you can document that a given patient is an irrational a-hole bastard without using those exact words in the chart, nor asking them if their parents were married to each other, and they paint a picture that makes lawyers dump them as clients in haste.
Also, we’re getting about a dozen COVID patients/week, so 1-2/day. Haven’t seen any flu, and we get few peds, so RSV is like a unicorn for us.
When I started, we’d get maybe 1 drunk a week, and 1 OD/month. Now it’s 3 of each per night, or more. We never used to get any weed patients. They’d be embarassed to show up at all. Now there’s about 1/night minimum, times the last 10 years. And if you can afford weed, you don’t need a bus pass. Hoof it, or make other plans. We’re the ER, not Uber nor Greyhound.
And if you try to camp in the lobby after discharge, because you’re afraid of the dark, you get ejected and marched off the property for trying to check back in a few hours later for the identical complaint. How much slack they get (sandwiches, bus passes, etc.) is inversely proportional to how much of a problem they become, coming or going.
It’s a Trauma Center, not a Drama Center.
Personally, I wish they’d amend EMTALA and let us require $50 cash before treatment for anything but heart attacks, strokes, and critical trauma. Even if you’re homeless, here illegally, or a million-dollar trust fund baby and hypochondriac. If the doc diagnosed you with a legit emergency (not an urgency) you’d get the $50 back immediately. But if it was b.s., or you could and should have gone to urgent care for the problem, the $50 is gone forever, no refund. In exchange, if you think you’ve got enough of a problem to slap a $50 bill on the counter, we’ll give you the full work-up, no questions asked.
We’d have half the patients, but the ones we did have would be totally legit, 24/7.
EMTALA is just the government telling people that if they go to McDonald’s, they get a free Big Mac meal, no questions asked. Then people wonder why that Big Mac now costs $4017 if they have insurance, and they’re stumped as to why 5000 community hospitals with small ERs closed since EMTALA was made law, so now they have to wait 3 hours or more to be seen in Big Ghetto ER for anything less than a sucking chest wound. Even if they live on Park Avenue, and called for a $3000 ambulance ride for their sore toe.
People bitch because there are no prices posted.
Okay, here’s a cluebat for the Entitled Bastards of the World:
Walking in the ER for anything is $1-2K, minimum.
If it’s serious enough to be admitted, it’s closer to $5-10K.
If you’re critical, it’s $15K and up.
Bring that in cash when you check in, and we can talk about your critical 4AM case of the sniffles right away.
Otherwise, take a number, wait your turn, and suck it while we work on the actual critical cases, until we get to your minor distress.
With a 5-tier triage system, we’re going to take the 1s and 2s first, then all the 3s, before we even talk about your level 4 sprained ankle, or your Level 5 need for a med refill because you still haven’t followed up with anyone a month after we saw you the first time.
Don’t like that? Hits too close to home?
DLTDHYITAOYWO
Depending on who you ask, the average age of a nurse in this country is 46 to 50 years.
A quarter of all RNs plan to retire in the next 5 years. I’m just barely outside that quarter.
So if anyone thinks things suck now, wait until the last of the Baby Boomers retire in the next 5-10 years, and you suddenly have half the nurses trying to treat twice the patients.
Oh, that’s going to be fun. Not.
(That’s before we start to find out if the 66% of medical workers who got vaxxed 2-5 times since 2021 start dropping like flies from Suddenly™.)
Y’all ain’t seen nothing yet.
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