With the new year having come and gone, I have finally recovered enough to post a new blog. No, I was not hungover, although my body ached, my head throbbed and I barely got off the couch New Year’s Day. That’s because I worked New Year’s Eve and got my ass kicked. I’m recovered now so that I can vent, make fun of and comprehend everything that happened that night.
As predicted, the ER was quiet when I first came on shift. So quiet in fact that we didn’t staff the waiting room because NO ONE was in it. Sure some people did trickle in the old fashioned way, but the majority of our patients arrived by ambulance, whether they truly needed the ride or not, whether their complaint was a true emergency or not (always NOT). This has been an annoying epidemic for years, people arriving by ambulance because they needed a ride to the hospital for a non-emergent complaint. If health care is truly going to reform, this is one abuse I’d like to see changed.
So all was quiet… ish. Steadily ambulances would come, dropping off amateur drinkers and partiers who couldn’t make it to midnight. Or those who were too drunk to walk and fell over. Just as we’d get one settled, there’d be another one to assess. There were several raves in town NYE and good ole “X” isn’t what it used to be. It’s been super-sized, cut with GHB, formaldehyde and who knows what else because they don’t show up in our standard tox screens. The “kids” also aren’t what they used to be, for that matter. They seem to believe that they’re entitled, to nothing specific but everything in general.
“I don’t want your shitty hospital food. Order me something amazing to eat. That rave worked up my appetite,” entitled Raver demanded.
“You’re not in here for broken hands. Pick up your cell phone and order it yourself. The number’s 411. The hopital’s address is on your ID band on your wrist. Your other wrist.” Nurse Me slides curtain closed.
And because you’re altered (drunk/ high) Mr. Raver, I nor my co-workers needed your permission to perform the tox screen. You see, the “do-gooder” who called 911 for you because you couldn’t seem to get up off the floor, put you in a precarious spot. Because you’re drunk and high, we can’t legally release you but you can continue to refuse care, as you have been doing which is going to get on my nerves the second someone who REALLY needs my help and REALLY needs to be in an ER is put in the bed next to you. And because you have yet to demonstrate that you can be cooperative and play by the rules, we have assigned you a babysitter. Now I’m going to have to be without a valuable, skilled nursing attendant who can check patient vital signs, perform basic wound care, check blood sugars, hemoglobins, and transport patients to and from radiology, because YOU and 9 others can’t handle your X. Jimi Hendrix, Chris Farley, Dee Dee Ramone, Janis Joplin…never came to the ER for a bad trip or overdose and neither should you.
The rest of the patients in the ER thank you.
“No I don’t want to hear ‘one more thing.’”
“No, I’m not ordering food for you.”
“No, I’m not sharing my dinner with you either.”
“Yes, you are getting on my nerves.”
“No, I’m not going to ‘let you go then.’”
“Your attempt at reverse psychology is pitiful. And frankly you’re too high to be any good at it. You’ll get to go home once your tox screen comes back clean and you can show that you’re cooperative.”
“A couple of hours. So lay back, relax and take a nap. It’ll be easier for you that way.”
“And you don’t get to cry. Trauma nurses and docs are immune to tears.”
Well, we are. At least the tears that accompany a drunken temper tantrum attempted manipulation. We are not immune to the tears that accompany a wife’s tears as we crash intubate her husband for agonal breathing from bleeding in the brain after being hit by a car crossing the street. This man, Mr. Raver NEEDS to be here and NEEDS MY attention as well as the attention of 6 or 8 of my co-workers. Don’t even think of acting up Mr. Raver because the attention is no longer focused on you. Don’t do it, don’t try to bite through your restraints. Now you’ve done it, kicking and flailing your legs so that your stretcher is about to tip over buys you 5 mg of Haldol. A wonderful anti-psychotic drug which you’ve just demonstrated you need. Nite nite.
Now the ambulances are arriving 2, 3, and 5 at a time! Shit. I guess the respiratory therapist, 2 med students and myself can take Mr. Hit By A Car to cat scan (CT) by ourselves. Better yet, I’m going to grab one of the residents from the Fast Track part of the ER. That makes me feel better.
“Cat scan. This is Nurse Me.”
“Mr. Raver is awake and doing what?”
“Thanks, Nursing Attendant. Peek your head around the corner and call for the first doctor you see. Ask him/her to have a nurse give more Haldol to Mr. Raver. Thanks.”
My team and I return from cat scan, Mr. Hit By A Car needs a neurosurgeon stat and neurosurgery stat-er. What? We’re getting an air bus (helicopter) twofer? One in and out of consciousness, ETOH (alcohol), facial fractures and open femur fracture and the other awake with abdominal pain and distention and left ankle deformity? Shit. What, a multiple stabbing 14 mintues out? A found down-unresponsive-heavy odor ETOH-vomited on self but vital signs stable 7 minutes out? Shit, shit, shit. Divide and conquer.
“Med students, stay with Mr. Hit By A Car. Come get me if his heart rate drops below 65, if his blood pressure shoots up or tanks or if there are any arrhythmias on the cardiac monitor. Neurosurg should be here in a minute.”
Work, work, work. Assess, assess, assess. Found down ETOHer, hypothermic. 2 large bore IVs (thanks Fire Rescue!!) with warm saline wide open, foley inserted so ETOHer doesn’t pee himself, labs sent, oxygen by face mask. Respirations 9 and regular. Nasal trumpet inserted “just in case.” Heated blankets piled on, heart rate and BP OK. Lights out on to…
ETOH air bus facial fracture patient #1 surprisingly stable and airway patent. Lethargic, but rousable and answers questions appropriately. Ortho doc at bedside cleaning and splinting open femur fracture, then transport to CT, then to ICU. Distended abdomen air bus patient #2 with blood in the belly via ultrasound being run upstairs to the OR with trauma team.
Multiple stabbing man woke up Frankenstein style while having his chest cracked (emergency thoracotomy)? COOL! I mean here’s the Propofol and #8.0 OETT (endotracheal tube). Foley inserted into hole in right ventricle, running up to the OR.
Time to check on the rest of the patients. Mr. Raver, snoring. Perfect. Found down ETOHer warming up, still not conscious. OK. Drunks (7) sleeping it off in the hallway, IV fluids running. Wow, it really stinks in this hallway. Mr. Sucker Punch To The Face difficult to rouse? Shit. Crash intubate, run to cat scan. Holy crap, that’s a big head bleed. Did his pupil just blow? Shit. Neurosurgery? You’re gonna have to have someone scrub out of Mr. Hit By A Car’s surgery to come assess Mr. Sucker Punch To The Face, he needs a ventriculostomy until you can replace Mr. Hit By A Car on the (OR) table with him.
High speed MVA vs tree? Car splint in half? Patient found belted to 1/2 a car seat unresponsive, bilateral open tib-fib (tibia-fibula) fractures? 3 minutes out? Rally, rally, rally. Distracted by hot fireman showing pictures of the accident.
“I am looking closely.”
“Wait. Is that an upper body in the tree?”
“Didn’t see the lower half of him?”
Holy shit. Happy New Year.
Multiple GSW 20 minutes out? Time to pee.
“Wakey, wakey Mr. Raver. Wakey, wakey. There you are, good morning, sunshine. Ready to go?”
“You’ve been here since 9:15 last night.”
“It 6:25 am. Happy New Year.”
“Yes, I’ll untie your hands.”
“Here. Let’s watch this video we took of you. This will fill in some blanks for you and also show you why you ended up in restraints and with a tube in your penis.”
“All clear now?”
“No, you can’t have this tape. But what you can do is press the erase button. Now sign here and you’re free to go.”
“No, I don’t know where your friends are.”
“No, no one called or came looking for you. Maybe you and the 23 other drunk/high “overdosers” can go to breakfast together? You still want something better than shitty hospital food, right?”
Phew. Time to sit down. High speed MVA? 4 patients? One with brain matter coming through the nose, 2 with multiple orthopedic injuries, and one with a head lac complaining of wrist pain? 6 minutes out? Oh look, it’s 0702! Tag, dayshift, you’re it! Anyone want to go for margaritas at This Bar Always Opens At 7AM? Great! Let’s go!
And there 9 of us sat, drinking our first New Year’s Day cocktail of choice in silence, beaten down by the previous 12 hours. Aaaah. With the first round guzzled and the second round on its way, we were able to speak. And speak we did. “Holy shit! What the hell just happened?” And we were off, each recounting the highlights of NYE in the ER. Of course we all had our favorite Raver story, laughing and harassing their silliness, stupidity and ultimately entertaining behavior. Those of us that were “lucky” enough to work in the trauma zone recounted the gory highlights. And then another moment of silence. 8 people died (or were brought in dead) to the ER that night. 27 people were hospitalized with broken bones, internal organ injuries and lacerations. 5 people were still to drunk/high to be discharged by 7am and 12 frantic people called into the ER looking for their loved ones. Only one of those callers found their loved one in our ER. None of the trauma patients were brought in sober. Happy New Year. Now, who’s ready for round 3?