The pain scale.

Here I am contemplating at least, my last few shifts as an ER nurse.

Of course, all of this could fall through and I could have years and years of ER nursing ahead of me.  Hey, there are worse things.  But, if this is to be my last stint of ER duty, even for a while, I want to get a few things down and thought I would share.  For those of you here only for adventures and pretty pictures, come back soon.  They will return. 

Now...sit down with any ER nurse and ask them about the pain scale.  At the very least you will get a groan and an eye roll.  Some, like myself, will go off on a passionate rant about the misuse and abuse of the standard 1-10 pain scale.  This sounds like it isn't a big deal, but it might be more so than you think.

Let me tell you why.

First off, when you come in complaining of pain, we take you seriously.  You took the time out of your busy day to come all the way down to the ER and probably waited a pretty good amount of time in the waiting room to boot.  Obviously this is more than just a minor boo boo.  (Except when it isn't, but that is another rant.) I get that you are trying to convey to me the serious and urgent nature of your pain.  Again, you are here, that tells me something.  Telling me you have level 10 pain because your ankle hurts, or even your stomach hurts, doesn't do that.  The first thing that does, is prevent that pain from ever getting worse.

You see, the scale only goes to 10.  Yes, even if you insist your pain is 25.  So, when your migraine gets worse, or your back starts hurting from lying on the junky ER stretcher mattress for a couple of hours, there is no way to document that.  The computer will only allow an entry up to 10. 

Your pain got worse?  No it didn't.  10.

One guy I worked with, definitely of the ranting variety, would ask people who rated their pain a 10, "So, if I set you on fire right now, you wouldn't notice?"

It gets irritating.

Especially when you arrive and are texting your friend about OMG you are at the hospital and eating the bag of chips from the vending machine in the lobby while you tell me your belly pain is a 10 out of 10.  Look, if you won't take this seriously, why should I?  I have a guy next door with 6 out of 10 chest pain for the past hour.  Who do you think is getting my time?

But, the real reason is different.

The real reason is that I have seen people in level 10 pain.  Most ER personnel have and it can be quite the profound experience.  You see someone who is gravely hurt and fading in and out of consciousness.  Every moment they manage to stay awake they are crying and begging for medications maybe you can't give them because their blood pressure is too low from all the blood they lost.  Frequently, the pain overwhelms them and they fall into animal screams before they lose consciousness again. 

So, what was your pain level again?  Let me give you a clue, if you can tell me it is a 10, it isn't.

Please, respect the pain scale.  It can be useful if used properly.

For a good example of what I am talking about, look here:  Pain Scale

The ER kicked my butt.

I doesn't happen often. 

Yesterday, the ER won. 

I am good at my job.  Much of that arises from a time when I wasn't very good at my job.  Not being very good at your job when someone's life or health depends on your proficiency is a very stressful situation.  That stress leads you to work hard on getting better or it burns you out.  I worked hard and got better and my stress level at work decreased to an acceptable level. 

But. 

And that is the nature of the emergency room.  You never know what is going to happen. 

Yesterday started off well enough.  I was busy, but nothing too bad.  Then a DKA arrived.  For those who don't know, these are somewhat personal for me.  These are possibly life threatening emergencies and they deserve as much of your attention as you can spare if you are the nurse.  While I was getting that all settled in, my sepsis arrived.  Systemic infection that can be life threatening.  Good times.  Dehydrated to the point that I couldn't find an IV site.  Luckily, my co-worker came to my aid with an ultrasound, just in time for them to tell me about the STEMI that was arriving into my other room.  Everything else stops for the STEMI.  This is an evolving heart attack.  Time is tissue.  We had a lot of work to do to get this guy to the cath lab within the window.  Again, without a couple of co-workers, this could have gone badly.  Even with all the help, I was starting to get a bit overwhelmed. 

We get the STEMI out and up.  I walk back over to my sepsis, to try to get back up to speed with where I was and what needed to done.  They tell me there is now a code stroke coming into the room where the STEMI just left.  It isn't even clean yet.  Oh yeah, I have another room with another patient I haven't even mentioned. 

This is the point where I realized something has to give. 

Mind you, this happened on a good day, in a good hospital.  At the morning meeting they informed us that we were 'upstaffed' today.  And even though we had an extra nurse, my charge wasn't going to send anyone home  just in case. 

So, working in my favor was an extra ED nurse, a charge nurse that was good at recognizing and fixing problems as they crop up, and a pretty well run hospital.  Without any one of these things, this could have been a lot worse.  It reminded me of other places and other times when I was not so fortunate.  Sometimes these things happen when you are down a nurse, with a green charge in a place that cares more about saving money.  I've been there too. 

I'm tired.  I need a break from all of this.  Is it weird that I am looking for a more sane work environment in a prison?  Probably.

I am pretty sure though, that I won't have to do urinary catheters on 2 year old kids and CPR on 90 year old people.  I guess I will see. 

Yesterday, everything worked out thanks largely to my coworkers.  We got everything settled and I even got sent of to lunch.  Then I returned to the new patient that wouldn't stop pooping on himself.  Some days.

And on this day I broke a little.  As I have before.  When I got home my family put me back together again, like they do.  I will go back again later in the week and try again. 

It's time for a change.

I'm ready.