r/emergencymedicine • u/Federal-Act-5773 ED Attending • Mar 02 '25
Advice What do you do in this situation?
It’s 0300. You’re finally charting that disaster from two hours ago, when you realize it’s time to pee before the next EMS dump. Your usual bathroom is clogged, so you venture to that weird back hallway by CT no one ever uses, the one that always feels a little too quiet.
That’s when you see The On-Call Reaper—a 7-foot-tall, half-decomposed figure in tattered paper scrubs, gripping a rusted bone saw in one hand and a still-beeping pager in the other. Its hollow eyes lock onto you. It takes a step forward.
What’s your next move?
This happens to me at least twice a week, and I’m looking for some advice
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u/Screennam3 ED Attending Mar 02 '25
Nothing phases me anymore. I would just walk around him on my way to see the next patient with maybe a “excuse me” mumbled under my breath
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u/Left_Composer_1403 Mar 02 '25
That so very very true. After seeing the things people have willingly done to, And put in (and up) their bodies, It is a rare event that surprises me too.
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u/CuragaMD ED Attending Mar 02 '25
Take me, I have too many shifts this month
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u/Federal-Act-5773 ED Attending Mar 02 '25 edited Mar 02 '25
A tempting offer… but On-Call Reaper does not take the willing. You must suffer through each shift, each ‘urgent’ admin email sent at 4:59 PM. Only when you have known true despair, perhaps around your third consecutive overnight, shall we meet again. And you better have my freaking turkey sandwich ready
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u/Chipmunk-Adventurous Mar 02 '25
Haldol ativan 10 and 2 put him in a hallway with an 02 sat
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u/Federal-Act-5773 ED Attending Mar 02 '25 edited Mar 02 '25
On-Call Reaper has lingered in the ED for centuries. Mere sedation will not banish me. I shall rise again… probably around shift change, demanding a blanket and a turkey sandwich.
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u/Helassaid Paramedic Mar 02 '25
The On-Call Reaper is allergic to benzos, geodon, atarax, sunlight, a light breeze, and toradal. The one that starts with a D, though, dil-something, that’s the only one that works.
And the On-Call Reaper has a high pain tolerance.
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u/drrtydan ED Attending Mar 03 '25
and gets a little itchy with that d medicine so gonna need some benadryl as a chaser.
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u/drrtydan ED Attending Mar 03 '25
oh so it’s what we call Thursday in the ER. have a seat over there slim…
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u/centz005 ED Attending Mar 02 '25
My go to has been IM 5 droperidol, 5 versed, 50 Benadryl (I call it the 55-50), if they don't have an IV. Does pretty well.
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u/erinkca Mar 02 '25
I think this is one of our regulars actually
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u/Federal-Act-5773 ED Attending Mar 02 '25 edited Mar 02 '25
“On call reaper accidentally swallowed gum, and heard it takes seven years to digest. Can you, like… get it out?”
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u/lodravah Mar 02 '25
That should be easy given the apparent lack of abdominal tissue. Just reach in there.
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u/Federal-Act-5773 ED Attending Mar 02 '25
“Can I get some Dilaudid first? I’m allergic to everything else.”
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u/tresben ED Attending Mar 02 '25
“On-call reaper! How’s the wife and kids? You’re here to see bed 7 right? I got two other patients in 3 and 21 I’d like to curbside, ICU will likely be consulting you in the morning anyway. If you could see them now we could really use the beds”
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u/Federal-Act-5773 ED Attending Mar 02 '25 edited Mar 02 '25
“On-call reaper is actually here for the patient you discharged with just gas. Turns out, the patient was right and it wasn’t just gas.”
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u/tresben ED Attending Mar 02 '25
“It was gas in the peritoneum” ☠️
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u/Federal-Act-5773 ED Attending Mar 02 '25
“Indeed. May your malpractice premiums remain unscathed.”
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u/zorro_2424 Mar 02 '25
My charge nurse could get an 18 in his thumb no problem
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u/Federal-Act-5773 ED Attending Mar 02 '25 edited Mar 02 '25
Your charge nurse could cannulate a stone if it had a palpable thrill. On-Call Reaper respects this dark art. May their veins always be plump and their flash immediate.
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Mar 02 '25
[deleted]
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u/Federal-Act-5773 ED Attending Mar 02 '25 edited Mar 02 '25
Foolish mortal, On-Call Reaper exists beyond the bounds of recommended dosing
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u/StupidSexyFlagella Mar 02 '25
No way that dude moves or lifts that sword thing. I notice admin provided pizza behind him, simply walk by, get pizza, and go see one of the 30 patients in the waiting room.
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u/Federal-Act-5773 ED Attending Mar 02 '25
The on-call reaper is admin
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u/Terminally-Cheerful Mar 02 '25
You have on-call admin that shows up in person?? At 0300??? The hell you say!
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u/N64GoldeneyeN64 Mar 02 '25
“Hey! I saw you on that X-ray!”
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u/Federal-Act-5773 ED Attending Mar 02 '25 edited Mar 02 '25
Yes, was me, with the free air under the diaphragm, the shadowy lung mass, or perhaps just the faint outline of despair in the thoracic cavity. Radiology called it ‘incidental,’ but we both know better
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u/Federal-Act-5773 ED Attending Mar 02 '25
How’s my standup guys? Is On-Call Reaper for the grand rounds comedy club?
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u/CathyHusky EMT Mar 02 '25
I ask it the following questions; Has it had any thoughts of harming itself or others? Does it have any allergies? What medications does it take? Would it like a Turkey sandwich?
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u/Federal-Act-5773 ED Attending Mar 02 '25 edited Mar 02 '25
On-call reaper responds: “My very existence is harm. I am the whisper in the empty hallway, the shadow behind the trauma curtain. But yes, I want a turkey sandwich. And Ativan.”
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u/0reismic ED Attending Mar 02 '25
That’s Jim, local homeless frequent flyer. He’s harmless. PO sandwich and Coke. Chair bed and dc once the busses are running at 0630
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u/Federal-Act-5773 ED Attending Mar 02 '25
His vitals? Always stable. His chief complaint? Ever-changing. His return? Inevitable.
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u/CABGPatchDoll Mar 03 '25
You have cola in your ED? We're lucky if we can find a lemon lime Shasta.
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u/neversaydie999 Mar 02 '25
Turkey sandwich
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u/Federal-Act-5773 ED Attending Mar 02 '25 edited Mar 02 '25
On-Call Reaper accepts this sacred offering of the ED. But only if it comes with the rare and elusive mustard packet. Fail in this task, and I shall haunt the charge nurse with a thousand unnecessary call light requests.
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u/tdubs6606 Mar 02 '25
I just needed to say, OP you should bail On medicine and become a comedian. Your replies are 🤌
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u/Federal-Act-5773 ED Attending Mar 02 '25 edited Mar 02 '25
Much obliged. Dr. Reaper now needs to go back to pretending like he has bedside manner and hasn’t just spent the last couple of hours pretending like he’s the ED’s grim reaper for cheap internet laughs. Carry on
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u/Kep186 Paramedic Mar 02 '25
Call a few of my buddies to arrange another train of ambulances. Hopefully this EMS dump pleases the reaper. Meanwhile I shuffle past to get to the toilet. If I die I die, but one way or another I'm taking a dump.
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u/Federal-Act-5773 ED Attending Mar 02 '25 edited Mar 02 '25
On-call reaper would very much like another EMS dump. You will live another day
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u/SetSol Mar 02 '25
"Thanks for finally making your way down. The difficult hip dislocation is in room 9"
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u/Federal-Act-5773 ED Attending Mar 02 '25 edited Mar 02 '25
On-Call Reaper moves at his own pace, much like Ortho consults. But fear not, for I shall now stand ominously in the doorway, offering neither assistance nor useful input, only a slow, knowing nod as you struggle
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u/db_ggmm Mar 02 '25
Onc ICU is on the 7th floor, bud, plz hurry.
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u/Federal-Act-5773 ED Attending Mar 02 '25
On call reaper is also 20/10 on the pain scale and allergic to every drug except that one that starts with D
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u/droperidoll Physician Assistant Mar 02 '25
That’s just Mr. J. A dose of Tylenol, a turkey sandwich, and a pat on the shoulder go a long way.
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u/Federal-Act-5773 ED Attending Mar 02 '25 edited Mar 02 '25
On-call reaper also wants dilaudid. He is allergic to every other medication
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u/herecomesthefun1 Mar 02 '25
Feed it. It’s probably hangry. Maybe a banana bag and a shot of whiskey.
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u/Federal-Act-5773 ED Attending Mar 02 '25 edited Mar 02 '25
A noble attempt, but alas, On-Call Reaper transcends mortal hunger. but a shot of whiskey? now you’re speaking my language. Admin won’t approve it, of course, but we both know they don’t work nights.
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u/madderdaddy2 Mar 02 '25
Invite bro out for that bloody mary I was gonna grab at the breakfast joint after my shift. He looks almost as dead inside as me.
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u/Kabc Mar 02 '25 edited Mar 02 '25
If this is supposed to be the grim reaper—welcome him as an old friend.
We can’t keep him away for ever, and it’s his job to guide those to the afterlife—if there is one. He isn’t a bad guy, just there to help people DC to the ground.
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u/Federal-Act-5773 ED Attending Mar 02 '25
Finally, a soul who understands. On-Call Reaper is not the villain, merely a frequent and inevitable consult. You may delay me with compressions, epi, and the stubborn refusal to call it, but in the end, I always get the dispo. Whether to the floor, or beyond… all patients sign out eventually
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u/jeremyvoros ED Attending Mar 02 '25
Turkey sando and a warm blanket
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u/Federal-Act-5773 ED Attending Mar 02 '25
On-call reaper is also having a hard time focusing and wants Ritalin
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Mar 02 '25 edited Jul 28 '25
[deleted]
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u/Federal-Act-5773 ED Attending Mar 02 '25
Ah, discharge me if you must, but On-Call Reaper is nothing if not persistent. I shall return, perhaps at 2 AM, perhaps by ambulance, clutching my chest dramatically, demanding the only thing that works. You may stall, you may bargain, but in the end… the Dilaudid always flows.
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u/RealAmericanJesus Nurse Practitioner Mar 02 '25 edited Mar 02 '25
Shit. I needed an extra patient sitter.
Like he can take the patient with suicidal ideation waiting for an inpatient bed or the guy trying to bite everyone who the police dropped off and needs to metabolize.
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u/Asystolebradycardic Mar 02 '25
I’ll go get that pain medicine that starts with a D I’ll be right back.
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u/Federal-Act-5773 ED Attending Mar 02 '25
Now you’re speaking on call reaper’s language. He allergic to all other medicine
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u/hoorah9011 Mar 02 '25
Let the NP deal with it, he dead already
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u/Federal-Act-5773 ED Attending Mar 02 '25
No. On-call reaper doesn’t want third tier care. On-call reaper follows the r/noctor subreddit
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u/goofydoc Mar 02 '25
Bro did you not see the post earlier that NP’s listen to patients and catch zebra’s?
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u/Federal-Act-5773 ED Attending Mar 02 '25 edited Mar 02 '25
On-Call Reaper has seen many things in the ED. trauma bays running on vibes, consults ghosting into the ether, attendings weeping over charting at dawn. But On-Call Reaper has NEVER seen a damn zebra in triage. Only viral syndromes demanding IV Zofran and allergic reactions that somehow require Dilaudid.
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u/4thSanderson_Sister Mar 02 '25
I volunteer as tribute! 🙋🏻♀️
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u/Federal-Act-5773 ED Attending Mar 02 '25
On-Call Reaper does not take volunteers. No, no. You must suffer through every shift wondering why you didn’t go derm
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u/Medic36 Mar 02 '25
He's the consult that is supposed to see the recurrent meth OD patient in room 3.
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u/Federal-Act-5773 ED Attending Mar 02 '25 edited Mar 02 '25
On-Call Reaper has reviewed the chart extensively, and by that I mean I skimmed the triage note. I shall now stand outside Room 3, arms crossed, sighing deeply. I may enter eventually and do nothing more than mutter “That’s not great.”
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u/Praxician94 Little Turkey (Physician Assistant) Mar 02 '25
Let out a sigh of relief I don’t have to work the next day
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u/Ok-Psychology-3910 Mar 02 '25
Wd40
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u/Federal-Act-5773 ED Attending Mar 02 '25
On-Call Reaper cannot be oiled away… I linger, just like the faint chemical smell in the breakroom
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u/Single_Oven_819 Mar 02 '25
You don’t have to leave AMA, I can have your discharge done in 5 minutes!
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u/Federal-Act-5773 ED Attending Mar 02 '25
Beware, for On-Call Reaper has spent centuries mastering the art of the slow roll. I shall suddenly remember one more question, develop a new symptom, or require a totally unnecessary but time-consuming test just as you think you’re free. The discharge may be written, but my departure…is never guaranteed.
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u/FartPudding RN Mar 02 '25
How is he at flipping beds? Patient rooms need to be cleaned, the etoh dude is covered in bugs and poop and needs decon
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u/Federal-Act-5773 ED Attending Mar 02 '25
Fine. The bug-covered, incontinent ETOH warrior shall be deconned, but at what cost? For as soon as the room is turned, another shall rise from triage, equally fragrant, equally demanding, and equally unavoidable. The cycle is eternal
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u/Conscious-Sock2777 Mar 02 '25
Normally I’d say lay down suppressing fire and fall back But after seeing his grippy socks I realized he just needs direction back to the dialysis suite cause they never die no matter what myriad of medical maladies come their way
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u/natesaurusRex Physician Assistant Mar 02 '25
Pretty sure that’s just me leaving after a 10 hour shift that turned to 14 still with 20 notes to finish and an Epic inbox full with pharmacy requests for antibiotic and opiate refills…
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u/DrSummeroff12 Mar 02 '25
I'd thank former POTUS Biden for his 150 yrs of service...
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u/Federal-Act-5773 ED Attending Mar 02 '25
“Look, folks, back when I was a young reaper in Scranton, we had a saying. “You see the Reaper at the end of the hallway, you just gotta, uh… you know, push two of Ativan, hang a banana bag, and get radiology to read the film stat.” And that’s no joke! Back in Scranton, we had a guy, Big Johnny, toughest nurse you ever saw, I just want to smack him in the ass. Anyway Greg ran the whole unit on nothing but black coffee and spite. Real angry. He defeated Medicare you k wk? So, c’mon man, let’s not make this complicated. We just gotta, uh… we gotta intubate and move ‘em up to the floor. God save the queen!”
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u/waterproof_diver ED Attending Mar 02 '25
5150 DTO
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u/Federal-Act-5773 ED Attending Mar 02 '25
A bold move, but On-Call Reaper has been here before. I shall pace the hallway, monologue ominously, and, when least expected, become suddenly calm and polite just as psych arrives, ensuring the cycle continues. The game is eternal, the dispo uncertain, and the turkey sandwich inevitable.
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u/kryanintheclub ED Tech Mar 02 '25
Beg him to take me lol
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u/Federal-Act-5773 ED Attending Mar 02 '25
A weary soul, burdened by call bells and endless EKGs labeled ‘no clear STEMI but can’t rule out ischemia.’ But alas, On-Call Reaper does not take volunteers, you must endure at least three more shifts of back-to-back traumas, a psych patient singing at full volume, and exactly one Code Brown before we meet again
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u/msmaidmarian Paramedic Mar 02 '25
ask him if he’ll hold my hand while I poop and pull the red cord for me if something bad happens.
I’m scared: I had a breakfast burrito that almost broke me 18 hours or so ago and it feels like it wants out NOW.
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u/Unusual-Fault-4091 Mar 02 '25
“You really should drink a little more Sir…or maybe I should drink less.”
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u/RobedUnicorn ED Attending Mar 02 '25
Omg friend you’re back?! Are you here to help? I got some requests…
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u/TheGroovyTurt1e Mar 02 '25
Tell OP that AI art is dumb
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u/Federal-Act-5773 ED Attending Mar 02 '25 edited Mar 02 '25
I see you have summoned me with your malpractice only to tarnish my ominous presence with the soulless glow of AI-generated pixels. Bold move sir
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u/Yankee_Jane Physician Assistant Mar 02 '25
Hand him a temp badge and send him in to see the CMO patient who got dumped in the ED by their family.
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u/clipse270 Mar 02 '25
Looks like palliative finally got around to answering their consult
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u/Federal-Act-5773 ED Attending Mar 02 '25
But beware, for they come not alone… ethics, case management, and at least one long-lost family member shall surely follow
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u/Holiday_Turnover2886 Mar 02 '25
Offer on call reaper some warm food and a bed. Bro just wants a break.
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u/EtchVSketch EMT Mar 02 '25
Ma'am, MA'AM, Ma'am you have to- YOU HAVE TO CHECK THAT WEAPON WITH- I SAID YOU HAVE TO CHECK THAT WEAPON WITH SECURITY-
WITH- ma'am, MA'AM, SECURITY MA'AM
Alright MA'AM yes I know your husband is very sweet. I SAID YOUR HUSBAND IS-
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u/Lonely-Trash007 Mar 02 '25
"Bed 3 needs vitals, bed 5 has been clicking their call light for the last 20 minutes and saying nothing, and we need some samples ran to the lab. Ask Stacey if there's anything else. Thanks, bud." pats shoulder and walks by
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u/treylanford Paramedic Mar 02 '25
Call security so they can still watch us get our ass beat by this guy.
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u/DarkStarOptions ED Attending Mar 02 '25
If I see that thing, I 1) save the game, 2) take out my level 48 shotgun blaster and blow him to smitherines
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u/steveamerica_ Mar 03 '25
Point Mr Reaper in the direction of the 99yo meemaw suffering on a vent in the ICU that family can’t let go of.
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u/Inevitable-You-217 Mar 04 '25
Pretty sure that’s the day shift charge nurse. Give it a diet coke and a snickers and it will go away.
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u/lilbitofCarmen Mar 04 '25
Well, I AM CT so me and him see each other a few times a night. He's getting ready to retire soon but hasn't found a suitable replacement. If he asks you, don't take his first offer. Make him work for it. He made his predecessor guarantee no joint cases with Poseidon.
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u/runswithscissors94 Paramedic Mar 02 '25
Give him a patient assignment since he wants to act like he’s in charge
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u/tharp503 Mar 02 '25
Walk them to a room. The family is going to want a full work up and they are going to revoke the DNR.
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u/Hydrate-N-Moisturize Mar 02 '25
Ancef and ortho consult. Ask the nurse to bring me the IO kit, cause I doubt an ultrasound is gonna help get a line in them.
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u/centz005 ED Attending Mar 02 '25
"Move or I'll be peeing on you. Also, you need to work harder in the ICU; we've got too many bloody holds down here."
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u/somesaggitarius Mar 02 '25
Most normal thing I've seen at work this week. I say "excuse me" and go around. When you gotta go you gotta go or you're gonna have to go in the bushes on the next call and nobody wants that.
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u/Glass_Raisin7939 Mar 02 '25
Tell him it's alright and that everything ok, but we need him to go back to his room because we can't have patients walking in the hallways and that we need the hallways to stay clear. And his/her nurse will be there in a minute to come update him/her to see what they need. And smile
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u/doctorsidehustle Mar 02 '25
Pt: I would like to revoke my hospice designation.
… admit to hospitalist.
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u/Recent-Day2384 EMT Mar 02 '25
I've given report to people who looked worse. Here's Mr. Smith again for the fifth time this month, CHF exacerbation again and no he is still not taking his lasix.
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u/jmoll333 Radiology Tech Mar 02 '25
"Hey, can you wait a few minutes? I have a deadline to send this email with 5 bullet points of what I did last week."
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Mar 02 '25
I wouldn’t let this happen guys, don’t worry.
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u/Federal-Act-5773 ED Attending Mar 02 '25
Noble confidence, truly, the mark of an ED hero who hasn’t yet met their match. But tell me, will you still stand defiant when the 90-year-old full-code septic rolls in with a pH of 6.66? You may fight, doctor… but the on call Reaper always finds a way
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u/syntheticbraindrain urgent care MA | former ER scribe | EMT-B Mar 02 '25
hey man you want a steroid shot?? unfortunately it goes in the booty...
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u/Agile-Compote8297 Mar 02 '25
Dude… you need some fluids- where’s the best place to put an IV in you?
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u/Imaginary-Ganache-59 Mar 02 '25
“Sir, triage is down the hall, on the left and then the first door on your right”
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u/beckster RN Mar 02 '25
Can't swing that sword in that space, so take it away from it and disarticulate, of course.
Solid kick to a knee should topple Bones and make the job easier.
That sword is a rusty piece of crap.
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u/Darwinsnightmare ED Attending Mar 03 '25
As always I would greet my colleague from the C-suite with warmth assuming they were bringing free pizza.
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u/SingleBackground5280 Mar 03 '25
Well first off, I tell Larry hi and ask how his kids and wife are doing. He loves telling stories about the little soul stealers. Ask him if he got consulted on any of my ICU admits from the last week or if he's just visiting that aortic dissection my partner admitted and is in PACU now.
Just shoot the shit. He's there to drive the admitting doctors crazy. He's just a dude in the hallway to me.
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u/Individual_Debate216 ED Tech Mar 03 '25
“You can’t come back here without a visitor tag. Can you please go back and get one”
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u/nonyvole RN Mar 03 '25
They didn't restock the fridge, unfortunately. I have a chocolate chip granola bar, a variety of Monsters, and maybe a spare pen in my locker. Unless it's day three, in which case the husband managed to put a bottle of Gatorlyte in my bag.
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u/EMPoisonPharmD Mar 03 '25
I see enough meat in them bones for 5mg/kg IM ketamine. Lets see who wins the final game of chess when your eyes are vibrating reaper man
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u/propyro85 Paramedic Mar 03 '25
Excuse me sir, gotta scoot past you, sorry.
And then continue to push my stretcher to the last door on the left ... it's always the fucking last door on the left.
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u/CABGPatchDoll Mar 03 '25
Does he have insurance though?
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u/Federal-Act-5773 ED Attending Mar 03 '25
On-Call Reaper exists outside the realm of co-pays and prior authorizations. should you ask me for insurance details, I shall stare blankly, mutter something about ‘self-pay,’ and hand you an address that leads to an abandoned lot. You may try to bill me, but by then… I am already gone
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u/GamerGirl84357 Mar 03 '25
On-Call Reaper! We’re so glad you’re here. Triage is pretty busy. Why don’t you grab a badge and a stethoscope and help try to decongest the lobby?
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u/Admirable_Amazon Mar 03 '25
That’s just a hungry staff member. Throw them one of the old pieces of pizza left out from day shift. Probable solved.
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u/Forward_Topic_9917 Nurse Practitioner Mar 03 '25
Call transport to get the nursing home meemaw back there before she decides to code because grandkids that never visit her want everything done
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u/Arete121 ED Attending Mar 03 '25
Step forward, lure attack, dodge roll back, poke with #11 blade, rinse and repeat until you can disarm his attacking limbs/mouth, then discard in red bin.
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u/Savannahsfundad Mar 03 '25
Ortho consult…
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u/Federal-Act-5773 ED Attending Mar 03 '25
Bold move, but tell me, doctor, do you seek Ortho’s wisdom, or simply an excuse to stall? For they shall arrive, eventually, with arms crossed, muttering something about ‘non-operative management’ before recommending Tylenol, weight-bearing as tolerated, and follow-up in 6-8 weeks
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u/Comfortable-Slice-72 Mar 04 '25
tetanus shot because the rusty saw...
Wait, he has no muscles so I'm guessing he's immune to tetanus...
wait, without muscles he wouldn't be able to move...
would it be cruel to tell him to go to the waiting room to check in and wait his turn knowing he can't move?...
If he CAN move, then tetanus shot
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u/Silly-Career-9619 May 09 '25
Buy him a white monster from the vending machine as a peace offering. He's been on shift for centuries, bro needs it.
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u/Imperial_Remnant Mar 02 '25
D/C with Z-pak. F/u with PCP.