Wednesday, August 24, 2011

Med Lit 5038

I signed up for this elective in hopes of keeping my literary side alive. And maybe in hopes of starting a project or collaboration somewhere. Anyway, first assignment of the year, done:

Post an essay on Blackboard about a medical encounter, in which you tell about the same events from two different points of view. For example, Patient/doctor, patient/family member, medical student/family member, etc. You may structure the essay into two parts if you like.


Me:

St. Patrick’s Day, 11 PM. Anthony, my roommate, was next door pre-gaming with our buddies for an all-out St. Patty’s bash downtown. I was waking up and getting dressed for my rotation at St. David’s ER—the first rotation of my EMT clinical training. A required part of my uniform was a black fanny pack, which I wasn’t allowed to take off at any point during the rotation. I felt a bit self-conscious strapping it on before leaving the apartment.

The charge nurse on duty that night introduced himself as I came in and reported to the nurses’ station. Mike was a large man in his mid-30s, who had a vise-like handshake and sported various Celtic tattoos winding up and down his forearms. I saw his eyes shift to my fanny pack as he greeted me, and a faint smirk formed in the corner of his mouth. “You’re with Colleen tonight,” he said. “You can find her with her patient in room 30B.”

The woman in 30B was a narcotics addict. It was apparently not the first time she had been brought in for an overdose. Colleen waved me over as I came in. “You can help us hold her down while we get an IV in place,” she said. It was easier said than done—the woman was easily over 200 pounds and would not stay still long enough for anyone to place the needle in, not to mention the fact that her arms were already covered with needle tracks. Mike came barreling in after five minutes and began giving orders. Among them was an order for me to strap down the woman’s arm and hold it still with everything I had. I knew from the moment he came in that everything he said would be non-negotiable. With that in mind, I choked out any and all thinking and put my weight on the patient’s arm. After what seemed like an eternity of cursing and needle caps being thrown about the room, the IV was placed. The ER attending finally came in to give orders for oxygen and fluids, while everyone else funneled out.

Our next patient was an old man brought in for a heart attack, already intubated and stabilized by the paramedics. Colleen joined in with the other nurses as they wired him up with the usual mess of tubes—IV, Foley catheter, heart monitor, oxygen mask. Colleen handed me the ventilator bag and told me to hold on to it for a minute while she filled out some paperwork for the attending.

The night went on like that, patients coming in, getting tubes attached and then handed off to someone else. There wasn’t much time to ask questions or feel guilty about my detachment. I was a 6-foot, 180-pound pair of hands with a fanny pack and the word “dumbass” stamped across my forehead. Finally, at 6:30 AM, half an hour before my rotation ended, a technician found us and asked me to help with a patient. I followed her into the room, where a teary-eyed young woman was lying naked from the waist down on a bed, looking like she had been through a hellish night. A resident physician came in and explained the situation to us—the woman had a painful abscess in her lower groin region which needed to be drained and bandaged. Our job was to keep her calm during the procedure, and to make sure she didn’t move too much. She cried through the whole procedure as we clasped her hands in ours and told her it would be over soon.

Mike and Colleen smiled and waved to me from inside the double doors I walked out of the ER. I felt I could take some pride in Mike’s last words to me—“You’re going to do fine here.”—although I wasn’t sure how I had earned that. I left St. David’s just as the sun was coming up. Cars were beginning to line up for the freeway entrance, and coffee shops lining the streets were opening for business. It suddenly seemed strange that so many things could exist and function outside of the hospital.

Anthony was already up and making coffee by the time I walked in. I walked straight through the living room and threw off the fanny pack before stepping out onto the balcony and lighting a cigarette. Anthony came out with two cups of coffee, and we smoked and drank. “So how was it?” he asked. “Did you get to do anything cool?”

I thought back to my night, all the incoherent patients I met that I barely spoke a word to, people I strapped tubes and wires to, people I held down so nurses could start IV lines on, and finally the young woman whose hands I held as a doctor tore open a hole above her vagina. “No,” I said. “I didn’t do a damn thing.”

Anthony studied my expression as he sipped his coffee. “Well are you going to go back then?”

But this, I was prepared for. There was no thought needed as I looked back at him and said, “Yes. I’m definitely going back.”




Mike:

Nobody ever wants the graveyard shift for St. Patty’s day—it’s usually just a shit-show. Most of our patients are always drunk, crazy, or incoherent in some other manner. I guess it was just my turn to bite the bullet this year.

The night starts out like any other. I get my coffee, look at the rotation list to see who’s on for the shift, and then look through the patient charts. An hour into my shift, Colleen tells me that there’s an EMT trainee coming in later for a rotation. “Alright,” I tell her. “You mind looking after him?” She gives me the ok, and not long after, I see him walk in through the double doors, wearing a buttoned uniform, complete with what looks like a fanny pack hanging off his waist. I can't help laughing to myself a bit. The kid looks eager but clueless. With his gangly frame and remnant traces of acne, he can hardly be over 19. He comes around to the nurses’ station and I let him know where to go. Colleen’s already with one of our regulars—a heroin addict that likes to steal meds from vet clinics and overdose from time to time. The kid shuffles on over while looking back at me, like he’s half uncertain whether Colleen’s actually in the room or if he’s about to walk in on some elaborate prank.

After about 10 minutes, I get buzzed to help out with our dope addict—no one can get a line started on her. I crack my knuckles and walk into the room to get things organized. First off, I need to get her to lay still and stop moving her arm. I give everyone a job and tell the kid to hold her arm down for me. I can tell he wants to say something, but he forgoes it, instead snapping on some gloves and jumping in. I get the line started and Dr. Ramirez arrives to take over. We can tell right away he’s in a bad mood, so nobody stays to chitchat that isn’t needed.

The rest of the night goes about how I expected. Drunk old men, some homeless schizophrenics, one or two heart attacks. Colleen and the kid seem to be seeing a lot of action—they barely get a moment to sit still for the next 8 hours. The kid’s expressions seem to sway between confused and frustrated, but he keeps doing what he’s told. No job seems too dirty or trivial for him to complain about, and I like that about him. The ER isn’t really the type of place where you can take a lot of time to process things in your head; people come through, we plug up their holes and make sure they’re breathing ok, then send them off to whoever is next in line to treat them. It’s a completely new experience for the kid, but he’s trying hard to get acclimated.

I give him a pat on the arm as Colleen finishes signing his paperwork at the end of the night. “Good job tonight,” I tell him. “You’re going to do fine here.”

We wave at him as he walks out, and then get back to our charts as the double doors close. An announcement blares again on the intercom: another ambulance arriving soon with a Tylenol overdose patient.

1 comment:

Jo Bryant said...

This was a great read - loved how you dealt with it