ICU and mass casualty alerts

It was one crisis after another at work today. Actually the past three days have been just one thing after another. V-Tach easily turning to V-fib (i.e. not-so-deadly heart rhythm one minute, deadly heart rhythm the next) was Monday. Tuesday was "Oh, nurse... I feel dizzy. Oh, I think I shall faint on you now."

And then there was today. First of all, fishy had to go back to Fish ICU. The powers that be said we couldn't use portable oxygen tanks to help oxygenate the fish's water. Something about it being a waste of resources or something - bah. If that fish is floating upside tomorrow the blood will be on HR's hands. Er, that is if goldfish have blood. Anyway, fishy is listless again and has lost a lot of weight. Definitely has the dwindles... everyone is upset about it, the doctor is suggesting he be sent back to the big tank with the other fish and placed on hospice care, but, I just don't think we're ready to accept that. I know I am in denial still.

So that was early this morning. Then, an actual tragedy occurred during lunch - some accident at a local refinery (there are many large ones around here). We heard the code called over all the loud speakers, one I had only heard used as a drill before. But this time it wasn't a drill, they were actually prepping for massive disaster with possible casualties - yikes! It turned out about 12 people were exposed to the toxic whatever-it-was gas or explosion thingee, and I do not know what their condition is now, probably not good since smoke and chemical inhalation is not good, but anyway, it wasn't very massive like we had thought. Time consuming though, prepping everything like that - the ER docs were chatting in the coffee break room about it all afternoon.

My afternoon was spent with patients doing my little "patient education" thing about their new or not so new but never treated diagnoses of heart failure or CHF. I know I do this everyday since it's my job, but today was just really hard. The last patient was a real let down - the caretaker supposedly cares for the patient who, unfortuneatly because of disabilities, cannot care for his or herself. However, this caretaker had no interest in what was being said, doesn't care if this patient repeatedly ends up in the ER and hospital, completely ignorant. I wanted to punch them in the face for their obvious neglect of another human being whom they were being paid to care for. I'm almost positive she will refuse to schedule this patient's follow up appointments by making up lame-ass excuses and we will repeatedly see him in the ER with decompensated heart failure as we have the last 12 times in the past 10 months and who knows what else they'll develop-perhaps renal failure? All I want is for this patient to be able to live their life out of hospital - just look for the symptoms of fluid overload or dehydration. Really, all I was asking the caretaker to do was to remind the patient to weigh themself every morning and to either take the medications everyday as directed, or not take them. You can't just take them sometimes. You either choose to take them and stick with them or don't.

So, it was like asking them to sacrifice a limb just to make sure the person was weighed everyday. Oh, and stay away from salt - how DARE I ASK THAT.

All the while this sweet little old patient sits quietly.

And yes, I know, elder neglect/abuse is reportable, yadda yadda, we have to see much to much "reportable offenses" at our office, some even occurring at our office. It's disgusting. Sometimes it is the family, but most of the time it is these "caretaker" people - I wonder if it was really better in the olden days, did the family really take care of the older generation? Was there more respect? If there were those days, I wish it were the same for elderly now.