Oh. My. God. Have I ever mentioned I sometimes find myself hating triage??? I've spent two twelves in a row there, and by the end of my shift last night I was borderline homicidal. Or, as goes the running joke around here, "my psychotic nerve was flaring up." (Scott actually had a patient tell him that one night.) Something in the air was bringing out the worst in people, you'da thought it was a full moon. I understand when you feel like crap, and you're entitled to whine a little. What you're not entitled to do, is be entitled. You're not allowed to yell at the nurse who's reached near-frazz and can't find any goddamn thermometer probe covers. For the benefit of all mankind, I have devised a simple set of rules that will provide you (and me, mostly me) the optimal triage experience. It goes a little somethin' like this:

1) When I call your name in the waiting room, to get you back to triage you, don't roll your eyes and say something like "Oh my god, it's about damn time." This sets us up to *not* be friends right out of the gate. And trust me, you want me to be your friend.

2) If you walked in of your own free will, walk to me when I call you instead of sitting there in that oversize wheelchair with your big dumb cow eyes and waiting for me to come get you, push you through the throngs of other people, and navigate us backward through a door that wasn't designed for a wheelchair. Since when is nausea a reasonable reason to require a wheelchair?? (Or come to the emergency department for, for that matter?)

3) As I seat you in the triage room, I will be asking you to remove your coat from one arm so I can check your blood pressure. Please do this. It makes me grumpy if I have to ask you eight times. If it is too much to concentrate on telling me your story and taking off that coat, the story can wait for five more seconds.

4) When I ask you what brings you in today, and you tell me "I'm real sick," I want to bonk you over the head with my keyboard. Everybody out there is "real sick," tell me what the hell hurts.

5) Just the facts, ma'am. Just the facts. I have 22 more patients to triage after you, and another 8 are standing in line waiting to check in. While I'm sure your life story is both interesting and poignant, I simply do not have time to appreciate it now. Tell me your chief complaint, and answer my questions, and we'll be okay.

6) I've covered this before. Bring your medication list with you. And know your allergies. "Well, it's a little blue pill, I'm not quite sure what it's for, but you can call my pharmacy and they'll tell you" is not acceptable. I don't have time to make phone calls to find information you ought to know. And "allergic to all sorts of things" with no further specification is equally unhelpful.

7) Physics/physiology review: If a large appliance falls from a reasonable height onto your 6-year-old, this is a Bad Thing. Please for the love of Pete do not tell the clerk just that your child has "abdominal pain," as this does not tell us we need to see him sooner. Folks are waiting up to an hour and a half to be triaged, and it's really not in his best interest to sit in the waiting room that long with internal injuries.

8) You may be unhappy that you were just discharged in the past day or two from our hospital, you may not have felt you should have been sent home. You may feel you should have been admitted the last time you came to the ER. You may think the nurse upstairs was snippy. You may have hated the food. Okay. None of these things are my fault, and I can't change a darn one of them now. Let's talk about your symptoms today and what we're going to do with them.

9) You will get brownie points if you smile or otherwise try to be nice to the nurse. And you will score major points if you joke and laugh with her. Points most often translate to shorter stays. (Huge kudos to the young guy I triaged near the end of my shift on Monday, who admitted he was broke and didn't want me to order anything he didn't absolutely require; his words were, "Can you give me 1800's medical care, for 1800's cost? I know it'll hurt, but I can afford it." I cracked up.)

10) Don't ask me, after I've triaged you and requested that you return to the waiting room, if there's a place you can lie down. Yes. There are. They're called Beds. And people are waiting seven and a half hours for one. Have a seat.

11) Don't approach the front desk and demand anything. Demanding will get you nowhere, and may get you kicked out. Ask any number of the psycho family members we've escorted off the premises in the past couple of days for threatening bodily harm if they aren't taken back to the back RIGHT NOW.

12) If you're bringing a sick child to the ER, you have to physically bring that child to the front desk to check in, so we can eyeball them quickly. And to one mom in particular, thank you for understanding this: we really do know what we're doing, and if you lay your limp and unconscious three year old on the counter and say "She keeps passing out," we will move and we will move quickly.

13) It is not necessary to preface your story with "My doctor sent me here." This tells me you're a pain in his ass, and he's pawning you off. And it won't get you to a room any quicker. Similarly, "the nurse I called said I should come in." No additional credibility comes from that line either. And this, from a nurse who does telephone triage.

14) Unless you are a doctor, or a nurse, or a paramedic, or an experienced EMT, I'm not likely to trust that you've correctly diagnosed yourself. Being an MA or a CNA does not qualify you to do my job. Try again. And don't try to use the lingo if you're not comfortable with it: you'll sound ridiculous and I'll laugh at you when you go back to the waiting room. (A couple of months ago, Scott arrived on scene and was moving toward the patient to do his initial assessment, when a family member pushed in front of him and said, "I'm a medical assistant." To which Scott replied, "Hi. I'm Scott. I'm a paramedic. How about you let me handle the paramedic stuff?")

15) Don't feel compelled to tell me what you think you need. This part is my job, and I'm really good at it. Even if your doctor sent you here (see # 13) and told you you should have abdominal x-rays and this and that, if he did not send orders with you for those things, I'll handle it. When we implement the "Patient Self-Diagnosis Form" and "Patient Self-Order Form," you may feel free to do these things.

And finally, a short list of bad reasons for an ER visit, and good:

Bad reason: vomited three times today
Good reason: vomited everything you tried to drink for four days, and diarrhea too.

Bad reason: child with a cough and sore throat
Good reason: chid with tonsils so swollen her voice is muffled and she's spitting into a cup

Bad reason: skateboarding accident resulting in scuffed elbows
Good reason: child with an extra s-shaped joint in the forearm after a bike accident

Bad reason: high blood pressure for 2 years
Good reason: blood pressure of 220/110 with facial droop and arm numbness and a killer headache

Bad reason: baby with a snotty nose who's cooing and smiling and slobbering all over
Good reason: baby whose ribs are sucking inward with each labored breath (we call this retraction, and it means your kid could go downhill fast)

Bad reason: to get your narcotic fix
Good reason: to bring the frazzled nurse her Starbucks fix and a hug and a kiss (thank you sweet love)

All right, people. Class is over, for today.
It's gorgeous out, my snow might melt - and barring any major meterological catastrophe, I finally get to go for a ride on the bike tomorrow. It's been entirely too long, the weekend after Thanksgiving when we went to Santa Fe.
I. Can't. Wait.