ramblings of a frustrated ER nurse

Okay, this post has been a long time coming. I have always wanted to write about my experiences at work, but I have never sat down to do so. I'll probably write a post like this every once in a while, mainly because I think I'm interesting and funny :) This one is entitled:

Chest Pain Syndrome

So, you're sitting there in the ER waiting room because you have been running a fever for a few days and you are sure you have swine flu, and these dang elderly people clutching their chest and arms have been going in before you! How dare they! They were just wheeled in the door with their oxygen tanks, and the ignorant triage nurse decided that their condition warranted an immediate bed, while you, poor you, suffering from chills and a cough are left in the waiting room with the rest of the undeserving masses.

Suddenly, you think to yourself.... "Ah ha, what if I suddenly come down with chest pain! Then, I'll do a bait in switch once in the room, and the stupid doctors and nurses will certainly fall for it!"

(Of course, you incorrectly assume that no one before you has tried this, and you are unaware that the doctors and nurses actually have medical knowledge).

So you come up to the desk oh so pitifully, holding your chest and doing your best "I'm hurting" face. You say with a certain amount of well rehearsed fear in your voice: "My chest has been hurting a lot, and I'm having a hard time breathing".

Brilliant plan?? NO! THIS IS NOT A BRILLIANT PLAN! Let me tell you why.

Reason number 1:

- If you are under 35 with no history of heart problems, the triage nurse is merely going to do a quick EKG, check your O2 saturation, blood pressure, and heart rate, and send you back to the lobby with a reassuring "well sweetie, your heart looks fine and your oxygen level is 100%. We'll call you as soon as we get a bed." You will then be on the ER blacklist of people to never believe.

Trust me.... Us nurses are not as dumb as we seem, and we never forget a face.

Reason #2

- If you are over 35, even if you swear to the Dr. that you no longer have any chest pain, he or she will still order a slew of diagnostic tests to run, because no Dr. in his right mind will risk missing an MI (myocardial infarction, or heart attack. Yes, I like to use abbreviations, I think they make me sound cool)

Reason #3

- These tests will be expensive and time consuming. Instead of a flu swab we are doing chest x-rays, blood work, IV insertions, medications (nitro, aspirin, Lopressor, etc... nitro, by the way will give you a massive migraine that the Dr. probably will not give you anything for, because, after all, we don't want to stress your poor heart)

You will remain in the ER for hours, and chances are the Dr. will want to even keep you overnight in the hospital just to make sure you're okay. If you decide to leave we will mark in your chart that you left AMA (against medical advice), and good luck getting insurance to cover this ridiculously expensive visit.

Reason #4

- You will now have the diagnosis of Angina in your medical record, meaning you can no longer get a clean bill of health from your insurance. Your premiums will most likely go up.

Reason #5

- The Dr. will probably not address your actual reason for coming to the hospital. When you tell him about your earache, or toothache, or whatever, he will say "First let's make sure your heart is okay. Then we will worry about the rest." (Oh, and btw, it takes 4- 8 hours to officially rule out a heart attack)

All this to say, resist the temptation to fake the chest pain ( And yes, I have had numerous patients do this). You don't want to be the patient that cried chest pain if your massive heart attack suddenly hits you. Nor would you want someone who does not need it monopolizing a cardiac room and valuable resources if your mother or father is the one having a true heart attack.