the lord is testing me.

tomorrow i plan on waxing poetic about how much i love my job.  so, naturally, tonight i will get all my wrath out.

i swear, the ED has a personal vendetta against our floor.  ok, so maybe that's dramatic.  what it comes down to is the ED has 95% great, smart, savvy nurses who provide their patients fabulous care and are fun to chat with on the phone.  then there are the other 5%.  i'm not sure that they actually have degrees, come to think of it.  they may be homeless people off the street.  or circus clowns.  these are the nurses who send up suicidal patients without sitters, who transfer ICU patients to the floor on accident...also the nurse who sent me the patient once who was about 85% dead.  these are the nurses who i curse today.

so we get this ED admit.  long term trach, oriented x 0, biting and hiting and crazy.  yum, my favorite type of patient.  she rolls up to the floor flat on her back with a trach just bubbling with secretions.  according to transport, she's been like this since they left the ED.

oh no you DIDN'T.

ABCs, people, and A does not mean admit patient to floor so you can go about your business.  AIRWAY.  as in what this patient is unable to use because she needs to be suctioned like 10 minutes ago.

so we suctioned her, and of course she immediately begins to vomit up bile that smells like stool and is now coming out of her trach.  ooo, lookie!!  aspiration pneumonia.  greeeaaaaaaaat.

let me break it down for you.

1. please suction your patient.  thanks.
2. if your patient has been suctioned and still sounds like she's drowning, maybe someone should come with her on transport so she doesn't die.  yeah, i know you're busy.  send a tech.  or better yet, send a respiratory therapist.  frankly, i don't care if you send a circus monkey that knows how to work a yankaur suction, anything would be better than nothing.
3. also, would it kill you to give meds for the BP that's over 200 systolic?  or maybe you want this patient to have a stroke too? (18 hours and an ICU transfer later, we found out that this patient did actually stroke out).

seriously, i looked at this patient and i wanted to take the time to trek over to the ED and back just so i could smack that nurse upside the head.  i really had to hold myself back.

but then i was too busy to plot my revenge, as the patient began to drop her sats and continue to aspirate on her vomit.  so then we called a rapid response, sunk an NG, took a million vitals, and suctioned her.  like 10 times.  and then she basically became a 1:1 floor patient (my favorite, again) and was continuing to be unstable with pressures of 250s/130s as i dragged my sad tired self home.

thank you, incompetent ED nurse, for ruining my night and almost killing your patient.  i look forward to our next rendezvous, in which you will undoubtably continue to act as if you are indeed a garden gnome and not a licensed professional.