Train wrecks!

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Specializes in nursing education.

I cringe every time I hear this phrase, "train wreck." It's so dehumanizing. I heard a fellow nurse say it today. I said, "do you mean a patient with multiple comorbidities?"

OK, so that went over real well...

It's like when a nurse calls an elderly person with dementia a "gomer."

How do others deal with this? What do you say, or do you ignore it?

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How do you feel about my personal favorite.. *****?

Maybe you need to get off your horse and realize NURSES are also human .. and struggling with ever increasing demands and complicated patients.

Many times we need to de-stress and step back... any way we can.

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I think you're being really uptight and I'm glad I don't work with uptight people.

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Specializes in ICU.

We all have our quirks and things we hate. I use "train wreck" a lot - thought I'm usually referring to someone really unstable with multiple comorbidities if I say it. If we're talking multiple comorbidities and stable, but throw in some excessive complaining/neediness, then I reserve the right to change my term to "hot mess." ;)

You want to talk dehumanizing - I hate it when my coworkers complain about a patient in that patient's hearing. I don't care that the patient is sedated and on the ventilator, if you call her a "fat &$%&$#& cow" while you're helping me turn her, I am going to be mad. They say that hearing is the last thing to go, and I don't care what the patient's neuro status is - wait until you're out of the room to be positively evil!

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

I think that as nurses we need to blow off steam sometimes. I think train wreck suits some patients with multiple co morbidities and complications that thier hospital course resembles the conflagration and chaos that resembles a train wreck. I don't think nurses or ohysician for the matter, mean this as a derogatory term....it's more of a descriptive term and is never said to the patient.

Some of these references come from a book....The House of God...The House of God is a satirical novel by Samuel Shem (a pseudonym of the psychiatrist Stephen Bergman), published in 1978. It portrays the psychological harm done to medical interns during the course of medical internship in the early 1970s.

Laws of the House of God

  1. GOMERS DON'T DIE.
  2. GOMERS GO TO GROUND
  3. AT A CARDIAC ARREST, THE FIRST PROCEDURE IS TO TAKE YOUR OWN PULSE.
  4. THE PATIENT IS THE ONE WITH THE DISEASE.
  5. PLACEMENT COMES FIRST.
  6. THERE IS NO BODY CAVITY THAT CANNOT BE REACHED WITH A #14G NEEDLE AND A GOOD STRONG ARM.
  7. AGE + BUN = LASIX DOSE.
  8. THEY CAN ALWAYS HURT YOU MORE.
  9. THE ONLY GOOD ADMISSION IS A DEAD ADMISSION.
  10. IF YOU DON'T TAKE A TEMPERATURE, YOU CAN'T FIND A FEVER.
  11. SHOW ME A BMS (Best Medical Student, a student at the Best Medical School) WHO ONLY TRIPLES MY WORK AND I WILL KISS HIS FEET.
  12. IF THE RADIOLOGY RESIDENT AND THE MEDICAL STUDENT BOTH SEE A LESION ON THE CHEST X-RAY, THERE CAN BE NO LESION THERE.
  13. THE DELIVERY OF GOOD MEDICAL CARE IS TO DO AS MUCH NOTHING AS POSSIBLE.

Several of the terms common to the jargon of junior hospital staff were widely popularized by the book:

  • To turf (verb: to find any excuse to refer a patient to a different department or team)
  • To bounce (verb: a turf that has returned to its first department)
  • Gomer (noun: "get out of my emergency room" - a patient who is frequently admitted with complicated but uninspiring and incurable conditions)
  • LOL in NAD (noun: "little old lady in no apparent distress" - an elderly patient who following a minor fall or illness, would be better served by staying at home with good social support, rather than being admitted into a hospital with all the iatrogenic risks of modern medicine. Compare "NAD" = "no abnormality detected" or "no apparent distress" (used to record the absence of abnormal signs on examination).
  • Zebra (noun: a very unlikely diagnosis where a more common disease would be more likely to cause a patient's symptoms - from the common admonition that "if you hear hoof beats, think horses, not zebras").
  • Buff the charts (verb: to make a patient look well treated in the charts or medical records, without actually receiving any treatment.)

The book takes place during the Watergate scandal, and follows such events as the resignation of Spiro T. Agnew and the stepping-down of Richard Nixon.

The book is very likely autobiographical, as the BMS is a thinly veiled Harvard Medical School (commonly called HMS), and The House of God representing the Beth Israel Hospital, now a part of Beth Israel Deaconess Medical Center, one of the HMS-affiliated hospitals in Boston, Massachusetts; "Man's Best Hospital" (MBH) represents Massachusetts General Hospital (MGH). There are also references to a community hospital called Mt. St. Elsewhere or Mt. St. E.'s, which likely represents Boston City Hospital (The scenes of the hospital on TV show it to be near the old elevated orange line. Boston City Hospital was near this line. St Elizabeth's is near the green line. )St. Elizabeth's Medical Center or Mount Auburn Hospital (Cambridge) which was part of the Harvard Medical School teaching hospital system.

Some American doctors felt that The House of God resonated with their own experiences during their internship training. The House of God - Wikipedia, the free encyclopedia

35 years later, author revisits 'The House of God' - The Boston Globe

Great book by the way.

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Specializes in Critical Care, Education.

So I suppose OP would not like patient complexity described in terms of "rig count" (number of IV pumps and other pieces of equipment surrounding the bedside)... or maybe that is more of a Southern thing, since it is also used to communicate the number of active oil drilling locations in an area.

Every profession has it's own culture, jargon, symbols and rituals. (check out Peg Neuhauser's work on professional tribes) Adoption of the culture is a normal part of professional assimilation. As long as we treat the patient & family with respect, I don't think that there is a huge issue here.

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What would be the accepted vernacular for "panties in a bunch"?

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Specializes in CCU, SICU, CVSICU, Precepting & Teaching.

A sense of humor is an essential quality in a nurse. "Train wreck" is pretty darned mild compared to some of what you'd hear in an ICU or ER. I suggest you read "House of God", and if you can finish that book without laughing until you cry at least ONCE, you're not qualified to be a nurse!

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Specializes in LTC Rehab Med/Surg.

I guess we should all discard any individuality and simply recite the scripts.

I've used less that flattering terms to describe a pt's condition. Condition, not the pt. There's a difference.

I haven't heard anybody use "gomer" in a long time.

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Specializes in nursing education.

Thanks, everyone. I appreciate the insight and feedback.

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Specializes in Critical Care.

First of all, "train wreck" and "multiple comorbidities" are not the same thing. Multiple comorbidities could refer to a patient with aortic stenosis, alcoholism, varices, and a chronic wound. A "train wreck" usually refers to multiple acute conditions that are often caused by each other. If a patient presented to the ER with those comorbidities, but now the chronic wound has become septic, the sepsis fluid resuscitation in combination with their AS has put them into fulminant pulmonary edema, their varices are now actively bleeding, they haven't been able to hold a drink down in two days and are now in full blown DT's, that is a train wreck, and as you can see those are really two very different patients from a Nursing standpoint.

I's not sure "dehumanizing" was the term you were looking for. Taking relatable terms and making them more technical and mechanical could be argued to be "dehumanizing", not the other way around.

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