Saturday, December 1, 2012

Chip on my shoulder

"Hi sir, welcome to the emergency room at ____, my name is S and I'd like to know what brings you here today?"
"Well, I've got this pain in my tooth here." He winced as he pointed. So did I, in sympathy.
"That looks pretty painful- what happened?"
"I was eatin' potato chips and one of them got stuck. I can still feel it even." He winced again. So did I, but not in sympathy.
"On a scale of 1-10, 10 being the worst pain you've ever felt, what are you feeling now?"
"It is better than it was when it first happened, so it's like a 4 now. But earlier it was a 10."
"I see... Have a seat, a nurse will talk to you soon."
"Ok... can I get anything for the pain, ma'am? They wouldn't give me anything in the ambulance."
"I think the nurse will see you really soon, so I'd wait for her opinion."
"Oh, ok."

She had heard the exchange, gave me a look, and threw him unceremoniously into the pile of charts to go to urgent care and he was discharged 5 minutes later.

But really- calling an ambulance for a potato-chip induced dental pain? Really??

Adventures in sitting: The man inside the shell

He was a handsome man once; now his scrubby patches of untrimmed beard and age-taut skin were indicative of a strong man gone to seed.  His eyes were slightly mismatched, much like his thoughts which emerged form his brain in perfectly animated little phrases and movements. If you weren't listening to his words, you might not even notice that strung together, they made little sense. He babbled, cursed, cooed, laughed, and insulted, often incomprehensibly only to himself.  He would not stay clothed and was constantly reprimanded by the physicians to stay decent.  "Hey, it's hot in here, ain't it?" his eyes rolled wildly at me. "It feels ok to me." "Well, they wouldn't mind, *would they*?" and he would begin to tug his shorts down.  Halfway down, he would forget what he was doing and I would pull them back up.  When his sitter left for lunch, I knew that I was inevitably going to have to watch him.

He stared at me for a few minutes as I avoided eye contact (my rule number 1 when in close proximity with a psychiatric patient). Yet, he seemed harmless enough. "Hey, I'm hungry! I had a sandwich... like, I had... like here." I pointed to the half-eaten tray on his lap. He clapped his hands in excitement as he remembered. He suddenly proclaimed, "I feel, like, so lucky.  You're one of the good ones, aren't you?" Cackling and smacking his lips, he began to babble.  In the middle of his soliloquy, he suddenly turned to me. "HIV isn't real, right?" His large eyes focused on mine.  "It is, I'm afraid," I replied.  "I don't wanna die. Am I gonna die here?" "Not here, I don't think," I replied. "Oh, ok," he smiled, and bit into an orange without peeling it.  

"I need to go pee pee," he announced. I helped him as he grunted to his feet and he let me drape the faded johnny coat over his shoulders. He waited patiently as I scrambled for a urine cup and moved jerkily toward the bathroom. Halfway to the toilet, he had forgotten what he was doing there. Turning around to look at me, he asked conspiratorial way, "do you do drugs?" "Er, I can't say that I do." "Well I, I, I have... a secret..." "And you want to tell me?" He nodded, "I know I shouldn't... but... like... but..."

He had lost his train of thought again. As he gathered them, he twirled the urine cup in his hand like a wine glass, like he was at a party and he was trying to tell a story.  I motioned him toward the toilet and he dismissed it with an impatient wave of the urine cup, insistently trying to continue his story. "Yeah, yeah, ok... but anyway... yeah, like... you like music?" I smiled, "I do like music, a lot." His eyes sparkled, "oh, I do too, but you know, I never liked what's his name. Famous guy." "There's a lot of them." "Yeah, ok, you're right. But I was a pianist, you know and I can't get enough of Chopin."

I was still nodding and smiling, but I could not help but notice that his speech seemed more fluid as he talked about his passion.  "Ooooh, I just got a new cd of Chopin etudes, played by the BEST. You know who that is, right?"
"There are a lot of great ones out there," I replied, "you're going to have to give me a hint." '
"You're right, but he is the BEST. Arrau."
"Claudio Arrau?"
"Yeah. But I forget where is he from?"
"I really have no clue, sounds French."
"Oh, really? I thought he was from Brazil!"
Now I had to look it up. Wikipedia stated that Claudio Arrau was Chilean and I felt a chill- not just the chill that you feel when you realize that your neurosyphilic psychiatric patient high on meth is more with it than you are, but also the chill when you realize that you've made a real connection with someone.  He was no longer merely bemusing, but a tragedy of growing proportions.  I felt a pang of pain hearing the scars of his heart, seeing the scars of the drugs and hard-living on his body, and examining the scars of his rotting mind.

I gently led him back to his stretcher- he had forgotten to actually use the bathroom, but didn't seem to need to anymore. He bounded joyfully onto the bed still clutching his urine cup and immediately began to remove all his clothing. The sitter was back from lunch and I was relieved from my duty of watching him.  As I rejoined the world of the functional and cognizant- the same world of the judgmental and callous- I could not help but think about the descent of what used to be a handsome, cultured, and intelligent man into the meth-baked shell he had become. Often we can't see this downward cascade of events that is precipitated by first times- the first rush of a new drug, the first fun time at a bar with sketchy patrons, the first date with what will become a bad boyfriend. How can we avoid these poor life-changing decisions?

The more I think about it, the more I realize- we really can't. We are at the mercy of chance, whether we accept it or not.


Friday, October 26, 2012

Teenage Wasteland

Work hard, party harder. Ah, college, when it was ok to be so young, so dumb, and have so much fun.  Remember all the free food, all-nighters, and especially the huge parties? The parties with beer on the ground, dark corners, and unlimited alcohol for pretty freshman girls? Labor Day weekend was the prime kick-off school-year party time and I was nostalgic, almost.

Sitting in the drunk tank on the morning after the first big party weekend of the year, I had a full-house, but an unusually young one. The college girls had awoken and were giggling at the snoring homeless man between them. They had probably never been so close to one before. The drunk tank is a great equalizer in that respect.  Their expensive clothes were disheveled, their recently trimmed hair mussed, but they were still young, still beautiful, still able to recover gracefully from being blackout drunk.  They were also great socializers, still in the middle of that magical period of freshman year where everyone could potentially be your friend. They made fast friends amongst each other and discussed outfits, boyfriends, and the Iliad. They also attempted to needle me into letting them leave, as infrequent visitors to our fine establishment usually do when they have gotten bored of sitting in the drunk tank.

We had an assortment of students that day, male and female, ranging from the super pretentious schools to state schools to community colleges. They quickly fell into a hierarchy, the ringleader a clever-looking brunette from one of the most prestigious institutions in the country. Finding me sympathetic but impermeable to begging, she needled, wheedled, and stopped everyone who walked by with her sad story.  She flashed a bright smile and smoothed her hair, sitting rigidly upright with her hand raised as if she were in lecture. She was charming and I have to admit, I thought she was just in the wrong place at the wrong time...

After 2 hours of fruitless attempts, however, the underage little minx slouched down, sighing, "well, I might as well get comfortable since it looks like I won't be leaving anytime soon." Her whole countenance had been an act! I asked her nonchalantly what she meant and she grinned, explaining that people tend to do what you want them to do when you look pretty, neat, and are charming. "I wish I had a mirror. I probably look horrible, otherwise, I'd have been out of here if that resident thought I was cute," she sighed. She knew so much yet so little. She was well-practiced in the art of manipulation way beyond her years; perhaps that's how she came to matriculate at one of the most competitive undergraduate schools in the world.

People like my little patient often do slide around the rules- their increased intelligence and will to mislead do confer them advantages. For example, she did not get expelled that day like some of her drunk tank compatriots from state and community colleges. In fact, I would be surprised if she came off with more than a slap on the wrist.

I'm sure I won't see her again, but I know that she will be out there in society, slithering her way up to the top on the golden ivy-laced path.


Sunday, September 2, 2012


Reason 1 to rid your apartment of cockroaches: they're gross and totally unsanitary.
Reason 2 to rid your apartment of cockroaches: they depreciate the value of your property.
Reason 3 to rid your apartment of cockroaches: they might crawl in your ear when you sleep so you wake up to a munching sound. Then, you have to come to the ER for the PA, then nurse, then tech to try to fish it out. It might wave antennae at you as you look futilely through the otoscope. Then, when you kill it with viscuous lidocaine, you might push it in further. Finally, people will come in with these things to get the job done.
So much for sleeping tonight.


Thursday, August 23, 2012

The Aging Doctor

She was a disheveled, frumpy little thing, with wild eyes and stringy white hair. Slumped on her bed, she was labeled as a psychiatric consult patient, which generally means she was medically low maintenance/priority for our staff unless she causes a disturbance.  However, because her advanced age, the doctors decided to make sure she had no underlying medical problems. And of course, I was asked to draw blood from her with the distinct undertone that she would probably refuse.

She stared at my face as I approached, bloodshot eyes suspicious, lip snarled. "Well what do you want now?"
"Hi, I am S, a technician working in this area. The doctor would like me to draw some blood work...'
"He doesn't know what he's doing.  I'm fine."
I usually like to hear "no" three times before I stop trying, so I tried again.
"Well, he just wants to make sure you're OK since you are in the ER, you know... I see you've brought your veins here with you today and I will be very quick with the needle."
"These young doctors keep ordering all these unnecessary tests. Look at me, I'm fine. I don't even know why I'm here."
"Well, you had said you want to hurt yourself to somebody and they called the ambulance.  How do you know they're unnecessary, ma'am?"
"Where is this place? Am I at ____? (I nodded) I was trained here, you know. I worked here for decades. What do they know?"
I eyed her in a new light; the looks, smart little shoes, haughty dismissals made sense now.
"I guess I ought to call you doctor!"
"Yeah, well, I'm retired many years," she replied, slightly mollified. Then, as if she suspected me, she added defiantly, "and if I wanted to hurt myself, there is nothing you or anyone could do about it."
"I wouldn't say that... that will make you stay even longer. But if you let me draw blood and we have evidence you have nothing going on, then the psychiatrist will see you faster and you could potentially go home sooner."
She considered this. "Fine." She gave me her arm and refused to look at me.

My patient had threatened to put a violent end to her life by taking a metal statue and thrusting a part of it into a light socket.  Alarmed, her facility called an ambulance and she was transported to us.  Looking at her 80+ year old frame in mismatched sweats, one would never guess she was once a pioneer of medicine.  I stayed with her and slowly, I gathered the pieces of her story.  One of the first female physicians, she underwent unbelievable hardships and prejudice what was once the gentleman's exclusive club of medicine.  She told me haughtily that back in the day, there was little distinction between the fields. Your primary care physician could also be your surgeon who could also do your autopsy.  She scoffed at 80 hour residency work weeks, stating that the residents today miss out on so much, which is why they don't know how to put their hands on a patient anymore.  She decried her treatment in her facility, then mused the potential benefits of new technology. Fired up about her passion, she burst temporarily from her depressed cocoon of stained sweatshirts and dementia, and suddenly I caught a vision of the timelessly beautiful and viciously ambitious young physician she was.

Then, she remembered her current state and fell silent. The sharp-eyed girl became again an old woman. I felt the sinking feeling of an elevator descending too fast. What it is like to be at the top of the world, then falling slowly, piece-by-piece, day-by-day, year-by-year into the abyss of dementia, I shudder to think.  Soon, mercifully, the helping hand of dementia and sundown-ing helped her out of her gloom and returned her to the daily distraction of confusion.



"Hi, may I speak to Mr. Rash? This is RN Experienced here at the hospital and I just wanted to talk to him about his trip to the ER here yesterday. I see that he came in for a rash... is he feeling any better?
Oh, I'm sorry he can't come to the phone, wait... WHAT is he doing?
He's bathing in bleach?!... Who told him to do that?
Well it's definitely not a good idea to bathe in bleach.
Yes, well, what kind of cream was he prescribed? Yes, you need to take that prescription and fill it and it will make him feel a lot better.
Please, that would be a great idea. Please tell him to drain the bathtub right now.
Well bleach could burn your skin, it's really not a good idea to bathe in it.
Yes, but I strongly recommend he get out of that bathtub right now. Thanks and please call us if you have any questions. Go drain it right now. You have a good day."

True story.

Friday, August 17, 2012

Bloody Assumptions

A woman dressed in all white rushed in and slapped her hand on the triage counter to get our attention.
"My husband! I need to see my husband!"
S: "Ok, let me look him up in our computer to see where he is."
"Hurry, this is an emergency!" And she burst into worried tears.
S: "It looks like he is not in our system yet. Did he come in by ambulance?"
"Yes. I can't believe you won't let me see him."
S: "Please try to be calm ma'am, you actually arrived before the ambulance did. What is he coming in with?"
She tearfully listed an extensive list of cardiac surgeries and history, his passing out at dinner, and that he had "stopped breathing twice." The triage nurses and I looked at each other- this sounded bad. We looked up to see him coming into our ambulance bay, and Ms. Hypochondriac ran to his gurney.

I followed her, and saw, with horror, a vomit basin filled with bright red foamy stuff. I've seen bloody CHF spit-up before, and this looked just like it. He groaned and seemed weak so the triage team expedited him to critical care before even getting his history.
I brought him into the room and helped the critical care team immediately undress him, take an ekg, and put him on our monitor system, gingerly removing the large red-filled basin to a biohazard bin. Upon looking closer at the bin, I froze. What were those little granules?

I asked Ms. Hypochondriac if it was blood. "Oh, goodness no, he raspberries right before we arrived."
I stared at her blankly as it began to register. "He ate such a big bowl," she added with big eyes, as if eating more would have made a big clinical difference.

Raspberries! Such a big fuss over vomited raspberries!
It was not blood in the basin, which I verified with a gastroccult. I could barely leave the room without letting Ms. Hypochondriac see the grin on my face. I don't think she could have appreciated it.

Working in the ER, we are so hyper-focused on the worst-case scenario that it is sometimes hard to see the most obvious (and comical) possibilities.


Thursday, August 2, 2012

The Man Who Lived

Poppy Lucky was at a popular upscale restaurant in a nice part of town.  His big Italian family was celebrating his birthday or some equally important event, as one can imagine, with extravagant Italian food, wine, and dancing.  In the middle of  his celebratory dance, Poppy suddenly clutched his chest, fell to the ground, and usually, this is the last memory Poppy would have.

Not this day.  Poppy Lucky opened his eyes to twenty concerned and astonished faces and bright fluorescent lights. "What are you all doing here? Where am I? Why does my chest hurt?"
"Dad!" His son and daughter rushed to his side.
"Why is everybody crying?" Poppy was perplexed.
He would not know until later that the EMTs and Paramedics had performed CPR on his body that had no heartbeat and no breath for half an hour, and even shocked him once with a defibrillator.

"Poppy Lucky, what day is it today?" RN Muscles asked.
"Why, it's Sunday, isn't it?"
"Yes, yes it is," RN Muscles replied, "And do you know my next question, Poppy?"
"No, what is it?"
"Did you go to Church today?"
Poppy thought this was funny and gave us his warm smile.  I could tell that the deep creases in his face were shaped by his frequent use of that big smile throughout his life. He was also pure astonishment. He had many questions, as well as he should have.

As what seemed to be dozens of his offspring, their spouses, their children, cousins, siblings, and family friends took turns to come see him, he began to realize the gravity of his situation.  I could tell that though he was accepting their professions of fear, love, well-wishes, and gratitude with graciousness and well-practiced  humor, he was troubled. It was nearly impossible for him to understand that he had collapsed and almost died.  I don't think he could reconcile nor process the minutes in his life in which he technically ceased to exist.  After all, who really could?

"I'm sorry to interrupt you," I interjected once, "but I'd like to write down your blood pressure and see how you're doing, Poppy." "Well of course, young lady, please come in," he waved me in.
"So, how's his heart-rate?" his red-eyed son asked nervously.
"You know, it is a very stable 70 beats per minute right now," I answered.
"What about his blood pressure?" his son continued perplexedly.
"I think it looks like right where it generally should be at 110/70," I answered.
"What is that blue line? Why is it flat?" his daughter tried, "Why did the machine start beeping?"
"Oh, Poppy, you need to keep this sat probe on your finger, see? It stopped beeping. The blue line is his oxygen level, and it's quite good at 99%" I answered.
"So everything is...okay?" the son asked, a bit incredulously.
"It certainly looks that way," I replied.
"Oh Dad, it looks like the machine still thinks you're alive and that you'll be with us a while longer," he squeezed Poppy's hand and wiped his tears with the other.  This would be an awkward conversation in any other situation, but his words were oddly appropriate for that moment.
"So are you feeling any pain right now, Mr. Lucky?" I asked.
"No, not really, except my ribs, where they apparently worked on me." Poppy shrugged, but I could still strongly sense his uncertainty and sense of wonder at all that had passed.

Perhaps in future days, he will tell his grandchildren and great-grandchildren stories of bright lights, tunnels of darkness, flying angels and the voices of loved ones calling him back into the world of the living, but I saw in those first moments I spent with him an acutely incredulous man.  Those he loved best had convinced him of the biological facts, but it will probably take a long time for Poppy to find peace with how/why he beat the odds of staying asystolic/apneic, of sustaining brain injuries, of being intubated, of not coming back.

Poppy knew he had been given another chance at life the moment he understood what had happened to him.  As he described to me his family, the meal, the dancing, his eyes gained a dream-like state and his voice softened.  I could tell that he was habitually proud and extroverted, but during his stay, he became increasingly contemplative and humble. He will undoubtedly be a changed man after that day. And in some ways, so will I.


Wednesday, August 1, 2012

"So I Was Having Sex Today..."

(in an increasingly serious order from funny to NSFL)

Patient 1: "... when my boyfriend grabbed my boob and now it feels kinda lumpy and sore."
S: "Is that why you came to the ER today?"
Patient 1: "Yes, it's sore and I wanted to get it checked out."
S: *keeps straight face* "Ok, well the doctor will come in to see you in a moment."

Patient 2: "... and my girlfriend was on top ya know, and she was goin' up and down when I look down and it's like a ****in' bloodbath. I was so pissed she didn't tell me she was on her period, and then I started to feel pain, man."
PA: "Well, yes, it sounds and looks like you tore your frenulum." !! ouch!!

Patient 3: "... and I just felt a lot of pain."
PA: "Um, ok, well let's take a look at it. We might have to do a swab for chlamydia..."
PA: "... oh my... I think you fractured it."
What the PA won't tell him is that after surgery, it's common to lose an inch or two.

Patient 4 didn't say much, but it was obvious what happened. He had been using a cockring which he did not try to remove until 4 hours later. By then, his scrotum had swollen to about 3 times its normal size and was quite stuck. Our first attempt at using lubrication to slide the ring off was laughable. Even more funny was how our ring-cutter broke with no noticeable dent to the ring. At this, patient 4 finally admitted that the ring was made of titanium! Now, the fire department had to be called and much to the chagrin of a very private patient 4, he was surrounded by a room full of very fascinated male residents, nurses, firemen, and one female tech who was pouring ice water onto the electric saw to keep the ring from over-heating and burning him. After the ring was cut off, patient 4 left us wordlessly, probably too embarrassed to even say thank you to the team that saved his genitals from falling off. (In animal husbandry practices, this is actually how they castrate sheep and calves)

So next time you feel like gettin' busy, be safe! Otherwise, you should know that there is a small but distinct possibility you could end up awkwardly meeting yours truly,


Tuesday, June 19, 2012

Ascites Proprieties

My patient had an enormous belly- the kind one might endow compulsive congratulations... if he were not male. There are some patients one can immediately identify as "sick", and Mr. Ascites was one of them. Liver cancer had turned the well-muscled mechanic into a jaundiced, gaunt specter with an exaggerated paunch.

He didn't say much, but every inhalation was an agonized groan. His belly was taut with mysterious pregnancy. When the doctor pierced his peritoneum with a needle connected to long tubing, putridity birthed violently into vacuum-sealed bottles. Mrs. Ascites was nonplussed and put on samba music from her phone. "Sometimes he fills up 7 whole bottles of that stuff." Since his diagnosis almost a year ago, he undergoes paracentesis once a week. She showed me the needle marks dotting the underside of his belly, puckered like an orange.

Our efforts yielded over six liters of brown liquid.

"And that," Mrs. Ascites remarked, "is why I never drink beer."
As I carried the bottles away, I could feel the heat through my thin gloves and I shuddered involuntarily. It was irrational, but the heat felt like radiating poison. There are so many faces that evil wears in this world, but one of the most powerful, not to mention ugliest, is cancer. It is merciless. No one is indefinitely spared, no one has an out-of-jail-free card- not the bravest, the smartest, the most accomplished, the most seemingly healthy among us.

I looked back once more to see that my patient was shivering, so I took a heated blanket from the warmer and draped it over his bony shoulders. He moaned, for happiness this time. Warm blankets are my favorite way to make patients happy. "Do I look like the lady of Guadalupe, now?" he asked his wife and they shared a laugh. She took his hand and drummed the samba beat on his arm with her fingers.  Cancer was an unwelcome intruder to the warmth of their lives and they treated it as such, with complete irreverence.


Sunday, June 3, 2012

The Stinky Details

It is the beginning of the month of June, the time of the month still ripe with the promise of nice weather, sunshine, medical school applications (again) and of course, welfare checks. The beginning of each month is a homeless feeding (drinking) frenzy that ends up irrevocably in the ER. Out of twenty patients at any given time today, eleven of them were drunk skunks. And I do mean skunks.

I never spoke with Mr. Stinkpot because when he came in from the rain this afternoon, he collapsed happily in the stretcher-bed and snored merrily throughout his whole stay. Barely rouse-able he would have flown entirely under the radar... but for his unfortunate feet. The pungent ripeness of dried feces, urine, and sweat from his caked-on jeans mixed with the rich earthiness of his socks that had been stuck to his fungus-covered feet too long.

Browned with concentric rings of yellow, the socks had holes where his feet would rub against well-worn shoes. However, this was no time to admire the joint effort of time and absolute poverty/slovenliness. The smell emanating from his room across the hallway and down the length of all the rooms on the section educed from passersby an extraordinary look of horror and disbelief, myself included.

It was hard not to keel over each time I walked by, which was potentially extremely unproductive, so I decided to take action. First, I found and aerated several bottles of peppermint spirits to clear the air as much as I could to abstain from gagging in close proximity. Then, I went in for the kill. Peeling the socks from his feet revealed much scaly sloughing and thick, yellow nails curled inward from lack of trimming. The janitoress yelled at me from down the hallway to seal the socks in an extra plastic bag before she disposed of them herself in a special container. I then took warm soapy water and a towel, cleaning the horned crevices between his toes of accumulated human filth. Drying the feet, covering them in fresh socks, then throwing a blanket over my efforts cleared the air, except when he shifted his position. Then, small pockets of noxious odors would accost those so unluckily positioned.

How did Mr. Stinkpot become this way? How could he stand to be so dirty? How could he just not care? No one becomes this way overnight; he fell into his situation from one drink too many, too many times. He could stand to be dirty because he had acclimatized to it. His nose no longer recognizes his own reek as foreign. And lastly, of course he doesn't care. To care would be excruciating. One phrase I hear most often amongst drunks is "I don't care/I don't give a ****/who the **** cares/what do you care/no one cares/other potentially impolite permutations. It is impossible to care when nobody in the world cares for you.

I am almost certain he will not notice his feet are clean when he wakes up. But my almost is by no means certain; perhaps in his depth of winter, he might yet discover within himself an invincible summer.


Thursday, April 19, 2012

Proctologian Mimicry

Mr. Jumpy eyed me suspiciously. "Don't let her near me! I say, don't let her come anywhere near me!" He shuffled to another side of the bed.

"Why, what's wrong?" A nurse asked.

"I can't believe she did that to me, that doctor there," he pointed at me. I had been nowhere near the new elderly patient, so the nurse smiled and humored him, "what did that bad, bad doctor do to you, Mr. Jumpy?"

"I'd know her from anywhere. I will never allow anybody to put a finger there again, you hear? Now if you'll excuse me, I'm going to hide my anus."

I have logged another "first" to my list of experiences. This was definitely the first time I was mistaken for anyone's proctologist.

For the rest of the morning, everytime I walked by, he would mutter and shift, presumably hiding his anus. He watched me as I went about my duties and eventually allowed me to give him a pillow/blankets.

"You know what," he mused a few hours later, "you' all right. Just never do that to me again."

"Ok, Mr. Jumpy, I promise that you have nothing to worry about from me."

Mr. Jumpy didn't turn out to be mentally ill, surprisingly... he was just a man terrified of rectal exams.


Wednesday, April 18, 2012

My Friend Betty

I was doing an EKG on my patient Ms. Sloppy, lifting one large breast to put on stickers when I spotted Betty scurrying across a pale leg. I followed my first instinct and grabbed Betty in a piece of gauze. Gingerly, I opened the gauze and Betty looked at me for a second and we were friends at first sight. Then she attempted to scurry to the underside of my gauze, perhaps to get closer to me.

I tried to tip her into a urine cup, but I had to use my gloved fingers to carefully fish her off the gauze, though she used her spider-silk-thin legs to cling as she might a particularly hairy leg, perhaps. Engorged to about six times the size I'd previously seen, Betty the bedbug seemed comfortable enough where she was. I shook the cup, which made her lose her balance and she landed on her back, delicate legs waving in the air.

She is the perfect parasite, carefully designed to glide on light, feathery legs that help her otherwise cumbersome body escape detection. Her glossy ectoskeleton was clunky (due to overeating, perhaps) but aerodynamic and provided sufficient armor to make sure she did not suffer from being knocked around the cup I carried in my pocket. I had a long and busy day, but this did not fatigue Betty as much as it did me. Every time I showed my new friend to my co-workers, she would wave her little legs with just as much energy as before.

She had a magical effect on everyone she met. Psychosomatic pruritis followed everywhere she went.  And everyone was itchy (to meet her). 

The janitors had the most interest of all in big Betty. As the first line of defense against colonization in the hospital, I would have imagined them to see her family more often than anyone else. But no, they surrounded the little orange urine cup and they spoke in hushed tones like there was a mystical aura around it. The infestation of bedbugs isn't just physical... it's psychological, they whispered, awestruck and reverent. I hear they're impossible to get rid of and even if you do, you still feel like they're there, another added, like some sorta curse. All nodded.

At the end of the night, though, I put a quick end to our friendship; though we had a great time all day, Betty was getting feisty, clinging onto the sides of her cup, perhaps attempting escape. The janitor who watched me wouldn't believe Betty was gone and exclaimed every few seconds that 'the legs are wavin'! ' But I knew... Betty had already gone to a big bed in the sky.
RIP Betty

Saturday, March 17, 2012

Playing with Bullets

"Excuse me, I wanna get your number so I could like call you about my care and stuff."
"I'm sure that we'll give you a lot of numbers for followup appointments for your care, Mr. Gunshot-wound."
"Well what I mean to say is can I get your number so we can like hang out and stuff?"
"Haha, aren't you a charmer?" I beamed him a smile and turned to finish stocking the trauma room.
"Wait till I become a doctor. Then maybe you'll talk to me when I'm like the one taking care of you."
I looked at him pointedly. "I'm going to get there first."

He grinned dejectedly, but seriously- I wasn't about to give my number to my young gunshot wound patient who was about to be discharged. The bullet was still lodged in his leg and they were not going to remove it via surgery. I wonder that he had the interest to ask me for my number a few hours after he just got shot.

I had to hand it to him, though, as I thought about him and laughed to myself on my way home. He was pretty smooth and definitely a young player in the making.


Friday, February 10, 2012

My Life in the ER: Musical Edition

Scene 1: S is walking to work in the afternoon and feeling great after spending the morning at the gym.

S: Oh, what a bright and lovely afternoon- I could break into song! The air is brisk, the sun is shining, nothing can bring me dowwwn. :musical interlude as she walks into ER:

Scene 2: Crowded ER treatment area

S: Oh my what a busy day it is,
oh my what a busy day.
The patients load is rather high and
The drunks are piled up that-a-way...

That man has a mesh bag on his head,
he must have tried to spit.
(Mesh bag head man: dramatic snore)
Those others also have been restrained,
just beware they also might spit.
(Drunk chorus: growls)

(change of key)
But I cannot complain- I'm not sitting,
and changes afoot are a-plenty.
I've got a pager now, and it rings a bell (riiing)
whenever my nurses need meeeeeeee-----

(change back into key)
Oh my Mr. Mesh bag man just woke,
oh my he just woke up now,
he's screaming that he needs to pee,
but no empty rooms I can see.

Mr Mesh bag head man (solo): I can't wait, I can't wait! I'll kill you all just wait!
Tech chorus: We have no room- just a sec- be patient and you'll go-
Mr. Mesh bag head man: I will wait, but just a sec- you need to take these off--
Tech chorus: You can pee with one hand, we won't release you-
Mr. Mesh bag head man: I can't ****ing take my pants off- you dirty *****sss-
Tech chorus: Then you will wait, Mr. MBHM, security is a-coming-
Mr. Mesh bag head man: I hate *****es!
Security: I'll help you sir, what do you need?
Mr. Mesh bag head man: Thank God!
Security: How can I help?
Mr. Mesh bag head man: I would like to be releaaased- I can't pull my pants dooown.
Security: I can help with the pants, but I won't hold it for you. (wink)

End Scene.

Scene 3: Ambulance bay

(scuffle ensues)

Nursing staff chorus (softly)
Oh my is that hot mess coming here,
Oh dear, she's rolling our way.
She's thrashing, yelling, cursing lots,
and a mesh bag is over her head.

Ms. Drunk Pregnant woman looks defiantly around and opens her mouth: AAAAAAAAAAAHHHHHHHHHHHHHHHHHHHHH

(she continues)

New resident chorus:
What is that?
What could that be?
It is so hard
to believe THAT is a she.

Yet she must be,
though who would want
to impregnate
somebody like that.

Let me out! Let me out!
You *****es let me out!
You are all ****ing retarded
and I want to get out.

What the ****, let me out!
what you n***** lookin' at?
Just shut the ****ing up
and let me ****out.

Bemused Very Tanned Drunk Guy:
Who you callin' a n****?

Ms. Drunk Pregnant Woman:
What the ****, shut your face,
who do you think you are,
when I get the ****ing out
of these restraints, I'll make you pay!

Mentally retarded patient in room 3: Gyahhhhhhhhhhh?

Doctor solo: Take her out as she so desires! To the ambulance bay she shall wander- until she can control her terrible mouth, she can get her ultrasound yonder. I believe I shall exercise my power, for your pleasure and your thanks, please make haste and open up- the most crude of all drunk tanks.
Nursing staff chorus: And be careful, she spits!

Scene 4: Treatment area
(from afar, synchronized trio
Tanned Drunk Man, Mesh Bag man and drunk chorus join in: AAAAAAAAAAHIIIIIIIYAAAAAAAAAAAAAA

repeat x200)

S: Oh my it has been a crazy day,
Oh my, I can't wait to go home-
I've got a candy bar waiting for me-
the sweetness will keep me warm!

Final Song:
When you go to the ER, guest,
be sure to bring ear plugs,
for though the chorus is plenty boist'rous,
you will still want to squash them like slugs.

The tale of the ER drunks must end,
for my morning is swiftly passing,
I must return to work again,
and therefore this passage is ending.

Normal Patient Chorus: Hey nurse, hey nurse, hey nurse! This place might be craaaaaayzeeeee.... But it is better than tvvvvvvvvv
Nursing Staff Chorus: It is, after all, the full moon, full moon, full moon moon.
Manager Solo: And in the eeeeend- patient satisfaction is our frieeend. Can you please stay, my favorite tech, to help patients find their way--- bring them upstairs and sign out laaaate?

S: I suppose... I ... caaaaaaannnnn.
(squeaky stretcher wheels fade into distance)
End Scene.

Tuesday, February 7, 2012

Family Problems

An 18 year old man was rushed into my trauma room- a bullet had gone into his back. As the physicians were crowded around, arguing with each other about the best course of action, he said quietly to me at his side, I feel it right here. There was no exit wound- there was a bullet still inside.

I put a hand over his and felt the sharp point of the bullet barely protruding from his right chest/abdomen.  "Hey, he says he feels it right over here." The doctors looked up and started moving the ultrasound probe near the bullet.

"Hey, I'm really uncomfortable, can I lie on my side?" Absolutely not, the doctors replied. And the young boy laid sulkily in the chaos, feeling unheard.  "It's because the bullet went so close to your spine. If you move, you might be paralyzed," I whispered in his ear. He nodded. He understood.

"Where were you when this happened?"
"At my grandmother's funeral."
Shot at a funeral... Really??
I had seen the new tattoo on his young neck- RIP Grandma- "Is that the tattoo on your neck?"
"No, it's the other one. And I don't want to talk about it."

Things were moving so quickly because he had to be transferred to the operating room immediately, but I couldn't help but feel for the young man- so young, with so many family problems, a bullet in his chest and nobody able to answer his basic questions.


Dumb Idea

"Why did you do it, sir?"
"Well, when you get a little bit drunk, have you ever thought maybe I'll just jump out of a window?"
"Actually, no, sir, I have never thought that."

My patient had jumped out of a second story window "just to scare (his) brothers".  Still intoxicated, he babbled happily about the party and what had gone on before he jumped.

"Oh, by the way, I can't feel or move my right leg- can you help me fix that?"

Sure, Mr. Jumper, will do. Just know that your actions have warranted that you can have no visitors, a sitter, and a lot of pain/surgery in the days to come.


Friday, January 27, 2012

In Which I Lose My Temper

I'm not proud of it, but I showed my temper last night.  Thinking of it still makes my blood boil.

The attending physician asked me to take vital signs on a woman in room 13, a section that I was not working in.  I agreed to do it, however, as it was the attending and came to the room just as the OB-GYN residents exited the room.  I knocked the partially open door and the young and obese drama queen told me to stay out as she got dressed. The doctors outside were discussing her impending ultrasound and such, so I knew that she was not supposed to get dressed.  I paused at the door and told her to wait a second before getting dressed.  When I peeked inside that they had left her lying back, exposed, and still in the stirrups.  So sloppy. It was understandable why she was upset.

"Din't I tell you not to stay out, miss?" 
"You look so uncomfortable and the head doctor is worried about you. He wanted me to get your blood pressure right away. Can I help you with getting up?"
"No, you can get out. I don't need your help."

The OB-GYNS then barged in without knocking and she ordered them around.  For whatever reason, I was the target of her ire. I'm not sure what kind of hold she had over the doctors, perhaps she had something seriously wrong with her, but they did her bidding as she imperiously commanded them around the room.  Silly, as the clumsy new residents had no idea where we kept anything. I watched silently as she flexed her ugly attitude.

"Get me a pad," she turned to me, "and you can get the **** out while I get changed."
Obviously, she was not going to cooperate with getting vital signs.

Wordlessly, I left and shut the door without responding. I didn't think I could muster anything polite at that point. This perceived insult incurred bellowing on the other side of the door as vicious curses and rejoinders that I should never enter that room again.

Honestly, how does she expect hand-to-foot waiting service when her manner is so horrible? Boggles the mind...


Wednesday, January 25, 2012

Why We Keep Our Legs Crossed

In an epic battle between pit-bull and testicle the other day, the pit-bull most decidedly had the upper hand.

Frolicking in the snow, it waited until the human in question looked away into the distance, smoking a cigarette outside in his underwear.  Sensing preoccupation, the stray little dog grabbed the opportunity, so to speak, and the hapless gentleman made a visit to my trauma room.

Usually, rabies shots are administered 0, 3, 7, and 14 days after the bite. The first is an immunoglobulin shot, then a series of shots in the arm.  Usually, the first shot is given to the bite-area, but as this case was in a sensitive spot, the shot was administered to the patient's backside.  Interestingly enough, this was the most frightening part for the patient, who is lucky to still be, for all intents and purposes, an intact human male.

His animated re-telling and subsequent musing that at the sight of any dog, he will run inside or jump headlong into a motor vehicle was amusing, to say the least.

Moral: Keeping one's legs crossed isn't just polite, it's potentially life(/genital)-saving.


Thursday, January 19, 2012


Dr. Devoted was a very quiet patient, despite or maybe because of his local celebrity.  I had seen him myriad times on TV and sometimes in the community. I had even known him as a young child singing in a choir at an annual benefit concert where he made opening remarks about his successful career and long fight with cancer. He was winning then.  

Last night, I had seen him for the last time of many times in my ER, a shell of the man he was. He had definitely taking a trouncing from his disease, but regardless was always polite. He was also honest. He never pretended to not have pain nor to have more than he did.  He would meekly ask for a pillow, but never without that hint of need.  Last night, he was too weak to open his eyes. His frame was thinned from what I had known, his neck curved into an uncomfortable dive into the awaiting pillow.  Pale, weak, with his wheelchair heavily protected by his beloved wife, he lay in quiet slumber as he awaited his room upstairs.

I did not realize his time would come so soon.  Recognizing Death standing over someone's shoulder is yet a skill I have to develop. I can foresee struggle, even grave danger, but not Death himself with any regularity.  Dr. Devoted was a scholar, public servant, and kindred spirit. Rest in peace, sir, for you have touched uncountable lives with your passion and wonderful use of your role as a public figure.  

Rest in Peace.

Monday, January 16, 2012

What is That?!

We had a very pleasant trauma patient who needed to go to the CT scanner for a fall. I had adjusted the blanket on him and exposed him during the trauma exam to uncover a large metal ring around his genitals. Like this:

Between the nurses, techs, and doctors, none of us had ever seen a penile ring before, but we all kept extraordinarily professional faces and demeanors despite this fact.  As soon as people walked around the curtain, however, their faces changed into varying expressions of "What IS that?"

Finally, a male nurse mustered up the courage to ask, "so why do you wear it? What is the purpose of wearing one?"

"Purely decorative purposes." Mr. Cockring smiled. "I can remove it if you like."

He took our intrusion into his personal life with such a great sense of humor and grace.
It made for a good experience in the trauma room in face of the several homicides (shootings and stabbings) that also came in during the course of the night.

Also, because we had three extraordinarily good-looking male trauma nurses that day who did not want to be hit on, I helped Mr. Cockring with various tasks throughout the evening. We had a few inspirational conversations with his partner about their travels together around the world.  They were just really lovely, open-minded and intellectually curious people.

Then, I tried to troll the security officers by hiding the ring in the bag of valuables to be locked up, but they chased me out of their office.

I looked it up later- apparently, they are also used as a sort of tourniquet to engorge the area even more
 so.  Interesting.

Saturday, January 14, 2012

A Cranky Tour of the ER

Mr. Crank was in a minor motor vehicle accident with his grandson in the car. Both were our patients in urgent care.  "I'll do it myself," he snapped when the PA tried to help him into a gown, "but I need to go to the bathroom right now." His expression and tone of voice was pure insistence. He was the kind of person that wanted things done in his way, his time.

I wheeled him to the bathroom and helped him out of the wheelchair. He grumbled, and complained, but I soothed him by asking him about his family.

Mr. Crank's urine dipped positive for blood and he also had had several spinal fusions and felt pain in his lumbar back.  Due to all these criteria, we sent him back to the regular section of the Emergency Room.  "Throw him on a stretcher in the hallway. We can't deal with him now," said Triage Nurse Cranky right in front of Mr. Crank.  "Throw me in the hallway, eh?" he grumbled. "Well now, Mr. Crank," I appeased, "since you are going to have an x-ray anyway, let's go see if they're ready for you now so you don't have to wait."

I wheeled him to x-ray where x-ray tech Crankier with whom I have a friendship accepted Mr. Crank even though the orders weren't complete.  "Now you gotta get in a gown, Mr. Cranky. We don't got all day." He mumbled and began undressing. "Now what are you gonna do with all that stuff?" I volunteered to get a bag. When I came back, she was positioning him on a table. "Don't you roll back this way, stay still or we'll never be done. Hold it! Hold your breath!" I helped position him and distract him from his pain.  Yelled at and out-cranked by x-ray tech Crankier, Mr. Crank stayed quiet and followed instructions very nicely after that.

When I left him in the other section to return to urgent care, Mr. Crank thanked me for being his advocate in the face of nurse and x-ray crankiness.  He probably knew that he would have been neglected had he been "thrown in the hallway."

Later, I checked on the computer and Mr. Crank was transferred to critical care.  An hour later, I checked again and he was now a full-trauma.  Mistriaged, misdirected, and out-cranked.  What an ordeal for Mr. Crank!

When I left urgent care after closing down the section, I returned paperwork back to the main ER to see Mr. Crank sitting, discharged, outside valet parking in his wheelchair wearing a neck brace.  He called me by name and I sat with him until his son came by to pick him up.  He had received an unprecedented tour of our ER that day, but he turned out to be pretty mellow by the end. Mr. Crank proved to be only cranky as a stranger, but a gentleman with acquaintance.


Friday, January 13, 2012

Kitchen Nightmare Recipe

Triage note states: Left finger laceration from cutting an onion (personal notes in parentheses)

1- (very pleasant young lady) patient with cut on (dominant hand) finger
2- visitors, a friend and a 2 month-old newborn in a cradle (optional, but helpful)
1- box of pizza (adds to atmosphere)
1- technician (yours truly)
1- (busy) physician's assistant
1- suture removal kit, soaking solution
length of time: 2 hours

First assess patient (she is in no apparent distress).

Uncover the finger gently (patient winced and barely allowed me to gently lift gauze from finger)

Assess quality of cut. (the smell and appearance verified that:
1, The cut actually occurred 2 days ago.
2, Patient never sought care until today.
3, The fingertip is horrifyingly puffy, crusty, leaking fluids, and green.)

Staunch bleeding and flush debris from cut. Discourage patient from eating pizza with the same hand. (In this case, I had her soak her finger, to her relief in some sterile water/soap)

Inform PA of situation, help prepare bandages.

(Hold patient's hand as she flails and shrieks at the size of the needle as) PA administers tetanus shot.

Assess cut (and realize that part of soft tissue is necrotic to bone and may need debridement/surgery. Explain to patient that debridement means to scrape off necrotic tissue. Allow patient to squeeze my hand and screech in fright as friend laughs at her misery), cut away some dead tissue and skin flap

Call hand/plastics (who refuses to come see patient and refers her to a clinic for the next day)

Wrap finger in antibiotic cream and gauze bandages, send her away with antibiotic cream, follow-up information, (and misgivings).

(Wonder what is happening with her now.)

Enjoy newfound appreciation for having all my appendages intact.



I was standing in the trauma room, wedged in a space between the trauma closet and another patient bed, holding the penis of a rotund drunk who could not reach it himself. He possessed a perfumed aura of fermented dairy products and neglected hygiene and graciously obliged us with a true-to-life rendition of his favorite soundtrack of mating large mammals. As I nimbly caught most of his interrupted spurts of diseased brown fluid in a deluxe male urinal, the techs who were gossiping on the other side of the trauma room looked at me in disgust. Then, they turned away and continued their analysis of a co-worker's perceived slight in hushed tones, lest I hear too much.  The absurdity almost made me laugh out loud.  It was my second time holding someone's genitals that day.

The first was a very weak old man who could not move much. From behind the curtain, I had heard the doctors musing, 'well we definitely need a urine on him' so I quickly fetched a urinal.  From across the room, I heard, 'Oh, sir, are you able to pee? Oh, he's going now.' Rushing in and pushing aside the curtain, I saw the doctors standing nonchalantly away from the bed. The looked at me and nodded as if it were a matter of course that I should be getting that urine sample now. I cut open the soaked diaper and despite that urine sprayed in uncertain spurts all over the bed, I managed to grab the slippery thing and get enough of a sample to send.  Unfortunately, Mr. Peed-on-Me was soiled and nobody would come in despite my pleas, so I moved him, cleaned him and changed his linens by myself.  As I was preparing to send the hard-won urine sample, a nurse popped her head in "Hey, what's your name again, can you go put bed 1 on a bedpan?" Before I could reply, she left, and the very obese lady in bed 1 refused to use the bedpan until I lugged a commode across the department to accommodate her. When I helped drag her body out of bed, I felt something in my mid thoracic back shift and twinge... so far, it's turned out to be nothing. (knock on wood)

The trauma room was uncomfortably warm and my drunk seemed to stop grunting.
"Are you about done, Mr. Drunk Half-Passed-Out?"
"LEAVE ME ALONE I WANNA SLEEP why won't you just... let me... go... ho... zZZZZzzzzzzzzzzzzzzzzzzz......"

I wheeled the sleeping Mr. DrunkHPO back to the hallway where I had first apprehended his "I NEED TO PEE NOW NOW NOW NOW NOW HURRY I NEED TO PEE NOW" request to find that the spot was already staked by a little old lady who looked like she had Death flexing his fingers over her shoulder.  I left Mr. DHPO in front of a closet to assess Lady Shriveled and a transporter yelled into the phone next to me "I'm sorry, but it's crazy down here, I can't find her. They've got people in hallway spots that aren't even spots! Does that even make sense?"

I had more than 12 patients in my section of critical care, several of whom needed labs, several more of whom needed to use the bathroom/had already gone in bed and needed to be cleaned, almost all of whom needed vital signs charted, urines dipped and sent, a transfusion to pick up from the blood bank, and the nurses from the other critical care section asking me to do quick blood assays.
What's more, patients just kept coming into my critical care section, one after another, with no end in sight.
With each patient comes a set of duties that should be performed immediately, such as the vital signs monitor, bloodwork and an EKG.

EKG's can be difficult to perform with certain patients, but each patient needs to have an EKG within 10 minutes of being triaged. In the time it takes to be registered, triaged, then brought to our section, I am left with only a few minutes to undress, expose, and perform the EKG with nurses and doctors at my elbows trying to assess the patient.  An EKG requires the patient to stay still, so this can be a challenging task if the patient is nervous and moving incontrollably.  As I was doing an EKG on Lady Shriveled, a student nurse sniffed at me, "we've got this, can you go put bed 3 on a bedpan?" Bed 3 was a code-brown.  As I gathered the materials to clean her/change her linens, a nurse from the other critical section team came to ask me to do a quick blood test.

I was wearing thin, and somehow, this helped me think more clearly.
S: "I can do it, but where is your tech?"
RN: "Tech Useful is doing an EKG in room 9."
S: "Wait, Tech Useful is extra today."
RN: "Oh, really? Who is our tech?"
S: "Actually, Tech Laid-Back is supposed to be in your section... Also, Trauma Tech Sour-face is supposed to be out here too.  You have 3 techs, and they only have me. Nobody has helped me out all day."
RN: "Hm, let me go check."

He walked around the department and looked at the assignment sheet- nobody else was to be found.  I ran the blood test anyway, but at least now, the charge nurse and team leader nurse became aware and concerned about the people missing in action, even prompting an overhead page, to no avail.

One patient began to code, and out of nowhere, Trauma Tech Sour-face, who had been hiding in the trauma room appeared, pushing us all aside to say, "I've got this," and jumped on the patient's chest to do compressions. Other techs appeared too, and suddenly, our department was full of dedicated, hard-working heroes. It wasn't the first time I laughed in absurdity that day.

It was, however, the first time I ever reported anyone to the managers.  Tech Laid-Back had tried to do damage control with me, saying that she accompanied a helipad transport. However, helipad transfers usually take 45 minutes and she was gone for more than 3 hours.   She offered me help when she finally appeared, but the rush was already over. My impending burn-out was still prescient, however, and it took all I had to finish the shift gracefully.

Believe it or not, the overall workload that night was only a bit heavier than it usually is for our busy sections.   I was only subjected to the abuse that night because of the lack of teamwork that night.  In my section, 2 of 3 nurses were new graduates and unused to the procedures and stress of treating of critical patients.  Their preceptors unfortunately took their training status as an opportunity to gossip instead of helping.  Between Tech Useful and me, the sections stayed functional, but barely.  If any of the other techs had done even the bare minimum instead of hiding wherever they were, we could have functioned very smoothly. The coding patient in 9 might even have been caught earlier had another pair of eyes been watching.  Ugh.

I carefully control my internal environment to exclude resentment, but it became very difficult that night last week.  It took me a week to work through these emotions and I can only hope the new nurses don't learn to become complacent like their preceptors.

Meanwhile, here's to the successful completion of another week in the life of a ERTech.


Thursday, January 12, 2012

Chapped Lip Service

"How can we help you today?"
"I got this sore and it hurts real bad."
"So where is the sore, Mr. Abuse-of-the-System?"
"Right here, can't you see it?"
"That cut on your lip... is that it?"
"Yeah, that's it."
"Well, don't keep touching it because it won't heal up. You can put some bacitracin on it so it doesn't get infected."
"Like this?"
"You don't have to glom it on... just a little will do."
"Thanks so much!"

-__- Really?? You came to the ER for a chapped lips??

Nurse Crotchetty: Did you really come on the ambulance for a sore tonsil? Is that really necessary?
Mr. Tonsil: (nonchalant grin)
Nurse Crotchetty stared him down... : Put him in the waiting room.
Mr. Tonsil: Aw man...

Another day in the life...


Wednesday, January 11, 2012

Endangered Species

I saw a triage note in Nurse Lazy's hand. The chief complaint was "SOB" for (not"son-of-a-#@$(U", though later, I felt like cursing someone out) "short of breath".  Peering over at the hallway spot, I saw a large stretcher filled to capacity with a morbidly obese woman. Lady Tiger Stripes had stringy streaks of gray hair covering her face, showing her age and I remarked "looks like we'll need an EKG," to which Nurse Lazy humphed and said "yeah ok, but after I get labs."  

Her posture alarmed me. Lady Tiger Stripes was slumped forward and breathing heavily. It didn't seem to bother nurse Lazy who stuck her nonchalantly a few times in the arm. Since she spoke slowly and sometimes would not answer, the nurse became impatient and stopped asking her questions.  As he was about to jab into her hand, I stroked her arm "he's just going to try one more time, ok?" I felt her tension melt a little and the third IV was successful.  Nurse Lazy left us in the hallway to begin the arduous task of his write-up, a whole double-sided nursing note that necessitates the marking of a few check-boxes and a short paragraph. With her age, weight and disposition, I knew I had to get an EKG as soon as possible and looked around for a room I could use. It is inappropriate for a woman to be exposed in the hallway, after all. 

After some bargaining (I'll clean up! It will only be a little while) and pleading (please? there is another trauma bed available) with the trauma tech, I wheeled her into the secluded trauma bay and tried to help her undress. "My, your tiger stripe gown is lovely, can you help me get it off?" She murmured and tried to smile.  Then, she made an attempt to move, but she was too heavy and slumped back.  I ran for the sat probe, something wasn't right.  Her tiger suit zipped open in the front and did the fastest EKG I have ever done. Her posture kept moving forward, as if she was too tired to hold herself up. Her breaths were shallow and deep rumbles in her chest sounded like a huge coffee percolator as she inhaled.  No good.  

Her probe finally read. It was 94%, which was borderline ok... then I watched it dip to 93----92----91----86---85 and hover there, then move slowly up.  The pleth was clear and the reading was real.  She looked more drowsy than before and made a smaller effort to react to my periodic "Hey, wake up, are you ok?" I high-tailed it for help. 

The first person I saw was Nurse Lazy. "I pulled LTS into the trauma bay and her sat is mid 80's to low 90's. She's having trouble breathing." Hm, ok, he sniffed and walked leisurely back to his computer to finish his electronic nursing notes. I looked around helplessly and went for the doctors.  I handed the attending the EKG and told her rapid-fire about the new patient. Her smiling eyes became hard when I told her about the oxygen saturation, and she, 2 residents and a med student ran inside to find LTS barely breathing.  

When I told Nurse Lazy they were going to intubate, he said "aw man, really?" LTS did eventually have to get her tiger gown cut off her, and a raw stench of unbathed human body, urine and stale cigarettes formed an aura around her.  We were unfazed and she was saved by quick thinking and good respiratory care under the attending's supervision.  

At the end of the shift, the attending shook my hand to say that I had saved LTS from dying in the hallway by pulling her into the trauma room when I did. I could feel no pleasure, though, only sadness that people are still in danger when they are in our care.  So much of it is preventable with careful, conscientious care, but when you're the only one who is doing it, the burden of having so many patients at once is hard to bear.  

The trauma tech growled at me, but I cleaned up as I promised after we took LTS to the ICU. A feral day, but a life saved and many hard lessons learned all around. 


Sunday, January 1, 2012

Happy New Year!

As we counted down to the new year, I looked all around me at the nurses, EMT's, paramedics, doctors, technicians, and business associates around me and felt a warm glow. And no, it wasn't from the champagne I already snuck a taste of.

It has been a whole year (minus two days) since I first entered the Emergency Room as a technician, two whole years since I began as a volunteer.  The changes since then in my person, mentally, physically, and emotionally have been significant and long-lasting.  I almost never walked home after a long day or night shift, regardless of how tired I was without thinking about, reflecting on, and analyzing what I had seen- all the chaos, emotional situations, and funny occurrences. Most people would probably think of what I do as Hell on Earth, but it is a ring-side seat to the unabashedly naked (sometimes literally) and diverse circus of humanity.

Although I am very frustrated with the lack of a positive response from medical schools, I find comfort in learning something new every shift, acquiring new tools for the toolbox of my future in healthcare.  I will also keep busy doing the best I can do for my patients both as a technician and musician.  Life, as the ER teaches me often, is much too short to waste on regret.

So far, I have eluded the cold armor of jaded apathy and hope to stay that way. For some healthcare workers, it is only a matter of time; for others, they will constantly maintain their humanity in the face of difficult situations. My co-workers, I observed, even though dressed in their shiny holiday best, could not help but discuss work. Later, I laughed at myself because I was doing the same thing.  What we do is inseparable to who we are though we are all marked by the specters of our unresolved traumatic experiences. However, we also know that there is no reason to forget the joy of being together welcoming the bright future.

Although my lessons of the year had been taught under a heavy, heavy hand, I very much appreciate all that has been accomplished and everyone who has contributed to filling my cup of happiness.

Cheers to everyone.  As I emptied my small glass of champagne with my cheering co-workers, I felt hope bubble in my chest for the adventures of a brand new year.

Happy New Year!