And so on

I've had a very strange week at the hospital. Last Wednesday some things took place that while inappropriate to detail set the stage for me to make a good impression on the staff quite inadvertently, and have been told to apply the next time there is hiring, and for the first time, I believe that I have a fair chance at a job all because I did something that I didn't want to do. Again, sorry for the lack of details--let it suffice to say that it's best to do the right things, always, even if it embarrasses the hell out of you.

So today I saw head trauma at its best. The patient fell down a flight of stairs and from the looks of it, destroyed her head. Massive amounts of blood gushing out of seemingly everywhere. It's common knowledge that the head bleeds profusely when injured, but my goodness, to see it is something else. Making matters more complicated was the fact that she was hearing disabled, and so to try and evaluate a patients level of consciousness is difficult when that person cannot communicate through words. For fear of brain bleed and spinal cord issues, a CT scan was ordered, and I got to see the inner most parts of this woman's head.

We also had a patient today who accidentally lit his leg on fire after dropping a cigarette after pumping gasoline (nice combo!). He suffered from second degree burns, and last time I checked he was on massive pain medication.

I assisted in the suturing of a little girl who was playing with a knife (imagine letting your two year old mess with a kitchen knife, grr!) and surprisingly she lacerated her index finger. I'm fairly certain my ear drums are destroyed from all the bloody murder screaming she did into my ears as I tried to help her.

And finally, a patient was presented to the ER for abdominal cramping--she was five weeks pregnant and had noticed some vaginal bleeding. Upon a pelvic exam it was determined that she was actively having a miscarriage. I wasn't in the room for the exam, but suddenly a Tech appears with a small container labeled "dentures". However, when she opened it up, and showed me, there before me lay the miscarried fetus. While it was not very developed, there still was a sense of sadness because while some may argue that it was never alive, I do hold to the belief that it was a forming human being, who for whatever reason had died.

Not to end on a sad note, though....
I'll be back on Saturday, and hopefully will have more tales to share....

How many firemen...?

My very first patient of the day was someone who had severely lacerated his thumb with a knife and needed sutures. He was extraordinarily nice chatting with me about how he had once been an EMT. He tells me that I should work at Children's Hospital because I have the "demeanor" for it, and that I would be well received with patients and staff. I took this as a compliment until he followed through with that I would probably not be able to deal well with adult patients who yell at me or are rude to me. Ha. If only he knew how wonderfully some people treat me!

As this Internship progresses, I am finding myself not stunned, shocked, or phased by much anymore, except for a few things. Can you guess what they may be?! I do however, keep waiting for my first dead patient....it has not yet occurred but I really thought that it would today. We had an elderly woman who had passed out for seemingly no apparent reason and upon presentation to the ER her heart rate was about 34 beats per minute. As I adjusted her monitoring system thinking that there was no possible way her pulse could be that low, her heart was going into all sorts of wacked out rhythms yet she continued to speak to the staff as if this were an ordinary doctor visit, even while staff is wheeling in the crash kit and an AED (Automated External Defibrillator--bad news for you and your heart if you need to be shocked).

She passed out again at the hospital while using the restroom and apparently her heart stopped momentarily, but spontaneously restarted. Last I saw of her she was meeting with a cardiologist and being wheeled to the Cath Lab.

My favorite patient of the day was a woman who had fractured a vertebrae in her back and was in severe pain. Since mostly men were working today, guess who was in charge of following her around when she got up to use the restroom...? She just kept repeatedly saying "Shoot. Ow. Give me a minute. Shoot. Ow" Over and over again. And she'd make this weird grunting sound--difficult to reproduce but we generated odd looks as we transported her around.

Second best was an almost 700 pound man who was whiny and nasal and generally.....difficult. Unfortunately he needed to be transported to another hospital, but it is extremely difficult, (if not impossible) to move this heavy of a patient from one bed to another without collapsing or further damaging the patient. So, we called in the Firemen. Not one, or two, or even three. We called in ELEVEN of them, and also had staff members assisting his transition. Now you can start the joke:

How many firemen does it take to move an almost seven hundred pound man?

As he's being moved from one bed to another, he's complaining about how his oxygen is getting cut off, he can't breathe, they're hurting him....the works. Staff told me that he's become so accustomed to not doing anything anymore he relies on everyone else for....everything. I'll never forget the sight of seeing him transported away. He had no shirt on, and was literally pouring over the sides of the bed, every which way. In fact, this man weighed so much they couldn't even lift up the cot to put him in a more comfortable position.

Of course every day here is something awkward. I've been seeing a lot of old person body parts of late, something I could certainly do without. But I hear it's all part of the job, so maybe one day I really will get used to spreading a woman's legs as we place a urinary catheter, or not blush when people (men) seem to lose all their pride when walking through those ER doors and let everything hang out--whether we want it to or not. ;)

The days of this Internship are speeding by and as time progresses I am finding myself more and more at home in the ER and quite at ease with the staff--and they me. I'm quickly discovering that my time there is not enough, but I relish every moment--even with those special patients who come my way.

Looking Up

I don't want to speak too hastily, but I believe that I have finally fit in with the staff of the hospital. I realize that this may sound a bit silly, but you know when people like you and when they're pretending to like you. How, in a weeks time we can joke around with each other is beyond me, but I am plum pleased.

So today I got to see live and in person my very first drug addict. It was weird walking into the room with my Tech because you immediately knew that something was wrong. When asked why the young lady and her friend were at the hospital, there was a lot of silence, then some hemming and hawing, and then a "she missed her vein". This young woman is lying on her bed looking freaked out and kind of scary. She's balding (common for meth addicts) and though at first glace you'd know something was wrong, I doubt you could guess she's a drug addict. Unless of course you examined her arms-- she has enormous bruises and welts covering the entirety of both arms.

The Tech explains she and I need to do a blood draw, and this patients friend states that she may become "agitated" and that the blood draw will be "difficult". As if on cue, the patient begins moaning, crying, whining and screaming that we're hurting her. Unfortunately, she began this crying before the needle was even in the skin. It's amazing that a vein was even able to be located, to be honest. Drug addicts veins are a tad different than those who do not use drugs. Imagine that. Apparently her friends frequently shoot her up, so why this IV/blood draw was so painful was beyond me. However, she was badly infected in many areas and running a low grade fever, so even she needed medical attention.

In my down time today, the ever so courteous staff allowed me to start IV's on them. Surprisingly, their techniques are a bit more complicated then what I learned in class, so it was an excellent refresher and a lesson in what I can do better for when I am doing this on real life patients who need help.

I went with a 96 year old patient to have an MRI done today. It was sad seeing this poor elderly woman in terrible pain from a fall with no family by her side. As the Nurse prepped her for the MRI, removing her false teeth, I realized how much it sucks to get older. I know it sounds sentimental, and perhaps corny, but have you ever looked at an elderly person an wonder who they were when they were younger? All that lay before me was a frail woman, barely cognizant, no teeth and in immense pain. Surely she is much more than that, but at that moment, she was merely another patient in the Emergency Department who needed an MRI.

As it turns out, the person doing the MRI had gone to high school with my brother, so I introduced myself and got an invitation to return another time to go over some case studies and other things of interest. Ahh, it pays to know people ;)

The MRI machine cost three million dollars, and per patients costs over $4000 to have one done. Should you be wearing anything metal, it literally will be ripped off your body and can/will impale the poor patient. The magnetic force is so strong that it has the ability to lift a car. And, the newer the machine, the louder it will be. It's amazing to watch an MRI in progress--the human body is simply amazing, and this machine details the intricate workings.

So, another great day down at the hospital. The staff are now asking me when I'll be back.

Things are looking up.

Reverse

If anything, today was entirely different than Monday. The highlights of today were the lowlights of Monday and vice versa. I'm grateful that there are people looking out for me, and give my utmost thanks first and foremost to those who are trying to get this Internship to work better so that the experience is even enjoyable than it already is.

Considering I was only at this hospital two days ago, I was recognized by most of the staff, and have noticed that I've already begun making friends here. (!!!)

First patient of the day was a rather large man with severe right lower quadrant pain. He had a cardiac history past, but it was my understanding that this was not a cardiac issue. When left alone in the examining room with him, I found that I had little to say besides questioning him about his pain and where it radiated to, and I realized that I'm in a totally different place than I've ever been. I've somehow gained this right to ask people pertinent questions about their visit to the ER and they actually treat me with respect. I've noticed that almost all the patients I've come in contact with are openly willing to share their life story. To cut to the point, it's amazing.

The ER was not busy today until about an hour before I left. However, I divided my time between following Techs, Nurses, a Physicians Assistant and a Doctor. Everyone here seems very open and willing for me to shadow them and are open to questions about any procedure.

An elderly man came in with scalp avulsion (a forcible tearing or surgical separation of one body part from another) and I got to watch as his scalp was literally stapled back together. Bloody, but fascinating.

Another moment I was assisting with an EKG when the announcement "Code Blue" was announced. Code Blue is the secret term for active CPR in progress, and all of a sudden, I admit, I got terribly excited. It was only then that I realized how morbid I am: I get excited because there's the possibility I could see people dying. Fortunately for the patient, his heart had only temporarily stopped--then started again--so the code was called off.

I also assisted/watched two urinary catheters placed, but this time in placed in women. Let me tell you, this is no better an experience than watching/assisting it placed in men. It's gross, uncomfortable, and makes you feel strange internally...difficult to explain unless you've seen the procedure.

I paid a visit to the psych ward where there are always the best of the best just waiting for you to meet with them. In this case, it was an unruly woman who was playing the lively game of "Guess how many times I can say a four letter word that starts with F in less than five minutes" Let's just say the count was extraordinarily high--and I had to help draw blood on her. Psych patients sure are special...

A call from the ambulance came in for an unresponsive woman with bradycardia (slow heart rate) so the room was set up and I eagerly awaited her arrival. She came in with a dangerously low blood pressure and respiratory rate yet managed to stay somewhat aware all throughout. The Doctor placed a Central Venous Catheter into this woman's chest where her subclavian vein is located (right below where the clavicle bone is located). This is quite a procedure to watch and I was right next to the Doctor. He placed the catheter, slit open a small portion of her chest with a scalpel, drew some blood, kept the catheter in and stitched it up. To me, simply amazing. To the staff, more than likely, a normal day at work.

My final patients of the day were two people involved in a car accident. I got to attend to this little girl who was dearly sweet and very concerned that her pulse, blood pressure, and pulse oximetry levels were not good enough. She was also asking what happens if she "stops doing good". Fortunately, her exam checked out just fine but on the way home I happened to see where the accident had taken place, and the damage was extreme--the little girl was fortunate to walk away from the accident with no damage.

I look forward to next week....let's see if anyone remembers me, and if maybe this time I'll be able to participate in more patient care. I'm itching to do an IV/blood draw again...

:)

Almost Lost

Where to begin...

The day started out excellently. I arrived at my designated time after rushing over from my medical terminology class, nervous as can be. I enter the ER and standing there is the Tech I first had months ago when I was a student and completing my clinicals. She instantly recognized me and ushered me into the department, quickly introducing me to staff including very friendly Doctor's and Nurses. One of the other Techs actually said he remembered me from my first clinical there. Imagine that!

So everything is going great, the Tech that I am assigned to is wonderful and I'm feeling huge relief and major thankfulness that the day is going swimmingly. The department is busy, and I'm following the Tech going room to room assisting with everything, and feeling generally great about it.

And then...

In walks a Paramedic in training. He approaches me and asks what I've seen so far. For some reason, I'm stumbling over medical terms, and generally sound like I have no idea what I'm talking about. I tried to relay the info to him about a man who is hypotensive (low blood pressure) and tachycardic (fast heart rate). We chat, and he tells me to go listen to an elderly woman's lung sounds. I reply I don't have my stethoscope. FAIL!! He wasn't pleased, but after some begging, he loans me his. I leave feeling rather sheepish.

I enter the room and ask the elderly lady for permission to listen to her lungs. I tell her to take a deep breathe, she does, then holds it for a long time. (Psst, don't do that) I tell her to exhale. She does. The key to breath sounds is to inhale and exhale in an even manner so that whoever is on the receiving end can listen and see if there are issues. This lady also has a horrific cough (result of COPD and emphysema) so all I can really hear is diminished breath sounds bilaterally (both lungs).

Did I also mention that her friend told me that this lady is feisty, and my dear patient also proudly announced that she is...er...the term for a female dog? Imagine all this coming from a very cute looking woman in her mid eighties! All things considered, this made it a bit tough to get the job done.

I head back over to the Paramedic in training, and explain to him what I've heard. He begins this series of questions about the respiratory system. I was pretty much lost at the beginning, and as he questioned me, I realized how little I know, and by the time our conversation was finished, I was convinced he thought I knew nothing, and I felt quite poorly about my lack of knowledge.

Thanks to my excellent Tech she re-assures me that I'm fine and then allows me to do EKG's (electrocardiograms) on a few patients. It goes marvelously, and I'm starting to feel confident in my skills.

Until discouraging moment number two occurs. (I'm telling you, this was not my day)

The director of the Emergency Department approaches us and tells my Tech that I am not allowed to do anything in the way of patient care. No EKG's, no splinting, no vitals, no nothing. Her explanation? How does she know what I have learned in school is compatible to what the hospital has its employees do? As I tried to explain she kept putting me down in the name of "not trying to put me down", and telling me that I'm untrustworthy and overall, may not be competent, because really, she has no idea who I am.

Sad moment indeed.

Honestly at this point, I don't know what I would have done without my Tech. She is a marvelous woman who is real, honest, and professional. We talked about the issue at hand and decided that what I needed to do next is get in touch with the EMS director at my school and see if we can get this issue straightened out because really, what's the point of me spending all this time and money if all I can do is stand around and watch? I'm not allowed to do anything hands on, so I honestly was very discouraged.

Bad as the day looked; I still wound up having fun and enjoying myself:

• A man walked up to me with a cup full of urine and asked me what he should do with it (...)
• I went to take a temperature on a 95 year old woman and she thought it was a rectal thermometer, so she began lifting up her gown. I told her it was for her ear, so she opened her mouth instead
• A man told me that "walking" was just too much of a nuisance (nothing was medically wrong with him)
• The man mentioned earlier who was hypotensive and tachycardic told me jokingly that he's "dying" and hates "when that happens"

Some days will be good.....others will be bad. But you know, I'm going to keep plugging away at this with all that I have. Maybe it'll all work out eventually, and if not, I have the benefit of standing in the corner of the medical rooms getting to watch everything done on the patients. I'll be officially the best observer on the planet ;)

What an adventure, indeed.

"Develop success from failures. Discouragement and failure are two of the sureest stepping stones to success."