Nursing Voices

Saturday, June 30, 2007

Fireworks, Haldol, and the 4th of July.

Look at that nurse. She looks so patriotic. I’d bet if her you asked her, she would tell you she is a member of the Daughters of the American Revolution. I love the flag that she's draped in, and I especially like her cap. I give her cap at 10/10 on the Emergiblog Cap Scale. She's dressed and ready for work. It looks like the 4th of July is her favorite holiday.

City Hall, Morning Sun, Iowa

My favorite holiday is the 4th of July, too. Independence Day is steeped in tradition. When I was a little girl spending my summers in Morning Sun, Iowa, my grandparents took me into town so I could participate in the local 4th of July festivities. We watched the annual tractor pulling competition, the Independence Day cakewalk, the greased pig contest, and of course I got to take a spin on the kiddy rides that were setup in front of City Hall. There was a horse show later in the evening followed by fireworks, and homemade cherry pie topped with vanilla ice cream. It was heaven on earth.

The 4th of July came with new traditions when I started working as a psychiatric nurse. The other nurses and I bring in fried chicken, watermelon, pies, and ice cream for our patients. We also brace ourselves for the surge of psychotic patients who traditionally flood into the unit when firecrackers start popping, and the fireworks start going off in the nighttime sky. My patients really think that the sky is falling and that the world is coming to an end. And God help us if a psychotic person has a few beers while watching Will Smith in Independence Day. They come running in believing that the aliens are out to get them. Damn aliens. They really know how to kill a holiday.

Giving a lot of Haldol is another 4th of July tradition. It’s a psychiatric nurse’s holiday drug of choice.


Blogger Julie, RN said...

I have many fond memories of childhood Independence Day festivities, as well. Ah... to go back in time. Yours sound like small-town Americana. Awesome.

Now, to consider this weekend's full moon which preceeds the fireworks on Wednesday, I will predict my week will flat-out suck.

I pledge allegiance to Haldol of the first-generation antipsychotics
And to the relief that it may give;
One drug, under utilized,
indispensable, with therapy and benzos for all.

9:47 AM  
Blogger Mark said...

It is always better to give than to receive.

10:13 AM  
Blogger Kris said...

But don't you hate nervous Interns who order 1mg of Haldol IM on the guy who's made a mace out of a can of powdered nutritional supplement and his belt?

7:54 PM  
Anonymous Anonymous said...

Why is THIS not being discussed about by every med oriented blog on the internet? I wish you all would stop whining, complaining and being so "dismissive" of patients and instead all come together and start changing things from within. How many more of us have to die before you all change?

Did Mrs. Rodriguez die for nothing?

County officials express dismay at the events surrounding the recent controversial death at King-Harbor hospital. One nurse has resigned.
By Charles Ornstein, Times Staff Writer
May 20, 2007

In the emergency room at Martin Luther King Jr.-Harbor Hospital, Edith Isabel Rodriguez was seen as a complainer.

"Thanks a lot, officers," an emergency room nurse told Los Angeles County police who brought in Rodriguez early May 9 after finding her in front of the Willowbrook hospital yelling for help. "This is her third time here."

The 43-year-old mother of three had been released from the emergency room hours earlier, her third visit in three days for abdominal pain. She'd been given prescription medication and a doctor's appointment.

Turning to Rodriguez, the nurse said, "You have already been seen, and there is nothing we can do," according to a report by the county office of public safety, which provides security at the hospital.

Parked in the emergency room lobby in a wheelchair after police left, she fell to the floor. She lay on the linoleum, writhing in pain, for 45 minutes, as staffers worked at their desks and numerous patients looked on.

Aside from one patient who briefly checked on her condition, no one helped her. A janitor cleaned the floor around her as if she were a piece of furniture. A closed-circuit camera captured everyone's apparent indifference.

Arriving to find Rodriguez on the floor, her boyfriend unsuccessfully tried to enlist help from the medical staff and county police — even a 911 dispatcher, who balked at sending rescuers to a hospital.

Alerted to the "disturbance" in the lobby, police stepped in — by running Rodriguez's record. They found an outstanding warrant and prepared to take her to jail. She died before she could be put into a squad car.

How Rodriguez came to die at a public hospital, without help from the many people around her, is now the subject of much public hand-wringing. The county chief administrative office has launched an investigation, as has the Sheriff's Department homicide division and state and federal health regulators.

The triage nurse involved has resigned, and the emergency room supervisor has been reassigned. Additional disciplinary actions could come this week.

The incident has brought renewed attention to King-Harbor, a long-troubled hospital formerly known as King/Drew.

The Times reconstructed the last 90 minutes of Rodriguez's life based on accounts by three people who have seen the confidential videotape, a detailed police report, interviews with relatives and an account of the boyfriend's 911 call.

"I am completely dumbfounded," said county Supervisor Zev Yaroslavsky, who has seen the video recording.

"It's an indictment of everybody," he said. "If this woman was in pain, which she appears to be, if she was writhing in pain, which she appears to be, why did nobody bother … to take the most minimal interest in her, in her welfare? It's just shocking. It really is."

The story of Rodriguez's demise began at 12:34 a.m. when two county police officers received a radio call of a "female down" and yelling for help near the front entrance of King-Harbor, according to the police report.

When they approached Rodriguez to ask what was wrong, she responded in a "loud and belligerent voice that her stomach was hurting," the report states. She said she had 10 gallstones and that one of them had burst.

A staff member summoned by the police arrived with a wheelchair and rolled her into the emergency room. Among her belongings, one officer found her latest discharge slip from the hospital, which instructed her to "return to ER if nausea, vomit, more pain or any worse."

When the officers talked to the emergency room nurse, she "did not show any concern" for Rodriguez, the police report said. The report identifies the nurse as Linda Witland, but county officials confirmed that her name is Linda Ruttlen, who began working for the county in July 1992.

Ruttlen could not be reached for comment.

During that initial discussion with Ruttlen, Rodriguez slipped off her wheelchair onto the floor and curled into a fetal position, screaming in pain, the report said.

Ruttlen told her to "get off the floor and onto a chair," the police report said. Two officers and a different nurse helped her back to the wheelchair and brought her close to the reception counter, where a staff member asked her to remain seated.

The officers left and Rodriguez again pitched forward onto the floor, apparently unable to get up, according to people who saw the videotape and spoke on the condition of anonymity.

Because the tape does not have sound, it is not possible to determine whether Rodriguez was screaming or what she was saying, the viewers said. Because of the camera's angle, in most scenes, she is but a grainy blob, sometimes obstructed, moving around on the floor.

When Rodriguez's boyfriend, Jose Prado, returned to the hospital after an errand and saw her on the floor, he alerted nurses and then called 911.

According to Sheriff's Capt. Ray Peavy, the dispatcher said, "Look, sir, it indicates you're already in a hospital setting. We cannot send emergency equipment out there to take you to a hospital you're already at."

Prado then knocked on the door of the county police, near the emergency room, and said, "My girlfriend needs help and they don't want to help her," according to the police report. A sergeant told him to consult the medical staff, the report said. Minutes later, Prado came back to the sergeant and said, "They don't want to help her." Again, he was told to see the medical staff.

Within minutes, police began taking Rodriguez into custody. When they told Prado that there was a warrant for Rodriguez's arrest, he asked if she would get medical care wherever she was taken. They assured him that she would. He then kissed her and left, the police report said.

She was wheeled to the patrol vehicle and the door was opened so that she could get into the back. When officers asked her to get up, she did not respond. An officer tried to revive her with an ammonia inhalant, then checked for a pulse and found none. She died in the emergency room after resuscitation efforts failed.

According to preliminary coroner's findings, the cause was a perforated large bowel, which caused an infection. Experts say the condition can bring about death fairly suddenly.

Hours after her death, county Department of Health Services spokesman Michael Wilson sent a note informing county supervisors' offices about the incident but saying that that police had been called because Rodriguez's boyfriend became disruptive.

Health services Director Dr. Bruce Chernof said Friday that subsequent information showed Prado was not, in fact, disruptive. Chernof otherwise refused to comment, citing the open investigation, patient privacy and "other issues."

Peavy, who supervises the sheriff's homicide unit, said that although his investigation is not complete, "the county police did absolutely, absolutely nothing wrong as far as we're concerned."

The coroner's office may relay its final findings to the district attorney's office for consideration of criminal charges against hospital staff members, Peavy said.

"I can't speak for the coroner and I can't speak for the D.A., but that is certainly a possibility," he added.

Marcela Sanchez, Rodriguez's sister, said she has been making tamales and selling them to raise money for her sister's funeral and burial. Her family has been called by attorneys seeking to represent them, but they do not know whom to trust.

She said the latest revelations, which she learned from The Times, are very troubling.

"Wow," she said. "If she was on the floor for that long, how in the heck did nobody help her then?

"Where was their heart? Where was their humanity? … When Jose came in, everybody was just sitting, looking. Where were they?"

Sanchez said her sister was a giving person who always took an interest in people in need, unlike those who watched her suffer. "She would have taken her shoes to give to somebody with no shoes," she said. Rodriguez, a California native, performed odd jobs and lived alternately with different relatives.

David Janssen, the county's chief administrative officer, said the incident is being taken very seriously. In a rare move, his office took over control of the inquiry from the county health department and the office of public safety.

"There's no excuse — and I don't think anybody believes that there is," Janssen said.

Over the last 3 1/2 years, King-Harbor has reeled from crisis to crisis.

Based on serious patient-care lapses, it has lost its national accreditation and federal funding. Hundreds of staff members have been disciplined and services cut.

Janssen said he was concerned that the incident would divert attention from preparing the hospital for a crucial review in six weeks that is to determine whether it can regain federal funding.

If the hospital fails, it could be forced to close.

"It certainly isn't going to help," Janssen said.

At the same time, he said, the preliminary investigation suggests that the fault primarily rests with the nurse who resigned. "I think it's a tragic, tragic incident, but it's not a systemic one."

Supervisor Gloria Molina, who hadn't seen the videotape, said she wasn't sure the hospital had reformed.

"What's so discouraging and disappointing for me is that it seems that this hospital at this point in time hasn't really transformed itself — and I'm worried about it," she said.

Supervisor Mike Antonovich said he believed care had improved at the hospital overall, but added, "It's unconscionable that anyone would ignore a patient in obvious distress."

Rodriguez's son, Edmundo, 25, said he still couldn't understand why his mother died. "It's more than negligence. I can't even think of the word."

His 24-year-old sister, Christina, said, "It just makes it so much harder to grieve. It's so painful."



Times staff writers Stuart Pfeifer and Susannah Rosenblatt contributed to this report.


8:16 PM  
Blogger FetchingGal said...

Happy Canada Day, too. ^_^

11:44 PM  
Blogger MY OWN WOMAN said...

Dear Anonymous,

Have you ever heard of the boy who cried wolf one too many times?

I'm not saying this is what happened in this case, but it's pretty clear that she had been to the ER a number of times. If she wasn't getting the help she thought she should have received there, she should have gone to another ER. I'd be interested in knowing what her abdominal scans and Xrays showed from her previous visits; along with her blood work.

Please, don't get me wrong, I feel awful that this has happened. It's a terrible assault on any human being. Unfortunately, I have seen the "drama" that DOES unfold in the ER, especially a crowded ER in attempts to get back into a room only to find that screaming abdominal pain patient is now kicking back with a bag of chips and a bottle of Coca cola.

I don't know what the answer is. If you have one, I'm sure all the hospitals would love to hear it.

11:11 AM  
Blogger Kris said...

As if we don't really care about our patients. I'm sure you don't vent about your job on occasion, Mr/Ms. Anonymous. Someone find "Anonymous" some Haldol, please?

6:26 PM  
Blogger Amrita said...

Why was 'nt I one of your patients on the 4th of July?

11:19 PM  
Anonymous mo said...

oh wow
I am a RN. I have been for 10 years. I started in the ER and moved to the ICU.
I am a bitter cynic with some burn out issues but even I can't be as cold as you.
The women died on the floor because of ongoing medical incompetence.
She went to the ER over and over because she was in trouble. She wasn't calling "wolf" you ignorant ass. She was calling I have a hole in my guts . Every nurse she saw and every doc she saw didn't give a crap. They ignored her subjective findings and went with the objective. The Xray and Ct scan? Radiology missed the perf. The docs didn't bother to check for themselves and they turfed her.
The medical and nursing staff that let this women lie on the floor and die are monsters.
There are no excuses. No oh she brought her on herself for doing something so damn coming back to a hospital when she was getting sicker and sicker.
How charitable of you, blaming the victim for her own death. Yes, I would be so much more in awe of her if she had just stayed home and died there.
The nurse that refused to triage her should lose her license and be charged with criminal negligence causing death.
The hospital needs to pay and then close it's doors.
Anyone who wants to make excuses for this debacle needs to have their license to practice revoked.
If you are such a raging bitch you believe that someone who has the temerity to actually GO TO THE ER when they are sick needs to die for their decision then you are mentally ill.

You call this VENTING about work?

And you don't know what the solutions are?
How about triaging patients and leaving your personal racist bullshit at home ...let's give that a fucking try okay?

1:29 AM  

Post a Comment

Links to this post:

Create a Link

<< Home