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

Schizophrenic Encouragement

I was in a somber, pensive mood walking to the gym early in the morning when I saw Mr. Orange Juice riding toward me on his bike.

The first time I met Mr. OJ a few months ago, he came up to the triage desk and asked me for orange juice.  I asked him if he was a patient.  Then, the other nurses pulled me aside in hushed voices and told me, it's just Mr. OJ the happy schizophrenic. Just give it to him and he'll leave because he is harmless.  I was curious- ok, but why the hushed voices? He was good friends with K, they explained. K was a middle-aged night-shift Charge Nurse who had suddenly died a few weeks before of a brain aneurysm. It shook the whole department to the core because she was a constant presence up until that fateful day.

I took out two little cartons of orange juice.  Mr. OJ graciously thanked me and called out, WANT TO SEE MY NEW BIKE????? The staff followed him out to see his new bike. I didn't go, but was highly amused..

Mr. OJ probably didn't remember this instance when he saw me on the old flagstone entrance of the gym. I lowered my eyes as he got closer, but then I heard an indulgent "you'll be all right." The huge black schizophrenic man on the bicycle grinned ebulliently at me as I looked up in surprise, "you are just like me when I was younger. You'll turn out ok." He zoomed by me without stopping, a flash of fluorescent orange, and called cheerfully once more over his shoulder, "you'll turn out ok!"

I couldn't help but grin stupidly to myself.  He is the happiest schizophrenic I ever saw. And totally made my day.

S

Overlapping Worlds

I started playing violin at 10 years old when my old violin teacher came to my elementary school to recruit students. She was a funny lady with a dry wit and a great love of all things artistic and of elephants.  I begged and pleaded with my parents, who had long ago decided after my disastrous attempt at keyboard that I should never learn to play another instrument. Progressing quickly though, I guess I proved that I can, indeed, sit still long enough to practice and become proficient at an instrument. In any event, my old violin teacher had been calling me and last night on my dinner break, around 7pm, I called her back. She didn't answer, so I left a cheery message and went back to work.

Lo and behold, I was looking at the facility board on the computer when my heart jumped to my throat.  My violin teacher I had just called was a trauma patient.  No wonder she didn't answer the phone.  I ran downstairs to see her- she was ok and rather thrilled to see me again, cupping my face in her hands like she used to. I stayed with her long enough to pull out her IV and send her home. 

I've had several weird crossings of fate lately.  A co-worker suggested I go see a psychic or palm reader.  

S

Musical Misinterpretation

I got to work today in Valhalla, the Emergency Room section above the rest, upstairs in an area resembling an actual hospital wing, It always smells like fried food, is bright, cheery, and actually has windows.  Up here, there is signal for the cell phones, patients have their own rooms, bathrooms, and a television to remedy the long hours of sitting there waiting for test results. Patients are happier up here, and so are we.

A few weeks ago up in Valhalla, I had a tough-guy patient. Wiry, with a sleeveless black shirt, a mustache-beard, and bald, he was the epitome of "biker".  He talked in a folksy but brusque way and was an all-in-all stereotypical middle-aged biker dude.  Imagine my surprise when I walked by his room to hear, blasting, the most beautiful Beethoven quartet. I smiled to myself and listened outside the door for a few minutes- I miss hearing this kind of music. I remember chastising myself mentally for stereotyping.  Maybe even biker dudes had that sort of introspective, sentimental side to them.  

Today, when I was taking vital signs on a patient, I heard elevator-grade flute music playing loudly from the room next door. Curious, I walked in and asked the patient if she was playing the music to calm herself.  "Are you kidding?" she stuttered in an agitated way, "it's a pain in the *** and I can't even turn it off."

I checked the controller- the tv wouldn't turn on or off. The volume controls for the music would only get louder. And the music was awful.  The off-button was not working.  The only way I could get the music to turn off was by unplugging the whole TV set-up.  

I couldn't help but laugh, remembering my tough biker guy sitting in the room, captive audience to very loud Classical string quartets for 8 hours.  I don't know if he was enjoying it or gritting his teeth trying to jam all the buttons on the controller, to no avail.  Poor man, I hope it was the former. 

S

Hotel ER

When I brought her in a ginger ale. Ms. Snobby looked up from twiddling with her phone and said, "Thanks. Leave it there. I want another ginger ale and a cranberry juice. If there is no cranberry juice, I will settle for an orange juice." She will condescend to settle for our failings to stock the juice she requires. Well, thank goodness for that. 

When patients know what options we have in the hotel ER refrigerator, they have obviously been guests too long!

As luxurious as it is here, I'm sure there are better options to be had for a vacation from work.  Not to knock my place of occupation, of course, it's just that I wouldn't suggest nor expect anyone to voluntarily stay there. 


S

It Could Be Worse

I walked into the room to take vital signs on a very thin young man. He was very calm, his mother was an anxious ball of nerves.  She was so worried about her son.

After introducing myself, I immediately got a good vibe from him.  Polite, easy-going, he spoke softly and acquiesced to all my requests and questions with good humor.

S: "Do you feel any pain?"
Young man: "Not at the moment, thank you for asking."
S: "Ah, well that's good to hear!"
Young man: "Yes, I suppose so."
S: "If you don't mind me asking, what did you come in for?"
Young man: "Well, I have renal failure and have had type I diabetes since I was 3 years old. I'm waiting for the transplant team to come talk to me."
S: "Oh, I am so sorry! That sounds terrible."
"Well," he shrugged and smiled, "it could be worse."

Really? Life could be worse than having renal failure and living half your life in the hospital? He was right, of course- I've seen worse... But he is still so young.  I tried to imagine what it was like to go through dialysis every week, to be on the transplant list, to be on anti-rejection medication on top of all the diabetic worries, insulin shots, controlled diet... I can only thank my lucky stars.  He is tough and a down-to-earth.  He is not bitter, as far as I can tell. He exuded a peaceful acceptance of his conditions and thankfulness for having all his wits, limbs, and other functions intact.

I appreciate a good person when I find one, so I stopped by his room several times to just to ask how he was and if I could do anything to make him more comfortable.  He never required anything, though each time I came in, his mother would start asking me questions.  Poor lady.

S

Forgiven... for Now

Mr. Mumble-de-Gook waved me down. "MRRRHHGNNNNG"
I looked at him warily.  The last time I saw him was when he almost clocked somebody with his cane.
http://talesofanemergencytech.blogspot.com/2011/08/fencing-er-style.html

"MMRRRH HUUUUUNGRY"
Oh, he was hungry again. I made it a point to never feed him when he came in.  Last time I gave him a sandwich, he ate it, then peed in the box before returning it for me to throw out.   Besides, there were no sandwiches in that fridge last night anyway. And I told him so, cheerily. Maybe too cheerily.

He cursed at me. "That ****errrrr therrre," he would cry, waving his arms whenever he saw me.
A nurse informed him that there were no sandwiches.  And miracle of miracles- he FELT BAD. He apologized for calling me a liar. Would you ever believe? He is still a scumbag for coming in to demand sandwiches, but wow to be apologized to... my eyes were ready to become pricked with tears, though they never came. It's the thought that counts.

When he did get a sandwich, he celebrated in the only way he knew how- "MMMMMMM. MRRRRRRMMMMM...." with a smile on his gap-toothed, cross-eyed face the whole time.

S

Stop, Thief

I'm flabbergasted. Really. If you were to go into a doctor's office, would you ever think to go looking in the drawers? It's not even something I would think about.

Not only did she rifle through the drawers- I looked in when I heard the drawer door open- a patient's visitor proceeded to grab handfuls of bandaids, bacitracin, whatever was in there and stuff it in her purse. She saw me watching, but did not put them back and stared at me almost defiantly, as if challenging me to say something. I was too shocked to, but I just stared at her, not in a disapproving way- just really, really surprised.  She blushed and pretended nothing happened. I left the room in a daze.

There are so many different ways to live our lives in this world- I am thankful today to be on a path that I am comfortable with, where I don't have to blush cheaply to complete strangers in passing.

S

Luck of the Draw

For some patients, coming to the ER can be a wonderful experience.  The team that is taking care of you might be the A-team, a well-oiled machine that provides conscientious, pleasant, professional, and indulgent care of you. Not only are things done immediately and with great skill and precision, the bedside manners of the doctors, nurses, and staff are warm and reassuring.  Especially if you are in critical care, this can make a huge difference for your nerves, happiness, and prognosis during your considerably shorter stay.  Don't worry, a few hours is normal- if you had the L-team, you might have to suffer through many more hours of discomfort, though.  Working with the A-team is an incredible learning experience; we are calm, at ease, and responsible.  Therefore, when working with the A-team I might even venture to ask and doctors might even approach me about the biology behind what is happening to a patient. On these days, I don't even mind working double-shifts. It's such a good experience.  And even crabby patients leave us with a grudging respect, because everything that could or should be done, was. (picture of lucky cat)

There are other teams, of course, made of a mix of these personalities: http://talesofanemergencytech.blogspot.com/2011/08/nursing-species-in-er-jungle.html

Some teams are all-business. Things get done, but you leave feeling a little cold. Other teams are anything but professional; the staff is "personable" but you can't help but question if they know what they are doing.  Then, there is another category entirely- team-Lazybones.

I had to work with the ultimate L-team the other day.  Between the three nurses, Nurse Negative, Nurse Airy Fairy, and Nurse Lazy, all of whom liked to disappear into the ether when the trauma drama died down, I could not find a single one for an hour and a half at a time when my trauma patients were begging for legitimate pain relief.  Then, they ignored my request on behalf of the patient until the resident asked them directly, and disappeared again.  The surgical resident was more frustrated than I- the medications were ordered as she was suturing pieces of torn muscle and skin and the patient was crying out. But for the life of me, I again could not locate a single nurse from my team.  Then the O.R. secretary called me, livid, to pick up a stretcher that Nurse Airy Fairy had left there on purpose, covered in blood, bloody vomit, and other bloody gore.  She decided she didn't want to clean it.  Nurse Lazy couldn't get an IV in a patient and stuck him 5 times with the same needle, ripping off the blood pressure cuff sloppily every time I applied it. We never got a good blood pressure reading until it was absolutely required when the unstable patient went to CT scan, and then he asked me to draw all the labs with a butterfly.  Meanwhile, I was still the only one doing all the vital signs every hour, stocking the room, cleaning the rooms, helping the residents with the patients.  Where did they go for the whole shift? I still have no idea- maybe taking smoke breaks.  It's scary to imagine anything serious coming in that trauma room with such a dysfunctional team of nurses; thank you, white cloud! I can't imagine that any of them actually consider themselves competent with such attitudes towards working.

(picture of doom cat)
How to avoid such craziness when or if you come in as a patient? How do you make sure that we don't harm you more than whatever had happened to you already?

The details of the room you enter might give you a clue: if the johnny coat is strewn across the bed in a haphazard way, if the bed wasn't cleaned and newly made from the last patient, if there is garbage on the floors, if the drawers aren't stocked, you might be out of luck. That or we're just having a busy day. Nothing is for certain in that crazy place, after all.

S

Sleep Deprived

"Hello sir, my name is S and I'm a technician here. What brings you in today?"

"Uh... Well, I haven't slept in 2 days and want to kill somebody." He made violent hand gestures.

"Oh, right. Ok. Err... Can I take your vital signs?"

"I just want to sleep. And if you can't make me sleep, I want to kill you too." He stared at me weirdly.  I backed away from his bed.

I guess the wrong thing to say would have been, "buck up, son, two days ain't a lot.  I've gone months of 2-3 hours/night." I didn't, but I wanted to. Within a safe distance, of course.

S

It's Hard to Hide When You Just Don't Care

“She’s always like this,” the chubby woman shrugged her shoulders and looked away. She finally arrived to see her mother, though the old woman had arrived several hours ago.  I looked at her, hair perfectly arranged in a curly mullet, nails recently manicured, fingers clinking with shiny bands and jewels, and a smart little designer bag on her shoulder.  You would never guess they were related, Mrs. Stuck-inthe70’s and her mother, frail Mrs. Stuck, the poor thing delirious from the fever, thrashing her weak limbs as best she could, wearing nothing but a crumpled hospital gown and an adult diaper. She moaned and soiled herself. Her daughter raised an eyebrow and primly stepped out behind the curtain. She didn’t want to be there when the smell hit. 

We cleaned Mrs. Stuck the best we could, holding her hot little body still as we wiped her and changed all her linens.  When I made the list of belongings, I checked her body for anything I might list.  The hospital gown and diaper were not worth listing.  I checked her left hand- I take it as a sign of someone being well cared-for if she still has a wedding band on, if nothing else.  Nothing.  Although it might be taken off for safe-keeping, I like to think that in whatever state of mind, if a person looks down at that band on their hand that had been there for so long, they might still feel something.  I felt sad writing “no belongings with patient.” 

I also notice the general condition of the areas around the eyes, lips, nose and teeth.  The smell of a person, the presence of wounds, areas that are crusted over, dry, inflamed, otherwise abnormal tell me about the level of hygiene at any given institution.  At least Mrs. Stuck was in a good nursing home- she seemed otherwise clean. Mrs. Stuck-inthe70's must be paying a lot for wherever her mother must be living, in money, not necessarily emotional support.

Mrs. Stuck-inthe70’s poked her head in again, to say that she had to go, fingers clutching at her rhinestone-studded iPhone.  She left the room once more and as the scent of her faded, so did my annoyance.

Maybe it’s not that she doesn’t care- maybe she just gave up a long time ago.  Maybe it’s healthier this way for her, to be able to let go, though I think it’s totally disrespectful to “let go” before Mrs. Stuck was actually gone. In a time not far from now, I could imagine her crying crocodile tears at her mother’s funeral.  Too little, too late. 

S

Trauma Clouds

There is a common superstition about working in trauma. Certain people have "black clouds" and elicit groans from all staff working that day when they find out they have to work with you.  Having a black cloud over your head means that the bloodiest, blackest, most heart-wrenching traumas will more likely roll through the door when you are present than not.  You could be a doctor, a nurse, a tech- anybody. People will whisper and shake their heads; you are cursed.

I have the opposite problem, for better or worse.  When I work in trauma, I hardly get any. I average maybe 2 light ones per shift, whether 12 hour or 8 hour.  Several times, after a shift totally devoid of traumas, I hear overhead "full trauma now, full trauma now" as I am walking out the door on my way home.  They like to tell me that I've cursed myself by saying it, but I've been saying it for months. It's just the luck of some people, I guess. Nurses clutch at me for protection when I leave, maybe trying to stand under my "white cloud" for a little while.

I had 2 traumas yesterday, both crush injuries occurring between man and machine. One man got his fingers sucked in by a commercial dryer. Several of his fingers were slashed open and nails were shorn off, but he luckily avoided any nerve and bone damage.  The other was more serious, where a man crawled under heavy machinery to flip a switch when it fell on him, pinning him, shattering his pelvis, and rupturing his bladder. Not good.

Take care out there, gentle readers. Don't do anything silly when working with machinery or equipment or work without having your wits about you; the machine has its own intentions for which it is made and it takes  only a few seconds to change your life forever.

S

Improbable Imposter

Ms. Federica Garcia Lorca was a lovely little lady, slight of build, clear skin, shiny hair, big eyes.  She had abdominal pain and I was the one to situate her and show her to her room.  Exceedingly polite and rather charming, she claimed to speak very little English and so I spoke with what Spanish I knew and we got along swimmingly.  She seemed to understand me quite well in English or Spanish, though the nurse that went in later said she really needed an interpreter because she didn't understand a word.

Through the hours I checked up on Ms. Garcia Lorca, fetched her pillows, blankets, glasses of water, vital signs, EKG's, etc, I realized she knew more English than she let on.  Sometimes speaking slowly helped, other times it didn't. Words I used before were suddenly incomprehensible now. Something was a little strange.

A friend came to visit her and 5 hours into her stay, the woman in Ms. Federica Garcia Lorca's room was named Juana Ramona Jimenez.  I thought we had a new patient, but I peeked in, and there she was, feeling "much better." It was so strange, because I make it a point to address patients by name- now I didn't know what to call her.

An astute registrar, Spanish-speaking, was in the room when her friend was talking and realized that her friend called her something different.  She changed the registration name, so there were two names under the same medical record number in our computer system.

Ms. Garcia Lorca/Ramona Jimenez was discharged with one name and received prescriptions with the other due to a computing glitch.   I have had had patients who gave me false names before, but I would never have guessed that the sweet little lady was playing games with the system.  She just seemed too... clean-cut.  I learn something new every day about people and how little I actually know about them.

S

The Doctor I Will Never Be

Mrs. Unlucky had terrible abdominal pain, but test results were delayed for a long time because she had a prolapsed urethra and we couldn't get any urine on her. The catheter wouldn't pass through the nodule of protruding tissue.  http://en.wikipedia.org/wiki/Prolapse

The lack of urine sample was the least of our problems, though. Throughout the day, I took her vital signs, which were normal, every two hours.  Suddenly, in her sixth hour, her temperature shot up to 102.5F.  Her test results confirmed that she had a perforated colon, a dangerous and emergency condition where the bacteria were entering her abdominal cavity and causing a raging infection. All this confused her, as Mrs. Unlucky was a blue-collar worker with very little formal education. All she knew was that she was in pain and she was terrified.  Unfortunately, her problem was one that could only be helped by surgery, and I needed to do a pre-operation EKG, since she was going to go under full anesthesia.  The surgeon came in while I was setting up and stared at me in a patronizing manner. Perhaps he thought I was moving too slowly.  As I placed a sticker on her chest and whispered to her that the EKG wouldn't take long, he stood up straight over me and said nastily, "you need to stop what you're doing." I looked up in surprise. "Why does she need an EKG?" He quizzed me. Because she is going to be admitted for surgery, I wanted to say, but in this instance, I felt uncomfortable answering him.  It was beyond my "scope" to say so as a technician to a surgeon, in any event, and people have been fired for far less than saying things they don't have the authority to say. So instead, I replied simply,
"I was asked to do one."
"You'll need to do it later, then, because this is important," with an ever so slight emphasis on "this." He stared at me and waited for me to leave the room, and I did so without another word, feeling my blood pressure heighten and my face flush.

I had been part of a very nice team of nurses and doctors taking care of Mrs. Unlucky for many hours and now she was subject this surgeon's very different- abrupt and impersonal- care.   After he left, I found her crying, bewildered. The doctor had given her the choice of having a colostomy or an ileostomy, a bag that is connected to the intestines for waste removal, while the surgery site heals.  She didn't want either and didn't really know the difference, but she was pressed to make a decision, since he had to go get set up for her surgery immediately. I understood that he wanted to move quickly, but she was completely overwhelmed by how quickly the transaction came to pass.

May I never be too busy or haughty to intimidate patients or staff. That sort of manner doesn't at all come off as powerful or efficient. Rather, it just makes a person look like a total jerk.

S

Adventures in Sitting: The Strength of the Strongest Bond

"S, we need you pull you out of your current assignment to sit in urgent care." I gave the nurse a strange look. People that require sitting- alcohol abuse/substance abuse/psychiatric problems- aren't supposed to go there.  "I know," she said, "it's a special situation. They'll explain when you get there."

It was a beautiful late summer day and the afternoon sun was still dappling through the trees that were rustling gently in the sweet breeze.  I reluctantly entered the glass doors of the clinic to see that in room one was a woman, feeding a baby, speaking tensely with our manager.  The manager pulled me aside and explained: Mr. and Mrs. Feckless came today because he needed stitches removed from his hand.  They came to urgent care but it became glaringly obvious that both of them had had alcohol, both breathalyzing above .300.  DCF was called and we are waiting for them to arrive- Mrs. Feckless knows this.  "Where is Mr. Feckless?" I asked. "In the drunk tank," the manager said, "just stay in the room with her to watch her with the baby."

I entered the room and introduced myself.  Mrs. Feckless saw me and said, "I don't need to be babysat with. This is my baby, I would never hurt her." I diverted the conversational path by simply asking, "so how old is she?" She scanned my face and decided there was no intention of harm. With the indulgence of a proud mother, she smiled and said "7 weeks tomorrow." I admired the little one, who could not? The minute fingers, perfectly arranged little eyebrow hairs and eyelashes, a bow around her head, little stubby legs, the fresh smell of new life.  She is going to be such an exotic beauty, with olive skin and dark blue eyes.  This skein of conversation let Mama Bear put her guard down, and she told me about caring for Baby Feckless, bathing her, feeding her, rocking her to sleep.  Meanwhile, the baby was cradled in her arms and didn't make a peep, her gentle eyes at peace with her surroundings.

She was so gentle with the baby, knowing exactly what to do with every hiccup, burp, squeak, or kick of a little leg.  They knew each other better than anyone else.  The baby rested comfortably in complete trust, nestled on the mother's chest; it was the epitome of Madonna and Child, transcending time, space, culture and it was beautiful to see.  They gazed at each other with an unspeakable bond that was almost visible, shimmering in the air.

Mrs. Feckless looked younger than she was, but the lines on her face told me she didn't have the easiest life.
"She is the best thing I have. The only thing I have," Mrs. Feckless sighed, "I used to live in a half-way house. Then I met my husband. Everything changed. Everything bad that happens to me happens because of him!"
I paused, "... is he good to you?"
"Oh, he's the best. He's my best friend and we understand each other. We love each other so much.  It's just that he can be so stupid sometimes. Never shuts his mouth and now look, DCF is coming again."
"Again? You mean this isn't the first time?" I was incredulous.
"No, hah, it's ridiculous. The day she was born, I was alone. He was drinking and being an ******* on the streets. Then he realized he was gonna be a father and started calling my cellphone nonstop, screaming at me and the nurse telling me to hold it while he comes in the room. I mean how can you hold it? I was having a baby! The nurse told him never to call again and not to come in, but he burst in and caused a scene cause he was drunk, you know.  They called DCF that day.  But he's good to me, he really is."
On the day the baby was born. Unbelievable.

She was comfortable with me and made easy conversation, cradling the baby close.  The baby had dozed off and slept comfortably, positioned next to her mother's neck.  Maybe she never had anyone to talk about this with or maybe I was just a receptive listener, but she relished in the details of describing exactly how the baby would smile only at her, and how to decipher the squeaks that the baby used to communicate with her, and how gentle, quiet, perfect this baby was compared to her now teenage son, who was a nightmare baby.

"You don't have any children, do you?"
"Oh, no," I laughed, "that's... far in the future."
"It's a good thing. I was your age when I had my first. I was barely a baby myself and I had to grow up real fast.  If I had any advice for you, since you're nice and sweet, it would be this: travel, go to school, have fun, and never settle."
"Oh, I'll never settle, don't worry about that one."
She smiled at me and DCF walked in.

"Can you step out?" asked the severe woman wearing severe high heels.
"Of course," I said, feeling a chill and they shut the door behind me.
The tech that brought DCF over pulled me aside. "When those drunk fools came stumbling in, you know what he said to me? He looked me in the eye and said *****, get these ******* sutures out of my hand now. And I was like uh, hold on, sir. I told them he was drunk and was like you need to call DCF. You know what, they deserve this for being idiots. That baby is not safe with them."
I listened in silence. Maybe... but could anyone else take better care of someone else' baby when the mother is already attentive? Mrs. Reckless didn't seem very drunk at all- in fact, I would consider her to be more competent than many mothers with very young children I've seen in the ER so far.

The door cracked open and I heard, "I need to call my supervisor, so just hold on."
"Please don't take my baby from me, please, I'd die without her, please."
"I said I would call my supervisor. Please wait a minute."  The she-wolf in heels nodded at me and I went inside.

"I told him not to drink, but then he got ME drunk, and I never drink. You can ask any of them and now look!" Mrs. Feckless started crying and I got her a box of tissues, "He ***** up so many times. I do it once and now I'm being punished for it. It's not fair! I've done everything I was supposed to do- I sat here quietly, I waited, I didn't make a scene... but I'm still being punished."
She cradled the sleeping baby in her arms and kissed her several times. "Never, never... They're all liars. I don't believe a word they say.  She wants to put my baby with a foster family and says I'll get her back, but I don't trust her. I don't trust none of them. I just want to go home with my baby!"

I heard the clinic door open and watched 3 county officers walk in.  DCF came back in and I exited the room and grilled the officers.  Mr. Feckless had been arrested and Mrs. Feckless was papered. She may well be arrested as well. That would get her fired from her hard-won job at a supply depot.  I couldn't help but feel a cold horror, like I was taking part in something terrible and wrong, like a hapless grad student working in the monkey room under Harry Harlow.  http://en.wikipedia.org/wiki/Harry_Harlow

DCF came out once more and asked another tech to go inside and "distract her" with the paperwork. Mrs. Feckless was helpless and laughed bitterly, "I know what you're doing. You're taking my baby away."
"No, we're just making sure she's healthy," DCF said as she slowly wheeled the stroller out of the room.
"But what about all her clothes and things?"
"Well, do you have a bassinet at home? If you give us your keys, we'll take what she needs for her stay."
"But how am I going to get in and out of my house?" Mrs. Feckless looked so worn.
"We'll figure that out."
"Where is my husband? Did he get arrested? I'm have to leave him... this is too much, I can't take this. I'm losing my baby..."
"You won't lose her forever if you go to the session tomorrow as it says on this paper, since it is your first offense. If you do everything like we say, you'll get her back soon." The DCF woman said.
"How soon? Tomorrow after the class?"
"It depends."
It was too cruel.

Quickly, matter-of-factly, efficiently, it was all done and she was asked to leave.  I gave her a hug and told her to take care as she was escorted out, silent and broken, by the officers into the gorgeous afternoon. I watched her look longingly as they walked right past the van where DCF was tying in the still-sleeping baby.

S

Contracture Conjecture

Imagine waking up in the morning and having a stitch or something in your neck. Try as you might, you can't move yourself just right to get rid of it. In fact, you can barely move, maybe your arms will flutter stupidly as you try to grasp the railing on the side of your bed, but they won't work, stupid things.  The nurse will come in to see that you've wakened and give you your morning medications. You try to say something to her, but all that comes out is stuttery nonsense. You take a deep breath and try again.  "I...I...I'm m m m huun huh huhhn...g gr gry." "Ok, honey," she will say off-handedly and arranges the bedding, "We have to do a bunch of things. We will have to shift you first."

You can't move because your legs are twisted up so tight from contracture that they are half-crossed up to your chest and you can't even pee.  It's like being curled up tight in fetal position- forever.

http://en.wikipedia.org/wiki/Contracture
http://img.webmd.com/dtmcms/live/webmd/consumer_assets/site_images/articles/health_tools/dupuytrens_contracture_slideshow/PRinc_rm_photo_of_dupuytrens_contracture.jpg (Imagine this, but with your hip flexion...)

They had to drill a hole in your suprapubic area and insert a catheter directly into your bladder.  The contortion isn't painful, per se, but staying in one position will make the bones from your spine and pelvis bore into your skin.  Sometimes, this might cause sores. Depending on the stage, the sore can vary from just a red and tender patch of skin to terrifyingly open, ulcerous, boring caverns.  Luckily, you have people who love you and take care of you 24/7.  It's impossible to even imagine what you would do without them.

Today, however, your catheter seems to have been pulled or something- and urine is leaking out of the hole.  It's time for another trip to the Emergency Room, where so many nice nurses, doctors, and techs know you by name.  Luckily, it's not serious today- you've been here for this before and you don't even feel pain.  The inexperienced nurses will have no idea what to do with you, and will baby-talk and condescend, but the urology resident will greet you warmly.  He does a great job and that technician that held your hand earlier and had trouble prying your legs open for the procedure, she was nice too. She was really worried that she was hurting you, but it was fine, nothing you haven't experienced before.

That technician came in a lot of times to take vital signs. She chatted with you like you were anybody else and didn't use the sickly sweet voice.  You were glad she was the one to take you back downstairs to get taken home by the ambulance, and she was nice enough that you decided to take a chance and ask.

Ms. Bedbound: I-I-I-I w-was - w-w-won-d-dering g- - -if--you c-c-could---do--- a f-f- f -favor -for m me.
S: Of course, what can I do for you?
Ms. Bedbound:  D-d-d-don't-t-t g-g-get ma-ma-ma-d.
I couldn't even fathom where that came from. I felt so sick that she would think I would get mad.
Ms. Bedbound: C-c-c-could... -I -I -I- c-c-could-d- - -have- - a sn-sn-n n-ack-k?
S: Do you like graham crackers?
Ms. Bedbound smiled widely and nodded: C-cr-c-r-crack-kers-s w-would -b b-be n-n-nnice.
S: Do you want peanut butter?
Her eyes widened and she shook her head no. Her hands fluttered and hit the railing several times before she got a grasp on the two little packages I gave her.
Ms. Bedbound: Th-th-th-th-thank you!
S: No problem. Are we all set to go?
Yes, but Ms. Bedbound was agitated and was trying hard to say something I couldn't understand. I paused to look at her and she took several deep breaths to try again.
Ms. Bedbound: I-I-I-I-I'm...s-so hap-p-p-py!

I felt a chill.  Maybe it was because my heart was warmed, but there was more than that.  I couldn't imagine what her life was like, to be utterly dependent on other for every detail of her life.  Of all the things that could go wrong, she had almost all of them, as a young girl about my age.  Immobile, infertile, incontinent, totally dependent. Yet, she could say she was happy and mean it. She looked in my eyes and there was something so childlike in her glee- she let me know that at that moment, she was truly happy.  The catheter tube problem was fixed, she was leaving the hospital, and she had graham crackers clutched tightly in her hand.

My problems are not problems compared to hers. Meeting her made me want to stretch out in the sun and bask in thanks for the life I have.

S

Humor in the Time of Overcrowding

"Do you have time for a short story?" Mr. Professor asked as I was pulling my nurse-on-a-stick vital signs machine out the door. I stopped, "sure."

"So on Good Morning America this morning, this is a true story, mind you, there was a guy who got his foot stuck in some machinery and had the strength of will to cut off all five of his toes. When he called the ambulance, his friend said to him, why did you call the ambulance? Why didn't you call the tow-truck?"

I laughed at him for being silly, but he insisted, it was a true story- how great it is to have a sense of humor like that in such a time. It's true- it's a sign of the just how deep the friendship was and how smart the guy had been to do what he could to make his friend feel slightly better about the situation. Mr. Professor quickly became my favorite patient of the day. A local college lecturer, he had been in the middle of a class when the room suddenly felt very warm. After a dizzy spell, he came in to visit us and we observed him for changes in troponin-levels- something that signifies damage to heart-muscle.

Every time I came in, he would greet me warmly and I would open up and talk to him, tell him stories of what I had seen, including when I had a full half-hour's worth of one-sided conversation with a man who was completely deaf. He was surrounded by loving family who carefully and tenderly cared for him. A man with a great sense of humor and presence, who really made my night.

S