Things you only hear if you work in an ER.

Sometimes you hear things, when you work in an ER.  You know, how you just hear a couple of sentences in passing?  You may or may not know the context.   It may be disgusting, sad, funny, puzzling or infuriating.  But there are just some things you only hear if you work in an ER.  Some snippets of conversation I have had or overheard in the Emergency Department:

"Is the guy in room 6 dead?"
"Not any more."

"I was ejaculated out of the back of the truck"
 (Dude meant ejected.For which we thank God. Because the other possibility is just too disturbing.)

"Whose vomit is that?"

"The fast-track nurse fainted.  Can you go check on  her?"

"He wears pink tights all the time!"

"My doctor says my prospects are fine.  But he thinks I need a colon option."
(contributed by a coworker)

"Are those worms or noodles?"
"I don't know. Are they moving?"

From a fully dressed patient "Can I get dressed now?"
From the confused nurse "Uh, ma'am, you are dressed."
Patient, nodding head cheerfully  "Uh huh!"
(Still trying to work that one out)

"Do you smoke?"
"Yes. No. Wait.... do you mean tobacco?"
(Never mind, I think I have the answer)

"Surgical history includes bilateral hysterectomies....."

"I threw up off the porch.  And I need to chew my food better!  There was whole french fries in there!"

Stated very loudly to a friend while in triage ..
"I think your brother has give me the nasty AGAIN!!!"

From a five-year-old:
"I have my tummy hurting and I swallowed two monies"
(Xray showed two coins in stomach)

"He my first baby daddy and my cousins baby daddy but not the daddy of this one"

"Patient has made a clean sweep of the drug screen.  She BINGO'ed for everything!"


Sometimes, my job is just a lot of fun!

The Chick Fi Ass Co.

Several weeks ago, when Dan Cathy, COO of Chik Fil A restaurants, made some public statements about being against marriage equality,  I thought "Wow, what a dick".  That was about my only response to it at first. I had no plans to eat either more or less of their chicken, nor did I really care what the guy thought or said.  Why should I?  Freedom of speech, and all that.  He's a stuffy old "Christian with a capital C because I am righteouser than you"  rich white guy.  Statistically, lots of guys like that are dicks and lots of them own businesses.  There are some things to like about the fast food chain, tho.  They are closed on Sunday, which I think is great.   People in non-essential jobs need a weekend day off!   For worship, rest, family or whatever, I think it is good when a business makes it easier for their employees to have a life.  If the stated reason is that the religious views of the owners don't line up with working on Sunday, then even better.  They put their money where their mouths are. Good for them.  Also I love their chicken biscuits and their diet lemonade.  I like that the restaurants are always clean and the staff is polite.   So I was willing to let the pleasantness of the restaurant override the dickheadedness of the owner.  Because, yes, everyone has the right to state their beliefs without censure.   And boycotting a food because you disagree with the world view of the company owners is goofy.  See my post on Oreos for reference.

A decade or so previously, it was Cracker Barrel restaurant under scrutiny in the media for (written, plainly stated) discriminatory policies toward minorities and gays, and asinine statements by the upper management/owners. This was a bit more than talk, so I avoided the restaurant for a few years. Fortunately, the policies and attitudes of this chain have evolved quite a bit.  They aren't perfect but they are making progress, and as far as I know haven't contributed any corporate profits to political hate groups. If anyone knows differently, please let me know.  I want to be aware of these things.

Mr Cathy really upped the ante, tho.  My plan to basically ignore one more self-righteous bigot making noise in the media, and all the subsequent hype and hysteria resulting, sadly failed.  I learned that for years, the Chick Fil A  corporation has been contributing funds to groups such as the Family Research Council and affiliated groups known for spending those same funds to lobby government agencies to deny civil rights for gays and minorities.  Look it up.

Yeah, that is a lot more than talk, folks.  That means that money spent at Dick Fil A is going to be used to lobby against other people's rights.  Not to exercise their own.  Not to protect their own.  But to take yours away or ensure you are never granted them, if you happen to NOT be white, Christian, straight, male and conservative.   That is impossible for me to swallow, no matter how good the lemonade.  They will be getting no more of my money.  This is not Biblical, it is not freedom of speech, it is not "their right". It is never someone's damned right to try and limit someone else's rights.  It is corporate sponsorship of hatred and spite. That is far from Christ-like.  I will not be a part of it.

Nope, it isn't about freedom of speech.  Few people were planning to protest the whole stinkin' fast food chain because the dick in charge was being, well, himself.   He can say what he likes.  Most people don't really care.  It is the corporate sponsorship of hate groups that is stirring outrage in people who believe in civil RIGHTS.  So those who are supporting DickFilA  are supporting a hate group.

It isn't about "standing up for Biblical principles", either.   Or standing up for God, or Christian values, or any of that nonsense.   I will verbally and vociferously defend someone's right to say, believe, value and worship any thing they please. Even if I think it is stupid.  Even if I think it is wrong.  Even if I think it is mean. That said, I will probably say that I find it stupid, mean or wrong. But I will never say you have no right to adhere to it.  Oppression of other people is not Christ-like.  It is not biblical.  No one is trying to force this business to abandon their principles.  No one is asking that they open on Sundays, sell lottery tickets and alcohol, cheat their customers, etc.  No Christian principles are being violated.   It is not a violation of one person's principles when others protest the attempted regulation of their own.  It is not an infringement of one person's rights when others want the same rights for themselves.  It is not oppression to deny someone the power to oppress others.  


Now, let's talk about the "Biblical version of marriage" that is being so staunchly defended here.  Ummm, Mr Cathy have you read that book? Because I have, and while I remember a lot of stuff about being loving, being faithful, being obedient, cleaving to each other etc,  I do NOT remember the part where it actually defined or laid out rules for what was and what wasn't a legitimate marriage.  In fact, if you just use the examples in the Bible, then apparently marrying your half sibling is okay, and so is polygamy, concubinage and a lot of other stuff that our society considers pretty ooky.  And family values apparently include tricking your brother out of what is rightfully his,  abandoning unwanted children in the desert and offering to let your teenage daughters be gang-raped by an angry mob.  Admittedly pre-marital sex, adultery and divorce are specifically prohibited.  But there are no conservative political groups lobbying against those things.   Funny, huh?   Because it seems those things would do far more damage to the family structure than anything that people outside the family could do.  Yeah, Adam and Steve across the street  aren't going to effect a marriage nearly as adversely as daddy making a move on sweet little Salome the babysitter.  Please shut the hell up about the sanctity of marriage until the people currently allowed the privilege learn to respect it.  Inter-racial marriages didn't cause society or the institution of marriage to collapse and gay marriages won't either.  They probably won't do any better but it would be damned hard to do any worse.

If you are buying DickFilA chicken, you are not supporting free speech or Christian values.  You are supporting oppression.  You are supporting denying other people the rights you have.  (Unless you are gay and if you are eating dicken sandwiches I bet you aren't)  It isn't a figurative support. Part of the money you just spent will literally, actually, factually be used to try to prevent other people from having freedom equal to yours. Eat that sandwich if you want, but that is what's in it.

How to aggravate a triage nurse.

This week I spent 48 hours working in the ER, and because of a shortage of triage nurses over the weekend, spent half of those hours in triage.  This is just one job I do in role as ER nurse.  It isn't my favorite one, or my least favorite.  My least favorite, and one I rarely have to do because a) I am not very good at it and b) my boss has mercy on me and gives me other "leadership" stuff to do instead, is being charge nurse.   That crap will make you crazy.  I would rather be in triage, or doing chart reviews or building Meditech menus, or even working in Fast Track.  What I absolutely prefer to anything else is just patient care.  From hangnails to heart attacks, that is what I like to do best.  But I do spent a lot of time in triage.  It isn't so bad.  Sometimes it is funny.  A lot of times it is just mentally exhausting.

For those of you who don't know, the triage nurse is the one in the little room, or at the little desk in the ER who first sees you, takes your history, bandages the bleeding, gets your vital signs and so forth.    It usually takes about 5-10 minutes per patient.  Sounds like an easy job, huh? Not particularly hard or stressful or important.  No need to be polite, truthful or even reasonably civilized to this person.  He or she is just the person who checks you in.  But you might try being very dramatic or obnoxious to her, because that might get you to a room faster.

Right.  I can hear the laughter of ER nurses and medics everywhere.   For those of you who don't get it, let me explain.   The triage nurse is St Peter.  That's right, we are at the gate, and we decide who gets in.  Not the ER docs.  They are busy taking care of other people who have already been assigned a room and seen by a nurse. They have a patient to assess, three sets of lab to review, someone that needs stitching, a set of admit orders to write and two patients to be discharged. They don't care who gets in first because they are too busy to care and are happy to leave those decisions up to the triage nurse. The charge nurse doesn't decide either.  She only has a certain amount of rooms, nurses, techs and docs to share among 4 times that many patients and she is trying to monitor all  87 of these people to make sure they have the care they need. Patients get good medical care, doctors get tests results on time, nurses get to go pee every 4-6 hours. She has to answer about seven gazillion questions a day.  She is happy to let the triage nurse  decide who needs care the soonest.  Your family doctor who "sent you here" or called ahead most definitely does not get to decide. For one thing, he only sent you here because he didn't have the time, inclination or resources to deal with you today and wanted you to go away.  Not because he really thought you had an emergency.  Even if he did call ahead, which he probably didn't, he has no ability to judge the level of insanity currently going on in the ER and your appropriate place in it.  That is what the triage nurse does.

Last but certainly not least, neither you, your mom who is an RN in a foot clinic, or your brother-in-law who is a medic, gets to decide.  You may be in pain, feel like crap, be scared to death and think you are dying.  I get that, don't doubt it.  But you don't actually know how sick you are (or aren't), much less know about the other 12 people waiting.  So you don't get to decide.  The triage nurse decides.  That is her job.  She is very well trained for it.  She has years of nursing experience and judgement and education and the guidelines of the department and if needed, the second opinion of her coworkers.  She can do 75% of a head-to-toe primary assessment just watching you walk in the door, sit down and state your name and date of birth.  Her powers are limited.  Even if you are pretty sick or in a lot of pain, she cannot get you into an already-full ER immediately when 5 other just-as-sick people are ahead of you.  Because of her nursing ethics and conscience, she will not put you in a less-critical category than appropriate just because you are obnoxious.  But this is the person who decides into what category you fall. This is the person who might bump you up in line if you are really sick or miserable.  Think about that before you insult, try to intimidate, or aggravate her.

Please don't get the impression that every patient that comes into triage is being rude or melodramatic.  In fact, about 90% are reasonably pleasant people.  Some of them are delightful.  A lot of them are funny.  They may be scared, sick, upset, mad, wet or muddy, bloody, ignorant of all things medical or a medical person themselves, hysterical, stoic, or terrified. But most people do the best they can to behave decently and reasonably even in trying circumstances.  It's that ten percent that can make triage a more frustrating, aggravating, infuriating job.

Even in a world of 100% sane, sensible people, triage would be a trying job.  It takes some mental effort to sort an infinite variety of illnesses/injuries into 5 simple categories. There is always something you might miss, which can be worrisome.  Rooms, nurses and docs are limited.  People who are sick, scared and miserable do sometimes have to wait a long time.  We, the ER staff, do not like that much better than the patients and families.  We feel bad for the ones who are truly sick or hurt.  We are anxious that something might go wrong(er) while they wait.  On very busy days you need to thing about reevaluating people after a couple of hours.  We are constantly bombarded by requests for food, water, blankets, buckets, ice packs and a place to lie down. (Which, once and for all, we do not have.  You left your couch at home to come here.  Our places to lie down are our exam rooms and they are full.  Requests to management for couches and/or stretchers in the lobby have been categorically and eye-rollingly denied. If you walked across the lobby to ask for a pillow you are not too sick to sit up.) People we encounter are often excited, upset, scared and generally freaked out.    We understand, but it can be hard on the nerves.  Our goal and our job is to keep everyone safe. We would like to keep them all happy and pain-free, but it isn't possible.   We are doing the best we can.  So be nice.  

The triage nurse needs to know what happened.  She needs to know when.  She needs to know your history.  She needs the patient to answer the questions as much as possible.  Yes, even when they are three, or ninety, demented or half-conscious.  It is part of the assessment. It is also rude to your 87-year-old grandma to answer for her just because she is slow. Hush!  Every vital sign we do and every question we ask has a purpose.  It takes five minutes.  Calm down and help us get it done.  If you are not the patient but need to feel as if you are having an influence on the situation, are just an asshat, or want some attention, be aware that every attempt to "rush" the triage nurse will only make things take longer.  Be aware that, as a patient or visitor,  you cannot insult the triage nurse because he/she doesn't give a tinker's damn about your opinion.  Know that the average triage nurse is about as easy to intimidate as a bull elephant, and if you do manage to make her consider you a threat, it may result in your having a conversation with our security staff, being expelled from the department, or being arrested.  Realize that a triage nurse has a bullshit meter like no one else on earth.  If you are lying or faking, we know it.  We probably won't call you on it, but we will word our assessment so that the other nurses and the doctors will understand that you are full of crap. If you just want to irritate the triage nurse, here are some ways to do it.

Burst into the triage room, ignoring the patient already in the chair,  and demand immediate attention for the cut on your finger.  Look insulted when the triage nurse asks you to have a seat and wait your turn.  Say indignantly and loudly that you are bleeding to death.  Wave the unbandaged finger around so you will drip blood in the floor.  This will demonstrate the rudeness of that nurse who is ignoring you in favor of the kid with the broken arm who was there first. 

Demand a stretcher to get a patient out of a car, in spite of the fact that they walked from their house TO the car.  Become indignant when the nurse brings a wheelchair instead.  Insist that the patient cannot stand or walk even while he is getting out of the car and into the wheelchair with minimal assistance.

Walk from the parking lot into the ER lobby, past a row of wheelchairs and collapse in front of the triage door, stating you can't walk.  Alternately, you can cling to the triage door and gasp that you have to sit down, instead of just sitting in the empty chair eighteen inches away, to which I am pointing.

Tell the triage nurse that you should be next because the other people waiting "don't look as sick as I am".  This makes you look like the selfish jerk you are.

Be as disgusting as possible. Cough in the nurse's face.  Poke your sores with a finger. Wipe your nose with the back of your hand.  Act completely astounded if she asks you to cover your mouth or disinfect your hands.  Spread as many germs as you can manage in your short visit to triage.

Tell the triage nurse that you (or the patient with you) is having a heart attack, a ruptured appendix, a massive stroke.  You don't know what they are having.  And if you really thought it was a heart attack, why didn't you call an ambulance?

Repeatedly walk into triage while the nurse is with another patient to ask for kleenex, a phone, ice, blankets and a place to lie down.  Behave as if that patient doesn't exist, much less deserve a nurse's undivided attention.  Do not say excuse me,  or thank you. Ever.

Argue with the patient. Or, if you are the patient, argue with the people with you.  Don't worry about what the triage nurse is trying to do or the three people waiting behind you.  We all have time for you to air your dirty laundry in public.  It's classy.

Deliberately slump out of the chair or wheelchair while stating you are going to pass out.  Yell at anyone who tries to get you to sit up or to support you.  Yell and curse at the triage nurse when she uses ammonia to revive you.   Flail your arms around and give her a good cussing.  Then slump back over.  Yeah, that seemed realistic.

Keep your head down and mumble at the nurse because you are too sick to answer.  Again, yell and curse when the nurse keeps repeating the questions.  Even better if you jump out of the chair and stomp out the door.  You were just too sick too cooperate with that nurse.  Glad you feel better now.

Never, ever attempt to control your children.  If they are the patient, allow them to wander around the room while the triage nurse is trying to assess them.  Ignore her repeated requests to "bring him over here please" or "hold him in your lap".  If they resist, allow them to flail and scream and kick the nurse without any restraint or reprimand.  This is acceptable behavior for a four-year-old.

If your kids are not patients, allow them to run in and out of triage while grandma is being assessed.  They shouldn't have to wait five minutes for sodas and coloring pages.  Let them grab any piece of equipment they want to examine with their dirty hands.  It's fine if they want to wander around into dual triage or the EKG area with other patients.

Tell the triage nurse that you have not given your child Tylenol or their prescription medicine or made them wear their splint or have their dressing changed because "he didn't want to".  A five-year-old's wishes are more important than his healthcare, and you as the parent are not responsible for making him do things for his own good.  The triage nurse will consider this a reasonable excuse for letting your child get a lot sicker.

If you seem frightened, the triage nurse may try to reassure you  that you (or your child) do not have life-threatening illness.  Be insulted by this and act as if she is trying to refuse to take care of you,  instead of having some compassion for your fears.  The fact that she said "we will take care of you" or "that will need some stitches"  was just a ruse to make you think that you would actually get appropriate care.

Be very annoyed when the nurse asks you what meds you take or what surgeries you have had.  This is not important, and she is just trying to be difficult.   She should not expect you to know the answer to these questions.  Maybe if you are rude enough, she will stop asking stupid questions.  

Sit or stand calmly in the waiting room until it is your turn for triage.  Then begin yelling, cursing, sobbing , gagging or flailing around like an octopus.  The more you can sob or yell while being assessed the better. This makes her believe you are sicker, because she is stupid, has no actual knowledge base to make an informed decision, and has never seen anyone as dramatic as you.  Be sure to call the nurse a stupid bitch when she attempts to apply a splint or bandage.  She meant for it to hurt.

Basically, just be as rude, dramatic, loud and disruptive as possible.  You are sick, that is an excuse for any obnoxious behavior.  No one is expected to be reasonable when they are sick.  The other people in the lobby are just stupid for waiting their turn and following instructions.  The ER staff aren't actually people trying to do their jobs.  They are just there to thwart you. Please make their job harder.

Never, ever, answer a simple question with a direct answer.  For instance, if the nurse asks if you have had surgery before, answer by saying that you have had several broken bones and an MRI of your back and the doctor thought you would need surgery but you went to the chiropractor instead.

If the nurse asks you what meds you are taking, do not tell her their names, give her a list, or let her see the med bottles.  Tell her you take a little blue pill for water and two round white ones for sugar.  Or better yet  "my wife keeps up with all that".

Conversations should go like this:

Nurse:  When did the pain start?
Patient:  I've been sick at my stomach every since three weeks ago. I went to see Dr Doolittle and he put me on some medicine but it didn't help
Nurse:  Okay.. but when did it start hurting?
Patient:  Well, after that I started throwing up and that made it hurt.
Nurse:  So that was what day?
Patient: Two days after I saw the doctor.
Nurse:  Right. But I don't know when you saw him. How many days has it been hurting?
Patient:  Well, okay, three or four days?

Nurse:  Are you dizzy?
Patient: I've had a headache for a few days.
Nurse: Uh huh.  But are you dizzy?
Patient: I've got a headache I tell you!
Nurse:  I know, sir.  Are you also dizzy?
Patient:  I keep having weird tingling in my hands.
Nurse: When did that start?
Patient:  When the headache started.
Nurse: Which was when?
Patient: Oh.... last week some time
Nurse: And are you dizzy as well?  
Patient: I just feel tired all the time
Nurse: So you've had fatigue.  Okay.  But I really need to know if you have been dizzy or lightheaded at all?
Patient: No! Why do you keep asking me that?

This kind of question-and-answer session will ensure that the nurse spends a lot of time with you. But if you are in a hurry, it might be better to just give simple, direct answers to the questions.

Honestly, it is in your own best interest to cooperate with the triage nurse.  It will ensure that she gets the correct impression of your condition.  It will help your visit go faster. It will help prevent your getting the wrong medicines. It will also help prevent the triage nurse banging her head on the wall in a combination of exasperation, amusement and mental fatigue.  You don't want that. Because if the triage nurse goes bonkers and runs screaming out the door, that means some nurse in the back will have to divvy up her patients among her already overloaded coworkers and come be the triage nurse instead.  That means there are less nurses taking care of patients, which means slower turnover times. Which ultimately means YOU have to wait in the lobby longer.

If you want to make a triage nurse's day, it is easy.  Be as calm and reasonable as you can under the circumstance.  If we see you are making an effort, it will make us try harder for you.  Answer the questions as best you can, without evasion or embellishment. Listen to our instructions. They are for your benefit.  Let us help you by reassuring you, telling you what may happen, and providing ice, bandages and throw-up buckets.  We wouldn't be there if there wasn't some tiny remnant of our abused psyche that actually still wanted to help people.

Other weird religions

Why does no one seem to care that Mitt Romney is Mormon?  I have been asking myself that question for months, thinking that some wild-eyed fundamentalist Christian or some sarcastic atheist somewhere would surely bring it up.  But that hasn't happened, and it puzzles me.

I would be ecstatic to think that the majority of Americans have suddenly grown up and realized that a political figure does not have to share your religious values to be a good leader.  But that is moonshine and madness, we all know it.  The majority of Americans view any religion that varies two degrees from their own with extreme suspicion, frequent disdain, and all too often hostility.  We will skip for the moment the ridiculousness of that attitude, considering the "love and brotherhood" message of most religions in the whole dang world......  But I digress.

Here's the thing.... my personal beliefs aside, I have to say that ANY religion, viewed objectively, is just goofy.  If you just start reading the "what we believe" section of any religious group's website or handbook,  some of that stuff is just going to sound weird.   Yeah, even my own Sunday-school class made me occasionally think "say WHAT?" as a child.   You learn to take it on faith, because, hey. That's what makes it FAITH and not, you know.... science.  So I have no personal objections to Mormonism other than the ones I would have to any patriarchal, oppressive religious sect.

I have a strong personal belief in God, and almost none in organized religion.  Which is why, as a rule, I couldn't give a fig newton what religious background a person has, preferring to measure them by their own character and behaviors.  Unfortunately that is not, as I mentioned above, the view of most Americans. Witness, if you will, the uproar when a non-Protestant white boy was elected president in the sixties.   Then there is that whole piece of ridiculousness about our current president having ties to Islam.  Apparently any religion that varies from Christian Protestant is a big hairy deal.  Until it just isn't.  We got right over Kennedy being Catholic, and the uproar about Obama being a "secret Muslim" seems to have mercifully faded as well.  But at least during an election season, there was a small but vocal and somewhat vicious segment of the population that made a big noise about having a president with a different brand of religion.  So why is Romney getting a pass?

Folks, Mormonism is NOT mainstream middle-class Christianity.  It differs from regular old Bible Belt  Sunday School teaching as a pineapple differs from a watermelon.  Far more so than Catholicism from Protestant religions.  Equally as unlike as Christianity and Islam.  Yeah, I know, that is going to get a lot of panties in little wads.  But they are both Abrahamic religions, along with Judaism.   Despite the fact that followers of these three religions frequently declare themselves anathema to each other aside, they are fruits from the same family tree.  Dysfunctional siblings, if you will.  We can consider Mormonism a genetically drifted son of Protestant Christianity, and therefore a troublesome nephew to the other two.  But there are many more differences in cosmology between the three big guys and Mormonism, than there are between any two of them.  

Let me say again, I have no personal objection to it, but why is it NOT an issue for those who would normally be wild-eyed and bushy-tailed about it? Is it because it is considered an alternate form of Christianity?  Maybe, tho Catholicism didn't get a free pass.  Maybe it is because the people who would ordinarily make a big fat hairy deal out of it would rather have a rich white Republican in office with an admitted allegiance to an unusual religion, than a black Democrat with loose ties to another one.  Yeah, that IS ugly, isn't it?

I hope I'm wrong.  But the next time these same froth-brained tribal monkeys start screaming about some candidate's religious views being incompatible with the values of our country,  well, I guess we will know the truth, won't we?  Because if Mormonism is acceptable, there is no reason to object to any brand of Christianity, Islam, Judaism or even Scientology in a political candidate.  In other words, oh ye of so very much vociferous and vocal faith .... if you are going to let this go by without a squeak then you should shut the hell up for ever.  Because now we know.

Reason # 24

This was copied from an email I sent to a friend in December of 2008.

Earlier this week I had a patient come in by ambulance at about 6:30 am.  The medics called in a radio report of a 30-something female with anxiety-induced chest pain,  vital signs okay.....  They seemed amused by something and trust me,  it is NEVER a good sign when EMS is snickering.  While they were still in route our charge nurse got a call from some wild-talking guy who said he was coming up there to "be with J because we used to be married and I think she is real sick.  I've been holding her tongue for two hours!"  Then he hung up.  Needless to say the charge nurse had a bemused look on her face, and we spent the next few minutes trying to imagine what that might have been about.   Was the woman having a seizure?  Was he trying to shut her up?  What? WHAT?

 

While we were still speculating, the medics rolled in with this tiny, frazzle-haired, wild-eyed woman on the cot.  Except for looking extremely freaked out, she seemed to be just fine.  I went in with one of the MSAs and as we were hooking her up to monitors, doing assessments and taking vital signs, the medics (with some interjections from the patient) told me this story.

 

It seems that the patient, hereafter known as J, was having a sleepover with her ex-husband, hereafter known as D.  They are still on friendly terms and had decided to do a little crystal together.   Fine, so far.  The problem cropped up when the party ended and they tried to go to sleep.  Poor J, who has a problem with anxiety and was having a nasty cough at the time, couldn't sleep.  (I'm not sure but I think the methamphetamines MIGHT have been a factor)  Anyway, she took a couple of Xanax bars to help her relax, and went to sleep on the couch.

 

A couple hours later, Mr D gets up and finds her asleep on the couch.  Having crashed from the meth letdown and the Xanax, she was very difficult to awaken (read that as "nearly comatose") so he called 911.  All well and good so far.... .but now comes the utterly, unfathomably crazy part.  J was deeply asleep and breathing heavily, and one imagines, noisily due to the respiratory and sedation issues.  So D decides that she "can't breathe" and his solution for that was to stick the first three fingers of his right hand into her mouth and throat UP TO THE THIRD KNUCKLE.   Holding her tongue out of the way, you see.  At which point she awakens, finds herself choking on his fingers, throws up and begins to struggle with him.   Even though she was fighting him tooth and nail - and I mean that literally, he had bite marks on his knuckles-  he did NOT give up on his life-saving efforts.  He held her down and continued to "keep her from swallowing her tongue because then she started having a seizure".   So for twenty to thirty minutes, he held this poor woman down with his fingers jammed down her throat. She was spotted with blood, hers and his.  She had scratches on the back of her throat! She was (naturally) hyperventilating and began having carpo-pedal spasms, as well as being partly asphyxiated by this well-meaning but drug-crazed idiot. 

 

So there you have it.  Reason # 24 not to do drugs.  Because your fellow users MAY be the people on whom your life depends later.  It is a bad deal if your primary rescuer is, quite literally, smokin' crack. 

 

When Mr D showed up later I went to talk to him before letting him into our department and into the presence of the patient.  He was upset and worried, so I assured him that the patient was fine.   He wanted to visit, and since she had said she was okay with that (she swore he was only trying to help)  I told him he could come in IF he would remain calm.  He agreed.  But then.... he wanted to talk about what happened and tell me how he "held her tongue down so she could breathe".  I tried to explain to him, slowly and patiently and repeatedly, that this was SUCH a very bad idea.  Not surprisingly, he didn't get it.  When he assured me for the 11th time that he "HAD to because she couldn't breathe!!!"......  I snapped.  "LISTEN, don't EVER do that again, you could have KILLED her, do you underSTAND me?????"  The silly crackhead looked at me with spaced out eyes very solemnly for a second, nodded ... then burst into tears.

 

Here I had to heave a HUGE mental sigh.  It wasn't even BREAKFAST time fercrissake, and I was in some surreal Twilight-Zone sort of space with these people who didn't understand such simple concepts as why sleep was difficult after doing methamphetamines, and why a  person "couldn't breathe" with half a grown man's hand jammed in their airway. 

 

They were discharged not long afterward, she with a diagnosis of bronchitis, upper airway contusions, and the recommendation to stop using drugs before she had a cardio-pulmonary event that proved fatal.   D had his bitten hand and scratched arms cleaned, and was advised to stop doing drugs before he did something else completely hare-brained and dangerous.   Because, as we pointed out to him, his judgement was less than stellar while under the influence.  Though personally, I doubt it was a whole lot better even when (if ever) he was clean.

 

In the ER, truth is indeed stranger than fiction!!!

Put down the Oreos and move to Canada.

Today the Supreme Court upheld the healthcare mandate commonly known as the Obamacare ruling.  Government mandates and the healthcare system are both terribly complicated, multi-faceted issues and I can understand some points on both sides of this argument.  But good heavens, at the uproar.  Social media sites and workplace conversations are all atwitter (pun intended) over it.  Some people have even gone so far as to say- or tweet - or post- that they are so disgusted with our government that they are considering moving to Canada.

Canada. Really?  The country that already has socialized healthcare?  You are going to move there to avoid a socialist system?  Well, at least you will avoid having to live in a country where English isn't the ONLY official language. I'm sure that will be a relief. Oh, wait.... Parlez vous Francais?

This same afternoon I saw several posts/tweets about a gay pride ad that featured a multicolored, six-layered Oreo.  I thought it was really pretty and hey, it had six layers of gooey stuff in it.  I wanted one.  Or seven.  But some people really disliked that ad because of it's inclusive message.  So much so, that they are "boycotting" Oreos.

Oreos. Really?  A cookie made from totally unhealthy processed food by a multinational company often accused of environmental insensitivity and exploiting low-wage workers?  Okay, maybe a boycott is not crazy, here.  But you are boycotting a cookie.  I am sorry, but it is hard for me to take that seriously. Especially since you are against the cookie because the cookie was used to symbolize something you don't like.  Yeah, that is important.

Can we take a step back and try to gain a healthy perspective here?  Is it sane and reasonable to leave a country because they passed a law that you don't like?  Unless you are schizophrenic or horribly confused, this can't be the first one that disgusts, irritates or scares you.  No matter what you deem important or sacred, there is a United States law or tenet that violates it, somewhere.  If you reject every commercial product that at sometime, somewhere, was used to promote something you don't like, you are going to be reduced to eating homegrown food,  catching lightning bugs for entertainment and wearing.... uh.... well, you won't be wearing anything.  There is no fabric, clothing manufacturer or fashion line that hasn't promoted or been promoted by just about everything.  Eating homegrown food, spending more time outside and being mostly naked might actually be a healthier lifestyle for you.  But I bet you aren't going to stick with it for long.

Let's be clear, I am not making fun of these people for disapproving of homosexuality or for worrying about the direction of our government.   No, I am making fun of them for implying that they are going to completely reject and/or leave a snack food or a country because, basically, they didn't get their way.  It is the adult equivalent of "If you won't play my way I'm taking my ball and going home".   It's juvenile.  It's obnoxious.  It's just silly. 


There is no institution, no country, no religion, government, organization, no person, place or thing that is going to do everything just the way you want it all the time.  This is called reality.  Get used to it. Grow up.  Do you file for divorce the first time you lose an argument with your spouse?  Do you leave a church the first time the sermon rubs you the wrong way?  Do you give up your child for adoption the first time she blatantly defies you?   Do you refuse to drink water because your enemies drink it too?  What kind of petulant, spoiled child ARE you exactly?  I think you should put down the Oreos, pack your bags, and move to Canada.  We won't miss you.


Those of us that remain will hopefully continue to struggle for what we believe individually to be right and best.  Maybe we can do it in a way that is respectful, even of those with whom we disagree.  In a way that is conscious that our way is a good way, but it is not the only way.  

The horse wreck - from Sept 2011

Am posting some old notes to the blog. New stuff later!

The horse wreck

It's been fifteen years or more since I started trail riding.  So I've been lucky.  Although I've been thrown, had a horse fall, been run thru countless briar patches, slid down some hills that made me want to throw up, had my arms and knees whacked on countless trees, and made a couple of slightly terrifying river crossings, this was my first major wreck. 

Gwen and I decided to tag along with the Arkansas Trail Rider's Association on a ride from Woolum to Mt Hersey.  Since this trail is near our new cabin, we wanted to see it.  The ATRA gang was very welcoming and we had a nice ride out to the Mt Hersey river access, where we had lunch.  We were halfway back to Woolum when disaster struck. 

This trail had plenty of steep, rocky places, narrow trails and about 6 river or creek crossings. There were also lots of places wide enough for the 30+ riders to get bunched up and get everyone's horses stirred up. But that is not what happened. No, Rocky and I were the victims of plain bad luck.  We were walking calmly down a smooth, flat trail.  There was a washout in the trail and when he stepped down into it, like he has done 1000 times before, the loose dirt slid under his feet, and he turned a somersault. I say "he" turned it, because I only participated in about the first half.

As he went down, my right leg hit the ground with the force of a woman and a horse behind it. Crunch. I came off and hit the ground while he completed the somersault, partly in the gully and partly on me.  OOF was the last coherent thought I had for a while.  When everything stopped moving I was on the ground with one leg under the horse, staring at his hind legs. In a distant sort of way, I knew I should move before he started kicking me in the head.  I understood the implications.  I just couldn't move.   Gwen (who had apparently teleported into the trail beside us) was simultaneously holding onto Rocky, pulling on my leg and yelling at me to get away from the horse.   Somehow, she got my leg free of the horse and the tangle of reins. (No, my foot was not caught in the stirrup. I am not a greenhorn!)  I scrambled to my feet, and my right ankle did this weird crunchy, wobbly thing. 

Now, I am forty-five years old, and a combination of luck and good genes has so far prevented me from having broken bones.  But it took my mind only a nanosecond to register crunchy/wobbly as WRONG.  So I fell back down.  A woman from the ATRA group sort of dragged me out of the trail.  Then I was looking up at Gwen (who was still doing the teleportation thing) and said "my leg is broken, my right leg". Then everything was sort of gray for a while. 

That nice little gray hazy feeling was very brief.  Then several things returned all at once.  Hearing, vision, clear thought.... I saw a group of trail riders getting Rocky up.  And he was able to get up!  And he was not, apparently, broken.  I was so relieved at that!  

Along with my other senses, however, my sense of PAIN!!!! had also returned.  My ankle hurt. A lot.  And it was still wobbly.  Gwen had, on hearing me say that I had broken my ankle (not my leg, I was pointing to ankle and saying leg), had gone to get a splint and ace wrap out of her saddle bags. In the mean time, the other riders had gathered around Rocky and I to brush off the dirt, gather up far-flung equipment, and assess damage.  Not knowing me, or that I was an ER nurse, they were not willing to accept my self-assessment!  Gwen splinted and wrapped my ankle for me. Then the fun really began.

We must have been at least a couple of miles from the trail head. Maybe more.  And there was no place accessible by vehicle. So.  I was either going to ride out, or I was going to wait an hour or more for a rescue crew to get to me, then package me, then carry me out.  Over a mountain and thru a river.  No. Huh uh. Not.  So back on the horse I must go.  One of the riders asked me if I thought I could ride out.  "Yes," I said  "I think I can ride. I just don't know how I'm going to get on."  As it turned out, I was going to be hoisted up and over by a group of gentlemen now collectively known as "my heroes".  Someone gave me a couple of Aleve.  I petted and praised my poor, shaken up, bruised and sore horse, and down the trail we went.  Slowly.  Very carefully dodging trees and bushes and anything else that might hit my foot.

Most of the other riders had gone ahead, some to alert the emergency services. But there was a group of about eight, all strangers to Gwen and I, who rode along with us, helped me navigate obstacles, offered advice and encouragement, distracted me with talk and jokes, and were just wonderfully supportive.  I didn't even catch the names of most of these people but they were marvelously kind to us and in spite of the fact that I must have put a huge kink in their plans for the day.  Someone mentioned that I would make the next edition of the "Roundup" in their trailride article. I sincerely hope they won't be quoting me.

Once we arrived to the truck the question was "How do I get OFF the horse?"  Apparenlty the answer was to have someone swing my injured leg over and then sort of fall backwards and hope these guys catch me. Which they did, of course. But for someone with control issues, that was a bit much.  However I was so extremely very glad to get down from that horse. The hour or so we spent riding back with my throbbing ankle dangling and bobbing around and feeling the bone clicking around in there had just about exhausted my supply of pithy remarks and patience.

Once I was stuffed into the back seat of the truck with jackets stuffed under my head and ankle,I looked up to see a Park Services Ranger standing at my head.  He was about 12 years old.  And had that big hat......  Anyway.  He took my name and number, and let me know that there was both an ambulance and a HELICOPTER on the way for me.  Do you want to go in the helicopter, ma'am?  No. No I don't.  And I'm not going in the ambulance either. This truck right here is taking me to Conway ER.  Yes, I will sign your waiver. Yes, I'm sure.  Goodbye now, little ranger boy.

And then Sherry, one of the ATRA riders and my new best friend, stuck HER head in the truck to ask if I could take hydrocodone. Oh heck YES. Yes I can!  And no, I don't mind drinking after you to take it with your water bottle. Not at all.  Did I mention that I love you?

So after a brief stop at the cabin to pick up my purse and the dogs, we were off to the ER. Poor Gwen, who had been serving as nurse, wrangler, rescuer and driver, was tired and hungry but wouldn't stop to get her dinner.  By this time, the drugs had kicked in, and propped up with pillow and ice on my ankle, I was pretty content in the back seat of the truck. Except for the fact that Gwen had declared me NPO after a few sips of peach tea with my pill.  

When we got to the ER, Gwen pulled up in the ambulance bay, where we were met by Kenneth, Persey and a wheelchair.  Riding in a wheelchair when stoned is fun.  Anyway...... they got me on a stretcher and got me properly tagged and identified and ordered an Xray.  Then Kenneth, with a raised eyebrow and a hand on my boot, silently poses the question.  Do we pull this off over your injured ankle and listen to you scream?  Or do we cut it off and listen to you whine about your favorite boots?  (and they really are, they are lined, waterproof Ariats and I love them)  No, he didn't verbalize any of this. I understood the choices.  And I picked option A.  So with Ashley stablizing my leg and Kenneth pulling on the boot... well, it was still horrible.  I yelled and said profane things.  So they stopped.  And I gritted my teeth and said "Just do it".  So with a shrug (it's your leg, sister) they went on pulling and the boot was saved!!! 

My coworkers and, in this case, nurses and doc, were great.  But they did laugh at me a lot. I'm not sure why, tho I did hear Brooke say something about me being "hilarious when she's on drugs".  Hmmm. I get his from my mom, who is also not a frequent drug user, and also a nut job when so medicated.  Gwen suggested that I might hush, and save myself the later embarassment, but I heard Ashley say "oh no, let her talk!"  There may be some blackmail in my future. But I don't care. Because once my Xrays were done, and my ankle officially broken, but not "surgery tonight" broken, Ashely gave me her own, cold, Diet Mt Dew.  So I love her too.

We left the ER with my ankle in a boot, crutches and a lortab prescription in hand.  My medial malleoulus is broken and the ligaments on the lateral ankle sprained and swollen.  I have numerous small bruises and sore spots from the fall. But both my horse and I will live to ride again so I am calling myself lucky.

More than lucky, I am blessed.  I have been the grateful recipient of numerous phone calls, texts, Facebook postings, visits and gifts of food, flowers, wine, shower chairs, and books.  A bit of bad luck on the trail is no match for my wonderful friends, family and ER family.  Though I am sure my patience will wear thin with forced chair rest in the coming weeks, and my butt may be permanently molded to the recliner, it is all only temporary!