I've ceased with the pre-shift ritual of meditating in my parked truck along with a soothing piece of Music. No more prayers to God en route to work asking for more patience, more humanity, more understanding. I have accepted the fact that it will be no different than any other night in the urgency Department, no matter if I blare Yanni's rancid piano etudes or make a promise to God to pass out my own body parts to the discharged patients as they leave. Nothing will change. I use to look forward to production a difference in someone's life, helping a poor soul whose body has given out. Those moments are few and far in the middle of now. Instead, I resign myself to the fact that the next 12 hours will be spent pasting a fake smile on a tired body, going straight through the motions of caring, repeating ready-made lines of false concern and giving out medical guidance that fall on deaf ears. I use to feel important in my role as payment Nurse at a major Er of an inner-city charity hospital. Now, as I sit in my truck at 6:45 in the evening, gangster rap blaring, I send out a quick impromptu message to God..... "Please God, allow me the opening to be gainfully employed 12 hours from now."
7:02 Pm-
I receive a quick report of the clingons and leftovers who haven't made it out of the branch by convert of shift and to no surprise to myself and the night crew, a few names are all too familiar and the reports of their most recent "illness" unmistakably recitable from memory. The usual apologies from the day crew for not getting them out before we arrived go unnoticed. A shrill screech from one of the psych beds startles no one. We all just look up from within the "safe" confines of the nursing station, confirm that our overweight safety force is camped out beside the room, shake our heads briefly and go on about our business. We go straight through the ritual of taking our own baseline vital signs, popping a few Xanax and removing sharp objects from our pockets. Sick person safety is important and we wouldn't want to accidentally stab one of them repeatedly in the chest.
7:17 Pm-
My former job aside from direct Sick person care is triage. Introductory interview, vital signs, brief medical history, current medical problem, current medications, height, weight etc etc. My first of 35 or so fits the typical profile of this or any other Er in the country. 40 year old, female, morbidly obese, diabetic, hypertensive, multiple psych meds, very limited English, less tasteless sense, no means to pay. She complains of the usual nausea, vomiting, diarrhea and generalized abdominal pain. She's already spent thousands of dollars of other people's money last week for the same complaint. She didn't fill her scripts, didn't consequent up with her Gastroenterologist as requested and by no means was this 300 + lb, truffle hunting leech going to alter her diet one iota in order to preclude an additional one strike of diverticulitis. Her idea of a "Clear Liquid Diet" was a bucket of chicken and bowl of menudo an hour prior to her arrival. So here she is, totally oblivious as to why she is still sick. Non-compliant with her meds, non-compliant with the discharge instructions, consequent up or diet instructions, which included a bland, low-fat, liquid diet for a few days until she was able to tolerate semi-solid/or solid food.
She bitches profusely when she is not brought right back and put into a bed, instead she is sent back out to the waiting area for a lengthy wait. We are full and busy with the truly "emergent" patients but she can't seem to fathom this. She barrels straight through the exit door, into the waiting area calling me every name in the book (in Spanish) and swearing to never come back again. "Pendejo!", she mutters. Oh, she'll be back.
"Next"!
7:31 Pm-
My 3rd Sick person is a 23-year-old mom of 3, the oldest being 10. She has somehow mistaken our "Emergency Department" for a pediatric clinic and wants her brood "checked out" because they feel "hot." No climatic characteristic ever taken at Home, no Tylenol or Motrin given before the decision was made to spend 00.00 of other people's money and to waste our time babysitting 3 snot-nosed, unkempt ankle-biters who are no more sicker than the man in the moon. I usher them one at a time onto a scale for weights and am not surprised that each is twice the size they should be at their particular ages. One, I have to pry finger foods and a "Big Gulp" from their obstinate limited mitts prior to the weight so as not to inadvertently add 5 lbs to his already triple digit reading. The electronic scale beeps incessantly and reads, "One At A Time, Please."(Ok, not really) With all their vitals being general they are ushered out into the waiting area where they eagerly pounce on the Furniture and run colse to like the defensive line for the concentration Deficits.
I am verbally attacked by my obese belly pain lady, who has "been waiting for hours" (uh, how about 20 minutes). I abruptly consideration the "positive Cheetos sign" on her fingers and colse to her lips and remind her that the sickest are seen first and to have a seat. She tosses me a "Pincha Pendejo" and rumbles back to her seat. I sneak in a quick call to God asking that he makes sure she looks before she plops back down in her chair(s). I can hear the intercom announcer now, "Code Blue Trauma, Er Waiting Room." I mentally picture the scenario of the code team spending the next hour removing baby Julio from the rectum of a 300-lb verbally abusive Hispanic woman.
"Next"!!
9:21 Pm-
I've survived the evening meal crowd with my job intact and make my way back to the rehabilitation area to sustain the rest of my team in the rehabilitation of the patients who were lucky adequate to make it back ahead of the non-emergent riff-raff. I make my way to the Ems radio center when I hear....."Unit 842 code 2 Sick person report"....we have a 102 year old nursing Home patient,....found unresponsive on the floor....no Iv....she's now awake, combative, confused, covered in stool, incontinent of urine, blah, blah, blah..." The report from the nursing Home prior to her Ems vehicle reveals that this Sick person had a tendency to "dig out stool from her rectum when constipated." "Oh, that's just friggin lovely"
9:25 Pm-
The waiting room intercom a buzz......"I beeen waiting for 10 hours, you pendejo...you piece of...." Click!
9:33 Pm
Our lovely elderly finger painter arrives, covered in poop from head to toe. Ems personnel smirk as they wheel her by, updating us as to any changes en route. Nope, no changes, except that now she's given up the fight and is again unresponsive and her breathing more shallow. In an instant her breathing stops and is immediately rushed to trauma 1 where Cpr is initiated. "Code Blue Er-1, Code Blue Er-1."
9:57 Pm-
"Time of death, 9:55" is belted out by the code team leader. "She never stood a chance." "It was her time." "She had a long and good life." Blah Blah Blah Blah. She had a horrendous death. Born covered in amniotic fluid, but unmistakably a proud occasion for her parents one can be sure. She died, however, covered in shit, piss and bedsores. The nursing Home where she spent her remaining days in agony and perpetual loneliness should be burned to the ground. No family, no attention, nowhere near as important and proud as she once was. Left to waste while the understaffed workers at Our Lady of the Perpetual Petri Dish took their extended breaks and pillaged straight through her Personal Care Unit). I hear, "Whew, thank God.....Click."
10:22 Pm-
Our usually bevy of drug-seeking, bipolar, depressed, suicidal, Xanax, Vicodin, Demerol hounds arrive as scheduled with multiple and various complaints of, throbbing head headaches, continuing back pain, stress, anxiety, fibromyalgia, blah, blah, blah....!
They are easy to spot, almost always familiar, with the same ole' story. Most we know on a first name basis. They are all, coincidentally, allergic to the same medications; Tylenol, Motrin, Vistaril, Toradol, Aspirin or any other non narcotic or inoffensive placebo we've attempted to quell their "pain" with in the past. The only thing that works is "Demerol" and they must have a large contribute of Vicodin in the form of a prescribe when they leave. (Vicodin has Tylenol in it but apparently doesn't cause a severe allergic reaction when mixed with euphoria,....go figure!)
Security is usually called, for to tell them "no drugs tonight" is just asking for a fight. 00.00 later of other peoples money and they usually leave with their buzz on and their script for Vicodin. But usually not before asking for a "shot for the road" or additional scripts for anxiety (preferably Xanax) or sleep aids. 30 pills are often the amount of pills given, depending on the frequency of the prescribed dose. This usually last a few days for the typical drug seeker and then they'll usually return with more "pain" and a hungry monkey.
In the age when Doctors are sued for both under treating pain Or for prescribing too many narcotics and "getting them addicted", we medical Personal Care or judgment. I mentally prepare for the answers to the complaints made the night before by this unique Er culture of ignorant, non-compliant, abusive, poor, helpless, drugged-up, psychotic, dregs of society.
I say a prayer for Mrs. Mullins and her house and curse all those who've abused the ideas in the last 12 hours, spending thousands upon thousands of dollars of other people's money but contributing nothing to community what-so-ever. Once I deem that I will have a job come 6:45 that evening, I ease my tired body and shattered mind out of my vehicle, rove up to my apartment and into bed, hungry, frustrated, angry. Where I will fight the demons for an hour or so until I am able to fall asleep. I don't. I am woken by a dream whereby the Er staff are all patients in the waiting room on a busy night. I am called into the back where a 500-lb female nurse is ripping my clothes off with one hand and swinging a 6 foot rectal scope in the other like a pair of numchucks in a Bruce Lee movie. The alarm clock sounds and I immediately spring up and grab my ass, praying that a 6-foot proctoscope isn't dangling precariously from it. It's not. I breathe a sigh of relief and make my way to the shower and into an additional one fateful night of chaos and mayhem.
6:43 Pm-
I pull up to the Er, park my truck and sit. I clip on my name badge, giggle as I read our "Mission statement" tattooed on the back. "To enlarge the medical ministry of Christ," it reads, and I take a limited to ponder that statement. I smile, answer it's considerable and profound meaning and bow my head to pray.
"Lord, today, give me your divine power to accept my responsibilities within this ministry. I pray that..."
Just then a beat up delta 88 rolls by on two wheels, with a exact lean to one side. I watch as they take up two parking spaces in the "staff" lot and out pops Ms Hinojosa. I cringe. She leaves a trail of urped-up fajita and menudo straight through the Sick person parking lot, into the physicians parking area, towards the Er entrance. Anger churns inside me and I hang my head, seeing down at my badge and the mission statement on the back. I try desperately to find the peace and pride I felt just 2 minutes earlier and I resume my prayer......"Lord,....I just.......If you could only find it in your heart to............Oh Forget It!!!!!....... Never Mind."
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