It's never a good thing when a patient is called in, and everyone working triage groans. If all the nurses working know you by your first name:
A. You've been here WAY too many times.
B. Clearly, you come in for unnecessary and frivolous admissions... and
C. You always get sent back home. (if there were really something wrong with you, you'd stay)
We had a visit from a patient (let's call her Margo), who we've gotten to know very well over the past several years, now on her fourth baby.
Resident: "I have a patient coming in... it's Margo ___."
Cacophony of disbelief from everyone within earshot: "Oh nooo... not again!"
She's 32 weeks (a mere 8 or so more to go!) and only on her 9th admission to OB triage during this pregnancy, which, in comparison to her first pregnancy, isn't bad. With that child, she was on visit #36 by the time she finally delivered, and practically everyone who worked OB knew her name. Considering we only triage patients who are 20 weeks and up, that's more than a few visits per week. Back then, I remember caring for her two days in a row, both times for a slip and fall on icy pavement. Oh, Margo.
It never ceases to amaze me that she is willing to drag her husband and several small (screaming) children to the hospital in the middle of the night, through nasty weather because she's feeling some vague abdominal pain and general discomfort.
She actually told the person wheeling her up from the ER, "I really think it's something serious this time... I'm not kidding."
She was triaged and discharged back home with a clean bill of health within 45 minutes.
Until next time...
Showing posts with label triage. Show all posts
Showing posts with label triage. Show all posts
Sunday, February 25, 2007
Wednesday, January 31, 2007
Girls Just Wanna Have... Babies.
You know her. She's the labor-wannabe. Let's call her Labor Girl.
******
Labor Girl arrives in the ER, breathless, cheeks flushed, anxious but elated. This must be it!
Her husband, let's call him Dear Hubby, parks the car and then joins her in ER triage, arms loaded with suitcases, birthing ball, boppy, radio and fan. He is a little panicky... a trickle of persperation slides from his upper lip. What have I gotten myself into?
But Labor Girl is thrilled. The deck of Uno cards is tucked into the front pocket of her suitcase, and a CD of soothing music resides in the portable stereo. This is going to be fun!
She is quickly retrieved from the ER and wheeled to OB triage, breathing obediently when her belly hardens. The babe inside her kicks in protest. She smiles knowingly.
******
Once she is safely ensconced in her tiny (if not somewhat unsatisfactory) triage room, she slowly strips out of the clothing she had carefully planned as her "going to the hospital" outfit. Dons the threadbare and breezy hospital gown, careful not to displace her perfectly coiffed hair and generously applied makeup. Pushes the call light.
Dear Hubby commences hand-wringing in the corner. Perhaps Labor Girl should share her deep-breathing techniques with him.
******
Soon the monitors are applied, blood pressure and temperature checked. Labor Girl dutifully answers the questions of the triage nurse, alternately smiling and breathing with the periodic tightening.
******
Labor Girl arrives in the ER, breathless, cheeks flushed, anxious but elated. This must be it!
Her husband, let's call him Dear Hubby, parks the car and then joins her in ER triage, arms loaded with suitcases, birthing ball, boppy, radio and fan. He is a little panicky... a trickle of persperation slides from his upper lip. What have I gotten myself into?
But Labor Girl is thrilled. The deck of Uno cards is tucked into the front pocket of her suitcase, and a CD of soothing music resides in the portable stereo. This is going to be fun!
She is quickly retrieved from the ER and wheeled to OB triage, breathing obediently when her belly hardens. The babe inside her kicks in protest. She smiles knowingly.
******
Once she is safely ensconced in her tiny (if not somewhat unsatisfactory) triage room, she slowly strips out of the clothing she had carefully planned as her "going to the hospital" outfit. Dons the threadbare and breezy hospital gown, careful not to displace her perfectly coiffed hair and generously applied makeup. Pushes the call light.
Dear Hubby commences hand-wringing in the corner. Perhaps Labor Girl should share her deep-breathing techniques with him.
******
Soon the monitors are applied, blood pressure and temperature checked. Labor Girl dutifully answers the questions of the triage nurse, alternately smiling and breathing with the periodic tightening.
"Well... I'd rate these contractions about 6 or 7 on the pain scale." Straight face. It's that darn pain scale again.
******
Bad news.
"I'm only dilated to 2 cm?"
Labor Girl is clearly disappointed.
Doubt begins to curl around the edges of her optimism.
"Are you going to send me home?"
******
After a short while, the monitors are removed, and Labor Girl begrudgingly goes for a stroll. This isn't as fun as she had anticipated. Who wants to go for a walk at 2:30 in the morning? Another wave of doubt crests. Maybe if I walk a little faster.
******
Round and round she drags Dear Hubby, whose exhaustion has overtaken his fears.
The nurses smile understandingly each time the determined couple rounds the corner. Does Labor Girl think this is a race that she can win? That if she makes it through the hallways quickly enough or does enough laps, then we'll keep her?
******
It's time to be rechecked.
"Yes," Labor Girl nods to the nurse. "The contractions feel much stronger!"
She holds her breath, awaiting the verdict.
"I'm still 2 cm?!"
******
And now, here it is: the Walk of Shame.
Poor Labor Girl.
She trudges out the doors, pouting, vistaril in hand. How can this NOT be it?
Dear Hubby gathers the belongings and follows her solemnly home. Thank goodness this wasn't it.
******
And so, you see, sometimes no matter how badly you want it, labor it is not.
Maybe next time, Labor Girl.
I'm sure we'll see you soon...
Sunday, December 17, 2006
Get. A. Clue.
As per usual after my third night in a row, I'm feeling a little punch drunk and slap happy this morning. (Consider this fair warning that the following post should be read with a VERY sarcastic tone of voice... if you're in the habit of reading posts out loud, that is.)
To all potential patients who choose to shoot up, snort, smoke or drink substances that are a) not legal and/or b) not really recommended during pregnancy (or the rest of your life for that matter):
No matter how dumb or tired your OB triage nurse looks, she is not dumb enough to believe the following really convenient lies that you are about to tell.
-- your UDS tested positive for marijuana because your sister-in-law smokes pot in your house
-- your UDS tested positive for cocaine because you were with a bunch of friends that were smoking crack
Girlfriend, get a clue. And get some new friends.
---------------------------------------------------
Well, you get the idea. Enough sarcasm.
It's been a weekend full of weirdness and busyness... both the good and the bad. Absolutely exhausting, but very fulfilling. I don't know about everyone else that I worked with, but I hope that they walked out of the building this morning with a tired smile and a sense of accomplishment, as I did.
Is there any other profession in which the juxtaposition of such wildly different emotions and realities is so striking every time you come to work? To feel so helpless in the face of unknowns and uncertainties, yet so full of hope for a smooth labor, a good outcome. Sometimes I feel the fear creep up on me... there are SO many things that can (and sometimes will) go wrong. How can we possibly make it through?
Yet we always do. We are never alone. There is always another willing set of hands, another discerning eye, another reassuring word.
Sigh.
To all potential patients who choose to shoot up, snort, smoke or drink substances that are a) not legal and/or b) not really recommended during pregnancy (or the rest of your life for that matter):
No matter how dumb or tired your OB triage nurse looks, she is not dumb enough to believe the following really convenient lies that you are about to tell.
-- your UDS tested positive for marijuana because your sister-in-law smokes pot in your house
-- your UDS tested positive for cocaine because you were with a bunch of friends that were smoking crack
Girlfriend, get a clue. And get some new friends.
---------------------------------------------------
Well, you get the idea. Enough sarcasm.
It's been a weekend full of weirdness and busyness... both the good and the bad. Absolutely exhausting, but very fulfilling. I don't know about everyone else that I worked with, but I hope that they walked out of the building this morning with a tired smile and a sense of accomplishment, as I did.
Is there any other profession in which the juxtaposition of such wildly different emotions and realities is so striking every time you come to work? To feel so helpless in the face of unknowns and uncertainties, yet so full of hope for a smooth labor, a good outcome. Sometimes I feel the fear creep up on me... there are SO many things that can (and sometimes will) go wrong. How can we possibly make it through?
Yet we always do. We are never alone. There is always another willing set of hands, another discerning eye, another reassuring word.
Sigh.
Monday, October 23, 2006
Welcome to OB Triage
Sometimes I'm convinced that the management and physicians have conspired to place a glowing sign at the ER entrance that states (in large flashing pastel pink and blue letters), "All pregnant freaks and their families, WELCOME! C'mon in to OB Triage" To top it off, the sign is only lit during the most inopportune (i.e., already busier than crap) times.
Case(s) and point:
You are 26 weeks pregnant and have been vomiting for four days. You are starting (Starting?) to wonder if something is wrong. When do you come in to triage? 2:00am on a Saturday night.
You are 39 weeks pregnant and twisted your ankle while tripping over your toddler. Yesterday. Oh, and you don't have a car or money for a cab, so you've missed your last four prenatal visits, despite being high risk due to a history of high blood pressure, diabetes and a pulmonary embolus. When do you roll into triage by ambulance (thanks, glad I just paid my taxes so that you could spend about $1000 of my tax money for a ride... oh look, here comes the rest of your family, who got here in their CAR.)? 2:00am on a Saturday night.
You were sitting on the couch naked ('cause that's something I'd admit to my health care provider), 36 weeks pregnant, eating ham (I repeat, while sitting on the couch. Naked.), and your boyfriend took it upon himself to "check" your cervix, only he noticed some green funk down there instead. In addition (as if that were not bad enough), there was something pinkish on your boyfriends fingers when he pulled them back out. But it might be ham. (Gag. True story.) When do you come in to triage? 2:00am on a Saturday night.
You are 21 weeks pregnant and have not had a bowel movement in three (seriously, I'm not kidding) weeks. When do you come in to triage? 2:00am on a Saturday night. (because NOW it's bothering you?)
You are 24 weeks pregnant and have not felt the baby move for "a couple" of days, which concerns you, despite the fact that you weigh almost 400 lbs and probably have a foot and a half of adipose tissue between the baby and the nerves of your abdominal skin. Oh, by the way, you also have asthma and are having a coughing fit but forgot to bring your albuterol inhaler. What else do you take for your asthma? Nothing, just the albuterol, and since you usually feel worse at night, you use it an average of 6 times every night. (Pause, while nurse picks up lower jaw from floor.) And the icing on the cake, you are latex allergic and have a history of MRSA, so you must be kept in contact isolation. When do you come to triage? 2:00am on a Saturday night.
You have not received prenatal care during this pregnancy due to the slight inconvenience of being incarcerated for the last few months, in another state ("It was my boyfriend's dope in the car, I swear!"), and your mother only recently bailing you out. Now you're just curious how far along you are, and "Can we do an ultrasound to find out the sex of the baby?". When do you stroll up to triage? (Are you sensing a pattern yet?) With perfect timing, you, too, arrive in the middle of our "lunch time". (Looks like it'll be a couple of peices of the Halloween candy someone brought in, swallowed whole, on the run, again.)
Yes, there are quite a few legitimate patients who visit the triage unit amidst the chaos. I wouldn't be surprised if most of them get lost in the shuffle.
Hey, at least I still got my health.
Case(s) and point:
You are 26 weeks pregnant and have been vomiting for four days. You are starting (Starting?) to wonder if something is wrong. When do you come in to triage? 2:00am on a Saturday night.
You are 39 weeks pregnant and twisted your ankle while tripping over your toddler. Yesterday. Oh, and you don't have a car or money for a cab, so you've missed your last four prenatal visits, despite being high risk due to a history of high blood pressure, diabetes and a pulmonary embolus. When do you roll into triage by ambulance (thanks, glad I just paid my taxes so that you could spend about $1000 of my tax money for a ride... oh look, here comes the rest of your family, who got here in their CAR.)? 2:00am on a Saturday night.
You were sitting on the couch naked ('cause that's something I'd admit to my health care provider), 36 weeks pregnant, eating ham (I repeat, while sitting on the couch. Naked.), and your boyfriend took it upon himself to "check" your cervix, only he noticed some green funk down there instead. In addition (as if that were not bad enough), there was something pinkish on your boyfriends fingers when he pulled them back out. But it might be ham. (Gag. True story.) When do you come in to triage? 2:00am on a Saturday night.
You are 21 weeks pregnant and have not had a bowel movement in three (seriously, I'm not kidding) weeks. When do you come in to triage? 2:00am on a Saturday night. (because NOW it's bothering you?)
You are 24 weeks pregnant and have not felt the baby move for "a couple" of days, which concerns you, despite the fact that you weigh almost 400 lbs and probably have a foot and a half of adipose tissue between the baby and the nerves of your abdominal skin. Oh, by the way, you also have asthma and are having a coughing fit but forgot to bring your albuterol inhaler. What else do you take for your asthma? Nothing, just the albuterol, and since you usually feel worse at night, you use it an average of 6 times every night. (Pause, while nurse picks up lower jaw from floor.) And the icing on the cake, you are latex allergic and have a history of MRSA, so you must be kept in contact isolation. When do you come to triage? 2:00am on a Saturday night.
You have not received prenatal care during this pregnancy due to the slight inconvenience of being incarcerated for the last few months, in another state ("It was my boyfriend's dope in the car, I swear!"), and your mother only recently bailing you out. Now you're just curious how far along you are, and "Can we do an ultrasound to find out the sex of the baby?". When do you stroll up to triage? (Are you sensing a pattern yet?) With perfect timing, you, too, arrive in the middle of our "lunch time". (Looks like it'll be a couple of peices of the Halloween candy someone brought in, swallowed whole, on the run, again.)
Yes, there are quite a few legitimate patients who visit the triage unit amidst the chaos. I wouldn't be surprised if most of them get lost in the shuffle.
Hey, at least I still got my health.
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