Buried Acorns and other nuts

I was off the last two nights. I was expecting a quiet night as it was rainy. It was a fairly quiet night except…. I was reading the reports of the last two days and several were generated about a 10 year old in the ED psych unit. He had struck a tech and had bitten a CRISIS therapist. They had removed his bed because he was jumping all over and trying to trash it. My first round through I checked on him and he looked like a normal quiet kid, playing in the corner. A couple of hours later we got the STAT call. He had thrown his mattress and was all agitated. We had to go in and take his toys out of the room and then had to go back in and hold him down while he was medicated. While waiting for the meds he was yelling, screaming and calling anyone within range “fucking assholes’” and saying how he is going to kill us. He was punching and kicking the door, and head butting it. We went in and got him medicated. The MD came in and observed his behavior and ordered another round of meds. We went in again. We would bring in the mattress, and place him on the mattress and hold him down so the RN can IM him. He punched each of us, but he is only 10. When we took back the mattress he grabbed my arm and dug his fingernails in and broke skin. It was minor but everyone said to sign in. His parents were IV drug users. They abused him and he was taken from then when he was five and he lives with foster parents now. The damage has done and his wiring is all wrong. They were testing him for the alphabet (HIV, HBV etc) because he bit the crisis Dr. Everyone said I shoudl sign in to cover myself, so I did. There have been numerous references to The Exorcist and people were looking for a priest and holy water. I’m glad they didn’t have pea soup for dinner in the cafeteria.

While this was going on, in between rounds of med, we got called to another part of the ED. Nurse found a patient snorting oxycontin. He is a medical patient and they don’t have to change into a johnnie and be searched. My partners searched him and got the oxy and a large knife and removed his clothes and personal effects. We went back in and searched the room. He has tracks and looks like he might be getting dopesick.

We have a police portable radio in our office in the ED. Just before end of shift we heard a pursuit. A guy had flashed a gun in a road rage incident. The police located his car and he rammed the cruiser when they tried to pull him over. A pursuit ensued and ended shortly later with “shots fired” coming over the radio. Then they called for an ambulance and started a crime scene. According to the morning news he wasn’t shot, only his car, but I will find out more tonight.

Most nights I just don't feel like writing...Either there is nothing going on to write about or its the same routine with only the faces changing...

Tonight I came home feeling good. We had a female come in through triage for suicidal. She lost her mother yesterday, she said, and she was here with her father and sister. She was getting cold feet and decided to leave. The nurse begged her to stay but she walked out. She had not been cleared medically or seen by CRISIS. With a nod from the nurse we would have hung onto her and done what we had to to keep her safe. Nurse allowed her to go but said she would call the police to go to her home and bring her back on a PEC (police emergency committal). I caught up with the patient in the parking lot and told her she would be brought back by police if she left. The nurse came out and together we were able to talk the patient back in voluntarily. Many people talk suicide, threaten suicide, make suicidal gestures. The overwhelming lot are just that, gestures. But unfortunately, a few actually do go through with it and nobody wants it to be their patient, even though for some, it has. We had a gunshot suicide not to long ago where the wife left a guy so he went outside and head shot himself in the front yard. The wife and her family were at the hospital and his family was also there and we had to keep them all separated, as they blamed her. Lots of guilt and anger going around.

It was a strange night. Started with the trucker on the highway who decided he was having a heart attack. He called 911. He wouldn't pull over for police so he drives his rig to a grassy area next to the hospital entrance. Police call an ambulance. He refuses, saying he is not going to pay $700 to be taken a hundred feet (it was longer than that.) He is going to walk. He makes it a few feet and goes down, but is still conscious. Some of our suits are out there waving their Nextels, trying to look important and I am called to bring out a wheelchair. So I go out and load him and bring him in. He is a big unit and its 90 degrees out. He refuses to give insurance info to the registrar. We think he doesnt have insurance. When I left end of shift he was still there. They said later he did have a heart attack.

Had a female approach me saying she was a patient over the weekend and was here for her meds. We don't handle meds so I take her to the pharmacy. They don't have them. I take her to the ED and there is no record there. I take her to medical records and there is no record there. This took about 45 minutes, all over the hospital. So she says she will go home get her receipt and come back tomorrow. She said she was admitted for ETOH. Later I find out she was admitted Friday night, my day off. She ran out of the ED trying to escape and was caught in the employee parking lot and brought back and restrained. She was admitted under a different name, so its no wonder no one could find her meds. Correct name usually is need to know information. What a waste of time. Yesterday on day shift a psych patient ran out of the ED. The guys chased him, as he was a keeper. He swung at one of them. The other guy took him to the ground. They got PD to help bring him back. One of our guys ended up with a broken big toe. Sometimes you feel like its us vs. them.

We got called to a floor room 18 to assist staff. Yesterday I was called to another floor room 18 for a 91 year old who punched a nurse. I am wondering if the dispatcher got it wrong and we need to visit the old guy again. She didn't. This one was a male a few days into detox who was shaking like mad and wanted to leave. He was in no medical condition to leave. Detoxing is pretty nasty and it takes a few days.

Waiting room is packed, SRO. Female comes running in wearing a restaurant uniform. She has another female in the car who is having an allergic reaction to shellfish and cant breathe. I go yank her out of the car. She is gasping and groaning. I wheel her through the full waiting room and notify the triage nurse. She takes her right away. A little while later the patient is fine sitting in the wheelchair waiting to go in back, talking on her cellphone.

2 DMR patients come in after duking it out in the group home. They come in about five minutes apart by ambulance They go to opposite ends of the ED. Each has a DMR worker with him. Around 2300, one is discharged, but his worker brings him over to the other so she can chat with the other DMR worker. Both workers are obnoxious and become verbally abusive to staff. We escorted the discharged one and his worker out the door. Its too busy to be putting up with their verbal abuse, and nobody wanted to see round two of the fight.

Hope it quiets down for the midnight shift.