I've seen some weird things

but never anything like this.

Rupture Weekend

So, as I've mentioned before, the past weekend was pretty action-packed. We had the guy with a globe rupture, and then we got another kind of rupture.

I got report from another hospital letting me know about a transfer. This was a thirtyish woman with a two-day history of lower abdominal pain and a positive pregnancy test. She was coming from a small community hospital with no GYN services, and needed an ultrasound to rule out an ectopic pregnancy. I was told she was stable and in no serious distress.

An hour later, an ambulance rolls in with the transfer. She is paler than milk, diaphoretic, shivering; her belly is distended and painful. Because she's young and in great shape, her blood pressure wasn't terrible (yet) and she wasn't too tachycardic (yet), but it was clear that this was no stable "rule out ectopic." This was a full-blown ruptured ectopic.

Of course, we all spring into action with fluids, blood products, warming blankets, and immediately prepared her for surgery. I went up with her to the OR, and when the two GYN docs with me ran into the room to set up, I was left in the holding room alone with the patient. It was a Saturday night, so the place was empty. "Hello?" I yelled. "Is there a nurse around? I need to endorse this patient!"

I look down at the woman, and she's lying there quietly, with her eyes closed. I started attaching monitor leads so I could keep an eye on her until someone came. Suddenly she takes a deep, trembling breath in...pauses....and lets it out, her face slack.

I almost soiled myself. In fact, I think maybe a little pee might have escaped.

I grabbed her wrist to feel for a pulse, yelling, "Ma'am! Miss! Open your eyes!" as I desperately looked around for a code cart. I have never felt so alone in my life.

Fortunately she opened her eyes. "Are you ok?" I asked? She nodded. Her pulse was around 120 and thready. I started pumping up the pressure bags on all the blood and fluids that were hanging around her to squeeze out as much as I could into her. I finally noticed a nurse slowly sauntering down the hall and yelled for help. Thank goodness the docs came running out of the OR and they all took her in.

I found out later that they suctioned two liters of blood out of her abdomen, fixed the rupture, and she's in the ICU but ok and recovering.

The lesson I learned? I will NEVER go up to the OR with a case like this again without another ER nurse with me.

An Observation

So, I slept in a little today since work was crazy over the weekend. For some reason lately the day shifts are woefully understaffed, and yesterday, because of a sick call and some kind of schedule mix-up, we had seven nurses. We're supposed to have fifteen--or at least ten would be nice. And of course, sick people were pouring in. So it was a little stressful.

I woke up feeling a little cranky and tired; my muscles felt stiff from running around like a maniac for two days. So I leashed up the dogs and took them out for a walk.

On a park bench near the grassy area where the dogs like to sniff around was this dapper yet peculiar looking young(ish?) male person. I immediately thought, "Oh great, another weirdo, crazy alert, look out."

And then it occurred to me: Why the bad attitude? I live in a city known for its great diversity, where anything can happen and usually does. I have the great fortune to be exposed to a multitude of cultures, cuisines, ethnicities. Why can't I look on the unusual people I meet in my life and work as another example of this great diversity, and smile, and feel fortunate to be able to have all these interesting things in my life? Furthermore, it's a beautiful day, I have two days off ahead of me, the sun is shining, the leaves are unfurling, my dogs are happily sniffing around and doing their doggie things. A gentle breeze is ruffling my hair. I'm healthy, my family is healthy, I have a job that I (mostly) love, I have a place to live, I have friends and people I care about. What's to be cranky about?

As I'm lost in my happy springtime multicultural reverie, deciding to love everyone and be a beacon of love to the world, a nice-looking woman approaches me and says, "Excuse me?"

I turn to her with a smile and say, "Yes?"

She says, "Can I tell you something?" And then proceeds to rattle off a screed about how at the shelter they spray her with some strange chemicals but they don't spray anyone else, and it's because the black people think she's white and the white people think she's black, and how the government is looking for her, and how after we're finished talking if anyone approaches me I should RUN because they will try to get me because I was talking to her, and how she doesn't know what to do, but that she knows that God will help her because he gives her messages through Jesus, His son, and how does she get these messages? Through a seashell she holds up to her ear. And then she asks me, "What should I do?"

"Ma'am, do you feel sick in any way?" I ask.

"No," she says, and smiles.

"Hm," I say. "Then honey, I don't know what to tell you to do."

She says, "Okay," and wishes me a good day, and moves along to the elderly Russian Jewish Orthodox couple walking with their adult son who is developmentally delayed. As I pass them with the dogs, I overhear her telling them they need to get their son a Bible and this will cure him of the devils that are infesting his spirit.

Fucking crazies.

Two yucky words

Globe rupture.

Ew.

(For the uninitiated, the globe I am referring to is the one in your
eye socket.)

I hate visitors.

Listen, I know it's helpful to have someone with you when you're in
the ED. But the key syllable here should be ~ONE!

Ok, so I'll make an exception for kids so both parents can be at the
bedside. But you don't need both parents, all the siblings, both sets
of grandparents and the next-door neighbor at the bedside in our tiny,
eight-bed pediatric ER. Also, having all of you stalk me and
individually ask me the same questions is going to drive me batty.
Also, all of you are freaking LOUD, and the parents with the septic
infant in the next bed do not appreciate the party atmosphere.

Speaking of a party atmosphere, there is a large community of people
in the neighborhood of the hospital who ALL show up when one of their
number is hospitalized. I'm not talking about ten people here. I'm
talking at least 50 that I can recognize, and that doesn't include the
various children they drag along with them. Whenever a relative is in
the ED, the chaos starts: there is a constant parade of relatives in
and out of the ED; the relatives in the waiting room monopolize the
TVs and eat food that some one of their group has cooked out on the
street in the back of their car. It would be just like a tailgate
party, except that the people with migraines and nausea and vomiting
don't need to be exposed to the noise of the partygoers and the smell
of their food as they wait to be called back to a bed.

The party crowd are an emotional and dramatic bunch, and it's not
unusual for fights to break out that require security to intervene.
Once a husband and wife had such a knock-down-drag-out fight, I had to
triage them both: him for "chest pain" and anxiety, and her for
screaming, "I want to die and kill you too!" as the police dragged her
out (because of course this is homicidal AND suicidal ideation and the
cops wanted her to get checked out by a psychiatrist first). And I
ended up triaging one of the cops, too, because she bit him.

Look, the ED Is not the place for your family reunion. Go rent a hall
or go to a park, or whatever.

Help Girls Rock Out!

The Willie Mae Rock Camp for Girls is a great summer day camp that teaches girls to play rock and roll and DJ--they teach instruments, form bands, and have a huge concert at the end of the camp session. It's great! I've been trying to finagle my summer schedule so I can be a band coach for two weeks.

Now they are trying to raise money to go year-round with an after-school music lab--they need coaches, instruments, soundproofing, you name it. They're campaigning via the Pepsi Refresh Project, which is a funding platform for community projects.

I almost never campaign for any cause, but I had to get behind this one. Please, take a moment to visit the site and vote for the Willie Mae Music Lab!

April is always disappointing

April is a deceptive month. I always think, "hey, the weather is beautiful, it's lovely outside, Easter is over--things should calm down in here soon."

Nah.

I think this every year, and every year, without fail, I am disappointed. We are always packed to the rafters seven days a week, with ambulances coming nonstop. Yesterday was the first day the waiting room wasn't stuffed to the gills.

But I got to be a "real" nurse the last couple of days. I educated a family about the last stages of death so they could be present with their mother calmly, holding her hand lovingly through the last hour of her life. I reassured an exhausted single mom with a (possibly) seizing child. I put in two difficult Foley catheters: one in an elderly woman who had broken AND dislocated her hip at the gym (no, she didn't break it while working out, she broke it twisting to open the door for someone!) and a 13-year-old with spina bifida and hypospadias who had a bad UTI with urinary retention. Got them both in on the first shot (and I inserted the elderly woman's Foley from behind! HAH!).

I also had to put up with the MOST unpleasant, most annoying nurse in the world, a real "C-U-Next Tuesday," as our pediatric attending would say. She begs for help and then criticizes the way you do it. She makes up rules about the way the ER works as she goes. She's mean to the techs, the clerks, the residents. She's slow and fixates on procedure and paperwork instead of actually helping patients or jumping in during a crisis. She makes me want to hang myself. The only way I can get through a day working with her (because I'm often assigned to float, and when she's there, she bitches until I float to help her--exclusively. With her three patients, while everyone else has twelve) is to remember that people who enjoy making others miserable are often miserable themselves, and that NO ONE in the ER even likes her a tiny bit, and how that must suck.

Almost Midnight on the Ambulance Ramp