Brick Wall

A responsibility I have at work is to perform an EKG when a doctor orders one for a patient. The test requires that electrodes and leads be placed across the patients chest. Something that is interesting about health care is that as a provider of health care, you are allowed access to certain parts of the body that you would not otherwise have access to. So professionalism is of the UTMOST importance. This is for ethical reasons, legal reasons and just being a good person reasons. When I am performing an EKG on a female, I always make sure to never use my palms or finger tips when palpating the chest. I never ask them to be fully unclothed. The routine is always that the gown is pulled up above the abdomen and but still covering the breasts with only a 1-2 inch area around the sternum being uncovered. A blanket is used to cover everything from the lower abdomen and everything distal. I verbalize all of my procedures in order to keep the patient informed at all times of the process. I also always make sure to ask if it’s okay for me to perform the procedure before I do anything.

The other night I ran into a problem for the first time. A 40 year old female consented for me to perform the EKG, but I could sense a little bit of hesitation. After asking if she would prefer a female nurse perform it, she declined my offer and urged me to continue the test. After pulling the gown up to the abdomen, the patient exposed her chest to me and remarked that she’s no longer shy because she’s had an EKG all week. This did make me slightly uncomfortable because I never need to expose that much of the chest to perform an accurate EKG. The next thing she said got me.

“One of them is purple, I know it’s purple. And I don’t care.” She was referring to her nipple. To be honest I tried not to look at her nipple, so I took her word for it. I was thrown off guard and did not quite know how to respond to reassure her that, I’ve really seen it all. Purple nipple or not, it was not something that bothered me or disgusted me. I ended up retorting with, “I don’t know” and “it’s okay.” Today I am still wondering what I could have said to keep that professionalism intact. She then laughed about it and said, “Yeah I guess it doesn’t matter. It can be turquoise for all I care!”

I do not care about the physical aesthetics of my patients. I care about the physical health of my patients in terms of survival and well-being. I will assess for wounds, abnormalities, foreign objects, marks and other medical signs of poor health. Purple nipples are not a high priority in this case. What I do care about peripheral to physical assessment of health is personalities. I find it very interesting to notice personalities of my patients. I don’t know why.

I wanted to tell this female that, your purple nipple is fine. I do not notice it. It does not disgust me. I wanted to tell her that: you’re so pretty on the inside because you are strong, because on the inside, for a brief moment, you let go of what society has dictated to you what is pleasing to the eye and you loved yourself, for yourself in a way only you can love. I believed she truly didn’t care, for that brief moment, that her nipple was purple. Or turquoise. I wanted to tell her, if you can see that you’re beautiful, then I can too. And you are.

But that wouldn’t be professional. That would be dramatic. There has to be a way to shorten all that down to a sentence or a phrase. I’ll think on it.

Night Shift with the Peeps

Night shift is interesting because there’s a lot of down time and you really get to know the team you’re working with. This night, we had a motorcycle accident patient. He was going 90mph, intoxicated and with headphones. Other than having poor judgement in regards to personal safety, he was a nice guy. He had a lot of dirty abrasions and got scrubbed up pretty good. I like retelling people that what we scrub with is something that’s similar to what you would clean a bath tub with. There are long plastic teeth that really take off flesh. I felt bad doing it. Gotta get that asphalt out!

There was also a 50 year old female who had been out drinking and got kicked in the head. She was being very uncooperative. Asking what can be done about her bleeding head and then refusing treatment. She kept accusing us of treating her different because she was Mexican. Then she played the race card. Even though our staff had a lot of ethnic variety, she still played the race card. It was ridiculous to say the least, but very entertaining. Instead of getting medical treatment, she got a ride with the police.

There was also a elderly gentleman who had a fall. He was very respectful of our help and was really one of those great patients you’ll remember for a long time. He was having pain all over his arms and was found to have a C-6 fracture. He didn’t make a fuss, nor did he ask for much, but you could tell he was in a lot of pain. What really got me was that his daughter was there at 4am in the morning and was with him the whole time. The devotion she had for her father moved me tremendously. He kept telling her to go home to get some sleep and she kept telling him no. “Too bad Dad. I’m staying here. You’re stuck with me. You’ve always been stuck with me.” It’s easy seeing your father in the emergency room.

Half Shift

Sometimes I’ll get half shifts and they’re great because you’re there for a lot of good work and leave before you get tired. I wish I could have half shifts all the time. My half shift was pretty heavy. 3 traumas came in within 5 minutes of each other. Also 2 chest pains. I got to see a chest tube placement and somebody got intubated.

Chest tube placement. A suction is palced within the pleural cavity in order to alleviate pneumothroax symptoms. The trauma surgeon locally anesthetisizes the lateral thorax around the 5th intercostal space, or wherever the pneumothorax is. Then he makes an incision about an inch wide in order to go in and break into the pleurum. I did not expect to hear the sound of air rush out of this guy’s chest, but it happened. It was like a basketball deflating. Then they shove a thick tube into the incisions and hook it up to suction. This creates negative pressure in the pleural space. I think I got that all right. I’m sure my physiology teacher won’t read this. Anyways. Knife goes into your chest. Tube goes in. Air comes out. Fun.

I got to see some pretty nasty avulsions on an older gentleman. They were about the size of envelopes on top of his head and on his right shin. Pretty Gnarly. He bled a lot. Nice guy.

Work is work

I did a few things last night at work that I never did before. Kinda refreshing.

A young male about 12 years old came in with a cast to get removed. The preferred method for cast removal is to use a vibrating disc saw with vacuum attachment. This thing looks incredibly menacing, but it isn’t. It looks like a 4 inch diameter rotary saw, but the thing is it only vibrates back and forth, it doesn’t spin. This allows the cutter to only cut casts without cutting through clothes or skin. The problem with this machine is that it makes the nastiest noise when it turns on. It scared the kid really bad. I was being nice and stopped a lot because the kid kept screaming and telling me to stop. I think the doctor got mad at me for taking so long. Next time I’m just going to turn that thing on full spin and slice it off.

I helped a elderly gentleman pull down his diaper so he could pull out his penis to pee in a urinal. Afterwards he screamed at me to call his son. When asked what the number was, he responded with 411 in San Francisco. I told him I couldn’t call him with only that information. He then yelled at me some more.

Later in the evening a combative and drunk 25 year old male came in to visit the ER. He had gotten drunk and fought a bouncer. He had a laceration above the left eye upon initial examination. It sure livened up the mood in there. He began calling all the nurses bitches and to let him off the backboard and restraints. He promised he would be good and just wanted to go home. Then he tried to get up and punch at people. 2 security guards and I held him down as the nurses provided treatment. He called me a “bitch ass cocksucking faggot that can’t get any pussy because you suck cock you cock sucker.” Then he started crying and said he was sorry. I was glad I was working with the team of nurses, doctors, security personnel and law enforcement officers. Everyone was safe and treatment was provided in an orderly fashion. So guys, when you go get drunk next weekend just remember, if you’re going to hit the bouncer and then get your butt laid out, don’t wake up in the ER and try to swipe at the people trying to help you.

Funniest moment was when he was asking us not to transport him to the hospital because he didn’t want to pay for the ambulance ride. He said he didn’t want to go to the ER because it would be really expensive and he’d get in a lot of trouble. We told him he was already in the ER. He said “Nuh uh, you guys are liars.”

That pretty much took me to the end of my shift. I washed my hands and headed home.

Salsa Salsa!

3 large hothouse tomatoes (diced)
1 small red onion (diced)
2 limes (squeeeeeeeeeezed)
1/2 cup of chopped cilantro
5 cloves of garlic
tbsp of salt
tbsp of sugar

ALL FRESHHHHHHHHHH wooo.

It was okay. Burned my tounge a bit.

Virgin Mojito

I heard it’s not as fun, but still tasty. Not really worth the effort. Really work on that simple syrup. It’s the glue that binds the ingredients. Simple syrup is 1:2 sugar to water.

http://miniandmicro.blogspot.com/2009/08/mojito-who-keeps-her-legs-together.html

Mini post

2 double traumas, 2 stroke codes, 1 man eating dirt and covered in ants. Had beef brisket yum.

On my lunch a lady was trying to get into the hospital after hours. Her water had broke. I had to stuff the beef brisket in my mouth and help her through the side doors. I hope she names her kid after me.

Another Another

I remember being really hungry today. I also realized that one thing I can almost not stand is bad breath. I’ve been really good at handling the gross stuff, but bad breath is almost too much. Almost. Yuck. Some people think GI bleed’s smell bad. I don’t know. GI bleed’s aren’t that bad I think. The worst breaths are the ones that linger. They sit in a little pocket of air where you can dodge it, but once you put down your guard you’re sure to run into it again.

I decided to take a lunch break this shift. I should do it more often. I don’t miss much and I get to take a breather. Good advice!

Couple of traumas today came in. I had my first gun shot wound patient. It wasn’t that cool. He shot himself in the leg. Meh. Also this guy came in with head trauma that lead to a concussion. He was reported as being an agressive combatant. Everyone was ready in the room to hold him down to get him intubated. It turned out that he was gentle as a lamb, just very confused. Confused lambs = Agressive combatants.

Rule of thumb: trauma doctors are way cooler than you’ll ever dream to be. They drip awesome when they sweat. The problem is they never sweat. So you’ll never get to be there with your little wash basin full of vomit to catch that awesome. The awesome lives in them and stays in them until they decide to metamorphose into a member of the Transformers. Then and only then do they release a little bit of awesomeness. It’s released in the form of a Power Metal Band from Sweden. You can’t even touch that.

Truth

After being a month away from work after traveling through South East Asia I was a little bit hesitant to go back to work because I was afraid my skills had become rusty from lack of practice.

It’s crazy to see the things you’ve forgotten you remember.

It’s like watching someone else’s hands do your work.

I had my first trauma in a very long time. Communication is key, but that requires two people. I can’t always blame myself for not being forthcoming. Some people just don’t like to listen. The trauma came in as a double trauma and was another motorcycle accident. This time it wasn’t this guy’s fault. You can be the best motorcycle rider in the world, but not everyone else is. Broken clavicle, bruised arm from elbow to shoulder and torn neck muscles. No blood, no gore.

It so happened that in the other trauma bay was a good friend of mine that I hadn’t seen since I left for Vietnam. I had met him on my last shift before leaving for Vietnam and we talked about all sorts of things. He was in the military and worked in the intelligence department during the Korean War. He told me a lot about Vietnam before I left and that it would suck. It’s strange how on the first shift back he ended back under my care. He remembered me too. The tough fellow is about 70. Has no heart problems, no intestinal problems, no breathing problems. Healthy as can be for a 7u0 year old. Then he had an accident today where he fell 10 feet off a ladder breaking 6 ribs. He tries to get out of bed, but the pain is too hard. Did I mention that he broke 6 ribs? His insides is like a bowl of meat cereal and the guy tried to get up to leave. He was quite upset about his broken ribs like anyone would be, but instead of crying about it he just cursed a bunch. I got him some juice and water and he calmed down. One tough old dude. Get well old friend.

Saddest thing today. A female about age 25, who looked like Jessica Alba if Jessica Alba played a lot of volleyball came in with a stroke code. At first I didn’t think that this patient was the stroke patient. Quite frantically to my dismay I found out she had almost full left side paralysis. This stuff usually happens to people in their 40’s or 50’s. It was really surreal to see this happen to someone so young and pretty. She came in just like she walked off the sidewalks of downtown La Jolla. Imagine if your roommate had a stroke. Imagine if one of the guys from Hanson had a stroke. Imagine if Megan Fox had a stroke. She was either in denial or confusion because the unparalyzed half of her explained to everyone that she felt fine. Very common with stroke patients. It’s hard to describe what you can’t feel.

Get stung by a stingray? Put the wound in warm water!

Yup.

Bunch of other crazy stuff happened today. I can’t remember the rest. Oh yeah, there were two volunteers in the ER today that were a couple. I didn’t ask them how long they’ve been married, but they fight like they’ve been together forever. It’s so cute to see them make fun of each other. I think when you get comfortable with someone for over 20 years, you’re allowed to say those things. So cute.

I had some good hot dogs. I drank some juice. I washed my hands and went home.

I love my job

Last night was one of the best night shifts I’ve had ever. Bar None. Barn Close. Horses out. Head down. Butts up. Etc.

Shift started off slow with everyone cracking the usual jokes about when the storm is coming. All laughs and smiles until the shit storm starts.

I was stocking and doing the usual patient checks until I was assigned to be a constant observer for a suicidal patient. Smiles and hellos were exchanged, but I guess sometimes people placed under hospital care for suicide are not very talkative. Being a constant observer means I’ll just sit for a very long time and will not be able to do anything fun that comes along. Luckily I was relieved of my CO duties to do a quick wrist splint. Then the shit storm started and no one had an umbrella. It was raining poo and you didn’t have an ella or an eh. no ehs at all. eh.

A 40 year old male began to have a huge distended stomach for some reason. I overheard that the patient had a bad case of diabetic ketoacidosis and Glucose levels of 1200 mg/dl. I got into the room just in time to grab a spot to take over CPR. A fellow tech graciously provided me a stool and away I go. This is the second time I have had a chance to do CPR and it’s a good thing that I had been reviewing CPR that afternoon for my BLS recertification. The patient was smelly, sweaty and pale. The doctor looked confident yet puzzled by many abnormalities that were showing up on the monitor. I kept chugging away like a engine piston on this man’s chest. Every time I gave a compression, a little bit of vomit would jump out of his mouth pass the suction. This guy was seriously vomiting up everything. I’ve been told in numerous classes that patients with ketoacidosis present with a fruity odor in their breath, but I could never understand what they were talking about. Was it like chewing gum fruity? Was it like smelling a smoothie? I found out what it smelt like and I will never forget it. The word fruity definitely describes it, but I wouldn’t say it was exactly a fruit salad.

The guy lived. High fives all around.

A drunk female approximately 25 years of age was admitted kicking and screaming. She was also spitting a lot too. Took about 6 guys to calm her down and ensure the safety of everyone in the ER. Eventually after she had come off her inebriated state, she started crying a lot and for a really long time. Then her boyfriend came, then she cried some more. All the while she didn’t notice that her dress was completely pulled up passed her waist. I guess she was still really inebriated. I offered some blankets to cover her up to which she accepted and fiddled with until it fell on the floor.

Some more drunks came in as well as some victims of assault. Lots of blood and gore last night. Amongst it all I noticed something personally about this line of work. You can have about 10 spitting, cursing, scratching, clawing, uncooperative, smelly, complaining, angry patients that might ruin your day, but the minute you get a patient that shows an ounce of gratitude, the slate is wiped clean. You magically love working with people again. One person is all it takes.

I recently took someone to the ER. It was more of a personal trip than a business related matter. This girl had food poisoning and we decided it’d be best to see a doc. 6 hours of waiting, unit of zofran and benadryl, 2 nurses and an ER doc later we headed home with a perscription and she was still kinda in pain. Yeah sure there are some ungrateful patients out there, but you know what? There are a lot of jaded healthcare workers out there as well. Socializing while someone’s in pain waiting for medication is just unacceptable. Practicing lazy IV placement is just insincere. Listen closely to the patient. Tend to them. It’s not a perfect world, but let’s aim for it.

I also got to do my first burn wound dresssing! WOOT!