Sunday, August 29, 2010

Superstitions of the ER (audience participation welcome)

ER docs and nurses (and paramedics) are a superstitious lot. I thought it might be interesting for those not in the business to read about some of our superstitions. In no particular order, here are my favorites (and please add your own in the comment section)...

1. The "Q" word. "Quiet"... it's truly the kiss of death. The "S" word... 'slow' carries the same jinx. Usually some newbie nurse or clerk who is "not superstitious" will say, "Wow, I haven't seen it this quiet in here in a while." Everyone around will groan and in five minutes ten ambulances and a bus from the nursing home will arrive, and one of the ambulances will call ahead announcing the imminent arrival of a pediatric code.

2. The full moon. The story goes that the full moon brings out the crazies and the trauma and maybe even makes normal folks sick. The story goes that during the full moon the ER will be hopping. Studies have been done. Really, they have, but in spite of the fact that the statistics do not bear this out... ER docs and nurses will not let this one go. It just seems to be right and it's nice to have a large, inanimate object to blame for your woes.

3. The "black cloud". I have a reputation as being a 'black cloud'. This means that when I come on shift the heavens open and sick people get some magical message that tells them all to come to the ER now. The black cloud label is hard to shake because even though you may stack a whole bunch of reasonable shifts in the hopper, the minute the ER goes nuts the nurses look at you and remember that at some point you had been declared a 'black cloud'. Sometimes the only way to shake this label is to wait for a new hire doc to hit the ER and let it be known, quietly, that new Dr. so-and-so is a terrible black cloud.

4. "Dissed paramedic" revenge. There may be something to this one. Paramedics are independent minded individuals. When you, an ER doc or charge nurse for example, read them the riot act, especially if it is done in front of others, that paramedic can respond by bringing the rest of his patients for that evening right to you. This is most obvious when the medics have a few places to choose from in terms of where they take their patients. 911doc gave me a hard time about that last patient... oh wow! this homeless schizophrenic with chest pain would be best served by seeing 911doc... let's bypass Metro and go down to Mercy... it's only another ten miles and 911doc is all that (evil smirk).

5. Major concerts or sporting events. It would make sense that if your team is playing for the title that the ER would be hopping after the event, either from the riot which accompanies a loss or the riot which accompanies a win. Still, working the night shift about ten years ago the night our team won the NBA title, the ER was as slow as I had ever seen it. This, of course, means they didn't try very hard to riot well.

6. Holidays. They suck. All of them. There's no mystery here... Thanksgiving and Christmas and the ER is the only game in town. All the doctor's offices are closed.

7. Superstition has it that spitting on the board  will produce a shitstorm. Many ERs do not have 'boards' anymore... at least not the kind you can spit on... they are now, usually, computer monitors.  I spat on the old chalk-board once, as a joke, walking out the door, and as I drove home I was passed by two ambulances running lights and sirens going to the hospital. Hmmm.

I know you've got more out there... let's hear 'em.


  1. Actually, it's around the New Moon when crazy shit happens.

    Also, if I plan and bring something that I like, and that is very healthy to eat, I won't get to eat it.

  2. Our system's got a crew member who is fond of a specific healthy food item from a specific fast food locale. However, every time he eats it, we end up in a race against Death with patients.

    We told him he's not allowed to eat there anymore, and this information has been disseminated throughout the department.

    We also have our "black clouds." They tend to be the nicest, sweetest people to work with.

    Then there's my husband, who calls and asks, "Has it been quiet today?" He's been lecutred accordingly...

  3. The random rule, as in...

    Emergency Room patients will randomly come in all at once.

    Sometimes, I swear, they meet on a corner, all of theme, before coming in.

  4. Never bring a book to read. EVER. It doesn't matter if it's for learning or pleasure. Even if it's on a Tuesday night and you're the trauma float nurse in the dead of winter, which in theory, holds no evil (unless it's a full moon). It's an invitation for badness. A complete rookie mistake. Just sayin....

  5. and say, that reminds me (just watched 'raising arizona' again)... almost every shift in the ER develops a theme... there are plenty of nights when everyone seems to be having heart attacks... there are copd nights, and then there are the ortho nights. but, and this is very bizzare, there are also nights where i'll take care of three or four people with esophageal foreign bodies, or a few kids who swallowed coins... spooky.

  6. The phrase "batshit crazy" comes to mind when I think of how I tried to study while working as an EMT for a private transport service. If I really needed to study (like for a test) then we would be really busy, like wall to wall, with really sick people needing transport, not seeing the inside of our quarters until the shift was just about over.

    Oh, by the way, don't watch any movies on TV. You will inevitably get a call when there are 30 minutes left in the presentation, and therefore, will never know how it ends.

  7. Coming from a moher and not an ER Doc..

    He hasnt pulled his trach out in a while.. then BAM out it comes.

    Or He hasnt been in the hospital in a while.. Bam he gets admitted..

    These are two phrases we dont utter in my house. Its like a jinx curse.

  8. I do not know how true this is across the board, but my parents are both paramedics and will readily admit to punishing certain ER doctors... so at least that myth is true in one part of the country.

    They also tell the story of a certain paramedic who went so far as to call the nursing home to see if there were any patients who "needed" a trip to the hospital after a charge nurse ripped into them.

  9. Say a frequent flyer's name 3 times and they will magically appear... just like in the movie "Beetlejuice"

  10. I like it when it is busy b/c we get paid on what we see. so slow is bad for me.

    my superstition has never let me down. when it is slow i pull out some CME to read. The department automatically fills. I have never got through a full page

    -er doc

  11. checking the crash cart before midnight will bring on a code!

    also, everyday that i had a haircut booked 4 times in a row someone coded right before i was to leave work and head to the salon....

    never, ever, ever bring christmas cards to write, you'll end up staying 16 hours b/c it's so busy!

  12. I agree with serenity, I'm pure fee for service so if it's quiet I always complain loudly how quiet it is and ask various staff to go out to the parking lot and injure a few people so I can pay the mortgage.
    Luckily I'm a shit-magnet so this is rare, but the quiet word sure does irritate some folks!

  13. I agree with all of the superstitions above. However, we never say a frequent flyer's name even once or they magically appear. We just describe them and use initials.

    Days DEFINITELY have themes. Today was "belly pain & vagina day".

    There are "axioms" too. For instance:

    1.teenaged girls wearing "granny panties" aren't sexuallly active, but those wearing thongs are.

    2. young ladies with vague belly complaints and no distress just want pregnancy tests (I've stopped giving them the results...I tell them that if they want the result, they can get a copy via medical records for $20. OR, they can go get the SAME test we use at the dollar store and do it at home).

    3. anyone who knows their "normal body temperature" is a goofball.

    4. when a patient says "you just don't understand"; I am understanding perfectly.

    5. a nursing home patient with "diarrhea" is on at least 2 laxatives until proven otherwise.

    6. a patient with a suitcase is the most stable patient in the department.

    7. any patient with an allergy to Haldol has just never been given a large enough dose.

    8. most "migranes" AREN'T.

    9. there is an inverse relationship between the severity of a patient's condition and how much they complain.


  14. As an MOD, I found that I bring the shitstomr if I stand in the ER longer than it takes to see the patient and run. Any longer, and someone will notice me.... Don't stand there long enough to check a chart, or call the nursing sup - just get out NOW. If they see me, they'll think, "hmmm, maybe I can't really handle this myself, maybe he really needs admission after all".
    I also agree with the book, Q word, holidays, planning to write a lecture

  15. The Law of Three...they always go in threes. The first has been hanging on forever, the second is expected and the third is a suprise.

  16. Don't forget the "white cloud" of any student nurse/doctor/medic. If there is anyone who is anxiously awaiting "something good" in the department, all will remain quiet.

  17. I think it happens on the patient side too. I am normally not superstitious at all. I will never have surgery without making cookies for everyone that is going to take care of me...anesthesiologists, doctors, nurses, everyone...I even bring extra just in case I forgot someone or didn't realize someone would be assisting because I would hate for something bad to happen just because I missed someone. It started as something nice I wanted to do and now I can't go without doing that. I have no idea what I think will happen if I don't bring the cookies but I guess because every time I have brought them things have turned out well and I don't want to take the chance and test it. And that sounds completely crazy to me, but it is what it is. So far it has worked out well. (And really, hopefully this was my last surgery so I won't need to worry about that again anyway).

  18. OK, not exactly a Superstition, but I always like to say "Call me Ishmael" when I do an epidural on a >300lbs patient...
    and NOBODY ever gets it, I mean it took ME 10 years to figure it out, there was this Surgeon who would say that every time he'd walk to the table for some fat slob.
    and his name wasn't even "Ishmael" which was really confusing.

    Frank "Ishmael" Drackman

  19. Reminds me of an ER doc I worked with who once asked one of his nurses if he had any sardines. After getting a rather confused look in response, he told him that he planned to dangle it over a patient's stretcher to see if he could get Shamu back in bed.

  20. Frank: if someone doesn't know where "call me Ishmael" comes from or the implications...then they don't have a well rounded education. geez.

    I find that if you erase a name off the wall board before the patient ACTUALLY goes out the door...they will find some reason to stay...or develop some new disease...

  21. OH YEAH?!?!?!?!?
    Sorry I missed "Moby Dick" day, Dick.
    And I never got "Little Women" either, they weren't really that little.
    and anyway, I'd rather know Alot about a Little, than a Little about Alot.
    Did you know the Blood/Gas Partition Coefficient of Sevoflurane is .68????!!!!
    Do you even know what Sevoflurane is!?!?! and what makes it better than Desflurane???
    Who didn't have "Well Rounded Education" now, Sertoli Cell Breath???

    Frank "I'm a very good Driver" Drackman

  22. Frank - But it was a white whale. What happens if the patient is some other color?

  23. Never ever ever turn off the lights in an empty trauma room.

  24. My Grandpappy used to rub Mongoloids for luck.....

  25. Changing into clean clothing invites a greater mishap then the one corrected.

    Universal precautions do not protect you universally-something uncovered will immediately be covered with something noxious.
    Dr Pete

  26. When you have one piece of equipment that sits unused for a month, two of them will be needed at the same time.

  27. great list.

    completely agree with the clean scrubs deal... i once changed scrubs three timesin a shift... the first for sitting in a chair full of urine (drunk gal thought it was potty chair), then got doused in gastric contents when my stethoscope hooked a gastric suction container, and got to top it off with arterial blood from a neck wound.

  28. 1: Tooth to tattoo ratio
    2: Drunks will always burn you
    3: The "Hispanic panic" does exist
    4: Dr. X is real? I'm not sure about this one.
    5: Gingers will always need more.

  29. "Gingers will always Need More"???

    Porno title? REM album? Code Name for the imminent Israeli raid on the Bushehr Reactor???
    Ted Kennedy's Last Words???


    Please reply forthwith,

    Frank "Sea Monkeys are Just Shrimp" Drackman

  30. Frank, I can only guess that our friend is referring to natural redheads as "gingers". Apparently in England having red hair is on par with having facial neuroblastomas or weighing 523 pounds as far as social acceptability goes. No clue why....

    If this hypothesis is correct, he may be referring to the generalzed nursing assumption that redheads bleed more, especially postpartum.

    Or he could be bat-shit crazy and off his meds.

    Pattie, RN

  31. I heard somewhere that redheads are more sensitive to pain and are harder to anesthetize.

    An observation: Have you ever met a red haired male who wasn't an attention-seeking smartass? I haven't, though I admit my sample size is small. Conan O'Brian and Carrot Top are examples of what I'm talking about.

    My oldest son has two exasperating friends who fit this description, and we also have a nephew who is a red haired monster. I'd be willing to test the pain theory on them.

  32. Peggy got it before Frankie did, I think the Sevo fumes are getting to you Drackman..

    Pattie, I have always been one to encourage thought, but holy shit that is some over analyzing. And you say I am off my meds...

    Cynical "I love me some ginger" Bastard

  33. OK, Commercial Dog...
    To get the high volume comments, some post suggestions:
    1. What is your favorite color cat?
    2. A story about sauntering to the nurses station and casually mentioning your patient is arresting... and that you don't know where the ambu bags are.
    3. Is wearing fatigue fabric scrubs gay?

  34. dear most recent anonymous...
    do i know you? are you the same anonymous that emailed me about penile augmentation surgery?

  35. 1. Orange (ginger.
    2. Did you really? So did Happy Ho.
    3. Yes it's gay.

  36. Cynical Bastard:
    I guess I'd be cynical too if I had balls the size of the President's(Peace be upon Him)foreign policy achievements instead of the Big Brass Ones Jehovah blessed me with along with that mark of the Devil...
    SORRY, I didn't know a Racial Epithet for my own race, I've always been partial to Red Heads, Ginger Grant, Howdy Doody, Manfred von Richtoven.
    and when you've been called HookNose, ChristKiller, Hebe, Kike, Shylock, Yid, hmmm is that the best y'all Goyim could come up with???
    "Ginger" just doesn't have the impact of a well timed "Spearchucker!"

    Frank "Yeah, I killed your God" Drackman

  37. I have never tried to punish an ER doc. I might be in one of his rooms one day after one of my crazy ass patients cuts me or something.
    I do however, always punish this one charge nurse...stupid bitch.

    About number 5 though: I want to live where you do. Dude, home games are the WORST here. We have a really shit Big 12 team (I mean, we lost to freakin' Iowa...WTF). It is balls to the wall on home game nights. Last time we had a dude literally dying in the middle of the road...and the traffic was so bad we couldn't get to him. Scary shit. It's all good though. I saved his life with the Lidocaine I gave him prior to RSI, you know it reduces that ICP or whatev. (I know, I know, I tried to get our medical director to show me a decent study to prove this. He laughed at me.)


  38. Funny that I just read this post. I'm a paramedic and my last shift I really was read the riot act by a charge nurse in front of about 15 people, including my patient's wife, for not diverting to a closer hospital. I'm sorry, I didn't want to come to your ED as much as you don't want me here. Unfortunatly, my patient was fully alert, understood the risks, and insisted on coming to you so we drove the extra 4 minutes. Since you don't want me bringing you people that are sick, I'll be bringing you everyone that isn't. Ran out of meds, back pain for 5 days, belly pain for a week, flu like symptoms, insect bites, drunks... You're 100% right on this one.