No Thanks

the emergency roomSometimes, in the emergency room, we have to put patients in physical restraints- for their safety as well as ours.

A patient comes in for a mental health evaluation- the dude is huge. Luckily (for us) he’s got his equally large brother with him to keep things controlled. The patient was in restraints on his trip in the ambulance, so we decide it’s best that we place him straight into restraints when he’s transferred to our gurney.

I’d just completed some training on restraining patients in a safe and professional manner so I took charge and let the rest of the staff know that I would be at the patients head- and would be the only one talking to him while we applied the restraints. Staff tells me that I can go ahead and do that but he’s not gonna respond to what I tell him- he’s been mute since EMS was called.

The point of talking to the patient isn’t really to make conversation, it’s to be professional and keep the patient informed to alleviate some of the stress of the situation. So we go ahead as planned. Limbs are assigned for restraint and I take my place at the head and start talking to our patient.

“Ok sir, we’re placing your left arm in restraints now, we’re doing this for your safety,” and so on. I tell him, “I’m sorry we have to do this, it’s for your safety.”

Out of nowhere, the guy looks up at me “I forgive you,” he says.

“Uhhh…thanks man.”

“You are forgiven.”

I don’t really know how to respond but it’s nice that he’s broken his silence and the things he’s saying are not threatening- so I continue and reply again, “thanks man.”

“I love you…”

Uhhh…I guess that’s a nice thing to say. It’s certainly not a threat which is the only thing I’ve been worried about with this guy- up until this point. I respond again with “thanks man.”

Next thing I know, this guy has his lips pursed and he’s started to sit up and his mouth is making a beeline- straight for my lips.

“No!” is all I can manage to say- as I push this guy back down onto the gurney, one hand on his forehead and the other on his upper chest. The problem is, he’s really strong so I have to really exert some effort in pinning him down- and I’m squeezing his forehead pretty tight.

It takes me a few seconds to compose myself and then I manage to say “I hope I’m not hurting you.” He replies, “you’re not.”

Wow, I was glad when that was all over, I tell the doc- “that dude tried to kiss me!” We had a good laugh about it and got back to work. Such is life in the emergency room. I wish I could say that was the only time that something like that happened…

Vitamin C

When someone walks into triage and says “Uhh…there’s someone in the parking lot- tweaking out in their car,” you know you’re in for a treat.

I walk out to the lot and find said tweaker, and after introducing myself, and writing down my name as well (first and last as per request,) I set about my investigation…

Are you wanting to be seen in the emergency room today? The answer?…completely unintelligible. Oh yeah, sure, let me hold your soaking wet backpack for you while you fidget with your ziploc bag full of pot residue and leftover crumbs. Better bring that receipt that you found on the passenger side floor- that definitely looks important.

Yes, you are correct; to be seen in the emergency room is your constitutional right- this wheelchair is your portal to a healthy and renewed life…

After a triage process with little or no relevance to the visit, we head back to our room- as per the constitution. Wow, we certainly do have a lot of energy today. Vital signs are a total disaster- the inflating blood pressure cuff is obviously the most intolerable of all things and just about causes a complete and utter meltdown. I’ll just go ahead and put the chart up and let the doctor know that he’s got a new patient to see.

Enter doctor, I remain in the room- partly for the safety of all involved parties and partly for my own interest in the unfolding drama.

The doctor starts in with his questions:

So what’s been going on, why are you being seen today… and so forth.

Then he gets to: What have you taken today?

I’ve taken all kinds of stuff: lisinopril, vicodeine, vitamin c, vitamin b, vitamin e…

Doc: Ok, I wanna talk about vitamin C- Vitamin Crack…

It was all I could do to keep a straight face…the patient was so “cracked out” that they didn’t even miss a beat and just started in talking about smoking crack. It wasn’t the most professional thing I’ve ever seen, but in the stressful context of the situation, it was just what was needed to lighten the mood.

Plus…I think the patient rather liked talking about crack. They were…passionate about crack.

 

The Great Fall

Victim and Perpetrator

Last night my wife and I come in from work together. As always, our Great Dane, Diesel, is excited to see us and comes running happily to greet us. We make our way into the bedroom and somehow or another, Diesel loses his footing  and lands with his full weight, hip first- right on my wife’s foot/ankle. She was done for…

Reeling in pain, I tried to keep her comfortable and hope that it was just a bump and that she would be stiff but mobile in the morning. We apply ice through the evening and I wrap her up in an ace wrap for comfort.

Middle of the night, I wake up…I hear a strange sound…rustling. I peek off the edge of the bed and see Heidi’s crouched figure, scooting on her butt into the bathroom….oooh…that’s not good. Two more times in the night I hear (and partially see through sleep drenched eyes) her crawling into the bathroom.

Morning comes and there’s no way that she’s going anywhere- other than the doctor’s office. We both have stick-shift cars so she can’t even drive herself. Looks like we’re scrapping this day of work. Call the doctors and manage to get seen early by the ARNP. I whisk her all around the facilities- in a wheelchair- she hated that. Make way for the invalid!

We get a couple of x-rays done and head home. After calling around, we manage to score some crutches from family…saving ourselves the sixty dollars the medical supply store was going to charge us.

A bad sprain and a referral to the podiatrists, which she’ll most likely blow off- is what we get for having a clumsy dog that weighs 160+ lbs.

Eight months pregnant and on crutches. She’s a sad sight to see. I still think it’s kinda funny…don’t tell her that though!

Code Win!

Code blue, dialysis area.

This is usually one of two things:

1.The patient has fallen asleep…in which case- big deal, they’re probably in their bathrobe anyways.

2. They’re dead…

In the most recent code- called to the dialysis area, the patient was of the latter type. I didn’t get to run down to the code but I was in the ER when the patient was wheeled over. They were able to get a pulse back and the patient was intubated.

Time was spent trying to further stabilize the patient and then a central line was placed. Placing a central line involves putting an iv into a deep vein and feeding it so that it ends near to the heart. It allows for quick delivery of meds and the medicines get into the system quickly. Also, the line can be used for drawing blood or running iv’s. It’s a good thing to have on someone who is a hard stick if you need to give meds and you need to do it fast!

The patient is stabilized enough to get them transferred to the ICU. I don’t see them go upstairs, I just get the task of taking up a forgotten wheelchair an hour or two later.

When I get to the patients room I see them. The tube used for intubation has been removed and the patient- is sitting up and talking! It just blows my mind how resilient the body can be and how efficient and knowledgeable our life-saving staff are.

Getting screamed at by a crack-head because you “work for the government” can get a little old, but getting the “wins” like I described -make it all worth it. It refreshes your spirit and brings you joy when you think about what you have the opportunity to be a part of.

 

It Takes Two

 

 

Uhh…just waking up…11:15am…

Alright honey…let’s head to the ER….

Three buses later…

 

Hi, what are you being seen for today?

Nausea and vomiting.

And you sir?

Low back pain…real bad…been goin’ on for ’bout a month.

Ok, let’s get some vital signs and we’ll take you back to a room.

Can we go to the same room?

Uhh…no.

It’s the team approach! A family affair, the duet, table for two…however you want to put it. It’s so bizarre to me when couples check into the emergency room- just ’cause.

If you’ve been in a car accident and you come in as a family- or with a friend from the wreck, that’s one thing. But when your significant other checks in and then minutes later you say…”I guess I’ll check in to,” in my mind…your complaint loses a bit of it’s urgency.

Lord knows that sometimes for guys, we won’t go to the emergency room unless we’re dragged there. But when you check in to pass the time while you wait for someone, well-they have a place for that. It’s called the library.

Tased and Confused

Here Comes the Pain

Ever been tased? Yeah, me either…except for a few times as a teenager with friends….with tasers from the corner store. Never have I experienced the shock that comes from two electrically charged barbs stabbing into me and lighting me up like the first smoke of a discharged patient. The feeling that causes grown men to fall down, curl up into the fetal position and sometimes wet themselves is foreign to me- and I’d like to keep it that way.

We often get patients brought in via police chauffeur that have been tased. If the barbs end up sticking in a tricky place, the patient may show up with jewelry in place- to have them removed by a doctor. I’ve never been in law enforcement but it seems that most times someone has been tased, they deserved it. Still…some of these tasings seem like they are just down right awful…hopefully enough to get the recieving party to think about changing their ways.

There’s no way for the user to control where the two magical taser barbs end up, and when you’re doing push-ups in the hallway- trying to pump yourself up for police confrontation…you’re just asking for it.

I always thought push-ups were a great source of exercise and could offer great health benefits. Even though I’m on a program to get to 1000 pushups a day (I’m at 500 right now,) if an officer of the law is drawing down on me with a taser, I won’t try to scare him off with a round of pushups. Oh no…he can lift his own body weight repetitively…we better just leave…

Ever licked a nine volt battery? Try licking 900 nine volts-at once. That’s what it’s like when one of the taser barbs ends up stuck in your tongue as you try to spring up from your last super-set of pushups. Getting your tongue pierced looks painful enough, but sticking my wet, freshly pierced tongue on an electric fence…no thanks.

As it turns out, it’s hard to make your raps sound cool with a taser barb and half a foot of wire hanging out of your mouth.

Fire Crotch

Of my tales from the emergency room, this one will definitely be re-posted to the top stories page…

I come on shift to find that I’m going to be doing a 1:1, this involves watching over a restrained patient(s) and documenting their behavior (baby sitting.) The patient I’m watching was brought in by the police department after quite a fight. Needless to say, he went from their handcuffs- straight to our restraints.

This gentleman (a definite stretch of the word) goes back and forth from being friendly with me, to downright threatening my life. He’s big and he’s mean and he makes sure that I know it. I spend mass time and energy trying to convince him to come to ct scan with me and finally he agrees. I take a security guard with me and he cooperates to go from the ct table- back to the gurney and into restraints.

Not long after I get him back to the room, he informs me that he has to pee. Luckily, he has enough slack on the restraints to perform the necessary movements on his own, so i just have to give him a urinal that’s sitting on the counter. He’s unable to make any urine, “stage fright,” he says…I hadn’t pegged him for the timid type.

Fast forward a couple minutes, he says “Dude, what was on that urinal… my dick hurts.” I tell him that the urinal was clean and assume he’s delusional. “Dude, can you get the doctor to come look at it? I think there was something on that urinal!” I reply “No, there wasn’t anything on the urinal and if you got something from a urinal, there wouldn’t be any visible symptoms this fast. “Well, can you look at it?” he says…

Now, I’m not in the business of examining people’s private parts nor do I have the expertise to diagnose any findings- so I tell him no. He’s getting more and more vocal and he’s really rubbing his crotch at this point. He rubs and rubs and gets louder and louder, “dude, my dick hurts, it HURTS!” At this point I have no idea what’s going on but this dude is getting pretty worked up.

All of a sudden he stops and looks up at me. “Noooo! The pepper spray!!!” he exclaims.

The police had hosed this guy with so much pepper spray, you would’ve thought they were cross-training with the fire department! Every time I went over by the guy, to give him some juice, my eyes would start watering… his face had been soaked in mace.

It’s only natural to rub your eyes when they’re on fire, and while using the urinal, he had transferred a bit of the residue to his groin. The best part was, that before he figured out what was happening, he was rubbing his crotch like a madman trying to sooth his pain- oops.

For the next half hour, he wailed and moaned, dropping F-bombs at full volume and writhing around in agony. I put some gloves on him and fed him a steady supply of wet wash cloths until the pain finally subsided. The rest of the day went much better, it was just what was needed to break him of his attitude. Hilarious.

Aggression Management

Today I took part in an educational offering through work. Our entire emergency room staff is being trained in a program that teaches “management of disruptive and violent patient behavior.”

I was excited for this training for a few reasons.

The ER where I work sees a large amount of drunk,mentally unstable, and otherwise violent clientele. Many people are shocked to find out that legally, a patient can be restrained by all four limbs to the gurney when they have crossed a line and become a threat to others, or are trying to leave when they have been legally detained by the state. So, the job (some days) can be part care provider, part bouncer. It’s important to have staff trained to manage these situations for the safety of all parties involved.

Secondly, the program that we teach places an emphasis on recognizing levels of aggression. When staff can recognize the stage of escalation that the patient has risen to, they can have a response that is appropriate- and most likely to calm the patient to a manageable level. The levels that we teach progress in the following order: Calm, Verbally Agitated, Verbally Hostile, Verbally Threatening, Physically Threatening, and Physically Violent. Our number one goal in the emergency room is to de-escalate the patient to a calm and manageable level.

Thirdly, it’s always fun to put a mini whooping on your co-workers. The end of the training concludes with mock restraint scenarios where employees act out as patients who’ve gone off the deep end. This is fun because we all love to wrestle around and once someone’s tied to the bed… the ways to mess with them are endless. The most important thing (in my opinion) that comes out of the mock scenarios is the “team approach.”

We’ve had some scary situations at work and having everyone on the same page, knowing their responsibilities goes a long way in ensuring a smooth “operation.”

From spitting, to punching, scratching and biting- the staff of the emergency room have seen it all. What makes the ER  unique is that we regularly have “customers” who try to become violent towards us- the very people trying to improve their well-being. I love being a “grunt” in the ER, assisting the nurses and docs- I often get to be part of the restraint team. I have a certain “skill set” that allows me to be very effective in patient control. Wanna see my first cage fight? Click here.

Thanks to this seattle times article, I’m now acutely aware that I have the most violent job in washington state. Does this bother me? Not really… not because I enjoy violence… really it’s the opposite. I love challenge- when someone is ready to fight, engaging them in combat is easy. Taking someone who’s physically threatening and talking them down to a state of calm is much more satisfying and challenging than judo throwing them onto the gurney. There is a point in time where you’ve done all you can and there’s no way you can come to a state of calm -unless you put the smack down… that can be satisfying too…

Triage

Today I worked (mostly) in the triage area of the emergency room. For those unfamiliar with triage, this is the area you see first when you walk into the emergency room.

The glass windows, manned by the brave souls- stationed, waiting to recieve whatever complaint comes through the doors. I’ll readily admit it, I love being in triage. I’m fascinated by the human drama that unfolds as someone checks into the hospital.

The emergency room seems pretty straightforward…you go there when you’re having an emergency. As I’ve learned, everyone’s interpretation of an emergency is different. Working in a busy hospital, in the downtown of a large city, we get a whole host of different complaints and characters that come along with them.

Chest pain always gets attention, sometimes it’s someone who’s actively having a heart attack. Other times, it’s the fella that tells me, ” I was jumping a fence and I fell off the top and my chest was the first thing that hit…on a rock.” That was two days prior, now ( strangely enough) he’s having chest pain.

Mental health has become a significant portion of our caseload in the emergency room and just like anything else, it’s always something different. Sometimes it’s a person that knows they’ll get a warm bed and a sandwich, other times it’s extremely sad. I’ve had some enlightening conversations with patients who came into the ER because they were suicidal.    We all get the blues sometimes, but some of the stories that have come my way have broken my heart and made me grateful for the life that God has blessed me with.

Even though we are designated to recieve trauma patients by EMS every other day (we’re a level 2 trauma center,) a traumatically injured patient can walk through the doors of triage- any time of day or night. We’ve had gunshot victims show up in the parking lot, stabbings walk in, and people who’ve been in the car accidents that present looking fine on the surface, but turn out to have serious internal injuries.

No matter what the complaint is, everyone presents differently. You’ll see someone who has been vomiting for two hours (and decides it’s time to hit the ER) and can’t be consoled by the most experienced of staff members.  Two minutes later, a person comes in, wheeled over by a doctors office, with a heart rate of 180- calm and cooperative.  While we all deal with pain differently, and display our emotions on different levels, the stories that people give (to complete strangers) at the triage window is what really makes things memorable.

Today a guy comes in, but he doesn’t want to check in as a patient. He wants a needle. For obvious reasons, we don’t give out needles just because you want a sharp. The guy says that he just wants one and that he’s willing to pay for it….he would buy them at the store but he doesn’t want a whole box.  Thinking this guys a drug user? I know I would’ve, but the nurse continues to listen to his story (thoroughly entertained, I’m sure.)

“I’m not a druggie” he says ” I wanna drain a cyst on my cat’s back.” I’m thinking this would probably be a job best handled by the vet but our friend informs the nurse that “they want 47 dollars just to see the cat!”  Turns out that the cat is well over ten years old and sounds like it’s had a rough life.

The best part of the whole story, he tells the nurse,”and you know how he got the cyst?…hawk done swooped down in to get ‘im!”