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obviously a bored housewife - Sing a Song of Sixpence
Pocket full of rye
obviously a bored housewife
It's been brutal at Hospital X.  The nurses are short staffed and this is hitting the overnight shift particularly hard. We've got float and agency nurses who are perfectly nice people, but the ED at 3am is a bizarre place and the world's best nurse in the family practice clinic can be frustrated to tears -or screams- in the ED.  We're so short staffed that the ED has become a complete log jam. There are open beds upstairs but we can't spare a single nurse or tech to move patients with ready beds from the ED to the floor because otherwise the unstable patients in the ED will die. This is definitely suboptimal but I've been too tired to do much more than keep my head down and see more patients.

I'm in a ghastly stretch of five overnight shifts followed by a DOMA (I get out of the hospital for my day off at 8am following an overnight shift and am due back at 6am the following morning for day shift; doma = "Day Off, My Ass") and 5 day shifts. I'm going to be fairly crispy by the end. I've told my boss twice in the last week that I have had it, that this is it, that there is no way I'm coming back. Both times he said that he was terribly sorry to hear that and could I pick up an extra shift. Both times I said yes, of course.

Last night we had an acute MI that went to cath lab, an acute stroke in a 34 year old mother of 3, a horrible trauma (car fell on a guy and burst into flames), two gun shots, a stabbing, an unstable GI bleeder, a rape victim who had been set on fire, and all the usual other stuff we see. Oh, wait. Maybe that was the night before. I think last night was the leaking aortic aneurysm, the crazy woman who stabbed herself repeatedly in the abdomen with a arm-long sliver of window glass and managed to hit every organ in her body, the young woman who appeared to have been beaten and raped but wouldn't talk and was in the middle of multisystem organ failure, and the 5 year old who inhaled a plastic something and required a surgical airway. It's all sort of running together now. The City X cops who were supposed to be guarding a murderer who had run in front of a car left to get us food because we were so overwhelmed. The murderer was intubated, he wasn't going anywhere.

There was another riot by another family. The victim was drunk, high, and going 100mph the wrong way on the freeway without his seatbelt. The semitruck did everything possible to get out of his way but it wasn't enough.  The guy went through the windshield and was stuck, a la "Signs," between his car and the semi; the highway needed to be shut down to get in an ECHO truck to extricate the guy . Unbelievably, he was still alive when he got to the ED. In addition to me, 2 residents, the trauma surgeon, the surgical PA, and half the nurses in the department did everything we could for over hour before we pronounced him. The deceased family did not take this well. We were accused of not doing anything to try and save his life, of being happy he was dead, of wanting him dead for spare parts.  I had to walk away before I lost my temper. Multiple family members ended up handcuffed after threatening the police officers who were attempting to de-escalate the situation. I heard about that later, I was already taking care of other people.

This morning, when I left the ED 3 hours past the end of my shift, it was grey and raining. Perfect sleeping weather. The non verbal woman still bothered me, I hope I didn't miss anything on her. I slept -sort of- until hot sun on my pillow woke me up and I realize that the jackhammer in my head does not mean I had a great time last night but that there is construction outside my window. I look out. The neighbors both sides of me have suddenly decided to have work done; I hate them with the passion of ten thousand fiery suns. I'm too tired to sustain that so if quickly fades into grumpy annoyance.  I try to go back to sleep but it doesn't work.  I get up, do some laundry, unload and reload the dishwasher, make some food for dinner (or breakfast or whatever the one meal a day I end up eating when I work overnights is called). Normal stuff, but I feel like I am moving through mud. I'm so tired that thinking hurts.

I open the door to get mail and see that part of the construction crew belonging to the house on the right is lounging against the hood of my car. I know I should say something, but I'm just too tired. I stand there  on the porch in my bathrobe in the afternoon sun and stare at him. He stares back.

"Nice time to wake up, Lady!" he calls derisively, "Maybe you should get a job!"

I close to the door, realize I have still not gotten the mail, and trudge up the stairs. Maybe I can get another hour of nap in before I have to be back in Hospital X. As I drift off - despite of the sun, the heat, the jackhammers- I realize that today is June 30th; we'll have brand spanking new, fresh out of medical school interns tomorrow.

When I finally sleep, I have nightmares.


11 ellucidations or expositions or put your $0.02 here!
From: ellameena Date: June 30th, 2008 11:03 pm (UTC) (Link)
Thank you for all that you do. I've spent a lot of time in the ED lately as a family member--psych emergency, regular emergency, "minor" emergency...*sigh* Well, we've managed to stay out of peds. I am nearly on a first-name basis with the security guard who gives me my badge each time. Our hospital seems to manage pretty well, however, I do find myself thinking a lot about how things could be improved. Many of these visits, especially with my chronically ill mother, could be handled in a sort of after-hours urgent care setting. For example, she had to go in last night to rule out a blood clot, infection, and dangerous drug reaction. It wasn't screamingly urgent, but it couldn't wait until morning (except that actually, it did because it turns out they don't do leg ultrasound at night). Seems like there should be a different place for us to go, where we wouldn't be thrown in with people who had just chopped their arm off with a chain saw, or are actively having heart attacks. But there isn't. We've done this enough that I am seeing recurring patterns of kinds of tests that cancer patients end up needing in the middle of the night. It would be neat if there were a 24-hour urgent care in the cancer center that could handle this stuff, and then potentially do a direct admit, rather than funneling people right into the ED. Maybe that's a silly idea. I don't know. It would also be easier if I, as a family member, could order a CBC, blood cultures, chest X-ray, and other minor tests while we're cooling our heels in the waiting room or exam room. LOL.

I've noticed lately that with the out-of-control health problems my family has I am angry. I have not yelled at any doctors or nurses yet, but I have yelled at the pharmacist and a few other nearly-innocent bystanders. It has little to do with the person I am yelling at, and I regret it later. You must be angry, too, after having tried hard to save a patient and losing him, but it's really great that you were able to bite your tongue and stay cool. I appreciate those people who have done this for me, and I am trying to do better.
denyse From: denyse Date: June 30th, 2008 11:24 pm (UTC) (Link)
I totally know what you mean. I've had many a day feeling absolutely nauseatingly wasted after a string of insane understaffed overnights only to be kept awake by someone hammering or some other construction. Or random phone calls, people knocking at the door or stuff like that - and of course getting the derisive 'wow, you slept in late' comments. Grr. I haven't had 5 hours of uninterrupted sleep in almost half a year.

Our new interns are already here and have been for a few days. They look...stunned. The float and traveling nurses look stunned too. We had an MI in a 33 yr old pregnant lady which really made me think I should start looking after my own health more.

Last night (this morning, really, as I didn't get to bed until 7:30am because baby needed to be fed after I was off work) I dreamt endlessly about signout rounds and having to stay in after my shift to finish up things like lumbar punctures and notes ad infinitum.

Emergency departments really are getting overloaded - too bad I don't see that getting fixed in the near future.
bigby From: bigby Date: July 1st, 2008 12:35 am (UTC) (Link)
Dear illuminated preservation! You do realize that your blog about hospital X has saved at least one TX Childrens ER doc a (debatably) deserved/undeserved yelling at. We always try to cut medical staff some slack but then when all nerves fry, I remind myself or sweety about one of your interesting nights and ask if a night like that would excuse [whatever]. If the response is yes, we let things be.

As to interns.. In general, can yours be trusted not to do anything leathally stupid, or do you have the same white knuckle express for their first few weeks?

I had one want to use the medical hard surface disinfectant wipes to clean kids... then there was the one a few back who sprayed the disinfectant over the counter and argued that the remaining two servigns of food that were contaminated would be just fine.
deire From: deire Date: July 1st, 2008 01:43 am (UTC) (Link)
((((hugs)))) for you

(:small but vicious virtual kick to the man who has no respect for car, the brain of a small moth, and the politeness of the average testicle scratching baboon:)
uplinktruck From: uplinktruck Date: July 1st, 2008 04:28 pm (UTC) (Link)
Dante missed a couple of circles in his dissertation.

The soft foam ear plugs help with day sleeping. They shut out enough noise to allow you to sleep, but not so much noise that you don't wake to the alarm clock.

Been there, done that, even got a couple of t-shirts.


Beware of burn out. We need people in Emergency that know what they are doing and actually care about the patients. To burn you out would be a tragic loss.
moon_grrl From: moon_grrl Date: July 1st, 2008 07:28 pm (UTC) (Link)

Don't worry, Dr Fig

Mr. Construction Worker cum Master of Assumptions will have to get down on his purulent knees and thank you when you save his or a loved ones' life late one night.

Again, I say, you are much more calm and patient that I am. I would have lit out after that jackass like a possessed woman. Get some rest if you can, ok?
shennan From: shennan Date: July 2nd, 2008 01:07 pm (UTC) (Link)

Re: Don't worry, Dr Fig

Your entire 5 shifts, DOMA, and "Nice time to wake up, Lady! Maybe you should get a job!"; all seems very ER-meets-Ally McBeal-meets-Scrubs... in a surreal, twisted, "of course this would happen" way....
zendifferential From: zendifferential Date: July 12th, 2008 10:33 pm (UTC) (Link)
I will say upfront that my night shfit experiences were NOTHING like yours - entirely low stress. But the sleep disturbance...

I used to be fond of coming home at 9am, pulling a cold beer out of the fridge and drinking it on my front stairs. People going to work would give me the dirtiest looks, which amused me to absolutely no end.

Your bravery is amazing. I have always had enormous respect for the men and women in the ED - your posts just make me appreciate you all that much more.
From: narciblog Date: July 16th, 2008 11:28 pm (UTC) (Link)

A proper response

Since you were standing there in your bathrobe, I say you should have flashed him.
From: (Anonymous) Date: August 13th, 2008 12:17 am (UTC) (Link)

Re: A proper response

Why reward his bad behavior?

--a fan from Th'InterWebs.
From: (Anonymous) Date: August 20th, 2008 02:41 pm (UTC) (Link)


I just thought I'd pop in a comment about your blog, which I discovered while doing research for an article I'm working on. Your posts are really well-written and quite enjoyable; I hope you'll keep posting. I also alerted a few of my friends who are ED nurses to your blog - I know one of them has already visited today. She said it brought back a lot of memories of her days in the ED (she's a stay-at-home mom these days). Great work! :)
11 ellucidations or expositions or put your $0.02 here!