Tuesday, October 18, 2011

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. : )


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. 

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.


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.  


Sunday, October 9, 2011

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!


Saturday, October 8, 2011

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."
"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.


Friday, October 7, 2011

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.


Thursday, October 6, 2011

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.


Saturday, October 1, 2011

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."

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?