I am going to start numbering my flights by triple digits with the hope of breaking 100 before I graduate. Today was flight #5 if I’m counting correctly. It was a busy day in the ED, but with our new renovations, busy days are not as hectic and scattered. There is room for charts. There is an extra computer console. The doctors area now consumes twice the space that it did previously with both a deep low counter (and chairs that push under the counter out of the way), and a higher shelf for overflow or old charts.
Anyway, I had four active and interesting patients when I was called to the roof for a scene call, about 35 miles away as the crow flies, probably an hours drive or more. It was a beautifuly sunny late summer day. Visibility must have been almost unlimited. The mountains were bursting with shades of green from all the rain we’ve had, and the rivers were shimmering and blue as they snaked along the folded basin and ridge landscape (geographers will be able to localize me a little with that clue). We flew from our moderately rural landscape to “the middle of nowhere” which is where the medic told me we were when I could see nothing but trees and hills. WE floew over a ridge to a small farming area where a landing zone had been set up next to a big white country farm house. Next door was a stable with a horse that ran to greet us, but was blocked in by a fence. On the porch of the faded red log cabins inbetween was a country family watching us from their porch. It was like landing in a miniature toy railroad set.
When we got to the patient, I was shocked by a sight that I have almost never seen here in our rural parts–two well-muscled, trim, athletic looking men in biking tights and lycra shirts, tanned and sweaty. (As opposed to the pale, chubby, puffers and bloaters I see at the grocery store). One got tangled in a guard rail when he misjuged the bottom of the windy mountain road right in front of the country white house.
He had an open femur fracture. When I got him into the ED and cut off his biking shorts, the little clot over the break let loose and blood and fat (bone marrow) started streaming out of his leg. Ick. That grossed me out a little bit. Off he went to the operating room within about 2 hours of his arrival.
I just finished a 13 1/2 hour shift, and spent 36 of the previous 48 hours sleeping and delerious. I have a horrendous sore throat. My voice is almost gone though, and I’ll bet by the end of my next 12 hour shift it will be completely gone. How can I see patients if I can’t speak? BEing delerious would have been fun, except that it was a crappy way to spend my 2 days off. And if you’re going to be delerious, I’d reccomend skipping the headache and joint pains. The benedryl, however, I couldn’t have done without.
I’m too worn out to really think about my day, but a few notable patients:
-the anxious man whom I gave a script for ativan who called back an hour later saying he lost it
-the 12 year old with classic textbook symptoms of appendicits in whom I skipped a belly CT and the surgeons took him straight to the OR (yay me for making a clinical diagnosis of appy!)
-The man with a 31,000 white cell count and a creatinine of 6.2 who sat in the ED for about 10 hours while medicine and surgery pissed over who would admit him.
-the nurse who pulled me aside at the end of my shift to tell me about his burning urination
Odd Art stopped by today, but I suspect that’s not his real name 😉 Welcome Odd Art, I’ll stop by your corner often!
Today was a much better day at work. Sick people that I might have actually helped. The sickest, in fact, had their consultants already in the department, so I was more of a formality on those, but it’s good to see sick people and have help close by. By sick, I mean almost dead. One patient was having a severe heart attack with a pulse of 20 and an unobtainable blood pressure, but…he was awake and in pain. He went straight to the cath lab.
Well, OK, that was the only almost dead guy, and the cardiologists saw him before I got into the room. I saw a 3 year old with an incarcerated hernia…surgery was already there as well, so that was a no brainer for me. I saw a 65 year old man with a multiple sclerosis exacerbation, hallucinations and too weak to walk. He was an easy admission. I saw a lady with decreased appetite and weakness with no demonstrable explanation. She was admitted because her husband couldn’t take her at home. That admission was a little harder to sell, but I had no leeway…she couldn’t be sent home.
I treated a lady with first trimester bleeding and did an ultrasound that was cool. I stopped another guy’s bleeding with gelfoam (artificial clotting dressing for bleeding wounds). He was taking both aspirin and plavix and his finger scrape just wouldn’t stop oozing.
Right at 11:30 (my shift ended at midnight) two patients were brought in with police escort. But thankfully, I was seeing the little girl with the hernia, so I didn’t get caught up in either of those tangles. I actually left with a smile on my face.
The end of summer marked their 56th year together. Soon, they planned to return to their winter home in florida. He spent the last few weeks of summer building a garden wall of loose stones. A new pile had been delivered today. “I’ve got enough to last me for ten years,” he happily told his wife. After a hard days work in the garden, the octagenarians celebrated the end of summer by going out for dinner. Thye returned home early, he opened the garage door with the automatic opener, while she went in the front door with her pocket book to use the ladies room. When he didn’t follow her in, she returned to the driveway. He was on the ground with blood pouring out of his ear.
An ambulance arrived, quickly scooped him up and brought him to the hospital. His face was blue, he was vomiting, medics placed a bag over his mouth and blew oxygen into his lungs. We moved him into the truama bay where I placed breathing tube and examined him. His pupils were dilated, fixed, non-reactive. He was dead, kept alive by the ventilator. I broke the news to his wife. “But just earlier today…” she protested in a thick accent. “Do you have any family members we can call for you?” “No, no one. No one in this country.” She was beside herself with grief. The wall he was building, the garden, their home in florida, what was she going to do? Neighbors arrived to help ease her pain. I called the coroner and notified him that he was not an organ donor. I signed the death certificate. I picked up the next patient’s chart waiting to be seen.