Milk-tea-and-memories - Your Reservations, Fuck 'em

How to Go To a U.S. Hospital in 2022

Welcome to the hospital. You may have heard that we're understaffed. We are. We are no longer in a position to live up to the hospital experience you had back in 2019.

This post is about how to get the best possible care despite these trying times. Much of it is also applicable to long term care facilities and other institutions who are running on empty.

The Emergency Department

Consider: Do you have to go to an emergency department to get the care you need? If you need a prescription or a covid test or an inhaler or an x-ray or a STI test or basic diagnosis and otherwise you're probably fine, go to your doctor, a quick clinic, or an urgent care. You will not get care faster in the emergency room. I promise. Go to the ED if you are reasonably sure you would die or lose a limb if you didn't.

The ED is not first come first served. People who are going to die if they are not seen get seen first. If you are stable, even if you are in pain, be prepared to wait. At the height of covid we had stable people waiting for over 24 hours in the waiting area. We also cannot legally tell you to go somewhere else, even if we're pretty sure you're not sick enough to get seen anytime soon.

Bring your home meds. You are going to be there a while and you might not get in a bed in time to get your next dose. Even when you do, it takes a long time for a doctor to order your home meds. We never intended you to stay here for 4 days, so the infrastructure isn't there. Also, bringing your home meds is going to save you money.

RE: the above- tell us what you're taking, when you're taking it. We do want to know that so we don't give you anything that would interact with it. We also really want you to keep taking your home meds so you don't get worse.

Bring a charging cord for your phone, a change of clothes, a book, and if the visitation rules allow, a friend. You're going to be here a while.

The Emergency Department is designed to figure out what's wrong with you and do things that will save your life or help you leave the ED without having to get admitted. Sometimes the ED will treat pain, but each pain medication dose is ordered separately, so it's probably not going to be on the time scale you want or need. I hate to say this, but do keep asking. We have been really conditioned to assume if you stop asking, you're not in pain anymore.

If they tell you not to eat, or not to take a certain med, follow that advice. I know you've probably been there for a while and no one's told you why you can't do these things. That's not great. Ask why if you can, but assume the request is legit.

In order for you to be admitted, you need to be sick enough that they can't just kick you out with a cab voucher, a prescription, and a turkey sandwich. That's pretty dang sick these days. Pretty much, you have to be in danger of dying or losing a limb if you don't get admitted. And also, a bed in the hospital has to become available that can accommodate your needs. This usually means someone else has to get discharged or die. That might take a while, because they were just as sick as you when they came in.

The Hospital Floor

So they decided to admit you, a bed became available, and transport finally showed up to take you to your new bed.

Bring the following: A charger for your phone (I know you'd think we have these, but I swear we don't- they've all been stolen). If you smoke, bring nicotine lozenges or gum (you can't smoke or vape here. We have patches, but if you wait until you need a cig, it's too late for a patch to work, and if you try to sneak out most places will not let you back on the floor and you'll have to go back to the ED). If you have heartburn regularly, bring tums (we can order you tums, but you'll only be able to take like 1 every other hour, and let's be honest, if you use tums you usually need more than that). If you take a weird med, bring it (especially HIV drugs, chemo drugs, and meds for autoimmune conditions, because it takes forever to get some of these because we don't always have them on site). If you have severe allergies, consider bringing your own food. Seriously.

RE the above: Tell us what you're taking, when you're taking it.

Do not bring narcotics. There's too much liability on our end. Both because we cannot control how much you take if they are in your possession and if we find them we have to call security to watch us count them and store them in a locked drawer and which will be destroyed in 30 days if you forget to ask for them on the way out. It's just a hassle and someone is always in danger of getting sued over it.

If you drink more than 4 drinks a day, or use street drugs, tell us. Tell us please please tell us. We will not tell the cops. If we know, we will then be able to ask you questions about your withdrawal symptoms and can give you meds to control them. If you wait until you start swinging at us and having seizures we will not be happy.

Also, if you're on MAT, tell us. We don't automatically re-order suboxone or vivitrol like we do other meds. Addiction med has to be consulted, come see you, and work miracles to get that ordered for you while you're in the hospital.

If you see pain management, tell us as early as you can. Pain management has to be consulted and then work absolute miracles to get the admitting providers to order your home regimen, because anything more than 10mg of oxycodone every 4 hours is terrifying to them, even if you take 160mg of methodone everyday at home without a problem. The sooner they know you're here, the less likely you'll be miserable for a week before those things can be re-ordered.

Also, bring a friend. Seriously. I'm not kidding please bring a friend who is willing to help take care of you- things like turn you, help you dress, feed you, hold your hair back when you puke, and change your sheets when you pee the bed. And please bring someone you feel will follow the rules and ask before getting you something. You don't want to stay longer just because your friend brought you food you weren't supposed to eat because they felt bad for you.

A scheduled event is not really scheduled. Yes, you might have been told that your surgery is scheduled for 8am. You might have been told your dialysis was going to be "this afternoon". These things are not set in stone, and unless you are literally and currently dying, nothing is happening "right now". I have watched people wait days for appendectomies, gallbladder removals, displaced fractures, and other urgent-but-not-immediately-life-threatening problems. All a late intervention means is that someone else would have died if they did it as scheduled.

MOVE. Barring an unstable pelvic fracture or two broken femurs, if you can get out of bed and walk around, walk (ask your nurse if they want you to ask for assistance when you get out of bed to prevent falls). If you can't, sit up in a chair for part of the day. If you can't do that, move around in bed- roll back and forth, bend your knees, point your toes, do anything to keep you moving. If you're in pain, take pain medication strategically and move when it's most effective.

6:30 to 9:30, day or night, is the worst time period to put your call light on. Report time is 7 o'clock, meaning we have about a half hour to learn about our patients and set up our day, after which we have about 15 mins allotted per patient to assess the person, discuss goals for the day, find and pass daily medications, get vitals and blood sugar if applicable, and do anything the patient needs to get them set up for the day (water, pain meds, set up tray/feed, toilet, etc...). Put it on if you need to, but know that it will take a lot longer to be answered during these time periods than any other time of day.

You can refuse anything you want to refuse. You just can't sue us about it later. You can even say "I know you told me to do this thing, I am not doing it, please document accordingly". We will probably try to explain the consequences of not doing the thing. I recommend you listen, but the choice is certainly and always up to you.

You can leave against medical advice. It is also a thing you can do. As long as you let us tell you the risks, you can leave with prescriptions, education, and a wheelchair ride to the front door if you care to stick around for an hour or so after you declare you would like to leave. Some insurance companies have rules about this, which you can find by calling them. Just call and ask "what are the consequences of leaving against medical advice?" Some insurances don't have any consequences, some will completely refuse to pay for the stay, and some will refuse to pay for a second ED trip or admission within 30 days for the same problem.

Our prioritization system is: Critical (CPR, evaluating changes in status, dealing with changes in vital signs) Urgent (bed change for incontinent patient, pain/nausea/time-sensitive meds, drawing stat labs, answering phone calls from doctors, etc..) Routine (scheduled meds, scheduled assessments, calling family members, basic comfort things, ambulating patients, education, etc..) and Extra (everything else that has to do with comfort but isn't necessarily going to change outcomes).

I have had whole shifts where I don't do anything that isn't critical or urgent (with one routine med pass that was really late). I've rarely had a shift in the last 3 years where I've been able to do anything extra.

We're doing our best. Seriously. Nearly every shift I've worked has been absolutely flat out for 12 hours, and it takes a solid 2 days actually to recover from 2 days in a row of work. I would say I rarely get a full lunch break. Our patients are more and more complicated, and the decisions higher and higher stakes. Please understand. If you or a loved one hasn't been seen by the nurse in a few hours, it just means we're not as worried about you as the person down the hall who keeps trying to die.

We wish we could give you 2019 care. We really, really do. We don't have the resources for that anymore. We are triaging. The hotel vibe they were trying to present in 2019 is in the facility design only. You have to bring your own bells and whistles. You have to help us help you now.

for my med school crowd (if i have one at all):

so i want to go to med school and become an er (but i’m open to other specialties as i know nothing about them so please leave info or suggestions?) but i don’t know if i’ll be able to do it and the journey seems hard and man i would just really appreciate any information encouragement help suggestions etc!

we need these everywhere

UC or ER?

God, I can't tell you how much the "there's not enough enrichment in my enclosure" joke has helped my mental health. Because, for some reason I can't comprehend, pretending that I'm a zoo keeper caring for an animal (which is also me) just makes everything easier to comprehend. Like "Your head gets screwey when you're apartment is messy" just doesn't carry as much resonance as "The tiger becomes agitated when its enclosure is cluttered" because then I'll be like, no shit? The tiger? I've gotta keep things nice and clean for the tiger.

bakugou having a bad day at work and coming home annoyed, tense and snappy. you know he’s mad, you feel it when he comes through the door. not only in the air but the way he stomps on the ground and the loud clash when he drops his bag. so for these first few seconds you have a chance to prepare yourself for what you’re about to witness.

you see the back of his fluffy blonde head as he slumps into your living room sofa and lets out the loudest huff. so you step over and sit in the arm chair diagonally opposite to him.

“hey,”

“hi,” he spits, staring at the blank screen of the tv. his arms on the arm rest, his head resting in his palm. every few seconds his jaw clenches then he lets it go.

“so do you wanna talk about it?” you prod lightly, voice light like usual so he knows you’re not about to judge him.

he tuts, frowning and still not looking at you, “no.”

“you sure?”

“yes i’m fuckin’ sure.”

he knows he’s being disrespectful and stupid as soon as the words leave his mouth. the silence is thick between yoi so he robotically turns to face you with a hard glare in defence. but it melts upon seeing your face of indifference. fuck, he needs to do better.

when you lock eyes, your voice is steady but cold, “watch who you’re talking to.”

bakugou’s whole demeanour weakens, his body tensing with the heat of your words. suddenly what happened at work doesn’t matter at all now, not when you’re just as annoyed at him.

another silence hovers over the room so you get up to make your way to your bedroom. “you can leave or stay. i don’t care.”

bakugou grabs your hand before you’re too far, mumbling a quiet, “let’s cuddle.”

you blink at him like he’s dumb, “apologise. decide whether your gonna forget about your issue or talk about it.”

he doesn’t let go of you as he makes the decision on the spot, his hand on your arm sliding down to link your fingers together.

“i’m a piece of shit for talkin’ to you like that. i’m sorry.” you nod, still waiting for the next part, “i’m gonna forget and maybe talk about it later.” he flicks his eyes up to you, not forgetting how harsh your tone was, “if you wanna hear it.”

you’re a fool for your boyfriend, especially with how his eyes turn doe-like when you look down at him. red rubies asking for your forgiveness and a cuddle. he even slides a palm between your legs to rest on your inner thigh, ready to pull you on top of him. you don’t want to say no so you don’t.

“of course, i’ll listen to you. you’re such a bitch when you’re grumpy,” playfulness tinges your words, a slow smile slipping through to your cheeks. bakugou matches your smile, dragging you onto his lap for a cuddle.

you stuff your face in his neck for an inhale of his sweetness and your arms wrap around his strong body. he does the same to you, thumb rubbing your bare hip.

“thought that was one of your favourite things about me,” he drawls sarcastically and you giggle. bakugou sighs mentally at how he started the night with you. he could have came in, been honest about what he felt and had this earlier.

“that and how when i’m annoyed at you, you still have the confidence to ask for a cuddle.”

“confidence well deserved ‘cause look at us now,” he laughs but stops when you lift your head up to glare at him.

“i’ll leave right now,” you threaten.

“no, you’re not,” he says, his arms tightening around you with a peck to your forehead.

The everest chronicles

Rich boy! gojo getting all pouty because some guy hits on you at an event he takes you to and now you have a 6 foot GIANT leaning all his weight over you as he whines about not getting attention

[ WOUNDED PRIDE ] GOJO SATORU.

“satoru, you’re still pouting,” you hum, poking his cheek as he huffs.

“‘m not,” gojo mumbles, bitterly turning his head away from you. you can hear geto’s amused chuckle from the distance, making your boyfriend growl out a shut up, suguru under his breath, and because you’re supportive, you hide your own laugh.

“baby, he’s gone,” you cup his cheeks, grinning as he stubbornly refuses to meet your eyes, “you don’t have to be jealous anymore.”

“jealous?” he pulls away from you like you’ve insulted him—like the idea is simply too crazy to hear out loud, “me? jealous? what gives you that idea?”

“toru,” you snort, “you couldn’t be anymore obvious.”

“neither could you,” he accuses, narrowing his eyes at you, “you were trying to make me mad.”

“i don’t know what you’re talking about,” you say with faux innocence, making his arms cross.

and now his lips are even further jutted in a pout, though you know saying something will only make him more upset, so you choose to keep your mouth shut for now. but gojo can still sense your amusement, glaring at you before turning his head away with a petulant hmph.

“flirting with other men is considered cheating, you know.”

“i wasn’t flirting,” you giggle, “i was just making friends. like you told me to.”

“making friends doesn’t include zenin naoya,” gojo glares at you, prompting out a supportive yeah, he sucks from geto. gojo nods, pointing a thumb at geto in agreement, making you roll your eyes.

“you never told me you hated him,” you defend, “but i wasn’t trying to make you mad,” you add softly, cupping his cheeks again.

“yeah you were,” he mumbles bitterly. his cheeks are squeezed together by your palms, and his voice is slightly whiny—and suddenly, you think you fall in love all over again.

“i’m sorry, toru,” you smile gently, “i just thought you looked cute all pouty. i didn’t wanna make you mad.”

“i wasn’t pouting,” he grumbles, “i don’t pout. i’m a man.”

“you cry during movies,” geto points out—and you’re glad there’s no wine in your vicinity, otherwise you think gojo might splash it on his best friend’s crisp, white button down. and you don’t think his father would take kindly to the scene—which would only further complicate things.

“i’m a man with a heart,” gojo scowls, “that’s why i’m not single.”

“okay,” you break up the bickering, distracting gojo with a kiss to his cheek—he grins at the gesture, giving you one in return even though he’s still slightly upset with you (though he won’t admit it.)

satoru gojo is not a jealous man.

that’s what he’ll tell you, at least—but you know better. you can see it in the way his lips alternate back and forth from a tiny pout to an irritated scowl, in the way his eyebrows furrow with irritation, in the way he huffs and tries to act like he doesn’t care when suguru elbows him in amusement.

and it’s not as though you enjoy attention from…whoever it was you were talking to (apparently zenin naoya according to gojo), but there’s just a small part of you that’s lightly amused. gojo is like a magnet—the girls flock to him left and right like a slice of bread left out for the crows to fight for. you’re used to it by now, have learned to ignore the slight creep of doubt and simply ignore the jealous glares sent your way as you take his hand.

but that doesn’t mean you don’t enjoy the change of pace every once in a while—the rare turn of tables that have him irritated instead of you.

naoya is a little too entitled for your taste. there’s too much expensive cologne sprayed on and you’re sure if he could without seeming tacky, he’d have left the tag on his suit to show its brand new. that’s the case with all rich people, you think, too busy watering the roots to pull for the weeds.

you don’t particularly enjoy talking to him—but you amuse yourself all the same. he’s far too cocky when he asks are you an intern for the gojo’s? i haven’t seen you before—

and before you can answer, you hear a familiar voice spit: actually, they’re my date. you don’t even hear gojo come up behind you, and you know as soon as his arm wraps around your waist, your stuck to his side for the rest of the night whether you like it or not.

“don’t talk to naoya he sucks,” gojo mutters. you nod, agreeing with him to console the bitterly wounded pride he seems to be sporting.

“he’s the worst,” you agree, “and his cologne smells gross.”

“i have that cologne,” he gasps, “it’s my favorite. you hate it?”

“no,” you say quickly, “it smells nice on you. everything smells nice on you.” geto snorts, and you shoot him a warning glance before he can make the situation worse.

gojo doesn’t look convinced—eyes narrowed and lips curled in that soft pout of his when he doesn’t get his way. it’s a bit spoiled, just a little bratty in its own right, but makes you melt all the same, pinching his cheek gently as you chuckle.

“if i were you,” geto turns to you, “i’d talk to naoya more. it might humble satoru just a little—”

“if i were you, i’d shut up before getting punched—”

“you wouldn’t land a punch on me if you tried—”

“you don’t know that—”

“actually i do because you can’t fight for shit—”

“i’m an excellent fighter—”

“alright,” you hiss, glancing at the few heads that have turned to watch the bickering between gojo and geto, making you glare at them in slight embarrassment.

“baby,” gojo whines, “tell him i can fight.”

and because his ego has been wounded one too many times tonight, you let him slump onto you, ignoring the heavy weight as you sigh and wrap your arms around him. you’re sure quite a few people are staring by now—but you suppose people always stare when you date someone like gojo.

“you could totally fight naoya,” you agree. you think you’ve finally said something right—because he seems to brighten at your words.

“i could, couldn’t i?”

“yes,” you nod, “and you smell better. and you have better hair.”

“and i’m cuter.”

“of course,” you sigh, eyeing geto for help. but he grins, sends you a small wave with mischief in his expression as he wanders off—leaving you all alone to nurse gojo’s ego back to full health.

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