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I’ve ceased with the pre-shift ritual of meditating in my parked truck along with a comforting 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 dissimilar than any other night in the Emergency Department, no matter if I blare Yanni’s rancid piano etudes or make a promise to God to pass out my own body elements to the discharged persons who requires medical care as they leave. Nothing will change. I use to look forward to making a divergence in someone’s life, helping a poor soul whose body has given out. Those moments are few and far among now. Instead, I resign myself to the fact that the next 12 hours will be expended pasting a phony smile on a tired body, going through the motions of caring, repeating ready-made lines of untrue concern and giving out medical counsel that fall on deaf ears. I use to feel necessary in my role as Charge 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, grant me the prospect to be gainfully used 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 division by modify of shift and to no surprise to myself and the night crew, a few names are all too intimate and the reports of their latest “illness” without apparent effort recitable from memory. The ordinary 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, assert that our overweight security strength is camped out besides the room, shake our heads briefly and go on when it comes to our business. We go through the ritual of taking our own baseline critical signs, popping a few Xanax and removing sharp objects from our pockets. Patient safety is indispensable and we wouldn’t want to in an unintentional manner stab one of them repeatedly in the chest. 7:17 PM- My important occupation isolated from direct patient care is triage. Initial interview, critical signs, brief medical history, current medical problem, current medications, height, weight etc etc. My basi 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 little English, less mutual sense, no means to pay. She complains of the ordinary nausea, vomiting, diarrhea and generalized abdominal pain. She’s already expended thousands of dollars of other people’s cash last week for the same complaint. She didn’t fill her scripts, didn’t follow up with her Gastroenterologist as requested and by no means was this 300 + lb, truffle hunting leech going to modify her diet one iota in order to prevent another attack 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, completely unmindful as to why she is still sick. Non-compliant with her meds, non-compliant with the discharge instructions, follow up or diet instructions, which included a bland, low-fat, liquid diet for a few days until she was competent to tolerate semi-solid/or solid food. She bitches profusely when she is not brought straight back and put into a bed, rather she is sent back out to the waiting area for a lengthy wait. We are full and busy with the veritably “emergent” people who are in need of medical care but she can’t seem to fathom this. She barrels through the exit door, into the waiting area calling me each 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 patient is a 23-year-old mother of 3, the oldest being 10. She has in some manner mistaken our “EMERGENCY DEPARTMENT” for a pediatric clinic and wants her brood “checked out” because they feel “hot.” No temperature ever taken at home, no Tylenol or Motrin given before the decision was made to spend $1500.00 of other people’s cash 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 amazed that each is twice the size they must be at their queer ages. One, I have to pry finger foods and a “Big Gulp” from their obstinate little 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 normal they are ushered out into the waiting area where they eagerly pounce on the furniture and run around like the defensive line for the Attention Deficits. I am verbally attacked by my obese belly pain lady, who has “been waiting for hours” (uh, how in regards to 20 minutes). I instantaneously observe the “positive Cheetos sign” on her fingers and around her lips and remind her that the sickest are seen introductory 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 may listen 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. 9:21 PM- I’ve pulled through the dinner crowd with my occupation intact and make my way back to the treatment area to support the rest of my team in the treatment of the persons who requires medical care who were lucky sufficient to make it back in front of the non-emergent riff-raff. I make my way to the EMS radio station when I hear…..”Unit 842 code 2 patient report”….we have a 102 year old nursing home patient,….found unsusceptible 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 transport reveals that this patient 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 unsusceptible and her breathing more shallow. In an instant her breathing stops and is without delay 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 surely a proud moment for her parents one may be sure. She died, however, covered in shit, piss and bedsores. The nursing home where she expended her remaining days in intense feelings of suffering and perpetual loneliness must be burned to the ground. No family, no attention, nowhere near as prominent and proud as she once was. Left to waste while the understaffed laborers at Our Lady of the Perpetual Petri Dish took their extended breaks and pillaged through her personal belongings. A courtesy call to the nursing home is placed telling them that Mrs. Mullins will not be coming back and has been transposed to the ECU (Eternal Care Unit). I hear, “Whew, thank God…..CLICK.” 10:22 PM- Our ordinarily bevy of drug-seeking, bipolar, depressed, suicidal, Xanax, Vicodin, Demerol hounds arrive as scheduled with multiple and varied complaints of, migraine headaches, chronic back pain, stress, anxiety, fibromyalgia, blah, blah, blah….! Security is normally called, for to tell them “no drugs tonight” is just asking for a fight. $1000.00 later of other peoples cash and they commonly leave with their buzz on and their script for Vicodin. But normally not before asking for a “shot for the road” or further and added scripts for anxiety (preferably Xanax) or sleep aids. 30 pills are often times the number of pills given, depending on the frequency of the prescribed dose. This normally last a few days for the typical drug seeker and then they’ll normally return with more “pain” and a hungry monkey. In the age when Doctors are sued for both beneath treating pain OR for prescribing too a great deal of narcotics and “getting them addicted”, we medical personal are caught up in the proverbial “catch 22″. More often times than not I have been written up and on various occasions was at a point where my occupation was in jeopardy because I challenged their pathetic lies whenever these low-life drug addicts invaded our ER’s. Now I just shut up, shake my head and pray for an overdose. 11:12 PM Waiting Room intercom is ringing off the wall. “…how long will I…….can you tell me where I am on the list……Donde esta su Doctor…….I can’t find my child……..the dingo ate my baby…..PINCHE PEDEJO, I BEEN HEER FER TWO DAYS AND MY ASS FEELS LIKE SOMEONE POURED SALSA RIGHT UP MY……….click. Midnight in the garden of good (for nothings) and the evil (doers)- After a flurry of non emergent triages, (sore toe, “the shakes”, anal abscess, alien bodies in the nose, ears and stomach of a 2 year old, blah blah, blah) I call in an astute, well dressed, middle aged white male, who is walking rather gingerly and refusing to sit. Differential diagnoses race through my head, back pain, abdominal pain, rectal abscess,. or perhaps….no!….NO!……NOOOOOOOOOOO! Yes! The story goes (and it is a mutual one) that he and the Mrs. were “experimenting” in bed (against his wishes, no doubt) when a vibrator was jammed in his keester and is now painfully out of reach. Given the nature of the “injury” he is whisked back to a private room, placed on his side, lubed up like a 57 Chevy, and a valiant crusade is made to retrieve the 12 inch “perpetrator with ribs” from his big bowel. All to no avail. At one point we had a hold of the alien body (actually, it was made in the US) but the colon wouldn’t let go of it’s new found cylindrical friend. We tugged, twisted, yanked, pulled, all attempts proving futile. Finally the physician stopped, exhausted from the tug-o-war match, with the forceps, commonly employed to got rid of huge headed babies, protruding from the prominent lawyers butt, he made the decision to call in the surgical team. All attempts to stay professional, however, fell by the wayside when, for the duration of a moment of silence, a low buzz was detected in the room. Had the blood pressure cuff inflated? Were the incandescent lights buzzing? Was the TV on? No, no and no. We looked at the forceps and noticed they were vibrating uncontrollably, without any delay realizing at that point that this thing was STILL ON. A crazy rush by the scant crew to the exit door of the private room was attempted as to not embarrass this local professional with our boisterous laughter. No dice. We will all in the long run be written up and apologies made for our “unprofessionalism and disregard for the patient’s privacy and mental well being”. 1:02 AM Ten triages later and it is dinner time for this mentally worn crew. We retrieve our food, locate it to the middle of the nursing station and we eat. Not all at once, mind you but commonly a bite at a time. Eat a French fry, go wipe an ass in ER-1, a bite of a Big Mac, go clean up cherry cool-aid flavored vomit in ER-4, a sip of Dr Pepper, then physically restrain a combative Scitzo-effective patient. By 2:15 we have polished off the last bite of a hardened burger, ate our last stale French fry and sucked down the last gulp of our watered-down soda. A soda that is now as warm as fresh urine and feed that is as cold as Mrs. Mullins in ER13. 2:30 AM- Ahhh, my favored time for the duration of the entire shift is upon us. The “Last Call at the local bar crowd” (LCLBC) commence to pour in to the front entrance, while EMS brings the ones who got the shit kicked out of them through the back ambulance entrance. “Santa Rosa, this is unit 842….we are coming code 2 trauma with a 19 year old male…..closed head injury….intoxicated…combative….soiled….bloody…..no insurance…..blah, blah,blah. The same ole song and dance spews from this people who are in need of medical care bloodied spout as he is wheeled into Trauma-2……”I was just minding my own business”……”I only had two beers”…..”I don’t do drugs”….. “Can I get something to eat?” “RAALLLLLLPHHH!” “Housekeeping to ER Trauma-2, Housekeeping….” 2:31 AM- “Dear Lord, If ANYONE may make time travel possible, it’s you, God.” “Pleeeese, send me forward to 7 AM. 3:03 AM- Patient waiting room intercom is screaming………..”CLICK”…….”BANG, BANG, BANG”. 3:15 AM- I am ushered into the staff break room for a “time out” and reminded by the night supervisor that the cost of the intercom will be subtracted from my paycheck. 4:18 AM- Our portly female beast of a woman is ultimately ushered back to a room but not before mumbling under her breath as she brushes past me, “Pendejo”! A major “abdominal work-up” is ordered. 40 lab tests, urine tests, stool cultures, abdominal x-rays, Cat Scans, blah, blah, blah……She’s placed in a gown that looks like curtains stolen from the Grand Ole Opry, and given the reminder “Opening to the back, please,” tossed in for good measure. (“Lord, give me the strength to………..Oh forget it, never mind”) She’s given a URINE cup as she bounces her way to the bathroom. She fills it with STOOL. “Housekeeping to ER, STAT.” Can’t find a blood pressure cuff big sufficient so we will have to take a chance at an erroneous reading by placing it around her calf or forearm. The hydraulic bed grunts and groans with ever twitch and shift from this woman of substances. She proceeds to bitch and moan and will ultimately file a complaint with (in) humane resources, I am sure. Multiple attempts at IV access at last yields a vein that hasn’t been choked off by the mass of arm fat and IV fluids are initiated. After a quick assessment by the ER physician she is off to radiology, with a little 120 lb tech pushing 600 lbs of patient and bed up to the 3rd floor for a series of $3000.00 radiologic exams. X-rays that were done just last week and that she has no aim or means to pay for. It would have been more comfortable (and cheaper) had she driven to Sea World instead. Certainly more accommodating for a woman of her stature. 5:57 AM- Multiple early morning stragglers are triaged and sent to wait. The foul odor of urine, poop, BO, booze, vomit, etc, permeates the air. “One Hour Left”, I thought. We get all the results of the voluptuous Ms. Hinojosa’s tests back and surprise, surprise….”Diverticulitis.” Perhaps this time she will be compliant with her meds, compliant with her diet, compliant with her follow up, compliant with life. “Fat chance,”I thought. (Pun intended). Her IV is got rid of and a half gallon of fat globules ooze from the harpoon hole. She is hoisted off the bed with the help of assorted departments within the hospital; half of who will call in sick tomorrow with severe back spasms. The battered stretcher which now resembles a low-rider after a major accident is towed to the back for repair. Ms Hinojosa is discharged but not before requesting a breakfast tray. Request denied. Off she goes to the local “Taco Cabana” for a flurry of assorted breakfast tacos and a bowl of menudo. “She you in a few days, Ms Hinojosa.” “Pinche Pendejo!” 6:47 AM- The dismal faces of the morning crew are evident as they reluctantly make there way in, a good deal of still in mid-prayer, the newer nurses with walkman’s on, listening to ocean waves or cricket noises completely filled with Muzac. A quick report is given to the mentally exhausted night crew and apologies made for the missing bed in ER 3 and the dead body in ER-12. 7:07 AM- Each fellow member of the night crew, each with a phone in hand, are awaiting the instant the clock strikes 7:08 where, with lightning speed, a flurry of buttons will be punched to clock out, ending another exceptionally bad or displeasing but typical night in the ER. 7:47 AM- I pull up to my apartment and sit quietly in my truck. I recall the night’s events and wonder if I had made any critical faults in care or judgment. I mentally prepare for the answers to the complaints made the night before by this distinguishable ER culture of ignorant, non-compliant, abusive, poor, helpless, drugged-up, psychotic, dregs of society. I say a prayer for Mrs. Mullins and her family and curse all those who’ve maltreated the system in the last 12 hours, spending thousands upon thousands of dollars of other people’s cash but contributing not one thing to society what-so-ever. Once I deem that I will have a occupation come 6:45 that evening, I ease my tired body and shattered mind out of my vehicle, meander up to my apartment and into bed, hungry, frustrated, angry. Where I will fight the demons for an hour or so until I am competent to fall asleep. I don’t. I am woken by a dream whereby the ER staff are all persons who requires medical care 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 without delay 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 another 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 extend the healing ministry of Christ,” it reads, and I take a minute to ponder that statement. I smile, recognise it’s powerful and unfathomed meaning and bow my head to pray. Just then a beat up delta 88 rolls by on two wheels, with a definitive 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 through the patient parking lot, into the physicians parking area, towards the ER entrance. Anger churns inside me and I hang my head, looking down at my badge and the mission statement on the back. I undertake 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.” |
