I really should be cleaning the house. There's a whole list of stuff I need to do this weekend while the kids are gone, but I mostly find myself staring at my computer screen or blankly off into space. Sometimes I come out of it long enough to dab at the drool collecting in the corner of my open mouth with my shirt sleeve.
Night shift is getting to me.
Spent Friday with MixMan getting a CT scan and then fighting with the MRI tech about what test he was doing. . .he insisted on a full brain scan: 40 minutes in the imager with an IV for contrast for an 8 year old OCD deaf kid afraid of needles? HA! and I tried to tell him this wasn't for a diagnostic, it was specifically for the surgeon to be able to see the inner auditory canal, or IAC, for placement of the cochlear implant. I pointed that out to him on the order sheet from MixMan's PCP: "MRI IAC." and this is what he said:
"I've done brain MRI's on lots of deaf people. And I'm sure many of them have gone on to have cochlear implants."
Whaaaat?
Had a pretty good stretch at work this last weekend. Several drunks with head injuries, shocker there, eh? One of them apparently slipped on some peanuts at the Roadhouse and smacked her head on a table. Medics brought her in, she kept insisting she had a right to refuse treatment because of her religion, paganism. umm. okay. She loved the boys, though- the security guard, the CT tech, the 60 year old male nurse. Oh, yes. But anytime one of us girls would walk by her room, she'd yank the pressure bandage off her head, wave her arms around, scream, threaten to sue, and then start spurting blood in wide arcs from the little arteries she'd sliced open in her scalp. When we finally sedated her enough to suture, I had to hold a flashlight above the lac so the doc could sew, since our portable light in the psych room wasn't good enough. With the flashlight, and the blood everywhere, I kept thinking I heard choppers and the theme music to MASH playing somewhere outside the room.
My favorite patient was the LOL who came in from a nursing home, hx of CVA with right sided deficits, with sudden unexplained weakness in her left arm. CPHSS was normal otherwise. Staff said she was somewhat unresponsive and not her usual self. Excuse me, but if I'm not working, I'm usually somewhat unresponsive at 0300, too. Sheeesssh. But she's all dressed up, hat on at a jaunty angle, mardi gras beads around her neck, and I asked her if she got all gussied up just to come to the hospital. "Nope," she says. "I always dress like this." I find this rather curious, ask her what jammies she wears to bed. "I don't wear jammies. I like to be ready."
I'm a little confused by now, and I'm pulling off her hat, and glasses, and beads, and fuzzy sweater, and button up shirt, and tank top, and thinking of all the possibilities of what she could be ready for, this little old lady from a nursing home. So finally, I ask. And she says, "whatever might happen!! you never know when somebody is going to ask you to go dancing."
Well. She has a point.
Sunday, April 6, 2008
Friday, April 4, 2008
sooooo. . .you may have noticed something different
yeah, I changed the name. Since I can't really play in traffic anymore, and I spend the time I'm not at work puttering around at home instead of dinking around in the back of an ambulance or running into burning buildings, and while a lot of my posts are about Meth Central Med Center ER, many have been about home and gardening and single parenting and MixMan and Miss Diva, so I thought perhaps it was time for something a little different. But. . .a rose by any other name still smells as sweet. So remember that the next time I'm writing about patient vomit and such.
Thursday, April 3, 2008
there we were, in the congo
humans are not meant to be awake in the middle of the night. I look at some of the hard core ER nurses who have worked night shift for thirty years, and frankly, I don't ever want to be like that.
The docs have started a new schedule rotation so they can maintain a little consistency. This entails working the same shift for a month. There are a couple of doctors I'm not all that fond of, but they're completely different people at night. Particularly after the fourth or fifth shift, when they start getting a little punchy. Doc D, who on days is rather serious and nitpicky, and likes to micromanage, has scolded me on more than one occasion, but the other night, as I was headed into the fray with the IV tray, one of our critical patients with an Na of 108 started moaning and yipping. (those electrolytes. . .) Doc D looked at me, waggled his eyebrows, and said in his best gather 'round the campfire voice, "there we were, in the congo. . ." and the nurses' station erupted with laughter. Except for the charge nurse, who is one of those previously mentioned hard core thirty year ER night shifters. She doesn't much laugh at anything.
but tonight rounded off my last of 6 in a row, so now I've got a few days free. That makes for a happy firefighter girl. New tattoo tomorrow, an ACLS recert on Monday, snowboarding on Tuesday with the Rock Star, and the fact that the sun has been out for three straight days in a row makes me even happier. Besides, you just know, when you've hardly had any sleep because the kids need you, and you're heading into a 12 hour shift and you're so tired you can barely get the straw from your Starbucks lite honey frappuccino into your mouth as you walk down the hall for report, and the nurse stops you and says there's a junkie on bed 10 who desperately needs an IV and everybody else has already tried their two times and you put your coffee down and you walk in the room and you smack your head on the monitor so hard you see stars and you still manage to get the EJ on the first try. . .then, you just know that life is good.
The docs have started a new schedule rotation so they can maintain a little consistency. This entails working the same shift for a month. There are a couple of doctors I'm not all that fond of, but they're completely different people at night. Particularly after the fourth or fifth shift, when they start getting a little punchy. Doc D, who on days is rather serious and nitpicky, and likes to micromanage, has scolded me on more than one occasion, but the other night, as I was headed into the fray with the IV tray, one of our critical patients with an Na of 108 started moaning and yipping. (those electrolytes. . .) Doc D looked at me, waggled his eyebrows, and said in his best gather 'round the campfire voice, "there we were, in the congo. . ." and the nurses' station erupted with laughter. Except for the charge nurse, who is one of those previously mentioned hard core thirty year ER night shifters. She doesn't much laugh at anything.
but tonight rounded off my last of 6 in a row, so now I've got a few days free. That makes for a happy firefighter girl. New tattoo tomorrow, an ACLS recert on Monday, snowboarding on Tuesday with the Rock Star, and the fact that the sun has been out for three straight days in a row makes me even happier. Besides, you just know, when you've hardly had any sleep because the kids need you, and you're heading into a 12 hour shift and you're so tired you can barely get the straw from your Starbucks lite honey frappuccino into your mouth as you walk down the hall for report, and the nurse stops you and says there's a junkie on bed 10 who desperately needs an IV and everybody else has already tried their two times and you put your coffee down and you walk in the room and you smack your head on the monitor so hard you see stars and you still manage to get the EJ on the first try. . .then, you just know that life is good.
Tuesday, March 4, 2008
hey, Monkey Girl? I have that cold, too. I begged a doctor the other night to puncture my sinuses with a 14g since the holes at the bottom of my nose aren't quite doing the trick. Note to patients: when we give you a mask? wear it. I don't care how "uncomfortable" you think it is. If you don't wear it, you may find yourself getting sneezed on while I'm starting your IV because I can't let go of the catheter to grab a tissue or you'll bleed all over the floor, and we can't have that, now, can we?
Right now in the Meth Central Med Center ER, we all sound like lounge singers. we're gonna install a baby grand at the nurses' station, get sequins and bling for our green scrubs, and wear stiletto Danskos. Whaddaya think?
Right now in the Meth Central Med Center ER, we all sound like lounge singers. we're gonna install a baby grand at the nurses' station, get sequins and bling for our green scrubs, and wear stiletto Danskos. Whaddaya think?
Monday, March 3, 2008
the (Grateful) Dead had it right. . .sort of
so i've had a few medic students in the ER doing their clinicals lately, and it's made me a tad introspective. I had a couple of them tell me they passed first term at the head of the class because of me, and that makes me feel weird but good, especially since my first preceptor during my own internship two years ago told me I needed to pick a different profession. Bitch. (whoopsie, was that my outside voice?) Hell, I still get excited when I get to put in a 16g IV or shock somebody, but mostly that's because it reminds me I'm a real medic instead of housekeeping with IV skills. But watching a medic student shake with nervousness while putting in an IV or starting a saline drip, and seeing them getting excited about some broken bone they saw in an x-ray makes me a bit nostalgic, and since the honey is in Tahoe and I'm taking a little break from practicing Guitar Hero on the PS3 he left with me, and I've had a couple of beers, well, I thought I'd take a little trip down memory lane.
It's amazing to think how far I've come. Five years ago, when I first brought up the idea of being a paramedic with Miss Diva's dad (who I was still married to at the time), he told me about all the gnarly things I'd see. And maybe I got a little woozy when I had blood drawn, and I'd have to sit down fast when I started thinking about broken bones and needles. But I had a feeling that it was what I was being called to do, and the feeling didn't go away. In fact, it intensified over the next year, and I finally started the process by becoming an EMT Basic and volunteering with a local rural fire department.
My first real fire was a fully involved structure fire with a fatality. That was also, aside from funerals, the first dead body I'd ever seen. When we found her body the next day, what was left of her consisted of a head, hair intact, a flannel shirt-clad torso, and a pair of feet. The coroner used a small body bag and rested her feet on her chest before zipping it. I remember going home and sitting on my couch, the sound of traffic and shouting and my neighbors fading into the background under a strange buzzing in my head. To this day, I cannot open a box containing a Resusci-Annie CPR dummy without thinking of that woman, because that's exactly what she looked like.
The next body I saw was a woman a year older than I who drowned while rafting the McKenzie. I'd never seen pupils fixed and dilated, never seen flesh that pale blue hypoxic color. Now, of course, I'd recognize it anywhere.
Once I got past the mental block that blood is mythical and mysterious, once I got used to the metallic tang of it fresh and the sickly sweet smell of it after it had been spilled for a while, once I'd inured myself to the weight and temperature and feel of dead flesh and the crack of ribs separating from sternum during good CPR, once the smell of death no longer got to me, I managed just fine, and I'm pretty sure I've become an okay medic.
so yeah, it's harder if I look at their faces, and definitely harder if they crump in front of me. The only patient I ever lost in the field? Her daughter lives across the street from me, and every time I see her I feel a rush of shame, although there was nothing I could have done.
The babies, the ones my age, the ones that come in talking, those are the ones that keep me awake occasionally. Do I do more good than harm? Hard to tell sometimes. So maybe I spend most of my time now with other people who understand what I do for work, who aren't grossed out when I talk about boob smegma and projectile vomit and patients who shit out their mouths, and who can see the humor in being groped by a dead man. I still feel called to this profession, and I don't know really where I'm going to go from here, since the dream of being a medic/firefighter is over thanks to that one patient whose life I did save tearing my biceps tendon while I tried to wrestle him to the ground. My life has been saved more times than I can count by the patients I've cared for, the ones with grace and dignity and moxie. It's been a long, strange trip, and the compassionometer has fluctuated wildly from zero to overflowing. I would still rather feel too much than nothing at all, and so if I cry while I'm doing CPR or hugging the mother of a 3 year old Downs Syndrome girl just diagnosed with leukemia, well, that's just me, and you can look away or leave if it bothers you. And maybe I don't save a life every day, and I get a little jaded when it comes to migraines and chronic pain. But I am so thankful to be a part of this, and it is so hard to imagine doing anything else.
It's amazing to think how far I've come. Five years ago, when I first brought up the idea of being a paramedic with Miss Diva's dad (who I was still married to at the time), he told me about all the gnarly things I'd see. And maybe I got a little woozy when I had blood drawn, and I'd have to sit down fast when I started thinking about broken bones and needles. But I had a feeling that it was what I was being called to do, and the feeling didn't go away. In fact, it intensified over the next year, and I finally started the process by becoming an EMT Basic and volunteering with a local rural fire department.
My first real fire was a fully involved structure fire with a fatality. That was also, aside from funerals, the first dead body I'd ever seen. When we found her body the next day, what was left of her consisted of a head, hair intact, a flannel shirt-clad torso, and a pair of feet. The coroner used a small body bag and rested her feet on her chest before zipping it. I remember going home and sitting on my couch, the sound of traffic and shouting and my neighbors fading into the background under a strange buzzing in my head. To this day, I cannot open a box containing a Resusci-Annie CPR dummy without thinking of that woman, because that's exactly what she looked like.
The next body I saw was a woman a year older than I who drowned while rafting the McKenzie. I'd never seen pupils fixed and dilated, never seen flesh that pale blue hypoxic color. Now, of course, I'd recognize it anywhere.
Once I got past the mental block that blood is mythical and mysterious, once I got used to the metallic tang of it fresh and the sickly sweet smell of it after it had been spilled for a while, once I'd inured myself to the weight and temperature and feel of dead flesh and the crack of ribs separating from sternum during good CPR, once the smell of death no longer got to me, I managed just fine, and I'm pretty sure I've become an okay medic.
so yeah, it's harder if I look at their faces, and definitely harder if they crump in front of me. The only patient I ever lost in the field? Her daughter lives across the street from me, and every time I see her I feel a rush of shame, although there was nothing I could have done.
The babies, the ones my age, the ones that come in talking, those are the ones that keep me awake occasionally. Do I do more good than harm? Hard to tell sometimes. So maybe I spend most of my time now with other people who understand what I do for work, who aren't grossed out when I talk about boob smegma and projectile vomit and patients who shit out their mouths, and who can see the humor in being groped by a dead man. I still feel called to this profession, and I don't know really where I'm going to go from here, since the dream of being a medic/firefighter is over thanks to that one patient whose life I did save tearing my biceps tendon while I tried to wrestle him to the ground. My life has been saved more times than I can count by the patients I've cared for, the ones with grace and dignity and moxie. It's been a long, strange trip, and the compassionometer has fluctuated wildly from zero to overflowing. I would still rather feel too much than nothing at all, and so if I cry while I'm doing CPR or hugging the mother of a 3 year old Downs Syndrome girl just diagnosed with leukemia, well, that's just me, and you can look away or leave if it bothers you. And maybe I don't save a life every day, and I get a little jaded when it comes to migraines and chronic pain. But I am so thankful to be a part of this, and it is so hard to imagine doing anything else.
Sunday, February 17, 2008
Sunday, February 10, 2008
random musings of the mildly emotionally dispossessed
Mom's here visiting. She got a little worried last week when I called her bawling incoherently, crying so hard my eyelids were swollen shut, which made it difficult to drive, quite frankly. But I had just been at the home improvement store, and there was no school, and my paychecks aren't quite covering the living expenses, and night shift makes me crazy, and the kids were at each others' throats, and the lady at the home improvement store ran up and started freaking out about them playing around the big hanging rolls of carpet. So they climbed out, and MixMan started talking to me while I was talking to the lady about vinyl tile, and he's losing more hearing, and so doesn't really know when his voice gets loud, and I was trying to sign to him while talking to her, and she looked at me and said, "I can't even hear myself think." and I apologized, pointed out that MixMan is deaf, that he doesn't know how loud he's being. And she shakes her head, and glares at MixMan, and says, "I can't hear myself think to talk!!"And I guess I kind of lost it, because I said, "he's deaf, deal with it. I live it, bitch." I've never done that before in my life, called somebody i don't know a bitch.
Anyway, Mom flew over here two days later. She's kind of like me, wants to be present even if she can't really do anything. And she's as stubborn as I am. So. She's here until Wednesday, and the kids are loving it. . .all this personal attention from grandma, and I get to lounge on the what-will-become-of-me bed in my pink and green bedroom.
So I'm sitting here, listening to Sia, and keeping an ear peeled for trouble in paradise downstairs since my mom is at church and is not currently around to play peacekeeper. Mostly what I'm doing is thinking about what it means to be a parent, and a lover, and a friend, and how to balance all of those things into something that feeds the heart and soul.
I frequently think that my children are much better off with me being benignly neglectful than actively parenting. . . and I wonder how many years of therapy they're both going to have to go through because of how short my temper is with them sometimes. But they are so very forgiving, aren't they? I could learn a lot from them.
We lose sight of the fact that really, all we're here for is to relate and love and communicate with other people. What could possibly be more important than to know and be known, to open yourself up to someone else? Anything that prevents that is an excuse, and I am guilty of making those excuses myself. . . opening yourself up to the possibility of being loved, why the hell does that make us all so afraid?
I sit here, and I paint, and I listen to my music, and I drink my coffee. Sometimes I cry, sometimes one of my kids comes in and gives me a hug and a little kiss on the cheek. Occasionally, I rock back on my heels, hug my legs, rest my chin on my knees, and wonder how we all became so fragile and broken.
Anyway, Mom flew over here two days later. She's kind of like me, wants to be present even if she can't really do anything. And she's as stubborn as I am. So. She's here until Wednesday, and the kids are loving it. . .all this personal attention from grandma, and I get to lounge on the what-will-become-of-me bed in my pink and green bedroom.
So I'm sitting here, listening to Sia, and keeping an ear peeled for trouble in paradise downstairs since my mom is at church and is not currently around to play peacekeeper. Mostly what I'm doing is thinking about what it means to be a parent, and a lover, and a friend, and how to balance all of those things into something that feeds the heart and soul.
I frequently think that my children are much better off with me being benignly neglectful than actively parenting. . . and I wonder how many years of therapy they're both going to have to go through because of how short my temper is with them sometimes. But they are so very forgiving, aren't they? I could learn a lot from them.
We lose sight of the fact that really, all we're here for is to relate and love and communicate with other people. What could possibly be more important than to know and be known, to open yourself up to someone else? Anything that prevents that is an excuse, and I am guilty of making those excuses myself. . . opening yourself up to the possibility of being loved, why the hell does that make us all so afraid?
I sit here, and I paint, and I listen to my music, and I drink my coffee. Sometimes I cry, sometimes one of my kids comes in and gives me a hug and a little kiss on the cheek. Occasionally, I rock back on my heels, hug my legs, rest my chin on my knees, and wonder how we all became so fragile and broken.
Tuesday, January 29, 2008
a first time for everything
RevMedic's been giving me a tough time about the whole not posting for a couple of months thing. He can do that, though, because he's the sixth god of EMS, and he can stomach my chewy coffee when others only politely choke it down. So for him, I'll make an effort to post more often. Besides, when you have a story like this one, you have to share it.
So last night, I hadn't even been at work for an hour when a truck vrooms up to the ambulance bay and stops. The driver saunters into the waiting room and informs the triage nurse that his friend in the truck isn't breathing. He doesn't seem terribly concerned about this. She asks, to clarify, "your friend is having trouble breathing?" no, the man reiterates, he's NOT breathing. At all.
Oh.
As we pull the man out of the truck, the bizarre story unfolds. The patient had been at a friend's house out in the boonies and had collapsed. The friend had loaded him into a car and driven (rather erratically, as you can imagine) not to the hospital; oh, noooooo. To another friend's house, twenty minutes away, but also in the boonies. When I say boonies, I mean boonies. As in the northwest version of Deliverance country, where the tattoo to teeth ratio is very high, and where every single-wide trailer. . .er, um. . .home. . .has its own still out in the back yard, not for selling, but for personal consumption. But. . .I digress. So that second friend loaded the (pulseless, apneic) man into his truck, and drove the 40 minutes to the Meth Central ER doors.
By this time, the guy has been dead for well over an hour, if the friend can be believed. But because the patient is young, and he died under somewhat suspicious circumstances, and the friend's IQ is about the same as the GCS of a rock, the doctor decides he wants to work the code. We cut the man's clothes, start ventilating, get the crash cart at bedside. I start CPR. We see what looks like a very fine v-fib, a shockable rhythm, on the monitor, so we charge and clear. One of the nurses drops the arm she's putting an iv in. We all step back and the doc gives the order to shock. The guy lurches- nothing abnormal there- but that loose arm swings up with the shock and smacks me in the ass.
Imagine my surprise.
So last night, I hadn't even been at work for an hour when a truck vrooms up to the ambulance bay and stops. The driver saunters into the waiting room and informs the triage nurse that his friend in the truck isn't breathing. He doesn't seem terribly concerned about this. She asks, to clarify, "your friend is having trouble breathing?" no, the man reiterates, he's NOT breathing. At all.
Oh.
As we pull the man out of the truck, the bizarre story unfolds. The patient had been at a friend's house out in the boonies and had collapsed. The friend had loaded him into a car and driven (rather erratically, as you can imagine) not to the hospital; oh, noooooo. To another friend's house, twenty minutes away, but also in the boonies. When I say boonies, I mean boonies. As in the northwest version of Deliverance country, where the tattoo to teeth ratio is very high, and where every single-wide trailer. . .er, um. . .home. . .has its own still out in the back yard, not for selling, but for personal consumption. But. . .I digress. So that second friend loaded the (pulseless, apneic) man into his truck, and drove the 40 minutes to the Meth Central ER doors.
By this time, the guy has been dead for well over an hour, if the friend can be believed. But because the patient is young, and he died under somewhat suspicious circumstances, and the friend's IQ is about the same as the GCS of a rock, the doctor decides he wants to work the code. We cut the man's clothes, start ventilating, get the crash cart at bedside. I start CPR. We see what looks like a very fine v-fib, a shockable rhythm, on the monitor, so we charge and clear. One of the nurses drops the arm she's putting an iv in. We all step back and the doc gives the order to shock. The guy lurches- nothing abnormal there- but that loose arm swings up with the shock and smacks me in the ass.
Imagine my surprise.
Sunday, November 11, 2007
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.
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.
Thursday, November 1, 2007
levaquin dreams
Got called into the director of Human Resources office yesterday to discuss the traveler nurse and his traveling hands. I made the mistake of telling the assistant manager of the ER two weeks ago, and he was actually really cool about it. But then he told the manager, who called me into his office for another meeting. I came away from that one feeling like shit. He kept insisting that I must be suffering some ill effects from the incident. I just stared at him, told him I wasn't sleeping, but I'd get over it if everyone would just leave me alone about it. I work in the ER, for chrissakes. You have to be able to let go of things, or you'll go crazy. He finally threw up his hands and told me to talk to HR, which I put off until yesterday.
We do that more often than we think, at least those of us who are emotionally and mentally healthy. Letting go, I mean. There is a resiliency in the human spirit that we don't think of very often, but I see it almost every day. I watch patients and their families adjust to news they never thought they'd have to face. . .the smart ones, the ones who will make it, take it in stride; they let go of the whole life they had planned and open themselves to whatever it is that's been thrown at them. Sure, there's some shock involved-- "yes, ma'am, you've just been diagnosed with a very large tumor in your liver" takes some getting used to--but you can almost see the shift in their minds as they adjust and move on, and face whatever it is they need to face.
I see it in the dying, too, although resiliency becomes grace at that stage. I know that certain things take on almost mystical properties when my emotional armor gets left at home, when I'm over-tired or under stress, like I have been because of the traveler nurse issue. But we had a code a couple of weeks ago that shook me, and everyone else in the room, in the three hours the patient was there.
I'll call him John. He was 46 years old, found down by his sister and mother. No history of drug use, this guy was clean. Medics almost tubed him but he came around, and was conscious by the time he came into the ER. I sat with him, started his IV, drew his blood, cleaned the vomit from his face and neck, smiled at him, talked to him, reassured him. He looked so scared, and I told him everything was going to be okay. He nodded, and smiled, and I squeezed his hand before I left the room. His mom waited outside the room to hear the prognosis of her only son.
Next time I passed the room, they were pulling out the defibrillation pads, and John was seizing. As I was wrapping my brain around that, one of the nurses in the room screamed for me, the doctor started shouting for an NG tube and suction, and all hell broke loose. John's heart rate was over 200 bpm. We cracked the crash cart and the nurse went to push drugs, and we realized that John had sweated his IV right out. I started another on the left arm, then another on the right. And then his heart stopped.
The doctor ordered CPR started, and one of the nurses began. I shoved him aside and started compressions, screaming for a stool to stand on. Once I could get leverage, I discovered something: the chest of a 46 year old man is much different than the chest of an 80 year old man. And ribs break a lot harder and a lot louder. I could feel them pop with every compression.
We got pulses back, and then a pressure. John's left pupil was blown. We all sighed, and looked at each other, and stepped back from the bedside, shaking. The doc shook his head and ordered for the air ambulance to take John to OHSU in Portland for definitive neuro care. I left the room and headed to start a couple more IVs.
Ten minutes later, he flatlined again. His mother still sat stoically outside the room. Turns out she'd lost one of her two daughters two weeks before; her other daughter, the one who had been closest to John, was racing to the hospital from out of town. John's mom just sat, and waited. We explained what we were doing, the care John was receiving, the fact that his prognosis wasn't good. She nodded, said she'd just wait for her daughter to come.
I did CPR on John two more times before he finally died for good. The doctor called the code twice-- the first time, we had a spontaneous return of pulses before the monitor was turned off. But this is where grace in the dying comes in:
John laid there, tubes in every orifice, vomit in the creases of his neck, bedding soaked with sweat, ribs broken, wires everywhere, brain dead but heart still beating. He waited there, until his sister came, and that was truly one of the most beautiful things I've ever experienced-- watching that woman kiss her brother's face, rub his shaved head, tell him how much she loved him, told him he could go. And then he did, and nothing we did could bring him back that third and final time.
By the end of the three hour code, even the doctor was crying. Say what you will, but the human spirit is resilient. And some people who haven't amounted to much in life leave that life with an enormous amount of grace. And I am honored to be part of a leaving that is so graceful, even when I fight so hard against it.
We do that more often than we think, at least those of us who are emotionally and mentally healthy. Letting go, I mean. There is a resiliency in the human spirit that we don't think of very often, but I see it almost every day. I watch patients and their families adjust to news they never thought they'd have to face. . .the smart ones, the ones who will make it, take it in stride; they let go of the whole life they had planned and open themselves to whatever it is that's been thrown at them. Sure, there's some shock involved-- "yes, ma'am, you've just been diagnosed with a very large tumor in your liver" takes some getting used to--but you can almost see the shift in their minds as they adjust and move on, and face whatever it is they need to face.
I see it in the dying, too, although resiliency becomes grace at that stage. I know that certain things take on almost mystical properties when my emotional armor gets left at home, when I'm over-tired or under stress, like I have been because of the traveler nurse issue. But we had a code a couple of weeks ago that shook me, and everyone else in the room, in the three hours the patient was there.
I'll call him John. He was 46 years old, found down by his sister and mother. No history of drug use, this guy was clean. Medics almost tubed him but he came around, and was conscious by the time he came into the ER. I sat with him, started his IV, drew his blood, cleaned the vomit from his face and neck, smiled at him, talked to him, reassured him. He looked so scared, and I told him everything was going to be okay. He nodded, and smiled, and I squeezed his hand before I left the room. His mom waited outside the room to hear the prognosis of her only son.
Next time I passed the room, they were pulling out the defibrillation pads, and John was seizing. As I was wrapping my brain around that, one of the nurses in the room screamed for me, the doctor started shouting for an NG tube and suction, and all hell broke loose. John's heart rate was over 200 bpm. We cracked the crash cart and the nurse went to push drugs, and we realized that John had sweated his IV right out. I started another on the left arm, then another on the right. And then his heart stopped.
The doctor ordered CPR started, and one of the nurses began. I shoved him aside and started compressions, screaming for a stool to stand on. Once I could get leverage, I discovered something: the chest of a 46 year old man is much different than the chest of an 80 year old man. And ribs break a lot harder and a lot louder. I could feel them pop with every compression.
We got pulses back, and then a pressure. John's left pupil was blown. We all sighed, and looked at each other, and stepped back from the bedside, shaking. The doc shook his head and ordered for the air ambulance to take John to OHSU in Portland for definitive neuro care. I left the room and headed to start a couple more IVs.
Ten minutes later, he flatlined again. His mother still sat stoically outside the room. Turns out she'd lost one of her two daughters two weeks before; her other daughter, the one who had been closest to John, was racing to the hospital from out of town. John's mom just sat, and waited. We explained what we were doing, the care John was receiving, the fact that his prognosis wasn't good. She nodded, said she'd just wait for her daughter to come.
I did CPR on John two more times before he finally died for good. The doctor called the code twice-- the first time, we had a spontaneous return of pulses before the monitor was turned off. But this is where grace in the dying comes in:
John laid there, tubes in every orifice, vomit in the creases of his neck, bedding soaked with sweat, ribs broken, wires everywhere, brain dead but heart still beating. He waited there, until his sister came, and that was truly one of the most beautiful things I've ever experienced-- watching that woman kiss her brother's face, rub his shaved head, tell him how much she loved him, told him he could go. And then he did, and nothing we did could bring him back that third and final time.
By the end of the three hour code, even the doctor was crying. Say what you will, but the human spirit is resilient. And some people who haven't amounted to much in life leave that life with an enormous amount of grace. And I am honored to be part of a leaving that is so graceful, even when I fight so hard against it.
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