Good enough

I love the Emergency Department. I know that when I look back on this time in my life I will never forget walking through the automatic doors, into the admitting area and then being buzzed back into the ER. As I walk by triage, corner past a few exam rooms and enter the expansive department, I always glance around for staff that I know. Initially, this was intimidating--I'd often introduce myself and then there'd be that awkward pause of "Okay....now what?" But these days, I just walk right in, say hello, and get to whatever task is at hand for the moment.

The phone ringing indicating that the ambulance is trying to get ahold of the department is reminiscent of that creepy ringing phone in a scary movie indicating impending doom. But it must be answered.

The initial flow of staff when a genuine emergency is ushered into the room as they quickly rush to hook them up to monitors, do blood draws and evaluate--where I get to see staff at their best.

The interaction between the staff as they laugh and talk amongst themselves about the various patients who have come their way that shift.

All things that I will always remember.

However, with the good also comes the bad. For some reason, certain staff has chosen to either not remember me or to forget who I am, regardless of how many times I have introduced myself. This has grown tiresome. As I've stated before (probably many times) I hate the way most women treat me. I had one female Tech approach me today when the department was dead quiet and essentially tell me to not stand around, that I'm free to follow "whoever". This, I obviously know. And I wasn't standing around, either. I was waiting for my assigned Tech to return after telling me to stay put. But I digress. Treat me poorly, what does it matter anymore...(I say this cynically, don't start worrying about me just yet)

I also had a Nurse today turn and ask me for help and then look at me in horror because she thought I wasn't wearing my name badge. I was simply standing behind a patient and the badge was not clearly visible. You should have seen her face though....sheesh. Scary! Then she introduced herself....but we have met every week for the last month. Why does she not remember me?!? .....thus is my story.

And finally, our favorite pal, A. My goodness, I cannot wait until I never see them again. No one person has ever tried to annoy me more subtly than them. Ugh. I wish I could go into more details, but I cannot. And please don't get the impression that I'm insane or something of the like. I'm just saying--as I'm sure anyone reading this has experienced what it's like to have to avoid someone in close quarters....it's manageable but super annoying.

I helped take care of a woman today who has been repeatedly beaten up by various boyfriends, has a broken wrist as a result of the last one, was covered with bruises and quite obviously drunk but very sad. Not much to write about her, just someone that stuck out in my mind today. She told me that I was "awesome" and that it was nice to have someone who cares. I think often times these people are blown off because they're deemed unworthy in one way or another. It's a tough thing to see, and I know I can't do much to help, but it doesn't stop me from feeling bad for these people with no one to turn to. ....ugh. The human condition.

On the other end of the spectrum, have you ever seen someone and are struck by the fact that something is not right with them? That there is something evil lurking within? We had a patient in today who had a grand plan to kill all the Police/have them kill him. He was about 6' 6" and weighed 350....maybe 400 pounds. He was scary and as the Police and ER staff talked with him, he was clear about his intentions to kill. But his eyes....oh his eyes. There was something there that I have never seen in anyone before, and don't care to see again. God only knows what will become of this man who is intent on committing terrible crimes against people.

I asked an Ear, Nose and Throat Doctor if I could watch him perform a procedure and learned that however wonderful the human body is, there is something deeply disturbing watching a tube be stuck down someones nose and looking at the vocal cords, tonsils and epiglottis (cartilage that covers the windpipe). The Doctor was great though as he showed me how to look for deviated septums, and show me that for this particular patient her nose was just great, straight and clear for the purposes of sticking his various tubes into. Neat....but really not for me.... :)

Final patient of the day was a little boy who broke his arm while playing at the park. Typical fracture, common break for children but when the orthopedist came in, I was less than impressed as he told the child to "man up". He did a great job repairing the injured arm, but man alive...his bedside manner was severely lacking. But hey. Maybe he had a horrible day or something. Who am I to judge....

So I started my goodbyes tonight to the folks who won't be around this Saturday. Strange saying goodbye because I A) hate them and B) feel like everything shouldn't be wrapping up, really I feel like I just started. Yet, here I am.

Good enough.

Three

After today, I only have two more times scheduled to be in the ER. Funny how when I first began this Internship I thought it'd be very hard to get enough hours in, let alone complete the program. And yet, here I am....counting down the final times that I will get to have this hands on experience.

Today started off well. I got to see a man get his shoulder put back into its socket. Apparently, it's been an issue he's had for three or four years now--his shoulder just comes out way too easily and sometimes, try as he might, he cannot get it back into place. He was accompanied by a friend, and the moment I entered the room, I had that crowd pleasing effect of all the guys automatically adjusting their behavior, words, everything. (Note: this change is as evident as the light of day--there's no hiding it, unfortunately)

It took a bit of work on the behalf of the Doctor, Physician Assistant, Nurse and I, but we all got his shoulder back into place. The patient, so pumped up on Propofol was saying all sorts of silly things, but once he came to, he turned out to be quite normal, but still needed his vitals monitored.

And so, I was left in the room with two very silly, very much trying hard to impress me guys. One kept telling me how he and his friends are a "tough crowd" and his friend (the patient) relayed to me how his shoulder just popped out of socket--he was reaching for a glass of water, coughed, and out came the shoulder (?!?!)

Come discharge time, Mr "I'm from a tough crowd" comes up to me as I'm trying very hard to look incredibly busy staring at a computer screen and asks me for my number....in front of some of the other staff members. It generated many laughs, jokes, and high fives, and...a very red face from me.

The best story of my day came when I was ushered into an exam room, not quite sure who was there but based upon the urgency of the tones, I knew it was something serious. Lo and behold, there was a young man with a hand drenched in blood. It was funny--my first thought was "Hmmm. Good special effects". Nice to know my mind is geared towards false movie injuries instead of real life...

So, he's freaking out, his hand is gushing blood and I'm quickly filled in that he was cutting foam with a table saw, was guiding the foam through with his left hand when it got caught in the saw. The end result was partial amputation of three of his fingers, the worst being his pinky finger. It was not only mangled, but his bone was sticking through. I got the task of putting him on oxygen and cleaning up his non injured hand. Try making small talk with someone whose hand is falling off right in front of you.

At one point, the Doctor comes in to examine the hand and give the patient some injections, and Mr. Patient asks "Is there anything I can put into my other hand just to squeeze it?" And suddenly....everyone is looking at me. So, I glove up, hold hands with this guy and he squeezes the hell out of my hand while I try to console him.

Last I saw of him, he was being admitted to the OR, but according to the ER staff, it wasn't looking so good for his hand...the nail beds of his three injured fingers were destroyed, and the x-ray of his pinky showed incredible more than likely un-reparable damage. According to a Paramedic, due to the severity of damage to his pinky finger, it would be un-wise to just amputate that finger--there's a high chance of infection spreading to the rest of the body, so....this poor kid just may wind up losing his hand. Just like that. Word to the wise, don't use a table saw. The damage it can do is incredible.

Downward

As my internship wanes, I am discovering that I am tired of being the "Intern". I either want a job in this profession or just give up the whole idea entirely. It's not because I don't love it--I love EMS so very much, but this....this is wearing on me. Things certainly changed when the whole "situation" with A occurred. My fun times in the ER vanished rather quickly, and try as I might to not allow it to happen, everything changed. Ugh. I realize that whoever is following this blog of mine must think that I'm bi-polar....continual highs and lows. But maybe that's just the wave of the ER---up's and downs and... nothing in between. I just want a paid position now--I guess I'm no longer content in being the observer--I want to interact more with the patients.

By now you should know that most things that are presented to the ER do not phase me. Except for today when someone told me that the cute little girl in the room across the hall was being held on a psych watch for "suicidal ideations". I check her medical history and see that she's been physically and sexually abused. And for the first time since I began my ER journey, I felt something akin to my heart cracking as I thought and pondered who would do this to a child? How? The thought literally depressed me...hurt me--and I don't know why. (Minus the obvious answers)

Her and I wound up spending about an hour together today, and she had moods swings that ranged from sweet to downright mean--telling me I'm stupid because I wouldn't play the games she wanted to. It was a bit funny being reemed by an eight year old. However, once she was coaxed out of her foul mood, we had a good time as she styled my hair and asked me to sing for her--for whatever I do must "come from the heart". By the time I left, she was hugging me, asking me not to leave and just stay with her.

Other than my encounter with this child, nothing of note occurred, but I learned a valuble lesson for the day. This little girl helped me place some things into perspective, and opened my eyes to the fact that my time at the ER hasn't all  been for naught. It's all in the little things.

Having a wonderful time. Sort of.

I've come to the logical conclusions that like all of us, we have our good and bad days. I suppose that the environment of a job is much like a person--ups and downs on a frequent (or infrequent) basis. Today, it was as if the ER had a personality change from how it was last week. I often get a bit tachycardic entering the department because I have no idea what lies before me--happy staff? Angry staff? Shouldn't be so unpredictable, but life is, so really why would I expect the ER to be any different....we all have our bipolar days.

Unfortunately, not much happened today in the way of patients. Kind of a non dramatic, non trauma day. The theme for the first portion of the day was: Car Accidents. Everyone kept coming in after crashing or being hit in to. Little kids, pregnant women, men....take your pick.

 One man had been having a lot of stress lately but went to work, only to discover that he was feeling even more anxious and having strange sensations in his chest. His boss granted him permission to go to the ER but shortly on his way, he discovered that he was feeling confused and even worse than before. He then calls his boss who instructs him to come back to his job and someone there will take him to the ER. It was at that time that he passed out and crashed into a light pole in front of the Police and many bystanders.

His chest pain had only increased upon his arrival to the ER and after receiving the preliminary care one receives when experiencing chest pain, a nurse handed me a pair of Trauma sheers and instructed me to cut off his clothing. I learned that it's a lot harder than it looks---as I'm busily trying to cut off his two shirts, the thought struck me that there should be a class on how to properly remove clothing from a patient in pain. I know for one that'd I benefit greatly because I spent half my time struggling with the dang scissors and the other half methodically tearing his shirt apart. Then came the part of removing his pants while keeping his boxers on. Again, not an easy task. Comical, really--if you want to put a word onto it. Little innocent Sarah stripping a man (almost) naked. Oh, awkward.

My next favorite patient whom I only got to see for a short quantity of time was this 90 year old cute as a button lady. I believe she weighed somewhere in the 66 pound range (I'm not exaggerating) and had the strangest voice I've ever heard: Try talking in your most high pitch voice that you can attain. Then take that voice and bump it up to or three levels, and even still--you'll be far off from what her voice sounded like. It was so high pitched that for the life of me I had no idea what she was saying, so I looked like an idiot nodding my head and smiling at her as I helped transport her to another ward of the hospital.

So when the ER is having a good day, and I once more have the feeling that I'm not an outsider trying desperately to fit in, I'm quite at ease and happier than one can fathom. Below is how I've often felt when all is right in the Emergency Department:

Domino Effect

I really thought that I'd gotten beyond the point of having to introduce myself to staff and tell them why I'm at their ER. To be honest, I feel like an automated recorder now: "Hi I'm Sarah." "Are you doing a clinical here today?" "Well, no, actually I'm doing an Internship through Front Range" "An Internship? For what?" "I'm a certified EMT, and I thought it a good idea to do a voluntary Internship just to gain more experience" I'm really, really tired of saying this.

Saturday I was with Techs that I haven't yet met, and since it was two women, I don't think they quite cared to meet me. Friendly, but stiff as if I'm intruding on their work day. I understand that to them I am just a student, but come on, give me the benefit of the doubt here.

The first Tech I was with explained to me what a blood draw is, and why we would do one. Seriously? I already told her I'm IV certified, but it was if she didn't care. Methodically, she explains: "This is a butterfly needle. It's used for drawing blood" Wow! I just stopped paying attention and instead focused on the patient who was there for a voluntary psych hold because he was hearing voices. During his blood draw, he began crying. His tears were....yellow. Seriously, this man was crying bright yellow tears.

After that, my Tech left--maybe on lunch break, I don't know. I was just left standing there in the department feeling quite uneasy. I wandered around, entered exam rooms with some of the nurses and watched them evaluate patients. It was quite ordinary, overall. But one of the nurses who actually does know me was showing me this woman's feet and ankles which were extraordinarily swollen, and at the very least, at least I got to observe swollen feet. A sign of congestive heart failure, perhaps.

Another Tech--a rather tall man--nicknamed Sasquatch by some of the staff began speaking to me. Funny thing is, I've officially met him three times now, but he still has no idea who I am. Can I blame him? No. I think overall I'm not a big stand out student/Intern, so why should he remember me? It doesn't matter because for three hours he and I had a jolly time together. He told me stories from his days in the field and about his wife who is a nurse and all the exciting things she's seen. It was nice to have company, for this day was no ordinary day.

We worked together on a young man who had sudden acute lower right abdominal pain. A nurse asked us to get 'Vittles" (vitals) on him, and even though this man was supposedly in heart wrenching agonizing horrific pain, he still was aware of the fact that a young woman (me) had entered the room and was trying to coax and work on him. Funny seeing men's entire demeanors change, even if they're "dying" when I appear. I've gotten more than my fair share of admiring looks, winks, and efforts to be charming. If only they knew how they appeared to me. This poor guy accidentally kicked me in the arm as I was taking his blood pressure--I guess the severity of his pain was so bad that he could not lie or sit still.

I also helped irrigate the wound of a two year old who had just been bitten on the neck by a Black Labrador Retriever. The wound while relatively small made me wince because a) I have a black lab and b) what would now happen to the dog?

Another woman came into the ER with chest pain, and when I entered the room, she had her hospital gown on backwards. It was explained that she'd have to switch it around, and so she did--with apparantly no unease with the fact that she was topless and braless and had the biggest chest I've personally ever seen. Well, when it came down to it, I was assigned to perform her EKG, and it was quite difficult placing stickers around her enormous chest. So, I'm working on getting everything ready and she turns to me and says "Can you imagine what these were like before I had my breast reduction surgery?!" Egads. The very thought....

Alas, my big friendly giant Tech had to go work in admissions, so he had to swap places with another staff member. Unfortunately, this staff member is no longer allowed to talk to me (no lie--this is a continuance from Wednesday's blog about "doing the right thing") so I was once more alone. The other female Techs didn't want me to assist and so I once more wandered aimlessly, probably looking like an idiot. Said staff member (we'll call them A for simplicities sake) went out of their way to avoid all eye contact, and even when I was told to go into the same room that A was in, it would create an awkward and uncomfortable atmosphere.

The last patient of the day before I left was brought in via ambulance. He was ushered into the room and since A was working on the patient, I chose to not join in on the fun. But then this Tech comes up to me, completely oblivious to the fact that I'm in the ER all the time and says "You need to go into the room. It'll provide great experience. Anytime an ambulance comes in, you should go in, you don't have to stay out here". And really, what could I say? So in I went. And in the small room were the ambulance crew, a nurse, A and me. I'm on one side of the patient, A is on the other and there is no eye contact made, no words spoken. It's a bit hard to work in unity with someone who now refuses to acknowledge your existence. Not that I blame them--their job is at risk, but still--it was agreed upon that they could talk to me if it was job related. Not so much, apparently.

Well, this patient stunk. He was missing teeth, looked like a bum, and talked so slurred that I would swear he was drunk out of his mind. He was covered in urine, the bottoms of his feet were black, and you couldn't understand a word he was saying. We chose just to cut off his clothing due to the nature of the situation. When another Tech appeared and asked if we needed any help (mind you, there were six billion people in the small room already) A yells out "Yes!! We need your help!!" and so one more was added to the mix, which was fine with me because I actually wanted to get out of there. Surprisingly, smelly people gross me out.

A common mistake of EMS providers is the assumption that a patient is drunk when they are in fact, severely diabetic. This man had a blood glucose reading of over 700. Normal blood glucose is between 70 and 150 mg. This reading would thus indicate a serious medical problem. However, he was also complaining of pain in his scrotum, and the EMS provider explained it to the doctor as feeling "like a hockey puck". The doctor, a comical man turns to me and says:  "I'm sorry sir. You have.....a hockey puck" Hahaha....

The only nice part of the day that didn't make me feel like no staff member cared about my existence came as I was headed out the door. A Tech said "You're leaving? Feels like you just got here--time flies..." I know that's not very heartfelt or anything, but for a day like yesterday, it just dampened my soul. I guess I'm just not used to people not liking me, and not being able to converse with me. With the loss of A's communication, I seemingly have lost where I truly do belong. It's like the domino effect: One small change causes a similar change nearby, which then will cause another similar change, and so on...

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.