Vegas times

[yyz]

I don't think he likes the Vegas hospitals. How are the hospital(s) up your way?

Las Vegas is a sewer between the bright lights and the suburbs. I dont envy Clint's position at all.

I should have done some write-ups over the years!

[Dr Feelgood]

Did someone say shit??? Come play at the poop plant for a day!!

#SmellsLikeMoney

[SixFive]

Back to the ER today, 🤦🏻And I have this dickweed named Gregory. He’s homeless, and I love to help homeless people. Feed them, offer them services, a safe place, and the ability to clean up. This guy though is a punk. He comes day after day and complains. Somebody always is stealing his things supposedly, and he always wants a catheter. This is a man who can walk and is oriented, but he always tries to con the nurses into putting in a catheter he says he needs one BC he’s going to drive to Detroit :rolleyes:

This guy is the epitome of a button bitch. He presses his call light constantly for food, drinks, to hand him his homeless bags of crap, to complain about other staff, and to request security. He always want to report his valuables being stolen. Nobody wants to get within 10 feet of him much less go thru all his bags of crap xsto

Anyway, I finally get him a room assignment and out of the ER. Once he got up there though he raised hell Bc he didn’t have a private room. Gmafb! What a terrible patient not to mention horrible human being.

[MadJack]

he says he needs one BC he’s going to drive to Detroit :rolleyes:

[SixFive]

AMA failure

I have a friend in Kentucky who is physician. He says that he his favorite acronym in medicine is AMA. This stands for Against Medical Advice and generally refers to a patient who decides to leave the hospital before the physician determines they are medically ready to leave. He jokingly says this Bc usually this is the type of patient who is difficult to provide care related to non-compliance or just being a jerk. Why waste the time and money of the taxpayers to come to the hospital only to sign out AMA because you need to smoke a cigarette or for any trivial reason? I had a regular patient back home who would come to the emergency room for chest pain 2-4 times a week, be admitted, then leave AMA the next morning Bc she needed to drink. Why admit her in the first place? Well, she would always have elevated heart enzymes and out of control hypertension. She was likable, and relatively an easy patient, but still the whole process got old really fast.

Yesterday, I had a patient who I knew right away was going to leave AMA on my shift. He was 42 with a diagnosis of bilateral arm abscesses. He’s a heroin user, and we commonly get patients with his history admitted in the hospital. The treatment is to lance or sometimes do an I&D surgery on the abscess, IV antibiotics, pain control, and IV fluid hydration (supportive care). The abscesses are caused BC the heroin is cut with who knows what and non-sterile/dirty injections. The user also exhausts his veins, so resorting to skin-popping or muscling is used which will cause more frequent abscesses.

The nurse who gave me report said he was getting Morphine 4 mg and Dilaudid 1 mg for pain. The Morphine for him is a waste of time because of his high opioid tolerance. The Dilaudid is more on track, but it would have to be about 2 mg every two hours instead of every 4. Patients who are used to using heroin in large amounts like him start to become “dope sick” pretty fast, and they just can’t stand it. The body gets addicted to the heroin and starts to withdraw with symptoms like pain, nausea, vomiting, diarrhea, anxiety, restlessness, tachycardia, and abdominal cramping. They keep using heroin BC the “dope-sickness” is such a horrible feeling. Dilaudid is nicknamed Hospital Heroin, so to keep him from leaving, you essentially give enough of it to substitute To stave off the dope sickness.

I liked this guy. I treat everybody like I would want my folks treated no matter their circumstances until they give me a reason not to do so. He was honest about his habit which he said was $100 a day. I asked him if he worked, and he said he was a trained plumber. He can do side jobs, but BC of his addiction, he can not keep a regular job. I asked him if he got his money by hustling, and he said he did. I usually see patients with a $40-$60 a day habit. $100 is a lot of heroin! He told me he starts to have withdrawal symptoms at about the 6 hour mark. I told him it must be exhausting for him to hustle enough to keep that up. Have you ever thought about being a heroin user as being hard work? If you had no money, no possessions, and no family/friends to help, could you come up with $100 a day? It’s so sad that he has not been able to kick this and use his street-smarts and resourcefulness to do something productive.

I communicated with his physician several times during the day, and he seemed to care, but his hands are really tied as to what he can do. This guy is already ordered big doses of opioids.

I tried to confirm his methadone dosing with a local clinic, but I could not. If I could have obtained an order for methadone, he might have been comfortable enough to stay. I know this guy is going to leave, and I can’t do anything about it. He did end up leaving around 3pm. He apologized to me and thanked me for helping him and caring. I gave him a little money for the bus even though he didn’t ask for it. I gathered up some food for him to go, and told him how to get out of the hospital, and he left. I didn’t mention earlier, but he has a wife who is also a heroin addict. I know he was worried about her, and this is another reason he was leaving. I know women who are addicted have to resort prostitution/sexual favors to hustle their money, so I’m sure he had all those thoughts running thru his mind as well.

Lastly, his story is a common one. He was hurt on the job and prescribed pain pills. The opioid crisis hit, so it became very difficult for him to get his prescriptions, so he started using heroin BC it’s so much cheaper than street pharmaceuticals. $100 a day for heroin is probably on the lines of 640 mg of oxycontin which would have a street value of over $1000. If you didn’t know, many doctors who had been prescribing opioids for their patients completely stopped. Some would offer referrals to pain doctors, but many did not. The “opioid crisis” made it difficult for many people who have legitimate chronic pain to get their medications. Of course, using heroin is a poor choice, but it’s just not as easy as lumping all users as worthless “dope heads”. There are so many sad stories and ruined lives. I have seen so many heart-breaking cases, and it’s even more sad to me that I can’t do anything about it when my job is to help people.

[freelancc]

I don't think he likes the Vegas hospitals. How are the hospital(s) up your way?

there is only 1 in town... and i try to avoid it at all cost.. most people i hear go across state lines to St. George Utah where there are many more options for health care..

[SixFive]

Crack and Jack

I’m working, and I hear another nurse talking about her patient who doesn’t have an IV. Nobody can get it, and there’s no PICC/Midline nurse available. I tell her I’ll give it a shot since that’s my specialty.

I go in the room, and the patient is a nice older lady probably 70 or so. Her arms are completely discolored and bruised, and she is jaundiced. She obviously has some liver failure problems. I don’t know anything about her when I walk in the room other than she needs an IV. She starts by saying I must be there to start an IV on her. I tell her I am and remark that I hear she’s been difficult (I can tell she’s the kind of patient I can cut-up with). She smiles and agrees with me.

I ask her why she is in the hospital and she confirms she has cirrhosis. She said she had a lot of bad habits in the 60s/70s Vegas scene. She said she drank a lot and did a lot of coke. “Crack and Jack were my friends” she tells me. I’m intrigued now because of of her openness, so I say she must have made good money to afford those “friends”. She said, “yeah, I was a hooker”. I asked her if she had any famous clients. She said sure, Wayne Newton, Sugar Ray Leonard, some Saudi princes, and lots of mob guys! She said Wayne Newton likes her so much he gave her a horse!

I have since looked up Wayne Newton. I knew who he was of course, but it appears he has given away several horses over the years. She said her horse was an Arabian. I asked her what happened to it, and she said she would ride it from time to time but it died unexpectedly.

While speaking with her, I get her IV and tape it all securely. I believe everything she told me because she was so honest about things she didn’t have to tell me. She’s a very interesting Vegas character who agrees that this place was much better when the mob ran things. She was also resigned to her fate whatever it is. Be it today or tomorrow or next year, she knows she has a terminal condition, and she’s ok with it. She said she had led an incredible life and has no regrets.

[SixFive]

Free is not fast enough!

Patient is in the ER. She needs a blood transfusion and dialysis. She’s chronically ill with end stage renal disease, but she commonly misses dialysis BC she is stupid. She then comes to the ER Bc she can’t breathe

She gets a unit of blood and emergency dialysis and is streeted. This happens at least once a week. She has Medicaid, and she calls the ambulance every time Bc she doesn’t have a car. There is no accountability. Bad choices, hmph... just call an ambulance and have the hospital bill Medicaid 50 k every week. No skin off her nose.

Anyway... I’m all for Medicaid and even open to Universal Healthcare discussion. I just want some accountability for these leeches to the system.

At the end of her treatment, she is ready for discharge. The husband is given a number for a local transport company that will take them both home and bill Medicaid. He complains that he doesn’t usually have to call, and he doesn’t want to do it. He also complains that the company always takes too long to get them. 2 hours is a long time to wait I know, but it’s free...

I suggest he call a cab or get an uber if he wants to get home earlier. Quit complaining. Free is just not fast enough for this clown. How about be thankful that the hospital once again saved the life of your wife who is too stupid to keep her free dialysis appointment which causes her shortness of breath and this an ER trip? Idiot. He’s ranting and raving up and down the Er hallway. Get lost, professor, and we will see u in a few days. Ungrateful moron.

[SixFive]

My patient is big. I’m talking 600 pounds big. She has these tiny little legs and a gargantuan abdomen. She’s in the hospital because she has a peritoneal infection. In her case, she developed a hole in her lower abdomen/pannus which resulted in a huge infection and sepsis. She has had surgery a few times to try an debride this wound, and she’s on IV antibiotics. She has a large dressing over this wound. The wound also unsurprisingly is positive for MRSA. She’s in a “big boy” bed, and she literally is almost as wide as the bed even though it is 4.5 feet wide.

Anyway, she’s only 40, but she’s incontinent. We have the Pure Wick system which basically looks like a hotdog made out of a sponge. It is placed down between the labia and hooked to suction, so when she pees, it goes right in the suction container. A great invention for her for sure. When she poops thought, it’s another story

The cna tells me she has pooped, so of course he’s going to need help. We gown and glove up (no masks of course BC there is a shortage (don’t get me started on that bullshit). We started cleaning her, and the poop is soft and all up in her multiple crevices, and folds. I roll her over to my side while the cna starts cleaning. She is on her side against the rail, and she can hold on and help. It takes a long time to clean her, and I can feel something wet on my leg. I look down, and it’s wet, and I also feel moisture on my stomach?? I say out loud something is getting me wet? I step back a bit, and my isolation gown is caught between the bed and the side rail. The patient’s would is draining, and it’s copious and straight up pus!! Idc that she has MRSA even. This, I have decided on retrospect is the grossest thing that has happened to me in my career. The pus has drenched thru my gown to soak my scrubs on the abdomen and thighs area areas. There is a puddle of pus on the floor!!

To make it worse this patient said, “didn’t the other nurse tell u that my wound drains when I’m turned over? no she didn’t I say, and why didn’t u tell me? I was livid and disgusted. We finally finish up after putting skin protectant cream all over and on her “coochie” as she requested.

I walk out soaked with pus and head to the bathroom. It’s 6:45 pm, so thank goodness it happened late in the shift. My co-workers are mortified like me and send for some hospital scrubs. I tell them they won’t be big enough, and I go rinse and wash my scrubs the best I can. I then dry with paper towels and put back on. They bring me scrubs, and I try on the shirt, but it doesn’t go below my navel so I’m not wearing them. They can’t believe an x-l won’t fit me, and I remind them that I’m not a small person.

I finish my shift, give report, go home, and strip and shower.

Let’s relate this to covid. This patient has mrsa which is very contagious, harmful, and hard to kill. I was wearing all the right PPE correctly, but the gowns are made of paper and are not reliable. Covid is much more contagious. We can’t even get plain old surgical masks. There are no n95s. It’s a joke. How am I possibly not going to catch this crap? Pray for me and my wife. This time sucks to be a nurse. Here we are all scared of covid and I get a gigantic exposure to Mrsa ffs

[kickserv]

We can’t even get plain old surgical masks. There are no n95s. It’s a joke. How am I possibly not going to catch this crap?

That's fucked up.