Friday, October 31, 2008

Rosemary's Baby

Police brought her in for a med eval after she expressed thoughts of hurting others.

She claimed she was spawn of Satan.

While the paternity test made its way to the lab, Rosemary's baby vividly described how she planned to find her "boyfriend's girlfriend" and douse her in kerosene before lighting her on fire in front of her children.

This all came out before she started hissing.  Little-known side effect of satanic insemination: it makes the offspring half snake.  Or at least so she claimed as she writhed in the bed and kept sticking her tongue in and out.  The possession came next, which was pretty similar to the whole snake thing, except it involved speaking gibberish instead of the hissing.  It wasn't until she leapt up and tried to attack other patients that she earned herself 5 of haldol.

Within a few minutes she appeared to be snoozing soundly, but in true demonic fashion, she fought off the medication and jerked up in bed once more to begin screaming and spitting (sadly, her head was not able to complete the 360˚ turn).  Another round of haldol put her down for the count.

Happy Halloween!

(Be safe out there.  You don't want to end up in the ED... it's scary.)

Thursday, October 30, 2008

The Mummy

Tucked away in a darkened room at the end of the hallway, a patient slumbered under a tightly-wrapped web of blankets.  Or at least, I assumed it was a patient.  

Everyone instinctively gave the room a wide berth, not daring to disturb the sanctity of the resting place.  At one point during the shift, I noticed the patient's vitals hadn't been checked in hours, and went to grab a set.  The nurse laughed as I set off down the hall, warning me to "be careful."

Entering the unlit chamber, I announced my presence, but received no response.  Reaching out to tap the patient on the shoulder, he awoke with a start, slowly rose to a sitting position, and with the blankets hanging off his tiny frame, the little old man boomed: "Get your filthy damn hands off me, you f*ing piece of shit," and continued to hurl obscenities until I left the room. 

Wednesday, October 29, 2008

The Incredible Hulk

Walking past the triage bay one night, I noticed a large crowd of officers surrounding a patient sitting on an ambulance stretcher.  Asking the charge nurse if she needed an extra set of hands, I was quickly told to stay away from the patient.  Taking a closer look, I saw a 6' 2" probably 250lb ripped dude angrily secured in handcuffs.  I decided to keep walking.

A short time later, I heard a commotion from a patient room, and ran over to see what was going on.  Apparently ripped dude was wigging out on PCP, and had ripped himself out of restraints, flipped the stretcher upside down, and was currently attempting to tear the sink out of the wall.  Lacking a tranquilizer dart gun, we let him burn off his rage in the room until he calmed down enough for a few of us to run in with a much-needed B52 (benadryl, 5 of haldol and 2 of ativan).

Almost immediately, he shrank back down into a mild-mannered and misunderstood physicist, but we all knew he was but one rage-filled moment away from another rampage.

Tuesday, October 28, 2008


We could hear her screaming from the other side of the department.  

For the first four hours of my shift it was a near-constant whine coming from the distance, but when my assignment changed to the team that was taking care of her, I experienced the Banshee at full volume.  A 28 year old female brought in for acute anticholinergic poisoning, she screamed almost constantly for 8 hours.  

Red as a beet from vasodilation, dry as a bone from affected sweat glands, hot as a hare from hyperthermia, blind as a bat from dilated pupils, full as a flask from urinary retention, and mad as a hatter from blocked CNS receptors [thanks UpToDate!], she ended up receiving over 30 of Ativan with no effect.  Every time she was medicated, she would nod off for a few moments before jerking up in the bed again, tugging at the restraints and screaming at the top of her lungs.

Once an ICU bed finally opened up, five of us accompanied her up to the unit, where she was immediately classified as a Trick, not a Treat.

Monday, October 27, 2008

The Exorcist

The little old lady in bed 7 wasn't a monster, she was just misunderstood.  Or so I thought when I volunteered to go draw blood on a demented patient that a nurse no longer wanted to deal with.

Entering the room, I found a sweet, kind, and charming woman who smiled politely while I explained that I needed to look for a vein.  Realizing that I had forgotten a vacutainer, I told her that I would be right back, and she asked if I could bring a glass of water with me when I returned.

I made it back to the beside a few minutes later, cup of water in hand, and reached over her arm to tie the tourniquet when she transformed. With rage in her eyes, she suddenly grabbed my arm and started spitting while screaming obscenities.  Climbing out of the stretcher, she tried to bite off my hand while lunging at me with her yellowed, razor-sharp, MRSA-tipped fingernails.

Calling for help, I scrambled backwards out of the room lucky to escape with my life and skin intact.

Nurses say that late in the night shift when we've cleared out the patients, if you're very quiet and stay perfectly still, you can still hear echos of her profanity-laced screaming drifting out of bed 7.

Sunday, October 26, 2008

Nightmare on Hospital Street

Everybody knows the ER can be a scary place.  Pale, listless creatures with empty vials roam the hallways after midnight searching for victims rich in blood, everyone's concerned about the undead, and no one in their right mind wants to work on a full moon.  

So, in the spirit of Halloween, I thought I'd use the next few days to tell the tales of some of the truly terrifying patients who've made their way through the Big City ER.  

Be afraid.  Be very afraid.

Livin' on a Prayer

Took a road trip yesterday to visit a friend at Small Liberal Arts College.  The drive there was beautiful - winding my way through New England on a beautiful early fall morning, looking at all the richly-colored leaves.  The drive back last night nearly killed me.  Literally.

In retrospect I clearly should have spent the night, but I figured driving through a little rain wouldn't be a problem.  An hour into the drive I was caught in a torrential downpour on an unlit, isolated stretch of highway with 30 miles until the next exit.  Between the plume churned up by the tires of the car in front of me, and the 40mph wind gusts throwing rain at my roommate's borrowed car, the windshield was a wall of water even with my wipers set to Adderall.  I couldn't see the road ahead, could barely make out the tail lights of the next car, and there was no shoulder for me to pull over.  I narrowly avoided two downed trees, and at one point completely lost control of the vehicle when I hydroplaned for the fist time in my life.  

Thankfully there were no other cars around me at that point, but as I barely missed crashing head-first into a guardrail, I kept thinking "Please don't let me crash here.  I know which small town ER is closest, and I really don't want to be a patient there."

Saturday, October 25, 2008

Public Service Announcement

It's 10pm.  Do you know where your senior citizens are?  

Trauma roster for the evening:

An 83 year old female who fell at home while walking without her cane.  Lac to the nose and a torn rotator cuff.

An 85 year old male who tripped on the rug and ended up with a nasty ankle fracture.

A fiercely-independent 92 year old female whose fall in the bathroom resulted in left hip and left shoulder fractures.

And finally...

A confused 78 year old female who somehow managed to find her way onto her son's treadmill, and ended up with a shoulder dislocation after falling off the back.

Friday, October 24, 2008

Big Dude

Most patients enter our ER through one of two ways, either walking into the waiting room or arriving in the ambulance bay via EMS*.  A few weeks ago, however, I noticed a van parked in the ambulance bay as the charge nurse came over to ask for an extra set of hands.  Wheeling a stretcher out to the van, the doors opened to reveal the largest human being I've ever seen.  Later measurements confirmed that he weighed in a just under 700 pounds.  Surrounding the stretcher with ER staff and positioning it behind the gentleman, we had him basically fall onto the gurney before taking a running start to push him up the small ramp and into the ED, where he was evaluated for back pain.

At the time, I figured our encounter would be a once in a lifetime experience, so imagine my surprise when he returned a few days later as a trauma patient after falling at home.  Pressing him for information about the fall, the triage nurse learned that the bannister on his staircase had broken beneath him, prompting a tumble down a flight of stairs*.  

*Contrary to popular belief #1: arriving by ambulance does not get you seen faster.  Ambulance patients wait just as long as everyone else, though if they have an IV they must stay in our triage hallway rather than the waiting room to prevent them from walking out and shooting up through their line.

*Contrary to popular belief #2: despite the rumors making their way through the ER at the time, we do not transfer patients to veterinary hospitals if they are too large for our CT scanner.

Wednesday, October 22, 2008

Coming Soon

Coming soon to a DI suite near you: Scotch Tape x-rays.

According to an article in today's Chicago Tribune, physicists have discovered that Scotch tape emits x-rays when peeled off in a vacuum.  Researchers suggest that "the process might be harnessed for making inexpensive x-ray machines for paramedics or for places where electricity is expensive or hard to get."

So, next time we're stuck waiting ages for a portable chest, I'm just going to pump out the air and grab a big roll of tape.

What Am I Missing?

Why is showing up to the ED naked suddenly in vogue?  I already posted on the two naked dudes from over the weekend, and now I have my third in less than a week.  Is the Big City hosting a nudist convention?

My most recent gentleman was discovered running down the street naked by police.  EMS delivered him to our critical care area in a tightly-wrapped sheet, where he received an altered mental status workup.  Patient denied knowing where he was running to/from, why he was naked, and where his clothes could be found.  

Personally, I try to limit my naked running to the summer months - it's just too cold at night now.  Maybe he was hoping the patches of fungus he had growing all over his body would keep him warm?

Tuesday, October 21, 2008

The Tables Have Turned

Nobody knows their veins better than a heroin addict.  

I learned this fact when I was lucky enough to have an addict as the very first patient I ever drew blood from.  Unlike the rubber arms we practiced with in the phlebotomy class provided by the hospital, she did not have multiple punctures in her arm indicating exactly where to stick the needle.  She was, however, kind, patient, and instructive.  Sure, I was a little weirded out when she sighed and claimed the latex tourniquet "felt good against her skin," but she claimed it was only because she'd been clean for six months and missed the sensation of shooting up.  While basking in the memories, she pointed out different veins that a very nervous new ER tech could try, showed me angles to go in at, and offered tips on how to find veins on tough sticks.  Thanks in large part to her help, my first attempt at drawing blood was a success.

Flash forward a year and a half to last night, a busy Monday, where I was drawing labs at triage in an effort to speed up patient flow.  Real Friendly Addict rolled up to the desk in his wheelchair, and under the guise of "Hey buddy, let me show you where the good ones are," kept pointing me to heavily scarred, overused veins.  Playing along, I kept searching the arm until I found a small but juicy one above the elbow, and struck with my butterfly.  

Real Friendly Addict quickly turned into Pissed Off Addict and screamed, "Hey, I was saving that one!"

Monday, October 20, 2008

It's the Economy, Stupid

The New York Times took a look at trends associated with a slowing economy in their Week in Review section over the weekend.  

According to an economist cited in the piece: "Death rates fall, people smoke less, drink less and exercise more.  Traffic fatalities go way down, which is not a surprise when people drive less.  Heart attacks go down.  Back problems go down.  People have more time to prepare healthier meals at home."  

This almost makes a recession seem like just what the doctor ordered.  

The article goes on to say that we should plan on longer, slower songs, an increase in laxative sales, and a decrease in carbonated beverages.  Oh, and suicides are also expected to rise. 

I will do my best to monitor these key benchmarks and their effect on the ER patient population as the economic crisis continues to unfold.  Especially laxative usage.

Sunday, October 19, 2008

Fixing a Hole

One of my favorite movie scenes of all time comes from The Godfather, when the foolishly stubborn Hollywood producer refuses a request from Don Corleone and wakes up the next morning in blood-soaked sheets to find the head of his race horse laying at his feet.  Great scene for a movie, less great if it happens in real life.

Especially if you happen to be a 72 year old recently discharged from the hospital after having a graft to repair an aneurysm in your leg.  One of my patients from the other night woke up on his first night home and felt something wet in the sheets.  Turning on the lights, he discovered a large pool of blood formed below his leg.  EMS rushed him to our critical care area, where we observed a steady leaking of blood out from underneath the tegaderm that covered his wound vac.  Surgery rushed down to see him, and was shortly thereafter I was able to bring him up to the OR.

Given his history of anxiety, the news that he was at risk of losing his leg was especially not well-received.  Thankfully, his son and daughter were with him, and both were extremely supportive.  I wished him luck, and hoped that the surgeons were able to repair the graft and save the leg.

I never found out what happened to him, but at least he didn't have a severed horse head and an angry Don to add to his troubles.

Saturday, October 18, 2008

By the Numbers

Stats from Friday night...

2008: The age, more or less, of our crying psych patient if she did, as she claimed, kill Jesus.

464: The critically high blood sugar of our drug-seeking diabetic who rode her power scooter in from the next town over to score some Percocets, while refusing treatment for her diabetes. 

2: The number of crash intubations performed on patients who unexpectedly lost their airways.

0: Net balance of naked patients.  EMS delivered a naked, jaundiced patient in liver failure shortly after our trauma patient escaped by running out the ambulance bay doors and leaving his clothes behind.

-1: The loss to our roster of regular drunks after one died this week following injuries sustained in a fall.

Friday, October 17, 2008

CPR Guidelines Change

As I learned from WhiteCoat's post yesterday, and as reported by CNN this morning, the Bee Gee's classic "Stayin' Alive" may be more aptly-named that anyone thought.  Like the guy quoted at the end of the article, I had always been told that "Another One Bites the Dust" had a rhythm that matched the recommended rate of chest compressions during CPR, but at 103 beats per minute, "Stayin' Alive" is nearly identical to AHA guidelines.  

Definitely a more optimistic song to be humming the next time I'm pounding on someone's chest.

Thursday, October 16, 2008

Just a Tech

Taking a sip from my trusty Big City University water bottle the other day during a brief lull in the stream of crazy people overrunning my team, I received a look of incredulity when the medicine resident doing her ED rotation learned that I, a mere ER tech, attended college.  Revealing that she herself had graduated from Big City University a few years ago, she immediately began grilling me with questions, designed I believe, to see if I really was a student there.  Finally she asked me, "So, do you want to be a doctor or something?"  

Normally I'm loath to advertise my pre-medness for fear of being labeled as "one of those," but in this case I explained that I was finishing my bachelor's in biology before applying to med school next year.  Looking at me blankly, she replied, "Well I volunteered in a bunch of hospitals when I was an undergrad, too."

Feeling a little like Ben Stiller's character in Meet The Parents, I explained that I actually got paid to work in the ED, so everybody wins.  For the rest of the shift, however, she insisted on referring to me as "Volunteer," and treated me with an inexplicable degree of hostility.

When non-ED residents rotate through, they usually learn pretty quickly that we work as a team, and that arrogance will not win you any points with the staff.  With anyone else, I'm more than happy to show them where to get supplies, draw a second set of labs to make up for the orders they forgot, or run interference keep them from being tied down with every single patient request.  But not for her.  Each time one of her several crazy patients had any sort of question, I immediately replied that I was just the tech, and went to drag the Doctor to the bedside.  I think she eventually got the message.

Wednesday, October 15, 2008

The Risks They Take

A friend sent me this article that appeared in the Washington Post yesterday.

A tragic reminder to thank EMS, firefighters, police officers, and all those give their lives in service to others.

Tuesday, October 14, 2008

Toys 'R' Us

Orthopedists have far too many cool toys.  Sure, we've got the rapid infuser and the defibrillator in the ED, but the Orthopods get the messy, hands-on, bone-crushing devices that look like they belong in a medieval dungeon.  And frankly, I'm jealous.

A couple nights ago we had a poor bastard who sliced the tips off two of his fingers in some sort of machinery accident.  Orthopod Resident came down, took a look into the stumps, and then explained that there was too much bone and not enough skin left to close.  Solution?  He whipped out a file and started whittling down the exposed bone until there was enough skin overhanging it to suture.  Badass.

Several months earlier I walked into the trauma room and discovered a team of Orthopods surrounding a (surprise!) no-helmet motorcyclist whose unfortunate collision with a guardrail left him with a rather impressive long bone fracture.  What caught my attention, however, was the resident wielding what appeared to be your standard, crank-operated hand drill as he bored through the patient's leg.  Mesmerized like the 8 year old boy whose father just let him play with the power tools, I watched as the drill bit worked it's way through the leg and poked it's head out the other side.  A curved piece of metal was connected to either end of the thin rod inserted into the leg, and was used to suspend a weight off the end of the stretcher to maintain traction (looking something like the picture above).

Now that is a cool way to make a living.

Monday, October 13, 2008

I Would Do Anything For Love

Shirtless, tattoo-covered skinhead arrived via EMS doped out of his mind.  Pulled over by the police for driving like a bat out of hell, the medics found a couple of empty prescription bottles in the car that had just been filled that morning.  Apparently his psychiatrist failed to explain that Klonapin, Seroquel, and his other meds should not be taken all at once.  Semi-responsive, he kept mumbling about needing to get home for his son, who alternated between two years and two weeks old in his description.

Meanwhile, out in the waiting room, his only slightly more put together girlfriend showed up in hysterics, sobbing about how she needed to see her sweetheart.  The triage nurse explained that he could not have visitors until after being evaluated by the psychiatrists.  At that point, she decided that she, too, was suicidal and needed an eval, but rapidly changed her mind after learning that they didn't have double rooms in the psych ward.

Every five minutes for the next hour she ran up to the desk asking for an update, until she was finally asked to leave.

I'd like to think that I would do anything for love, but feigning suicidal ideations in order to spend quality time in a pysch ward with my overdosing significant other?  I won't do that.  

Sunday, October 12, 2008

Dude, Where's My Chopper?

Headed up to the top of the hospital yesterday afternoon to receive an incoming severely hypertensive pregnant female transfered by helicopter from a small town hospital several miles away.  Once the helicopter touched down, I ran up the ramp with a stretcher, and with the rotors spinning overhead, slid her out the back along with the flight nurse and flight medic.  

We brought her down to OB and I helped transfer her over as the flight team gave report.  After maybe 15 minutes or so, I accompanied them back to the elevator and up to the helipad.  

The only problem: no helicopter.  

There are some areas of the Big City where I'd think twice about leaving my car, but I assumed the roof of the hospital would be a pretty safe parking spot.  I turned to the flight team, who figured that the pilot had flown to a nearby airfield to refuel.  While we waited for him to return, I enjoyed a great view of the Big City with the leaves starting to change, and didn't really want to return to the madness below once the helicopter finally landed.

Saturday, October 11, 2008

Friday Night Light(weight)s

Another Friday night at triage, and another deluge of drunk Local College students occupying the resources of a Level I trauma center.  No less than six drank their way in last night, with only one of them blowing over .200, but all of them covered in very foul-smelling vomit.

In between the string of future politicians, we had a high school football player delivered by EMS after experiencing some tingling following a rough tackle.  One of our trauma nurses happily broke out his Leatherman to unscrew the helmet as we did our best to remove his pads without cutting through everything.  He was a cool kid, who thankfully ended up with full feeling and motion in his extremities, and was able to walk out in some chic paper scrubs a couple hours later (right before the next wave of drunks hit).

Friday, October 10, 2008

Multicultural Awareness

Pt: "Hey buddy, get me that Chinese orderly, would ya?"

Me: "...I think you mean the Filipino nurse who's taking care of you, sir."

Pt: "Yeah, whatever."

So much for the era of political correctness.

Thursday, October 9, 2008

Buy U a Drank

I had just started my shift in our critical care area the other night when, just like on a game show, the chorus of ringing alarms led me to check out what lay behind curtain number three.

My prize was a 60s-ish looking female shivering in the stretcher, with multiple liters and one banana bag hanging, whose heart was pumping away with a rate in the 180s.  I hooked the patient up to the EKG, and started running a rhythm strip as the nurse began to push adenosine.  Almost instantly, the patient started moaning, but within a few seconds her heart rate had dropped to 90 and the attending looked relieved.  

After half a minute or so, the heart rate jumped back up to 225 and her pressure dropped to 80s/70s.  While the nurse ran to prepare a diltiazem drip (a calcium channel blocker to slow the tachycardia), I went to grab the defibrillator. With the patient's pressure continuing to slowly drop, and the attending getting increasingly anxious, we just stared at this gallon-a-day drinker while waiting for the medication to be ready.  And then, all of a sudden, her heart rate spontaneously dropped down to 95, and she remained in normal sinus for the rest of the night.

Alcohol withdrawal's a bitch. 

Wednesday, October 8, 2008

Damn Doctors

Why is it that those good-for-nothing doctors never treat you for what you come in for?  Why do they refuse to fix what's bothering you and instead run a bunch of fancy tests to waste your whole afternoon, and then keep you overnight!?

Take my older gentleman over in bed 8 the other night.  All he wanted was for somebody to take a look at his ear.  It had been hurting on and off over the past week, and since he didn't have a doctor of his own anymore, he figured he might as well stop by the ER and get it checked out... could it be wax? The pain came in waves, you see, and he felt his hearing was going a bit in the bad ear, too.

But leave it to those doctors to ignore the ear pain after he told them that whenever his ear hurt, his chest hurt too.  Didn't they realize the problem was with the ear!?  Instead of doing what they were told, those quacks kept rambling on about the whatchamacallit... flipped T-waves on the EKG and some abnormal blood tests.  His blood was just fine, thank you very much, and if they fixed that darn ear he was sure the chest pain would go away too.

Damn doctors.

Tuesday, October 7, 2008


I should have realized I'd jinx myself the other day when I wrote about overhead pages not applying to the ER.  Walked in to work the other afternoon and discovered we had just lost a traumatic cardiac arrest an hour or so earlier - never a good way to start off.  Not long after the beginning of my shift we received a patch for an incoming bad MVC with prolonged extrication and a heart rate in the 30s.  I poked my head into the trauma bay once she arrived, and even I could tell this one was in pretty bad shape.  A few minutes later, after I had returned to my area, I heard several pages for the code team to CT, where the patient went into cardiac arrest and died.

Shortly thereafter EMS delivered a (surprise!) no-helmet motorcyclist who crashed head first into a passing car.  Also in bad shape, sporting a CT-revealed head bleed, he was rushed up to the ICU.  

A few hours later our last major trauma of the evening rolled in: a frail-looking 86 year old female who had fallen down a long flight of stairs.  She was a train wreck - multiple fractures, bruises and lacerations, and a pressure in the 70s.  Every time we tried to move upstairs, she turned south, and eventually they discovered a cardiac tamponade on the ultrasound, resulting in a quick page to CT surgery.  The resident ran down, grabbed a big-ass needle, stuck it into her chest, and drew out the blood that had accumulated around her heart.  He then jumped back on his horse and rode off into the sunset, looking for other lives to save. 

Monday, October 6, 2008

Reasons I Love My Job

I get emails from work with the subject line: "Urine and sputum samples."

Thank You For Not Screaming

Normally I hate sitting with psychiatric patients.  When our psych unit is full and no sitters are available to come down from the floors, ER techs get pulled from their assignments to sit with the psych patients and make sure they don't kill themselves or escape or whatever, and it is by far and away the worst part of my job.

That said, I am currently swamped with studying for upcoming midterms, and actually appreciated the opportunity to review my notes while watching a trio of interesting characters the other night.  So, in that spirit of gratitude, a few thank yous are in order...

Thank you, 48 year old Soccer Mom, for overdosing your on your Percocets and choosing (by virtue of having your family call 911) to spend your evening with us in Big City ER.  Though I was unable to help you in your request to "get the fuck out of here," I enjoyed the time we spent together as you drooled all over yourself while dozing.

Thank you, Creepy Girl, for sitting quietly while buried under blankets and peering at me from underneath your sweatshirt hood.  Thanks also for not listening to the voices that told you to throw the nearby suture tray at the staff until after I was done watching you.

And finally...

Thank you, Stressed Out College Student, for taking 10 Xanax for your "nerves" and not crying until after they took you to the psych unit for further evaluation.

Thank you all for your efforts to support my education.

Sunday, October 5, 2008

The Fool On The Hill

If your brother died last month from a heart attack after smoking crack, don't you think that might be a sign to end your own cocaine habit?

This was the question posed to a 32 year old male patient who arrived via EMS complaining of 10/10 chest pain after smoking "a bunch" of crack an hour prior, aka the same behavior that killed his brother.  Granted, this gentleman had a large scar spanning his skull, and between that and the drug use was probably playing with a few spades short of a full deck.

Sometimes you can't help but to shake your head in wonder.  It's sad.

Saturday, October 4, 2008

When I'm Sixty-Four

APRN: "It says on the list you gave me that your husband is on several medications for  his high blood pressure, diabetes, high cholesterol, asthma, and arthritis.  How many pills does he take a day?"

Pt's Wife: "Oh, he doesn't take any of those any more."

APRN: "Why not?  These are serious conditions that he needs to be medicated for."

Pt's Wife: "Well, his prescriptions ran out you see."

APRN: "Why didn't you have your doctor refill them?"

Pt's Wife: "Because our doctor died, dear, and I haven't found one we like yet."

APRN: "How long ago was that?"

Pt's Wife: "About five years ago this November."  

Friday, October 3, 2008

You Can't Please Everybody

Just got back from a long eight-hour shift full of truly sick patients.  It was one of those nights that's rough for everybody - we were short-staffed, results were slow, hallways were packed, we had no available beds and no transporters to bring patients anywhere.  For half the shift I covered two teams and moved nonstop from one patient to the next, dealing with the demented, dying, psychotic, manipulative and abusive people that tend to accumulate on nights like these.  

And unfortunately, on nights like these people wait.  There comes a point when there's simply nothing more that can be done for a patient in the ER, and until a floor bed is available they're stuck with us.  It's not because we're lazy or we don't care; we had techs and nurses wheeling people up all night, I tried my best to do whatever I could - grab an extra blanket or pillow or food tray - for everyone who was forced to wait for hours.  

So at the end of my shift, after half and hour of standing at the bedside and holding a neb treatment up to the face of a demented and severely wheezing old woman who had fought with us all night and would not tolerate a mask, I passed by my patient who had been waiting all afternoon and evening for a bed and who I had told earlier that I would try to find a phone for him to call his daughter.  

As I walked past him to go punch out, having forgotten in the commotion to get him the phone, he looked at me with this disgusted leer and said, "You know, you people are all the same.  You all promise you're going to help someone, and you never do."  And I realized that sometimes you just can't win.  

Thursday, October 2, 2008


Impressive x-ray of a kid who had been stabbed in the head while trying to prevent a robbery (definitely something you don't see every day).

The second half of the video talks about a 12 year old who was found driving drunk... unbelievable.

Stairway to Heaven

Overhead pages - asking a patient to return to their unit, calling our ICU-based code team to a patient's room - are generally ignored in the ER because they never apply to us (the one exception being pages for respiratory/anesthesia/code in CT, when everyone pauses for a second and thinks, "Is that my patient?").  

A couple weeks ago I was working at triage when a code was called in a stairwell on the 5th floor.  As usual, nobody thought anything of it until a minute later, when the trauma team was paged to the same location.  Another nurse and I started wondering what was going on up there, when one of the other techs came and grabbed me to help bring a backboard and collar up to the patient.

Huffing it up the stairs rather than waiting for the elevator, we noticed a few drops of blood leaking from the 4th floor landing to the 3rd.  The 4th floor had blood streaming down its walls, and by the time we reached the crowd of doctors, nurses, respiratory techs, and curious bystanders huddled on the 5th floor landing, we discovered where it was coming from.

An older female, who was visiting a family member in the hospital, had stumbled and fallen down the stairs, giving her a nasty and deep laceration on her skull.  Fighting to maneuver the backboard through the crowd, I helped the other tech slide her on as we waded through the blood that had only recently been controlled.  We carried her back up the stairs to a waiting stretcher (just like stairwell extraction in EMT class), and then ran back down again to meet her in the trauma bay, where she received some well-deserved stitches.

Wednesday, October 1, 2008

One Thing at a Time

Listening to the EMS radio out at triage, I overheard a patch for an incoming GSW punctuated by sounds of screaming from the back of the ambulance.  I made my way over to the trauma bay and helped prepare the room.  A few minutes later, EMS arrived with a 28 year old female sporting a single through and through GSW to the left lower extremity just below the knee. 

In between shrieking about her pain and swearing at us for cutting off her clothes, we learned that she had been parking her car when her ex-boyfriend approached her.  The two argued, and he promptly shot her in the leg before she could even get out of the car.  All the screaming quickly stopped, however, once the ultrasound machine was brought over to check for internal injuries.  

As the probe moved over her belly, she smiled at the resident, and politely asked, "As long as you've got that thing out, would you mind checking the placement of my IUD?"