Saturday, May 09, 2015

Dear Cheerful Nurse from the ED at County General. . . .

Thanks for calling. Thanks for being so cheerful! I don't know how you do it, working, as you do, in the pits of hell.

I apologize for that patient who stumbled into your ED today. He stumbled into ours, here at Sunnydale, with a chief complaint of having fallen over due to weakness on his left side. When the CT and MRI didn't show anything, the folks in our ED transferred him to the Neuro CCU. . .but not before he started demanding pain medication for his stroke pain.

Because strokes, as you know, are painful.

(end scarcasm)

Anyway, I got him up here and determined that, while he did show some weakness on the left side, it was distractable. Sometimes it moved to the right side. Sometimes he complained of tingling and numbness all over. At least, that's what I think he said; it was hard to tell, given how many teeth he was missing. Yes, yes, he told me he wasn't a heroin addict too. I'm sure he wasn't; after all, if a person's a heroin addict, that means they'll have tracks all over and crappy veins, and it only took two tries with a Sono-Site to find a vein in his upper arm, so that's not so bad, right? Right?

Oh, you saw those healing puncture wounds, too? Well, I'm sure we can agree they weren't from heroin. Of course not.

Gosh, you sure are cheerful.

Yeah, he told me that he was heading over to County, since the folks over there knew how to treat him. After all, because he's not a heroin addict, there's no reason he shouldn't get Dilaudid or methadone for his stroke pain. He repeated that a number of times to both me and the doctor, who said he was messing with the wrong sheriff. Given the doctor's age, accent, personality, and ethnicity, all I could think of at that point was Cleavon Little in "Blazing Saddles," and I'm certain I made a spectacle of myself, going red-faced in an attempt not to bust out laughing. Luckily, the doctor had seen "Blazing Saddles" too, and caught my eye, and said, "'Scuze me while I WHIP THIS OUT" before pulling the records that had come up from the ED with the patient.

I do love my colleagues.

But not nearly as much as I love you, Cheerful Nurse from the ED at County General. You're indefagitable.

Where were we? Sorry. Oh, yes, the track marks. That didn't come from shooting up any and every imaginable substance while not living on the streets. Yes, we saw those. You'll notice, if you look at the guy's feet and under his tongue, more of them. No, I did not look at his penis. Sorry. My exam was truncated.

My exam was truncated by his starting to swing at me, demanding AMA paperwork, and generally being a cussing asshole. I was fine with him swinging at me while I was standing at the foot of the bed, but once I moved in to try to take out his IV, the swinging got a lot closer and a hell of a lot more personal. Which explains why he showed up at CGED with an IV from Sunnydale still in his upper arm. Consider it a favor from me to you; you don't have to risk sticking him. Y'know, he tried to stab the above-mentioned Doctor Sheriff with a shiv made from a spoon when Doc Sheriff asked him a few simple questions, I'm sure you'll agree that leaving the IV in was the best choice. Discretion is, after all, the better part of not contracting blood-borne diseases.

That was why I had Danny wheel him out after he signed out AMA. Danny is six-five, three-fifty, Polynesian, and covered with interesting geometric tattoos. Somewhere, there's a photo of me curled up under the desk in the fetal position as a result of that patient interaction. I can send it to you if you're interested. That's really all I can tell you. No, no, you don't have to send him back, you can keep this one.

Thanks. 'Bye, now. Byeeee.


Lace said...

Oh the stroke pain!? the changing of symptoms? the "only Dilaudid helps my pain and then getting angry and cussing when you don't deliver. God damn that sounds familiar.

Brian said...

Why wouldn't she be cheerful? That's not the worst patient she's seen today.

In the neuro ICU, when you're nearly spoon-shanked by a crazy homeless stroke-faking drug addict, that might be the most dangerous shift you ever had. In the ED, we call that Tuesday.

JEN said...

Only Dilaudid can help them. Of course.

Dr. Alice said...

Some days the only thing that keeps me sane is reminding myself that when the apocalypse/EMP/collapse of society takes place, patients like this will be the first to go down.

Not that I won't be shortly behind them, but still.

RehabRN said...


Dayum! Makes you wish he would have been a real stroke patient instead of a real wound up heroin addict.

I feel for you Scrub Ninja. Much admiration.

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Jo said...

I would just like to make very clear, here and now, that I was in no way belittling the Cheerful ED Nurse. Rather, I was in awe of him, being so. . . .well, *cheerful,* even if it was in a wry sort of way, about our mutual lunatic.

I wouldn't last ten minutes in an ED. I like a certain amount of adrenaline, but I hate flat-out chaos. The folks who work at County General, with its metal detectors and its theft-proof wheelchairs, are a totally different breed than I am. I admire them, the way I admire people who fly in wingsuits or mountain-bike down Everest, but I could never be them.

Let alone be as cheerful as my Cheerful ED Nurse Guy was. Golly.