maybe a six on the grody scale

My first day back to work was halloween, and thank goodness it was slow. I'm still not 100%, but I got my sense of humor back yesterday (didn't really realize it was gone until one of the doctors looked at me and said, "you're feeling better, arent you?") It's nice to work in a hospital; I take patient admits to the floor and then turn on the portable oxygen tank on the way back down to the ER, suck some O's until I have to go back to work again. The nurses laugh at me, but they're also very careful to make sure I'm not pushing myself. Awww, isn't that sweet?

Meth Central Med Center is now a fully operational cardiac hospital. We've had our emergency cath lab open for a couple of months, and we've had a few emergency caths in that time, but my first one was last week. It was the night I was wearing new shoes, which you may not give a hoot about, but it's an important part of the story. Those of you in EMS already know what that means.

So it's about 15 minutes before my break, and we all know what happens when firefighter girl gets hungry. Well, we don't all know, but RevMedic, you can fill them in. It's not pretty. Medics call in with code 3 traffic. Their patient is a 69 year old male who crumped and did a face plant at the dinner table right into his pasta salad. Heart rate initially 20, they have him externally paced at a rate of 70, on a non-rebreather mask and an assload of versed. All other vital signs are within normal limits.

We get the guy on our table, I get him on the monitor, move the oxygen to our wall outlet, etc. etc. One of the nurses grabs me by the shoulder and hisses in my ear, "I can't get our defibrillator to pace him! Make it work!" so I sigh, and connect the our zoll to the pads already on the patient. I look up, see one of the medics watching the exchange. We try not to laugh, because this is a serious situation.

The 12-lead EKG shows some stellar ST elevation; highest I've ever seen. Dr. Twitchy is in rare form tonight, and his 3 espressos and 4 diet cokes were obviously not enough caffeine. He's going by the cath alert check list instead of his normally well-working brain, and the nurses and I wait impatiently for his orders. He ticks off the cath alert sheet-- nitro drip dopamine drip heparin drip oxygen-- and asks if the patient has had aspirin since entering the hospital. We all stare at him in disbelief, then stare at our mostly non-responsive patient, who still has pasta salad stuck in his ear, and moans occasionally with the jolt of the pacer. There is no way that man is chewing up and swallowing anything.

I try to draw blood with the third IV I start. You can tell the patient smokes- the blood is dark and thick and hard to draw, even through an 18g catheter. Lab tries drawing on the other side. We finally end up with maybe 20 mL, and as I'm pushing it into the tubes, I notice the floaties in it- little chunks of what look like butter.

I am not kidding you.

Let's remember, this is a cath alert, and the man is having a heart attack. Lest we forget, a heart attack happens when the vessels in the heart become clogged with blood clots or plaque-- stuff very similar to the chunkies sitting in the test tube in front of me. This guy is maybe 5' 10" and weighs approximately 165 lbs. He is not a large man. Although his oxygen saturation is 99%, his skin is still grayish. This concerns us until his wife walks in. She looks a lot like him, down to the gray skin. She also reeks like cigarette smoke. We're starting to have a really good feeling about the success of our impending heart catheter placement.

We get the guy onto the cath lab table. The cath nurse asks my charge nurse if I can stay to help, and that's pretty cool because I've only ever seen one of these from the outside. We get him all hooked up and they're swabbing him with iodine in his nether regions and he starts shivering a little so we cover him with a blanket and I've got all the lines and pumps untangled and running and the oxygen is ready to transfer from the gurney to the wall and I reach to hand the tubing to the cath nurse and the guy hangs his head over the side of the table and starts puking into his mask which I yank off his face so he doesn't aspirate and they're grabbing suction and he pukes again

all over my new work shoes. And my scrub pants. And the floor, and the cords and tubing and everything else. There is a moment of silence, when all you can hear is the plop plop of the puke dripping off the table. And then the guy's top dentures slip out of his mouth and clatter on the floor, and the tech behind the glass- the only member of the room not currently coated in regurgitated rotini pasta salad- tries very hard not to laugh.


on a completely different note: remember John, from the last post? We got a letter letting us know that much of his bone and tissue was used in transplants. And I wish I could tell the people who got his stuff about John's last three hours.