11:09PM, 1 hour after getting home from a 14-hour shift
Well, I am already behind on my pledge to document this ER experience. Little did I know just how draining 12-15 hour shifts can be. Especially as a nursing student fresh off the press, I almost feel like I am being thrown to the wolves every morning at 7am when I walk onto the floor. Luckily, (most of the time) I have a very protective preceptor who keeps me close under her wing, but it’s still a lot to take in for a newbie.
Today the trauma room saw its fair share of blood, gore and more. And I saw far more than my typical allotment. First a man came in who had fallen from a 30-story building. That didn’t last long. While in my freshness I was very much distracted by the nearly-severed foot jutting out from a protruding tibia and fibula and a matching skull flap, the internal injuries were the real outcome-predictor. Seasoned nurses told me that shearing forces can cause the entire aorta to rupture. I only spent a few moments in the trauma bay on that case, but it was more than enough time to be imprinted in my memory. The second case was more hopeful. A middle-aged man came in to the ER already in cardiac arrest with CPR in progress. Lost in the hubbub of the moment was a warning from a veteran RN for us NOT to cut off the man’s down jacket. But once the presiding resident made the call, all hands were on board cutting off and removing clothing at lightning speed. Soon there were downy feathers snowing down and nestling in every crevice. In an already chaotic scene, the sight of the feathers made it even more absurd. I served as the scribe, which was an excellent way to follow the rapid-fire succession of events. From no pulse and asystole, this man was successfully revived and stabilized with a v-tach rhythm before he was quickly shipped off to the cath lab. This was a much better outcome to be a part of. Minus the bird feathers and blood that tarred the floor at the end of the code…
One sad event that really stuck with me and I need to unload before going to sleep. We discharged a young woman who came in for seizures. Since we weren’t on her team prior to discharge, we asked for a brief history. She said that she fell down a flight of stairs during the seizure. My preceptor asked if she hit her head on the way down and the patient nodded, like it was obvious. She asked how she got help and who found her, and this poor young lady said, “What do you mean, who found me?” I took care of myself.”
My preceptor tried to clarify, and asked, “Oh, ok, but who called the ambulance?”
She responded simply, “I got myself up, and called it myself.”
For some reason that really sounded sad to me, and more so when my preceptor asked how she was getting home. She had no one to come pick her up and she didn’t feel safe going to the subway because of all the stairs, and her discomfort around trains. Even though she lived less that 2 miles from the hospital, she barely knew the bus lines. Taking her out to discharge, I glanced through the glass exit doors to see a dusky sky, quickly turning black. My sadness for her was almost overwhelming. No one should both come to the ER and leave completely alone, yet too often this is what happens.
Let’s leave this entry on a funnier note. My first patient of the day was a loud old blind man with an Albert Einstein-esque hairdo, who compensates for his lack of sight by screaming all the time. Anytime a shadow of a person walked by his room, he would yell, “NURSE, NURSE! CAN I GO HOME YET?” When asked to lower his voice by my sweet and mouse-like preceptor, he would yell, “I CAN’T HEAR YOU! WHY DO YOU TALK SO QUIET?” She would reply, obviously bothered by his loud volume, “Why do you talk so loud?”
“I STILL CAN’T HEAR YOU! WHEN AM I GOING HOME?”
“Sir!” Finally reaching to the top of her internal volume modulator, my preceptor gathers all her strength and yells back, “We can’t send you home until we have your lab results. Sir, we are getting them as soon as we can!”
“OH OK! FINE, WELL WHY DIDN’T YOU SAY SO?” Exasperated, my preceptor escapes the room. Thinking it’s over, I go onto the next patient, but it’s not two minutes later that I hear him again, “NURSE, NURSE, I AM READY TO GO HOME. CAN I GO HOME NOW?”
I don’t know why this was so funny, but somehow it was, and we were all laughing. In an ER, where things are so emergent and tense for so many people, sometimes you just need to take things a little more lightly and help others see the small humor in daily things as well. I find that I say cheesier jokes in the ER, and brace myself, expecting a courtesy grimace at most, but I actually get more laughs there than I do at any better jokes that I ever crack outside of the ER. Happiness is a hot commodity in the ER and it’s in demand. I like this work because no matter what, I always find reasons to smile.