Gobble Gobble Gobble

There are days where I know my family puts the fucked up in dysfunctional (hey... it works when I spell it!). Some days the drama of being married to a cop proves difficult. There are hard decisions and sometimes feelings get hurt. What can you say? It's not personal... some people don't see integrity as worthwhile until its questioned.... I, on the other hand, beg to differ. Without getting into details... I won't have any problems sleeping over this decision.


So the trauma room was just what I needed last night. Stocked and ready to rock. The ER was dead... just a couple of drug seekers and a little bit of bullshit on the side. Had a rollover with an open fracture to the leg. Nice guy, sober, appreciative of all of his care. Ate with the ER family.... I stopped feeling sorry for staff that works night shift on Thanksgiving... we have the BEST leftovers! Had a super huge spread with some of the greatest people I could work with. What a family!!!

Ended my night with a "found down" in the rain. He was out at least 4 hours and had a core temp of 83. We decided he needed to be tubed.... no SOCM medics or lower type peons around. I asked and they said yes! Got the tube on the first shot... save a little green vomit it was easy as hell! His lactate was nearly 20 and his pH was 7.0.... poor sick guy. I hope he enjoyed his turkey today.

Irritated

Sitting in triagony the other night. Not sure where the sense of entitlement comes from these days. We were busy as hell. Sick patients, transfers, traumas is addition to all the other associated bullshit. If you have flu-like symptoms, want a work note or just have a headache and are out of Percocet you really, REALLY aren't getting in before the wheezer that can't talk, the walk-in stab wound to the chest or the seizing head bleed. I had more people up in my face screaming about the wait time and that "people that walking in after me are getting seen first." (see also: the WALK-IN stab to the chest)

I have mentioned the intellectual Olympians known as our hospital security (not police). Again sitting in the penalty box when a young lady walks in with a box marked "Perishable" with biohazard tape. She stopped at security and asked how to get to the OR. (anyone getting the drift here?) He told her that she would have to go back out of the ER, down to another building and through the ass-backward way to another security checkpoint and waiting room. Absolutely not! This chick goes straight up! There is a patient prepped, tubed and (probably) open waiting on this kidney that has already been out of the previous owner for at least 3 hours. (She just arrived from another big teaching center about 3 hours away)I walked her up to main control myself and the kidney-bean got where it needed to go. This fucker seriously cares more about me texting at the desk than getting a fucking organ where it needs to go on time. Yup, I wrote it up!

Am trying to get a proposal to one of the state EMS conventions. I want to do a neuro lecture about traumatic brain injury and pre-hospital treatment. With my neuro, ems and flight background, plus the fact that I have lectured before you would think it would be a slam dunk, right? Negative. One of my coordinators is on the committee and he was giving me a hard time.

• have you lectured before? we don't want anyone cutting their teeth here
• do you really think you can lecture for 90 MINUTES?!?! (my normal lecture is 4 hours)
• have people actually heard you speak? who was it?
• do you think you could have a proposal ready in time? (told him my whole 4 hour lecture was at home on the computer.... could email it the same day)

whatever.... I'm qualified, organized and am a pretty decent teacher. I gave him my proposal, but I'm going to email it to someone else on the committee as well. Ugh... we will see. There is no monetary reimbursement, but it would be one hell of a resume builder.

Dear God...

I understand that there is a reason behind everything you do. I can't begin to understand the grand plan or meaning behind it all. I guess my role is to keep faith and roll with the punches. I have tried to give more than I take and make my time here worthwhile. The last 18 months have been challenging to say the least. My professional, personal and family life have hung in the balance at some point or another. I hope that I have used these opportunities to grow and make myself a better person. So now, after ANOTHER sleepless night, this time worrying about my mom (who was taken to the hospital as I flew back from my trip)  I ask.... can I get a freakin break?

Thank you

Amen

The trip itself was incredibly relaxing. Jamaica is infinately sad and beautiful at the same time. So much poverty amid all that green water and blue sky. I had champagne with breakfast every morning and something called a Dirty Banana from the beach bar (or swim up bar) any other time I needed it. It rained every day... I didn't care. Got a ton of sun, ate great food and swam in the ocean every day. What can I say.... it was fabulous.

Called in tonight so I could spend more time with mom (and getting moms house together so she wouldn't have to). Back to the grind tomorrow.

Somedays....

... you can't win them all.

Last night I don't think I won any! Some nights everything you touch turns to gold and then there are nights like mine. Seriously, don't know where this shit comes from.

I was supposed to be walking the green mile again last night. Not in charge, just rowing with the others. One of the nurses absolutely hates the trauma room and asked if we could switch. Easy enough and the world swings my way for a change. I picked up the room from one of the guys who is both thorough and laid back. If only he worked nights! The room was both empty and stocked..fan-freakin-tastick. The trauma docs immediately decided to put one of the traumas back in the room for chest tube placement. 18 year old female, t-boned on the driver's side. Rib fractures 4-11 on the right side with a hemo/pneumo. The doc did an incredible job of numbing her and with a little "liquid margarita" (aka dilaudid) she did great.
Once she got settled, the trauma started rolling in. 3 from another accident.. nada too sick. Two rolled out and we got another upper airway burn from a house fire. This guy went into his burning house after his cat. He made it out, the cat did not. Nice 22 year old guy with a history of asthma. He was wheezing, but still managed to laugh and joke despite the house (and the cat) being a total loss. Got scoped at the bedside, and then to burn ICU for overnight observation.
Did I mention we were on diversion with very few inpatient beds? OK, just checking....

Local EMS agency overrides diversion (it happens) for a man with chest pain, in a 3 degree heart block and 10/10 pain. One thing I have picked up along the way: if you have to use a towel to wipe the sweat off, THEN use benzoin to get the 12 lead EKG and normal EKG patches to stick.... life is NOT Good today. Get your shit ready. This poor guy had a rate in the 50's, a pressure in the 200's despite 180mcg of nitro. Bad juju my friends. He was awake, talking to me while 50 million things happened around him. Hemocult, heparin bolus and drip, projectile vomiting + zofran = baby asa and plavix PO. IV morphine and titrating the shit outta the nitro. Consented for cardiac cath by the CICU and rolled out 35 minutes after hitting the trauma room. (no other bed when he arrived). He coded as soon as he hit the cath lab..... died 45 minutes later. 50 years old..... I kept telling him to hang in there and that things would be ok.

Next contestant. 86 years old, from the nursing home. Dementia, prostate cancer, vomiting blood, being bagged on arrival. The nurse didn't think she was supposed to send the DNR. We were fixing to get medieval on him as the charge nurse convinced the NH staff to fax the goddamn DNR already. It finally, thankfully showed up. He was fluffed, puffed wrapped in blankets, put on a NRB and left the hell alone. What a damn relief. In an effort to reverse my karma I grabbed a COW (computer-on-wheels) popped up Pandora on some Michael Buble and put that in his room as well. Hell, if the man is going to die he may as well have some relaxing music!

He had just gotten settled and I was feeling a little better when we got the next call. Flash pulmonary edema 2 minutes out. Pt shows up on CPAP via a transport service (not 911 type EMS). 28 years old, 450lbs from a respiratory-type nursing home. She had been short of breath for greater than 40 minutes and the facility chose not to call 911, but to wait for their normal transport service. She was awake and saying "help me" when she arrived. As we watched she stopped breathing on CPAP and the game was, unfortunately, on. Bagging her was a BITCH, I had to pull her hair just to open her airway and it took 3 of us to get a good seal. Roc and etomidate... the resident got the tube on the second look. (long story involving the dumbass attending.... better saved for a later rant) Even with color change she looked horrible. Purple and mottled no matter what we did. Confirmed tube placement a million times... she dropped her rate from 140 to 60... but never brady'd down like our shit-airway people usually do. Shit BP + Shit O2 sats.... femoral pulses impossible to feel through the FUPA and the cheese down there was disgusting. We coded her for 11 minutes the first time, and got a pulse back after 2 rounds of drugs. Lost it again after I art-stuck her for labs. Coded again for 15 more minutes.... everyone took turns with compressions as she was too big for the geezer squeezer. P's and T's... everything covered. Even darted her left chest just to see if it changed things. Over an hour of coding the big girl when we were finally done, followed by cleaning the hell outta the room and the quest for a bariatric body bag.

As we were zipping her up, my transfer... self inflicted GSW to the right temple with an exit in the left temple. He said he was cleaning the gun and it was an accident. (yes, awake and talking... just destroyed both eyes) Accident my ASS!

So on the advice of one of our university police officers my breakfast consisted of "Jameson's, 3 fingers with 5 ice cubes." Perfect for a night like that.

Hot Now

Last night was exactly what we anticipated. Fucking insane all night long. I had a great group walking the green mile, but some nights even a great group can only take you so far. There were some superfreaks out and about. I didn't get to see any "real" costumes, but I still wonder about what people were wearing when they left the house last night.


Sad case, college level math professor from somewhere in Africa found wandering. No idea who he was or where he was. CT scan showed a BIG head bleed. He was still awake, but squirrely as hell. We were, of course, too short on security and extra staff to have someone watch him, so we all basically did a drive-by of his room whenever we could. Ditto with the drunk that fell at 3pm and bonked his head. He was still metabolizing to freedom 13 hours later. Lots and lots of drunk bastards last night. Some more functional than others.

Trauma, on the other hand was wide slam open with MVC's and GSW's. Some dumb fool pulled a gun on three other dudes. He got off a round or two before the other guys lit his ass up. 4 total GSW's in a span of 15 minutes in addition to the multiple accidents that were coming in. I ended up pulling multiple patients out of the trauma room back to the green mile just to make room. Oh, and of course all of this happened when the computer was down.

My all-time favorite Halloween patient.... 29 years old, found down in an alley. Combative as hell. He came in proned out, handcuffed and strapped down all the while flicking us off. If Criss Angel and the guy from The Crow had a psychotic child then this would be him. Black stringy hair, crazy black eyeliner, tattoos and fake blood all over him. When he pancake flipped him he arched up off the bed, head back and screamed "I'm going to kill you all!" I looked up and said... "Holy Shit, it’s the Devil!"

Had an unrestrained female hit some guy head on. She was pregnant and until we unstrapped her she was normal. When we logrolled her she went apeshit and grabbed my male nurse by the cahones. It was not a pretty picture.

I figured that since we all worked that extra hour we deserved a well earned break. The CC knew I was going to the "bathroom" as I drove through the monsoon to get hot. fresh doughnuts and coffee for the department. It was just what we needed to make it through that last hour. So am glad to be home, dry and happy.

FYI: I am NOT doing this SHIT next year!