It’s a steady day in the emergency room- not too busy, when I overhear a nurse taking a call from another area of the hospital. Nuclear Medicine has a patient that is short of breath after a stress test. They want to send down the patient to the emergency room to get checked out.

I’ve got nothing better to do, so I walk down the hall to Nuc Med to see if I can help with the transfer down to our department. I walk in and see the patient- nearly as wide as they are tall- working very hard to breath. Fifteen liters of O2 isn’t helping with the respiratory distress. The patient isn’t thrilled about the idea of coming to the ER and is protesting- complaining that they’ll end up spending all day down there.

After a bit of persuasion- the patient is convinced to come pay us a visit in the ER. They drive their motorized wheelchair down the hall and I follow, carrying the oxygen bottle.

In the room, and into a gown, the patient is assisted with getting onto the gurney and complains of being uncomfortable. Next thing I know- the patient is slumping over, grunting…

“Uhhh…something’s happening!”

With just me, the nurse and the doc in the room- I sternal rub the patient and loudly try to coax a response. Nothing…

I ask “Are they seizing?”

“No!” Says the doc. He looks worried as he runs to grab gloves…

“Well…are they coding?” I ask.

“Yes!”

I’m already checking for a pulse- no pulse! I flatten the bed and start cpr. The nurse runs for more help and soon the room is packed full as we work to save this persons life.

After a half an hour or so of stabilizing treatment, the team from the cath lab comes and takes the patient for a cardiac catheter. Later, I hear that the patient made it through the cath and that they think there’s a good chance they will survive.

It’s been over a week and the patient is still alive.

People think that cpr is such a lifesaver- when in fact, it’s usually unsuccessful in saving the individual that it’s performed on. You gotta remember- they’re dead when you start…

It was really cool to be a part of the team that gave this person another shot.

Working in the emergency room comes with it’s own set of unique challenges. One of the common struggles that we must overcome- the tendency to become calloused with our mental health population. I often want to say, “quit whining, get a job, stop looking for attention- you’re wasting time and resources.”

Many times, what can appear as “attention seeking” is really a cry for help with a much bigger issue.

A patient presents to the ER – they’ve swallowed a pen. Although I’ve seen two cases of accidentally swallowed toothbrushes, this was no accident. This person, when stressed and upset, chooses to swallow things. They say that, it’s how they manage their anger- they used to cut. Now they swallow things.

This is certainly intriguing to me- swallowing a pen is a pretty bizarre way to cope with life’s stresses and I’m interested to find out more. The patient is extremely cooperative and more than happy to talk while they wait for x-ray results (which will show a pen lodged in the esophagus.) I find out that they’ve been hospitalized around fifty times for swallowing something (inedible!) Nine major surgeries have left their body scarred and mutilated, from the waistline- to the neckline.

“Isn’t it hard to swallow a pen,” I ask.

“No, it’s easy.”

“Do you always swallow pens?”

“No, other things too. Broken pieces of cds, hooks, nails.”

“Wow, what the worst thing that you’ve swallowed?”

“Probably a hook for a shower curtain.”

The patient shows me a massive scar that goes from the top of their sternum, along the neck- almost to the ear.

I ask the patient if they ever get tired of this? The answer- yes. They want to talk to someone before they get to this point. While waiting for endoscopy to come to try to remove the pen, I get to spend a good amount of time in conversation with the “world’s worst dieter.” I come to realize that they aren’t a total idiotic attention seeker- simply hurt and in desperate search of a way to heal their pain.

It was good to get fresh perspective on mental health- Lord knows, it’s not always easy. Every day is different.

There’s a reason we stock “spit hoods.”

Being a dad/husband, working in the emergency room, making music, and writing about work life has proven to be a challenge. Luckily, I enjoy a challenge- so this blog won’t be going anywhere- anytime soon. Here’s what’s been happening lately….

• Pt checks in because they are suicidal. After ten or so minutes of being “anxious,” they begin convulsing and wimpering like they are having some sort of seizure/they are  in the midst of an exorcism.

They get some ativan and their “symptoms” start to resolve…then they unplug the                          monitoring screen that they are sitting under and “try to shock themselves” with the cord. Now patient gets moved (mostly so that we don’t have to worry about them damaging our all-important patient display monitor.)

I’m watching multiple “mental health clients”- and not “easy” relaxed patients either. Now I see the “spazoid electrician” with something in their hands- and their visitor begging for them to give it back. I approach just as the patient opens a small pocketknife- my ninja reflexes kick into play. I snatch the offenders hand so fast and with such force- that I immediately had control over that limb- and was gonna take it home with me if they didn’t give that knife up quickly.

“Guess what, now that you’ve displayed that you can’t be trusted- you get to have someone in the bathroom with you to watch you pee.”

• I’m monitoring a young man who’s come in because he’s having a psychotic break. He’s completely co-operative, but also- completely disconnected with reality. He get’s off his bed, I tell him to get back on his bed, he’s “smoking cigarettes,” puffing on his fingers and flicking his imaginary butts around the corner. He requires constant re-direction and I’m hoping that I don’t have to wrestle with him in order to maintain order.

One of the nurses says she’s got something that she needs to share with me- regarding the patient.  She says, ” Earlier, I heard him say to his guest- where’s that hot male nurse- the one that brought us back from triage?…” Just great, the cruelest of all jokes- I’ve just been told that the psych patient who I’m tasked with keeping calm and controlled- has the hots for me. And I’ve got to hang out with him for hours after receiving this awkward update…. I do my best to use my words effectively and keep him placated until I leave- even more strange situtation- averted.

• If your friend hits you in the head with a hammer- it’s probably time to move on from that relationship. Don’t let the fight progress until your entire thumb is being bitten off in a fit of rage. Lesson learned- if your homeless friend is crazy enough to hit you in the head with a hammer, you should probably do your best to keep things of physical importance- away from his filthy mouth….

This week in the emergency room has been very busy- yesterday (monday) we saw 186 patients. Today was also quite busy, not as bad as yesterday but- by the end of the day- there were 8 suicidal patients that had to be monitored.

One patient stood out to me. She was an elderly gal that came in with enough bags to fill a u-haul and a guitar case with writing scrawled across it. She looks quite upset and I can tell she’s genuinely in need of help.

Security screens our patients- swiping a wand over them and going through all of their belongings. When they open her guitar case, she picks it up and strums it. She’s about to put it back when I tell her, “It’s alright if you play something.”

“Really?” She seems surprised and excited. She’s been in tears and a nervous wreck up till this point.  She strums the guitar and closes her eyes. She starts in on a mournful, soul- filled version of Merle Haggard’s “Sing Me Back Home.”

Patients watched and listened curiously to the old bag lady with the guitar. It was funny to see people’s reactions. We are used to people screaming obnoxiously and yelling obscenities for hours at a time, but when someone is peaceably serenading the emergency room, no one knows what to think.

What amazed me most was that this lady played totally uninhibited. Even though her eyes were still wet with tears, and she was in front of total strangers- she was alone with her guitar and the music she sang. She sounded good too.

People talked about the “lady who was playing guitar.” It was a breath of fresh air- to me. It  actually challenged me. Talk about not caring what people think. It wasn’t like she was oblivious- she kept telling me how embarrassed she was of the state she was in. She was a medical professional for nearly thirty years. She doesn’t know it, but she taught me about life today.

When the day was almost over- a nurse yells, “Charles, there’s someone shot outside!” I grab a gurney and run out to find a guy in his car- shot in the leg. I pick him up and throw him on a gurney- he felt like a feather- I think it was the adrenaline.

It was a self inflicted, accidental wound- the gun still laying on the floor of the car. He had two guns in the car- not cheap guns either- the one he “used” cost around $900. This guy had a friend with him….who was obviously in shock. When I talked to him- he starts laughing- he says, “This is the second time he’s done this…I think he shot the same leg too…”

Back to life in the emergency room…and it’s busy!

It’s been quite the hiatus from writing- life is good! Our baby is growing, and my wife and I are learning the challenges and experiencing the joys of new parenthood. I’ve scheduled out my days so that I can continue keeping this blog current with the craziness of the emergency room. Thanks for continuing to visit!

Dude walks into triage…” I just killed three people, you know I did- call Tacoma Police right now!”

Of course, every psch patient says crazy things and I’m sure people are wondering what he’ll say next…did he eat their souls too? That’s when duder turns to the side and you can see his neck is filleted open from ear to collar bone….then he starts backing out of the ER.

I come running out because I hear that we’ve just had a walk-in trauma and I’m curious…I see the guy from a distance and see that he’s covered in blood and has a large gash on his neck…he’s a huge guy and extremely deranged.

When he turns his head…I get the full view- I see his carotid artery, tendons, muscle tissue- the full “zombie movie” style gash. Worst gash I’ve seen- and it’s running directly down his neck. People are following with supplies- waiting for him to drop to the ground so they can start working on him.

” Sir, you have a massive gash on your neck and it’s very important that you be seen in the emergency room,” I tell him. He acts like he didn’t even hear me- doesn’t even look at me. He walks over to where he’s set down a full energy drink- and pours it straight on his head. He shakes his head- with liquid flying off- and slams his fist down onto the can- completely crushing it. Holy cow- I’m not going anywhere near this guy.

He then proceeds to walk into traffic- people stop as he walks across the street- mass security following close by. Minutes later, he comes in, handcuffed with TPD. Still, this guy won’t cooperate- he’s medicated, intubated and after some quick stabilization, he’s taken straight to the operating room.

Definitely one of the crazier things I’ve seen…people were talking about how nuts this guy was. Don’t think he did kill three people after all- but I’m not gonna go find him and challenge him.

Now that I’ve been writing about the emergency room for almost three months- I get a fair amount of traffic from search engines. I recently reviewed the list of phrases that people have searched for- that brought them to my site. Some are quite interesting to say the least.

• “medical disimpaction stories”

So basically this person wanted to find stories about constipated people having fecal matter dug out of them…gross- but I can think of situations where this would make sense. Maybe it’s a medical student doing a project. Maybe someone is quite constipated and wants to know what might loom ahead. Who knows? Not me- and I want to keep it that way.

• “What happens if you get tasered and have a tongue piercing”
• “What happens if taser barbs are stuck in you”

Clearly, these are people who foresee the possibility of getting tasered as a part of there imminent future. Are they wondering if they should take the tongue piercing out before they get rowdy? What happens if taser barbs are stuck in you- uhhh…they taze the crap out of you and you fall down- wetting yourself.

• “rubbing my cock against urinals”

Hmmm…this is just disturbing. Why would you ever search for such a thing…and even more disturbing …what comes up when you do? I’m gonna leave that one alone.

• “Would the emergency room detect ativan being in my system”

It’s quite evident to me- from my time working in the emergency room that some of our patients are quite devious and find ways to get the most out of their “experience.”  This last search term really made me laugh…someone was doing their research.

• “how can a er patient know for sure they will be leaving with a script for vicodin 2012”

Wow…way to do your homework!  Someone is trying to find a specific problem to list as their chief complaint- so that they’ll be assured a fill of some narcs. Maybe there is a forum for drug seekers- where they share their tips and tricks? They threw 2012 in there…let’s make sure this is a current strategy and not something outdated- right?

It’s an interesting dynamic in the emergency room. I’ll just say- I’m happy, I’m not the one with the prescription pad.

A child is born! Hunter Alexander Siler was born on 8/11/12 and weighed in at a healthy (if not chunky) 8 pounds 9 ounces. He was 21″ long- including his enormous “cone-head” (a result of being in the chute for such a long time.) Regardless of personal bias- I’m convinced he’s in the top five- for cutest babies ever born!

The last time I wrote, we were fifty two hours into the labor process. I say “we” but it was more that my wife was exhausted, in pain, and losing her mind more and more each contraction- while I stood by- terrified and helpless. The plan was to go all natural- my wife is pretty tough- but after fifty two hours of prodromal labor (real labor that’s ineffective in dilation) she was starting to lose it and I was ready to medicate her myself. We head off to the hospital and it went steadily down hill, hour by hour.

Within a couple of hours of admission- we go for the epidural. The OB doc says “it will help speed things up,” if she breaks my wifes water for her- the risks she says- “there aren’t really any.” Doc says we’ll probably have the baby around 2am- it’s 8pm. I wake up at 9am, “did I miss the birth?” Nope, no birth- wife- still in labor and exhausted. She’s still contracting and fully effaced but not dilated more than a three. We wait and next comes the Pitocin- it’s necessary to get her dilating- her uterus is tired.

Both of our families arrive at 1pm and are anxiously awaiting the birth. It takes hours more until my wife can start pushing but when the time comes- adrenaline kicks in and she does a great job. Time goes by, and the doc says “do you want to try the vacuum- cause we need to get this baby out.” I ask about the risks- “there aren’t really any.”

By now, my wife’s water has been broken for over 18 hours, she’s got a fever and she’s completely exhausted. The vacuum- basically a suction cup that sticks to the top of the babies head and tries to pull him out- is unsuccessful. Now we’re off for a cesarean section- the absolute last thing that either of us wanted. I’m madder than hell at the way events have unfolded- and angrier that we’re both powerless. My hearts broken- knowing that Heidi won’t get the baby placed on her chest right after birth.

Even after working in the emergency room- I’m about to lose it watching the c-section on my wife. It’s a lot different when it’s someone that you love and care about. I don’t know if it was the stress of it all or what- but my nose started bleeding- mid operation.

Baby comes out with a giant “cone-head.” When I first see my son- I don’t cry- I laugh at the sight of his elongated melon- courtesy of being in the birth canal for so long.

Baby is crying and looks good but get’s taken away to the NICU because they say that he’s having to labor to breathe. When I get there with momma, he looks awesome and his oxygen measurement looks great. Six hours later, baby is back with mom and dad.

As of right now, baby has a bruised head from the vacuum cup but other than that, he’s doing stellar. Peeing and pooping and eating non-stop, he’s an amazing little creature. Despite the way things happened, Heidi and I are very grateful that it’s over and that everyone is healthy. Now for the hard part…

I’m not in the emergency room today, instead- my wife and I are in the OB ward. We’re fifty-two hours into a labor process that seems like it may finally come to an end.

My wife went through something called prodromal labor- where you have active- painful contractions but they aren’t effectively dilating the cervix. Two nights ago, my wife Heidi woke up with strong contractions and was unable to sleep at all. All day long, she labored on and off- with painful contractions but in irregular fashion.

After two nights of no sleep and contractions that bring her to tears, we get an appt. and go in and see the doc. Still no dilation. Doc says to go home, take an ativan, get some sleep and hopefully when you wake up- you’ll have the baby. The ativan helps but she only gets a couple hours of sleep and is up every half hour to hit the restroom. 48 hours of painful contractions and I make the executive decision to head to the hospital- let’s get this thing done.

We have to check in through the emergency room and even in the short few minutes that we spend waiting there, we see a chick fly off the handle. Apparently the paramedics had stolen three things of hers- specifically some orange juice and a space blanket. She starts screaming obsceneties at an ER tech and the tech walks out, saying she’s gonna call security. Hilarious irony- the patient screams, “I want a patient advocate bitch!”

Security comes and wheels the patient off to a room to put her in restraints, she’s sitting up on the bed, with a space blanket draped over her- she’s peering out of it like she’s in a tent. Awesome.

We head upstairs and as of right now, we’re about twenty hours in, my wife has an epidural and we’re just waiting to start the final descent. Keep us in your prayers, we’ll be proud parents soon. Stand by for pictures!

The last week or so has been quite “crazy” in the emergency room. For some unknown reason, the ER has been packed with psych patients on a daily basis. This particular day was no different. I’m in the hallway with a guy who checked in saying he’s homicidal (he turned out to be really nice, as well as respectful.)

All of a sudden, I see a gal to my left, standing in front of the nurses station- screaming at the charge nurse. It’s hard to make out what she’s saying because she’s talking to so fast and aggressively- but I do hear her say, “have you ever been strangled?” The charge nurse makes his way around the desk to try to calm the situation.

Next thing I know- the gal yells out- “Do I have to give you my vagina?” No sooner than the absurdity is off her lips, her sweatpants come flying off and she is completely naked from the waste down, screaming at the top of her lungs! This is definitely a first for me- and the guy that I’m taking care of- she’s baring her nether regions in front of the whole emergency room, and she doesn’t seem to care one bit. She’s put on a gurney and wheeled into a private room in order to contain the chaos that she’s creating.

Hours later, I’m in the hallway- watching a couple of mental health patients. One gal has been yelling out obscenities for hours- making just about zero sense. She’s insulted me- “Shutup white boy, I’m mostly italian,” she says. “I have hepatitis C, not AIDS- that was a rumor.”  Every word she utters, she puts her diaphragm behind- to give it that extra ummph. “I’m not a whore Justin,” whoever Justin was…

Later, our strip- teasing, pyscho friend ends up in a bed right next to the woman who’s turned into a disturbing alert system…and the screamer is still going strong. The stripper has clearly had enough of the nonsense and sits up to address her.

“Can you please STOP! I’m trying to eat. When I get worked up, I start to CHOKE! So can you please STOP!”

Wow….I couldn’t believe the reprimand I was hearing and I was waiting for a fight to break out. Instead, the screamer just says, “OK, I’m sorry.” She didn’t totally shutup after that but it was a marked improvement. I was just glad to have a little less chaos.

If you’re crazy enough to rip off your pants in a public place and scream in a grown man’s face-naked from the waste down…you’re probably crazy enough to beat the crap out of a fellow patient that’s annoying you. I’m figuring the screamer realized this as well and heeded the warning. Good times.

A guy is found sleeping in the bushes. Nothing the medics do works to get any response out of the patient. We run fluids, take bloodwork and find all kinds of stuff in this guys system. The main thing is that his blood alcohol level is over .3 and he has meth on board. He’s out like a light.

All of a sudden I look over from the nurses station- and there he is- standing completely naked at the end of the bed- that’s not good. I go in and get him back in a gown. Five minutes later- the same thing, this time he’s pissed- “What’s this thing in my dick?”

“It’s a catheter, we put it in because you were unconscious and that way you won’t pee all over yourself…”

“Get this thing out of my cock!” this guy screams- thus the vulgarity begins.

The amount of times this guy yelled out different, vile names for his penis should have been a good indicator that this was not going to a pleasant experience for those in charge of his care. The catheter comes out and this dude is cursing up a storm. The catheter is hardly out of his (insert creative name here) and he’s already trying to hit on random girls -passing in the hallway.

The nurse is in the room- he says to her…”You know I’ve got a huge cock?”

I snap right back at him, “No…remember…we put the catheter in…”

He laughs…”F you man….you’re an asshole.”

He really wants to go home and it looks like we’re going discharge him. We get him a shirt because we cut his off when he arrived unconscious. It’s a bright yellow “Safeway” shirt…he is not impressed.

He becomes progressively more and more vulgar and vocal as he waits to be discharged- voicing his discontent for all to hear. The world comes crashing down- the admitting doc decides that he wants the patient to remain in the hospital until he is sober- hours for sure.

The patient has already told me that he’s gonna leave- and get totally drunk and get it on with this tweaker girl he knows. He also tells the admitting doc that if he grew out his sideburns, he could really get some pussy…this guy is a real piece of work- and he’s getting angrier by the minute.

He postures, saying he’s gonna whoop all kinds of ass and that he’s leaving- the decision is made to put him in four-point restraints. I’m assigned the lead which means I’ll be holding his head and have to talk to him the whole time. He goes onto the bed and into restraints without a problem. He does however issue some nice threats.

“Ohh boy…if I catch you in a dark alley- I’ll punch you once in the face and you’ll be knocked out.”

“Yeahhh…I don’t think so….”

“What…you wanna test that? You better hope that I don’t find your address.”

“Yeah…that would be really bad- for you.”

The door was closed to the room and since he was making criminal threats against my safety, I had no problem issuing a few whitty comebacks. The goal, however, is to always have a calm and safe restraint- and to avoid restraints altogether if possible- so we do a quick debrief in the room before we leave.

Before I leave the room he says one more thing…

“I’m sorry for all that stuff I said- I know you’d whoop my ass…”

Hilarious.