Hurricane Aftermath

Walking through the "hurricane" just two blocks to the hospital was an odd experience yesterday. The day was beginning to brighten through the clouds and wind whipped around me gently. Leaves and branches were scattered about the street and the first cars were beginning to make an appearance on the roads. In front of the hospital, a battered little tree had split in half, but it was removed by the end of my shift.

It was oddly quiet, strangely silent. I normally associate the area in front of the hospital with lots of activity- from the researchers, physicians, students gathered around the little tables and benches, the food carts and their billowing fragrant smoke clouds, to the constant battle between pedestrian and motor vehicle in the crosswalk. All of that was gone. I was the sole, silent figure walking on the rustling, deserted street.

The normally busy employee entrance was closed and I made my way through the main entrance guarded by one lone security guard. Inside the hospital, life was also suspended. Valhalla, or the "section above", was unfortunately still being used to quarter my night-shift co-workers who had to work again the following night, so I was assigned elsewhere. In my new section, I arrived to see we had 6 providers/doctors for only 6 patients! Where normally our census boasted at least 80-90 patients at any given time in the ER, we had less than thirty in house, some of which were already discharged to go home. With each new EMS arrival, we would ask- how is it outside? Not bad, they would reply- the sun is coming out.

Sure enough, our patients started arriving. After staying 24 hours indoors, they flooded our gates, eager, angry, anxious. My first patient that came in during this rush was a young man and his hood rat friend, who sassed us from the moment she walked in. She would not elucidate her relation with him, whether familial, fraternal, or professional, but proceeded to try to speak for him, demanding amenities such as blankets, pillows, and food. He apparently arrived because he 'asked someone for a cigarette and when he smoked it, felt high." Good riddance when we kicked both of them out after determining no foul play.

We had, oddly enough, several very amply padded patients come in by ambulance. Their chief complaints were: firstly because they had lost power, secondly because they were alone and scared and thirdly because they wanted us to refill their at-home oxygen tanks. It took a lot of staff-power to move and shift them about, as they barely fit into our 700lb capacity bariatric stretchers. After whatever action we had to perform, whether it was holding legs open for a foley catheter for a UTI or moving them up from sliding too much in the stretcher or even just moving them to our stretcher, four of us would be breathless and incredulous. I will refrain from repeating some of the names I heard referring to these poor immobile folks. But wow, what are the chances we would get three of them within the same hour?

I had a very sweet old lady who then came in, for bleeding gums. If I should live to be 95 and my only problems were bleeding gums from a tooth extraction and deafness in one ear, I should be a very happy little old lady, grinning every day ear to ear with the bloody gauze in my mouth. My sweet LOL was totally with it and even chastised the nurse for pulling her clothes off unnecessarily- it's just a tooth, for goodness sake! She reprimanded. As I was helping her get up and dressed, she commented to me, it's so much harder to manage the motions of dressing with somebody else, isn't it? I gently squeezed her foot into her brown loafers and pulled her pants up for her and thought about what she said. How many babies, children, invalids, and elderly people must have passed through her life that she must have cared for. I pushed her in her wheelchair to the waiting room to await her daughter's car so she wouldn't have to sit in the draft.

More and more patients started coming in- and our tube system was down, again. I made 4 courier trips to the blood lab... on my return, the team leader nurse pulled me aside apologetically and said, "I'm sorry S, you have to sit." Soon, I had the prattling pretender (again) on my hands and passed the evening in more or less of a stupor, listening to him gab.

What a night! Our manager was wonderful through it all and had stayed the overnight shift, didn't sleep, then continued to work until the end of my shift. He ordered pizza and soda (white birch beer is delicious with pizza!) for us as a morale booster for coming in during the hurricane. Free food is the best morale booster there could be. <3 Our hero!

S

Disappearing into the Background

It was dark and still outside- the wee hours of a late summer night. A man limped through a long outdoor hallway lined with construction tarp and concrete into a brightly lit room. It was large room and had many chair and several people- he chose one in the very back where no one would pay much attention to him. Nobody saw him, or rather, nobody paid attention to him. Scruffy, muddy, and quiet, he hid in a chair that could not be seen by the triage desk. The people sitting around him paid him no mind. They were too worried about getting into our busy emergency room, never mind the bundle over there in the corner. A storm was coming, you see, and everyone wanted to avoid going outside.

The last time I saw this man- his pseudo-scholarly build, straight nose, glasses, beard, balding head, khaki shorts and polo-style shirt- he was covered in feces in critical care. The last time I saw him before that, he was stealing my things. Mr. Poopy was the stuff of legend in my mind. I felt guilty, but I disliked him on a personal level. I recoil at the thought that he had touched my life by touching my things. He was an unwelcome and dangerous intruder once to my polite academic community at a prestigious research institution and given me nightmares (before I became the tough old cat I am now from working in the ER). He was a homeless man in academic garb, a total counterfeit, opportunist and leech of the system. My co-workers know him on first-name basis because he had been there so many times. My tech hated him- called him the scum of the earth... yet, my tech died, and this cucaracha continued to live. I am ashamed to admit thinking these unbecoming thoughts last week in critical care, but I won't lie- I didn't have even a single reason to like the guy.

No one paid attention to Mr. Poopy (Tales of an Emergency Tech: Coming Back Full Circle) as he sat down in that chair, huddled down in the middle of the night. Maybe he felt pain- he had an extensive cardiac history... More likely, he might have just wanted to take refuge in a place he had been hundreds of times, away from the churning winds and penetrating wet. He curled up and closed his eyes, as he was apt to do. He was a very quiet man- shy, and addled in some ways. He couldn't answer questions quite the way you wanted him to. In any event, he probably went to sleep. It was going to be a long wait.

It was mid-morning before someone realized that he died in that chair in the corner. He was already blue- had probably been so for about 10 hours. And nobody noticed... not the triage nurses, not the visitors to the ER, not the security officers... Who would have thunk?? His body was taken to a private room for a last chance revival- but I'm sure it didn't last long.

Suddenly, a name, a face, a smell we've known hundreds of times, permanently seared into our memories- was gone. He was swiftly wiped from the face of the earth with no further questions nor inquiries. There was a general feeling, more of relief than sadness- the expensive interventions and work-ups he received gratis wouldn't happen anymore, we were minus 200 visits/year on our census, and the city was minus a limping, quiet, and creepy old homeless man. Just like that, he became a memory, if anybody else remembers, that is. How terrible and profoundly sad it is to die like that.

Rest in peace, Mr. Poopy. I hope wherever you are now is better than where you were.

S

The Section Above All The Rest

There is a section in our Emergency Room that is different from the others. It looks like a real hospital ward and smells like fried chicken and warmth. Compared with our real Emergency Room downstairs, it is like a hotel. Here, patients with stable vital signs, screened against drunks and the seriously ill, come to rest. They have call buttons, they have TV's, and they have yours truly, S, to serve them during their stay at Hotel ER.

After a few ghoulish shifts downstairs, working in heaven isn't bad at all. The isolation with a select few co-workers is ripe for camaraderie as well as vicious gossip, depending on who is there. It is a place where cougars can fawn over a new nurse and nothing gets done until closing time so no new patients are sent upstairs, or a really great team-leader nurse and attending physician can lead an organized healthcare battalion.

Last night, we had to close the section down early, in the wake of Hurricane Irene's approach. Our day staff did not want to drive home in the weather and drive back in the middle of the storm this morning, so they get to stay in "heaven". A charge nurse even sent cleaning people up to sterilize the room she was staying in. I made sure to stock the closets with extra blankets. I hope they don't ravage my section because I will have to restock everything before patients arrive today!

Stay safe in the storm and if I don't blow away, I will be back to update with adventures of storm-day.

S

Adventures in Sitting: The One that Broke Me

There was a time, y'all, not too long ago, that I was living in the valley of kittens and rainbows. Every patient, regardless of ailment or creed would get a blanket, a sandwich, and a smile (if the medical situation allowed). People weren't incapable of evil- sometimes their disease states just made them grumpy. Even my rowdy drunks didn't mean any harm- their curses and threats were forgotten by them before the next time they request an urinal or sandwich. If you were kind to them, I thought, people would respond in kind.

Oh to be young and naive! A shift in the drunk tank soon cured me of that.

Entering my shift in the drunk tank, I was given report of my 3 patients. There was Ms. Opportunist in the middle, Mr. Passed Out in the back, and Mr. Two-faced in the corner. Mr. Passed Out was passed out, Ms. Opportunist was sitting comfortably, and Mr. Two-faced was sleeping in his stretcher- he had been like that all day, the tech told me. Ok, that's fine, I replied, anything I need to know? Nah, they've been quiet all day, she said.

I was all set. My cart was equipped with water, sandwiches, and whatever else. Mr. Two-faced rolled over and woke up.

Mr. TF: Hi, miss, can I get a drink of water?

S: Sure, here you go.

Mr. TF: Thanks a lot, you're really nice.

S: It's my job.

Mr. TF: Miss, can I get just another glass? I'm parched.

S: Sure.

Mr. TF: Thank you so much. That really hits the spot.

He was very polite and kept to himself- he was easy-going and quiet. He asked for a sandwich half an hour later, stating he hadn't eaten in a day or two. No problem. He was very thankful for it- so thankful, he asked for another one. Again, no problem. He was comfortable, I was comfortable, things were good.

I checked his vital signs and breathalyzer- he was on the cusp of sobriety where the residents might release him, but still a few points higher than the dogmatic new resident might like. He asked whether he was going home, so I let him know it would be a little while longer. No problem, he said.

He was as sober as was possible for a chronic drunk, I could tell, and was getting restless. I let him go to the bathroom. When he returned, he perched on the edge of his stretcher. He acquiesced when I asked him to sit back all the way, though.

Without warning, he got up and walked to the side of his stretcher. Warning bells sounded in my head.

S: Hey Mr. Two Faced, what are you doing?

Mr. Two Faced: Just looking to see my stuff is here.

S: When you're done, can you please sit in the stretcher?

Mr. Two Faced: Sure, honey, anything you ask. Where is my stuff?

S: Isn't it back there?

Mr. Two Faced: No, where is it?

S: Let me check in the back closet..

Mr. Two-Faced: is it there? My big bag full of all my clothes?

S: Hmm, no, I didn't see it. I will call the nurse to see if she saw anything in the section you came from.

Mr. Two-Faced: Aw ****, I can't believe you guys lost my ****. again! Twenty times I come here, twenty times I lose every *** **** thing I own. I am homeless, y'know, I dont have much. **** me. **** you.

S: I'm calling the nurse, hold on.

Mr. Two-Faced: No, Get a manager over here, right now.

S: Mr. Two-Faced, I am doing all I can to locate your belongings. Will you please give me a minute, sit for a bit and we'll see what's going on?

Mr. Two-Faced: All my clothes! I don't have nothin'. All my ******** clothes. You guys better have a lawyer, cause I'm suing your ******* ****** for all it's worth. Take my clothes, eh? You'll pay for it.

S: Nobody here wants your clothes, Mr. Two-Faced, we're searching for your stuff right now.

Mr. Two-Faced: **** you. All of you are losers. You're phony. You pretend like you care then you lose all my ****. Well **** you.

S: I didn't lose anything. You were here before I came in.

Mr. Two-Faced: You work here, you lost my ****. End of story. You don't give a **** if I live or die or if I lose all my ****. You rotten *****!

S in a soft voice: I do care, Mr. Two-Faced. I'm really sorry you lost your stuff- really, I am. We're doing our best to find it and it has only been a minute since I made that call. Please, just hold on and I'm sure your stuff won't just disappear. Nobody here would want your clothes.

Mr. Two-Faced: **** you. I want a manager. RIGHT NOW. Go on, do your job, call the ******* manager cause I am gonna sue all of you *******. Dirty ******, what are you waiting for?

At this moment, Ms. Opportunist- can I please go to the bathroom?

S: Sure, but come right back.

I watched her from the door as Mr. Two-Faced starts pacing and screaming at me again. I have never had anyone scream at me like that, voice breaking from all the strain. What did I do to deserve this? I FED him, I thought with revulsion. I am keeping homeless psychotics like this alive so they could abuse me and abuse the system.

Mr. Two-Faced: This place sucks! All you could do is feed me bull**** about how you care and ****, but you don't give a ****. None of you care. You're heartless ******* who don't care if I live or die.

S: I do care, Mr. Two-Faced. I'm sad you can't see it.

I watched Ms. Opportunist come back out of the bathroom... and run out the door. I had completely lost control. Backing out of the room as Mr. Two-Faced tried to swing at me, I called security, and to my horror, burst into tears.

He had turned a switch and I was unprepared for his sudden outburst, after 12 hours of mind-numbing work already. He had been testing me and knew exactly which buttons to press. I cried for you, Mr. Two-Faced. You are just too broken, biting the hand that you were so thankful for, that fed you not too long ago.

Security jumped on Ms. Opportunist, pinned her down, brought her back, and restrained her. Mr. Two-Faced was thrown out. Mr. Passed Out was still passed out. And I grew up a lot that day. I will never forget the screeching voice, the angry eyes, and the semblance of civility that he put on when I first met him. Should we meet again, I have some choice words for Mr. Two-Faced.

S

Weak Acid, Strong Consequences

In Urgent Care, we are supposed to receive patients that triage nurses deem to have minor problems. Because triage nurses are not omniscient, however, occasionally we get something that is very serious. For example, we had a "minor motor vehicle accident" victim arrive, whose symptoms started and worsened while she was being treated, eventually leading to one-sided numbness and tingling. I transferred her to the trauma room soon after as a full-trauma so they could do a full work-up for spinal cord/nerve damage.

The other day, I saw that we had a "chemical burn" coming. The man and his relative were non-English speaking, but handed me a materials safety sheet that listed concentrated "Hydrogen Fluoride". He had accidentally submerged an index finger at work while cleaning masonry. I saw that the finger was inflamed with small, dark, funnel-like holes. HF, as I learned in high school and college chemistry, is a relatively weaker inorganic acid. Neither the PA nor I knew much more before we looked it up online.

Apparently, HF burns of less than 3% of a person's body can cause systemic failure and kill a person.

According to medscape, these are mechanisms behind how that can happen:

"The 2 mechanisms that cause tissue damage are corrosive burn from the free hydrogen ions and chemical burn from tissue penetration of the fluoride ions.

Fluoride ions penetrate and form insoluble salts with calcium and magnesium. Soluble salts also are formed with other cations but dissociate rapidly. Consequently, fluoride ions release, and further tissue destruction occurs.

Systemic toxicity occurs secondary to depletion of total body stores of calcium and magnesium, resulting in enzymatic and cellular dysfunction, and ultimately in cell death. Majority of deaths are resulting from cardiac arrhythmias that were precipitated by hypocalcaemia and consequent hyperkalemia."

http://emedicine.medscape.com/article/773304-overview

Yikes!! How long had it been since he was exposed? A day and a half ago! The inflammation might have been from the acid already etching away at the bones in his hand. That's much too long to not have been treated, so we sent him immediately to critical care. Our critical care physician deemed it serious enough to be immediately sent to the burn unit at a nearby hospital and the man was sent there by ambulance.

However, we found that the other hospital, through a serious oversight, did not look up how to treat HF burns and ignored the suggestions by our own physician to treat him immediately with intravenous calcium gluconate... and discharged him with bacitracin ointment and a few band-aids.

I've been thinking of him for the past few days, hoping that the polite young man will be able to keep his finger/life. It's a dangerous world we live in....

S

Drunk Tank Pentameter

The night was waning, shift was ending fast,

when charge had tracked me down with this request:

please open up the doors to yonder room,

where idiots who drink avoid arrest.

Thus far I *had* been very fortunate,

escaped the boring fate it is to sit.

Well bring them on, this can't be all that bad,

With forty minutes left, why not commit?

The dank and dim-lit room was prepped and set,

the stretcher sounds came drifting to my space,

a million miles away my mind had rest',

in girlish dreams of etiquette and lace.

Hi ho- the first intoxicated hailed,

but why and how did I end up o'er here?

You're drunk, the tech who brought him in had sneered,

with that, she turned her fat and ugly rear.

Come back! My resident had yelled- in vain,

and anger, seething, hot, and fueled by drinks-

induced the large and dang'rous brute to leap

from bed with limber strength to strike the minx.

Now I had no desire to be thus stuck-

though no immediate danger came my way.

against the wall I slunk to freedom safe,

escaping waving limbs and spittle spray.

Security came quickly at my call,

my boor became a gentleman in haste.

And all was peaceful, only for a while,

because the tech returned, smirk unerased.

Now I don't really mean to yell, she said,

the panic button, you have heard of it?

Stay *in* the room, and you will be okay,

Six years, I've worked and I have not been hit.

I thanked her with a smile upon my lips,

with irony appropriately placed.

When you're here, which will happen soon, I'm sure,

You might not boast an injury-less face.

When there is malice brooding in your breast,

don't instigate my drunks and cause a mess.

Naivete may seem to be my fault,

advice like yours, I could not ---

---regardless, shifts were changing very soon,

my soft and comfy bed was calling me to sleep,

which rare occasion is a cause for glee,

though even dreams are not immune from creeps.

S

Sundown Talk-down

"Can you please help me?" A nurse looked frazzled, "I have an old lady sundown-ing in room 12. She's pulled her IV out."

"Sure," It was the end of my shift, but I still hurried into the room to see little Mrs. Hallucinating sitting with her legs hanging over the railings.

She had undressed herself, sitting on a half-undone diaper, and thrown all her bloody bedding on the ground. Staring at it, she was exclaiming, "look at all that blood!"

S: "That sure is a lot of blood, Ms. H. Let me take a look at your arm."

Mrs. H: "It's not MY blood- I was watching it appear all of a sudden from that wall over there. I'm sure glad it's not mine. It's an awful lot!" She tried to snatch her arm away.

S: "Oh look, you got it all over you. Let me clean some of it off!" She acquiesced to my cleaning motions. Meanwhile, I held pressure over the bleeding vein until it stopped.

Mrs. H: "Well I'm in no hurry- I'm waiting here for the vets to get back."

Nurse: "The vets? You mean veterans?"

S: (I cut in) "Where do you think you are, Mrs. H.?"

Mrs. H: "I'm at the vet's. I'm waiting for the dogs."

Nurse: "What dogs?"

Mrs. H looked very confused.

S: "Do you have dogs, Mrs. H?"

Mrs. H: "No, I don't have any dogs. But you do, right there." She pointed at the wall.

Nurse: "There are no dogs here..."

The nurse and I exchanged looks.

Mrs. H: "There are two!"

Nurse 2: "I don't have dogs, I'm a cat person."

S (under breath): "Though we have dogs in the center hallway right now..." Referring to the 8 rowdy drunks in the makeshift drunk tank.

Meanwhile, Mrs. H. is struggling against us as we are trying to clean her. The nurses were exasperated. It was time to distract her, as terrible that it is, so we could get her situated.

S: "Mrs. H., are you English?"
Mrs. H: "No. I married an Englishman, but I am German."

S: "Oh, that's nice."

Mrs. H: "Yes, it is, isn't it?"

S: "Absolutely, can I see your arm so I can wipe it with this wet towel?"

Mrs. H: "You don't have to bother."

S: "Oh, but wouldn't it be nice to be cleaned up?" She let me take her arm.
Mrs. H, accepting: "I suppose it would be." She looked into my face and as I smiled, she smiled back and I took the opportunity to slip her hands through the sleeves of a new hospital gown. At least now she was dressed.

We had similar struggles with trying to get her diaper off, trying to stuff her legs back through the bars, and to replace the sheet she had soiled. Each time, I would distract her, then as a group effort, we'd sweep the sheets/diapers/cleaning pads under her. At first, she resisted lying down, but then I convinced her she must be tired (it was past midnight), at which suggestion, she laid back comfortably and stopped trying to climb on the "staircase" she apparently saw protruding from our blank wall. Then she did not want me to tuck her in a blanket, so I talked her into allowing me to make her comfortable and snug.

I stuck around for a little while, trying to keep her calm, because she would speak normally, then warn me about the bedbugs crawling all over the sheets, at which point, she would spring up and try to pick at them with her fingers.

Because the present was confusing and distracting for her, I tried to keep her in the distant past, where she told me about her parents, siblings, and husband. Using the ring on her finger as a prop, I would ask her to tell me the story behind the ring, and she would be distracted long enough not to rip out the second IV she discovered on her forearm.

Twenty minutes after I was supposed to leave, I mentioned how late it was and asked whether she was tired.

Mrs. H: "You young girls are just so sweet. I think I will take a wink right now, if you don't mind."
S: "Not at all, Mrs. H. Sleep well!"

Mrs. H: "All right, I will turn in, then."

She pulled the covers up to her chin. I quickly changed out of my scrubs and passing the hallway on my way out the door, looked in to see Mrs. H. being chastised by another tech for trying to climb out of the bed. Oh Mrs. H... I hope they don't tie you to the bed upstairs.

Though she is active and confused, she is also quite manageable and sweet. I hope I can be half as spry when I'm in my 90's...

S