Trauma

Read Part two here.

 

On Thursday, December 9, not that exact dates are important, I spent twelve hours working in the emergency room in the county hospital.  You may recall that I was a wee bit anxious about that.  We’ve all seen the televised drama of hospital emergency rooms and we all know that they are hustling, bustling masses of controlled chaos; blood everywhere, people maimed and disfigured, writhing in pain and crying out for help.  In short, barely contained hysteria.

Before this I had only ever been in an emergency room three times, two times accompanying the patient and once a hardly-even-qualifies-as-an-emergency recipient of mediocre at best care.  In each of those instances, things were so calm and serene in the working areas of the emergency room I felt sure the real traumas were brought to a different and isolated section of the hospital, protecting those of us with weak constitutions and weaker stomachs from the sights and sounds of such mayhem one could only imagine.

I was pretty worried about what I was going to encounter in this twelve hours working “in the county trauma center” as I was told over and over again, I would be doing.  The hospital in question is the County Hospital, the County Trauma Center, the County Teaching Hospital.  “You see everything there,” I was told more than a few times, and while I knew I needed to test myself and prepare myself for what I might encounter in a career as an EMT, I was still worried about what the day held in store.

When I arrived at 6:55 in the morning, the registration area was packed with people but it seemed to be the entry point for all who had business with the hospital.  There is no way I saw all those people pass through in my time on duty.  After a couple of missteps I found my way to the appropriate area where I was directed to one of the staff who would give me my assignment for the day.  The nurse I would be working with had not yet arrived and I was told to just hang out for a few minutes until she checked in.

I took the opportunity to get the lay of the land and understand, as best I was able, what was going on around me.  I was at Nurses Station 1, which amounted to a big open counter top ringed workspace with computers and chairs inside, and three computer terminals on the counter at one end.  Surrounding the Nurses Station were rooms and alcoves with hospital beds and various equipment inside.  On one wall was a white board which had each of the patient rooms and assigned staff scribed on it.

When Johnna, the nurse I worked with, arrived I found out we were assigned to three rooms, ten, eleven and twelve, and she set about showing me the ropes.  I followed Johnna around much of the time, observing her work, helping out where I could.  As an EMT, I am not capable or legally allowed to start an IV or administer any medications, but I was able to check and monitor vital signs and document them, I was able to provide comfort where possible both with my bedside manner and by providing pillows and blankets, food and beverages.  I watched as the over night nurse explained to Johnna what was going on with each of our patients at shift change and then we went about checking on and caring for each of our three patients.

I was surprised by how calm and serene everything was.  No crying or screaming in pain, no blood on the floors and walls, no severed limbs lying around or entrails dangling from eviscerated abdomens (abdomi?).  In fact, there were no trauma patients at all.  Well, that’s not true.  When you hear the word “trauma” you tend to think of violently injured patients in dramatic situations, or anyway I do.  The truth is, a trauma is any injury that is the result of outside forces, as opposed to a medical condition that becomes an emergency.  So knowing that, there were plenty of traumas, but nothing dramatic

I was also surprised to find how quickly it all became run of the mill.  No sooner had the patients left our care than I forgot their names.  The moment I walked out the door at the end of the day, I forgot most of the conditions we treated.  And the truth is, we didn’t treat all that many patients.  In fact, on two separate occasions the third of our three rooms, room 12, sat empty for more than an hour between patients.

When I arrived, the young woman in room ten had been there since 8:00 the night before, hooked up to monitors and with an IV in her arm.  She was complaining  of severe pain in her neck that worsened when she moved.  The nurse would give her an IV pain-killer and the pain would go away for a while and then it would come back again.  There were no obvious, outward signs of illness, but then there often aren’t.  Her vitals were unremarkable, she just periodically asked for more pain medication.  Being the cynic that I am, I considered, more than once, that she was just there for the drugs, but she didn’t look the type.  She was released without any definitive diagnosis and directed to follow-up with her Primary Care Provider (PCP).

The not young woman in room eleven was in early stages of Alzheimer’s Disease and lived in an assisted living facility with her husband who is apparently confined to a wheel chair and insists that she be the one to push him around.  She, apparently, fell while trying to help him in or out of his wheel chair and hit her head on the corner of the coffee table.  She was slow to respond, but we were told by the care facility that this was normal behavior for her (this is called “baseline”.)  I helped clean up her wounds and held her neck in place while the doctor rolled her onto her side to examine her back.  I observed while a technician conducted and Echocardiogram.  There was no benefit to my seeing this, but it’s not something one gets to see everyday (and it got me out of Johnna’s hair for about 15 minutes.)  A CT scan revealed that she had a subdural hematoma, which we learn in class is a serious problem worthy of priority transport to the hospital, (a subdural hematoma is what killed Natasha Richardson)  but no one seemed too concerned about it and she wasn’t showing any signs of being in serious jeopardy.  We monitored her condition while waiting for a room to open up and after a couple of hours of cooling her heals in the ER she was transferred to the ICU.

I was asked to assist one of the other nurses as he was about to clean a patient and change the bedding after he (the patient, not the nurse) had defecated on himself.  The patient had an open head wound and was in a cervical collar which needed to be supported while he was rolled from one side to the other for this procedure.  I was standing at the head of the bed, gloved hands holding his head and neck, ready to give the count to roll the patient when the Doctor walked in.  The nurse explained what we were doing and asked if the Doctor wanted us to wait till he stitched up the wound.  The Doctor wanted to examine the wound and see what needed to happen.  While I was standing there holding the man’s head, the doctor removed the bandage that was taped over the wound and started “digging around” in the wound to see what the situation was.  I was pleased to find that I was not bothered by this and had no inclination to pass out or vomit.  I didn’t voluntarily stand there and watch the whole procedure, (which frankly I don’t think makes me a wimp – like I told my teacher, “I’m not going to volunteer to look at things ‘for fun’.  I look at what I have to look at.”)  Also, I was in the way.  Twenty minutes later they called me back in and I held the patients C-spine while the nurse cleaned the patient and changed the bedding.    When we were finished and I let go of his head again, I had blood on the palm of my gloved hand.  My first time having someone elses blood on my hands…  Wait, that doesn’t sound right.

We had another patient, a 24-year-old, developmentally disabled woman accompanied by her mother.  She’d been seen the Saturday prior at another local hospital and diagnosed with Bronchitis, but she wasn’t getting any better.  Interesting the correlation between not taking the medication prescribed and not improving.  Anyway, this young woman had had her fill of needles and poking and prodding and she wouldn’t allow the nurse or myself to come near her.  She wouldn’t get fully on the gurney and every time Johnna walked in with an IV kit the young woman went into hysterics.  Johnna told the mother that we couldn’t treat her daughter until she was properly seated on the bed and that we had to put in the IV because the Doctor was going to require blood tests and there may be some medications to be administered.  She told the mother we’d come back when the daughter was properly seated on the bed.  For two hours we check back and the patient was sitting on the side of the gurney with her feet on the floor and every time we walked in she watched us warily to see what we might do.  Ultimately, it took four of us including the patients mother to forcibly hold her down and get the IV port into her arm.  She wasn’t happy, but once the port was in she was OK.

There were three “Level 2 traumas” that came in that day.  I assume “Level 2” means more dramatic as previously discussed.  The irony is not lost on me that two of those traumas came in while I was eating lunch in the Hospital cafeteria and the third came in while I was holding the C-spine of the head injured, soiled man.  I have no idea what those traumas were, what condition the patients were in, or what I might have seen had I been in the corridor at the time, but as luck would have it, I missed all three.

I observed a couple of EKGs, something else an EMT does not do.  I cleaned and prepped a handful of rooms, well, three rooms a handful of times.  The fact is, the experience is not the same as EMT work, at all, but it still exposed me to some of what I can expect.  While it was a long day, the first ten and a half hours seemed to go by fairly quickly for me.  It wasn’t until about 5:30 PM when there was a lull in activity and I stopped wandering around that the fatigue hit and my legs started to ache.  I would have given just about anything to sit down, but I didn’t want anyone to think I was being lazy and I was afraid if I sat down, I might never stand up again.  That last hour and a half dragged on and I was elated when 7:00 rolled around.  Elated that I got to go home, but even more so that I had made it through the day without incident and got a little more proof that I am cut out for this job.

~~~~~

Read Part 4 here.