Thursday, August 11, 2011

A Crappy Day

In the last 36 hours, I have worked 25 of them... Some moments were great, such as when I got to hold someone's kidney stones in my hand. He had four of them stuck in his urethra, lined up like b-b's in a toy gun and the urology resident plucked them out one by one with a scope and balloon attachment.
Others were just crazy, such as the whole shift when I worked critical care and trauma at the same time, handling over 15 very sick patients at a time.

My sickest patient was Ms. C-Diff. She was at home with her daughter when her daughter noticed she wasn't making any sense and called 911. The paramedics thought Ms. C-Diff was borderline between coming to the hospital and staying home, but luckily decided to take her along just to get checked out and maybe raise the census numbers a bit for their ambulance company. In the ambulance, Ms. C. Diff crashed and burned- when she arrived, her heart-rate was in the 20's and I was preparing the code-cart and gowning up for CPR.
Ms. C-Diff had shingles all over her face and a diaper full of ... C-diff.

She also had no veins to speak of and so received an IV in her neck and a central arterial line. She was breathing poorly with snoring respirations and we used a bag to push air into her lungs. Soon after, the doctors made the decision to intubate Ms. C-Diff.

Having a patient like Ms. C-Diff is very time-consuming. We needed EKG after EKG and everyone is high-pitched. They forget things or need more than one of something and I run across the department as fast as I can without startling other patients around me. The alarms are always beeping because her vital signs are unstable. There are plastic wrappers everywhere, blood flying everywhere, tubes, adapters, plastic parts, bottles, needles everywhere. And then the inevitable... "S, can you clean her up? Also, don't forget to take a sample."

(Disclaimer: You probably don't want to read this)
It was difficult to ignore the stench coming from her overflowing diaper through everything we were doing, but... It was time to clean her up. Armed with warm bath towels, various pads, blankets, and a new diaper, I cut it open to reveal vile, green, rotten liquid that just went everywhere. I scooped up a few q-tips full and put it in a specimen cup. (Showing the cup to an off-duty tech who just came in to see the action, I punned- You should be working here with me. You're missing a lot of good ****!) It was the consistency of pond scum and the subsequent double-handed scooping with a towel was terrible. I enlisted the help of another tech so we could turn her to clean her back side. "Make sure you wipe front to back like mother taught you, heeeheeheee..." ER workers have such warped senses of humor. It took us over half an hour to clean her up, then gown her, cover her with a blanket, sweep away all the debris, clean the blood from her face, arms, floor, and all the crap off her bed. The doctors were very thankful for my opening of 2 bottles of peppermint spirits to dispel some of the smell.
The effort was worth it. She looked like any other old lady with a tube down her throat. (You know, like they usually look.) Her daughter came into a very clean room, with her mother newly diapered and a clean, warm blanket over her poor invasively resuscitated body. The daughter was thankful and I was spent... but there were 7 more patients I had to see...

This morning, my Dove Chocolate had a fortune in the wrapper: You're invited to relax today.
I think I will.

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