Holiday weekends are always outliers in the emergency department, and coupled with the cooler temperatures and rain that we had, Thanksgiving was even more so. We weren’t busy, with our census hovering at around 60%. We didn’t get a lot of patients, but the ones we got were sick. In other words, we were a true emergency department and not just a free clinic for welfare queens, homeless bums, drug addicts, and illegal immigrants.
My shift was cancelled on Thanksgiving day because there were only 40 patients in a unit with the capacity of over 100. My wife and I had not made dinner plans because I was supposed to be working. We discussed having a freezer pizza, then decided to go out. All of the restaurants in the area were either closed or full, so we wound up driving to Orlando and eating at Maggiano’s. It was amazing.
I actually worked on Friday. A man came in complaining of flank pain. He had a history of kidney stones, so that’s what I worked him up for. It turns out that it wasn’t stones- when his CT scan came back, he was riddled with cancer.
Another man came in came in complaining of shortness of breath that we diagnosed with lung cancer.
At one point, we had a brief rush of patients during the 90 minutes that we were briefly understaffed. The morning nurses had gone home, and the ones scheduled for the afternoon hadn’t come in yet. I was covering 5 rooms for that period, and I was OK with that because three of them were empty. Then a line of ambulances came in to give me an asthmatic, a hip fracture, and a woman with a blood sugar of over 500. While that was going on, a woman flagged me down to unhook her father from telemetry so he could use the bathroom. He wasn’t my patient and I was quite busy, but it only takes a minute. I unhooked him and started to leave, and she stopped me to say, “He doesn’t walk well. I need you to walk him over there.”
I replied that I was too busy to do so and left to go see my patients, so she began yelling at me while following me across the department. I told her that she could walk him to the bathroom if she wanted to. It was at that point that she began yelling even louder and started telling me that I am a dick. She then said, “I am going to go get the doctor and tell him what an ass you are. I hope you get fired.”
My response was to call security. I told security to remove her to the lobby until she learns to control herself and act like an adult. Her husband chimed in at this point, saying “That’s my wife. She’s just worried about her father.” Security asked me if I wanted the husband removed as well, and I replied with: “No, he isn’t interfering with my patient care, just her.”
She ran over to one of the ED doctors and began complaining. The joke is on her. Doctors don’t run the hospital, nurses do. People think that because doctors write prescriptions and orders for patient care, that doctors are in charge, but that isn’t how hospitals work.
Anyhow, my charge nurse had to get involved at this point. He pulled me into the medication room and asked me what happened, then agreed with me that her following me around the ED was interfering with my care of my patients. They decided to teach me a lesson by having the father sign out of the hospital against medical advice. All because I was too busy taking care of sick people to be her personal butler. I guess she showed me.
On top of that, I had a patient with COVID, two with RSV, and the funniest one of all. A woman had gotten in a physical altercation with her roommate, and it was so funny I had to leave the room to keep from laughing. It went like this:
- Doctor: “So why are you here today?”
- Patient: “I got in a fight.”
- Dr: “How did that happen?”
- Pt: “My roommate locked me out of my room and said I wasn’t allowed back in because my pussy is too hairy, so I punched her in the face. She hit me in the face with the remote control, said ‘Merry fucking Christmas,’ then hit me in the face with a fruit basket. I fell and bit her on the toes, and that is how two of my teeth came out.”
It was at that point that I had to leave the room to keep from laughing.
That was my holiday weekend. Now to resume normal blogging…
14 Comments
oldvet50 · December 1, 2024 at 1:24 pm
I don’t doubt you are, but you need to expound on the last sentence of the second paragraph.
Divemedic · December 1, 2024 at 2:01 pm
typo
Birdog357 · December 1, 2024 at 1:53 pm
Have you only worked ED in Florida? I’m wondering if all this craziness is Florida man, or normal for an ED?
Divemedic · December 1, 2024 at 2:03 pm
I have also worked in Virginia, Arkansas, and Alabama. Dumb shit is everywhere. If people always made wise choices, Emergency Medicine would not be needed.
That’s why I have great job security.
I had a patient ask me yesterday if I was worried that AI would take my job. I replied that I don’t think so- I just don’t think that they can make a machine that can do my job within the remaining years of my working life.
He then told me that, if I had gone to college, I would probably make more money. So there is that. He was surprised that nurses are required to have a degree. He was under the impression that we only did what the doctors told us to do.
Birdog357 · December 2, 2024 at 1:15 pm
Did you tell him that a doctor of nursing is a real degree?
Tree Mike · December 1, 2024 at 6:40 pm
Sooo, do you have a spare pile of patience to grab from when needed? Either that or you have more than your fair share of stoicism.
Appreciate yer efforts to this blog.
JimmyPx · December 2, 2024 at 12:01 am
What did that woman do to get her blood sugar over 500–drink a bottle of maple syrup ?
Regarding AI I work in IT in a large hospital system tied to a teaching hospital North of you.. you can guess which one it is. There is no way that in the next decade at least that AI could replace humans in health care BUT it could greatly increase the quality of health care and the outcomes of treatments.
For example right now I am involved in a project where we take our years of medical records , expunge personal info from the metadata and then ship it up to the High Computing Center. Researchers are then using AI to go though all of the medical data and break down patient data, the treatments given and outcomes. So for example down the road say that you are an overweight middle aged male with high blood pressure and diagnosed with leukemia, the AI can give the doctors the report that based on 50,000 cases analyzed the most effective treatment for him is X. The treatment for an Indian female in her 20s might be totally different.
The other cool thing is that sometimes diagnosing exactly what is wrong with a person and the correct treatment plan can be challenging. Put all of the test results in and AI with a massive database behind it can easily say “there is a 97% chance this is what is wrong and here is the most effective treatment for this”.
This scares the hell out of doctors I talk to but it shouldn’t, at the end of the day it is the doctor and nurse’s call but AI can be a super helpful tool.
Divemedic · December 2, 2024 at 1:32 pm
Diabetic Ketoacidosis. It comes from being a diabetic, but not following dietary restrictions or taking your medicine.
Aesop · December 4, 2024 at 3:02 am
@Jimmy,
Yeah, but no.
GIGO.
The AI will have to work within the limitations of humans inputting correct information to the system every time. Starting with the foolish assumption that patients tell the truth.
That, right there, is the fatal flaw in the whole AI business plan.
Ai will kill patients even faster than humans, because machines will never question their own programming. This is why the “self-driving” car hit a pedestrian: the machine had never been told humans might jaywalk, so the machine’s correct answer was to ignore the person who wasn’t supposed to be there and simply run them over.
That’s the same AI that would be making life-and-death healthcare decisions.
Human beings, OTOH, will frequently ask “WTF?”, and refuse to do something that’s stupid, even when the machine tells them it’s the right answer.
This is why machines will never win, unless we let them.
TRX · December 2, 2024 at 9:23 am
> She ran over to one of the ED doctors and began complaining. The joke is on her. Doctors don’t run the hospital, nurses do. People think that because doctors write prescriptions and orders for patient care, that doctors are in charge, but that isn’t how hospitals work.
—
What? Decades of soap operas and doctor TV shows can’t be wrong!
TRX · December 2, 2024 at 9:34 am
> Researchers are then using AI to go though all of the medical data and break down patient data, the treatments given and outcomes.
—
That’s sort of scary, considering my 8-year-plus battle with EPIC’s EMR system.
The Electronic Medical Record works pretty much like a credit report. Random people can put stuff into it. Random people do, complete with typos and stuff some completely wrong they’re probably entering the wrong person’s data. Then the wrong data gets traded around the various EMR companies, just like credit data. By the time you get EPIC straightened out, they make another trade or purchase and all the wrong stuff is BAAAAACK! Almost everyone my medical insurance deals with runs EPIC.
Somewhere, someone at EPIC thinks I’m diabetic. I’m not. Every time I get it corrected, it gets uncorrected. And somehow they got my private cellular number, which now shows up at every medical consult I go to. I have a land line for that sort of thing. Only five people – customers and my wife – have that cellular number, and it’s not used for anything else. Random medical or insurance offices still dial it; I have most of the numbers blocked, but occasionally a new one shows up.
So, yeah, my likely scenario is being unconscious in an ER somewhere, and having the ER doc basing his care on a bunch of ludicrously false data, that the hospital somehow manages to avoid any responsibility for.
Divemedic · December 2, 2024 at 10:01 am
Yes, nearly all hospitals use EPIC. Still, we base treatment in the ED on test results as much as anything. If your blood sugar, A1C, and other labs are OK, we aren’t going to base treatment on a possible diabetes history.
I do agree with your point, though. The old saying was GIGO.
Aesop · December 4, 2024 at 3:36 am
Worked all 4 nights, Thurs-Sun.
Thursday was a ghost town. Heaven on earth, and a great potluck.
Mini-rush at 3AM, five abdominal pains x 5 ambulance runs.
4 out of 5 admitted, all legit visits.
Friday night, all the bullshit that usually walks in the door every night and didn’t on Thanksgiving, showed up.
Saturday night was even worse.
Then Sunday said “Hold my beer”, and it was an epic shitshow.
By 10PM Sunday, I wanted to kill all of my patients, all of the patients in the zone next to mine, and several of my co-workers, not least of which the part-time charge nurse (who graduated nursing school about the time I only had 15 years in this business) who wanted to grease the treads of too-f**king-many-patients,-not-enough-beds by throwing me under the bus, and yelling at me to do everything for everyone at once, faster, as if that was “helping”. It would have been justifiable homicide, hand to God.
{“I’m seven patients behind on a four-bed zone, because I’ve just done two admits and a discharge in the last 20 minutes, then you gave me an additional patient from another zone who I still haven’t seen, and then the critical ambulance run in the last open bed, and my beds are in three different zones.”
“ Right. So get the other critical patient upstairs right away so I can give you another critical ambulance run before the bed gets cold.”
“And me, with only two arms and two legs, all connected in the middle, and only able to be one place at a time…“}
Bit my tongue after that bit of Stupid Boss Syndrome, dug myself out with no help, and got things done exactly as fast as I would have anyways if Nurse Sorcerer’s Apprentice hadn’t decided her job description was to wave her wand and her arms and demand results pulled outta my ass, rather than give me any additional resources, or use any managerial common sense whatsoever, STFU, and just let me do my job.
Charge nurse’s job is to be lube in the transmission, to help things go smoother.
This one can’t tell the difference between oil and gravel.
(Probably a little unclear on shit vs. Shineola, for that matter.)
Thirty years in, I only have a few years to go with this.
I swear to Buddha, I’m going to make a short-timer’s calendar, and put it up on the outside of my locker, and check off my last 1000 shifts one by one, until the point begins to dawn on some people that at-will employment works both ways, and that indentured servitude was outlawed in 1789.
I love my job. Truly.
Being shit on by the people hired to supervise me, because they lack any managerial common sense, is not in my job description. I’ve looked.
I sense a heart-to-heart chat with my department director in the near future, barring a fortuitous Powerball winning ticket.
Divemedic · December 4, 2024 at 8:15 am
I am looking at 5 more years. After that, I don’t know. Maybe I will go PRN at some point. I don’t think that I will handle boredom well enough to completely stop working.
Hobbies won’t help, because I won’t have enough money to do all of the hobbies that I have- they have gotten more expensive over the years.
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