It Takes All Kinds

Twelve hours working in our critical care area last night, and for a while we were getting slammed with patients and things started backing up.  Obviously nobody ever plans on having to come to the ER, but it's interesting to see how different people react.  Some wait by gawking at other patients and asking what's wrong with everyone else who wheels by.  Most complain and act with varying degrees of rudeness.  And some, like a gentleman last night who experienced a vasovagal syncope while visiting from out of town, are polite, patient and funny.  

But he was the exception, not the rule.  My favorite example was a few weeks ago, where we had an old, sick looking lady with a huge history.  While the nurses attempted to place an NG tube, she stopped breathing and eventually lost her pulse.  We start coding her, and immediately the whole area becomes packed.  Chest compressions, crash cart, central line, doctors, nurses, techs, med students moving around and a lot of commotion.  I get a break from doing compressions and stay to grab whatever supplies people need.  Two beds over, I hear another patient start yelling for help.  Ripping open the curtain, I'm worried that I'll find another patient circling the drain.  Instead the man growls at me that he's thirsty, and wants water right away.  With ice.  And a straw.

At the same time all of this is going on, a newer resident goes to discharge one of our patients who'd been placed on a portable monitor in the hall.  He hands her the paperwork, returns to the area where the code is still in progress, and asks one of the nurses who's hanging medications on this pulseless old woman to go pull the discharged patient's IV.  

One of the many things I enjoy about my job is that it gives me the opportunity to see what kind of doctor I want to be, and what kind I don't.

Karma

Oddly enough, I had the same schedule last night as the night before: trauma, fast track, triage.  Trauma was once again quiet, with the exception of a man found unresponsive next to his bicycle, and who still didn't remember what happened by the time he arrived.  Urgent Care, however, was busy paying the price of an easy Monday - at no point during the evening were there less than 15 patients waiting for our "fast track" area.  I was able to help splint the victim of a bar fight gone bad who had broken bones in both of his hands, but beyond that it was ace wrap and crutches on repeat.  Instead of closing at 10:45, I didn't leave until nearly 1am for triage, which was quiet for the rest of the night.  

And speaking of karma, the 61 year old from Monday night reappeared in the check out line in the supermarket as I was grocery shopping yesterday.  I made sure to do a quick turn into the cereal aisle, and I'm pretty sure I went unseen.

Living After Midnight

Mondays are always our busiest days, but yesterday was surprisingly manageable.  My assignment changed three times in my first five minutes, and I ended up working trauma and a hallway team for the first four hours.  With the exception of a slightly odd 61 year old female with shortness of breath who kept talking about burning her bra and creepily pseudo-flirting with me, and the task of finding a patient who had been lost somewhere between the ED, ultrasound, dialysis and her bed assignment on the floors, it was a quiet opening to the night.

At 7:30 I moved to our fast track area, which is staffed by a PA or APRN and a tech.  Normally I'm not a huge fan, as our job back there mostly involves computer and paperwork, but I managed to bandage a few wounds and remove three sutures placed just next to a patient's eye (I love trauma, and don't have any trouble with cracked chests or stomach evisceration, but eyes are the one thing that make me squeamish).  I had a great PA to work with, and unlike every other time I've worked back there and had to stay late to close up, we didn't have a single patient after 10:45.

With no patients in the drunk tank (again, a pleasant surprise) where I was assigned for my last four hours, I moved out to triage at midnight.  Around 1:30 we received a call about a MVC a few towns away.  Two patients came in, and I moved over to the trauma room.  The first had a probable tib fib fracture but otherwise looked alright.  I helped get him on the monitor and ran bloods to the lab as the passenger rolled in, and by the time I got back I helped start up our third trauma in 30 minutes; a drunk assault victim who had been hit in the head with a baseball bat and ended up getting intubated.  Meanwhile, the driver was getting his hip popped back into place, but during the conscious sedation lost his respiratory drive.  I got to bag him during two unsuccessful attempts at intubation before anesthesia came down to get the tube in.  As we were working on the driver, the passenger came back from CT with a newly-discovered head bleed and aortic dissection.

Once everything calmed down, I returned to triage and got gassed by the fumes of the floor waxing while I drew labs on patients still waiting to be seen.  Right before I left for the night, a patch came in for an 18 year old GSW coming in, and as I walked out to head home, the ambulance flew past me on its way in.

Don't Call Us, We'll Call You

A pretty uneventful night last night, with the exception of a walk-in stabbing that I helped out in, and two patients who clearly had better things to do on a Saturday night.

Runner up was the first female member of Blue Man Group, a 21 year old female whose mother called 911 after finding her unresponsive.  Upon arrival, she presented with a blueish tinge, altered mental status, an oxygen saturation hovering in the 70-80s, and a well-vocalized desire to leave AMA.  After neb treatments, her sats improved and she started pinking up, but she continued to ramble about her "rights" and how she was brought in against her will.  Despite herlabs coming back completely abnormal across the board, her mother apparently changed her mind and wanted her to leave, too.  Hypoxia, it seems, belongs in the home.

Top prize, however, goes to one of my first patients of the evening.  While the trauma room was getting slammed with 7 traumas in my first two hours at work, I had the pleasure of showering off Scabies Guy.  Scabies Guy had already visited us earlier in the week, and this time was more sober than the last, but still wouldn't stop talking and trying to show me the mites that had taken up residence underneath his skin.  Covered head to toe in plastic, I politely refused, even after he proudly told me of his shower that morning.  Angry about being back in the ER, he couldn't understand why we were making him shower again.  Added to Lice Guy and Maggots-in-the-Leg Guy, I feel like I've finally completed the last leg in some unholy version of the Triple Crown.  

A Hard Day's Night

Long night last night.  I arrived and only had 5 patients, but within a few hours the hallways were overloaded with the kinds of patients I have the hardest time dealing with.  We had a drug-seeking 20 something female crying for hours on end to get her dilaudid, a schizophrenic man who was impossible to deal with, a sweet but completely demented old lady dumped by her nursing home, and a diabetic from lockup who threw his urinal on the floor.  On top of all this, we had a new medicine intern doing his rotation in the ED, and he got hopelessly backed up leaving us stuck with these patients for hours.  Later in the evening, a car pulled up to the waiting room and dropped of an 18 year old gun shot victim who was pale as a sheet.  They cracked his chest, but ended up calling it, and I listened to the sister sob uncontrollably as she collapsed in the hallway behind the area I was working.  Things started to clear out after midnight, and the last couple hours weren't bad, but it ended up being one of those nights where everything piled up and felt a little overwhelming for a while.  Tonight should be better.

Don'ts Of The Week

Selected highlights of the past few days:

DON'T take PCP.  Unless you enjoy ending up in four-point restraints naked while shitting yourself.

DON'T go boogie boarding if you're over 40.  Unless you want to be flown in by helicopter from the next state over because you have an L4 fracture.

DON'T get in the way of a moving forklift.  Unless you want to be run over and see your tibia from the outside.

And finally,

DON'T masturbate.  At least not so many times a day that you start getting headaches bad enough to bring you into the ER... unless you want everyone laughing at you from outside the curtain.

As Seen On TV

Sometimes I'm amazed how working in the ER can still feel like an episode from a TV show.  I've been an ER tech in an urban Level I trauma center on the East Coast for almost a year and a half now.  I work evenings (4pm to midnight or 4am) roughly 20 hours a week during the school year and full time during the summers.  Seventeen months by no means makes me an expert, but it is long enough to realize that medical dramas somehow seem to skip over the constipated old ladies and sobbing psych patients.  At the same time, it's short enough for me to still get excited when things get interesting.

Last night was decently busy for a Tuesday, but we were pretty well cleared out by 1am.  With only 3 drunks sleeping in wheelchairs in the waiting room, the chairs were cleared out and the floors were getting waxed.  Our ED is split into two halves; the side I was working closes down to all but minor cases after midnight and we had three patients on the board.  With the other side pretty quiet as well, I started restocking supplies when a patch came in for a two person rollover MVC.  The trauma room, which had been empty, suddenly became packed as we prepared for two critical patients.  The first to arrive was the passenger, who had been found twisted in an overturned vehicle and was in cardiac arrest.  The driver, her boyfriend, arrived a few minutes later.  He seemed to be in good shape, but went straight from CT to the OR.  She regained a pulse with after a few minutes of CPR, and after two chest tubes, a central line, and three units of blood, was stable enough to be moved upstairs as well.  Within 30 minutes we'd gone from snacking and surfing the internet, to trying to save two teenagers' lives, and back to counting the minutes until 4am.