Sunday, June 17, 2007

Things I've Learned... 

... From working in the Emergency Department.

1. Drunks are FAR too clever then we give them credit for.
They know the system far too well. Should one of them get abuse or out of line and we escort them out, or they have to wait in the waiting room for a spot like everyoen else, they will leave, walk next door to the physciatric crisis center, claim to have suicidal ideations, and they will bring them right back here. And then we HAVE to put them in a spot and have someone watch them. They will sleep it off, and then deny suicide in the morning.

2. Your Medicare Dollars are REALLY wasted. (Pun intended)
I can't tell you how many people I have registered with Medicaid who did NOT need to be in the ED, but could have gone to a primary care doctor or dentist. If we are loosing money on medicaid it's because primary care and preventative visits are not covered, and people come to the ED with a head cold and rack up a $1000 bill instead of the $100 bill a primary could have charged. Plus the drunks and drug seekers all seem to have Medicaid. I am paying for these people to sleep off their own excesses.

3. EMTALA doesn't work.
EMTALA is designed to prevent hospitals from turning away those without insurance who need care. Unfortunatly, it's BADLY written. While a private hospital like St Peters can turn away someone who has chopped off his fingers, but doesn't have insurance, we can't turn away a habitual drunk, or known drug seeker.

4. The "Look Test" is Real.
You don't have to be a trained medical professional to be able to look at at someone and KNOW that something isn't right. Of course this has to be used in conjunction with other stuff- like a complaint of chest pain and a bad look test is an instant "grab the nurse now" moment, whereas a hand pain that has an iffy look test, will be added to the top of the pile, but not rushed right back to a room.

5. It's wrong to judge someone- but we do anyway.
You get jaded in a place like this. You see a complaint of someone swallowing something by accident, or Suicidal or being stabbed or shot and you really judge the people. Sometimes you are right and you feel justified in your actions, sometimes you are wrong- and feel like a piece of shit. Most of the time though you are right.

6. Everyone things the ED will be a fast in/out experience.
If you EVER need to go the ED, you should allow at least 4 hours. If you don't want to 'sit around' for that long, then you are not really sick enough to come to the ED. And that 4 hours is just after you get IN the dept, that doesn't include the wait for a room. The ED is a happening place. Most of us (nurses, clerks, PCA's everyone) don't get to sit down at all for our 8 or 12 hour shifts.

7. People are MEAN
M E A N. I've had people tell me that it was on my shoulders if someone died and their son couldn't come in. We were on lockdown NOONE could come in or out- I had NO control of that. I've had people ask me if I was paid to think because I asked them to wait for the visitor liason. I've had people yell at me that they would sure because they waited too long to be triaged. I've been told that the fact that I can't give Medical information over the phone is unexceptable (That's a FEDERAL rule- not mine!) People just show no consideration at all.

8. Pus is Gross.
Yes Pus. I've seen blood, bones sticking out of the skin, poop, vomit, spittle. Nothing is as gross as pus. I'm gagging just thinking about it- so I think I will stop. Bile is a close second.

9. I will never EVER get on the back of a motorcycle.
Not for a million dollars. They nature of the injuries I see here because of motor cycle accidents..... it's NOT worth it.


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