I had to 45 Max a patient on this particular evening.
A 45 max is an emergency call out that a ward Nurse can use if her patient suddenly starts to look like death. I dial 45 and boom: a nursing supervisor, an ICU nurse, senior medical doctors, and security show up. It's a great resource for the ward Nurses to have. I can't dump the emergency on them and go back to my other patients but at least I have help with the patient who is the sickest right away. The doctors and ICU nurse will assess the patient. They will give me about 250 orders that need to be put into the system and actioned right away for the patient. The nurse supervisor and ICU nurse arranges transfer to an ICU (critical care) for the patient by hunting for an open bed somewhere. Security is there in case family members start whigging out. Maybe the 'looks like death' patient's family is freaking out or ,maybe my other patients' family members are going nuts because they are now being ignored because there is an emergency.
This particular patient was coming straight to my floor from the ED (A&E). I only had a brief report from a busy ED Nurse. "The patient I am sending you is a 45 year old male came in with fevers and pain, low BP, IV fluid bolus, IV antibiotics started, chest xray negative. He is alert and orientated, self caring, etc etc etc blah blah blah." (details changed to protect confidentiality)
15 minutes later the patient arrives on the floor. Luckily I was nearby and not with another patient getting grilled by their family when transport brought my new guy into my room. I took one look at this man and I immediately put the call out for a max 45. He was pale and not responding to me. I got vitals and his oxygen sats were in the 50's and BP was 50 systolic. I looked at his bracelet and yes indeedy he was the same guy the ED told me to expect. He had obviously deteriorated very quickly on the way to my floor from the ED. The ED staff have to process and get sick patients moved up to the wards way too fast because of all of the bitching by the folks out in the waiting room about the waiting time to be seen. And this is what happens.
So I call the max 45 and am doing my thing. He could have been septic or had some reaction to something who knows, diagnosis is what doctors do. The first people who responded was an ICU nurse and a medical doctor. I already got 02 and vitals and blood sugar on the guy and an IV cannula in (the one he had from the ED was hanging out). I also got rainbow labs (the docs expect the nurse to do this in an emergency immediately before they even get there and yes they were done in the emergency room earlier in the day), etc etc. The doc ordered the usual life saving stuff and I ran out of the room to get it and the crash trolley just in case. I was also cognizent of the fact that the orders from the doctor that I was actioning are illegal if they are not entered into the system, even in an emergency.
On my way back to the room with the crash trolley and other stuff the son of an elderly patient accosted me.
He got right in front of me and said "hey you get my mother a snack" He then proceeds to give me an order for what she wants as if I am a waitress and this is a restuarant. I kindly told him that I had an emergency with another patient and would find a way to get his mother some food as soon as I could.
Well he didn't like that at all. He fucking stands there and starts wailing about how "you can't get any service from these fucking bitch nurses" and of course there was the usual "you don't want to help my mother because she is old" shit.
I think it is too hard for some of these
Well... the max 45 responding medical doctor overhead the conversation and comes flying out of the room, face beet red, and starts yelling at the son like this:
"how dare you talk to her like that, that nurse has an extremely sick patient, she's not your maid, she is needed in this room right now"
This doc completely flipped. I was in shock. Usually physicians like to egg these kinds of family members on at the Nurse. Well some do. Others just stay silent. Multiple doctors will ORDER STAT at one Nurse 150 things at once...everything from time consuming insulin infusions to heparin drips, cardiac drips, NG tubes to suction etc etc and then tell the patient's and families that the Nurse isn't making them coffee because she "thinks she is above basic care and bedpans". Management won't back the nurses up either as they are so concerned with satisfaction surveys and customer service goals. They actually promote the"Nurses have nothing to do but be your maid and hold your hand" stigma whilst overloading the floor nurses with multiple patients who are way too sick and unstable to be on the floor sharing their Nurse with other patients.
So yeah, I was sure that it was snowing in hell on this particular day.
The son was like "oh, yeah, whatever, I'm sorry doctor". The doctor of course is a man and an authority figure. So the son will accept it when the doctor tells him that the Nurse is unable to play waitress right now. But if the *gasp* mere Nurse tries to tell a visitor like him that she can't play maid right now, visitor will accuse her of being lazy.
At this point we were already back in the "looks like a corpse" patients room and after 20 minutes of sorting him out we were locked and loaded and on our way to ICU. I was anxious to get him over there and transfer his care to the ICU nurse because I was in the middle of a drug round, a blood transfuson and a discharge for my group of patients when all this started. I do actually care about getting back to my other patients who were feeling neglected whilst wondering just where the hell I was with their stuff.
Still can't believe that I got that kind of back up from a Doctor. He was an older guy too.
Rock on elderly old school white coat wearing doctor I say.
General medical wards are hell everywhere but at least over here the staffing is a bit better and the back up is good in an emergency as opposed to the UK. Families are nuts over here too (worse probably, we have armed security at my hospital because of them) but I feel better able to deal with them sometimes. I do miss English MAUs though as far as admissions go. Ours are direct from the ED.