March 31, 2010, 2:07 pm

Lesson Over a Latte

I love these old shots!

This one is from the National Archives and was taken in 1946.

This is what I pictured when I thought about being a nurse. Neat rows of charts; clean, antiseptic wards; med cupboards with glass doors; crisp,white uniforms and totally cool caps!

I can smell the Lysol wafting through the decades…

Reality: clipboards flying, accusations that I hoard the charts, sort-of-clean floors punctuated by splats of body fluids, medications in locked computer systems, wrinkled scrubs that I want to peel off at the front door and not a cap in sight.

Plus, the the unique olfactory assault of ETOH and urine, so specific to the ER…

And no, it is not true that I wear my cap around the house.

I just try it on now and then.


One thing hasn’t changed since 1946 and that’s Grand Rounds! Granted, now they are online and this week Evan Falchek at the See First blog is hosting with a Health Care Reform theme. I was a week too early, my post on health care reform was in Grand Rounds over at Suture for a Living (sneaky way to fit in link that I didn’t put in last week!).

Uh. Hey nurses! There isn’t a single nursing submission in ‘Rounds this week! Are we tired or did we just get lazy? Raise your bandage scissors and repeat after me: “I solemnly swear to submit to Grand Rounds!”


(The story you are about to read is true.)

The day was uncharacteristically warm.

The corner Starbucks was packed with seekers of caffeine. Some rushed out, dashing to their cars with Frappacinos in hand; others stopped to smell the latte, enjoying the warmth of green metallic chairs on the adjacent patio.

The couple selected an empty table. They sipped their beverages as two gentlemen at the adjacent table conversed.

Guy – “First of all, man, don’t tell ’em you got a migraine…hear that all the time….back pain…somethin’…an orthopedic injury, that’s what you tell ’em you got… look up a doctor…you wanna “pain management specialist”, but not around here….next county….memorize it, man…name, address and phone number…you got an appointment but the pain is so damn bad you can’t wait, knowhatimsayin’?”

Dude – “I hear ya.”

Guy – “And you got to tell them that you are allergic to some junk…if you don’t…give you something…worth nothing!”

Dude – “What junk?”

Guy – “s’called Toradol…and you don’t want Motrin either so tell ’em you’re allergic…bad reaction to nausea stuff except fenagren…”

Dude – “Tordal and fengren?”

Guy – “Yeah…don’t lie about your name, address or give ’em fake numbers ‘cuz they can check that real easy.”

Dude – “‘Yeah.”

The Guy and the Dude stood up and prepared to go. As they walked away, voices fading, the couple heard…

Guy – “…won’t let you drive…”voucher” for taxi…don’t forget a prescrip…”


This guy did everything but name a specific hospital to visit!

If I had any doubt before, I am now sure that word gets around on the street regarding which ERs are “easy”.

And which ER will give that shot on the sixth visit in two weeks, despite knowing full well the complaint of pain is bogus.

Because it is just easier to medicate than it is to confront.

Every addict needs a pusher.

Just sayin’.


  • […] via Lesson Over a Latte // Emergiblog. […]

  • bongi

    March 31, 2010 at 3:04 pm

    sad but funny. now that i think about it, sad and funny are quite often very closely related.

  • Annemiek

    March 31, 2010 at 3:48 pm

    No doubt about it that this information gets shared on the street!
    I recognize the cabinet on the picture from my very old 1st hospital I worked at 🙂

  • Black Cloud ER Tech

    April 1, 2010 at 12:14 am

    It is truly evident that people do not realize that health care providers, firefighters, cops, etc, do indeed frequent Starbucks on a regular basis. Maybe we need to educate them that we, in the industries listed above, are keen on remembering faces… Enjoy your latte and dilaudid while you can, sir!

  • […] from Kim, at Emergiblog, this post about latte’s and life that is confronted daily in the ER-just need to add the Haldol […]

  • Jamie Davis, the Podmedic

    April 1, 2010 at 5:01 am

    Not surprised by this overheard exchange at all, Kim. Based upon the way that certain patients use the same arguments in the same ways points to some kind of grass roots conspiracy.

    Good post! (love the picture, too)

  • Katie Morales

    April 1, 2010 at 12:45 pm

    I love the old photos, too. Sadly, I remember the old chart rack and charts! I still have my cap as well! My mom remembers the old blue capes. Now I would LOVE a cape!! LOL


    April 2, 2010 at 6:08 am

    And it is very sad and yes, criminal (because that’s what you’re Starbucks guys are) that people like this represent maybe 15-20% of our patient populations. And because of them the other 80% may not get the pain control they need. Our patients with REAL chronic pain who have break through pain and for whatever reason, end up in the ED, may go untreated. These criminals have destroyed our compassion and our trust. I wish I knew what to do about it and if I did come up with a solution, I could probably sell it and retire.

  • JParadisi RN

    April 2, 2010 at 8:50 am

    Your post confirms what we’ve always suspected. ER is the only hospital department I can think of without filters for what walks through its doors. Other units or clinics need doctor’s orders or a referral for admission. Good luck.

  • maha

    April 2, 2010 at 7:44 pm

    I’m so angry right now. I don’t know if I would have been able to keep my mouth shut – if I were sufficiently sleep deprived, I think I might have loudly yelled at them and try to embarrass those jerks. These kind of people make me doubt everyone’s story until I find out otherwise, and then I just feel like a cynical jerk.

  • Jim

    April 4, 2010 at 6:05 am

    > “knowhatimsayin’”

    The proper spelling is “nomesane”.

  • Marijke

    April 8, 2010 at 2:41 pm

    Very frustrating. I mean, we know they’re out there, but there’s something very different about being confronted with it. What makes it more frustrating is if you do have legit pain, sometimes it is very difficult to convince the doctors and nurses that you have it!

  • NurseW

    April 10, 2010 at 7:36 pm

    Why does this matter? I am an ER nurse and I could care less if someone is there just for a fix, if the freaking DR is willing to order it, I’ll give it. I’m not a “pusher”, I’m also not a social worker, Rehab nurse, or interventionist. It’s up to the Dr to determine what treatment the pt needs, and if that’s a shot of narcs, so be it. I’m not able to save a drug addict, at least this gives me the time to tend to patients that REALLY need my care. Why is thier addiction, and subsequent success at swindiling drugs out of a DOCTOR, my responsibility. As long as they keep breathing, I’m clear.

  • chronic pain patient

    April 14, 2010 at 12:06 am

    I suffer from chronic migraines. I also have failed back syndrome from L4-L5 fusion with rods, screws, cages, the works. It took me MONTHS to get into a pain mgt clinic. In the meantime it was constant pain or go to ER when it got so bad I could no longer tolerate it. My surgeon and pcp drilled it into my head that only pain docs can write scripts for adequate pain control.
    Today I went to ER for a 5 day migraine. Dehydration was so bad it took forever to get a line in. Doc saw I wasn’t a frequent flier and graciously took care of me.
    Why the comment, you ask? He called my pcp who told him I was in pain mgt. I gave the triage a list in writing of every drug I take. We even discussed that avinza won’t work for acute pain, plus I couldn’t keep any meds down. I didn’t say I was in pain mgt since it had been well drilled into me that only pain mgt docs wrote for pain drugs. I also had his permission to go to ER as long as attending doc knew what I was on.
    My point? I still feel like I let a caring ER doc down. Then I see the post above. I’m paying for junkies. No wonder I’m still stewing over an innocent mistake. Sorry doc. And thanks 🙂

  • Nickie

    April 27, 2010 at 2:56 am

    This makes me so angry. I was just in the ER for a migraine that had been lasting about a week. They threw everything at it, I’d already tried Immetrex and a Medril Dose Pack, before going to the ER. When I got there, they tried Benedryl, Decadron, Toridal (I’m allergic maybe to Ibuprofen but I was desperate), Zofran, Magnesium. They did a CT scan and then stilll the pain was there, even with all of those drugs. So they ended up giving Dilaudid. I’d hate to think that the staff wuld think I was lying about my migraine pain just because of people who weren’t in pain who were lying.

    My doctor and nurse were both wonderful and treated me with respect and dignity. I’m young, and came in with a purse full of meds for my six different chronic conditions and they didn’t make me feel like I shouldn’t have come in, they cared and they did their jobs. I’d like it if my migraines were better controlled, but they aren’t yet, so until they are when they get that bad, the ER is my only option. I wish that these coffee drinkers could walk a day in my shoes with two chronic pain conditions and understand why faking it hurts others.

About Me

My name is Kim, and I'm a nurse in the San Francisco Bay area. I've been a nurse for 33 years; I graduated in 1978 with my ADN. My experience is predominately Emergency and Critical Care, and I have also worked in Psychiatry and Pediatrics. I made the decision to be a nurse back in 1966 at the age of nine...

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