Determining Severity

I’ll keep this short. The emergency room is not a fucking deli. You don’t take a number, and are then seen when a room becomes available. Don’t come bitching to me that people who arrived after you are being seen first. Patients are seen in order that they need to be seen. Your tooth pain is not going to be seen before someone who can’t breathe. Period. As I’ve said before, don’t be a dick.

So here’s how the process works, and pay attention so next time you go to the ER, you don’t ask a retarded question.

After you check in, a nurse will triage you. This means he/she will do a basic evaluation to determine if your complaint is bullshit or not. The bullshit-o-meter is based off of two main questions.
1.) “Does this patient need immediate life saving intervention?”
2.) “How many resources will this patient need?”
The answers to these two questions will determine your place in line, and basically how long we have to watch you go “Ahh. Ahh. My jammed thumb hurts so bad” off in the corner while we quietly mock you behind your back. The nurse will have assigned you a number between 1 and 5 in the computer system. This is your ESI (Emergency Severity Index) number. ESI 1 means you require immediately life saving intervention like, you know, when your heart stops. ESI 5 means you should have stayed the fuck home. “But Dexter, how can the nurse determine that in just a few minutes of interaction?” Because we went to mother fucking school that’s how. Oh, and by the way, our bullshit-o-meter works when you lie too. “I’m here because my back hurts and someone stole my pain meds….oh….and I have chest pain.”
“I’m sorry to hear that. We’ll call you when we can” *assigns patient an ESI 5*.

Every damn day I get the following questions and complaints:
“How much longer? I’ve got things to do”
“How come people that came in after me are already being taken to a room?”
“My ear hurts so bad. I need a doctor now or I’ll sue.”
“This is a joke. This is supposed to be an emergency room. I’ve been here 6 hours”

Fuck, I once actually had a mother bring in her 3 year old with a fever, and stand outside another patients room trying to get our attention. While we were actively performing CPR on a dying man, this woman said, “Excuse me. How much longer? We’ve been here an hour and my son is really warm” I shit you not this lady actually wanted us to kill someone because she was too stupid to give her kid some Tylenol at home. The thought of stabbing this woman crossed my mind briefly. She’s lucky her child was there. Instead we all collectively told her to kindly fuck herself.

So now you know how patients are picked to be seen. Don’t bitch when people are seen before you. That’s a good thing. That means you’re not dying

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Favorite Complaints

Serious question:
You ever wonder why ER wait times are so long?
If you replied “Yes. Yes I have,” then the answer is because assholes come to the ER for dumb reasons. If you replied “No. Not really,” you’re the asshole. Thanks to the EMTALA (Emergency Medical Treatment and Labor Act) regulations, no ER can deny you care for any reason. That means if you show up, and tell the nurse “I came to the emergency room because I’m lonely, and I just want someone to talk to,” he/she cannot legally reply “Man the fuck up. This is a place for EMERGENCIES.” It is for this reason that you have to sit in the waiting room for 8 hours with a broken arm while all the rooms are filled with assholes. Combine those assholes with the Affordable Care Act, and you’ve got a perfect storm of newly insured assholes coming to the ER for dumb reasons and healthcare workers unable to act out their fantasies of cuntpunching said assholes. Thanks Obama. So, for your reading pleasure I’ve put together a list of my top 10 favorite reasons people decided to increase your wait time.

#10. 19 year old girl.
“I swear I’m pregnant but I’ve taken 3 negative tests.”
Dis bitch actually came to an ER because she didn’t believe the three pregnancy tests she took at home. She wasn’t having any symptoms other than a missed period, but God dammit, “I know my body!” she proclaimed. “Nice to meet you Becky. Here’s your discharge paperwork. We recommend a follow up with a psychiatrist”

#9. 42 year old woman with her 9 year old son.
“My son got hit by a car yesterday. He says nothing’s wrong but I’m like ‘Dude. Somethin gotta be hurting'”
The little fuck trophy was playing in someone’s driveway when they accidentally backed into him. Kid didn’t even fall down when he was “hit”. Apparently the moms anxiety overcame her and she just couldn’t handle the thought that her child was fine

#8. 18 year old woman with her 5 month old girl.
“My 3 year old daughter fed my baby Ice Cream. She gonna be OK?”
Mother fucker yes! Aside from the therapy both your children will need later in life to try and cope with the fact that they have a retarded mother, your baby will be fine. By the way, do the math on those ages…

#7. 22 year old man.
“I almost got hit by a car yesterday”
Son of a bitch! This guy almost got hit by a car…yesterday
“Wait so, you didn’t actually get hit?”
“No no no. But it came real close”
“Ok? And why didn’t you come in yesterday?”
“I felt fine yesterday. Today I’m worried it might happen again”
“You came to the ER because you’re worried that you might almost get hit by a car again today?”
“Yea” *Looks at me like I’M the idiot*

#6. 34 year old woman
“I just got out of rehab and I guess my tolerance ain’t what it used to be. I’m super tired”
What’s the first thing you do when you get out of rehab? Shoot up, of course! She calls 911 because she feels more tired than she usually does after her standard heroin dosage. “I’ll save you! Here comes you Narcan. Have fun puking your guts out in 30 seconds.”

#5. 18 year old woman
“I got my period at work and I’m cramping really bad. I wanted to go home early but my boss said if I don’t come back with a doctors note, I’ll be fired”
She literally came to the emergency room for a doctors note. Bitch, this ain’t the first time you lost an egg. Shove a plug up your bearded oyster, take a Midol, and deal with your own shit like a grown up.

#4. 28 year old man
“I keep going unconscious when I sleep”
The fuck? Is this some Inception shit right here? Dude actually thought he kept passing out after he fell asleep. He suggested we watch him fall asleep and see what happens. As much as I’d love to sit here an watch you get a few REM cycles going, I think I’ll go stab myself in the ear with a spoon. “Nice to meet you Brad. Here’s your discharge paperwork. We recommend a follow up with a psychiatrist”

#3. 42 year old woman
“I think my tit popped”
She got punched in the tit during a bar fight and now felt like her implant was leaking saline. The fight started because she was showing her new tits off to another woman’s husband. It didn’t take long for us to notice her right headlamp was shining quite a bit brighter than her left that night. Sorry you wasted all the money you just spent on those things. I’m sure some of your “clients” will still like you just the way you are.

#2. 55 year old man
“It’s cold and wet outside”
An Urban Outdoorsman was brought to us by ambulance because it was raining and cold. Don’t you dare say “Aww. You can’t deny people shelter from the cold!” Fuck off. This was in Florida where the lowest temps of the year are like 68. This douche had just been evicted from underneath his bridge, and his cardboard box wasn’t waterproof on its own. Homelessness isn’t anything to laugh about but when you act like a dick and abuse the ambulance service, I’m gonna call you an asshole, and tell you we’re out of turkey sandwiches, and fucks to give.

Here’s my favorite
39 year old woman
“I think I have new monya”
I couldn’t help myself. I said “Are you sure it’s not old monya?”
“Oh yea I’m sure. I got a shot for that a while ago.”
Fuck. I realize Pneumonia may not be the easiest word to spell but fuckin A lady. This grown ass woman legit thought she had taken steps to prevent Old Monya from getting her, but now this new strain of the disease had found a way into her system. We made sure to give her a shot to help treat this improved Monya that bested her previous vaccine

So there it is. Just a few examples to show you why your wait for the ER seems to be getting longer and longer. It’s not because of assholes like me being “slow” or “lazy”. It’s because of assholes like these that are either to dumb to realize they’re being an asshole or just don’t care that they’re being an asshole.

American Healthcare

The health insurance and hospital billing system in this country is fucking ridiculous. Emergency rooms alone will drain people of their life savings in a matter of minutes. The following is a piece of text taken directly from hospitals website regarding their charges:

Emergency Department Charges
Emergency Department charges are based on the level of emergency care provided to our patients. The categories, with Category I representing basic emergency care, reflect the type of accommodations needed, the personnel resources, the intensity of care and the amount of time needed to provide treatment. The following charges do not include fees for drugs, supplies, or additional ancillary procedures that may be required for a particular emergency treatment. They also do not include fees for Emergency Department physicians, who will bill separately for their services.
 
Charges
Category I
$172.00
Category II
$327.00
Category III
$478.00
Category IV
$878.00
Category V
$1,246.00

If you should find yourself truly sick, and end up racking up enough resources to fall under the Category V bracket, you might as well tell them to pull the plug. Not only will you get slapped with that $1,246, but the doctor will bill you for each minute he/she spends at your bedside. Then you’ll get additional charges for all the medications we give you while you’re there. medical-billTo give you a comparison on how much meds cost in the ER, here’s an example. You can buy a bottle of Tylenol over the counter for $3.99 at most pharmacies. In the ER, we will charge you $4.50 per pill. Should you be so unlucky to have a stroke, fear not, for we’ll give you a clot busting medication that has the potential to save your fucked up leg, arm, and face. It’s called Tissue Plasminogen Activator or TPA. Guess how much a single dose of this medication can cost. Did you guess $30,000? Correct! Thirty thousand mother fucking dollars. Do you know how many hookers you could buy with that kind of cheddar? Click Here to find out.

I digress. So after your Category V bill, your doctors bill, and your medication charges, we’ll then charge you for any and all procedures we do while you’re in the ER. That means everything like checking vitals signs, placing an IV, drawing lab work, EKG’s, X-rays and CT’s, etc. Let’s talk about some of these tests. For those that don’t know, an EKG tests one aspect of heart function based on the electrical waves we can measure.KernFig1 The test involves placing ten or twelve stickers on your chest, arms, and legs, attaching wires to said stickers, then printing out 6 seconds worth of electrical wave measurements. The whole test can be performed in under a minute if you are cooperating, but since the results of this test can diagnose a heart attack, we’ll go ahead and charge you $800 for it. No biggie. After all of those charges, we go back and tally up all the supplies we used on you while you were in the ER. Things like needles ($3.75), alcohol swabs ($1.85), band aids ($2.90), gauze ($12.50), and saline flushes ($8.25) rack up your bills even higher. Mind you hospitals buy these supplies in bulk for fucking pennies each.

All this is just for your ER visit. Should you happen to fall into Category V, there’s a good chance you’ll be admitted to the Intensive Care Unit for at least a night or two. For that we charge $2,851/night. That’s one expensive ass hotel room. That’s just the cost for the room by the way. Don’t forget about the supplies, procedures, meds, and doctors bill. You think an doctor specializing in intensive medicine is cheap? Yea they didn’t spend all those years in school to work out of the goodness of there heart.

I once had a friend who broke his pelvis falling off a roof. Long story short, he lost a shit ton of blood, and spent a week in the surgical ICU before spending another week on a regular unit. His total hospital bill between the ER, surgery, the ICU, and Med/Surg unit was over $700,000. Do you know how many hookers you can buy for seven hundred thousand mother fucking dollars? Click Here to find out.

 Here’s a personal story. Not long ago my wife found my 1 year old son with an unknown pill in his mouth. Poison control was unable to identify the pill so they recommended a visit to the ER. It was later determined that the pill was Losartan which is used for blood pressure management. We went to the ER , which I happened to be working at by the way, and all they did was check vitals signs, observe for an hour, recheck vital signs, then discharge. I’m not complaining about the care. My son needed nothing else, and if I had a sphygmomanometer (blood pressure measurer) at home, I would have just kept him home. Thanks to the “Affordable” Care Act I was paying $1,200+/month for insurance for my wife, my son, and I. My insurance only covered 45% of ER visits after I paid my deductible. Before you say it, fuck you. I know it’s shitty insurance, but it’s all I could afford. So for the 92 minute ER visit with no supplies used, my bill totaled $1,342.58. Later I asked for an itemized bill to see what I’m paying for. The lovely people that handle insurance and billing informed me that if I had answered “no” when they asked if I had insurance, the bill would automatically have been reduced to 25% the initial cost.
So with insurance I paid 55% oangry-dudef the ER bill,
and without insurance I would have paid 25% of the bill. Fuck me sideways and call me Jane. Welcome to the American healthcare system people! Needless to say, I promptly canceled my current health insurance. Instead I take that $1,200/mo, and save it for a day when I might actually need it. The maximum tax penalty I would face for not having insurance is a fraction of the cost I was paying out of pocket to actually have insurance.

 So Dexter, what’s the point of all this? I’m not recommending anyone cancel their health insurance, or suggesting that I have a way to fix this fucked up system. However, in light of the fact that we’ll be choosing between a criminal or everyone’s racist drunk uncle for our next POTUS, now might be a good time to make good on your promise to denounce your citizenship, and move to a country with free healthcare.

5 Ways To Piss Off An ER Nurse

 

Here’s a short list on how to get yourself on the short list of patients that get denied pain meds, a larger needle than necessary, or a “come to Jesus” meeting during their stay in the ER.

#1) When asked “What brings you to the ER?” Begin your response with, “WebMD said…”

If I had a dollar for every time people incorrectly diagnosed themselves on WebMD, I’d be able to pay off my staggering student loan debt. A headache does not mean you have a Brain Tumor. It’s far more likely your headache is caused by your last remaining brain cell getting tired of trying to make you function like a normal member of society. WebMD was invented to help people make a more educated decision about seeking medical attention. WebMD was not invented to override the years of medical training that your ER nurse or doctor has received. Every time a patient begins his/her response with, “WebMD said,” the triage nurse will immediately think, “Oh fuck me. It’s another one of these douchebags.”

#2) Lie to them

No healthcare worker is going to believe that your blood alcohol level of .48 was the result of “2 beers” or that the track marks on your arms are “mosquito bites” or that the Barbie doll head stuck up your ass is because you were “walking naked in your daughters room when you tripped and fell into her toy box.” The term “Full of Shit” applies to more than just constipation. We’ve seen it all, and we don’t judge. However, when you lie to us, it does not help your case. I once had a patient tell me all of the track marks on her arm were from all the hospital IV sticks because she’s been so sick over the last few years. She was there for a fever related to her Endocarditis. The Endocarditis she got from shooting up with dirty needles. The sooner we can cut out all the bullshit, the quicker you will be cured. What’s that famous movie quote? “The truth shall get you discharged!” Something like that.

#3) Treat the ER like a hotel

I didn’t spend all that time in school racking up the aforementioned debt to become a waiter or a maid. Ain’t nobody got time to bring you juice, then a turkey sandwich, then a blanket, then a pillow, then a Popsicle, then some morphine, then turn the lights out because fluorescent bulbs hurt your eyes. Someone is in the next room with an actual emergency while you’re sitting here because “someone stole all my Percocet.” I once had someone with Incarceritis (Someone under arrest complaining of chest pain because they don’t want to go to jail) demand I stop treating someone who was actively having a stroke, just so I could bring them a turkey sandwich. You’re a grown ass man; start acting like a grown ass man. Oh and by the way, I know damn well your mom taught you how to say “please” and “thank you” so don’t pretend like she didn’t.

#4) Come to the ER for dumb reasons

As much as I love job security, if you’re 25 years old and come to me at 3am  because you woke up with a fever, your parents failed you. Go home, and take some Tylenol. Here’s a short list of reasons NOT to come to the ER:

You ran out of pain meds
Someone stole your pain meds
You dropped your pain meds down the drain
You’re drunk and now you’re vomiting
You need a school/work note
You think you might be pregnant
You’re hungry
You’re cold
You’re lonely
You missed your vein when you were shooting up and now you’ve got an abscess

Truthfully, that last one probably needs medical attention but it’s your own fault so I’ll help you but no fucks will be given to you

#5) Use an ambulance as a taxi

Ambulances are for emergencies. I’ll repeat that. Ambulances are for emergencies. Ambulances are NOT for people who can’t find a ride, for people who stubbed their toe, for people who don’t want to wake their friends at 2 am, or for people who don’t have Uber money. If you literally will not make the trip to the hospital without dying on the way, by all means, call an ambulance. I once had an Urban Outdoorsman (homeless guy) arrive by ambulance with the chief complaint, and I quote, “Its cold and wet outside”. I’m sorry, did you suddenly regret your decision to fold up your box and move out from under your bridge? Another patient told me “I been pukin’ for months now. Den I think to myself ‘Well…better call 911.'” For fucks sake lady, you’re 500 pounds. You could probably afford to puke a little. I once even had a concerned mother bring her child in by ambulance, and after being asked “What brings you to the ER?” she responds, “I didn’t have a thermometer”. I shit you not. This fucking lady didn’t have a thermometer so she called an ambulance. How about the 25 year old girl who came in by ambulance because she broke a nail? The list goes on people.

In conclusion, nurses and doctors have a lot of patience. However, I’ve provided you with a list of ways to piss them off, and ensure your visit to the ER is less than pleasant to say the least. Do with it what you will.

Bitch, Are You Retarded?

Ok ladies. This week is all about you. Men get a bad rep because we do stupid things, however you women aren’t without fault. While you may not put yourselves in as many dangerous situations as men do, you’re quite capable of making poor life choices. What’s say we start off with a story? This actually happened to me about a fortnight ago. That’s right. A fortnight. A 64 year old woman came in to the ER for abdominal pain. We do the standard work up including a CT Scan of her abdomen. The CT results read something like, “Patient has 12.7 cm glass cylindrical foreign body in vaginal canal. Large spherical bulb like formation on one end of cylinder” Can you guess what it is? If you said glass dildo, you’re wrong. It was a crack pipe. This brings me to my first piece of advice for my readers without a penis.

#1) Your Cockpit is not a pocket
As mentioned a few weeks ago, your Baby Canyon is responsible for the worst smell in healthcare. While it may be convenient to store your flavored lipgloss up there, it’s not going to help the horrible stench that comes from your unwashed South Mouth. I don’t know what it’s like to have the Jaws of Life between my legs, but I feel like it would be difficult to put something up there and forget about it. Day after day that logic is challenged by another yeast infection related to a switch blade, or a mans wedding ring, or a roll of quarters getting lost in your Pimps Paycheck. Just don’t do it.

#2) Don’t be a bitch
You women are viscous creatures. If a guy wrongs another guy there will be a fight, maybe some cuts and/or broken bones, and that will be the end of it. You women go after each other’s souls. “But she slept with my boyfriend!” Bitch, you set her house on fire! As much as I love the stories that come out of your carefully plotted revenge, it gets old. Who am I kidding? It never gets old. I once treated a 39 year old woman who was hit by a car and broke her femur. Turns out she was intentionally hit by another woman because my patient had cut her off….6 fucking months prior. Another woman was brought in because she had been stabbed in the uterus. Turns out she had recently slept with her pimp, and a “coworker” wasn’t about to share her baby momma-hood with another woman. She stabbed her in the uterus to “make sure she could never get pregnant”. What the actual fuck?

#3) No glove, no love.
Solid advice right there. That back alley coat hanger abortion will not work out in your favor. Neither will the STI you got from the Rando you decided had the best pickup line last night. It’s a little known secret that when a woman presents to the ER with itching, burning, or pain Down Unda, the nurses and doctors place bets on which STI she’ll be diagnosed with. “Trichomoniasis? Fuck! I had $30 on the Clap. Double or nothing on the Lady of the Night that just walked in?” I once had a woman who came in with three different STI’s. I guess she thought she’d get a discount if she handled three at the same time. Sorry lady, I’m sure group rates work in your line of “work”, but at the hospital we charge per diagnosis.

Guys may put ourselves in more dangerous situations more frequently, but you woman have a long way to go before you can throw that first stone.

Bro, Are You Retarded?

This week we’re going to talk about how stupid men can be. Don’t worry ladies, you’ll get your turn.
Men, why must we perpetuate the stereotype that we’re mindless, sex crazed animals that do stupid things when we’re with our friends? Lighting a bottle rocket sticking out of your asshole, while sounds hilarious in theory, has never gone well. I can’t tell you how many crispy taints I’ve seen on July 4th. It’s not a pleasant sight. Here are some tips to help you decide if what you’re about to do is a bad idea or not.

#1) If your idea involves sticking your dick somewhere it doesn’t belong, it’s a bad idea.

Just because it fits, doesn’t mean it should go there. You honestly think sticking your Weapon of Ass Destruction in a hot tub jet will work out in your favor? Honestly? I met one guy who put his Tiny Tim into his wedding ring. Ask me if it got stuck. Yea by time he came to the ER, it had been stuck in there for 4 days, and had become necrotic from the lack of blood flow. Go ahead and Google Necrotic Penis and you’ll know why this was one white guy who could truthfully say “I’m black from the waist down.” Now ask me if his Womb Broom is still attached to his body… Let’s just say he’ll have to pee sitting down for the rest of his life.

#2) If the idea came to you while you were intoxicated, it’s a bad idea.
 

“But Dexter, how do I know if I’m intoxicated or not?” If you’ve had a few drinks and the thought, “Maybe I should text my ex” crossed your mind, you’re intoxicated. Here’s a better idea. Buy a keychain breathalyzer for $20-$30, and if you blow higher than .04, your idea is a bad idea. I once had a patient that thought it would be funny for his friends to spin him as fast as they could on a bar stool. He was holding onto the sides of the stool, but didn’t realize his middle finger was caught between the spinning stool and the base. He lost the top of his middle finger. When he got to the hospital I said “Ooo now that’s a bummer.” He replied “Ehh. It’s not the end of the world. Just the end of my finger”. He then asked if the surgeon could replace the finger tip with a bottle opener.

#3) If your idea involves you becoming airborne at any point, it’s a bad idea.

What goes up, must come down. Had a patient decide his first parkour experience would be jumping from the rooftop of a 3 story building into the window of an adjacent building about 10 feet away. This story ends with a broken pelvis and a brain bleed. He survived because I’m awesome at my job and single handedly saved his life without anyone else’s help. No I’m totally kidding….he didn’t make it. LOL! The moral of the story is humans weren’t meant to fly. Also that if you don’t pay attention in Physics, you’ll be bad at estimating your projected parabola. And that’s officially the first time I’ve used that word since high school.

You’re welcome

How To Get High At The ER

Step 1) Don’t be a dick

I don’t care how famous you are or how many board members you know. When you want your drugs, you’re my bitch. As mentioned last week, I’m not your waiter. If you come in to my ER and act like an asshole, you’ll be treated like an asshole. Oh shit! Your family donated a million dollars to this hospital this year? Then where the hell was my Christmas bonus? Saying something like “Hey man, real talk. I’m in a lot of pain and Tylenol ain’t helping no more. I need help. Please” will go a long way toward getting your fix. Saying something like “I know the director! Get me my meds” makes me respond “Oh really? So do I. He hired me. He hired me because I don’t put up with assholes like you. Guess who just got moved to my lowest priority”

Step 2) Don’t be allergic to NSAIDs

For those that don’t know, NSAIDs are Ibuprofen, Aspirin, Naproxen, etc… Drug seekers claim to be allergic to NSAIDs so the only options we have left to treat their “pain” is Morphine or Dilaudid. I have worked in medicine for over 13 years. I care for roughly 4,000 patients per year, perhaps 1/4 of those are given NSAIDs. That’s 13,000 patients I have personally medicated with an NSAID, and I have NEVER had one patient so much as scratch an itch on their ass, let alone have a true allergic reaction. You’re allergic to NSAIDs? I call bullshit. If the bombs drop, and it turns out the government does have an underground fallout shelter, and I am the medical professional authorized to permit passage inside, all NSAID allergic individuals will be turned away to battle it out with the other post apocalyptic factions who are allergic to tylenol and tramadol in an irradiated wasteland. In my future utopia there is no room for the poor protoplasm that is allergic to ibuprofen. “Oh shit NSAIDs make you break out in severe hives? That’s OK. We’ve got Benadryl to treat the hives. Here’s your Motrin.”

Step 3) Don’t ask the nurse to “Push it in fast”

Most nurses are in a hurry because they’ve got a million things to do in the next 5 minutes. They would love nothing more than to give your 1mg of Dilaudid IV “Shove” and be done with the “I hurt my back because I was building an orphanage” story as quickly as possible, but unfortunately, that would lead to even more work because it would likely stop your breathing thus leading to a mountain of paperwork. I’m not speaking for all nurses but if you tell me to “Push it fast”, I automatically dilute that shit in 100 mls of NS and let it drip in over 30 long ass minutes. So much for your high. Now all you get it a few hours of pain relief like the medication was intended for. Damn.

So there you go people. You want to get high in the ER? Don’t be a dick, don’t be allergic to NSAIDs, and don’t tell the nurse to “push it fast”. Instead try this, say “Hey man, I’ve been having some lower back pain for a while now and Motrin ain’t doing shit anymore. Can I please get something stronger? My pain doctor is closed and I’m out of my MS Contin. I totally get it if you gotta give me something weak to start.” Trust me being cordial and up front will get you further than your retarded plan will.