Good days, bad days, and balanced days

There were good days and bad days, and ones that were a combination 

It was one of those days when everything seemed right with the world. I woke up feeling great, breakfast came out perfect, nothing burned. My boys were doing well and everything was going smoothly. I just knew it would be a great night at work as I headed in to the ER in good spirits.

One of the new people who worked out front registering patients, came back to us and said we had a patient with chest pains out there that needed immediate attention. Within a minute this sweet lady was back in our Chest Pain area of the ER and being assessed. She was tiny and she looked so afraid. I am sure that when you are in the midst of a heart attack you must feel panicked and that only makes it worse, yet you have no control over your fear at a time like that. Her deep blue eyes fixated on me and I could feel the silent screams for help coming from them. Soon she was settled in and the staff busied themselves with taking good care of her and giving it all they had to save her. 

I turned to the desk to see a frantic looking person whose eyes were darting around like june bugs on an outside light in the summer time. I went to this person and asked how I could help. It was the daughter of this little lady who was in the chest pain room. . I gave an update on the patient, or at least the basic info that we can give. I then escorted them to our critical patient waiting area (one that we often call the grief room) and I advised the doctor who was caring for the patient that her family was in the grief room. 

My attention was immediately diverted as an ambulance came in with a person screaming in pain and vomiting into an emesis basin. She had an arrow sticking through her ankle. It was sort of freaky to see that arrow and the blood oozing out around it. I am certain it had to be excruciating, enough so, that she was very nauseated. She had the look of agony and her hair was dripping with sweat. I am certain the pain and anxiety was tremendous. She was settled on a gurney in room 4 and report had been given to the nurse from the EMTs that brought her to us. As I stood at her bedside, the patient told her story. She was at the hunting camp with her brothers and one of her girlfriends when this accident happened. Everyone had been drinking for hours as daylight approached when Joey decided to show them how to operate his new compound bow. Our patient, Junie, was way on the other side of the room reading a book and minding her own business. She was not drinking and had been nagging at the others the whole time about how unsafe it is to mix alcohol and weapons. They had laughed at her, while calling her “grandmaw” and said they knew all of the safety rules, so “shut it up”.  Within a few minutes of the statement, one of the brothers picked up the bow, inserted an arrow and it released, firing across that room and right into Junie’s lower leg (at the ankle). 

It was something I had never seen before and have not seen since that day. She smiled through her pain and said, “Maybe I should have had a drink, I hear it lessens the pain!”

After minutes she was sent to xray and her IVs were started  as we awaited the orthopedic physician’s arrival. It was a certainty that she was heading to the Operating Room soon.

The sweet little lady in the chest pain area was now stable and her mother and grown child were standing at her side, holding her hand and looking very concerned. After a few hours this patient was admitted and was scheduled for a heart cath procedure the next morning. The next afternoon when I returned to work, I asked the supervisor how this little lady did in the heart cath and learned that she had gone into cardiac arrest and did not make it. I did not know her but, I was so sad to hear the news. She was 53 years old.

Junie, the patient with the arrow in her ankle, came through surgery well. Extensive work had to be done to rebuild her ankle and she would be involved in physical therapy for probably a year to recover to normal function. Yet she was lucky in my view, that arrow could just as well have hit her in a more vital area and caused significant, life-threatening damage or even death.

As we walk through life and face what we must face each day, it amazes me how very fortunate we are to avoid such injuries. Most of the time we don’t stop to analyze and realize just how lucky we were today. My days are all a surprise. I never know what to expect but I do know to expect the unexpected.

It was now 7:00am and my shift was over, so out the doors of the ER and to my car I walked, grateful that I had not been shot by an arrow or gone into cardiac arrest.

Disruption from a Rude Man

What did you say?

It was well after midnight and things had begun to settle down in the ER. It was one of those nights that ebbed and flowed like a roller coaster. We would go from rush, rush, rush with seriously injured people, to a few patients who really had no business being in an ER at all. Emotions were leaping sky high and then settling into the bottom a of ditch. 

I am no longer surprised by anything that happens in an ER. There was a 23 year old woman who came in because it was that “time of the month” and she just didn’t feel good.  I hate to tell her the shocking news....”That is Normal”, it is not an emergency.

We had just sent two patients to the ICU because their situation was life threatening and life for them was on that balance bar between “living” or “dying”. These were the patients that need the help of the ER. 

Suddenly there was quite a ruckus going on in our ER. Two sheriff deputies came in with a young angry prisoner. The prisoner/patient was very thin and he appeared to be mad at the world and everything in it. He was kicking and spitting and yelling obscene things as they basically dragged him to the bedside. He was handcuffed and his feet were shackled at the ankles. Even though he was tethered on all four limbs, he struggled and wriggled constantly. The prisoner was clad in an orange jumpsuit that said “Mobile County Jail” on the back. This man was finally forced onto the gurney so that he could be examined, yet he would not lay still and he tugged and twisted continually. His nurse grabbed some leather restraints to strap him down and the physician on duty walked over to his side to begin his work. The patient was sweaty and looked very tired, and I felt such empathy for him for a brief moment. 

Then he began screaming at the nurse that he was going to F...her when he got untied. Next he looked at another nurse and said “When I finish with her, I am going to F... you too, you Bitch!” The ER physician told him to calm down so we could check his injuries, he said “Hell No, you Mother F...er, I’m not calming down!”

I looked passed this loud, screaming, patient and saw the little 78 year old lady who lay in the bed closest to him. She looked totally mortified. I knew she was afraid and I stepped over and closed off the curtain so that she could no longer see the goings on. I said, “it’s going to be ok Mrs. Carson, they just have a young rowdy patient, but it will be taken care of and everything will be ok.” I added, “You are safe”. She remained silent, but she nodded. I saw her big eyes and her unnerved expression, as I patted her hand, then she assured me that she understood.

Our physician, Dr. A., who was attending this un-attendable patient, said "we will need a urine sample for a drug screen". The patient said, Oh HELL NO, I will NOT give you my piss!” At that point, Dr. A calmly said, “Ok, that is fine, sir, we will come in and get it”, as he turned to the nurse and said, “Cath him”. The patient started screaming even more vile and detailed scenarios of what he was going to do to the two nurses who were taking care of him. It was difficult to hear his words. Dr. A. withdrew the female nurses and sent two Male nurses over to care for this patient. 

Moments after the male nurses walked to his bedside, the prisoner/patient began screaming “I will F... your wife, I will F... your mother, I will F... your sister, your daughter!”   I could see the pressure building in the faces of those male nurses and I feared a battle was about to take place. The tension was so thick in that ER it could be sliced like apple pie.

Dr. A. stepped back over to the bedside and he ordered lots of sterile gauze pads. The minute they were handed to him, he had one of the male nurses to put them into the patient’s mouth.

Our unpleasant patient still tried over and over to scream but he was very muted and his words could hardly be heard much less understood. It was a mumbling garble of soft sounds coming from his mouth. Everyone’s nerves were suddenly calming from the tension that had been building up to that point.

Dr. A. stepped very close to this now silenced, rude patient and smiled. This caused the prisoner/patient to be newly enraged, but though he tried to scream, only soft garbled sounds came out of his mouth. This guy wanted to get at Dr. A so bad, there was no doubt about it. By this time we had hospital security at the bedside as well as the deputy sheriffs that brought him to us.

Dr. A. leaned over close to his ear and said, “I can’t hear you”. The patient tried to raise up and he kicked and jerked all that his restraints and chains would allow. Meanwhile Dr. A continued to smile at him. That enraged this patient even more and he struggled even harder to move and to speak, without success. Dr. A. said, “Did I hear you say you are sorry?” Of course this guy was not sorry for what he had said. He only wanted to say more vile and disgusting things to us all, but thanks to Dr. A. he would not have that opportunity.

After a while, this patient relaxed and fell asleep. He was treated for the injuries he had sustained in a jailhouse fight (which he provoked). His urine tested positive for narcotics and cannabis, which was no surprise. He still was not a nice person when he awoke, but he was more subdued than when he arrived.

I thought of this young man (he was 24) and I hope that he got his act together. He was like a runaway train headed straight towards a violent death if he did not get help. I realize you cannot help someone who is not willing to admit they have a problem and not interested in changing. But oh how I wish Dr. Phil or someone could have intervened to save him from his hate-filled life of destruction.

She was ours for the moment...

Our baby

It was a Friday and I had been busy catching up on some things that I was behind on at home. I felt like I had worked all day and now I found myself behind the wheel heading in to work the night shift in the ER. I wore a smile all of the way to work when I worked in that ER. My previous job had gotten so tedious and I  had become miserable and sometimes I found myself wanting to cry when I drove in to that job. So the ER was a wonderful workplace to me, odd as that may sound. I felt like I could make a difference in people's lives at the hospital. Just being there for them in their time of pain and discomfort helped me.

Most of my favorite crew was on duty that night, so that made the promise of a great night even greater. Coffee in hand, I headed to clock in and get report from the person I was relieving. It was busy already, with almost no beds open, so the throngs of people in the waiting room was growing like a big balloon about to burst. I always work better under stress, so I was ready.

We had several people who were being admitted but we were awaiting the call to allow us to move them up to their assigned rooms. This backup was a common occurrence and I felt sure the people in power were unaware of the ramifications to the ER when people are waiting long periods of time to be moved out and up to their rooms. It ties up the bed and keeps us from bringing people back to be seen who really need to come back and be examined and treated. It was like a horrific traffic jam that I saw oh so often and was powerless to fix.

Like any logjam, it cleared itself and we began to bring people back with all manner of problems. People are so diverse in their ways of reacting to delays and pain. More often than not they react poorly, but many are humble and kind no matter what, I just love them all. Sometimes it is a personal challenge to cheer up a patient and or their family, but most of us were skilled at that.

We had a sweet elderly lady who had slipped on some grease her husband had spilled on the kitchen floor earlier and forgot to clean up. As it turned out, the husband had dementia and had become very forgetful. The wife walked in not knowing about the spill and she said she was in a big hurry, so was walking faster than normal. Suddenly her feet flew into the air and down she fell, hitting her head on the way to the floor. She had a huge knot and bloody spot on her forehead, a sore wrist and her knee was hurting her as well. Soon she was assessed and sent off to the Radiology department for several xrays and a CT scan of her head. The fact that she was on Coumadin (a blood thinner) was of special concern. This was a very sweet family, the patient, her husband and her daughter were there in that tiny room.

I looked up as I walked passed that room and saw an ambulance arriving with a male patient. He was a very big man, very muscular, with a huge beard of salt and pepper gray. He was also very intoxicated and had called 911 because he had shot his toe while cleaning his gun. This accidental shooting had sobered him up with pain but he was still in an angry mood. I guess if anyone shot their toe it would put them in a foul mood. The orthopedic surgeon was called immediately and he was being attended by several nurses at this point. 

Then it happened, it was the one and only time it happened on my shift, the whole time I worked at Springhill Hospital. We were the only hospital in the city that had a special program that had been broadly advertised for young mothers who had unwanted births. Anyone who gave birth and did not want the baby could come into our hospital, explain that they wanted to give up the baby and hand it to any employee, no questions would be asked of them. This way they would know the baby was in good hands and that it would be adopted by someone who wanted a baby. I thought it was a great program because it had the potential to save the lives of many babies. Across the country there had been several widely broadcast, cases  where young girls would give birth and put the baby in trash cans. To know that they could hand the baby over to a healthcare worker, without questions, was a wonderful alternative for the mother and for the baby. Nationwide, hospitals had created this "don't ask" policy and our hospital was the one in Mobile that joined that program.

Well one of our male nurses was walking down the hallway coming back from the cafeteria when a young lady walked up with a bundled blanket and inside was a very small infant, it was still unclean from its birth. Blood and mucus was stuck to this little baby girl as she lay there naked in that blanket...the young mother handed her baby to him and said she was giving up her baby and heard about our program, then she walked right out the door.

He was shocked. We thought he was playing a joke on us when he first walked through the ER doors with that baby. Everyone of us that gathered around her felt so much love for this poor infant starting off her life with a mother who could not or would not keep her. The ER physician came out immediately and examined the baby, he called up to the nursery upstairs and the nurses came down to get her about 15 minutes later. None of us wanted to let her go. I know that baby had to feel love because we all poured our love out to her for those precious moments she was with us. I thought of her many times and hoped that her life turned out happy. 

As that shift wound down and I was thinking of the hoard of people we had seen come through our doors, that baby was the star of my shift. The little lady who fell turned out not to have any serious injuries but was kept over night as a precaution. The man with the shot  toe, went to surgery and returned without his left big toe. They were unable to save any of it, so he couldn’t wear flip flops anymore but should recover otherwise.

My crew was weary, yet happy to see the clock on the wall that told us the shift was over. I did love my job but it could be exhausting at times, in a good way. I clocked out, and then I was again behind the wheel, thinking about that precious baby girl as I headed home to my family.

So much noise from such a small child...

The Screamer

There was a loud screaming sound that greeted me that day as I entered the ER doors to start my evening shift. It was so shrill that on the back of my neck was hair standing at attention as my eyes searched for the source of that awful noise.

I could not believe that much volume was coming from her little lips. She was only 12 years old, bone thin and very frail. Her eyes were big and a beautiful shade of blue. Thin, fine, sweaty hair was matted and clinging to her head. The look of complete despair covered her little face.

I walked passed her bed and to my locker to secure my things, then headed back into the scream zone she had created and continued to maintain.

I picked up her chart and saw this huge word that described what was destroying this tiny 12 year old girl...it was Adrenocoritcal carcinoma (her mother called it stomach cancer, probably because the daughter would say, “My stomach hurts”, but it is actually a kidney cancer).  A horrible illness at any age but made worse when a child has to suffer with it. Her parents carried with them all of the information about her condition and its progression. Her current treatment regimen and medicines were also presented to us. It appeared that her parents were accustomed to the sound of her screams, but I could see this had taken a toll on them.

The mother was eager to talk about her daughter and about their life as a family. The mother had once been an opera singer when they lived in Miami. She continues to sing but they had moved to a totally different area. They now lived in Memphis, it was a place that offers more of a country, serene environment to care for their children and also it was only 10 minutes from St. Judes Children’s Hospital where her daughter is treated. There was improvements in her daughter’s condition (Channing was her name), so they took a  bit of a risk and drove to Florida to visit family. She said it had been so long since Channing had been well enough for such a trip and this might be their only opportunity. A child fighting this kind of battle is so unpredictable, they had to jump while things were going smooth in her treatment.

They were just passing through Mobile on their way home and Channing suddenly was in so much pain that they had to locate a hospital and we were the lucky one. I enjoyed meeting this wonderful family and it helped me to see just how fortunate I am to have healthy children and grandchildren. 

After all of the testing was done, Channing did have to be admitted and later had a minor surgical procedure to stabilize her before she left our facility. Unfortunately, that had become a way of life for her and her family and I could not see a bright future for them.

Later in that shift, we had a female patient about 50 years old who was suffering from severe abdominal pains like Channing had suffered. This woman was a chronic alcoholic and she suffered from pancreatitis and some malfunctions of her liver. She trembled as she lay there suffering and I could feel her misery as I tried to comfort her with my words.
She was in so much agony. She also told me of her shame that she played a part in her situation. As she spoke I noticed she looked lost in thought. I could only imagine what she might have gone through to get to where she was today. I felt just as huge emotion for her suffering as I did for Channing. I also knew that her situation would likely continue to deteriorate, just like Channing’s would.

I learned early on when I began working in the ER that it would be painful. It was painful to see and to feel the things these people were experiencing. I knew the only way I could cope was to care for them, to try and brighten these moments in their lives as best I could and then to put my feelings on a shelf. I realized that I could not bear the continuous weight of the pain and sadness there and live happy. In my mind I will still occasionally revisit my memories of these patients, I feel what I felt in that moment of time and hope their lives are better now as I know this is something over which I have no control.

We all want to protect our children, but sometimes it is out of our hands. I speak from experience as one of my sons had cancer at a young age and there is nothing to compare to the fear it brought me.

My sweet grandmother used to say, “I wouldn’t take a pretty penny for the experience, but I don’t want to go through it again.”

Much of the time spent working in an ER is boring and mundane but every shift has at least one patient that stands out and many shifts are filled with them. Through the tragedies, the deep sadness, the frustration, the funny times and the strangeness that happens, it was the best job ever to me.