Another Triage Tale

Another ER night shift, another exciting opportunity to triage.

So, TINS, TIWFDASL, and another lucky soul ambled in to have his disease fought and his life saved from the scourge, the morbid threat, the life changing consequences of having contracted….THE SNIFFLES!

I sought to elicit his chief complaint, history of present illness, review of systems, daily medications, and medication allergies. His answer to the last, stopped me in my tracks.

“I’m allergic to everything.”

I did another literal, physical double take. “Pardon?”

“I’m allergic to everything!”

“Uh, sir? Are you telling me that you have never, ever, in your entire life, taken a medication that failed to make you ill? Every single time? Without exception?”

“Yep.”

“Every time? Not once did a medication fail to make you ill? Every single one you have ever taken?”

“Yep.”

“I’ll make sure the doctor knows that.”

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Nursing Story The Third

Another day found me triaging. As always, TINS, TIWFDASL, and my next lucky contestant sat down. Again, with the chief complaint, history of present illness, review of systems, vitals, allergies medications and personal medical history.

As I wound up my interview, I asked, as I typically did, “Do you have any questions?”

Of course, my correspondent replied, “Yeah. Is the doctor gonna give me any medicine with any side effects?”

“Sir, why do you ask?”

I found out why he had asked. “Well, I don’t want no medicine with no side effects!” (No, he did not appear to be a Rhodes Scholar).

I performed a literal, real, physical double take. “Excuse me?”

“Because I don’t want no medicine with no side effects!”

Being an old fire department medic, I commonly repeat back what I had just heard, in order to assure that I had heard what I had thought I had heard. This time, I needed it.

“So, you’re telling me that if anybody, anywhere, ever, anytime, had had any side effect from any medication, whatsoever, then you do not want to take that medication? Did I get that correct?”

“You did. I won’t take no medicine with no side effects!”

I told him, “I’ll make sure that the doctor understands your concern,” and ushered him back into the waiting room.

Nursing Story The Second

Again, TINS, TIWFDASL in some other ER, in some other little town. The night of THIS story, I had a patient assignment, and one of my patients was the subject of a an order that he receive an IV (infusion of sterile fluid) and a blood draw. Typically, these are performed simultaneously, as very few folks really enjoy a second needle stick in order to obtain the blood that you did not obtain the first time you subjected them to a needle stick, to start the IV. I thought, Easy-Peasy, no problem, I can do this, just like the thousand and twelve other times I had done this very thing.

I gathered the supplies I would require, and approached the patient, launching in to my stock spiel. “Hello, sir, I’m Reltney McFee, one of the nurses, and I here to start an IV and draw some blood. Please, say your name.”

He said his name, the name I was expecting, and asked, “What’s an IV?”

I explained, “Well, sir, I stick a small needle into your vein right here on your forearm, and slide it out, leaving a small plastic tube in the vein. I connect this here tubing to the hub of that plastic tube, and administer sterile fluid to help you feel better. You should feel the benefits in under a half an hour.”

“Will it hurt?”

My internal dialogue, effective squelched by my functioning thought/speech filter, ran along the lines of either “I’m fixing to stick you with this here pointy thing, and you wonder if it’ll hurt? Naw, hell naw, I won’t feel a thing!”, or “Yep. Hurt like a motherfucker. I don’t think you will completely pass out, but, just in case, I’ll get some towels when your bowels and bladder release from the pain, OK?”. Due to that filtering, I said, “Sort of, for a minute.”

He then asked me, “Doc, hurry up!”

I corrected him. Not every male with a stethoscope is a physician. “Sir, I’m a nurse, not a doctor. I’ll be as gentle as I can be.”

He was not listening, it appeared. “Oh, doc, doc, doc! Hurry up!”

I set my stuff down, and faced him. “Ok, here is how this works. I can, if you wish, do this really fast. Or, as an alternative, I can do this once, correctly. Which of these sounds better to you?”

“Uhhh, once sounds better!”

“Very good choice. Now, maybe you would allow me to do this, just like I’ve done it several thousand times before, OK?”

“Uh, OK.” And he stuck out his arm.

So, I applied the venous tourniquet, prepped the site, set up my blood draw tubes, readied my adapter, tore my tape and prepared my site dressing, one puncture, blood flash, and steadied the hub as I withdrew the needle. Attach adapter, obtain blood, remove adapter, attach tubing, secure tubing connection, tape hub, apply site dressing, create and tape down “tug loop” in IV tubing, set IV drip rate, and collect my trash and blood and off I go. Send blood, chart IV start, done.

Like I said, Easy-Peasy!

Nursing Stories The First

So, TINS, TIWFDASL in an ER in a little hospital in Da City. The night of this particular tale, I was in triage, and so found myself interviewing this febrile, coughing, achy, miserable soul.

We had conversed about his medication allergies, which medications he regularly took, his own medical history, and were beginning to chat about the events that had led him conclude that a visit to ER was the prudent way to spend his evening.

He had already cataloged the fever, cough, and myalgias culminating in our lovely little chat, when he shared with me the fact that, “Doc, I’m so sick that I cannot even smoke!”

I had spent a rather busy night in triage, and was kinda lacking in sympathy. In addition, my “Thought/Speech Filter” was in need of some preventive maintenance. I replied, “You do know, sir, that in some ways, that could be regarded as a clue?”

Fortunately, this gentleman had a very robust sense of humor. His chuckled reply confirmed it: “I know, right?”