Welcome to the Emergency Department

Graveyard Humor

2012-02-01T22:34:00.002-05:00

Me: Hi, this is Hobbes calling from [Hospital ER]. I'm calling for the medical examiner.

Dispatcher: Another one bites the dust, huh?

Me: Yeah, we're just knocking 'em dead over here.

Who said there are no stupid questions?

2012-01-09T23:47:00.002-05:00

That person has obviously never worked in an ER. Or, perhaps, never spoken to a human being.

I have a new candidate for dumbest question ever asked.

I was giving report to an EMT who was transporting a patient of mine back to her nursing home. I was explaining to him that she had been sent to us for fever and tachycardia, and we had diagnosed her with a urinary tract infection. Her nurse had given her Tylenol before she'd left the other facility, and she had been afebrile the entire time with us.

The EMT asked, "Is she usually afebrile, on a daily basis?"

I stared at him for a moment, and then just said, "Yes."

Really, what other answer is there?

Someday I should learn to keep my mouth shut.

2011-12-19T01:02:00.002-05:00

I have tattoos. For the most part, they are hidden when I'm at work. But there is one which, depending on the cut of the scrubs I'm wearing, occasionally peeks out a bit. This has never been an issue.

And then there was this woman.

If she had actually been sick, maybe I would have given her the benefit of the doubt. But there was nothing actually wrong with her to begin with, and she had already been obnoxious in more than one way prior to this.

And then she saw my tattoo. And she said to me, ANGRILY, as if she were personally offended, "WHY do you have to have tattoos? I HATE them."

Without even thinking, I immediately replied, "I promise never to make you get one."

If I get fired and never update again, now you know why.

'Tis the season!

2011-12-12T14:18:00.002-05:00

It all started with a morbidly obese woman. I will never understand how a person allows him/herself to get to be that fat, but unfortunately we see a lot of it. So she was being admitted, and we were moving her from the ER stretcher (which she really didn't fit on anyway) to what is known as a Big Boy Bed. There were about six of us there to accomplish this.

As we were turning her to get the lifting pad out from underneath her, all of a sudden I caught the facial expression of the tech standing across from me, about to burst out laughing.

She held up an icicle-shaped Christmas tree ornament.

It had been stuck in the woman's back fat.

We almost had to leave the room because the two of us were silently cracking up. We couldn't look at each other, and I had to keep turning my face away from the bed as we got the woman repositioned so that no one would see that I was losing it.

Seriously.

A Christmas tree ornament.

Of all the things I have found in people's fat folds (the most digusting one being a moldy half sandwich), I do believe that this one was the funniest. And so timely!

Merry Christmas!

I know some people consider the ED a turn-on...

2011-11-04T17:30:00.003-04:00

I am so glad that this did not actually happen to me.

A well-known drug-seeking regular of ours was in the department for a possible overdose, as per usual. Her nurse (who happened to be male, which isn't really relevant except that it gives the story just that little extra something) told her that she needed to provide a urine sample. Naturally, she said she couldn't. He then told her that if she could not provide one, we would need to use a catheter to get one.

When he came back with the catheter, he found her spread-eagle on the bed, naked, masturbating.

What did he do next? Probably the only thing one can do in that situation: turned around and walked out.

The entire department has been teasing him about it for a good week now.

Overheard from Dispatch

2011-07-23T13:20:00.001-04:00

The original EMS call was for a "bug bite."

"Update from 911: 54-year-old female with a bug bite. Believes the bug flew into her ear, and now they're concerned because they can't find it."

It's eating your brain, lady. Or would be, if you had one.

You do know there's a difference, right?

2011-01-22T03:52:00.002-05:00

The ambulance had brought in a young woman whose initial complaint was nausea and vomiting. Apparently, on the way across the parking lot, she decided that she also had chest pain. She probably thought that it would get her into a room that much more quickly; in reality, it just meant that instead of the cushy private room with a TV that she would have gotten, she ended up in a noisy cardiac bay with a mere curtain. Her loss.

As I was getting her settled in and hooked up to the monitor, I told her, "I'm going to put some stickers on your chest."

She replied, "Yeah, they did that in the cab, too."

I said, "That was an ambulance you were in."

Are people really this dumb?

2011-01-06T05:44:00.002-05:00

I ask out of genuine curiosity.

A teenage girl had a chest x-ray. Sometime later, she complained that "ever since" the x-ray was done, her back had been "burning."

Her mother looked at the radiology tech with quite earnest concern on her face and asked, "Are you sure you didn't use too much radiation?"

Well, we wouldn't want to inconvenience you.

2010-12-30T05:34:00.003-05:00

"Hi, this is Mrs. X. My husband is in your ICU dying, and I just wanted to make sure that if he dies tonight, they won't call me until after 5:30 in the morning, because I'll be sleeping."

This was an actual phone call. The operator actually asked her if she was serious. Apparently she found that offensive. What a concept.

"Cheap Date" Doesn't Begin to Cover It

2010-12-29T04:02:00.002-05:00

A 21-year-old male was brought into the ED after his friends called 911. He'd been on a bit of a bender that night since his girlfriend broke up with him, and they were worried that he'd had too much.

The kid was smashed. He was slurring his words, passing out on us, and in general a pretty textbook presentation of a good night getting out of hand.

His BAC came back at 42.

Yes, 42. For those of you playing the home game, that's about half the legal limit.

You read that correctly: HALF.

This kid wouldn't even have blown high enough for a DWI.

Seriously, I think this is a poor commentary on the state of youth in America today. What are we teaching our children? Start building your tolerance, young friends! If you're going to end up in the ED, at least make it worth our while. "Pussy" is not an approved discharge diagnosis, no matter how apt it may seem at times.

Get It? A CATCH!

2010-06-06T04:47:00.003-04:00

A very nice gentleman walked into the triage office, a bright smile on his face.

"How are you tonight?" he asked.

"I'm fine, thanks," I replied. "How are you?"

"I'm very well."

"But I sense there's a catch?" I asked.

The patient held up his hand. There was a fish hook stuck in his finger.

Seriously.

2010-03-08T04:11:00.002-05:00

I generally try to be polite to everyone, no matter how much of an idiot I think they are. But when someone comes in from a snowboarding accident wearing a stiffneck collar for a probable c-spine injury, and the first words out of his mouth are, "Can I take this thing off for a second so I can crack my neck?" there is really only one appropriate response.

"Are you kidding me?"

Activate the Drama Team

2010-03-05T00:06:00.000-05:00

The other night I met the most anxious (and whiny!) patient I have ever seen in my entire life. And that's saying a lot. It wasn't the anxiety which brought her into the ED, however: she came in because she was constipated.

The doctor came out of the room and said, "I need to do a rectal exam. And I wrote for some Ativan." The first words out of my mouth were, "THANK YOU."

Then I added, "If you want to head back in, I'll meet you there with the Ativan."

The doc hesitated and, with the slightest hint of fear in his eyes, replied, "I've already been in there once. I'll wait for you."

"The knee bone's connected to the thigh bone, the thigh bone's connected to the..."

2010-03-04T00:18:00.000-05:00

Paramedics arrived at a nursing home to pick up a patient for a scheduled transfer to the hospital. They found the nurses running around in a panic:

"The patient has a broken neck!"

The x-ray report read, "Femoral neck fracture."

Seriously, you can NOT make this shit up.

Sucks To Be You

2010-03-03T21:57:00.002-05:00

The guy called first.

"I have a question. I had a vasectomy 10 years ago."

And your question is...?

"My girlfriend is pregnant."

Ah.

The girlfriend called about half an hour later.

"My boyfriend had a vasectomy 10 years ago, and I'm pregnant. Is it at all possible...?"

Sorry, sweetie. Looks like you're gonna have to own up to this one.

Actual Triage Note

2010-02-04T00:43:00.002-05:00

"...c/o right axillary cyst, pain to right shin, left arm pain, tingles to fingers, right eye pain, joint aches, can't sleep, feels like 'I can't breathe - someone sitting on my chest, having a hard time swallowing.' Pt sitting calmly dressed in PJs in no apparent distress. Pain to neck, feet, thighs, palms, headache to right eye, etc."

Yes, the triage note actually ended with "etc."

The doctor picked up the chart, read it through and said, "Well, I guess we'll just have to do one of everything."

I replied, "Hey, that can be your orders and your diagnosis all in one: one of everything!"

Breaking Up Is Hard To Do

2010-01-30T02:58:00.003-05:00

His story started with, "I was in a car accident 6 months ago."

This is never a good start, and rarely relevant to an ER visit.

He didn't go to a doctor at the time, because it was his girlfriend's car and she'd already had several accidents and he didn't want her to lose her insurance. What a noble guy.

Now, six months later, they broke up so he wants to file a claim.

I'm not sure which is worse: the general story, or the idea that people really think something still counts as an "emergency" six months after the fact.

Parental PSA

2010-01-11T00:09:00.000-05:00

Okay, stay with me on this one here, because it's a very difficult concept.

Ready?

One dose of Tylenol does not magically cure illness.

I know, I know: it's difficult to believe. But if your child has a fever, and you give him Tylenol, and then four hours later he has a fever again, this in and off itself is not a reason to bring him to the ER in a panic. This does not mean he is getting worse. It simply means that the Tylenol has worn off. Do you know what you need to do now?

YOU NEED TO GIVE HIM ANOTHER DOSE.

See how that works? Okay, let's try another one.

Your child had a fever yesterday. You gave him a dose of Tylenol yesterday. Today, he has a fever again.

He has not had any Tylenol since yesterday.

I'm going to leave this one up to you, parents. I know it's tough, but I have faith, deep down inside somewhere, that you can figure out what you need to do next.

Let's think about this here.

2010-01-10T02:49:00.004-05:00

I triaged a patient tonight, who kept looking at me with that "I know you but I can't place you and it's bugging me" look.

Then, all of a sudden, she got this big grin on her face and said, "I've got it! Walmart! I saw you at Walmart yesterday!"

"No, I don't think so," I said, knowing I had not in fact been in Walmart any time in the recent past. The woman looked very perplexed.

"You don't work at Walmart?"

Umm....NO.

Now, I know that the economy is bad right now and people are trying to make ends meet any way that they can, but if times have gotten so tough that your ER nurses are moonlighting at Walmart, then we're all in a lot more trouble than I thought.

Conversely, if you think you're being triaged by someone with a skillset comparable to a Walmart employee, then that just might explain a lot of the problems in healthcare today.

The Lady and the Snake

2009-12-12T20:33:00.002-05:00

It was a fairly typical evening in the ER, as much as that phrase can ever be used. Little did this nurse know the can of worms (::giggle::) which she would open simply by answering the phone.

"I have a snake inside of me. I can feel it moving around and biting me."

So of course the nurse who answered the phone (who wasn't me, thankfully!) asked, "Inside you, where?"

"Where babies come from."

The lady goes on about all of these snakes around her, and we basically figure this is either a crank call, or a certified wacko. So the nurse says you're welcome to come into the ER, but we really can't help you over the telephone. (Which is what we say to 98% of our phone calls anyway.)

We all had a good laugh over it.

About half an hour later...she showed up!

She wanted to know how were were going to lure the snake out of her. She suggested dangling a piece of chicken between her legs.

Then, when we told her that we would have to actually examine her, she refused to sign the treatment consent, started screaming that we had no idea what we were doing, and ran out of the ER.

We keep wondering if she will turn up again (somehow, they always do...) but so far, no Snake Lady.

It all started with a pair of handcuffs.

2009-12-08T04:01:00.003-05:00

Some of the best stories do.

In this case, it was a middle-aged man who was brought in by the police. The officer told me that he was complaining of wrist pain caused by the handcuffs and had insisted on being brought to the ER. So, into triage we go.

Naturally, I started by asking the patient which wrist it was, and he told me it was the right one.

"Can you rate your pain on a scale of 0-10?"

"What? It doesn't hurt."

At this point, the officer interjected: "You told me your wrist hurt. You insisted on coming here. That's why you're here."

Patient: "It doesn't hurt. It's metal."

Me: "You mean you have pins in it?"

Patient: "No, my whole wrist. It's metal."

Oookay. By this point, I had figured out that the guy was absolutely filthy stinkin' drunk. But it gets better! Next I asked him about his medical history.

"I'm a mental health patient at the VA. I should be going there but he wants to take me to jail."

Ah. The pieces are starting to fall into place. He perseverated from there on the subject of being transfered to the VA to be seen for his mental health issues, which I flatly told him we were not going to do. He also denied any suicidal or homicidal ideation, so he didn't even fit the criteria for our emergency mental health evaluation; and aside from that, he was DRUNK, so no mental health counselor would speak to him in that condition anyway. Basically, he didn't want to go to jail. Tough luck, buddy. Not my call.

He also told me that he needed to self-catheterize in order to urinate. Remember this point, because it will be important later.

AND he lied to me, in front of the officer, telling me that they wouldn't allow him to catheterize himself. The officer called him on it right there: "That's not true. You cathed yourself at the station."

Then the officer made him apologize to me for lying, which I found amusing.

Anyway, I got him into a room and put him in for an x-ray of his wrist, which he kept insisting had been "bent" by the handcuffs. (He did actually have a metal plate in it, but there was absolutely nothing wrong with it.)

Throughout his entire visit, he kept insisting that he wanted a mental health evaluation, and I kept telling him it wasn't going to happen. You can't have a mental health evaluation when you're intoxicated. It just doesn't work.

So, the doc reviewed his x-ray and pronounced him fit for jail. I thought I was off the hook, but then she threw me a curve ball: "Oh, and he needs a catheter before he goes."

Damn it!

Well, you know what, buddy: you cath yourself all the time. There is absolutely no reason that I need to do this for you.

Patient: "But you're going to measure it, right?"

Me: "There's a bag in the kit with graduated markings. You can measure it yourself."

But Mr. VA Mental Patient had found something new to harp on that he thought would get him out of jail: "If I get more than 200cc in my bladder I become nephrotic!"

Um...you turn into a giant kidney?

I don't know what it means to "become nephrotic," and honestly, I don't really care. I gave him his catheter and directed him to the bathroom.

But this is almost to the best part of the story!

I went back to discharge him after he had cathed himself, and he was INSISTING that he had drained 900ml out of his bladder.

"I want that documented! They won't let me cath myself! I'm going to become nephrotic!"

There's that funny word again. I want to see you turn into a kidney. Really.

By this point, the officer and I were both done arguing with him. He had already assured me that the patient had not only cathed himself less than two hours ago at the police station, but that they had additional catheter supplies for him on hand. Neither one of us felt like continuing to point out to Mr. VA that he was lying.

Now: THIS is the best part of the story.

I went into the bathroom to clean up the catheter supplies. I found the drainage bag sitting in the sink. The patient had disconnected the catheter from it. Would you like to know why?

The patient had had to disconnect the catheter because HE HAD FILLED THE DRAINAGE BAG WITH TAP WATER.

I was done. I just burst out laughing. Have fun in jail, Mr. VA Mental Patient!

A girl and her mom walk into triage.

2009-11-19T06:19:00.003-05:00

The girl was kicked in the shin while playing soccer at school.

...

Oh, sorry, were you looking for something more than that?

No bruising, no swelling, no deformity. The girl did not have a single mark on her. Not even the decency to walk with a limp.

I asked the mother what exactly she was looking for.

"I just want to make sure that she's okay."

Trust me: she's okay.

You are the rudest person on the planet. Goodbye.

2009-09-07T07:53:00.002-04:00

ER rule #437:

It is almost NEVER appropriate to walk into another patient's room to ask me a question about your loved one. If said loved one has suddenly stopped breathing or is otherwise actively dying, then you might be forgiven the interruption. However, if this is actually happening, chances are we'll know about it before you do anyway.

Wanting to know when your loved one will be discharged does not fall into the aforementioned category of genuine emergencies. Stay in your own fucking room.

There is a corollary to this rule, known as: "This is an ER, not a sideshow." I don't care how fascinatingly gory the patient in the bed next to you is. IT IS NONE OF YOUR FUCKING BUSINESS.

So, when the doctor is in the middle of suturing, and you wander out of your little cave and decide to park yourself at the foot of the bed to gawk, and I turn around, block your view, and with my nose two inches from yours ask, "Can I help you, sir?" in a decidedly UNhelpful tone of voice ... it does NOT mean that you should peer over my shoulder to try to get a better view.

It means BACK. THE FUCK. OFF.

NOW.

ER a la carte

2009-09-06T17:24:00.001-04:00

Actual question asked by a patient while waiting for the doctor:

"If I change the reason that I'm here, will I get seen faster?"

Balls. Seriously.

Misconceptions of the Masses

2009-08-30T15:33:00.003-04:00

So one of the first things any triage nurse learns is that when you ask patients what they're allergic to, you also have to ask them what kind of reaction they have, because 85% of the time it's a side effect rather than a true allergy.

For example, "I can't take morphine because it makes me throw up." NOT an allergy.

"Benadryl makes me hyper and jittery." NOT an allergy.

"Penicillin makes my throat close up." THIS is an allergy. Well done!

This is a conversation I had with a patient a few nights ago:

"Do you have any allergies to food or medications?"

"Epinephrine." Really? That's a neat trick.

"And what kind of reaction do you have to epinephrine?"

"It makes my heart race."

::headdesk::

Nursing Home Reports Revisited

2009-08-24T10:56:00.003-04:00

I'm actually sad that this patient never actually showed up. The nursing home called report to us, but then the patient opted to go to a different hospital. So I can't tell you if the report bore any resemblance to the patient's actual presentation.

Although my guess is not.

She starts off describing a woman in her mid-fifties with a history of a stroke, chief complaint: "She feels like she's having TIAs." Patient has a history of anxiety, was given Ativan a few hours ago, blah blah blah... I interrupted her:

"You said she feels like she's having TIAs. Have you noticed any symptoms?"

"Well, no, but she was kind of shaking when she told me."

Okay. I could feel things heading downhill from there, but I still tried to give her the benefit of the doubt. Here's where she lost me:

"Does she have any deficits from her previous stroke?"

"Left-sided paralysis."

"True paralysis, or just weakness?""

"Um, well, um, yeah, I'm pretty sure it's paralysis. Yeah, it is. I never see her move it at all. She walks though!"

Dumbfounded.

They always underestimate the power of the sphincter.

2009-08-24T10:53:00.002-04:00

He tied a string around it to make sure he'd be able to pull it out again. It didn't help.

It was a toothbrush.

Would that be Worker's Comp?

2009-08-19T07:17:00.002-04:00

A young woman presents to the ED, complaining of pain in her left side, which sounds like a muscle strain or possibly rib fracture. Triage continues:

"When did the pain start?"

"A few days ago, at work."

"Were you doing anything in particular when it first started? Bending, lifting?"

"I was upside down on a pole, pulling myself up."

Okay then.

Fun With EMS Reports

2009-08-11T13:42:00.002-04:00

No one likes a long-winded report. That's when you end up with exchanges like this:

"Copy that. And can you tell us the patient's favorite color?"

"I'm not sure, but she had an egg sandwich for dinner and she's wearing very nice pajamas."

I shit you not, this was an actual exchange over the airwaves last night.

FYI: Your time spent giving report should not exceed your transport time. If it gets too complicated, we just stop listening anyway. We'll figure it out when the patient actually arrives.

You know what I'm sick of?

2009-07-18T09:27:00.002-04:00

Medical shows that decide an illness is "not responding to antibiotics" after only one dose.

Maybe if television portrayed medicine more accurately, we would have fewer patients who return to the ED because they were given an antibiotic last night and THEY'RE NOT BETTER YET.

Or maybe...they should STOP WATCHING SO MUCH TELEVISION.

You know it's been a bad night when...

2009-07-13T09:02:00.002-04:00

...an ambulance shows up and the medic looks at you and says, "You're still here? I've gone home since I saw you last!"

You do not want to annoy the ED staff.

2009-07-04T00:16:00.000-04:00

Tip #1: When you come in for a bullshit drug-seeking complaint, and then leave without being seen because the wait is too long, coming back two hours later via ambulance will not get you brought directly to a room. It will get you triaged to the waiting room, and annoy the staff. You do not want to annoy the staff.

Tip #2: When the above attempt fails, telling the triage nurse that you are now "feeling faint" and reeeeaaallly neeeeed to lie down, in an effort to be seen faster might work, but will annoy the staff even more.

However, being seen by the triage nurse going out to the parking lot to smoke a cigarette immediately after you've complained of feeling faint may just get you left in the waiting room all night. And if you pass out, well then at least you'll finally have a legitimate complaint.

Tip #3: Asking for a cab voucher to get home after abusing our hardworking EMS personnel by using a completely unnecessary ambulance to get here for your bullshit drug-seeking complaint will not only annoy the staff, but will eliminate any chance you might still have had of getting the pain medicine you were seeking, and might just buy you a series of painful and completely unnecessary tests and procedures. After all, this is your health we're talking about. We need to be as certain as possible.

You do not want to annoy the ED staff.

Reason for Visit

2009-07-03T08:11:00.002-04:00

We have a sign-in sheet outside the triage office with three blanks on it: First name, age, and reason for visit. I happen to think this is a stupid system in the first place, because I'm not comfortable asking people to write down potentially confidential health information on a piece of paper that anyone walking into the ED can read, but nobody asked me.

Case in point: last night, a young man came in, and in the blank marked "Reason for visit," he wrote...(wait for it)..."visit."

He was actually there for an abscess in his scrotum. I can kind of understand why he wouldn't want to write that.

And then there's just random stupidity: like the young lady who, in the age column, wrote "NA."

Highlights from Nursing Home Reports

2009-06-21T01:43:00.001-04:00

I have a love-hate relationship with nursing homes. Their reports are always entertaining, but rarely informative.

One of my favorite examples is a little old man who came in a few months ago. The nurse giving me report started off with a general story of diarrhea over the past few days, with a fever that afternoon which she had given him Tylenol for. He had the usual history that you would expect from someone his age, a little of this and a little of that, but the whole story was very vague. So I asked her if she had any vital signs for me. Her answer?

"Oh, no, I couldn't get any. I tried three times but I just couldn't get them."

Um, excuse me? What does that even mean? Is the person ALIVE?

I didn't ask that. Instead, I went with, "Well, is he alert and oriented?"

Her answer to that was even less helpful: "Well, he was yesterday..."

At that point I just gave up. I ascertained that the patient was already en route via EMS and hung up on her.

PS: the patient came in on BiPap, in what we refer to as "imminent code" condition. He wasn't dead yet, but he was certainly heading in that direction much more quickly than anything else.

But he was coming in for diarrhea and fever.

* * *

Then there was the guy coming in for an acute change of mental status, who was described as "alert but unresponsive." I didn't even attempt to figure out what that meant.

* * *

But I have saved the best for last!

Nursing home calls us in the middle of the night, saying they're sending a little old lady because they couldn't wake her up. Vitals were all stable.

No joke: she was sleeping. EMS woke her up. We couldn't find a thing wrong with her. We sent her home.

I shit you not.

ER Lesson #1724:

2009-06-20T18:41:00.001-04:00

Apparently all it takes is one old man with priapism to reduce our maturity level down to about the 3rd grade.

Sometimes I guess you just need to laugh.

Sometimes it's hard to keep a straight face in triage.

2009-03-10T08:09:00.004-04:00

His chief complaint was abdominal pain: mid-forties, no medications, denied any medical history. When I did his vital signs, his blood pressure was fairly high. Higher than I would have expected from a pain response, especially given that he did not appear to be in any particular distress. In the interest of being thorough, I asked him, "Do you have any history of high blood pressure?"

And he responded: "No, no history. But every time I've had it checked, it's been high."

This patient also gave me the most detailed description of his bowel movements I have ever heard in my entire life.

My other favorite patient of the evening came in shortly after him. She thought she had a kidney infection. As per routine, my questions:

Me: Do you know when your last menstrual cycle was?

Her: About 2 weeks ago.

Me: Is there any chance you could be pregnant?

Her: I am pregnant.

Me: But you had your period 2 weeks ago?

Her: Yes.

Me: How far along are you?

Her: Six weeks.

Now, it's not so much the fact that she still got her period while she was pregnant. That's not actually all that uncommon. It was really the total picture: the fact that when I asked her when her last menstrual cycle was, it didn't occur to her to mention that she was pregnant, and if I hadn't asked specifically, maybe she wouldn't have mentioned it at all. (I am actually amazed at the number of women who don't think to volunteer this information when visiting the ER.) It's part of what I refer to as the "pulling teeth" triage. You'd think they were being interrogated by the police or something: they answer only the specific question you have asked, and volunteer nothing. (Usually in these triages, every reply sparks about 3 more questions as well, until you finally start to get a real picture of what's going on.)

The contrast to this is the VOLUNTEER EVERYTHING triage. They spend 15 minutes telling you about the splinter they had removed from their toe thirty years ago, everything they've eaten in the past week, and how their mother-in-law's cousin thinks their tongue looks funny, before finally telling you they're here for chest pain.

But it's not like that's something important that they should have mentioned FIRST or anything.

Selective Vomiting

2009-03-05T02:10:00.001-05:00

It's actually kind of a neat trick. We never did figure out how she did it.

She came in complaining that her pills were stuck right here, pointing to her epigastric area. They'd been there since she took them that morning. She ate breakfast, she ate lunch, she even ate dinner. But she couldn't keep water down because it couldn't get past her pills! They were stuck!

The doctor decided to test her. We gave her crackers to eat. No problem!

Then we gave her water to drink. It came back up.

Just the water.

Solid food: no problem. But every time we gave this woman water, up it would come. Just water. She could eat and drink at the same time, and yet manage to vomit up only the liquid without a single food particle in it.

You know, this might be a marketable skill in a circus somewhere. I bet she could make some good money.

Adventures in Triage

2009-03-04T07:44:00.004-05:00

"You can read the triage note, but I don't think it will help. I still don't know why he's here."

This is what I said to the doctor before he went in to see this patient. He didn't have much more luck than I did.

It started off pretty straightforwardly. He walked into triage and said, "I've been sick since Saturday." Unfortunately, that's where things started to get bogged down. No matter how I phrased it, I could not get him to explain to me what he meant by "sick." Nausea and vomiting? Cold symptoms? "Sick" has many definitions. I did, however, get the story of how he had his appendix out years ago and he was back to work the next day, so he knew he should come into the ED this time, because he had been sick for DAYS.

Yeah, we're back to that word again. But hey: we've eliminated appendicitis as a possible complaint! We're making headway!

It got better from there.

"Everything is just going right through me."

"So you're having diarrhea?"

"No, I mean peeing."

"You're urinating more frequently than normal?"

"Yeah, but I've been drinking water constantly."

Damn. I almost had a symptom there. I wrote down urinary frequency anyway. It seemed as good a starting place as any. Especially since the only other concrete thing I could get out of him was "kidney pain," while pointing to the middle of his back.

"Do you have any history of kidney problems? Kidney stones, infection?"

"No."

"What makes you describe the pain as your kidneys?"

"That's where it hurts."

He then proceeded to tell me that he didn't want to take any medications because he didn't want to "mask any symptoms." I refrained from saying I didn't think that would be an issue, since he hadn't been able to tell me any yet.

Do you know how to palpate wheezes?

2009-02-04T13:17:00.002-05:00

I would really like someone to teach me. It sounds like fun.

This was only one of the suggestions made to us by the nurse giving report on the patient being sent to us in respiratory distress. She was also very upset because the patient had an O2 stat (yes, stat) of 87% and she had put her on two liters nasal cannula and IT WASN'T HELPING!

There is a reason I will never work in a nursing home. I am more and more convinced that they are not real nurses; they are Martians in disguise. Maybe it's a test to see how long it takes us to figure out.

Dumb as a Box of Rocks

2009-02-01T12:01:00.000-05:00

An obviously pregnant woman in no apparent distress walks into triage. She has a blank, oddly bovine expression on her face. The conversation goes as follows:

Pregnant Woman: They told me to come in to Family Birthplace.

Me: Are you in labor?

Pregnant Woman: I don't know; I've never been in labor before.

Okay, so maybe that one was my fault. It's not an entirely unreasonable answer. I probably could have forgiven it if her face weren't so completely devoid of intelligence. Usually I ask "Are you having contractions?", which is a little bit more specific and gives them more to work with. But moving right along!

Me: Do you know how many weeks along you are?

Pregnant Woman: Huh?

Okay, different tactic.

Me: Do you know when you're due?

Pregnant Woman: I'm supposed to have a c-section sometime next week I think. I think I'm due around then.

Throughout this entire conversation, the blank, lackadaisical expression has never changed from her face. Contractions? Pain? I'm not even sure there were neurons firing.

At that point I just gave up and sent her upstairs to L&D. Apparently they told her to come in, so they could deal with her. Not my problem anymore.

Don't ask.

2009-01-31T11:59:00.001-05:00

"My boyfriend likes to stick things up there when I get drunk."

No, really: Don't. Ask.

Speaking of non-emergent emergencies...

2009-01-29T01:12:00.000-05:00

A gentleman called 911 (twice!) because his wife was sleeping and he was unable to awaken her. Each time, EMS arrived on the scene to find the wife awake and in no distress.

After the second call though, they brought her in to us on general principle. We couldn't find anything wrong with her either. Dude, it's 4am: let the poor woman sleep!

You did say you were a nurse, right?

2009-01-28T03:58:00.002-05:00

We were receiving an elderly patient from a nursing home, to be checked out for vague symptoms including not eating and increasing weakness. Why these things suddenly become emergencies at 2am I will never understand, but hey, it gives us something to do.

I took the report from the nursing home. It was a little sketchy from the beginning, but it started heading downhill around this point: "She's had a little bit of a cough on and off, and sounds a little gurgly, but I was unable to aus-cul-tate."

That's a big word for you, there. Are you sure you know what it means?

She went on to tell me various other bits of history (all a bit vague) and in general paint a picture of a gradually declining little old lady with dementia and various other ailments, who may or may not have some acute process going on, but who probably would have been absolutely fine being seen by her primary care provider in the morning, rather than being carted off to the Emergency Department in the middle of the night.

Naturally, I have saved the best for last though. My final question to the nurse giving report was, "Have all her vitals been stable?"

And her answer...(you're going to love this!)...was:

"Oh, I couldn't get vitals because she's too tiny."

Are you f*cking kidding me?!

So let me get this straight...

2009-01-26T09:37:00.003-05:00

A ten year old presents to the ED shortly before 3am, complaining of peri-umbilical pain for the past few days, with some nausea and vomiting this night. Her only significant history is ADHD, being treated with Adderall. The story unfolds...

Triage RN: So you just threw up the one time tonight?

Child: Yeah, it was after I had the coffee.

Triage RN: Coffee?

Mom: Well, she's been constipated too, so I thought coffee being a stimulant would help her to go. But then she threw up, and she hasn't been able to sleep, so I thought I should bring her in.

Let's recap: your daughter has a stomach ache, and has been constipated. So you give your 10-year-old daughter...who has a hyperactivity disorder...coffee...AT BEDTIME...and now you're more concerned because she threw up and can't sleep?

Just checking.

Semantics

2009-01-26T09:03:00.003-05:00

This was part of an EMS report, chief complaint: injuries from a fall.

"Several hematomas, no bruising noted."

Um...okay. Great. Thanks for clearing that up!

Tonight's Question

2009-01-21T18:14:00.003-05:00

"Can you use tampons if you have an IUD?"

Seriously, I don't know why people even think calling the ER to ask questions like this is a good idea. Maybe we should all start telling them what we really think.

Note to the Layperson

2009-01-05T17:33:00.001-05:00

When the patient is saying "Ow," you can stop doing compressions.

Trust me on this one.

Quote of the Night

2008-12-30T01:06:00.002-05:00

"I'm not drunk, I just can't hear out of my left eye!"

* * *

Also, coming in for chest pain, signing out AMA so that you can have a cigarette, and then coming back into the ER to say you're ready to be admitted now is not an effective use of your time or ours. And it only works once.

All-Time Favorite Triage Answer

2008-12-29T00:06:00.000-05:00

I actually get this one on a regular basis.

"Can you give me a number for your pain, on a scale of 0-10?"

"I don't have any pain; it just hurts."

Nurse Calls

2008-12-28T08:00:00.002-05:00

"If someone is not a diabetic, and he has a blood sugar of 178, is that normal?"

"Probably. It depends on what he's eaten recently."

"He just had a bowl of cereal with sugar on it."

"Well, sure, if he just had sugar, then you can expect his blood sugar to be a little high. If he's not diabetic, why did you check his sugar? Were you concerned about something?"

"No, I'm diabetic and I was checking mine, and my husband wanted to know what his was."

* * *

"I had a flu shot a few weeks ago, and I was a little sick afterwards for a few days, and then I got better, and now I'm a little sick again. Is that normal?"

* * *

"Hi, can you tell me if there's any sort of virus going around?"

The Perfect Crime?

2008-12-17T01:40:00.003-05:00

It's a typical afternoon. Two patients, brothers, are brought in by EMS from a motor vehicle crash. No particular injuries, but both are boarded and collared as a precaution. It's a pretty typical winter story: icy road, lost control. They check out okay, bruises and muscle strains, nothing serious. They even engage in some playful banter with the staff about how they were driving the one brother's stupid little Honda instead of the other one's truck.

I wasn't actually there that day. I heard that part of the story later from staff members who were.

I was there two days later when Brother Number One was brought back in, after taking all eighteen of the Percocets that had been prescribed on the previous visit, and Brother Number Two admitted that the accident had never actually happened. It was all a story that they cooked up to scam drugs.

I mean, I guess on the one hand, you have to give them points for a certain amount of creativity. I would kill to have been a fly on the wall at that accident scene though. They must have staged it at least passably well, because the EMS responders apparently didn't suspect a thing.

On the other hand: are you kidding me?

Triage Note

2008-12-14T08:08:00.001-05:00

"Sudden onset pain in left great toe while walking. Denies trauma."

This was an emergency, worth sitting in the waiting room for 3 hours between midnight and 3am.

You know what I find fascinating?

2008-12-06T03:02:00.000-05:00

The number of women who call the ER convinced that they have Toxic Shock Syndrome. Seriously: is this something that the average woman worries about on a daily basis?

Of course, the best part is that in all of the TSS phone calls which I have fielded to date (and trust me, it's a surprising number), not one of them has included a fever in her list of symptoms. It's always things like nausea, and general abdominal discomfort. You know, normal things that you would expect to experience during your period.

My favorite was the one who was obviously reading from a list of symptoms while she was on the phone with me, and wanted to know if it was still possible she had TSS if she only had one of them.

Seriously?

2008-12-05T19:53:00.004-05:00

A four year old girl is rushed to the emergency room in the middle of the night. During her evening bath, her mother noticed some hair falling out as she washed her.

Yeah, I'd like to tell you that there's more to that story, but nope.

Honestly, I would have thought it would be one of those call-your-pediatrician-in-the-morning things from the start, but if you'd rather spend your night sitting in the ER waiting room, only to be told that there is absolutely nothing we can do for you and that you should (gasp!) call your pediatrician to follw up, hey, be my guest.

It's right up there with the woman who's eleven weeks pregnant, and presents to the ER for nausea. What part of "You're going to feel crappy for another 30 weeks or so yet," did you miss? Now, just so I don't sound too callous, I am fully aware that there are women who have serious issues with vomiting during pregnancy, and do require medical treatment for it. I am more than happy to do whatever I can to make them comfortable. But trust me: she wasn't one of them.

Sometimes nurses are dumb too.

2008-11-29T09:47:00.002-05:00

I admitted a patient last night, and when I gave report to the floor, I told the nurse there that she had an order for Percocet for pain, and I had given her a dose in the ER at 2315. About an hour after the patient got up to the floor, I got a phone call from the nurse:

"I just wanted to check what dose of Percocet you gave her. Did you give her 5mg or 10mg?"

Hmm.

The order says 10mg, right?

I documented that I gave 10mg, right?

So what's the problem?

"Oh, well, I just wanted to check, because we only have 5mg pills up here, and I thought that's what you had down there too."

See, this is where I'm glad that my expensive college education included math classes, because I did something really novel here: I gave her two pills.

"Oh, okay. It's just that we only have the 5mg pills, so I wasn't sure if you would have given her 5 or 10, and I just wanted to double check."

Um, thanks?

I have actually greatly condensed the conversation here, because it took several minutes to get her to understand that yes, I did indeed give the patient the prescribed dose, the dose which was documented as having been given. And yes: 5 + 5 = 10.

I'm really not sure why this warranted a phone call.

Things Not To Say In Triage

2008-11-21T08:26:00.001-05:00

"Is this going to take long?"

"Tell her your pain is a 10/10. You'll get seen faster."

"I figured you guys would be bored at this hour, so I'd give you something to do."

"If I give you my cell number, can you call me when I can come in?"

"You're not going to do a drug screen, are you?"

And when you've given me a list of seventeen medications that you're taking, the answer to, "What medical conditions or health issues do you have?" is NEVER going to be, "None."

PCP is not a drug.

2008-11-11T07:53:00.002-05:00

It stands for Primary Care Provider. Now, I know this is kind of a dirty phrase in these parts. After all, why would you want to go through the hassle of making an appointment when you can just walk into the ER at your convenience?

But here's the thing: if you come into the ER with some stupid problem that could be dealt with at any time, you can expect to sit in the waiting room for 3-4 hours. Minimum. You can complain about that arrangement all you like, but it won't make any difference to us. You can even threaten to sue us. Go ahead: it'll give us something to laugh about in the nurses' station.

Remember: this is an EMERGENCY Department. We use a neat little system here known as "triage." This is not first-come, first-serve. People will be seen according to how sick they are, and if you have a hangnail or a pimple on your ass, you can sit in the waiting room all day for all we care, until all of the people with genuine emergencies are taken care of.

We will do our best to be polite to you, because someone somewhere decided that health care is now a customer service industry, and we're not allowed to tell you to get lost and stop wasting our time. But deep down: we hate you.

Do you really think you want the staff of your local Emergency Department to hate you?

Let's try this again, shall we?

2008-11-10T08:04:00.003-05:00

I am a nurse. There are many things that I can do, and I can provide you with much valuable information.

I cannot tell you how much it will cost to fill your prescriptions.

I cannot give you a note to tell your employer that you were here, when all you've done is sit in the waiting room for half an hour, and now you want to leave without waiting to be seen.

I cannot tell you how long you will have to wait if you drive over right now.

I cannot use our lab to test a sample of some dried up goo your 12-year-old daughter has in a cup, which she claims is the semen of some guy she gave a blow-job two weeks ago. And I don't care if you've driven two hours in the middle of the night to bring it here. What the fuck did you do that for?

And by the way, your antibiotic is not a painkiller. If you have taken one dose and your throat still hurts, this is not a reason to return to the ED. Your sore throat did not constitute an emergency on the first visit, and eight hours later is even less so. Get yourself a PCP.

Tonight's Phone Calls

2008-11-03T07:35:00.005-05:00

"My wife's water broke. Should I bring her to the hospital?" I don't know: were you planning on delivering the baby yourself?
"Have you called her obstetrician?"
"Her what?"

***

"Yeah, the police drew my blood at [another local hospital]. Can I come in and have you double-check it?" No comment.

Why I Listen to Dispatch

2008-11-03T07:33:00.002-05:00

"Service call...person stuck in a tub."

"[Ambulance] on scene. This...large person...is stuck in a bathtub. No illness, but a precarious situation here as far as getting him out."

What's Wrong With This Picture?

2008-10-28T11:48:00.004-04:00

You have brought your daughter to the ER to be seen for abdominal pain. Good job! You have taken the first step towards being a responsible parent. (Actually having a primary care provider would have been better, but hey, at least you're trying.)

When the triage nurse tells you that she will have to go to the main ER because her symptoms indicate a more thorough assessment is needed than what they'll be able to provide in Fast Track, you refuse, citing reasons like time and money rather than your daughter's wellbeing. (Okay, you're slipping a little here, but we'll cut you some slack. Nobody likes to spend the day in the ER, and medical care is expensive.)

When Fast Track bounces you back to the main ER (as you were warned they would), you take the time to verify that you will still only be charged for a Fast Track visit, because your daughter was seen there first. (Still getting the benefit of the doubt here: maybe you actually intend to pay your bill, unlike so many of your compatriots who view an ER visit as free medical care, simply because we're a nonprofit organization and can't force you to pay.)

Once in the main ER, you repeatedly hound the nurse in charge to find out how much longer you and your daughter will have to be there, contentedly ignoring the fact that there are patients EVERYWHERE and many people running in circles trying to do seven things at once. When said nurse (that's me) apologizes to you despite your unrelenting rudeness, and does her best to keep you updated on when your daughter's test results are coming back and when the doctor may next be available to see her, and calmly explains that she understands you have been waiting a long time, but the ER is very busy (not said: as you can plainly see), and many other patients (not said: who are far sicker than your daughter) have also been waiting a long time, you respond with such snotty comments as, "Yeah, but I bet they don't have my schedule."

You're losing ground fast, but still, all this could be forgiveable.

Your coup de grace: announcing to the nurse in charge that you will be taking your daughter (remember: being seen here for abdominal pain!) TO MCDONALD'S and you will be back in forty-five minutes to find out her test results.

All points previously awarded are hereby rescinded. I dub thee: bad parent.

Do-It-Yourself Lithotripsy?

2008-10-25T22:50:00.003-04:00

A vibrator inserted rectally is not an effective treatment for constipation. Just so everyone knows.

Also, if that's going to be your excuse for why it's stuck there, here's a little-known fact you might want to think about: we can tell from the x-ray whether or not there is stool in your bowel.

Have you heard the one about...?

2008-10-25T05:31:00.000-04:00

Have you heard the one about the guy who performed CPR on himself? It's one of my all-time favorite stories.

Apparently, he was using one of those automatic blood pressure cuffs, and he fell asleep while wearing it. His story goes that he woke up to the sound of it alarming, showing a flatline, and at that point he realized that he could not feel his heart beating in his chest.

Naturally, his next move was to check his carotid pulse. He couldn't feel it! So then he checked a femoral pulse too, and he couldn't feel that one either!

Luckily, he was trained in CPR, so he gave himself four self-compressions, and rechecked his pulses, at which point he was relieved to find them regular and strong. He immediately called for an ambulance.

The paramedics, bless their hearts, brought him to the ER on a cardiac monitor, and to all outward appearances took the whole thing very seriously. At least as long as he could see them.

To my credit, I listened to his entire story with a straight face as I did the triage.

I think my favorite part was the registration clerk turning to me with this deer-in-headlights look of panic and asking, "What should I put down for reason for visit?"

Revamp!

2008-10-25T01:00:00.000-04:00

Due to popular demand, I am revamping this blog: all ER stories, all the time! I deleted most of the old posts, and for the most part only left the ones that were medically-related, in some way.

So just give me a little time to get this up and running, and we'll see what happens. I think this will be fun for all of us. ;-)

Addendum

2008-10-24T07:54:00.000-04:00

Something else I learned in the ER this week:

Apparently, you can be arrested for DUI in a motorized wheelchair. Who knew.

This is a public service announcement.

2008-10-20T08:54:00.001-04:00

Things I have learned in the ER:

A giant hematoma next to a head lac will spurt if you press on it.

A large drunk woman should not attempt to scale a wall, even if she has locked herself out of her second-floor apartment. She should especially not do this on a first date, and if she does, she should make sure that the guy she was on the aforementioned date with does not spend her entire ER visit sitting in the hallway cuddling with her hotter friend. Prospects for a second date look slim.

Telling your nurses you haven't taken any pain medications in months after you've tested positive for both benzos and opiates will not win you any sympathy. And if you're claiming to have an extremely painful complication of a particular disease, at least have the decency to act like you're in pain, especially if none of your medical records show conclusive proof that you even have that disease to begin with.

Lying about your medication allergies to eliminate all but your drug of choice is not a good idea in the first place. But if you're going to do it, at least be consistent. When you have different allergies on every visit and they're all to pain medications, we tend to get suspicious. Especially if you're asking us to give you something to which you have previously claimed to be allergic.

If the nurses all try to put you on oxygen and a cardiac monitor the moment you walk into the ER because you're gasping for breath, and then you tell them you're just there to visit your friend, you might want to rethink your lifestyle.

Telling your doctor you have no idea why you rolled your car after you've tested positive for benzos, opiates, pot, AND methadone just makes you look dumb. All that without wearing a seatbelt makes you look like karma's attempt to reassert natural selection.

Also, as amazing as emergency rooms may be, there are certain things we cannot do.

WE CANNOT DIAGNOSE YOU OVER THE TELEPHONE.

We cannot tell you which doctor is working tonight so you can figure out what the chances are that you'll actually get narcotics before you bother coming in.

We cannot give you your doctor's home telephone number so you can call him at 3am and ask him to meet you in the ER. And no, we will not do it for you either.

WE CANNOT TREAT YOU OVER THE TELEPHONE.

We cannot call the ambulance back to drive you home because you don't know a single person in the state who can drive a car and you can't afford cab fare, but you can afford cigarettes, a cell phone, and whatever drug brought you in here in the first place.

We cannot "hold a spot" for you if you call ahead to let us know that you're coming.

We cannot tell you if you need stitches over the telephone. We cannot tell you if you need an IV over the telephone. We cannot tell you if you will get pain medicine over the telephone. We cannot tell you if you have Toxic Shock Syndrome over the telephone (although, if your only symptom is nausea and you have no fever, I'm gonna go out on a limb and say it's a pretty safe bet you don't). We cannot tell you if your arm is broken over the telephone. We cannot tell you if you are pregnant over the telephone. Did I mention, WE CANNOT DIAGNOSE OR TREAT YOU OVER THE TELEPHONE?

There are many other things that I could write here, but this has all just been since Thursday. The funny thing is, I love my job.

Trauma Codes Don't Come Back

2008-08-29T21:00:00.000-04:00

For some reason that thought kept repeating itself in my head during the drive down here last night. Or should I say, this morning. I didn't even know at that time that they had actually coded her, although I had suspected. I still don't know exactly what they did. I know that they at least started CPR, but they called it on scene.

I find myself needing to know the technical details. I think it makes it more tangible for me, more manageable. I want to know her exact injuries, what specifically it was that killed her, and how they tried to save her. I guess it's because it gives me something concrete to focus on, something I can understand. I think also because it all seems so unbelievable otherwise.

They were out hiking, my aunt and uncle, near their part-time home in Colorado, on trails that they have walked hundreds if not thousands of times before. He was slightly ahead of her, as he always was. He didn't even see her fall. He heard her say, "Oh no," very quietly, and by the time he turned, he saw her tumble down the hill and go over the edge. I find it difficult to describe the exact topography, because I've never been there, and I don't quite understand it myself. No one knows how or why she actually fell; I guess we never will.

It was quite a long way down. From the sound of things, she hit her head and died more or less instantly. That at least is a sort of blessing. I gather she broke just about every bone in her body. The story gets convoluted from there. I know there were people with radios, and they were able to get EMS to her fairly quickly (for all the good it did), even before my uncle was able to get to her himself. It was too steep for him to go straight to her; he had to go back down and around and come up the road. I can't imagine the agony of being able to see her, but not be there and not know what was going on.

Maybe something even happened before she fell. She could have had a stroke or something that caused her to lose her balance, and she could have been largely unaware of what was happening by the time she went over the edge. I think a part of me needs to believe that it was something like that. The alternative, knowing what was coming and being powerless to stop it, just seems too unthinkable.

My mom called me at work, around 11:30pm. It was so strange: when I picked up the phone, I didn't even recognize her voice at first; she had to tell me who it was. I'm honestly not sure if it's because it was so contorted by grief, or just so unexpected. I don't really remember much of the conversation. I guess she didn't actually tell me much at that point, just that my aunt had died, and I guess she said that it was a hiking accident, that she fell. I know I asked several times if she wanted me to come home, and she actually said no. (Apparently after she hung up, both my dad and brother asked her why she told me not to come, and her response was, "Oh, it's okay, she'll do what she needs to do anyway.") She said she had gone back and forth several times trying to decide if she should call me at work or wait until morning, and in the end she decided that I would rather know then. I think that was the right choice; if she'd waited until morning to call, I would have needed to sleep before I could drive home safely, and we all know I wouldn't have done that. Plus, if I'd been home, I would have been alone.

I remember being mostly concerned with making sure my mom was okay. In the end, after all my vacillation, that's what made me come home that night: I couldn't accept the fact that she was here and I wasn't here to take care of her.

I think I was crying before I hung up the phone; I'm honestly not sure. I know that as soon as I hung up our tech was there with her arms around me. I don't know if she'd overheard part of the conversation, or just read something in my body language or what, but she knew whatever it was, it wasn't good.

Originally, it didn't even occur to me to leave work. (Yeah, I know; it never does.) But I was just shaking and sobbing and I needed to at least step outside and collect myself. Everyone kept telling me to go home. At one point I remember saying that I needed to stay, because if I left there would be nothing to stop me from driving right to New York, and at that point I was not yet in any shape to attempt that.

Eventually I calmed down enough to realize that if I stayed for the rest of my shift, it would really only be in order to avoid going home to an empty house, but I would be absolutely useless. So I put myself back together, went home, threw some things in a suitcase, and here I am.

We're still not sure exactly when the funeral is going to be. They need to get her from Colorado home to Florida, and between the holiday weekend and the hurricanes threatening Florida at the moment, it's unclear how long it's going to take to arrange a flight. So we're probably looking at the end of next week.

I'm down here for the remainder of the weekend for sure, and then I don't know what happens after that. Luckily I'm off work until Tuesday anyway, but I don't know if I'll even be able to take time off after that to be able to go to the actual funeral. I'm still working on that.

I should really be going to sleep soon, but my normal schedule seems to be kicking in again and I'm getting my second wind. I took a two-hour nap this evening, but other than that I've been awake since five o'clock Thursday evening. I have a feeling it's going to get worse.

She said to my uncle Thursday afternoon, before they went out to walk, how happy she was that the weather was so nice, and that they could do things like that together, because you never know what tomorrow will bring.

Fuck.

I guess you had to be there.

2008-07-26T02:58:00.000-04:00

We had a patient tonight with (so we thought) the most hilariously ironic name ever, and we were all in absolute stitches over it. Then we discovered that it wasn't actually his name; there was one incorrect letter that made it not funny anymore. I'm dying to post it here, but even though it actually turned out to not be his name, it's close enough that I'm sure it would still end up being a HIPAA violation.

So just trust me on this one: it was fricking hysterical.

You know what's disappointing?

2008-02-22T15:27:00.000-05:00

Realizing that because of my chosen profession, I will never again get to enjoy a snow day.

You didn't need that blood transfusion today, did you? Come back when the weather is nicer.

Oh well.