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 wait, 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


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.
Category I
Category II
Category III
Category IV
Category V

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.

Medical Advice Over the Phone

Here’s something:

*Phone rings*
“_____ ER, how can we help you?”
“Yea hi my kid just ate a cheeseburger from McDonalds and it looks like it wasn’t cooked all the way. Should I bring him in?”
Now as much as we would love to say “Are you fucking serious? Hell no you shouldn’t bring them in! Stop being retarded” unfortunately we can’t. If we advise you not to come in, we get sued for refusing care. If we tell you to come in and you waste everyone’s time, we get sued for telling you to come in for no fucking reason. We end up saying “I’m sorry we can’t give medical advice over the phone, but if you feel like your child should be evaluated by a doctor, we’d be happy to see him.” Before we get half way through that response, your retard side stopped listening, and you’ve already formulated your next retarded reply. “Yea but I’m just wondering if…” Bitch no! For fucks sake shut your whore mouth already. We cannot give medical advice over the phone. It doesn’t matter how your simple mind decided to phrase your retarded question. Every question you ask is wasting precious time of my life I can never get back.
The most common question we get asked is “My child has a fever. Should I come in?” Here’s the answer we wish would could give, “No.” Give your kid some Tylenol and/or Motrin and stay home. If you’re dumbass brings your kid to the ER for a fever, guess what’s the first thing we’ll do? That’s right. We’ll give Tylenol and/or Motrin. The same stuff you can get over the counter only ours costs about 10x as much. Why? I have no fucking idea. Oh and by the way, the only reason we give that is because your kid is usually annoying as shit when they don’t feel well. There’s only 3 ways a fever can be harmful:
#1) The fever has lasted more than 5 days in a row. That could mean the infection has progressed to Sepsis.
#2) You’re not forcing your kid to drink water. In that case, he/she will get dehydrated very quickly. If your kid hasn’t peed in 8-12 hours, you fucked up and now we have to stab him with a needle and scar him for life.
#3) The fever is greater than 108 degrees. Not 100.8. One hundred and eight degrees. 105 is fine so stop acting like your kids brain is melting. The only way kids temp will get up to 108 is if you lock them in your car for a few hours. It should go without saying, but don’t do that.

By calling the hospital and asking retarded questions, you waste the time of the healthcare providers, thus increasing wait times and pissing people off for no fucking reason. A long this note, don’t ask your friend or family member in the healthcare field for medical advice either. They know the answer to your question, but they also know damn well you won’t believe them because no matter how educated and experienced they are, you can’t fully trust your well being to someone you once saw hanging on to the grass because they thought they were going to “fall off the earth” after drinking too much tequila that one night in college. You’re going to end up in the ER anyway so you might as well skip the interaction with them where they tell you “Just put some ice on it. You’ll be fine in a few days.”
The bottom line is stop tying up our phone lines and wasting our time with dumb fucking questions we’re not going to give you answers to. We cannot give medical advice over the phone.



Hello there. I’m a Murse (Male Nurse). I’ve worked at 24 hospitals in 13 states. I’ve worked on just about every unit, however I currently call the ER my home. I love what I do, and wouldn’t trade it for the world, but I felt like some things need to be said to the general public, and to the current clientele that find themselves in an ER at 4 am for a stubbed toe.
First off, fuck you. Go back home, and come back when you’ve got a real emergency. Second, fuck you. You don’t know more than me. You don’t know what’s best for you. You’re lucky I care so much about your well being that I’m willing to make you all better. Third, fuck you. I’m here for 12+ hours overnight, and I’m lucky if I get a bathroom break. So don’t be complaining to me about how you’ve got back pain because your Burger King job is so physically demanding.
Anyways, that’s a little about me. Tune in weekly to read more of my rants. Or don’t. I don’t give a shit.