Burn-out

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.

S

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. 

S

Code Pride

"Oh my gosh, what is that?" I peered down the ambulance bay tunnel and saw the EMS team running, one of them making compressions on the chest of a man on the gurney.  "There's a code coming!"

Charge nurse quickly pulled a patient out of critical care in time for us to pull a new bed for our new patient.  He was undeniably over 400lb, maybe even 500, and that's not counting the missing portions of his legs below the knees.  Foul, cloudy urine was everywhere and the tangy, musky odor saturated the air, causing more than one nurse to wretch.  The EMT was making half-effort compressions, trying to keep his already urine-soaked body far away from the patient.  He was visibly repulsed and his interest in pretending to do energetic compressions in front of us was waning.  "You wanna take over?" he asked hopefully.  "Not until he's transferred to our bed," I replied coldly.  It took six of us to safely move the large body over to the bed, whence I placed him quickly on the monitor and jumped up, straddling his shoulder.  His large arms were heavy and hung down the side, limiting the space I had.  A foul smell arose from my plastic garment as his sweat rubbed onto me.  "Begin compressions!" And so I began.

Meanwhile, the resident was right next to me with the attending. I could feel his excitement and nervousness at gaining the opportunity to intubate someone.  To young doctors, this was a learning experience and an opportunity to shine, never mind who the patient was.  They obviously didn't identify with this man, who lived a relatively short and limited life.  Huge and diabetic, he lost his legs a few years ago, and ever since, had been immobile.  As he repulsed even the ER team taking care of him, I wonder about the people he knew- whether anyone might have been kind enough to keep him company.  In his final days, he was filthy and had fallen a few times, as his injuries suggested. When he was found by a visiting nurse, he was on the ground.  I breathed rhythmically through my nose as I watched the monitor to make sure my compressions were deep enough though the smell was intensifying.  "Halt compressions!"

The resident had intubated, but there was something wrong.  The tube wasn't down far enough.  The attending moved over and tried to intubate. "Get me the glidoscope," she commanded.  "I can see the cords now." The nurses standing by were nervous- "we need to be doing compressions." "Hold compressions. The cords are *right* there", the attending commanded as she dug the tube down further.  Finally, she looked up, "give me a bougie." By now, I was commanded 3x by various nurses to start compressions, but the attending wouldn't have it. The struggle on her face didn't say whether she was more worried about saving the patient or looking a fool in front of the crowd of people around the bed, but I had my opinions at that moment.  It had now been over two minutes, maybe more since compressions were halted.  I had recovered my breath and was ready to go. "Aha." The attending smiled her beautiful smile- the CO2 detector turned golden- the tube was in, and the patient was still asystolic.

After a few more rounds of compressions, the attending asked, "does anyone object to me calling it?" She called it and everyone scattered, as was customary. Nobody wanted to be stuck with helping clean the crusty, smelly body.  The resident then noticed some blips on the screen that looked like ventricular activity, so he wanted to continue, but was unsure.  "Are you sure? if you want us to continue, then we will continue," the attending prodded, but we could tell she didn't really want to. The resident mumbled something in an embarrassed manner and we did not continue. I was left to clean the body to make it presentable for viewing.  It was just another day in the emergency room, but for this man, it was his last.  They say hearing is the last sense to go- I sure hope he didn't hear what was going on in his last moments with us.

S

Fat Chance You'll Catch Me Again

"Are you sure this thing is locked??" Ms. Peevish O'Bese whined about the stretcher as she tried to use it for support and it gave easily.
"No, ma'am, the stretcher is actually locked..." I observed, you just weigh more than 500 lb and its locking system can't sustain the effort of you trying to stand up.

I had been asked by a nurse to help bed 1 to the bathroom and oh, by the way, we also want labs and an EKG while you're at it.  When I pulled aside the curtain, I realized with dismay that I had been signed up for a bigger project than advertised. I was met with the whiniest voice telling me she had to PEE NOW, a bedpan on the chair and a distressed pair of eyes on a body I knew I couldn't move, that couldn't rotate on the bed far enough for me to even insert a bedpan, that would have crushed and actually broken the plastic bedpan. I'd seen worse from smaller patients.

"Please, I need to pee. I need to pee now. I want to walk to the bathroom, but I don't want to fall. I've fallen 4 TIMES since I've been at this place. Oh God, I don't want fall again."
 "Ok, Ms. O'Bese, give me one minute while I run for a commode."
"HURRY."

I returned 30 seconds later to her screaming about how she needs to go, Oh God, somebody help her, please help her, nobody cares, etc etc.
"Ms. O'bese, didn't I tell you I'd be back to help you? Please stop yelling."
"Oh, it's just that nobody ever listens here. This place sucks."
I ignored her running commentary about how my workplace sucks and set up the bedpan. She eyed it, "I'm not gonna fit in that, Oh God, it's not gonna work but I need to pee now. You don't understand. I NEED to PEE."
"Ok, well, how about we try it, because you've no other option right now."
"This place sucks. Don't you have the bigger ones?"
"In my 30 seconds searching and finding one (which is miraculous on its own), this is the best I could find (I had picked the bigger/sturdier one), and we don't carry bariatric commodes down here in the ED (I hadn't seen one for months). I'm sorry."
"This place sucks. I'm never coming here again. You guys aren't equipped to handle your customers." She struggled to pull herself up. I unlatched the bar and helped her swing her huge, swollen, weeping legs over. She tried to stand up by pressing against the bed, which gave against her immense force and, frightened, she sat back down and wailed, pounding her fists on the bed.  I persuaded her to try again. As she collapsed onto the commode, her backside was too wide to fit entirely, so she was wedged in it. Wailing and cursing she yelled at me to pull her nightgown up.  I did so, and she began to pee, filling the commode, then leaking all over the floor. It was time to call for help.  I beckoned the nurse who assigned me this mammoth job, who grudgingly came in. "You'll need gloves," I told her.

Nurse Snark's eyes widened and she immediately began to lay pillowcases and towels on the ground.  The whiny, peevish voice raised in volume and pitch.  "AREN'T YOU EVEN GOING TO HELP ME?"
"I'm not going to fall. We have to clean this up first."
"Oh, so you don't want to fall, but I have to."
We ignored her and realized the job required more people.  Nurse Snark called out, "I need 2 gentlemen to come in here to help." Two of our new residents came in to behold the sight of Ms. O'Bese stuck in the commode with her nightgown up, smelly urine all over the ground with towels haphazardly arranged, and Nurse Snark and me trying to steady the bed.  Eventually we did get her back to the bed, where she started yelling again about how much we sucked.  "Don't forget the labs and EKG," Nurse Snark reminded as she scooted out the room, leaving me with Ms. O'Bese.  Great.

I actually managed to talk her down, and a short while later, she apologized to me, "I didn't mean to take it out on you. I don't like her (Nurse Snark). It's like she owns the place or something." Hmm, ok.  But it was the end of my shift, and I wasn't about to stay to help with any more bathroom incidents with Ms. O'Bese, who must live a very stressful life.  How else does a person's voice get that way?

S