Saturday, June 13, 2009

Holy Crappy Week Batman!

Walked into work and as I was swiping in, an unfamiliar face dressed in scrubs with an unfamiliar ID badge approached me and asked, "excuse me but are you a nurse in the ED?"
"Yes I am" I cautiously replied, "how can I help ya?"
"Do you know the code for the tube system?"
"Are you new here?" I asked. I thought we weren't hiring anymore??
"Oh yes. I'm an agency nurse and I haven't worked here before. And they haven't assigned me a code"

That's what my mind said the instant she said "agency nurse".
When management is desperate enough to call in agency nurses, you can bet your last dollar that the fecal matter has well and truly hit the air recirculation device!!

I wasn't mistaken either.
Last three shifts have been pure chaos and unadulterated mayhem. You know all the amount of drama they manage to squeeze into one episode of ER? Well, try compressing each episode to 15 minutes and repeat for the entire shift and the next shift and the next shift and the next... that's how it's been down here in The Pit.

A combination of "work everyone up no matter what" doctors, combined with semi-indifferent/downright-lazy support personnel, staff callouts, a downed CT scanner, temperamental tube system, malfunctioning lab software and an erratically performing computer charting system... all conspired to transform an ordeal into the perfect and most horrific nightmare.

If that wasn't bad enough, the patients seeking our services were all the "borderline" kind: Sick enough to die at any moment... but they just ain't dead yet. Which means long, drawn out (and sometimes repeated) codes. Add to this mix, the more than usual amount of violent drunks, actively psychotic and abusive psych patients and more than the usual amount of attempted suicides.

You name it, we ran out of it:
* Pre-filled saline flushes? Check
* Primary IV tubing? Check
* Wrist/ankle restraints? Check
* Hospital beds for admitted patients? Check
* Pre-filled Dilaudid and Morphine Carpujects? Check
* 16 and 14 french foleys? Check
* Blankets (warm or otherwise)? Check
* Food trays (even simple sandwiches)? Check
* 20g IV catheters? Check
* Batteries for portable monitors? Check

On and endlessly on.
Everything from Dynamaps to portable EKG machines kept switching off because there was just not enough time to plug them in to recharge! At one point, our supply of Percocets, Zofran, Ativan and Propofol got so low that Pharmacy had to raid ICU stock for our supply!

I'm just thankful that our water supply didn't run out!

Nobody is yelling at anyone else... yet. But morale is strained. There is definitely a sense of "Us (staff)" Vs "Them (patients)" amongst some of the staff. Management is trying - and failing gloriously! - in trying to perk up flagging team spirit. Instead of support in the form of more staff/better equipment, meaningless platitudes are being offered (again!).

I mean, in what kind of "First Class ED" do I need to hunt high and low for a frigging thermometer??!!

We've been on continuous "Bypass/Divert" status since Monday but it seems to make not one iota of difference. Wave upon wave of the sick, the wounded and the dying keep crashing against the thin white line of ED staff... and we're just barely holding on.

We have not slowed down at all from the winter.

Just yesterday I walked into work at 1100 hrs and there were 19 "holds" (pts. who have been admitted to the hospital but are hanging out in the ED because there are no beds available). NINETEEN!!! Psych, Tele, ICU, Med-Surg, Stroke... you name it, we were holding 'em down here. Close to 40% of our ED bed capacity was being occupied by admitted patients - which meant that triage and bed flow was a complete disaster all day long.

We've been getting slammed like crazy. Last month, we shattered all previous volume records.

I've been consistently working over 44+ hours/week! I was supposed to work 1100 - 1900 yesterday but ended up staying till 2230 to help out because we were so busy (crashing patients left right and center).
And it was on my day off!!!

I mean, it's freaking JUNE; not FEBRUARY! What the hell people??!!

Monday, June 1, 2009


I try all I can, what more is there to do?
Why, lets intubate! And get a ventilator too!
One Pressor, Two Pressor, Three Pressor, Four
There's nothing left to pump into you any more
Five fluids, six fluids, seven bags and eight
yet your foley output shows naught all night.

You lie there listless in bed
and here I am at my wits end.
Surrounded by all of modern medicine's marvels
and with nothing to show for all our travails

The only saving grace, if any
Was that you passed from this world surrounded by family
As cruel and abrupt as was your passing
I can only hope the final battle was worth the living.

I'm tired. My feet hurt. My back aches. My mind is fatigued.
And yet, the thought remains - "what if I'd done this or that or something more?!"
A wise colleague imparts sage advice
"Hindsight never resurrected the dead"...

... and then after a pause, added:
"Go home! Get some sleep. I'll see you back tonight..."

And so I go home to toss and turn
and snatch fits of sleep
For return I must in the morrow
back to earn my keep.

To dance that dance once again
Against that ancient and final foe
We may win or we may loose
But the dance is one we cannot choose

- © Spook, RN [June 2009]