Monday, November 12, 2007

Momma's in Triage

I joke around with my nurses about this, but the more I think about it, the more it makes sense. Put my mom in triage, and watch the ED become an ED again. You know, like the old days on Emergency when they would wheel into Rampart with a diaphoretic construction worker they had just hung D5 on. (They always used D5)

You see, although she has no medical training per se, what she does have is some common sense, experience (she raised 7 kids, and before that her own family after her mom died), and balls. No, she isn't a hermaphrodite, but she is stubborn as a mule, and crazy like a fox-or maybe just crazy. And for better or for worse, she usually tells people how it is, or at least how she sees it. And in a community like ours, word would get around quickly that a " crazy lady is in triage, and we better find some other care, or better yet, go to our doctor (imagine that)".

Here's why it would work. She spent the better part of 27 years raising 7 kids, all of whom lived to graduate college. We were poor but did have insurance, as mom worked as a teacher full time. We got all of our immunizations, routine checkups were done, and believe it or not we survived all the normal childhood illness, sometimes with 3-4 kids sick at the same time. Occasionally we went to the doctors office, and even more rare was the ED visit. Probably 10 TOTAL visits for 7 kids over 27 years. These were usually for broken bones, turning yellow (my brother became very jaundiced with Hep A), lacerations or partial amputations. I guess she realized what was and was not an Emergency, or maybe just read the definition in the Dictionary- an unexpected situation (common colds and runny noses are expected) or sudden occurrence (back pain from a rear end MVA in 1994 is not sudden) of a serious and urgent nature that demands immediate action.

Now, there would be checks and balances, and if she was unsure about whether someone had a sudden occurrence of a serious and urgent nature that demanded immediate action she would ask one of the nurses on duty that would also take vitals. But my guess is she would be pretty good. She would require the "it's a spider bite " folks to bring in the "spider". She would tell the penis drip folks to put on a condom and go to the health dept. Most parents (usually just the mom at our ED) would be told to go home, hold and love their child and give Tylenol for the fever, and yes, there will be nights you don't get to sleep since you made the conscious decision to spread your legs and allow a sperm torpedo to inject you, and no I won't have the doctor give your child something to "get them to sleep". She would give the chronic pain folks a "life's not fair" speech so long and irritating they would never come back. But for most people passing through the door she would simply say, "what the heck is wrong with you to bother my son with this BULLSHIT?". (She may say bull dung).

Is it possible that she would miss something? Sure, but we all do every now and then. If you look at zebra illnesses, many are not an emergency at the initial visit anyway and require follow up visits. Is it possible hospital revenue might drop a little if you turn away paying patients. Possible, but I think it would be worth the risk to allow the focus back on EMERGENCIES (see definition above from American Heritage Dictionary-Second College Edition). But life is full of risks. Could we save lives if the speed limit was 35 EVERYWHERE (42,000 deaths last year). I suspect so. Could we reduce deaths if smoking was illegal EVERYWHERE. I suspect so. But these are not going to happen -you know, that personal responsibility thing and freedom to do and live as you please are still alive and well in this country. That responsibility also includes taking care of yourself, and seeking care at state hospitals, Christian clinics, and the like if you have no money or insurance. Yes, this may take a little effort, but again, life isn't fair. Patients that momma gently "redirected" would be referred to a clinic, family doctor, or health unit. My guess is that if you go back in time and follow people from school age and evaluate the decisions they have made ON THEIR OWN, you'll probably find out they made some bad ones or choose to pay for something else other than insurance (plasma screen, Kool menthols, meth). I shouldn't have to pay for their bad decisions and neither should momma.

Now sit back, be a fly on the wall, and watch momma go to work. Heck, she'd probably do it for free.

Finally I am starting an M.D.O.D. book club. These are not recommendations like Okras book club, this is mandatory reading. (I like calling her Okra)

This time I will start with One Nation Under Therapy by Christina Hoff Sommers. It points out a great deal about what's wrong with our touchy feely bullshit PC culture.

And The Politically Incorrect Guide to Global Warming and Environmentalism by Christopher Horner. Basically Al Gore is a dumb ass windbag eco-socialist.


  1. Can we borrow your mum [sic] down here in Australia sometime?
    Alas, I fear we're starting to turn into America, with the 'err on the safe side' and send an ambulance for anything and everything.

    Case in point, I took a call from a person with a known psych hx, who had apparently just found out his girlfriend had 2 weeks to live (same story as last month too). He wanted us (the ambulance service) to take him up to the other side of town to see the girl's family. (No, not the girl - she was somewhere around 80km away).
    When I told him he had no medical need for an ambulance, and that he should get a taxi or walk, he bitched about having no money**, and then told me he was now suddenly suicidial.
    Ding ding! Guess who got an ambulance now!
    (Although he also got the police, and a mental health assessment team, and was (forcibly) taken to the local hospital for assessment, so he didn't end up getting what he wanted).

    In the real world, he would have been told to harden the f--k up, and walk there, but alas we're not allowed to do that, just in case the waste of space _does_ actually try and kill himself. (Which, IMO, would have saved us all a lot of trouble and resources in the future).

    ** In my state, single person ambulance cover costs around $50 a year, and covers you for as many callouts as your fucked up logic requires. Although, at one point he did bitch about getting a $700 bill for getting an ambulance, yet still went down the 'I'm suicidal now you have to send me an ambulance' path. Go figure.

  2. Your mother reminds me of my mother.

    I had occasion to be a ship's doctor in the Russian Navy. One of the sailors claimed suicidality and I notified the Captain. He handed me his sidearm and told me to hand it to the sailor.

    I hesitated a bit and he said, "There are no bullets in it. If he puts it to his head and pulls the trigger then we will send him off the ship. If not, tell him to get back to work."

    Ah. I still get a warm feeling.

  3. Unbelievable! I can't wait to tell my children that they are not the ONLY children in the USA whose mother never took them to a doctor except for vaccinations. They are also going to find it hard to believe that they are one of the few who didn't spend a lot of time in the ER. Another thing they will tell you is that they rarely took an "antibiotic" that they could remember. And guess what....they even lived to be adults. I'll be darn!

    Awww....poor kids. They had a nurse for a mom and that's just the way things were.

  4. dear anonymous,
    sorry to hear that Oz is going the American way. had thought about packing it in and moving there. awesome place, just great. please drop by anytime and comment freely. very interested in the practice of E Med down there. have friends who have done multiple tours in iraq, one of whom is ER and tox boarded, he was very impressed with the Aussie docs he worked with. turns out you guys have a thing for beer or something?
    still remember diving on the barrier reef 18 years ago... just awesome.

    'cat. we will hire your mom tomorrow and pay her 50$ an hour. she will save us millions.

  5. I want to party with your mom, 'Cat. A book selection should also be Atlas Shrugged. In fact, make it required reading.

  6. Your mom is awesome. I can count on a single hand how times i've been to the ED. Why ED? Doesn't any else see the obvious joke there? I'm sure that it's been done to death tough. If it wasn't for stitches or a broken bone my parents would just look at me and say that I'd be okay. Maybe that has something to do with the fact that my father is a doc and my mom a nurse, but still...only went we had to.

  7. To our mate down under, I ate at Outback tonight in your honor. Downed a few Foster's as well. By the way, does the poo go down clockwise or counter-clockwise?

    Lynn-Atlas Shrugged is a fantastic book and it will be added to the book list.

    And just a warning. My mother is crazy, not crazy crazy, but enough on the edge to keep the waiting room free of all but the SICK and DYING. So if you do hire her, be ready for the press ganey scores to go down for the dept. for the first couple of months.

  8. press-gainey is a solution in search of a problem. they suck a weeping anus and love it.

  9. If my grandma was in triage:

    She'd stash some EXTRA STRENGTH tylenol and say "either you can be seen by the doctor after a really long wait or I can just give you SOME OF THE GOOD STUFF (slowly opening the drawer of the triage desk to show the patient the ES Tylenol) and you can lie down at home where it's not so darn loud with these kids and screaming people."

    If you were having an MI, she'd wheel you back (granny's 82, but she still does everything herself, dammit) and ask if you caught the weather forecast and compare weekend highs and lows between various TV stations on the way to the room.

    Grandma's never been to the hospital...ever (except to give birth).

    911--you've been on an ass, anus, and penis kick lately.

  10. Hm.....
    The last few times I was sent to the ER I have been

    There was one time a nurse told me I had to go to the ER. I was bitten by a feral cat. Very very hard, and drew blood and stuff. I freaked about rabies. was on the weekend.

    Anyways, I got a tetnus shot and antibodics. I am so glad I got them antibodics cause my arm got puffy and I got really sick, for a day.

    If I saw your Mom I would of hung my head...and said (I am sorry....this seems so silly, but I got bit by a wild animal....)
    Oh...that is what I said to the nurse anyways.

    Thank god for tiny community hospitals.

  11. Nurse K:

    re: "911--you've been on an ass, anus, and penis kick lately."

    At least it's not an ass, anus, and penis binge.

    I've never been on one of those, but I can imagine you would wake up sore the morning after.

    'Cat: I agree with "One Nation Under Therapy" and "Atlas Shrugged", how about "Freakonomics" and Dante's "Inferno"?

  12. At least it's not an ass, anus, and penis binge.

    Not that there's anything wrong with that.

  13. I was reading about the extinction of the dinosaurs a few days ago, and the article said that it was about 300,000 years after the big meteor collision that the dinos disappeared.

    And yet the anthropocentric global warming loonies are all worried about the last hundred years or so. Climate change is more appropriately measured in millennia than in human generations.

  14. Please, Don't make me read "Atlas Shrugged" again. errgh. Freakonomics is a good read, and The Divine Comedy : Inferno should be read in an annotated version with selections from Pergatory and Heaven - and a player's list so you know who all those Italians are and why he's consigned them to Hell. Great fun, that. ( I ordered the 'one nation...' book last night. I'm hoping for some relief from my sister's constant declarations of "Well, My Therapist Says...." It's like that SOB is a demi-god to her. So annoying....

  15. heheh.. the verification word I had to type was lilyass. Maybe it's the site that's on the binge.

  16. SC,
    Although I am confident that most of our moms could do a bang-up job in triage, since I'm already on the payroll (and 911, making less than $50.00/hr) I propose that triage nurses be issued a tazer (with training) and proceed to use it (with glee!) liberally. I believe you would see the same results you envisioned in your post.

    drx, that is probably one the best stories I have heard in a LONG time! Unfortunately, we don't have the balls to say/do something like that...not with all of the lawyers here.

  17. I like the Freakonomics book addition. And stop with all the peni, ani, and ass stuff. I'm trying to eat breakfast here. Ladyk, you would have been seen treated and given antibiotics and possibly rabies series (although according to Michael Scott only 4 people die of rabies in the U.S. each year). But you would have had to sit through a 30 minute momma discusion on how NOT to handle or come near a feral cat. Tasers eh. I all all for it as my TASER stock could break through 18 dollars a share.

  18. I all all for it. WHAT? I mean I am all for it.

  19. Oh guys....could you kindly run with this video link from my local Cleveland FOX affiliate that they ran on the abuse of EMS for transport to the hospital?

    There's some real gems in it, let me tell you.....just calling for you to hack apart!

    Thanks much!

  20. I was on the phone with my friend this morning when my daughter said she was "too sick to go to school". I leaned over, felt her forehead and it felt fine. She looked ok except a little stuffy. I told her she needed to go to school and that she could go to bed early tonight if she needed some extra rest. She persisted in asking me if she could stay home so I told her if I didn't see vomit or blood, she wasn't staying home. My friend laughed and asked when I became such a hardass. I really think once you have a bunch of kids you shift and don't accept any crap anymore. Can I work with your mom? She sounds cool.

  21. The only time I went to the ER as a kid was when I ran into a car, and somersaulted over the hood.

    I was spending the night at a friend's house, which was why I was out riding my bike at dusk. Her Mom wasn't home, something my Mom didn't know!

    I had a terrible headache all night and called the Pediatrician the next morning. She told me to go to the ER.

    Clearly if I'd been at home I never would have had the bike accident, which wrecked the nice French 10-speed bike that I saved my babysitting money all summer to buy, and if I had I would have been told to take some aspirin.

    This was before bike helmets were a big thing, and now days I ALWAYS wear my helmet -- and I have a 24 speed bike. So at least I learned something!

  22. I went to the ER with an acute gallbladder. The doc had me diagnosed within 10 seconds, did the ultrasound to verify, and I got surgery just in time.

    I can't remember the doc's name, but he was damn good, and super nice.

    The triage nurse didn't make me sit in the waiting room vomiting for too long, thank goodness, but there were some pissy people when I got called back before they did.

  23. brian and jen: will check out the video soon, can't do it from work.

    rad girl. as always, you rock.

    anon. glad you weren't badly hurt. we see kids here all the time for head bonks. the parents are always concerned becuase junior 'is sleepy'. rare, rare thing without a bike or car that the head bonk is significant.

    rioiriri: that's the way the ER is supposed to work! glad you had a good experience.

  24. 911-

    You'll truly appreciate it...

    It's an "investigation" into the misuse of the Cleveland EMS system by patients who call to get transported for toothaches, etc.

    Comical, at the worst.

    A picture of our patients, at best.

  25. Brian and/or Jennifer et al.:

    That video rocks. I love the nurse they keep showing saying, "You should make an APPOINTMENT with your DOCTOR for that stuff, honey."

    The patient that was in the waiting room with a bladder infection for 10 hours went home and called 9-11 to be seen quicker, but ended up being triaged to the waiting room and had to start over. She couldn't take the pain afterall. WOOOHAHAHAH.

    Cut back to the nurse, "Just cuz you come in by ambulance doesn't mean we're going to see you before everybody else."

  26. Anon Aussi,

    Did your patient have the "Technicolor yawn"? That's my favorite Aussie slang.