I’m currently rotating at a local community ER where the volume is less, the acuity is down, and unfortunately, the systems, nurses, and techs aren’t as consistently good as at the Medical Center down town.
A 93 year old lady came in the other day with left arm shaking that lasted for 30 minutes. She otherwise had no complaints, but she wasn’t a sharp historian, so I ordered a “Gradma-gram” and asked the nurse to place an IV. She asked me, “What are you hunting for with all of these tests?”. I explained to her the Chem 7 was for electrolytes, the UA was for occult UTI, and so on down the list. She replied “I don’t know why we have these order sheets if you guys just order everything anyways. And I hate being a phlebotomist, do I have to place the IV?” ”Yes”, I explained, because that was we could intervene more easily if something came up.
Two hours later the blood work is back and it shows that the pt is dehydrated with moderate acute kidney injury. I wanted to start IV fluids but knowing that it’ll take forever for the nurse to do it herself, I go to the room to hang the bag, at which point I see that the patient is without an IV. So I start one myself, hang the fluid, and then write the order. I find the nurse and tell her the update, that I’ve started the IV, hung the bag, and wrote the order, and if she could just double check that everything was OK.
Two thoughts from that night. 1) Old people will never tell you what’s actually wrong with them, and 2) if you have a coworker who does a good job, tell them that and cherish working with them always.