Thursday, July 9, 2009

- MedicMarch and the Volcano

Ms Boudreaux and I are on the same feeding schedule. I know this because I'm waiting expectantly in front of the microwave in the station. My small, hopeful face bathed in yellowish microwave light, nose up against the window, slave to the countdown timer, staring at my meal rotating in a tantalizing slow pirouette of deliciousness, and there's only 30 seconds left, and-

BEEP BEEP BEEP. BEEP BEEP BEEP. BEEP BEEP BEEP. BEEP BEEP BEEP. BEEP BEEP BEEP.

This is the not the happy mealtime chime you would expect to hear when your food is ready in the microwave.

This is the annoying insistent ear-needle that emits from my pager whenever dispatch gambles I will be too weak from hunger to actually kill the sperm-waste mouth-breather that has interrupted my mealtime and requested an ambulance, full code, to go and pick up a lady who has removed her own PEG tube.


You see, Ms. Boudreaux doesn't like to keep her PEG tube in. Invariably, after a period of, oh, 20 minutes, she realizes there's some sort of tube sticking out of her belly, and proceeds to start picking at it, until she worms it out. Then it lays on top of her, or on the floor, or wherever it happens to land, and then whenever the LPN or PCA or whoever goes to feed her at the next meal time, they find it and call us. We pick her up.

She suffers the bumps of an 18 mile ambulance ride, and I do mean suffers - even the slightest rock of the module makes her scream in terror, and the road between Major Metro Hospital and here is quite potholed. She gets her PEG reinserted, and than takes another 18 mile ride back, before being placed back in her bed...so she can start picking at her PEG again.

I know Ms. Boudreaux's paperwork by heart now. I should, after all. This is the 5th time one of me or my coworkers has picked her up this week....and the 3rd time I've picked her up in a 72 hour period. As a matter fact, I can carbon my run report from the shift before, except for the vitals. When we returned the last time, I asked the nurse to put something on the patent's chart - get an order for restraints, or tape a large dressing over the PEG so she can't get to it, or something. Izzy sees the name at the top of the chart and then looks at me and rolls her eyes.

I walk into the room, check on her as Izzy gets vitals, and step back out. I have to talk to someone. The ADON and the shift RN are all standing behind the Formica, intently staring into paperwork.

"Excuse me, ladies."

No one looks up. They are silent as church mouse.

"Excuse me, ladies," I try again.

The RN looks at me out of the corner of her eye, and then over to the ADON, who is still ignoring me.

After I don't go away, she looks up with a smile. "Yes, may I help you?"

Some thing's not right here, but I can't figure out what it is. The staff is at least looking like they're trying. The hall smells only faintly of decubiti and turds. The charts are stacked neatly. What the shit is going on?

" I just wanted to talk to you about Ms Boudreaux. She pulled her PEG tube out again."

The ADON looks up, and she looks PISSED. What have I stumbled onto here?

"The tube is out, which is why we called YOU! You NEED to take her to the hospital so she can get it PUT BACK IN."

"Did you guys try calling her doctor to get something to cover, like I suggested? Or maybe some restraints?" I ask back.

"No, but her doctor did say to TAKE her to the hospital so she can get her TUBE PUT BACK IN."

I don't know if it my blood sugar, or not. I don't know if it's the fact that Ms Boudreaux's room is DIRECTLY across from the nurses station and she should be the easiest to supervise. That I already tried to help by getting a doctor's order to cover that PEG. What I meant to say next was "This is ridiculous." But at some point between the signal from my brain going to my mouth it gets mixed up and instead it comes out

"THIS IS FUCKING RETARDED."

Whoops.

Izzy, the two nurses, and a PCA that was walking by all have eyes the size of dinner plates. It is very quiet.

Well, screw it. At least I've got her attention.

"I AM TAKING HER. I'M JUST TRYING TO SAVE ME, YOU, AND THE OTHER TAXPAYERS SOME MONEY. I'M TRYING TO MAKE THINGS EASIER ON THE PATIENT AND THE ER THAT HAS TO PUT THE TUBE BACK IN. I ASKED YOU NICELY LAST TIME I WAS HERE TO CONTACT HER DOCTOR ABOUT GETTING A PAD OR REST-" The ADON cuts me off, finally regaining her composure.

"For your INFORMATION Medicaid says we can't restrain patients. If you don't like it, they down the hall. Go ask them yourself."

That explains the cleanliness...Medicaid must be doing one of their inspections. She said this to try and intimidate me. It backfires. The ADON recoils as I get a gleam in my eye and a giant, manic grin spreads on my face.

"Down the hall? Oh, good. Which hall? I've got some stuff to tell them about the things I've seen here." I take off down a random hall at a fast walk.

Izzy would later tell me that right after I walked off, the ADON looked at her with the biggest "Oh shit!" expression that she's ever seen. Izzy just shrugged back, and after that, the ADON comes scurrying out from behind the desk.

"Sir! Sir! Sir!" she's screaming as she runs down the hall, adrift in my wake as a I storm down the hall. To be truthful, I'm bluffing, and can't think of anything immediately off the top of my head, but if I gave it five minutes I'm sure I can come up with something.

Just as I'm about to round the corner, she grabs my arm. I've never seen a 400 pound lady move that quickly except when there is a buffet involved. She's breathing heavily after her little 30 yard sprint.

"There's no need (huff, huff) for that (puff,puff). We don't (::minor pig grunt::) want anyone (::wheeze::) causing trouble (::fart::) (::wheeze::)."

There is steel in my voice but I'm no longer yelling. "Look, I'm taking her in. But you need to call her doctor and get some orders written so that she doesn't have to keep getting bounced around. She's terrified of it. It's fine if you can't restrain her - I don't know all those rules. All she really needs is a large trauma dressing taped over the site inbetween meal times, or something like that."

I walk off and load Ms Boudreaux up in my unit. I spent the rest of the shift waiting for a phone call from a supervisor that never came.

I've got mixed feelings. It was extremely unprofessional of me to talk to anyone, much less an ADON, with that kind of language. But I'll be god-damned if the next time we stopped into pick Ms Boudreaux up, it was for abnormal labs. And she had on a soft, vest-type apparatus over her abdomen, keeping her from picking at the PEG.



I won't say it justifies my actions or behavior....but at least this particular issue got fixed.

-MM

17 comments:

Ambulance Driver said...

Ah, nursing homes.

Without them, who would hire the bottom 10% of each nursing class?

alight said...

Thank god you spoke up. The suggestions you made were so obvious. I'll never understand some people.

AD, don't assume all of us nurses at nursing homes are bottom rung!

I will admit to working with some real winners, though. I had a similar issue at work and I remember looking at the nurse who came to ask me what to do with MR. So-and-so. "He keeps pulling at his tube, what do I do?"

Cover. it. up.

Really, that wasn't so hard, was it?

Beaker said...

I've always wanted to do something like that.

mommy-medic said...

You are my hero! I too lack a filter between brain and mouth at the most inopportune times, and what I think is often quite different from what comes out.

For instance I just learned someone tried to say my blog was a hipaa violation, so I deleted the whole thing. Then I got mad, put it back up, and went off about hipaa and the first ammendment. Would you be so kind as to throuw your input over there? Thanks.

Detail Medic said...

I too suffer from diarrhea of the mouth at times. I like to call it honesty, but my Lieutenant just doesn't see it my way...

Patent Absurdist said...

OMFG i just read this, aloud, to my husband, and damn if he didn't laugh his ass off. Which is somewhat uncharacteristic of him, so you KNOW this shiat is EPIC FUNNY.

Kudos, sir or madam. I shall be following your prose forthwith! (you are a DAMN funny comedic writer - please tell me you do that in your spare time and then sell it for large dollar amounts. Damn. Funny as hell. PROPS!

Ambulance Driver said...

alight,

My mother was a nursing home nurse, and a good one. I was more-or-less referring to the idiots like Medic march encountered.

EMS has its share of idiots, too.

alight said...

AD,

Seems as if idiots abound sometimes. I'd hate to be on the receiving end of Medicmarch's triade, to be sure...

...though I have to admit that I wish I had been present to witness it. ~grins~

Anonymous said...

MM-

I'm an RN and there was a patient like this on my floor. Unfortunately, she was not my patient. She was disoriented and didn't even know she was pulling on her tube. Apparently the other nurses who were assigned to her did nothing. Every time she pulled on the tube, she let out a bone-chilling scream. I traded assignments with another nurse, who obviously did not want to take care of her. I placed a gauze dressing over skin at the tube site (WHICH IS MADE FOR THIS). I further placed 4x4s on top and taped down the sides (using paper tape, of course). I was pissed that no one had tried this before. It was a success...AND NO MD ORDER WAS NEEDED FOR THIS INTERVENTION. Crazy, right?

medicblog999 said...

MM,
fantastic post!

I'm sitting on a packed train just pulling into London Kings Cross, and there are quite a few people looking at me wondering what on earth I am laughing out loud too.

Thanks for ending my 3 hour train journey on a high!

Loving Annie said...

You were well justified and did the right thing. After all, something intelligent got done.

Epijunky said...

MM,

You Sir, are my hero.

On behalf of EMTs and Medics everywhere, thank you.

Scott T said...

haha classic, hope you dont get a complaint

Ckemtp said...

Oh so freaking great, you are my new hero for the day! Maybe the week!

Front page linked.

Ckemtp said...

And E-mailed to my friends.

Tim said...

Awesome!

I hope that you get to talk to the inspectors the next time. I've always wondered what would happen if those visits came about unannounced...

Don't feel bad about taking someone to task over poor patient care regardless of their title.

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