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!