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.

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!”

 

Welcome!

My first post…hmm…what to say…

Let’s start with a little background. I’m an EMT working in an emergency room and this is a diary (manly version) of the happenings of day to day life. Nothing is ever the same and when you think you’ve seen it all- something surprises you.  I love telling the stories from work and most people are fascinated by the human dramas that unfold in the emergency room. Heartbreak and anguish, anger and regret, pain and pleasure- pursued, are some of the regular overtones of the day.  You’ll notice that peace isn’t found among the list. It’s rarely quiet in the ER, and when it is…everyone is on edge waiting for the world to come crashing off it’s rotation.

No matter the chaos, my role in the ER is to try and bring peace and comfort to those I serve, and serve with. The emergency room can be a place of desperate sadness and can cause those working in it’s core to become jaded and cold. I’ve felt it before, but my constant goal is to be refreshed spiritually and pour the love that I feel- into the lives of those I serve.

My best efforts to document the paths that I cross, and the struggles I observe will be contained in this blog. Personal victories, believe it or not, are many, and when they occur- it’s a powerful thing.  The opportunity that I have to serve such a vast diversity of people is truly an honor. I don’t have all the education of a registered nurse, or the expertise of a doctor, but I do have a love for people, a desire to see healing, and a passion for those in pain.

So whether it’s the story of a broken limb, a guy who swallowed his toothbrush (really…a full size one too) or a prostitute crying when she realizes that people can still care…I’ll be bringing it to you here. My desire is that you can benefit from my experiences and I can grow in the process. Thanks for stopping by.