Ooof.

Two of the worst days I've ever worked.

I feel like I've been hit by a truck. No, make that two trucks. Each carrying a circus-worth of elephants. And then the evil clowns leaped out and tap-danced on my spine.

I work a very busy shift: from 11:30 AM to midnight. The day shift has a few hours from 7:30 to about 11 when ambulance arrivals slow down, and the night shift is usually a little less hectic after about 2 am to 7:30 when they leave. But mid-shift is (almost) always busy. That's fine with me, because working this shift, I never have to wake up at 6 am, and I always get to go to sleep when it's still dark out.

It was two days of non-stop ambulances, and standing-room only in the waiting room. We were doubling them up in rooms, lining them up down the halls, borrowing stretchers from endoscopy to accommodate everyone. At one point, the "critical care area" had SIXTEEN patients in it. And one nurse.

And pretty much everyone was sick--including the staff. I took three residents back to the nurses' lounge to mainline Zofran into them so they could keep working. We sent one poor resident home, because she couldn't assess patients without leaving them to vomit every ten minutes.

I was precepting two orientees (thank jeebus one of them was a nurse with some ER experience), and then when the day shift left at 8 pm on the first day, I ended up being in charge for a while because the regular charge nurse had been in a fender-bender on the way to work. She was okay, just two hours late. I sent the preceptees to help out in areas that were being slammed and basically worked on getting patients upstairs--getting charts ready, badgering administration to get beds clean, and taking patients up and leaving them in the hallway. One floor had been saying that three areas that were slotted to receive patients from us had no actual beds in them. For the last five hours. Well, if they can sleep on a stretcher in the ER, they can sleep on a stretcher upstairs. I brought all those patients up.

The next day was even worse. A sample of the patients that we were dealing with?

In one area, we had three septic, intubated patients on pressors. Then we got a 57-year-old guy in stable v-tach. (yeah, that's an oxymoron if I every heard one.) The guy was sitting up, talking, no chest pain, no sob. The monitor was going crazy--loooong runs of v-tach interrupted by weird, slow, large-complex beats. We had him on amiodarone and esmolol drips, and it was not helping. He was a lovely, cooperative man. And I say "was," because about an hour after he got there, of course, he coded and died. He should have been up in the CCU, not down in the ER.

One of the 96-year-old, contracted, vented septic patients coded too. We got her back and stabilized.

We had a ruptured ectopic transferred from another hospital. Actually, it wasn't ruptured at the other hospital--it ruptured on the way over. Nice.

A ton of chest pains, a ton of renal failures. Some DKAs. A million things to do.

Then I was assigned on the second day to pediatric triage for my last four hours. Sometimes when we have enough nurses, we have a separate pediatric triage person to lighten the load, since pediatric patients often take a lot of time to triage.

Ugh. Three septic babies in a row. They went straight back. Then another three babies: all of whom had been born between seven and ten days ago and who were all "constipated." Then a parade of puking toddlers (I ended up going and getting a mop and bucket, because my little triage room was flooded with cheese-smelling puke.) A few asthmatics, who always go straight back. Pediatrics was swamped; kids in every bed. Then a motor vehicle crash showed up. Six patients: two adults and four kids, ranging in ages from 12 to three. And then an anxious 19-year-old who was away from home. He showed up with his coaches--he had been elbowed in the throat by accident while playing sports. His voice was gone, his throat was visibly swollen, and he kept saying, "it's getting harder to breathe." He went right back too.

I limped home an hour late. Sat on the couch watching TV until three am. Then went to bed and got up today around one pm. I have a paper to write and lots of things to do. But I'm beat, so here I sit, drinking coffee.

My feet hurt.