Only in the ER

The nurse instructed the patient to undress and to provide a urine specimen. She handed the patient a clothing bag and a specimen container. Minutes later, he handed the nurse the clothing bag with a dark amber colored fluid in it. He reasoned out that the specimen container was too small to hold all his urine.


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Whenever I come out into the ED Waiting Room to call a patient, I always feel like a celebrity. Patients and families rush up to me like I'm a goddess who's going to sweep them into the examination rooms. Right! Don't they know that the ER is like a madhouse and that it's almost Standing Room only?
Sometimes I feel like the hungry crowd is closing in on me. I can feel their hot breaths of anticipation and see the hostile glances from those who are left behind.


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The EMS is between a rock and a hard place. Because of the EMTALA/COBRA laws, NY EMS cannot refuse transports for the following:
1."I have a clinic appointment and I can't afford a taxi."
2. "I didn't make it to the Methadone clinic before closing time. I need to go to the hospital for my dose."
3. "It's too cold out in the streets and I don't want to stay in the shelter. Bring me to the hospital."
4."I just wanna talk with somebody."


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Sometimes at triage, it's like pulling teeth just to get the right information from the patient. They either bring all their chronic complaints, or they expect you to deduce their medical history from their medication bottles.
Then, after all that, their complaints change when they see the physicians.


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Most alcoholics are Houdinis. They can get out of the fanciest restraints. One advice I've followed through the years: Undress these patients and keep their clothes inaccessible. And if they do get out of restraints, it's easier to catch them. Just follow the ones running naked through the ER.


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Overheard at Triage, in the middle of the blizzard...
Patient 1: "I have ingrown toe-nail.'
Patient 2: "So what if I have this arm pain for 15 years?"
Patient 3: "I need a sonogram, my head is buzzing."
Patient 4: "Is lunch served yet?"
Patient 5: "I have itching down there. Do you want to see?"
Patient 6: "I need a physical."
Patient 7: " Is Psych open?"
Nurse: "Oh yes, they still have room for one more patient."

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The nurse heard grunting from the other cubicle. Thinking "Dolly" (one of our ER alcoholic regulars) was in pain, she drew the curtain. Dolly and her boyfriend were in a compromising situation.


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"Are you pregnant?",the triage nurse asked the female patient who rushed into the room. The patient was puffing hard and writhing in pain.
"No way! I'm just fat."
Minutes later, the patient's spandex began to sag at the crotch. The nurse barely had time to catch the baby.


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When undressing a patient for exam, be ready for the barrage of scents that assault the senses and challenge your gut. Don't remove the socks unless absolutely necessary.


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Sometimes, my ears ring because of the constant onslaught of curses from patients and families. I handle them as firm and as professional as I can be. And in my mind, I curse them back in my own language. It helps.


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A doctor looks around wearily, "Who's my nurse?"
I ask him back, "It's 12:00 o'clock already, don't you know who your nurses are?"


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For the umpteenth time, I had to explain to the irate relative. "Sorry, sir, there's a lot of patients today. Many much sicker than your wife. Yes, we know that her ingrown toenail is hurting too much."