Book of the year

I've thought about writing a book... several titles come to mind:

You Know You Are An Idiot When....

Suicide, Getting it Right the First Time....

Why Some People Should NOT be Allowed to Reproduce....

No Lifeguard in the Gene Pool Today...

Behind the Behind...

Life is Not Necessarily What You Think It IS...

Who knows- maybe I can find talent, and actually begin to write.

From 7 to 13

We seem to be missing a few rooms, two to be exact, 7 and 13... the stories vary about why they are gone, include everything from stolen space to the necessity of a supply room, but I am beginning to understand that the stories may really be an excuse.  People do not want to be thought of as superstitious- In part because it makes them look crazy and in part because to admit that the building has a mind of it's own well... it takes away our sense of control.  

I personally like the corner between rooms twelve and fourteen, a small bathroom and supply room are tucked in here-- areas where I like to sit for a moment and think... a place to simply get away from the noise and chaos of the beast that is an ED.  Some of my best thinking is done in here, though it may not always translate into real words.  

Now between rooms six and eight-- only a hallway exists, room seven seems to have vanished.  It may have been for lucks' sake, or maybe it really is there... a place for the patients to quietly exit on their journey- home.

We also have our words that are off-limits... a certain q and s word come to mind.  These are taboo- chocolate must be offered by the offender to the gods that be if these words are thought, let alone uttered.  

I never was superstitious, before I started here.  Now, yes, I do find myself offering to the gods on occasion-- all because of one lovely shift.  New guy, cracking jokes, flaunted the forbidden words- within 15 minutes we were packed, Full Code in 2, HI in 1, all other rooms packed with the expansion rooms also utilized, EMS called out to not one but four locations all with multiple victims.  Once all chaos was contained, he did it again-- he said the words-- cacophany of noise-- we thought it was bad before-- no the gates of hell may have had less wailing and gnashing of teeth.  The new guy... well, someone may find his body, eventually, too bad he wasn't finished paying off his schooling yet.

Dreams...

Ever had one of those dreams that you wake, feeling utterly confused--and look around for the body?  

I woke early this morning in a cold sweat, searching frantically for the body of the physician I was working with-- In my dream he had gone down in trauma 2, not unexpected, a year post a massive heart surgery, still has chest pain often enough to make the staff nervous, but the department was just a little to busy to be doing this.  

My arms ached, having done enough rounds of compressions for two doses of epi.  I think in my dream I had hoisted him off the floor and onto the stretcher myself.  Why is it that when you really need a department full of help all you can find is a first semester student nurse with the deer-in-the-headlights look or the "I want to be a med student when I leave high school" volunteer.  You hand one of them the radio and walk them through how to call for assistance while working this code.  The nursing student who had asked to "do as many IV's as possible today" is now pale and backing away from the tray...

 

The new staff directive still echoing from my training days-- No we don't use the code blue button in this department.  Generally only one MD in house, maybe 2 nurses and the first rule that I was taught-- "never use the code button in this department, we are the code team".  Great.  Yes, I did push it-- no, it doesn't work.  Remind me to let maintenance know about that.

Answers to the questions that are coming.... No, from where I sat in my own bed, even with the lights, on I didn't find the body of the MD, only the pillow I had thrown off my bed (the one that had been at the top of the stretcher).  And yes, my wall does have an indent, not the desired 1/2 chest depth, but still, I worked the heck out of that 'chest' with my rounds of compressions.-- Bet my spouse is glad that I was the only one in the bed at the time....

Out of my hands...

Sometimes, even if you do everything right...
Last night a "child" came in, if you still believe that 16 is a child.
Snowmobile vs tree, helmet was worn, the partner was nearby...
CPR which may or may not have been needed was started, EMS enroute, first officer on scene confirmed no initial respirations.
When the pt arrived in the ED there was a strong Sinus Rhythm, RR 30+, limited facial bruising, trauma protocol followed to the letter...
A, B, C, D, E, F, G, H, I... Intubation, IV's, foley, scans, fluids, drugs as needed, information provided to the family timely, a well orchestrated team, ending with the life-flight transport.
The pupils were the key... right blown, left pinpoint. GCS of 3, blood from...
The damage was too great. Even with everything in line, perfect timing... no neuro, no peds unit....
sometimes it is still out of my hands.

I always thought I would be able to be a compassionate service provider-- and then I actually showed up to work/play.  Sometimes you have to laugh just to keep from crying- or hitting someone.

Actual complaints of patients that want to be seen in the ED today:

"I've had seven bowls of cereal today and I'm still hungry"

"No there is nothing wrong with me.  I just want to make sure that I'm okay before I go on vacation (for three days)."

"I was licked by my cat, and I think I need a tetnus shot."

"My left leg is going to fall off!" (Small fishhook superficially attached to the leg, fell out on it's own.)

"I think I'm drunk"

"My right pinky hurts, and I've been known to go into cardiac arrest because of the pain (in my little finger)"

Pain...

Recently overheard

Nurse: On a scale of one to ten with ten being the worst pain you could ever imagine and

(over the nurse) Patient: It's a twenty!

Nurse: Let's start this again and please let me finish the question this time.  This is a scale of one to ten only.  Ten is the top

(over the nurse) Patient: It's a ten plus!

Nurse (sighing- probably rolling her eyes): On a scale of one to ten with ten being the worst pain you could ever imagine and one being no pain- 

In other words a ten is one of your body parts has been ripped off and is in the next room. 

Eight would be active labor without the epidural. 

Five is several broken bones etc..

Now, on my scale, what number would you like to use to rate the scratch on your arm.

Patient: Do I have to use your scale?

While we may not be quite as small as Mayberry, we are not a large hospital.  Our area is large enough to be a city, but rarely recognized on the map, and is often thought of as a "blink and you'll miss it" stop along the road.  

It doesn't seem to matter how large or small the facility you work in is-- there are a few static characteristics:

Frequent Fliers visit more than once a month.

More people plan to visit for "free" than ever plan to pay.

8 am is not too early for the drunk to arrive by EMS-- they may or may not be a leftover from last night.

The Sunday night of a three day weekend brings in all those that don't want to go back to work in the morning.

The more tattoos, the larger the fear of the IV needle.

Those that are grateful probably did need to be here.

As soon as the staff enters the room with a pre-conceived notion of how the visit will end the setup begins for a mistake to be made.

No matter how hard we try to educate, we can't fix stupid.