Originally Posted: 2005-04-07 12:50am
Emergency Room Manners
People, I am a triage nurse at a busy Emergency Room. I have a lot to say. . .
Do NOT come up to the front desk of the Emergency Room, fling your health insurance card at me, tell me that your doctor told you to come in, stand there with a bored expression on your face and cross your arms over your chest. That is not helpful. When I ask what you are specifically here for do not repeat that the Doctor told you to come in. When I ask what SYMPTOMS caused you to come in; Do not say that it’s in the computer. Ahem;
There are 16 God damn people behind you all sicker than your whiney morbidly obese smoking ass. I’m not going to take the 8 minutes to log onto the computer, log my way in and through your medical record until I get to the part where your doctor’s phone nurse writes “This asshole smoker called me because he’s got a cough” Just tell me that you’re here for the fucking cough!
If your spouse (usually the sensible one) drags you in for the stroke that you had 3 days ago and you still have facial droop, slurred speech, and one-sided paralysis do not state that “My wife made me come in” when I ask why you’re here. Just tell me what the fuck you’re here for. And after I put you in line to go back to the ER do not send your cringing hand-wringing co-dependant family members up to me every 15 minutes to ask if it’s your turn yet. IF IT WAS YOUR TURN WE WOULD BE CALLING YOUR GOD DAMN NAME. The window for stroke treatment was 3 hours. Now that you’re long past it you’re looking at a lengthy rehab. After 3 days another hour or four won’t make a lick of difference. Your anger, frustration, worry, and regret will not get you in any faster. As the slow truth of your stupidity sinks in do not glare at me.
Do not ask to talk to my supervisor or the hospital supervisor when I talk to you in the same tone of voice that you talk to me. This is not Burger King, you do not get it ‘Your way right away.’ The squeaky wheel does not always get the grease. Do not excessively first name me just because I’m required to wear a fucking hospital badge. Including my full name in every sentence is a shallow manipulation, an implied threat that unless you get your way another personally directed customer complaint is forthcoming. I am not stupid. Your threats annoy the shit out of me. Making it personal does not change the 3 hour wait. Making it personal may result in the oft-used ‘Therapeutic wait’ (reserved for true assholes). You do not want a therapeutic wait.
Don’t cough in my face. Being in a hospital does not automatically excuse you from the social expectations that we as society have had of you since you were three. Do not be like the drunks who tell me that “If you didn’t want to be coughed (shit, spat, vomited, bled, pissed) on you shoulda’ been a carpenter” If you continue this behavior do not be surprised when I throw a towel over your face while you are in mid-cough or mid-sentence.
Do not tell me that you “Can’t breathe” in long rambling 20 word sentences. In the ghetto that may mean something different, Here in the ER we have different standards for what it really means to not be able to breathe. My bar of not breathing will be reset weekly by the people that are truly blue and/or about 30 seconds from coding from lack of Oxygen. There are people whose lungs are so diseased and scarred that they barely exchange oxygen on a good day with the help of their home oxygen tanks. These people come in and let their bodies do the speaking for them. They eloquently slump over their wheelchairs (or the ambulance gurneys) and are never so whiney about it as the 23 year old single smoking mom (of 4 kids by 4 fathers) who has been nursing an upper respiratory infection for a week or two.
Similarly, do not tell me that little Shantiqua is ‘bleeding bad’ with her 1cm cut, that your bullshit pain is 10/10, that you are suicidal when you took 3 Tylenol instead of 2 (gasp!) after mommy grounded you, or that because your emergency is the worse that you’ve ever had, that it’s the worst that could possibly happen in the sum total of human experience. I’m supposed to act like your story is the saddest tale that I’ve ever heard. It’s not.
Sad? Sad is when the drunk driver that killed the kids is unhurt. Sad is when someone is actively psychotic but still lucid enough to know that they have driven away everyone in their life and ruined everything with their madness. Sad is listening to the same beautiful young woman beg for some medicines that will stop the hallucinations while crying in frustration and screaming her angst. Sad is when people pull up to the front of the hospital with a dead relative in the passenger seat of their car. I mean this guy had been dead for 15 minutes and the family only focused on driving to the hospital. Did they pull over and call 911 in an area where the average response time is 5 minutes? No. Did they do CPR? No. Did they expect me to single-handedly yard this 265 lb guy out of the car, into a wheelchair, back to the ER, do CPR, code him just like on TV, and make a miracle happen? Yes! Yes that’s exactly what they expected. I sat there with my fingers stuck in his throat where his pulse should have been and said “He’s dead, he’s been dead for 15 minutes. What is it that you expect us to do?” We argued over his blue/gray corpse for about a minute before I reluctantly took him back to the ER and started the rain dance. Guess what? After we abused his corpse for 20-30 minutes (not my decision) he was STILL DEAD. Who would have thought?
Yes, I know what’s going on tonight. I’ve seen your exact symptoms hundreds of times. I order your X-rays, labs, ECG, and then read/interpret them (and you) before deciding where you’re sent. The whole model of my HMO’s emergency service (and the withholding of that service) is built on our clinical judgement. I am not (nor do I want to be) a doctor and I am not allowed to ‘diagnose’. Yet my job responsibilities and description require me to do exactly that in order to facilitate care. This arrives us at a legal fallacy where we (nurses) all pretend that we don’t know what’s going on and that “you’ll have to talk to the doctor” in order to keep our jobs and licenses. When we do tell people exactly what’s up, they use that to decide to leave (without seeing a doctor = legal mess), or argue ( = pain in my ass), or press for more medical advice, or complain, or ask for special treatment, or otherwise cause problems. Tired of not being told what’s up by the person with the knowledgeable smile? Tough shit. No, I’m not stupid. Telling you has only got me into trouble in the past. As I don’t know you, you’re not worth it.
Do not believe that because your doctor told you to come right to the ER that you have a right to be seen right away. Let us discuss why he really said that; LIABILITY. Your doctor doesn’t give a rat’s ass about little Johnny’s sniffles as long as he’s out of the clinic before 5:00. Filling up his over-booked appointment calender could have an adverse affect on that, but sending them ‘right away’ to the ER won’t! AND no one can ever sue him for bad advice or irresponsible behavior because he TOLD them to go the ER ‘Right away’ for the ‘Highest level of care.’ Gotta keep those malpractice premiums down! Motherfuckers. There are only two things worse than a doctor that won’t see his own patients:
1) The second worse thing is doctors that not only won’t see their own patients, but they send them into the ER with a wildly unrealistic set of expectations. “My doctor told me to come in right away and to go right back! He said I was too sick to wait in the lobby. He ordered you to do tests, they are (stop me if you’ve heard this one before) ON THE COMPUTER”. I’m not taking shit for orders from some lazy-ass, wart burning, boil lancing, sprained ankle rotating, sore throat examining general practitioner who has assessed you OVER THE PHONE and doesn’t even have ER privileges. Piss-off! you can get an appointment at the clinic in three hours and you’ll be fine. Walk down to the lab yourself if you want those tests.
2) Advice nurses are the bane of our existence. Sure they can’t tell everything over the phone, sure people are generally bad communicators, sure the clinics and doctors are over-booked, sure it’s 2-6 weeks out to even see a doctor, sure my cheap-ass HMO added another 90,000 new members last month but no infrastructure to deal with them, but the solution for this is not Not NOT to ‘go to the ER right away where they will fill the fantasies that our unscrupulous marketing department has instilled in you.’ Fuck off. I love getting advice nurses for patients. They must know because they are reluctant to mention it. We hate them all and feel no shame in railing against them while they suffer (off the clock) in their sick and/or injured misery.
People! I could go on for pages. Think about every miserable customer service job that you’ve ever had and multiply that by tenfold with whiney patients. It’s not that I hate people; I just hate peoples’ sense of entitlement and instant gratification. Folks might as well say “I have abused my body for decades and I’m here for you to fix me.” Sheesh,
1) Don’t be an asshole
2) Lose the weight, stop smoking, take your damn psych meds, and take care of yourself!
3) Its not our fault or responsibility that you’re sick/injured. In fact, it’s probably yours.
4) Folks that arrive dead usually stay dead
5) It’s not like on TV
6) Years of patient abuse have (clearly) left us all a bit burnt out and jaded, so. . .
7) Don’t forget your manners when you come to my ER : )