the triage rant

WARNING: Disjointed, choppy vent session ahead. Someone needs a good nights sleep.


The system doesn't work. I don't care who you want to blame - the politicians, their policies, the tax cuts, the downsizing of social services, the lack of affordable health care - whatever. Blame it on whatever. Pick your target. I'm just making a blanket statement. The. System. Doesn't. Work.


"Normal" people will do anything in the world to avoid being in the ER. But there are "others" who consider it their destination of choice. And I'm at the point tonight where it is really getting to me. Because here are some of the things we see on a daily basis...


The Family Date Night. If one member of a family comes in to the ER to be seen, someone else decides to come in with them and have their (back pain, stomach ache, trick knee, ingrown toenail) looked at. Hey, if you're going to be sitting around a hospital while your loved one gets checked out, might as well get your money's worth out of it. Most prevalent on weekends, holidays, or any time we're getting slammed with ambulances.


The Enforcer. The people who haul their kids in because they're misbehaving. There's nothing wrong with the kids medically - they're just driving their parents nuts. So the parents will say something about anger issues or depression and the next thing you know we have to get a screener in to do a full-blown mental health workup. If either parent or child has played the system before, all they have to do is drop a couple of magic words (suicidal, violent) and the next thing you know we're down a nurse because now we have a 1:1 observation patient. Bonus points for the parents who check themselves in at the same time trying to get some Ativan for their "fried nerves". (I'm not talking about legitimate mental health needs. I'm talking about parents who want us to discipline their kids).


The Lonely Hearts Club Band. Not to sound unsympathetic, but these are the people who have no life. In their world, three hours in the ER for "weakness" is far better than sitting at home alone and watching the news. Never mind that this social visit probably includes needles and expensive tests, they keep coming back for more. We really are better than ER on television.


The Frequent Fliers. My personal favorite. These are the people you see so often that you know their home med list by heart. And all their family members (who, oddly enough, are usually frequent fliers as well). This is the group who has figured out how to avoid those pesky waits in the waiting room or triage. They simply call an ambulance and utter those two (other) magic words. Chest pain. And in they sail, triumphantly cruising by all those legitimately sick schmucks in the waiting room who, because they're too busy leading productive lives to learn how to abuse the system, actually have the idea that you only come to the ER when you think you're dying. Silly rabbits.


The Penny Pinchers. This is the group that says things like "Oh, yeah, I know that my doctor could have taken this splinter out of my finger, but he wants a $20 copay every time I go in. It's just easier to come here. Besides, I can get a hot meal while I wait."


The Quick Trigger Syndrome. The patient who wakes up from a nap with some nausea and immediately heads to the ER. A stomach ache for an hour? A dime sized bruise from last week that isn't going away? A zit that won't pop? A paper cut? That's what we're here for, right?


The Legitimately Clueless. The mother who calls an ambulance for her teenaged daughter with a toothache. The people who tell you that all of their symptoms started last week when they started a new med - yet they're still taking it. The twenty year old who is all freaked out because every twenty eight days or so she bleeds "down there". The chainsmoking mother who never opens a window and can't understand why her toddler's asthma is so bad this year.


I could go on and on. Don't get the feeling that people can only fit in one category, either. I can think of enough patients to fill the fingers of one hand who fit at least five of the above seven slots simultaneously. The number of those who match at least three are enormous. And we have one lucky family that proudly represents every single one of the previous groups. Every single one.


To a nurse (or anyone working in emergency medicine), the only thing more frustrating than HIPAA (our lovely privacy act) is EMTALA. (Who the hell comes up with these acronyms?) I don't even remember what EMTALA stands for, and I don't give a crap, either. It's an even bigger pain in the ass than HIPAA, because it states that we cannot turn anyone away for any reason. Period. Our hands are tied. We have to treat them no matter what.


So much is made of the fact that so many people don't have health insurance. There is no hiding your insurance status in the ER, but honest to god, none of us care. We're there because we want to help people - we really are. And we all totally understand that there are people out there who are doing all they can to survive, but still can't afford health care. This is not directed at those people. It's directed at those who have no intention of paying any of their bills - not for the meal they ate, or the ambulance they called or the EKGs or the blood work for nonexistant issues - nothing. This is why we're more attractive than a private doctor, because they can (and do) refuse to see patients who don't pay. We can't. And we don't.


We have one guy who has been in nine times in eleven days, seven of those by ambulance. There's nothing wrong with him that twenty years of psychotherapy wouldn't cure. He's an impossible IV stick, so we need IV therapy every time. Thousands of dollars of labs and scans and, to add insult to injury, once he managed to talk his way into an overnight admit because you can't prove that someone isn't having pain. A normal EKG, normal vital signs, rating your pain at a 10/10 even though you were sound asleep when we came in the room...all pale against someone pleading chest pain in the litigous world we live in. And he's not homeless, either. It's not like he's looking for a place to sleep.


People have forgotten what the word Emergency means. Or they don't care.


Or both.