The good news is, that the reason I haven't been spewing stories of lice infested alcoholics with eruptively phlegmy and TB infested coughs, who make unnecessary swings at a compassionate nurse, while simultaneously dying from HIV, Hepatitis C, severe pneumonia and a slew of co-morbidities (more on Mr. Tex later), is that I have been overwhelmed with the task of learning how to save lives.
Some relatively minor and basic essentials for survival in the field of emergency medicine have infused into my brain. Such as how to pharmacologically decrease a Supraventricular Tachycardic heart rhythm when a patient presents with a pulse of 220. Or the simple Intra Osseous access port(inside the bone...people) used on the unfortunate souls who present with little to no veins. These can only be placed by using a hand drill. No biggie. Or how about the amateur task of consciously sedating a patient while pushing versed and fentanyl, while manually extracting clots from their uterus. Elementary.
What has been challenging is this. Urine. Vomit. Urine and vomit. The worst is when a patient has both urinated and vomited while phasing into a seizure, a cardiac dysrhthmia, an altered mental state, or all of the above. The most vital take home point that I have actually taken home on my scrubs, is that I can't stand the smell of urine and, I throw up a little bit myself when I see someone vomit. What can I say, I am weak. I have also learned that there are only two types of Paramedics; there are the very hot, attractive ones that are tall, dark and handsome and there are the short, stout, lesbians. Nothing in between.
So, because I am learning to prioritize and manage in a way I didn't think my brain was capable of, I render to you a glimpse of my new job...from the beginning....
The San Francisco General Hospital has quite a reputation. A county hospital set on the slope of Potrero Hill, 'The General', serves as the only level 1 trauma center for the great city by the Bay. It is refuge for the uninsured, the underinsured, the homeless and the mentally unstable. It is gritty, worn in, worn out and weathered. The minds that steer its' course are incredible. So, I stand professionally on my first day, in the ambulance bay, stethoscope around my neck, pen in my hair, smile on my face, butterflies in my stomach, staring at the large bold, red sign; EMERGENCY. This is where dreams come true, huh? No, this is where people come to die. This is where the magic happens? Or, this is where miracles happen...sometimes...if luck chooses to be on your side. Is this where my brain will grow enormous from becoming so smart because I have to know everything there is to know about saving a life? I guess so.
I meander through the line of sick people, waiting by the dozens at registration. I am one of 6 newbies today. All brand new to the art and science of this environment, weaving in the delicate thread of our previous work experiences, adding to the fine medley of colors that make up our new dynamic work force. We shyly crowd into the report room where faces stare at the unfamiliar. These strangers crack ribs. Soon, I will crack ribs too.
Quick introductions rally around the room and soon the WELCOMES! and the GREAT TO HAVE YA's! and the I FEEL FOR YOU'S! start firing like a torpedo. There is only one male in our training group, which makes me feel bad that he will be inundated by estrogen. But, he knew what he was getting himself into as he registered for that first nursing course and put on a pair of the ugly, white starchy scrubs. I bet he feels overpowered by the stream of lady energy that is circulating the room. Or maybe he feels awesome. I take a look around. I inventory the staff and see that unlike Labor and Delivery, the ED offers a variety of genders; both male and female and likely some that are in the middle, being San Francisco and all. I see there are actually several Murses.
The two standing managers do a fast official welcome speech and I am finally able to put faces with the voices that I have been talking to over the phone for the past two months. They reiterate their excitement of our presence and explain the theoretical 'open door' policy encouraging that all and any questions be brought to their attention without hesitation.
We are reminded that the General is a diamond in the rough, a sanctuary in a world of chaos, a haven for the lost. We are told that everyone who works within these confines upholds the utmost respect for all, regardless of how many times a drunk man comes to the ER, reeking of bourbon, drooling and trying to touch the nurses boobs. You smile, you push him away, and then you pump his stomach. Easy. And all with a smile.
But what really permeated into my brain during this initial 30 minutes was what was said about the nurses whom we now can call colleagues. "We are a solid bunch. We work together. We are the jack of all trades, but the master of none."
The room fell silent for a moment as these words escaped her mouth and into our thoughts. Her silvered hair spoke volumes to her experience yet her modesty gave evidence that her head was not imploding with self-righteousness. A head that balanced Harry Potter shaped glasses and that sat upon a pear shaped figure.
As you all can guess, I have a terrifying fear of commitment (as evidenced by the 4 different moves I have made across the country in the last 9 months and my ever changing work status). I hope that I will one day grow out of it so that I can have a family with a husband and great, respectful children, and that I am not found hallucinating and delirious like my patient, Ms. Fawn, was found today. No medical complaint. She was very happy. The paramedics just happened to see her minding her business as she rhythmically undulated against a public garbage can. Her arms were swaying gracefully up above her head as if she were conducting an orchestra. Her eyes softly closed like she was in a dream, sifting and riding the tunes emitting from her make believe symphony. When we would ask her 'how are you?', she would say 'what?' When we would ask "are you in any pain?", she would say "What?" When we would ask "Ms. Fawn are you crazy and did you inhale, shoot, or inject lots of crazy drugs today?" she would say 'what?' The whats were in the tone of "What, what are you going to do about it?" Not, whaaaaat? as in what are you saying. Hmmm.
I figure if I can just stay sane enough to give this department the 2 years I promised them (do I even know how to do that?) then I could certainly commit to anything. But this was just the first day and as Harry Potter sat in front of me, talking at length about California and its' sorry excuse for a budget, I fought to keep my mind free of an escape route. You are here. Be present.
The trauma phone rings and a raspy voice is heard overhead. The sound is loud and echoes through the linoleum hallways. A 26 year old male cyclist hit a parked car and broke the windshield with his face. No helmet. My eyes went large and fixed. "I never wear my helmet," I mumbled as I pictured my body flying into a shield of glass only to be shattered by my once already broken nose. "Working here will certainly remedy that," someone replied.
I always speculate, while riding my bike helmet free, how the scenario would play out if I were to be jacked by a semi truck or sideswiped by a suburban. I visualize my body being catapulted into the air, flipping multiple times and landing in a way that would disfigure me for life. I then see myself wrapped in bandages and hanging from a trapeze swing-like device, mobilized in the exact angle needed to heal my crumpled bones, in a facility where there are no stairs because no working legs are around and everyone has to get up and down by electric elevators. I am eating through a tube and will never again enjoy the crunch of a carrot stick nor the snacktivity of eating sunflower seeds because my jaw bone has been wired shut. I am staring blankly at a television set that plays the PGA tour and am excruciatingly annoyed that my fingers can not bend to pick up the remote control. All because my helmet doesn't fit when I wear a pony tail.
The 26 year old survived but his girlfriend was pissed at what his face looked like.
The trauma radio chimes again. A 56 year old female, found on kitchen floor, suspected of shooting herself in the head. Breathing. Alive. Just barely.
I didn't get a chance to sneak my head in on this one as there were already 17 people crowded into the trauma room. In the air though I see things flying. IV tubing and monitors, gloves and medication viles. After a few hours of hard work, the woman came out of it alive, no thanks to us. I assume when she wakes up to find her heart still beating and more holes in her head, she might be disappointed.
A loud nose expels from the ambulance bay and a woman, who is 32 weeks pregnant, is rushed in, legs spread with a head propped between her thighs. They are hauling her into a room so that the child is born with class, and not on the unlucky surface of Gurney #8. This baby is coming and nothing is going to stop it. A smile collects to show my pearly whites as this is the first normal process I have seen today. Looks of disgust wash over my colleagues as I hear them, almost in unison, say how gross it is when they deliver in the ER.
Hold the train. You can watch brain matter and internal organs erupt from skulls and abdomens and it's no big deal? You can daily remove soiled clothing from crack attacked psychos and flush nasogastric tubes without a flinch? And you think the delivery of a baby, the miracle of life, the most joyous moment in most parents life, is repulsive? This made no sense. And although no one knew my name, they simply referred to me as the 'the one with labor and delivery experience', I was pushed into the room where a natural progression from in-utero to extrauterine life was unfolding. The obstetrics team was on hand and both mom and baby were fine. Sometimes, they just come faster when it is your 5th child.
And this was just an 8 hour day. I left feeling enthralled. Eager to learn and read and practice very small vein and arterial blood draws. To know how Sepsis really effects the organs. To determine how crystals form on synovial fluid when diagnosing gout. To see the progression of infection follow the airway, in through the mouth, down the wind pipe and spread through the branches of the bronchioles. To differentiate the signs and symptoms of meningitis and how it differs from other viral and bacterial infections. To learn the 8-point blocking system when someone threatens to rip my head off. To learn how to talk a suicidal patient down from their manic phase. To know why a pint of vodka a day is incredibly disgusting and how debilitating alcoholism can be to your body, your life, your family. To quickly fasten those damn condom catheters to prevent fireworks of tainted urine from spraying me and the already yellow tinted walls in zone 4.
To be able to save a life.
