De's Lost Thoughts: September 2007

Hey there...I've been meaning to pop more but, once again, my computer was on the fritz part of this week. A whole card fried. I have the worst luck, lol. But, my puter is bits and pieces put together so it gets a little finicky. And, it seems as someone always has an agenda for me lately, but that's okay when it's my family.

Anyways, Hannah made it safely on Saturday! Thanks for the prayers. I'm so happy, despite having her teenage angst arrive with her, lol. She is only going to be here 6 weeks this time as I am trying to make it even/steven for exchange at Christmas and Rachel's wedding. I hope we get to do something fun while she is here. DH is working in Albuquerque next month over a stretch so I hope we can go up there for a couple of days and have a "look-see". Hannah goes back to OKC on Nov 3rd.

Back to the subject of where should I work. According to the poll I put on my last post, it is 4/2 that I should stay at T, my current hospital. But I have to say I'm feeling pretty good about working at the new hospital, MV, especially when my friend C is there. I've yet to work with J (the girl I trained at T), but I did get an email from her saying "when are we working together". I also definitely like the change in patient demographics at MV for sure. Not so many drunks or transients, but more retirees and insured patients.

Oy, I said it didn't I? The hated word, "insurance". It's not supposed to matter for patient care, and it really doesn't except for the attitude of the patients, which in turn effects how you in turn feel about your patient and that affects how you deliver that care. People who have insurance are generally more likely to keep up with their health and take more responsibility in their life as a whole, and be more appreciative. People who don't have insurance (not those that simply can't afford it, but more the "working the system" group) tend to be more demanding, and rude, rude, rude.

I love the invention of the MSO under EMTALA (Emergency Medical Treatment and Active Labor Act) laws. Simply put, MSO stands for "Medical Screening Only" (see point #1 at above link). Good business for the ER and for the patient. How you say? Well the ER/Hospital doesn't produce a bill that will not get paid, and the patient is not billed for a non-urgent evaluation, and is instead referred to a clinic for their follow up healthcare. (There is no "refusal of care based on ability to pay" because the patient received an exam by a doctor/pa/nurse practitioner) Now, if the patient wants to receive treatment in the ER for their non-emergent complaint, then they simply pay their co-pay as if they were in a doctor's office. If they choose not to pay the co-pay, then they are simply discharged with information regarding their medical screening, and no treatment or prescriptions are given. The costs to both hospital and patient is beneficial as the hospital reduces it's self-pay (or no-pay) clients, and the patient gets a medical evaluation and direction on where to followup for their non-urgent healthcare (A typical ER visit for routine minor care will cost anywhere from starting at $500-$1000 vs $50-$100 at urgent care). Another side benefit to the MSO to everyone is that it decreases wait time in the ER because beds are less tied up with non-urgent issues like someone who has had a toothache for a year and wants pain medicine, instead that person is given low-cost or no-cost dental referrals.

Okay, so Thursday in the ER was a "get the party started" night. We had the usual trickling in of drunks, though not so many as we will get this weekend. It has gotten to the point that sometimes I just can't tell the weekdays from the weekends when the local college is in session. Case in point...last night received Ms. 17 from the college dorm because she was drunk and vomiting (kids are taught that vomiting when you are drunk is a positive sign of alcohol poisoning and you should seek emergency care - and in some extreme cases that is true except it is more likely your stomach "oy--you should've drunk so much dummy"!). So the sweetie's suite mates called 911. Now on campus that call goes to the campus police who very politely will issue you a ticket for drinking in the dorms, plus a ticket for underage drinking should it apply, and may also include public disturbance, etc (you get the idea). Well there has been such an outcry from the community on the issue of underage drinking and the results (accidents, deaths, etc) that the local college has really clamped down hard on this issue (about darn time) and it's a "two strikes and your out" policy. The student can be kicked out of the dorm, and in some cases, put on probation or suspended from the college.

Once we got Ms 17 checked in we start the usual protocol of putting her on the cardiac and oxygen saturation monitor, drawing blood, and obtaining a urine sample. She of course was oblivious, or at least wanted us to think that because there were definite signs throughout everything I did or whenever I checked on her that she was awake and hearing me (flickering of eyes, rolling her over, following some commands and not others when it was something she didn't like, etc). So all in all I felt pretty comfortable in ascertaining that she was going to be stable medical wise. Now the dealing with the parents who lived in a northern state was something else. Another little law, HIPPA (Health Insurance Portability and Accountability Act), prohibiting me or anyone discussing Ms 17's medical care without her permission. But wait, you say, she is only 17 and is a minor...nope, not when it comes to her healthcare because she is not living at home, is living on her own (albeit in a dorm) as an adult, attending college, all of which emancipates her and puts her under the HIPPA guidelines. The mom went belistic on me and stated we were breaking the law, we were going to call some 18year olds and not her parents when we were ready to release her, weren't doing our job about checking out the fact she hit her head, was bleeding profusely, etc. So I put the breaks on that one...explained the laws, stated no report or signs of head injury and Mom shouldn't take the words of another drunk minor about her daughter's condition, a doctor had seen and examined and obtained tests to determine her medical condition, etc. The most important issue I stressed was that I would love to call Mom when we were ready to release Ms 17 except whenever she called about her daughter she never spoke to me, the patient's nurse, nor did she leave a phone number where we could contact her. So I very firmly stated that the lines of communication went both ways. That shut her up immediately. "Can I talk to my daughter?" "Absolutely! Given me a minute to hook up a phone." Jeez, please be nice and be polite and you get a lot more out of us, but I did feel she was acting out of concern for her daughter (as I would be) because once I reassured Mom that Ms 17 was "okay" and let her talk to her, Mom was a lot nicer and friendlier. That drinking story turned out good except, according to Ms 17, she was being yanked back to the north and from living away from home.

Another drunk who is a frequent visitor to our ER didn't fare so well. I'll call himMr 25. He arrived drunk (duh), combative, and strapped down to a backboard and c-collar as he had fallen and EMS wanted to make sure he didn't seriously injure himself. We couldn't take him off the backboard until he had been cleared via x-rays (which were ordered immediately). But at some point while we were waiting on the x-ray results Mr 25 began vomiting. We could here the noises coming out of his room and the heart monitor started going off so up we were to check it out. You've heard of people drowning in their own vomit (Jimi Hendrix ring a bell?), well that is what Mr 25 was doing. We quickly rolled him over and began suctioning him, but it became apparent that he had aspirated his vomit into his lungs. 5 minutes later he was intubated and deep suctioning down into his lungs began. Now the real problems would emerge as I am sure he would get pneumonia and could end up sick enough to die. Hopefully we eliminated the possibility of brain damage from lack of oxygen as we were in the room immediately and worked on securing his airway, but you never know. Why do people have to drink so much? Ugh. Please be responsible!

Okay, enough of my story telling. So the real news of the day is that...(drum roll please)...I finally got the official word from the Director and I am staying at T. I was walking into work Monday night at MV and the Director was driving through the parking lot and hollered at me and we talked it out. She said she would love to have me permanently at MV but wanted me to be "happy and productive." I said I could be at either place but felt T was more "home" since I had been there two years, and that is why I wanted her and R (T Director) to make the best decision for both ERs. So the Director said putting it that way she would like for me to stay at T since she had plenty of staff and virtually no turnover and T was always in a flux, and that she could really use my "experience" there. The Director also said that at anytime if I change my mind to let her know because she would love to have me at MVas well and I could pick up as many shifts as I wanted. So that is where it is at, ladies, after months of fence straddling, lol. I know things are going to change at T (we were supposed to have a meeting Wed night but it got canceled), but I'll just roll with it. And then I will try and work at MV on Sun/Mon/Tues as that is when C is there.

So I'll leave you all with that and get off here. It is late and I should probably head off to bed. Have a terrific weekend!

Ciao! De ;)