Canadian Spiders On Drugs

I spoke too soon. It just may be a frikkin' spider bite!

In honor of Emergency Nurses Week...

I am a nurse first and always. My best friends are Emergency Nurses. Here is to all of us and all we do!

YOU MIGHT BE AN E.R. NURSE IF . . .
You believe that 90% of people are a poor excuse for protoplasm...
Discussing dismemberment over a gourmet meal seems perfectly normal to you..
You believe a good tape job will fix anything...
You have the bladder capacity of five people...
You can identify the positive teeth to tattoo ratio...
Your idea of a good time is a full arrest at shift change...
You find humor in other people's stupidity...
You believe in aerial spraying of Prozac...
You disbelieve 90% of what you are told and 75% of what you see...
You have your weekends off planned for a year in advance...
You automatically assume the patient is a drug seeker when presented with the complaint of migraine, lower back pain, chronic myalgia (choose one of the above), a list of numerous allergies to meds (except Demerol), and the statement that the family doctor is from out of town...
You encourage an obnoxious patient to sign out AMA so you don't have to deal with them any longer...
You believe that "shallow gene pool" should be a recognized diagnosis...
You believe that the government should require a permit to reproduce...
You threaten to strangle anyone who even starts to say the "Q" word when the ER is even remotely calm...
You don't think a referral to Dr. Kevorkian is inappropriate...
You refer to someone in severe respiratory distress as a "smurf"...
You believe that "too stupid to live" should be a diagnosis...
You have ever had to leave a patient's room before you begin to laugh uncontrollably...
You have ever referred to the E.R. Doc or triage nurse as a "shit magnet"...
You have ever restrained someone and it was not a sexual experience...
Your most common assessment question is "what changed, --- tonight ,to make it an emergency after 6 (hours, days, weeks, months, years)?"...
You believe a "supreme being consult" is your patient's only hope...
You want lab to order a "dumb s**t profile"...
You believe your patient is demonically possessed...
You have ever had a patient look you straight in the eye and say "I have no idea how that got stuck in there !"...
You believe that waiting room time should be proportional to length of time from symptom onset ("you've had the pain for three weeks...well have a seat in the waiting room and we'll get to you in three days")...
You have ever had a patient say, ". . .----But, I'm not pregnant; I can't be pregnant; how can I be having a baby?"...
You have ever had a patient control his seizures when offered some food...
You carry your own set of keys to the "leathers"...
Your idea of gambling is an ETOH level pool instead of a football pool...
You have a special shrine in your home to the inventor of Haldol...
Your idea of an x-ray prep is a second dose of Haldol...
You have recurring nightmares about being knocked to the floor and run over
by a portable x-ray machine...
You have every referred to subcutaneous air as "Rice Krispies"...
You have thought OD instead of BBQ when asked to get the Charcoal...
You believe that a large part of your daily calorie requirement is provided by Tylenol®, Advil®, or Excedrin®...
AND FINALLY....===YOU MIGHT BE AN E.R. NURSE IF...----YOU FIND HUMOR IN ANY OF THIS!!!

IT IS NOT A FRIKKIN' SPIDER BITE!!!

Frequent Flyer Guy: I got bit by a spider on my neck. Hurts like hell.

Night Witch: It is not a spider bite. It is a staph infection. It looks like it is a MRSA infection.

Frequent Flyer Guy: No, I am sure it is a spider bite. I get these all the time. They give me that white pill. I think I have a nest of spiders somewhere in my house. Even my girlfriend and kids get them. Maybe it is a brown recluse.

Night Witch: It is not a spider bite. And there are no brown recluse spiders in this state. You get these all the time because it is MRSA. It is highly contagious, that is why your whole family gets these. The "little white pill" - is that Bactrim, a sulfa medicine?

Frequent Flyer Guy: Well it may not be a brown recluse. But my friends mother's brothers neighbors ex-wife got bit by a brown recluse in this city and she nearly lost her arm. Yes, it was a sulfa pill.

Night Witch: I doubt it was a brown recluse since it is confirmed that we don't have them in this state but regardless, you will need antibiotics again. I also need to lance it and get all the pus out. And quit touching it. Your face will be next if you aren't careful.

Frequent Flyer Guy: Is it going to hurt to lance it?

Night Witch: Nope, won't hurt me a bit :>)

Frequent Flyer Guy: I am going to need a Vicodin prescription too.

Night Witch: Yeah, I'll give you 4 tablets, then you should be fine. If you laid off the meth you might get fewer of these, ya know.

National Physician Assistant Week

Congratulations to all my PA colleagues who celebrate 40 years of the physician assistant profession this week.

On October 6, 1967, the first physician assistants graduated from Duke University. Today, approximately 64,000 PAs are providing essential medical and surgical services to people throughout the United States and internationally.

PAs and NPs continue to provide care in every medical specialty from geriatrics to emergency medicine. For more information on PAs see www.aapa.org.

Scabies, lice and everything nice.

Tonight it was a family of 4.


School teacher Mama: No way!

Night Witch: Yep, no doubt about it. See the burrowing lines around Oscars waist line. See these little dots on Olivia's arms. One of you probably got them at school and spread them to the rest of the family.

School teacher Mama: No way, it just can't be. I cannot believe this.


Night Witch: Yep, I am sure. Elimite family pack for all of you. This is why your hands itch so much.

Vice Principal Papa: Gee, thanks. Thanks a lot. This should go over big in the weekly school newsletter.

I nod and agree, leaving the room, scratching my head, neck and arms. I hate seeing patients with scabies.

Down the Drain

For all those who question whether patients actually dropped their narcotics down the drain, here is the first scientific proof from my favorite medical journal that it can happen (all by itself).

The Girl and the Hot Dog

She came in wearing a baseball cap decorated like a wedding veil. Only two nights of freedom left before she tied the knot. 6 of "the girls" went to a Friday night baseball game -almost the end of the season.

Laughing, cheering her team on, she was excited about her upcoming nuptials. Suddenly, the hot dog was stuck. Right in the middle of her chest. She could feel it. Totally weird, because she could breathe fine. Swig beer. Nothing. Swig beer again only to upchuck without warning. Try as she might, nothing would go down past her manubrium. Her maid of honor, a life guard long ago, decided to try the heimlich manuever. One, two, three, four, five. Nothing, nada, zip.

In the "olden days" some of us would try Nifedipine sublingually. Others tried warm Coca Cola and a few would give them meat tenderizer. Sometimes these worked, sometimes not.

Now, I try Glucagon. Twice. Then I try Nitroglycerine. Nothing, just big headache and now the poor woman can't even take tylenol. "Call GI", my consulting doc advises. "She just needs scoped" he says.

2am. GI doc says "fine, admit her". "I'll see her in the morning".

"Please, can you do it as early as possible". "She is sweet, she is getting married on Sunday, she has good insurance", I beg.

"I'll see her in the morning". Click.

She is sobbing, mascara running down her cheeks. She is getting married in less than 48 hours. No time for an endoscopy on Saturday. " Please, can't you just shove a stick down my throat", she begs.

Hello, Good Buy

I love Target. You can get some cute stuff and good deals there. Target makes my patients appreciate me.

Every night I send Target at least 10 patients who lack health insurance. 300 great drugs I can write for a mere four bucks.

Skip that daily Grande' White Mocha Light Frappuccino just for one day and heal thyself.

All night I write for Triamicinoline, Atenolol, Hctz., Amoxicillin, Doxycycline, and that good old MRSA fighter, Bactrim DS. All night. Just some tried and true generic meds - - ones I know backward and forward.

THEM: Doc, how much will it cost? I don't have insurance.

ME: I told you, I am not a doc. Go to Target. (pronounce "Tar-shay" to elicit a smile) Don't worry, it is only $4 there.

THEM: $4? FOR ONE PILL?

ME: No, all the pills. Just $4. If you go to Target.

THEM: Do I have to say anything? Is there a card I have to show?

ME: Nope, it is for everyone. $4. Go, hurry, before they close.

THEM: Hey, thanks Doc. Thanks a lot.

ME: I told you, I am not a doc. Quit smoking too.

I know, I know, Walmart has the same $4 drug list and in fact Walmart initiated the program. But I don't do Walmart (don't get me started) and I like Target's funky red medication bottles.

So, yeah, I guess I am a Target Whore and I think some of my patients are too. Good buy, Good buy....

IO, IO, Off to work I go...

No veins and circling the drain? Have no fear, a new, improved IO is here.

Use the trusty powerdriver to insert that bad boy right into your leg bone, or even better, your arm bone. Great little tool and just seconds until Grandma has a pathway to her brain and heart.

It will take the RN longer to flush the IV tubing then it does to put one of these little lifesavers in your leg.

Rex and Maude

I transplanted Rex and Maude to bigger pots today. Rex is a 4 foot staggering Dieffenbachia. Maude is a short, stout Prayer plant. Rex has grown against all odds. He nearly died when I inherited him and so I rooted him in a big vase of water. He just shot up as long as I kept Maude nearby. Maude has never really grown. She maintains her own, sometimes nearly dying if I forget to give her water. She is picky, sort of old looking. Not real colorful, sort of dull.

The "Real Rex and Maude" were patients of mine. I met Rex initially in a internal medicine office I worked at. I soon developed a liking to him and began to make house calls nearly weekly to see his reclusive, obstinate, practically deaf wife. Maude had horrible never a smoker COPD in addition to Rheumatoid Arthritis, severe Osteoarthritis with a dowagers hump,anxiety, depression and agoraphobia. Maude was the love of Rex's life. He was tall, regal, handsome even in his 80s, smart and frugal. He would stock up the house with Ben Gay cream when it was on sale because Maude was addicted to it. He had metastatic prostate cancer himself but no chronic diseases like Maude. As the cancer spread into his spine he grew weaker and had to hire home health aids to care for the two of them. Rex's biggest worry was that Maude would be taken care of if he went first.

Rex died first and Maude hung on for another year. She did OK without Rex but you could tell she was hurting. Andre', an only child, would make frequent 5 hour journeys to see her, handling her affairs, making her the exact same dinners Maude herself used to prepare for the family. Andre' still deep in grief over the loss of his beloved of over 30 years.

Andre' gave me the plants ---- cleaning out his parents home - filled to the brim with loving memories and plain old crap. Both plants still alive but hurting, just enduring three deaths in one year.

And today, on this beautiful September afternoon, I promoted the two of them to bigger pots.

Rock on Rex and Maude, rock on!

Duo of Big Lips

Some fat lipped kids showed up tonight --- one charming 9 year old Filipino girl and one sullen, rude 15 year old Latino boy.

Both kids with some awesome Angioedema of the lips. Lips only. Cutie Girl has had it three nights in a row, just at night. She looked like a duckbill platypus, her lips were so big. She kept taking out a pocket mirror and making faces at herself in it. Giving me a very detailed account of the event.

Rude Boy wore a face mask given to him at triage. Mortified to have to take it off in front of his mother and sister - quickly looking at the floor. Happens to him every year when he starts school. Goes away after a few weeks. This time he had enough – he wanted those lips back to normal before morning – his first day of school. This was absolutely uncool for the first day of highschool.

I told him women pay good money for lips like that. He was not amused.

Johnny, I'll miss you

Johnny was well known to me – 51 but looked 75. Had that rough, tough, bad boy look - the kind that mom would have warned you about - aged and hard, but still sort of attractive. A true Marlboro man.

Used to have a decent job, a local school custodian. Somewhere along the line Johnny pretty much lost everything including his family and an ok life. An adult son with some serious mental issues that took a toll on Johnny. He with degenerative disc disease of the spine and a penchant for Vicodin and tobacco.

Johnny was “found down”, brought into the ER intubated. Spent some time in PEA and after taking a needle to the heart was deemed “critical” and waiting in line for his CCU bed but probably brain dead.. Urine tox screen came back positive for meth, cocaine and barbiturates. No Vicodin??? Johnny, what have you done?

You would visit me at the free clinic for your monthly quota of Vicodin. Charming me to convince me how much you needed them for your back. Always a smile, inquire about how I was doing. When I was dealing with a raging lunatic one busy Monday - you came out of your exam room to make sure I was ok. You so gallantly "saved me" when you saw me on the road, walking my bike with a very flat tire in 90 degree heat - givng me a ride to the hospital. I am so sad, I really did like you. I wanted so bad for you to be one of the few that "get better". I will miss you, Johnny.