Registered Nuts – Psych 101

6:42 PM

I pull into the lot and sit for a minute. I say a small prayer that goes something like, “God, why do you punish me so? I HATE YOU……Amen!”

I sigh a deep and agonizing sigh and hoist my tired ass outta my truck and into the pits of hell that is our Emergency Department.

This one tends to have the psychotic market cornered so as to promise an especially challenging shift. One that will one day assure my place amongst the ranks of chronically psychotic.


I’m met at the vacuum sealed double doors, coffee in hand and a bad attitude by a crash and a yell, “Hey, ..STOP HIM” I’m a tad stunned to see Atilla the Hun barreling towards me and a crack team of nurses and doctors all looking at him, pointing at me and caring less that he decided to make an untimely exit. As Mr Hun blazes by me I wish him well, pat him on the back and kindly hit the silver button on the wall, allowing him that very freedom that appears he’s willing to die (kill) for. We surround him in the parking lot where he is coaxed back inside by the unit clerk with the promise of a hot meal, a cool buzz (Ativan) and a quick admission to the floor in time for the NBA playoff game. All this love and attention because wifee wanted out and he wasn’t crazy about the idea. He’s put up for about a 1000 dollars a night, spoiled, pittied and pampered until he’s ready to say he’s sorry and he’ll be a good boy. 72 hours later he’s released with hugs abound. When presented with the $5200.00 bill he explodes at the admissions desk, shares a few expletives with the beleaguered clerk and vows to “never pay you sorry mutha*****!” No doubt the soon-to-be-ex-wife will soon end up in one of our local trauma centers, unfunded, unloved and unconscious.

7:04 PM

I’m sucking down my now lukewarm coffee and I am thinking, “All this already”….”AND I HAVEN’T EVEN STARTED MY SHIFT YET”.

No sooner do I sit down for report when I am approached in rapid succession by a flurry of angry, psychotic, confused patients and family members. “Can I have water?”… When is the doctor coming in?”…..”That 200 milligrams of Demerol just ain’t workin, can I get another ‘hunerd?”….”My father just took a shit in your garbage can and now he’s got the red thermometer in his mouth and the BLUE one up his….” “MA’AM,…I’ll be with you momentarily” (i.e. I’M DRINKING MY *****IN COFFEE)

The oncoming shift all look and feel as I do. There is distance in their stare. Want in their heart…And a loaded .45 caliber just under their fanny pack if a career change is near. The outgoing Nurses are bouncing around and singing like they are Oompa Loompa’s in Willy Wonka and the Chocolate factory. The elation at the end of another ER shift is truly palpable. You tend to be a little nicer, a little better nurse, a little more human, if only for a few moments. But we are just arriving and could give a damn about 90% of the crap that invades our Emergency rooms on any given day. All we care about is who is dying and how can we help. The animal’s will have to wait.


At once I establish who my patients are, why they are here and if they are pending admission to the Eternal Care Unit. I bury myself into the sickest one’s and assure that all is medically stable, comfort is being maintained, info is passed along, all the while offering up a healthy dose of compassion and professionalism. They are why I am here and why I chose this profession. My other 2 patients are chronic alcoholics, multiple visits, multiple attempts to dry them out at the tax payers expense, multiple personalities. Neither can see straight, pee straight or walk a straight line. Both have liver’s the size of Rhode Island. One has jaundice so bad it looks as though he spent his last drinking binge slurping Vodka Martini’s in a tanning booth. One will eventually get admitted as a medical patient because his blood alcohol level exceeded numbers that resembled surface temperatures of the Sun. He will go on to dry out overnight and sign out against medical advice by morning………. and, be drunk again by noon.


Contemplate suicide.


Can no way see leaving this bastion of humanity until I first answer a flurry of questions by the unruly masses still to be brought back from the waiting room. From the intercom and in broken english I hear, “Pinche Pendejo, I’ve been waiting for 13 hour’s and…………Click…. “Mrs Rosario, I am sorry that your hearing is diminished because you’ve got 3 pounds of earwax lodged in your auditory canal but I am presently caring for a man who is near death…..we are sorry for the delay… Please, GO SIT THE **** DOWN……..and thank you for choosing our hospital for your all of your personal hygiene needs.”


Contemplate homicide.


A naked man runs by the nursing station with little fanfare. We usher him back into a room and apologize to the parents of a visibly shaken 8 year old girl. A girl who has no business in an adult ER in the first place but who’s parents snuck her in so she could watch grandma vomit stool.




Catch an earful from someone elses patient who is unhappy that no one has fed her, angry because no one has medicated her anxiety with an otherwise near fatal dose of Ativan, pissed off at the world for her crack habit, her Hepatitis C and a botched lesbian relationship. She demands that her “spouse” be brought back immediately, spouting, “She is my wife you know!”

“Not in Texas she’s not!”!

As she marches back to her room to gather her things and leave, I suspect I haven’t heard the last of this incident. It is a “Methodist” hospital system you know. Hell, if it were a Catholic Hospital, I’d get a raise and an email link to sensitivity classes online.



12:02 AM

“GODDAMIT, I BEAN HER WAITING FOR ALMOSE 22 HOURS….Click…..Mr Sanchez, I am sorry that your gun-shot wound from the time of the Alamo still hurts you but we are presently “extending our healing ministry of Christ” by physically restraining a morbidly obese manic-depressive who thinks the ghost of Liberace’ sexually assaults him in his sleep. Now please, ****-OFF!!!!”

We gang-tackle Mr Palmer, re-dress him…AGAIN….assure him that Liberace pulled out and ran off as soon as he hit the floor, then strap him to a gurney.

12:42 am

I am then accosted by an angry family member who is complaining about the smell emanating from the bed next to his wife’s. In easy to understand, non medical terms I explained that one of the many glorious smells perusing through any given ER at any given time is the smell of rotting flesh. In this case, rotting flesh from the necrotic toe of a non-compliant, renal transplant patient given a new lease on life as well as a few body parts in spite of his heroin addiction. He stopped the insulin, restarted the juice and blew nearly a 1/4 million dollars of other peoples money in the process. I escort the man back to his wife’s bedside, reassured her that her gallbladder wouldn’t hurt so much if she’d stop wearing t-shirts with Jack-In-The-Box logo’s (you get ’em free with the purchase of a “number 3 with double-cheese”) and change her diet to one with less fat.

01:30 am

Dinner time and I relax to eat a little chow and watch a little of the Republican Party Presidential hopefuls debate on a little TV in the nurses lounge.

01:31 am



Fearing for the fate of my country, my life, my fellow man, my sanity, I crawl into bed 5, hit the call-light and demand a pillow and a Xanax..


There is light at the end of the tunnel when I admit 2 patients in record time. I have 3 empty beds and Mrs’ Karnes, a 22 year old Vicodin addict who came into our ER because her “Doctor in (insert fictional place here) forgot to refill her (insert narcotic pain reliever or benzodiazapine here) and now she is out her meds. After giving an Oscar-worthy performance she convinces the “treat ’em and street em ER Dr type to aptly write out a total of 3 prescriptions, each representing one of 3 classes of narcotic medications. She asks for another (insert “D-D-D Demerol” here) shot for the road and swings by the nurses station to thank everyone for their professionalism, patience, a nice buzz….. and most of all for her up and coming 3 day stone-fest featuring Oober Buzz and the Benzo’s. We applaud her commanding performances and wish her a speedy overdose. She is reminded that her “red card’ means she must stop by admissions and pay her bill and that she must also call for a ride because we cannot allow her to drive in her intoxicated state.


The Vicodin Queen observed sneaking away in her Escalade, shards of red paper seen flying from driver side window.



This is Mike, your nurse who was taking care of you…well, if you recall we discharged you not 20 minutes ago. You’ve already seen the ER Dr and you’ve already received your Dilaudid shot for your tooth pain you’ve had since just after the Crusades!”……………Mr Jones?…….”Yeah…..Okay……….” “You’re welcome Mr Jones……”

..”See you tomorrow”.


After A few rounds of Limbo the celebration quiets as the day crew comes ambling in. Each one reluctantly glances at the census board and are visibly shaken when they notice it full. 2 of which are patients they’d already seen the day before for the very same, non-urgent complaints. They didn’t fill their scripts, they didn’t call their follow up Doctor’s or their primary care Dr’s AND their “pain specialists” have put out restraining orders on them. All they know is that at any time, 24/hrs a day they can come into any ER with the law on their side, a bogus complaint, a false identity and demand that we get them stoned. And we do. By law, WE HAVE TO. They don’t bring any means or inkling to pay, they toss around that same pathetic chronic back pain or migraine story, display that same list of 20 meds they CAN’T take because they are “allergic” ( = doesn’t get them high) and cry and carry on until they are higher than a Polish satellite.


“AWWWWWWWWWWWWWWW…I NEED TO SEE A DOCTOR NOW YOU MUTHA…”…………………”Mr Baldinger……..Hello Sir, This is Mike, one of the Nurses here at Our Lady of Perpetual Pestilence Hospital. I apologize for the wait and I want to assure you that one of our fine (day) nurses will be with you momentarily to meet your every need. And please don’t worry about any red-cards, you don’t have to pay this time either. Besides, we are using BLUE cards now, which is a much softer color and………..CLICK……..JUST COME GET ME MUTHA FF……click. “Be right there friend, and don’t you fret Mr Baldinger, here at OL PeePee Hospital, Were here for YOU!!!……Click.


I inform the day crew that Mr Baldinger is in the waiting room attempting to steal the battery off of Mrs Martinez’s Hover-round.

They all run through the double doors and I double time out the back. As security rushes by, presumably for that little ruckus about to kick off in the waiting room, I release a deep, long sigh, mentally picture Mr Baldinger being hog-tied to a gurney and all to the amusement of a waiting room full of the world’s misfits. The drug addicts, psychotics, neurotics, non-compliants, drug-seekers, actors, beggars, the lonely, the homeless and the truly worthless are all equally represented. There are NO emergently sick patients out there. They are in the back with us. The truly sick who receive and appreciate our care, handling perhaps the last few moments of their lives as humbly and as kindly as their pain and regrets allow. Understanding the interruption when the worlds worst aren’t getting enough attention. I have to remind myself often that that is why I and so many other fine Nurses, Dr’s and ancillary staff put up with those who just plain shouldn’t be here. Shouldn’t be allowed there unless a true medical “Emergency” exists and who literally gobble up “HUNDREDS OF BILLIONS OF DOLLARS IN TAX PAYERS MONEY A YEAR!” I also remind myself that I did make a difference in someone’s life last night. I did bring a smile and a few laughs. And I can still comfort the sick and dying and always from the heart. And they know that. But I also know that this kind of work can drain the spirit and refill it with fear, hate and apathy (see above).


As San Antonio’s finest come blazing past me and abruptly come to a screeching halt at the ER entrance, I again briefly picture the drama unfolding inside. Driving away in my truck I smile large and begin to sing……….”Oompa Loompa Loopity Loo…I’ve got a special…