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JHKtheSeeker2234 karma

What was your closest call without actually being caught? How did you get away?

JHKtheSeeker63 karma

Yeah, we can get pretty insensitive and inappropriate at times. If the ambulance crew brings a CPR in progress to us, but the patient has no chance of reviving, we'll say they were pounding on a corpse.

If a patient stinks, we say they're diagnosed with acute shower deficit.

For obvious drug seekers, we say they have hypodilaudidism (dilaudid is a narcotic and a favorite request from drug seekers)

Other times, we're just insensitive assholes when privately discussing patients. When dealing with a morbidly obese patient complaining of leg pain with no injury, i went to the ER doc and said "so what could possibly be causing leg pain in a 400 pound patient? I think we have a medical mystery here. Like a case from House... will we ever crack this diagnosis?" It's shitty, but just being able to laugh at the surreal or ridiculous keeps us going

JHKtheSeeker51 karma

Septic patients are notoriously difficult to treat, especially once they progress past a certain point. One in particular stands out though. Elderly man from a bad nursing home was sent to us complaining of weakness, abdominal pain and fever (pretty standard so far). On arrival, he was breathing way too fast, cool, clammy, heart rate through the roof and blood pressure in the toilet.

We started the sepsis workup and treatments right away, but it was almost too late. We were dumping IV fluids into him but his blood pressure wouldn't stabilize. I just managed to hang pressors (very dangerous meds designed to constrict blood vessels and bring the blood pressure up) when he stopped breathing. At that point, we had to manually ventilate him and hope his heart didn't quit, then put a tube in his airway (which requires us to stop ventilating him for that procedure). By the time i got him to the ICU, I had six different medications going into five separate IV access points, and had to have him on a ventilator just so his breathing wouldn't get out. I honestly didn't expect him to survive the night oh, but I later heard that he had a full recovery and discharged a couple weeks later.

JHKtheSeeker49 karma

Nursing it's one of the few careers where being a straight white male is a huge detriment. There is a constant vaguely hostile feeling from some older nurses and doctors . There's the pretty common questions of why are you a nurse? As if wanting a well-paying job where I can help people isn't reason enough.

During nursing school clinicals my instructors would go into a room before me and almost apologetically tell the patient that there was a male student nurse helping out today, and ask them if it would be okay with them if I took care of them. The female students did not get that treatment.

Once I graduated and started working as a nurse, there was a house rule, but not an official policy that a male nurse needs a female chaperone when doing a catheter on a female patient. There was not a similar rule for females doing a catheter on a male patient.

Working in an emergency department, or the ICU kind of take some of the heat off because there are a lot of male nurses in those departments. But if I wanted to switch over to labor and delivery, there would be a lot of obstacles to get through. Obstacles that women do not have to go through at all

JHKtheSeeker21 karma

That's an extremely tough question to answer. Hard to narrow it down to just one. Some of the worst are those who know how to game the system. EMTALA is a law that basically states that when a patient presents to the ED, we have to evaluate them for emergent issues.

With that said, one patient does come to mind. A homeless male came in by ambulance with a complaint of altered mental status. He was clearly drunk, so we were letting him "metabolize too freedom" meaning when he was awake enough to walk (usually preceded by a request for a sandwich), we could let him go. Well he wasn't too excited about leaving the warm bed and started getting verbally abusive, so we had security escort him away.

An hour later, he came back complaining of chest pain. A chest pain workup on someone who doesn't have a heart issue, takes about 2 hours. So we did that song and dance, then discharged him again. He became verbally abusive again, threatened physical abuse again, So security was called again and he was escorted away.

Another hour passed and he came back saying he was suicidal now. If someone says that they are suicidal, then they are a mandatory hold until they can be evaluated by a mental health professional. After a certain point of the night, the MHP won't be in until the next morning, which means the person has to be held in the ER all night until they can be evaluated.

So, my point is the guy knew all the right things to say so that we would have to do certain workups, run certain tests, and eventually hold him all night. Bear in mind that there was nothing actually medically wrong with this guy, he just didn't want to stay in the homeless shelter that night. So he abused the system, got what he wanted, and didn't have to pay a dime for it, because it comes out of taxpayer money anyway. And bear in mind that while we are working on him, we are spending time away from patients who genuinely need help