Apr. 10, 2015

Confessions of a Triage Nurse

Warning: This blog entry is intended for people with a sense of humor.  If you do not have a sense of humor, please stop reading. By no means is this a reflection of the care that ER nurses give nor is it truly intended to act as a guide for patients regarding their illnesses. Only highly trained physicians are capable of diagnosing illnesses, both acute and chronic.

 Our world is funny.  Earlier as I sat at my triage desk watching patients trickle in and listening to their complaints, I realized the true impact of the "everyone gets a trophy" philosophy of our nation. So many people in this world have never had to solve their own problems and thus believe that it is someone else's job to do so.  Now don't start cursing me yet.  I am not talking about LEGITIMATE problems.  I am not referring to unexpected illnesses or unmanageable chronic illnesses.  Obviously if a person is doing their part by utilizing a sidewalk and the driver of a car loses control of their vehicle resulting in the pedestrian being struck down, the pedestrian doesn't really have any level of responsibility in the occurrence.  What I am talking about is the person that almost refuses to do anything or solve anything for them self. Here are common occurrences that I face when I, the trauma junkie, am trapped in triage.

1.  My blood pressure is high

 One of the first questions that follow is whether or not you have an existing diagnosis of hypertension.  If you don't, we will proceed without the voices in my head engaging in preparation for the rapid firing of silent insults that will begin pummeling you.  If you do have an existing diagnosis of hypertension, the next question will be whether or not you have been taking your medication in the manner that the doctor has prescribed.  If your answer to this question is no, you will be immediately discredited as a responsible human being and nothing you say matters to me from this point forward.  Seriously, you might as well stop talking.  I can already predict the path of your life and trust me, it isn't a pleasant path.  You are technically suicidal.  No? You don't think so?  You, my friend are wrong.  You ARE killing yourself.  Slowly.  Painfully. Deliberately.  Eventually you will end up as a stroke victim, trapped inside your body and angry that you are in that situation.  You will be rude to me and every person in this world that takes care of you when you come to the hospital.  You will be so angry that your nurse couldn't get into the room to help you do simple tasks like pulling your blanket up higher or offering you a drink of water.  Guess what? Not my fault.  You did this.  Nothing I did caused your current state. Another possible route for your life will be straight to the dialysis center.  You, the patient that couldn't find the time to pop a pill once or twice a day will now be visiting a local dialysis center 3 times a week.  You, the patient that isn't following doctor’s orders are obviously not caring about the end result: your kidneys will die.  Did you get that?  THEY WILL DIE.  Not might die.  Not could die.  THEY WILL DIE.  Again, this is your fault.  Not mine.  All yours.  TAKE YOUR MEDICINE PEOPLE. I could go on and on with this but I will spare you.

 2. I have a toothache

 THIS IS AN EMERGENCY ROOM.  WE DO NOT EMPLOY DENTISTS.  CALL A DENTIST or better yet BRUSH YOUR TEETH. Please, in the name of GOD, please brush your teeth.  Aside from the obvious breath equivalent to that which can be found in the mouths of the inmates at the local animal shelter, it's just pretty disgusting.  Can't you feel those little sweaters of plaque that form on your teeth after you eat? NEWSFLASH- Toothpaste and a toothbrush will remove that.  The simple task of brushing your teeth might actually raise your IQ and assist in your next job interview.  It could also save you thousands of dollars in trips to the ER because of YOUR failure to brush your teeth.  Seriously people.  BRUSH YOUR TEETH. The only dental complaints that should ever present to your local emergency room are abscesses that could obstruct your airway or those that are causing fever (SIDENOTE- simply brushing your teeth can generally prevent these abscesses) OR trauma that has caused damage to your teeth.  For example, if you are at a baseball game and you take a line-drive to the mouth resulting in broken teeth feel free to present to your local ER.  The staff welcomes actual EMERGENCIES.

 3.  I have vaginal/penile discharge

 You are an idiot.  Don't sleep around and if you do you should visit the local health department for screenings at least 2 times a year.  Snot coming out of your private IS NOT AN EMERGENCY.  You are an idiot and I refuse to talk about this anymore.

4. I need a pregnancy test

 Good for you.  Hike on down to your local dollar store and buy one.  We use the EXACT testing kit that you can buy for $1 at the DOLLAR store but we will charge you about $500.  Good for the hospital.  Bad for you.  We don't fill out Medicaid paperwork so you will get your pregnancy test but you will be paying for another one at your local OBGYN office. You are also an idiot. (It now occurs to me that you probably won't actually be paying your bill.  That will be left to the poor tax payers but that is a whole 'nother blog and I refuse to discuss it here.)

 5. My blood sugar is high

 This can actually be a legitimate complaint. These are the questions that your triage nurse will ask you. Have you been taking your insulin? If your answer is no you should be aware that much like non-compliance with the diagnosis of high blood pressure, non-compliance with diabetes is not my fault.  Want to regulate your blood sugar? Follow the doctor's orders.  (Brace yourself; this might hurt a little ) Part of what you can do is LOSE WEIGHT and EXERCISE.  I know you don't want to hear it but it is a cold, hard truth.  90% of Type II Diabetes is caused by obesity. That being said, in the event that you are vomiting or have a legitimate infection, your blood sugar and doses could actually be out of whack and qualify as an actual EMERGENCY. If this is the case, the ER staff won't necessarily roll their eyes at you when you aren't looking.

 6.  I have a headache

 Do you have a history of headaches? If not, proceed.  Have you taken medication for your headache and it hasn't helped? If so, proceed.  Is this the worst headache of your life and different than your usual headaches? If so, proceed.  HOWEVER, if the answer to the above questions is the opposite of those I have provided, GET THE HELL OUT OF THE EMERGENCY ROOM.  I also think it is simply adorable that most of our frequent flyers riddled with headaches are smokers.  NEWSFLASH- Smoking causes headaches.  Want to stop having frequent headaches? Drink plenty of water and stop putting poison into your body. YOU ARE CAUSING YOUR HEADACHES.  I AM NOT CAUSING YOUR HEADACHES.  Be prepared to sit in the waiting room because actual EMERGENCIES will be taken to a room before you. There is no need to holler and cry hysterically.  I realize you are in pain. I also realize that you are more than likely unwilling to hold yourself accountable for the cause of your pain.

 7. I am having a Sickle Cell Crisis

 My first question to you is why? Are you drinking enough water?  Did you stop smoking? Are you getting plenty of rest?  Are you making healthy choices with your diet?  If you answer NO to ANY of these questions, I need you to understand that IT IS YOUR FAULT THAT YOU ARE IN CRISIS.  You are in pain because your blood isn't carrying enough oxygen to the tissues in your body.  Do you know what a lack of oxygen does to the tissues in your body? IT CAUSES THE TISSUES TO DIE.  THIS IS PAINFUL. Proper diet, hydration and just taking the time to practice good, healthy, behaviors will not only save you time, pain, and money but will also extend your life by years.  Sickle Cell patients don't have long life expectancies.  Rarely do we see Sickle Cell patients that live past their forties.  I believe this could change if people would acknowledge their disease process, do the right thing and HOLD THEMSELVES ACCOUNTABLE.

 8. My back hurts

 Does it affect only one side of your lower back? If so, it might be a kidney stone which is a legitimate ER visit.  Did you injure it in the last 24 hours? Please, come in.  You might need to see a doctor.  However, if your back injury happened more than a year ago and you already have a pain management doctor GO SEE THEM.  Honestly, it is ridiculous for you to come to the ER.  The strongest medication we will prescribe in the ER is Ultram.  Deal with it.  I wish we would send everyone out with Lidoderm patches and stop feeding candy to chronic pain patients.  Have you ever dropped a Cheeto at the beach?  Every seagull within a mile can smell that thing and will be headed your way within seconds.  Lortab prescriptions are the ER equivalent to Cheetos at the beach.  Chronic pain patients can smell it before the ink is dry and will present wanting one of their very own.

 9. My fibromyalgia is acting up

 I literally have no words and am moving on.

 10. (Anything) that happened yesterday

 Chances are that if it happened yesterday and you are just now presenting to the ER this is NOT AN EMERGENCY.  Period.  Find an urgent care or a primary doctor to listen to your story.  I am so sorry that someone, somewhere, conveyed to you that you might be able to get some HUGE settlement from Wal-Mart because you failed to notice the bright red ketchup spilled on the white tile floor.  NEWSFLASH: It isn't Wal-Mart’s fault that you have the observation skills of a newborn kitten.  It is YOUR FAULT that you failed to use common sense.  Seriously.

 11. Can you get my prescriptions filled? I don't have any money

 NO. NO. NO.  NO.  NO.  NO.  NO. NO. NO.  You smell like smoke and told me to "Hold On" while you answered your iPhone 6.  Let me repeat- NO. NO. NO. NO.  NO.  NO.  NO.  NO. NO. NO.  It is not appropriate for you to save your last $30 for your manicure or your beer or your cigarettes.  You can afford a prescription. MAKE IT WORK.  Everyone else has to take care of themselves; I think you can also manage.

 12.  Can you call me a cab?

 No.  This is not the Ritz.  Call your own damn cab or call one of your friends that you just HAD to talk to during your triage assessment.  No.  I won't give you a bus pass.  How did you get to the ER? How do you get to the mall or the grocery store?  No.  No.  No.  FIGURE IT OUT.  YOU ARE NOT MY PROBLEM.  IT IS NOT MY FAULT THAT YOU CAN'T FIND A RIDE. Period. Also, it is crucial that you understand that I am not a waitress.  It is against hospital policy for me to accept tips.  Now I don't mind getting you the things that would make your stay better; For example, warm blankets or the occasional cup of ice water.  However, if I don't do this in a timely manner it is absolutely not because I am punishing you.  I AM BUSY.  I AM SAVING LIVES AND STAMPING OUT DISEASE.  Again, I am not a waitress.

 13. I have a rash

Seriously? Unless the rash is inside of your mouth and trachea, I DO NOT CARE.  THIS IS NOT AN EMERGENCY.  Find an urgent care clinic or go to your primary doctor.  Have you visited your local pharmacy? Tried Benadryl or Cortisone cream?  A small part of me dies every time someone checks in for a rash.  Literally DIES.

So it all boils down to this:  Use your brain.  Follow doctor's orders.  Take care of yourself. Save your emergency room visits for EMERGENCIES.  Please.  I absolutely LOVE my job.  I love being an ER nurse although I am sure you have questioned it a few times while reading this post.  I love EMERGENCIES.  E.M.E.R.G.E.N.C.I.E.S.  Emergencies.  Do me and every other ER nurse and patient with an EMERGENCY a favor:  Stay out of the ER if you don't have an emergency because no matter how many times you present with one of the above complaints we will take care of you and we will do so with a smile on our face and pretend to respect you while you are in our department. The problem is that more than likely, while we are doing all of that pretending, there is a patient with a real emergency that is waiting for the bed you are occupying.  Think of it as your own personal contribution to the health and well-being of the world.  Who knows? Maybe if everyone adhered to this train of thought and methodology things would improve.  Maybe the next time you present to the ER with an actual emergency you won't have to wait for the doctor to start the crucial steps needed to save your very own life.