rudeness (or a bad mood, or simply misguided jocularity) has no borders

Up North:

Cashier finishes bagging items and hands them to shopper, with a curt send-off of "Have a day."

Flabbergasted. "Excuse me?"

"Have a day."

On the bright side, at least she didn't wish me to NOT have a day. That might be bad.


Down South:

Eating lunch at the local gas station/gift shop/eatery place. A man who looks about 80 and speaks as if he is a widower is sitting at a table kitty-corner to us. He asks random questions about my 2-year-old and I oblige him with answers, even though I am struggling to get her to eat and keep the food off the floor.

By the end of the meal, after straightening up the drop zone around the high chair as best I can, I politely tell the man to "Have a nice day."

"Don't tell me what kind of a day to have! I'll have whatever kind of day I want to!"

Stunned silence. Ummmm...this is awkward. My husband looks at me out of the corner of his eye. He knows how uncomfortable these situations make me. I mean, what the hell, we're in Tennessee for crying out loud! Old men aren't supposed to say stuff like that! They're supposed to call me "girl," if anything, but not rebuke my attempts to be respectful.

The man smiles. "You weren't expecting me to say that now, were you?"

All of this North/South business confuses me sometimes, especially when I realize that I have actually made some friends here. But the one thing I am sure of is that borders do not define the essential humanity in us. We all have our "moments"--we just express them differently.

Coldicidal

"Coldicidal"* (adjective)--to falsely state that you are suicidal on a cold night in order to secure a warm bed in the ER and possibly an admission to the psych unit, where you will receive blankets and 3 square meals a day.

A middle-aged man walks into the ER gripping his chest and complaining of pain. That combination of moves immediately buys him a gurney.

The standard chest pain work-up is started--EKG, IV, labs, vital signs, chest x-ray.

The doctor enters the room and does a history and physical:

How long have you had chest pain for?

A couple of weeks, off and on.

Did you drink anything tonight?

I had a couple.

Okay. Did you do any drugs tonight?

No.

Have you used cocaine?

Yesterday.

Tell me about your living situation. Where are you living right now?

Nowhere.

Are you living on the street?

Yeah.

About an hour later all the tests come back normal. We're not going to do any exploring for blood clots or what not. All signs point to one thing. He is discharged "home."

You got a bus pass?

No, we don't give those here.

The other hospital gave me one.

Well we don't do that. You can call someone to come get you or you'll have to walk.

The obvious question is "why do you have money for cocaine but not for a bus pass?", but I bite my tongue.

He gets dressed and comes out to the nurses station, casually leaning on the counter.

Anybody here got change for the bus?

No sir, we don't give change here. You can go back and ask registration if they have it.

A minute later the phone rings.

Why did you send him back here to get change? We don't have money for him! He's asking for a dollar sixty.

We meant you could MAKE change, not give change.

Unsuccessful, he ends his short-lived conquest for money and exits to the waiting room.

All is quiet in the ER now. It's the middle of the night--just a few patients with tests pending--time to relax, break out the magazines and suck on popsicles stolen from the patient food stash in the break room, check email on Blackberries. The phone rings again. It's registration.

This patient you just discharged says he's suicidal.

There's a camera in the waiting room, and we can see him on the monitor pushing buttons on the vending machine. And even more interesting to note is that he has somehow found change for the vending machine.

Here is the precise point where his new diagnosis changes from "atypical chest pain" to "coldicidal":

1. It's 30 degrees outside.
2. He's homeless.
3. He's both hungry and suicidal.

Security proceeds to escort him through the exit door.

Better luck next time sir. By the way, this incident will be dictated into your permanent record, so you won't be getting any paper psych scrubs to wear anytime soon.


*Full acknowledgment and credit belongs to "Officer Frank the Tank" for coining his entirely original term "coldicidal." I promised I'd make him famous. Ha ha. Are you happy now? ;)

Need help with comment section!

I'm having trouble figuring out how to make my comment section appear right below the blog so that it makes a thread-like look.

I've seen this on other blogs and played around with the settings, but I just can't get it.

If anyone has any suggestions I'd appreciate them!

I woke up, it was a misty morning...

not trying to be antisocial, but...

After almost 2 years of writing on this blog I have still not really decided what is blog-worthy. I admire the people who can always stick to or rotate around one main topic on their blogs. I just don't want to start any more of them and so therefore this thing has turned into a hodge-podge. Without apology.

Tonight I was planning to go to a party for a co-worker who is in the military and will be leaving for a stint of active duty. The half-hour drive there will take me an hour (that is just me driving on the highway in the dark). The party is in Lebanon, which I pronounce Le-ban-on, which has my coworkers asking "where?" if only to be sarcastic. According to them it is "Lebnin" or something like that; I'm sure I still have it wrong. "You are too proper," they scold, "would you call it Louis-ville too?".

I was going to bring the infamous 7-layer taco dip. I originally asked what Tennesseans eat for side dishes. If it were up to me I would bring Hawaiian salad, potato salad or pimento cheese. They said that the taco dip would be fine. So I soaked the beans overnight and cooked them this morning, and now I have several pounds of black beans sitting in my refrigerator anxiously waiting to be married to cream cheese and Rotel.

I don't think that I'm going to go to the party though. Today has been a miserable day for me and I have spent it fighting the urge to rip these damned support stockings off with two hands and say the hell with it. Yesterday morning I had one of my large leg veins closed because the valve was warped from too many 8-pounder kids resting atop it, and I was instructed to wear these things for 5 straight days. Easier said than done when they are itching and pinching and rolling themselves down over the "baby fat" on my abdomen. How can I go to a party, with all the laughing and drinking and playfulness, when I am in a struggle to resist the urge to scratch, lest I appear to have scabies? I won't even be able to take any alcohol myself because I was advised to ingest 1600 mg of ibuprofen per day, which is surely eating away at my stomach lining and liver as I sit here typing. And that reminds me, I shouldn't be sitting like this, I need to get up and walk around again, lest I get a blood clot. Oy. I'd better have some nice-looking legs after all this!

The taco dip will be for work tomorrow night. I have the chips and everything already. It will help to get us through the shift, especially with all the beans I'm putting in there.

heeding the voices

My birthday is coming up this month. The great thing about birthdays is that they give you another chance to reflect on your life. Better than the new year when you are supposed to resolve to do things or not do things, of which about 75% of these haven't happened by the following January. With birthdays you get your whole life to make or break your promises and dreams.

I've learned over the years to listen to that little voice of God or angels or my brain or whatever or whoever is talking to me. This sounds kind-of crazy, but I will explain in order to make my case.

Several years ago I was in nursing school and commuting back and forth to Chicago from the suburbs almost every day.

Sometimes I would drive within a mile of my grandpa's house on the way home. But in my rush to get my daughter from day care, I never consciously realized how close I was.

On one of the afternoons the thought occurred to me that I should stop and see him. Just a quick visit. But what if he's napping or eating dinner or down the street at my aunt's house? I didn't want to be rude and just show up. I was finding every excuse that I could think of not to go.

A week later my healthy grandpa was suddenly dead, found lying on the floor next to his bed, at age 94. I never did stop to see him. I ignored the voice.

So today I was thinking about my mother, living alone up in central Illinois in a run-down house out in the country, surrounded by open land that puts no brakes on the cold, icy winter wind.

I was thinking about how I hadn't heard from her since she visited around Christmas. This, in itself, is nothing to worry about. I could go months without hearing from her. It has been like this for years. She lives her own life and seems to call me when it's convenient, and I've learned to deal with that.

But as I was sitting at the kitchen table eating my lunch, the little voice spoke up and told me to call her, and being that I'm about to turn 37 and I've learned that I need to pay greater attention to that sound, I called. I got the voicemail and left a message.

She returned my call later that evening, and as she rambled on about her visit to the spa and water aerobics, I breathed a sigh of relief. She was alive and well.

My mom told me that my aunt happened to have an extra ticket for an Eagles concert on the 18th, the day after my birthday. Some other family members that I hadn't seen in a long time were also going, but she told my aunt that she didn't think I would drive all the way up from Tennessee just to attend a concert. She figured that it wasn't even worth telling me about, but since I had called, she might as well mention it.

Little did she know that I had been in one of my all too frequent "I miss Illinois" funky moods lately, and had entertained the idea of driving up there for my birthday to cheer myself up. Later on I decided against such frivolity since we were planning another vacation in May. But now I had a reason to go.

So glad I heeded the voice this time.

best med rec this week by far

Medication reconciliation done on a 14-weeker prego who came in with shortness of breath:

1. Methadone

"I can tell you all about it--dose, how long I've been taking it, where I go to get it..."

"Are you taking prenatal vitamins?"

2. Oh yeah, I'm taking those

3. I have an inhaler, but I lost it.



"Do you have an ob/gyn?"

"Yeah."

"Who is it?"

"I can't remember the name."

Father: "Do you mind if I go out? I left my kid in the car."

It's 3 a.m., and they just made runner-up for the Parents Of The Year award. Almost tied with the parents of the 6-week-old who fell off the bed because "he rolled a little." Send more nominations to me. The contest is ongoing.

undercrowded

Ever since we moved to this house I have had trouble sleeping. It seems like I can't get through a night without waking up.

My first thought was that it was because I was working more night shifts. Bigger mortgage=have to work more=more stress=insomnia.

But I think that I have discovered the root of the problem. The bedroom is just TOO BIG. While it is lovely--with 2 closets, a fireplace, a bathroom, and a balcony facing the backyard--I do not feel secure in there. It feels like I am floating around in the open air when I am laying in bed.

I have always felt that I could live happily in a tiny home (that is, if I was able to part with some of the "junk"). I also thought that this was probably a character flaw of mine according to our society. Houses are built so large now--ours is from 1985 but still 3,000 square feet--it seems like living in a behemoth should be a normal way of life. Never mind all the earth's resources that it takes to maintain and run this house.

Our home in Illinois was 1,300 square feet. I was living happier in it. We were all closer. My bed was right next to the window where I could see and hear the oak leaves tap against one another every morning. I had birds to wake me and I could see strands of caterpillar silk reflected in the early sunlight.

I miss the simple life.

Rude Pencil

I found this pencil while unpacking some boxes in my room. Yes, that's right, I am STILL unpacking. That is beside the point.

I never really noticed or cared much about it--probably got it for free from some job fair back when I was a new grad--but now the message is so poignant to me, I am going to place it in one of my memory boxes so that it will last forever. Go on Southern nurses, remind me how rude us Northerners are. Wait a minute, I can't really consider myself a "Northern Nurse" anymore, now can I? Well, I will always be one in heart and spirit. Love live EICU!

expressing yourself

In ER world, nurses see lots of creative and innovative ways that patients choose to "express themselves." Why hold your anger inside when it can only lead to heart disease and aneurysms? Let it all out in the ER. The nurses are trained to therapeutically address your concerns. We are caring individuals.

Some ways that our patients like to release their pent-up feelings and emotions:

1. Tossing the written prescription on the floor in front of the nurse's station and storming out, all because the doc wouldn't write for Lortab or some other narcotic that the patient could sell on the street. Minutes later, housekeeper finds the word "bullshit" scribbled on the stretcher mattress.

2. One of my favorite nurses likes to advise his patients upon discharge to "drink plenty of water, eat your vegetables, and wear your seatbelt at all times in the car." Problem is that obese women who come visit us with barely a cold don't want this advice. "I sat in the waiting room for 4 hours just to be told to eat my fucking vegetables!"

3. Triage assessment on a patient brought in by ambulance goes like this: patient transferred to bed with help of EMS personnel, nurses assist patient into gown and instruct patient to lay down so that we can take vital signs, patient purses lips together and blows out a spitball straight into the air while two nurses are hovering above attaching electrodes. Or sometimes, the wall gets decorated. Safer for the nurse at least.

4. Phrase of the week: "I don't care." I don't care about this shit, I don't care about what you are prescribing me, I don't care what you say even though I myself chose to come here, I am not being admitted, I don't care if I have to pay the hospital bill out of my own pocket if I sign out AMA because you know that I won't pay it anyways.

5. Patient is bleeding profusely from surgical dressing, chux upon chux pooling up with blood. "When will I stop bleeding? Can I take a bath when I get home? Why do I have to stay here?" Fed-up Dr. Q responds with "I can't tell the future." Yes sir, go on home now, get blood all over your car and have your wife call EMS when you decide that you would rather bleed in the hospital.

Now I know why we studied therapeutic communication in school. Because it works so well in the ER. Patients always respond positively to logical reasoning there.