derp derp derp

do you ever have one of those days where you feel stupid all the time?  i just did.  i deserve it, probably, for thinking that for once in my career i finally kind of have it together.

lies.

so i had this sweet, innocent, kind GSW (no sarcasm intended) who started out the week with me with bile coming out of his chest tube.  oops.  a diaphragm repair and a few days later, he got his chest tube pulled and was going to go home.  except for the fact that he had whooshing sounds coming from under his chest dressing.  we did a stat chest xray, and it was so bad that i could even see the pneumo...because it was like half the lung.  not.  good.  the doctor called me to say that i needed to bring the patient up to the ICU for a new chest tube, so i went to let the patient know.  except for the fact that he wasn't in his bed.

...or in the patient lounge....

....or in the front lobby...

ok.  so my guy with the collapsed lung is nowhere to be found, and now i look like a total tool trying to explain to the ICU nurse that it's going to be a minute until we come up because i can't find my patient.

fortunately, he WAS in the cafeteria.

after an extremely awkward conversation in the checkout line where i tried to explain the situation without compromising patient privacy to the other half dozen people in line, the patient came back to the floor and i delivered him to the ICU.  at this point i'm sweating from running all over the hospital, but felt pretty ok...

...until i realize like 15 minutes later that i pulled out the patient's IV two days before because he hadn't needed it and then i just delivered him to the ICU with an urgent situation and no access.

derp derp derp.

so this nurse already thinks i'm an idiot, because first my patient was lost and now i'm the stupid floor nurse who doesn't have a line in my patient and didn't even notice.

well.  there's that.

so that situation was a loss, but i still was doing ok overall.  and i still had my guy down the hall who totally had an ileus that the doctors were ignoring.  we had FINALLY gotten them to turn the IV fluids back on for this man who had a belly like he was 10 months pregnant, and that was a victory.

so i wasn't a total failure.  until i went into the patient's room and realized that he had gotten a meal tray.

technically his diet was still general, but i had been advancing him slow because of his bowel function. the patient was developmentally delayed, so i didn't think that he'd be able to order dinner without me helping him.  except for the fact that i forgot when people miss two meals, the cafeteria calls them to ask them if they would like to order.

apparently what my developmentally delayed, 3 days post-op with an ostomy reversal, not fully returned to good bowel function patient would like to order was a personal pizza, a plate of french fries, and a brownie.

he ate the whole thing.

derp derp derp again.

and i quote the resident "have fun sinking an NG and sucking out pizza.  i'm going home."

some days you just have to chalk up as a loss.

exorcism, stat.

i just experienced a level of crazy that i was shocked existed.  i present the following:

a man and a woman are in bed.  she's 400 pounds with 12 kids.  he decides that she needs to be "cleansed", so he pours holy water all over her and her brand new mattress, then proceeds to eat unleavened bread in the bed.  she gets mad because he's wrecking the mattress, and they start to fight.  he starts choking her, and she calls out for her kids to help her.  the kids come running and the man starts threatening them, saying he's going to rape the 17 year old daughter and her 3 year old child.  the man starts chasing the girls around so the other kids go into the kitchen, get some knives, and start stabbing him.  by the time the police get there, there's water, blood, and broken glass all over the entire house and the man has almost a dozen stab wounds.  

...you know where this is going.  right to my door.  

the man comes in wearing a spit mask because he's out of control.  we get in report that he's some child rapist, so everyone is shocked when at 5 am the police guard at his bedside takes off the handcuffs and leaves.  after many calls to the police, they tell us that their investigation showed that he was the victim, so he's not in custody.  

no surprise here, but the man continues to act erratically.  he was restrained in soft points after he was found naked in the hallway, soaking wet and wrapped in a bed sheet.  he then got out of his restraints and was discovered drinking his urine, yelling "it is the blood of christ!!  i am jesus!!".  at this point he's completely out of control, threatening staff and staring at everyone with creepy dead eyes, so he's put in 4 point locked restraints.  

it's obvious that this man is extremely mentally ill (duh).  i came on shift and called the sheriff to make the patient a mental health hold.  the sheriff arrives to the bedside just as security comes to help me unlock the restraints so i can change the patient's sheets.  at this point he's peeing himself and screaming "change my sheets, bitch" at me.  his brother arrived to bedside just as the patient arched his back up off the bed and starting screaming and shaking and speaking in tongues.  i am wedged in the corner of the room, biting my lip as hard as i can so i don't laugh or cry, because this man is absolutely, terrifyingly insane and also appears to be possessed by some sort of demon.  the brother starts screaming and swearing at the patient to stop it, and when that doesn't work he hauls off and slaps him hard across the face.  

if that were my brother i would have done the same.  he was then escorted out by the sheriff, and we went about our day.  

it was one of the worst shifts that i've ever worked.  

the patient was dead.  he was jesus.  we were persecuting him.  the patient across the hall was satan and he and my patient we locked in "the ultimate battle".  my patient foretold of this 77 billion years ago that he would come to earth and die.  he was the king, and food will be brought to his mouth by beautiful women like milk to a baby.  there was sexual innuendo and inappropriate suckling whenever i offered him his glass of water.  there were erections when we put him on and off the urinal.  he would take ice chips into his mouth and then spit them out all over the floor because "i am god".  he had animate conversations with angels and every once in awhile would just open his mouth and scream at the top of his lungs.  he called me a liar and every other name under the sun and then talked about how this was heaven and we were "appreciating each others beauty".

it didn't help that the patient across the hall from him was also a mental health hold, and the screaming spun him up to the point that he tried to elope, and "ran" off the unit with his quad cane and his 1:1 sitter holding on to his gait belt for dear life.  

it also didn't help that my other patient is a fresh brain injury who's not oriented at all, combative, and climbs out of bed every time he has to pee and it takes 4 of us to hold him up because he's so unsteady.  

security was on the floor 3 times in 3 hours for 3 different patients.  

the moon is not even full.  this doesn't bode well for summer.  and i'm going to have nightmares about the burning flames of hell.  

you think you're cooler than me

every once in awhile we'll get a chief resident "on loan" from another hospital.  they rotate to us for a few months and then disappear, never to be seen or heard from again.  they're supposed to be coming to us for some great learning opportunity, but more often than not they just try to show us how superior they are to us.  this month's chief is no exception.

he's an jerk, plain and simple.

he'll walk away from you when you're asking him something.
he's rude to all of the nurses.
he's cold towards the patients and has a horrible bedside manner.
he's condescending and writes orders like "bathe patient".  bitch please, i KNOW YOU DID NOT just try to tell me i don't bathe my patients, mmmkay?

the other day one of my patients looked sick.  tachypnic, tachycardic to the 140s and had a temp of 102.  i followed him in the room and watched his two second "assessment" in which he didn't bother to introduce himself, stuck his stethoscope on the sore part of my patient's chest, and then ignored the patient when he said that it hurt.  he didn't acknowledge my presence at all, and on his way out of the room he tossed me a dismissive "he's fine" and turned off all of the lights to the room leaving me in the pitch dark wedged between the bed and the recliner.

the phrase 'nobody puts baby in the corner' comes to mind.

seriously.  rude.

he can take his attitude back to wherever he came from, and my condolences to the poor nurses who end up with him forever.

H&P gems

there's nothing that brightens my days quite like a good giggle while reading a patient's chart.  i have recently enjoyed the following:

• "patient states he 'put the pedal to the metal' and hit a wall going 100 mph.  denies meth x1 week". (oh good, way to cut back)

• "patient currently resides at big mama love's carehouse " (homeless shelter vs. brothel...hard to say...)

• "patient agitated, stating 'you sons of bitches aren't going to keep me from seeing my cats!!' " (delirious patient on why she needed to DC to her house and not to a nursing home)

• "patient states reason for admission is 'i use the bathroom too much' " (actual reason for admission: rib fractures x4 with hemo/pneumo that needed a chest tube)

good stuff, all around.