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. 


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