Once a Scientist...

Mr. Curious is a little old man with knobbly knees.  When I first saw him, he was under assault by two nurses pulling his clothes off.  As his little knees knocked against each other in cold, he politely answered the questions shot in rapid sequence.  I grabbed him a blanket and he exclaimed, "what is this blanket made of?"

S: I'm not sure, Mr. C.
Mr. Curious: Speak up, I can't hear you!
S: I am not sure what they're made of.
Mr. Curious: They feel so warm- why is that?
S: Well, Mr. C, I got them for you out of the warmer.
Mr. Curious: No! I mean, what is this material? It's remarkably warm.
S: I think all the little pill-like fibers keep heat in. More surface area, crevices, and insulation.
Mr. Curious: I'm a scientist, see, and I don't know if it would be too much trouble, but can I have a small piece of this blanket?

I told him he could keep it and he was enthralled.
He explained to me that he used to design polymers for industry and had amassed many patents in his 90+ years of life. It was wonderful to see that at such an age, in such a situation, his sense of wonder and intellectual curiosity was intact. Once a scientist, ever a scientist.

Happy New Year!
S

Basketball Team Loyalty

So I went to a college with a very good basketball team.  On occasion, I discuss college basketball with patients but because another team is the local favorite, I have to be careful what I say. Never did I expect, however, that I would be arguing about college basketball while pulling stitches out of someone's backside.  Apparently he might have been playing on one of the opposing teams of a game I had gone to see my freshman year.

I didn't hurt him too much. I think. : )

Just kidding.  Despite the arguing, he was quiet as a mouse about the stitches.

S

Holiday Hijinx

My white cloud brought me no traumas Christmas Day (yay!), so I kept myself busy helping in the other sections for the day. First theme of Christmas: there were many, many people who didn't chew their food well enough, coming in with foreign bodies in their throats.  I have to say, pulling steak out of someone's throat wasn't what I was expecting to be doing!

Another theme of the Christmas season has been the dropping off the elderly at the ER because nonnie or poppy "wasn't acting right." Unfortunately, because the holidays are the only time the family visits, the mental changes in their beloved, albeit neglected parents/grandparents/great aunts/great uncles were not necessarily acute.  "Yes, Mr. Dementia is confused sir, yes, he probably wasn't like this the last time you visited, no, actually, this isn't new- we've seen your loved one several times already this year and this has been his/her baseline. Also unfortunately, it is the holidays and their immediate placement in nursing homes is very unlikely until at least the next business day, please don't yell or call your lawyer?"

There were also many, many overdose patients.  One family found their son unconscious in the bathroom because he had taken whatever pills he had found in the medicine drawer in a suicide attempt.  The parents removed and brought the whole drawer to the ER. It was full of empty pill bottles. The only one still half full was the bottle of Vitamin D pills.  Waiting in the family room, the parents kept harassing our resident.  However, the clean-up process was long. The young man was covered in paint-chip-like flakes, which turned out to be half-digested pills. Yours truly also figured out how to work the new "stomach-pumper", but it yielded little, as mostly everything was already expelled or digested. When we finally invited the parents in, I could understand why the resident got so frazzled. If you could picture older hippie Trekkies, they were the disheveled stereotype.  When we transported the young man to the ICU, the father was at the bedside telling his son that they were going on a spaceship and warping to another universe.  Privately, though, he choked to me, "thank you for the best Christmas present ever, for bringing him back." The father then asked me if we shaved him.  "No, we haven't done anything, why?" "Well, you see, he was about five days unshaven the last time I saw him... So I was just wondering." It was probably how his son meant to look at the "end."  Poor family- I hope the best for them.

Another young man had overdosed on narcotics and was intubated when he came in. A nurse and I felt the long track marks on his right arm and looked at each other- "this guy must be left-handed!" Later, a respiratory therapist had undone the restraint on a wrist in order to draw a blood gas.  Alas it was his left hand! He was apparently awake, pushed her hand aside and ripped the endotracheal tube right out of his throat, balloon still intact and puffed up. Ouch!! He then looked at me and asked me for juice!! The doctor said no and he was admitted to the ICU for observation anyway.

Our Christmas Trannie came in to visit wearing a Christmas speedo. We know because she/he/it was smoking funny things and flashed us while in four-point restraints, shaking her booty and grinding toward the sky for all to see while viciously lambasting us at the same time. Talk about mixed  messages.  She/he/it was visually very feminine and attractive, so hearing his voice screaming in the ambulance bay was rather incongruous.  His bright lipstick made her fast-moving lips a hypnotic and mesmerizing point of focus.

In the midst of the hustle, one of our drunk/psych patients came in and latched onto me in triage while I was taking vital signs. She wouldn't let me go and bawled her sorry eyes out while pretending to be someone else. We knew her from her many visits by name, though, and called her out on it, making her sob even harder.  Meanwhile, our Christmas Trannie was tranquilized, and in the moment she/he/it rolled by, Ms. Hot Mess was distracted and I extricated my hands. The evening thus became considerably calmer.

This weekend has been at moments uplifting, hilarious, and poignantly sad.  All in all, though, I am just very tired... Managers had scheduled me on Christmas Eve Eve (1530-midnight), Christmas Eve (1100-2330), Christmas Day (0730-2000)... I am feeling the most burnt out I have felt since June, the month I was stuck in the drunk tank almost every day.

However, I am thankful to have today off. Post-holiday Manic Monday doubly busy- the day when everyone who said "I'll wait till after the holiday" or "We'll see if it gets better by Monday" decide to come in.  Looking forward to an early bedtime tonight. : )


S

Merry Christmas and Don't Drink Too Much

If I were over 100 years old and adorable, I'd want to drink whiskey shots too.  As many as I would like. However, I'd avoid falling out of the chair and hitting my head so I can continue to spend Christmas Eve with my family, instead charming all the nurses in the Emergency Room. : )

He kept crossing and uncrossing his legs to "get comfortable."  At first, he denied the alcohol, but then mused, well, I might have forgotten if I did have any. Luckily, he went home after his scans came back negative.

S

The Thin Line Between Tragedy and Comedy

At sixteen years old, Mr. Athlete was already a man.  He was tall; his waist was wiry and muscular in the way that only youth can sculpt.  His arms and legs were sinewy and had obviously been very active and athletic.  However, as he was wheeling into my trauma room, Mr. Athlete was not moving.

A trauma to his curly head had left only a little blood, but his Glasgow Coma Score (http://en.wikipedia.org/wiki/Glasgow_Coma_Scale) was between 5 and 6.  His eyes were half-open and not moving.  He made no sign of recognition to his name and rubbing hard on his chest only produced a spasm.  I pulled his neon sneakers off his callous-less feet.  The perfect body lay in front of me and it lay terrifyingly still.

There is something so terrible about a scene like the one before me. The potential strength of the body before me was meted by the delicacy and specificity of biology. Everything must be "just so" for us to function as we do; there are uncountable details that must be heeded to form the elegance of a merely functional being, let alone the highly sophisticated and elegant people we are and encounter every day.  I realized I was scared for him. In that moment, I wished fervently- nay, prayed- that he would come back and instinctively grabbed his hand.  It was ice-cold as he had been laying out in the cold until the ambulance brought him to us. His neurological state qualified him to be intubated, but the doctors fortunately stayed their hands as we called out to him one last time and his lips moved almost imperceptibly.  He could hear us.

His friends, still dressed in full gear, came in to keep him company.  They were cut from the same cloth- tall, slim, athletic, but with all the long-lashed, clear-skinned visage of children.  They were horrified to see their comrade thus. It was worse when his parents arrived, however, seeing their son with his eyes unmoving.

Hour by hour, however, he began to move a little more and his voice began to come back- words incomprehensible at first.  His remarkable transformation in the hours under our care was heartening. His scans showed no bleeding. He became fully awake when a nurse tried to give him a urinary catheter.

By the time he left, ten hours later, he made a remarkable transformation.  Because we cut off his clothes, I fetched him some paper scrubs and mesh underwear.  His friends laughed uncontrollably at the mesh underwear.  He grinned sheepishly and made a crass joke about feminine hygiene products. His tragedy suddenly turned into a comedy.

All was well and they- parents, child athlete and friends- walked together into the night.

S

Worst Boyfriend Ever

If your girlfriend is pregnant and decides against an abortion, please don't take it into your own hands help her change her mind.  It's a life-changing choice to drive the car into headlong traffic, sending her into the operating room- and in many more ways than one.  But of course, being the lucky **#%(* you are, you'll get off with only a misdemeanor because she doesn't want to press charges!!!

Luckily, the nursing staff sees what kind of *(#%)%)(#@* you are when you try to threaten/control/thrash/scream at us, and you got knocked out pretty quickly.  How dare you.

This is what I want to do to you!!

S

Holiday Plans

Holidays are great times to work... On Halloween, I apprehended a bunch of frat guys wearing superhero costumes, on Thanksgiving, I told patients that we had a "Thanksgiving Day Turkey Sandwich Special", and this ChanuChristmas, I will be working, but as a side project, I am organizing a caroling group to go around the hospital wards. I figured it will be fun to do something together with my co-workers and volunteer program.

The ER is festively decorated with shiny baubles and there are wreaths and garlands hanging around.
The most wonderful time of the year, indeed.

S

Perils of ER Dating Predators

NQ Honest is a co-worker from a different department who I see often at work.  He is a friendly young man with more than a hint of exaggerated machismo. NQ took to winking at me every time he saw me. I would return a curt nod.  Although he seemed nice, I maintained my strong ideas against dating anyone from the workplace.  There are stories (not mine) out there that can curl your hair!

NQ seemed to be encouraged by my lukewarm acknowledgment, however, and escalated his advances so far as to ask for my number.  I declined every day for a week until he told me it was his birthday. I can safely say, I will never be guilted by the birthday excuse again.

Strike one: After a barrage of "y havnt u been txting me lol" messages, he exchanged numbers the same week with RN McSlutty in the back hallway.  Oops.... Sloppy game, man. Subsequent pretenses to be infatuated with me were that much more alarming in the next few days.

Strike two: I was introduced to his mom 3 days after the strike one incident.  But this isn't going where you think it is. Working in critical care early in the morning, he rolled in as my patient, tachycardic at 160.  I was shocked to see him so pale, but ever the gentleman, he first introduced me to his mother. Although he told me he was there because he had worked overnight and was overtired, his chart told me that he had tried Cialis for the first time and took too much.  That would explain his extreme difficulty urinating and need to be catheterized after he downed 8+ glasses of water.

Strike three: Asking me out for drinks because his mom was so taken with me. My polite decline caused him to loudly proclaim in front of my co-workers, "you should be nicer to me after all those drinks I bought for you."

O_o 

Mr. Not Quite Honest has since been a strong reminder of the perils of dating in general.  It's a scary world out there, but apparently not as scary as taking a dip in the company cookie jar.

S

Don't look behind the curtain...

Mr. Saucisson didn't fit in the post-mortem bag.  We had to push his rotund belly around to stretch the heavy plastic so the zipper would reach.  And then we broke the zipper.  When the other tech went to find another bag, I looked at him.  It was eerie; the pallor of his face wasn't terribly noticeable and his eyes were slightly open, all-seeing, like the Mona Lisa.  I put my warm hand over his forehead and covered his eyes lightly. They stayed shut.

He had already passed by the beginning of my shift.  I never got to know him.  He was put into a room where crying family filed in and out all afternoon.  When they had all left, we pushed him into a far-away corridor room to clean him, then zip up the bag for the autopsy technicians to pick up.

I looked at him once more and closed the curtain.

An hour later, I was passing the staff bathroom when I heard nurses tell someone where to find the body. As one of them led the visitor down the hallway, I froze, realizing what they were going to see. Goodness forbid that this was a family member!! I raced down the hall, trying to hint to the nurse. "Um, are you going to see Mr. Saucisson? You see, he might have been moved." "Um, well, we just *changed the *linens (hard look)", "You know, we didn't expect any more family to come..." to no avail- the nurse looked at me weirdly and led him to the curtained room.  Suddenly, realization dawns on her face and she rushed out of the room to find out about the patient.  Meanwhile, the visitor tried to peek and I stopped him.

"Sir, what relation are you to Mr. Saucisson?"
"I'm his primary care attending, his doctor."
I sighed in relief. "Oh, I see."
"I heard he was very sick."
"Yes, that's definitely true."
"I also heard he recovered, but I wasn't sure if I would find him... alive."
"I'm sorry, but he had passed a few hours ago and the family has been here to see him."
The doctor looked struck. "Oh, oh I see. I had hoped to see him one last time. I only spoke with him yesterday..."
I took a step back. He was mentally prepared now.
"May I?" He took a step forward.
"Go right ahead."

I stood at a distance, to give them some time.  He came back out presently- and thanked me for preparing him to see Mr. Saucisson as he was.  He had thought there was a recovery...Ugh.   Crisis averted for the day!
S

The worse insult

PA: How could you not tell me this patient had an O2 sat of 87?!
S: I thought telling the nurse would have sufficed (considering pt x was on a bedpan, patients y,z,a, and b needed vital signs, crazy patient c was puking all over the floor, patients d and e both needed labs drawn asap, poor patient f needed to be wheeled to the bathroom, then home, and we got new patients g and h.)
PA: Well, I just would have expected that someone that just got into PA school would actually care about letting someone know, that's all.

The biggest insult in her remark? It wasn't that it was in full view of doctors, nurses, and patients. Nor that I was yelled at, nor that she snidely thought I didn't care, considering how many people told me the opposite during the course of the day. It was probably that she assumed I got into PA school. At this point, I would probably be very happy. Unfortunately, medical schools haven't given me much of an indication of anything yet. Sigh.

S

Of Chance and Drugs

This is my 100th post! And I worked a double shift- out of the last 32 hours, I worked 24 of them...  It doesn't feel so bad, but looking at it that way makes it look that much worse! Luckily, most of these past 16 hours in a row were  not on my feet, as I was in Urgent Care and had a lot of paperwork to do.

And little did I know, I missed the memo that declared today the unofficial Drug-Seeker Day!
It's the holiday where opiate addicts of all ages, shapes, sizes, and intelligence levels come to the ER to feed their gambling vice.  Will they score? Will they score big? And on our tab? (That would be the jackpot) Or will they get escorted out by security and blacklisted? Take a roll of the dice- somewhere along the way, many have apparently found reward in this terrible game.

Naturally, this game of opiate-collecting is equally one of chance and skill.  As far as chance goes, they might meet one of our new providers that doesn't know them by name/face/habit.  Perhaps they might come when we are tired/distracted/discontented and hope we might not notice how regularly they visit every 30 days to get that magical prescription. Maybe they might have a legitimate (self-inflicted) injury.  Or perhaps they might be skilled players and alternate between different pharmacies and providers every few days. Maybe they developed incredible powers to break down the will of providers or just the gift of gab and persuasive power.

In any event, I was working with a well-seasoned veteran APRN who knows the numbers to local pharmacies, certain pharmacies outside state borders, the websites to trace narcotic prescriptions for certain individuals, and  has an exceptional sensitivity for people.  His sarcastic pen broke many dreams and wrote many prescriptions for motrin and tylenol today. Becoming rather seasoned myself, I made sure security was already awaiting our problem clients on their escorted walk back outside.

There were quite a few seekers from out of state that were found on our databases to have been flagged in multiple states. They were very surprised to be found out so quickly, but I am sure they will find other places and other ways to gain these prescriptions lawfully.  Or they will come back tomorrow for another roll at the dice in urgent care.

S

The Right to Fight

Have you ever heard a person scream? Really scream? The primal, wordless screech of pain or despair that issues from deep within the lungs, blasting through the vocal cords? The kind that will make you unconsciously grit your teeth until you realize your jaw hurts?

Mrs. Independent was found unconscious. She lived alone into very old age with no known family and a history of Alzheimer's. She woke in the ambulance and put up a violent fight. Apparently she had been a veteran of some sort.  As she entered our trauma room, she let a loud, frustrated scream free.  She wanted nothing to do with us and was determined to let us know.

She balled up her fists and struck at us, but we had to restrain her arms in order to put an IV in.  She thrashed her neck, but we had to hold it still to avoid damage. She tried to kick, but we had to hold her still to check her back.  We pleaded, cajoled, chastised, but it was no use. She had a mental will of steel and would not submit.  Sadly, she knew exactly what was happening and made it purposefully difficult for us to do anything.  She continued her long, high-pitched screaming.  It was barbaric, but we had to hold her down as the knock-out medicine was pushed through her IV.

She went into a fitful sleep, but as we tried to continue interventions, she woke and began her long, sharp scream.  "I don't want any of it! Let me Gooooo(escalates into scream)!!!!!!!!!!!!!" "AEEAAAEEGGH"

And so it went- I stayed by her side for most of the shift, holding her head down firmly, fingers planted on her clavicles so she couldn't sit up.  Her screams echoed through the busy adjoining rooms and there was a silence after each, punctuated by beeping monitors.

"Were you a veteran?" I tried to talk to her. She paused for a split second and I took this as acknowledgment.
"Where did you serve?"
"Let me gooooo (octave increase)!!!!!!!!!!!!!!! Pleeeeeee (octave increase) aseeeeeE!!!!!"

It became an interesting case for me to watch. Usually, a patient acting out tends to demonize certain workers and reach out to others. Despite our best efforts, each new provider or service worker, whether it was a surgery resident, nurse, technician, chaplain, or social worker, she gave the same response. In fact, she screamed louder.  As I was a constant presence throughout the ordeal, I found it enlightening to observe the different methods of approach.

I usually approach distressed patients in a solemn, sincere, and calm manner, whereas there are others that try to meet the patient at their level of energy.  Although this other method can be very successful in certain cases, I find it distressing to acquire so much negative emotional energy on a regular basis.  For Mrs. Independent, nothing worked- she had  created her own impermeable self-discipline in her former life and has since held tightly onto her own ideals of dignity and independence.  Hard-headed, intelligent, fearful, she had estranged her own family to live here alone to the advanced age of 90.  She'd been through so much and now she had to put up with us and the folksy b-s of "so young lady, how did you come to be here today?"

Her high cheekbones were defined, but not gaunt. Her brow, though cut open, was still proud. She was absolutely furious with our intrusion into her well-controlled life and let us know it. There was nothing demented about what she was doing, but from a cursory glance from the busy modern healthcare system, it was easy to dismiss her to be psychologically incompetent.

Much against her wishes, I'm sure, Mrs. Independent was admitted for further observation and tests. As I watched her wheel down the hallway without screaming, I knew she was merely saving her energy, planning her next method of escape.  If anything, we had probably wakened her survival instincts.  Woe be unto the unsuspecting civilians upstairs!

S

A Stitch in Time Saves Nine

Mrs. Trip was leaving church when she mis-stepped on the curb and fell. It wasn't a serious fall in her estimation, but her side and neck hurt, and so she came to the emergency room to get checked out.

A stately lady, Mrs. Trip had aged very well into her 80's.  She was well-spoken and surrounded by loving friends and family. Her injury seemed potentially serious, but her scans all came back negative, so she was set to go home. Before she was to put her clothing on, she requested to go to the bathroom. Since she felt shaken and weak from the fall, she did not want to walk the distance to the bathroom, so I placed her on the bedpan.

As I removed the bedpan, my stomach flipped a little. It was full of bright-red blood.  Something was terribly amiss.    Yet Mrs. Trip felt fine, besides feeling a bit weak.  Several more scans located a bruise on her kidney that would otherwise have been missed.

She is a lucky lady to have discovered the bruise while she was in the hospital. Imagine having gone home, then seeing so much blood in the bathroom!

S

Vital Signs

On a busy day, it is easy to depend on the bright screen in the middle of the main area that shows patients' vital signs when they are hooked up to our monitor system.  Instead of having to trudge down the hall to a curtained room to see someone face-to-face, you could just pull the information from the screen.  Blood pressure, check. Pulse, check. Breathing rate, check. Pain level? Eh, just scribble something down.

Part of being a good tech, however, is taking those extra few steps to make sure your patients are comfortable, and more importantly, doing well.  The other part comes with experience- it has been almost a year since I began as a tech and I am developing an instinct for recognizing when someone is about to crash.  Mrs. Blotchy did not look well.  I knew as soon as I laid eyes on her. Although she was rather short of breath, she answered me crisply and politely.  I looked at the monitor and her breathing was in the high 30's-low 40's.  Other than her high breathing rate, there was nothing else in her vital signs that was exceptional.  I had seen much worse than her, but there was something about her that I can't quite put into words- my gut instinct formed the words before I could stop it. "She's going to get intubated, don't ask me why, but I can tell," I murmured to Newbie.

The nurse took his time putting her on oxygen and getting labs, but in my heightened alertness, I performed Mrs. Blotchy's EKG deftly and tracked down the attending.  The doctor was talking with another doctor about non-work-related subjects as I fidgeted and waited for him to sign the EKG, which contained irregular, non-sinus rhythms.  His distraction irked me and I used that as an opportunity to teach Newbie to make sure the attending always signs paperwork that is presented.

When I returned to Mrs. Blotchy's side, I asked her if she needed anything. Oh, no, she replied, I'm... quite all right, just a little... short of breath.  I felt her hand- it was cold. I grabbed her a blanket.  Her breathing had dropped to 25 breaths/minute. Usually, we are taught that people breathe at 12-20 breaths per minute. On monitor, she was pitch-perfect. She seemed to be getting better, right? Her color, however, told a different story. She was paler than before. Purple splotches were beginning to collect in mottled patterns on her ample flesh.  I alerted the nurse, and soon, we moved her bed to an open room near our nursing station.  Her heart rhythm was now settling into a very irregular pattern and the rate was quickening.  In a mere moment of suspended time, the whole room seemed to come to the same conclusion and everyone rushed toward her bed.

I grabbed the code cart and as soon as I made it to bedside, I heard "do you feel a pulse?" A nurse dug her hand into Mrs. Blotchy's inner thigh to feel for the femoral artery.  "No pulse," she reported. The attending physician folded his hands behind his back and stated calmly, "begin compressions." A male tech was at the bedside and began the violent rhythmic thrusts.  As the doctors at the head of the bed began the intubation process, the nurses were at the sides, trying to establish peripheral IV access to no avail- Mrs. Blotchy's heart was no longer perfusing her circulatory system. I ran for the intraosseus gun, which shoots an IV directly into the bone, oxygen saturation probes, saline flushes, defibrillator pads... In passing, I heard "Oh no, I never saw an EKG for Mrs. Blotchy," from the attending to my manager. I smiled at Newbie- lucky I had the doctor's signature- otherwise I might have lost my job in that moment.

"Halt compressions," we heard. Wiping sweat from his brow, the other tech stepped down.  It was my turn. I hadn't gotten a chance to put a gown on yet.  I climbed onto the bed, wedging my knee by her sweat-soaked side as the ultrasound probe checked her heart for activity. "Resume compressions." I felt her ribs crackling under my hands; the compressions had broken them.  The cold ultrasound jelly smeared onto my forearms as many hands moved around me. "Halt compressions."  A pulse had returned! Our happiness was short-lived as it slipped away once again just as quickly.  Mrs. Blotchy's face was now a deep purple. "Resume compressions." And so my sole concentration and purpose dangled on the thin cusp of life and death for a complete stranger. Yet she wasn't a complete stranger. We were intimately acquainted- as physically intimate as it was possible to be. I was pumping her heart for her and it was slippery, hard work.  She was defibrillated several times.  After about half an hour, I nudged Newbie to line up and I passed the baton. It was his first time, but he was good at it.  It was then that Mrs. Blotchy's daughter was escorted into the room.

She nearly collapsed from the shock at the sight- hanging onto the arm of the nurse manager.  "That's my mother in there!" She sobbed. The attending asked the nursing staff to give full report on the rounds of medications administered so far.  I don't think the younger Ms. Blotchy heard any of it.  The debris from a million packages littered the ground and bed. Newbie was doing compressions and six other hands were on the body of the woman who raised her.  "Please, please," she begged, "Please God don't let this happen to me, please." We defibrillated her for the fifth time.  "I didn't even get to say good-bye! Please, don't let this happen, please!" The doctors looked around uncomfortably. The monitor was still beeping with what seemed to be a pulse.  It was not a pulse, unfortunately. The ultrasound confirmed it. The only rhythm were agonal spasms in the heart muscle. This was one heart that would never beat again.

As the time was called, I could hear a rush of blood in my ears.  I always get that sensation in the surreal, suspended minutes right after everyone else exits the room.  As we began the process of preparing the body for viewing behind our curtain, the room around us was already noisily reorganizing itself.  The cycle of life and death revolves quickly in the emergency room.  I gave Newbie a pat on the shoulder. He had done well and learned a lot. If nothing else, he should remember that when taking vital signs, one should always assess the patient and not the monitor.

S

Dancing in the Moonlight

There is a superstition in Emergency Rooms... that when psychiatric patients suddenly collectively crawl out of the woodwork at once to overwhelm and abuse us, it is not a random act of terrorism but rather an organized, meaningful migration controlled by the phases of the moon. You may scoff at my apparent lunacy, but remember, I used to be just as logical and scientific as you are.  Back before I started working here, I didn't believe in ghosts, cold-blooded murderers, priapism, human cruelty, nor prolapsed urethras either.  Well, I still don't believe in ghosts, but I am otherwise that much more accepting of weird happenstances from my experiences in the ER.   

In any event, whether you believe in the correlation or not, last week's full moon coincided with one of the gnarliest weekends ever at the ER.   All surrounding hospitals, psychiatric treatment centers, urgent care facilities, even our own inpatient areas were totally overwhelmed. Patients were not moving and more kept pouring in. In our ambulance bay, plastic dividers were set up so patients didn't have to watch each other being sutured and otherwise cared for.  Psychiatric emergencies filled the corridors with jungle-like hoots and hollers.  

Mr. Man-child constantly made drawn-out whining noises like an opera student warming up and exhibited less self-control than an advanced dementia patient.  He was tied in 4-point restraints when I took over the job of sitting with him. 

"You's better get me out of these restraints. I'm gonna sue you like nobody's business. Enjoy your freedom now, ********, 'cause I'm gonna own ya when I sue you for all you're worth!"

Intoxicated and naked, he took another approach when I ignored him. "Fine, if you don't let me go, I'm gonna get naked." He tried to throw his blankets off him, though his 4 limbs were tied down. After a fuss and much struggling, he managed to expose his chest and copious rolls of fat.  Livid, he tried to stare me down. Nonchalantly, I ignored the large slitted eyes and closed the curtain to spare innocent passersby the unpleasant visage.  Then came the death threats. "When you walk out of here tonight, expect to get jumped, you ****, don't expect your kungfu skills will do you any good, cause ya know what? You're not bulletproof." 

(P.S. How scary is this... I usually do get affected by death threats like this because the possibility is a little too high to be ignored entirely...http://www.nytimes.com/2011/11/12/nyregion/when-gunfire-reaches-inside-the-hospital.html?ref=health)

As charmed as I was by his way with words, I had to put an end to the yelling. I met his fury with a calm, collected air, taking him by surprise.  "Mr. Man-child, you are running a fever of over 102 degrees, which is a dangerous condition. You are tied down because you're not making any sense. Think about it." He looked at me in nervous astonishment. "We are trying to help you. Please don't try to struggle and go home because this is really serious."  Careful not to sound like I was condescending to a child, I took him down layer by layer until his noise output was reduced to a quiet whimper every few minutes.  We had no opportunity to celebrate our small victory with Mr. Man-child, though, because Ms. Misogyny decided to start yelling at me to stop "doing a man's job, because you can't do it right. Just stand there and look pretty cause that's all you're good for."  

Twelve hours of this later, I was more than ready for a hot shower and the comfort of some peace and quiet.  

Walking into the brisk night on my way home, I saw the silvery full-moon slipping behind a cloud. Seeing is believing.  

S

New Blood

The first new tech, Newbie, has been hired! Hitherto, I had been the newest tech for about a year now.  Interestingly enough, I was chosen to train him for my 12 hour shift last night, which was great. His unadulterated enthusiasm and appreciation for his exciting new job was heartwarming.  Moreover, his focus is on patient-care and making sure our patients were happy and comfortable.  This aligned well with my own philosophy and we worked very well together.  The best part of Newbie was that he wasn't lazy. He followed me throughout my high-energy day with no complaints, though I realized at the end of the night that his legs were very sore from standing all day.

In direct contrast there had been another tech-hopeful that visited the ER often, hoping to get a foot in the door. A manager had approached me and asked me about her performance. Although our tech-hopeful had a lot of ER experience in another hospital and seemed to really want to be here, I had a feeling she had too much prior experience.  Experience can make a person more adept at a job, but it can also give a person insight into how to take shortcuts and become inert.  Although she stated she had worked many codes before, when we received one, she did not jump into the action and I worked the code alone, compressions and all.  Her manner and upturned nose suggested a weary boredom of her current job and an apathy for getting to know our ER and our people.  Therefore, to the manager, I replied that she was not a good fit for us, despite or because of her experience.

Newbie, on the other hand, wanted to get into everything, but not in a competitive way.  I was resolved to give him some organization in his training and showed him at least once, in detail, how I performed each task.  My own tutorage followed a "thrown to the wolves" philosophy.  I had to learn everything by trial and error.  Secretly watching the person "training" me helped me grasp details of the trade; otherwise, there were many instances in which I could have gotten in trouble.  It felt good leading Newbie into the rooms and jumping in with a plan of attack.  We cleaned up a massive GI-bleed, helped with draining abscesses, helped set up a lumbar puncture, etc. Though the amount of information was overwhelming, he was beyond satisfied with his new job.  It was also interesting seeing him perform his own little brand of personable magic with our patients.

I was holding Ms. Lumbar Puncture's hand when she said "I can't believe I'm getting a spinal tap on 11/11/11. This is going on my Facebook!" I laughed at the reference, but Newbie went further and launched into a spirited discussion with her about various obscure movies with the same actors. I have never been a movie-person, but watching them form an instant bond because of movies was enlightening.  Everyone has different skill-sets. Whether a person can be bothered to use these skills to relate to and help other people is what makes the difference. Newbie has this wonderful quality and I am proud of him.

Yesterday's shift helped me realize I wasn't doing myself any favors by abstaining from blogging.  The plan was that I used my weekly blogging time to work on applications for medical school, but that is a very different kind of writing that I don't enjoy nearly as much.  If anything, my informal little stories will help me get back on track.  Therefore, I am back.  Sorry for the wait.

S

Mrs. Sharp is Sharp

Mrs. Sharp came in exclaiming, it was so bright, I just couldn't see! It was so bright! A tiny little woman at the age of about 90, she could probably barely see over the steering wheel into the setting sun when she crashed into a telephone pole. She had no major injuries except a blood-soaked bandage over her lip. She was so slight, she reminded me of hare-lipped children I worked with in Asia.

Her eyes were unnaturally bright, like cat-eyes, with facets gleaming with different angles of light.  She had the most delightful mannerisms, however, and was very fussy.  She took care to remember all our names, the name of the ambulance driver, and various pieces of information about us.

First, before everything else, she wanted to use the bathroom, so I fetched a commode and bedpan, but then she wanted to talk to the doctor. She refused to get undressed because she insisted her sweater would not fit over the collar. No amount of convincing, cajoling, insisting, commanding would do.  However, she did try to bargain with us. "If you take this Thing off, I can get my sweater off."  "Just for a moment, no one else will know." (Because it's cute, here's a picture of an elephant shrew...)

When she couldn't get her way, she pouted and refused to get undressed. It took several doctors to convince her to do so. She insisted it was impossible! I walked her through how we would do it, arm by arm, then slide the sweater neck opening over the collar.  Knowing she was defeated by yours truly, a certified professional clothes remover, she sighed and began to undress.  She refused all help with the removal of her clothing ("I am a very independent woman, you know!"), however, and threatened us, "this sweater is cashmere! If it is ruined, you will be buying me a new one."  Then, as a declaration as she demurely slid her little pencil skirt down, "I will keep my slip on, thank you."

The feeling of the room was a little tense, so I smiled warmly and said, "you have always been a bit of a spit-fire, haven't you?" She looked at me with a poignant lift of her chin, "always was. Still am, always will be!"

If I were to guess her profession, by her organization of mind and manner of dress, I would have said lawyer. However, she was actually a schoolteacher, newly retired, so she says.

I took her on my arm to go to the bathroom a few times. She draped her purse over my shoulders and insisted I take the wet bath towels and tissue box in case she had to dab at her bleeding lip.  Very thankful for the attentive care, she became quite sweet and held tightly onto my arm as we walked.

At one point, while I was taking her vital signs, she looked very pale to me. Worried, I asked her if she felt all right- she was a mentally sharp little thing and looked me in the eye, "why wouldn't I be, dear?" I took her blood pressure, and it was a little low. "Here, try my other arm," she offered. The pressure was higher. "Let's try this arm once more, just to see," she said, and memorized the numbers for later. I was bemused. She was a curious little soul and likely because of her profession, quite young at heart.

Mrs. Sharp is as sharp and interesting as I should ever hope to be at her age. : )

S

An Unlikely Return

I looked on the board at the name. It couldn't be. The first and last name were the same. The age was similar.  I had to go look in the room.

The man in question was Mr. Poopy- the homeless man who crossed my path several times at different points in my life. He was the man who stole my ID when I was working in research in another building. He was the man who knew and was frisked by my late friend, still greatly missed. He was a patient of mine whom I had to treat with multiple, serious problems. He was a man who died, friendless, homeless, alone, and unknown to us for hours in our own waiting room.  

Suddenly, there was this doppelganger by the same name. I scrambled to the other side and looked in the room- the man did have a beard and glasses, but it wasn't the same man. He didn't have the same scholarly nose, wrinkles in his forehead, and strange stare.  I laughed at myself; Mr. Poopy, whether I like it or not, has become one of those fairy-tale figures in my life; an archetype of the leper- a lost soul, doomed to wander alone forever.  Why he continues to visit me, even in death is a mystery. 

Rest in Peace. 

Tales of an Emergency Tech: Disappearing into the Background
Tales of an Emergency Tech: Coming Back Full Circle

S

Hulk in the Trauma Room

When I come to work, the first thing I do is take inventory. Especially in the trauma room, I need to know where everything is and how to use set it up/use it because the technician should be the #1 resource when something emergent comes in and panic sets everyone yelling for x, y, and z.  That being said, when I see on the assignment sheet that I am trauma for 12 hours, and there has been no one in trauma for the shift before mine, I know that there are probably essential items missing from that room.

At this point, I hope and pray to my white cloud of trauma not to send anything my way as I feverishly restock that room. Simple things like normal saline bags, lactated ringers, and blankets must be put in the warming closet can save someone's life by keeping body temperature high as they are losing blood.  Unfortunately, these blankets are always disappearing as people come in to steal them for patients. (I do take them for my little old ladies and gentlemen, but at least I replace the blanket I take with one from the rack... ) Gauze pads, needles, gowns, flashlights, chest tubes, lube, cervical collars, invasive temperature modules, staplers, traction splints... hundreds of items and kits that need to be immediately handy just in case.  

It took me over an hour and a half to stock that room. We received only one trauma, but when I was checking his vital signs, I found a sneaky female technician snooping around the yet unused area behind me. She informed me, you can clean the other side, I am doing this side.  I stared at her in a bemused fashion as she shuffled around said, this side is almost done. She then told the nurses, I stocked that whole side, so you're good in the trauma room! The she-hulk stared down at me. I smiled ironically and said, well... thank you, that's all, I think. She slunk out reluctantly, returning to the chaos of critical care that she was probably seeking to escape for a longer period of time.  I saw that she had rearranged and removed some of my items, so I fixed what I could and sighed. At least the nurses had seen me at work and laughed at the she-hulk's brazen attack.

S

A Good Story Turned Bad

It was supposed to be a funny story, kind of.  A man was sleeping in his bed when a bunch of hoodlums broke into his house, took the giant bottle of tabasco sauce off his kitchen table and hit him in the head with it. It caused a small gash on his neck and a small egg near his temple.

When I came in and saw him, I thought the orange sauce mixed with blood was all blood... until I came close enough to smell the vinegar in the air, stopped, and looked quizzically at him.  After many buffalo chicken wing jokes, we released him and all was well....

A few hours later, another trauma was called and I was surprised to see Mr. Tabasco back so soon. He had fallen after taking a nap because he was very dizzy and got up too quickly. This time, he had a spleen lac and had to get sent to the O.R. : (

Poor Mr. Tabasco.  

S

Health-Care Team

For whatever reason, all my patients tonight were extraordinarily ill.  Intubation after intubation, respiratory emergency after respiratory emergency, significant chest pains, intestinal blockages, internal bleeding, traumas, ingestions, you name it- we were swamped.

Mr. Cat-eyes, one of my regular drunks who is here at least 3x a week was a critical patient today.  Because he was unresponsive (and still drunk), we pumped his stomach and fed him activated charcoal through that same oral-gastric tube.  Activated charcoal is pretty gross. It got all over my gloves, then on my bare hand when I removed the gloves. It's thick, sludgy, and tastes terrible, so I hear, except for one girl who took the pediatric cherry-flavored charcoal and said it tasted like cookies.  He was sweating profusely (diaphoretically) so I wiped his familiar face several times with a towel.  He wasn't clean- streaks of yellow exudate covered my towel.  The respiratory therapist was a nice young man.  He actually wiped a spot I had missed on the other side of Mr. Cat-eyes' face.  When Mr. Cat-eyes went upstairs, I couldn't help but wonder what had made him this way today. :(

In the other room, a nice old gentleman had come in for difficulty breathing.  Throughout the day, his eyes were half-closed, but he was fully aware and answered questions appropriately.  It reminded me of when animals are sick. They don't vocalize, but lie there, panting and staring through half-closed, glassy eyes.  I felt so bad for him and made it a point to go to his room often to shut off the constantly ringing alarm on his monitor. Both his heart rate and breathing rate were extraordinarily high.  The same respiratory tberapist from before came to find me because my LOM asked said to him "I feel so tired, but I wonder if I fall asleep if I'll ever wake up again." He made me promise to check on him often, which I was doing already. It really touched me to know that someone else was caring for patients. Not "caring" in the cold, clinical sense, but caring in the way that you move a lock of hair from somebody's face, or tuck a blanket around someone's bare neck.  This therapist even did something that I normally do; he came back when he was about to go home, to check on this LOM once more, to reassure him that he was in good hands, and that we were going to take care of him.  I think that my faith in humanity jumped a few points today.

I did my own mitzvah today after seeing the respiratory therapist with my LOM. An older man had come in for syncope.  Apparently, he had been fasting all day for Yom Kippur and fainted dead away after a glass of wine.  He and his wife were lovely people and very grateful for my detailed attentions to them despite the craziness of 2 intubations in the rooms around them and several patients down the hallway screaming from PCP use.  It was worth the extra effort to me. They were kind people- you can tell from the way their bright eyes crinkled when they smiled. After I changed out of my scrubs, I stopped in to see them one last time and wish them luck. Luck would have it that they were being discharged at that very moment and as my final work-related action of the night, I removed his IV and sent the pair of them out into the warm autumn night.  Work felt good tonight... Can't wait for 12 hours of trauma drama-rama tomorrow!

S

Where Artists Go in Old Age

Mr. Fuzzy Beard was picked up by the police for public masturbation.  Given the choice between jail and the hospital for psychiatric evaluation, Mr. FB chose the latter and sat comfortably, staring at everyone and everything with large, disconcerting eyes.  During the course of his stay, he received a sandwich and was very much pleased with it, temporarily distracted... until he saw me walk by.

"Hey, hey, are you *ethnicity 1 or *ethnicity2?"
"*Ethnicity 1, how did you know?"
"My wife, she's a painter, you know. She teaches painting to two little girls who look just like you."
Because all of us look the same, I know. "Oh, acrylic or oil?"
"Oil. You know, I'm an artist too.  Give me paper and a pencil. I'll draw a portrait of you."
"Really?
"Yeah, you'll have to give me $10 for it, though." I humored him and brought him a clipboard, a few sheets of paper and a pencil.
"Mr. FB, it looks like you're still eating."
"Yeah, I guess I am. You can draw a picture of me until I'm done. I bet you're better at it than I am."
"Why do you say that?"
"I can just tell that about you."

I smiled and asked his sitter if she minded me sticking around. "Nah, anything to keep him happy and quiet."
So I made a rough sketch of him.  It was a good likeness- if you can imagine a Harry Potter-world "mad wizard", Mr. FB would be it.  He had long hair around his balding pate and a full beard. His fingernails were dirty and he had a necklace of beads made from rolling up pieces of magazine.  His features were fine, however, and in some alternate universe would have looked scholarly provided his twitch tic and crazy eyes didn't betray him.

"Well, well, let me see it! You're taking an awfully long time, aren't you?"
"Good art takes time."
"What, you think Picasso more than a few minutes?"
"Absolutely sir, here, what do you think?"
"Ahh, that's wonderful.  See, I would give you $10 for this. Don't I look like a professor?" He smiled beatifically.

I should have included the dab of mayonnaise left on his beard, but otherwise, the likeness was real. I would take a picture of my drawing and show you, but wouldn't that be a HIPAA violation?

Later, he drew a picture of his sitter. From his picture, one can clearly see that he has been majorly influenced by Picasso. His sitter was less than pleased.

S

Code Pride

"Oh my gosh, what is that?" I peered down the ambulance bay tunnel and saw the EMS team running, one of them making compressions on the chest of a man on the gurney.  "There's a code coming!"

Charge nurse quickly pulled a patient out of critical care in time for us to pull a new bed for our new patient.  He was undeniably over 400lb, maybe even 500, and that's not counting the missing portions of his legs below the knees.  Foul, cloudy urine was everywhere and the tangy, musky odor saturated the air, causing more than one nurse to wretch.  The EMT was making half-effort compressions, trying to keep his already urine-soaked body far away from the patient.  He was visibly repulsed and his interest in pretending to do energetic compressions in front of us was waning.  "You wanna take over?" he asked hopefully.  "Not until he's transferred to our bed," I replied coldly.  It took six of us to safely move the large body over to the bed, whence I placed him quickly on the monitor and jumped up, straddling his shoulder.  His large arms were heavy and hung down the side, limiting the space I had.  A foul smell arose from my plastic garment as his sweat rubbed onto me.  "Begin compressions!" And so I began.

Meanwhile, the resident was right next to me with the attending. I could feel his excitement and nervousness at gaining the opportunity to intubate someone.  To young doctors, this was a learning experience and an opportunity to shine, never mind who the patient was.  They obviously didn't identify with this man, who lived a relatively short and limited life.  Huge and diabetic, he lost his legs a few years ago, and ever since, had been immobile.  As he repulsed even the ER team taking care of him, I wonder about the people he knew- whether anyone might have been kind enough to keep him company.  In his final days, he was filthy and had fallen a few times, as his injuries suggested. When he was found by a visiting nurse, he was on the ground.  I breathed rhythmically through my nose as I watched the monitor to make sure my compressions were deep enough though the smell was intensifying.  "Halt compressions!"

The resident had intubated, but there was something wrong.  The tube wasn't down far enough.  The attending moved over and tried to intubate. "Get me the glidoscope," she commanded.  "I can see the cords now." The nurses standing by were nervous- "we need to be doing compressions." "Hold compressions. The cords are *right* there", the attending commanded as she dug the tube down further.  Finally, she looked up, "give me a bougie." By now, I was commanded 3x by various nurses to start compressions, but the attending wouldn't have it. The struggle on her face didn't say whether she was more worried about saving the patient or looking a fool in front of the crowd of people around the bed, but I had my opinions at that moment.  It had now been over two minutes, maybe more since compressions were halted.  I had recovered my breath and was ready to go. "Aha." The attending smiled her beautiful smile- the CO2 detector turned golden- the tube was in, and the patient was still asystolic.

After a few more rounds of compressions, the attending asked, "does anyone object to me calling it?" She called it and everyone scattered, as was customary. Nobody wanted to be stuck with helping clean the crusty, smelly body.  The resident then noticed some blips on the screen that looked like ventricular activity, so he wanted to continue, but was unsure.  "Are you sure? if you want us to continue, then we will continue," the attending prodded, but we could tell she didn't really want to. The resident mumbled something in an embarrassed manner and we did not continue. I was left to clean the body to make it presentable for viewing.  It was just another day in the emergency room, but for this man, it was his last.  They say hearing is the last sense to go- I sure hope he didn't hear what was going on in his last moments with us.

S

Patient Patients

It's one thing to wait for 8-10 hours in a room for care and entirely another to wait in the bustling hallway, watching the nurses, techs, doctors walk by quickly, be on the computer, make inappropriate jokes. You can observe who is taking care of patients and who is waiting for a paycheck.  Ms. Alone was feeling terribly sick. Graying hair in a tangle, she was slumped over, totally forgotten for several hours at a time. Every two hours, she would patiently stick out her arm for me to take her blood pressure and open her mouth for me to take her temperature.  She had a low-grade fever, so I grabbed her another blanket and let the nurse know, in hopes that she would come help the lonely old lady soon.  Instead, the nurse asked the intern if he wanted to practice drawing blood.  The intern was thrilled, but he missed her veins several times.  Without complaint, she let us stick her multiple times. Finally, the intern asked me, abashed, to draw the final tube.  She did not complain, but smiled at and me and thanked me for taking good care of her as I pulled off multiple gauze pads off both arms to find a vein.  Sweet lady of good temper, I wonder what happened to you to make you so patient with us.

S

Fat Chance You'll Catch Me Again

"Are you sure this thing is locked??" Ms. Peevish O'Bese whined about the stretcher as she tried to use it for support and it gave easily.
"No, ma'am, the stretcher is actually locked..." I observed, you just weigh more than 500 lb and its locking system can't sustain the effort of you trying to stand up.

I had been asked by a nurse to help bed 1 to the bathroom and oh, by the way, we also want labs and an EKG while you're at it.  When I pulled aside the curtain, I realized with dismay that I had been signed up for a bigger project than advertised. I was met with the whiniest voice telling me she had to PEE NOW, a bedpan on the chair and a distressed pair of eyes on a body I knew I couldn't move, that couldn't rotate on the bed far enough for me to even insert a bedpan, that would have crushed and actually broken the plastic bedpan. I'd seen worse from smaller patients.

"Please, I need to pee. I need to pee now. I want to walk to the bathroom, but I don't want to fall. I've fallen 4 TIMES since I've been at this place. Oh God, I don't want fall again."
 "Ok, Ms. O'Bese, give me one minute while I run for a commode."
"HURRY."

I returned 30 seconds later to her screaming about how she needs to go, Oh God, somebody help her, please help her, nobody cares, etc etc.
"Ms. O'bese, didn't I tell you I'd be back to help you? Please stop yelling."
"Oh, it's just that nobody ever listens here. This place sucks."
I ignored her running commentary about how my workplace sucks and set up the bedpan. She eyed it, "I'm not gonna fit in that, Oh God, it's not gonna work but I need to pee now. You don't understand. I NEED to PEE."
"Ok, well, how about we try it, because you've no other option right now."
"This place sucks. Don't you have the bigger ones?"
"In my 30 seconds searching and finding one (which is miraculous on its own), this is the best I could find (I had picked the bigger/sturdier one), and we don't carry bariatric commodes down here in the ED (I hadn't seen one for months). I'm sorry."
"This place sucks. I'm never coming here again. You guys aren't equipped to handle your customers." She struggled to pull herself up. I unlatched the bar and helped her swing her huge, swollen, weeping legs over. She tried to stand up by pressing against the bed, which gave against her immense force and, frightened, she sat back down and wailed, pounding her fists on the bed.  I persuaded her to try again. As she collapsed onto the commode, her backside was too wide to fit entirely, so she was wedged in it. Wailing and cursing she yelled at me to pull her nightgown up.  I did so, and she began to pee, filling the commode, then leaking all over the floor. It was time to call for help.  I beckoned the nurse who assigned me this mammoth job, who grudgingly came in. "You'll need gloves," I told her.

Nurse Snark's eyes widened and she immediately began to lay pillowcases and towels on the ground.  The whiny, peevish voice raised in volume and pitch.  "AREN'T YOU EVEN GOING TO HELP ME?"
"I'm not going to fall. We have to clean this up first."
"Oh, so you don't want to fall, but I have to."
We ignored her and realized the job required more people.  Nurse Snark called out, "I need 2 gentlemen to come in here to help." Two of our new residents came in to behold the sight of Ms. O'Bese stuck in the commode with her nightgown up, smelly urine all over the ground with towels haphazardly arranged, and Nurse Snark and me trying to steady the bed.  Eventually we did get her back to the bed, where she started yelling again about how much we sucked.  "Don't forget the labs and EKG," Nurse Snark reminded as she scooted out the room, leaving me with Ms. O'Bese.  Great.

I actually managed to talk her down, and a short while later, she apologized to me, "I didn't mean to take it out on you. I don't like her (Nurse Snark). It's like she owns the place or something." Hmm, ok.  But it was the end of my shift, and I wasn't about to stay to help with any more bathroom incidents with Ms. O'Bese, who must live a very stressful life.  How else does a person's voice get that way?

S

Old Country Manners

Mr. Right-Handed had been a carpenter for the last 40 or so years before he had an accident one morning that split his dominant thumb in half lengthwise, cutting several tendons and causing him a lot of pain. He kept apologizing for not speaking English very well, though I understood him perfectly.  His deep blue eyes searched my face and crinkled into a smile. He trusted me to take good care of him.  His daughter sat in the background, distant and businesslike.

A stoic man, Mr. RH, didn't want to admit to pain at first, but as he got to know me through his many hour stay, he began to let me see the grimaces and such. He refused almost all the pain medication, however, and I stopped in many times to grab him another pillow or ice-pack.

When the surgeon finally took the bandages off, I was fascinated. The jagged cut went clear to the bone. It was then that Mr. RH finally agreed to have some morphine as the surgeon cleaned and stitched the wound up for evaluation the next morning. He asked me to stay with him, and I distracted him by making conversation through the bloody procedure, though the numbing medication was wearing off quickly.  We got along really well- he told me about his family and about his love for his profession, making customized handiwork for clients.  Occasionally, he would wince and I would hold his good hand.  My father is the same way about pain- he would never admit having any. I notified his nurse, and Mr. RH received some more morphine, but will eventually need surgery to re-attach the tendon.

10 Hours after I first met him in which he wasn't allowed anything to eat or drink, I sent him off with some juice and a sandwich box.  As he stood up, he thanked me, then remarked with a grin, "it looks like after alcohol" as he left on his daughter's steady arm.

S

On the Wings of Karma

Someone decided to switch me out of Urgent Care for 8 of the 12 hours I was supposed to be there. 8 Hours working as helipad tech isn't so bad though, so I refrained from notifying anyone that such a change had been made without my consent (not that it would even matter).

As I peered through squinted eyes in delight at the gorgeous day, feeling the warm breeze wash over my body, I received several patients and met some really cool medics that fly helicoptors for a living.  There was a crazy trauma where a man got his leg caught in a machine that has a threshing mechanism of action; the whole leg was bound with a tourniquet, and when they opened the cardboard encasing it, it was mangled beyond repair.  There is a middle-aged man out there tonight without a leg that had accompanied him his whole life.  

Meanwhile, Urgent Care got slammed. 8 patients at once is already overwhelming, but there were literally 18-20 patients in that waiting room. Whoever wanted a cake-walk shift was definitely mistaken to take this hellish post from me today. (Thank you!!!)

The balmy breeze on top of the helipad tonight lifted my spirits with the dancing lights of the helicoptor.  I watched the patients and their families in the tower across the way stick their faces up close to their windows, watching us working.  I waved and they waved back.  Being outside in that night air is definitely one of the keener sensory pleasures of being a tech.  

S

I Would Love to Go to England if the People Were All Like Him

26 Hours of interrupted sleep later, I think I've recovered somewhat from the splitting headache and nausea all through yesterday.  Whew.  I rarely get headaches and forgot how hard it is to get rid of them! Just imagining the pounding behind my temples makes me nauseous again. The mixed-up dreams and fitful sleep were the worst part though.

The good part of this experience is that I have refilled my empathy pool for people with headaches.    At work, I can generally tell if a patient is legitimately compromised, so I would turn off the lights and let a nurse know about the state of the patient. Other times, I might receive a surly or hopeful demand for that "drug that begins with a d", in which case, I just backpedal quickly out of the room and alert the nurse about the narcotic request.

The other day, I had the most delightful old man. I walked in to see Mr. Dickens lying on his back, a large bleeding "egg" over his left eye. Ever so polite, he brought out my good humor with his mild British accent and tongue-in-cheek charm.

"So did you get that shiner from a fall or a fight, Mr. Dickens?" I asked.
"Oh, I fell, definitely not a fight," he chortled. "Excuse, me, but if you get a chance, I was wondering, I've been here all day and was hoping to get something to eat."
"You know, I will have to check with your doctor about that- if you have to get a surgery, then you can't be eating."
"Oh yes, miss, I understand that they told me they are reconsidering the need for surgery."

I went out of my way to find a vegetarian option for this LOM, and when I presented him with an egg salad sandwich, he was delighted, using all the cutlery gingerly and politely.  It suddenly hit me how often I've seen patients wolf down their food and appreciated little Mr. Dickens ever the more.

"So what was your profession, Mr. Dickens?"
"Well, back in England many years ago, I was a professional voice recorder for books on tape."
"How wonderful! I used to read a lot of Dickens, Thackeray..."
"Dickens is delightful, isn't he? You sound like you like a lot of the Victorian literature."
"Yes, I do, indeed. What an interesting career you must have had."
"Yes, it definitely was."

I gingerly cleaned all the blood still draining from his eye, which was puffed shut. I had to rub out with peroxide what had dried and settled in his gray hair.  He was patient with my gentle and didn't say he felt any pain when I asked, though his eye was puffy with bleeding.  His accent was charming and conversation nuanced.  It's not every day I could gush over classical literature with someone.

Oh, Mr. Dickens, you made my day so much better, though you probably thought you were being fussy and making me busy.  Wishing you well.

S

The Next Time You Stop at the ATM...

The next time you decide to drive up to and stop at the ATM for some cash, please stop completely. Don't try to hang out your window and use the ATM with your car running because as you're hanging out, the car might start to move. You might fall out and get dragged about 20 feet before your car pins you against something, like a wall or telephone pole.  Then, EMT's will have to extricate you and bring you to meet yours truly in the trauma room. While you might be a delightful character I would probably not meet otherwise, this is just not the best circumstance to become friends.

End Public Service Announcement. Have a great day!

S

First Time for Everything

I can log a few firsts tonight:

My first confrontation with a co-worker.
My first instigation of a confrontation ever.
My first time trying to speak French with a patient.
My first time observing a glass eye at close range.
My first time taking a break to let off steam.
My first traumatic code
Working my first traumatic code death without help.
My first time being directly appreciated and recognized by a co-worker.

Which of these should I start with in my next entry?
S

Of Butterflies and Roaches

Every once in a while, I check back into a more comfortable reality, as if the realer-than-real life that I have been living in the ER has been a farce. The darkness of humanity will seem to be only a nightmare that dissipates with the morning light of the waking world.

I was pulled from my section to sit for a college freshman who had ingested 20-60 liquid advil in an attempt to harm herself. Oh boy... I've seen enough disturbing cases of these to be totally on my guard.  Young, "alternative", wearing black lace tights, and thick dark eyeliner, she commanded an adult appearance way beyond her years.  Yet, she surprised me. Polite, meek, apologetic, it was as if she got caught in high school for skipping class and was in detention.  She didn't even object to having a "sitter." She took it as her due.  It made me wonder about all the combative, abusive, spitting, terrible people I have sat with hitherto, and how little effort it took to sit with Ms. Advil.  She did everything we asked and more, even replacing the blood pressure cuff herself when she came back to the bed.

Instinct told me to reach out to her- she was a little overwhelmed and completely new to the hospital environment and asked me what "butterflies" were.  The more I talked to her, the easier it was to look through the smeared make-up at the very young soul in front of me. It became more and more apparent just how young she was, with baby fat still lightly gracing her jowls. She hadn't succumbed yet to the college-girl quest for angular chins and improbable diets.

"So what happened that brought you in here?"
"Well, I was going out with this guy Nick, and I was mean to him, but I didn't think I'd push him away. So when he told me he wanted a break, I got mad and lost my temper."
"Did you want to hurt yourself?"
"Yeah, but not anymore. I just love him so much."

I let her babble on about Nick and she thanked me for listening, for it made her feel better.  She was curious about the charcoal we had her drink to deactivate as much of the drug as we could. She didn't mind when her mother and grandparents came in to sit and stay with her.  I've had young patients fight tooth and nail to avoid their parents, but they were apparently a very loving, supportive family.

They had raised a good girl, albeit a little spoiled and impulsive.  They were also very protective, asking for every little detail, whether this IV should be hurting or if the bag should be changed, or if she could have ice chips and a toothbrush/toothpaste to brush her teeth, etc etc...

Sitting with them made me feel safe- removed somehow from the adult world of lies, manipulations, agendas, gambles, real psychiatric problems.  She was just being a pouty kid.

I heard a scream down the hallway from the PCP-ingestion that was heading my way. In stark contrast, this young girl was a brash young hellion with emotional problems and the will to harm.

My few hours of peaceful counsel with the Advil girl was ended by the arrival of the ugly character of the new patient next door, who brought me swiftly back to my adult reality as she started spitting at us. Sigh, just another day in the life.

S

Patients Say the Darndest Things

I set up a pelvic exam tray for bed 13. She eyed the pelvic light with a wide eye, "what is that black thing?"

"Oh, it's just a light", I switched it on and off for her to see. 

"I just had twins, so I mean, it will fit, but y'all aren't gonna stick that thing up there, are you?"  

"Ms. Colorful Language, have you had a pelvic before?"  

"Yeah."

"Then you know, it will be really quick. This light won't stay up there."

"Ok." She kept eyeing the light.

"Don't worry, honey, either me or the other tech over there will be here with you through the whole thing, ok?"

She nodded, but didn't say anything. I left the room and the very straight-laced, so-academic-as-to-be-a-bit-socially-inexperienced resident soon entered with the other tech.  He came out ashen-faced a few minutes later. "Well, I have never heard that expression before!" He sputtered.  "What did she say?" He wouldn't repeat it to me.  Later, I entered the room with him for something else. 

"Doctor, are you going to **** me with that black thing again?"

"No, we're all done," he said, blushing. I could barely hold my face straight.  "That's what I was referring to," he whispered to me as we left the room and a grin crossed my face as I bolted to find somewhere to laugh.  

S

My Mother is Radioactive

I was transporting a patient via wheelchair to the medical taxi we had ordered for him.  As I was bringing the wheelchair back inside, a woman ran up to me, "please," she said, "can you help my mother?"

Not being one to turn down these sort of offers, I asked her how I could be of assistance. "Well," she said, "my mother is radioactive."  I didn't allow the look of surprise to materialize on my face, but calmly said, "oh? What happened?"

Apparently she had had radioactive iodine treatment the day before and was now vomiting profusely with no relief. I wasn't sure how much radioactivity I was already exposed to, but decided to verify with the charge nurse as to what I should do.

Charge nurse hadn't really an idea either, so I was instructed to push the woman inside. As I entered the triage area, an alarm sounded, as the Geiger counter at the door had registered the high level of radioactivity. :-/

Later, I was informed that the woman herself was not radioactive, but her vomit and other materials expelled from her were.  I don't believe that I wasn't exposed, though. I hope it wasn't enough to give me flipper-babies one day.  Har har har...
I liked this picture of the radioactive cats...

S