Day One
I was working in the red zone when a patient came in and went into cardiac arrest in the lobby. I went to the trauma room, and was put in charge of the code cart. That means you draw up the medications, run the defibrillator, and deliver shocks as needed. You don’t usually look at the patient, as you are busy with other things. When I did look over, I realized that the patient was the 30-something year old son of an old friend. The last time I saw the kid, he was still in high school. The entire time we worked him, his wife was in the room. We had offered to take her to wait in the chapel, but she refused to leave the room. When the charting nurse said, “Time of death, 6:17” the wife let out the most anguished scream. It was something that you felt all the way to your soul. I spoke with his father, who told me that parents aren’t supposed to bury their kids, and asked me in anguish what he was supposed to do next. It’s much harder to stay detached when it is someone you have known since he was born. I had trouble sleeping that night because of it, and woke up at 3 am before staring at the clock for an hour and a half. I wound up only getting about four hours of sleep, not nearly enough after a day like that.
There was the man who lived in a group home because he was mentally retarded. He came in with stomach pains, but couldn’t tell us what was wrong because he is mostly non-verbal. It turns out that the group home served him refried beans the night before, and he needed to take a gassy deuce.
Day Two
Day two saw me assigned to the green zone because I think that they were feeling sorry for me from the previous day. That day was rough because I was sleep deprived. A woman was angry because her teenaged daughter was diagnosed with COVID, and we were sending her home with instructions to take Tylenol. The woman wanted us to write her a prescription for the Tylenol so Medicaid would pay for it, because she didn’t want to pay for it herself. So of course we did, gotta have those Press-Ganey scores to get paid under the Obamacare rules, you know. Your tax dollars at work.
Day Three
I was in triage for day three. A guy came in complaining of abdominal pain. Said he hadn’t seen a doctor about it. Then I pulled his chart, and an alert came up that he had just been seen at another hospital 30 minutes away. He was just discharged 35 minutes before for the same problem. He said in response, “Yeah, but they didn’t give me what I want.” He has been seen 14 times in one ED or another over the past three months. But we can’t say no, thanks to EMTALA. So again, your tax dollars at work.
I slept in this morning, then went to a local eatery for some chicken fried steak and eggs breakfast. I paid extra for onions in my hashbrowns. Now I have to get prepped for our next hurricane, set to arrive on Tuesday. So this is all of the posting you get today.
9 Comments
Fg · October 6, 2024 at 11:36 am
“patient was the 30-something year old“
Thoughts on what you’ve seen that could cause heart attacks at such a relatively young age?
Divemedic · October 6, 2024 at 2:11 pm
The usual applies:
Diet
See a doctor for checkups
As you get older than 40, you can get a coronary calcium scan, which is pretty good at finding heart problems before they start, but insurance won’t pay for them. It costs a hundred or two, but is a good idea.
Fg · October 6, 2024 at 11:39 am
And condolences of course, I find it helps me to know that God has a plan though I have no chance at understanding it. Just trust it.
grumpy51 · October 6, 2024 at 1:41 pm
People just don’t understand the waste in an ER. (I quit calling it ED because many non-medical think I’m talking about Erectile Dysfunction, which isn’t far off come to think of it).
People who come to the ER for pregnancy tests – yeah – $3k versus $15 at the drug store.
People who come to the ER demanding Dilaudid (Vitamin D in our world), that their prescription ran out. Despite us looking up in the state Prescription Monitoring Program, specifically there for controlled substances…. with fills listed for the past 3 years…. and NOT ONE fill for Dilaudid. Can we throw them out for abuse and lying??? NOPE….
And that Press-Ganey system?? Kaiser-Permanente (CA) did a study back in the early 2000s that compared PG scores to patient outcomes. Those patients who gave the highest scores had the worst outcomes……. gee, ya think?? It was because the docs gave the patient what they wanted versus what they needed……
Then there’s the for-profit facilities. Here I am (actually, there I was) working Fast Track with ZERO patients and the ED doc getting hammered with EMS. I stepped in to help, took 2. Shortly after, had admin come down demanding to know why I wasn’t in Fast Track……. umm because Dr Drain getting hammered and I don’t let my colleagues drown. I was told to go back to Fast Track “in case someone came in”. I stood my ground and was “released” (fired) shortly afterwards.
And yes, I’m older (started healthcare 1981), and I’m DONE…….
Dan D. · October 6, 2024 at 2:03 pm
“So this is all of the posting you get today.”
6:17 was entirely enough for me. Your dedication and hurt always exceed any words of comfort I can write.
I was imagining myself as that young man’s wife and if such a thing were happening to my spouse you damn betcha I’d be right there enjoying every moment of her countenance while praying for all of your collective wisdom. Even if it ended poorly.
That is the “for worse” part of the vow.
Wayne Johnson · October 6, 2024 at 3:16 pm
Different people respond in different ways.
It is not a club anyone wants to join.
It tests everything you hold dear (faith, family and friends).
I don’t blame her for not leaving.
Wayne Johnson · October 6, 2024 at 9:40 pm
0300 is a nasty time. Your mind goes all of the places you have carefully kept it away from during the day.
The fact that 0300 is exactly opposite the hour of Divine Mercy (3 PM, when Christ died is purely coincidental, I am sure…).
Good luck! Doing more than is medically justified in cases like this is a sign of your humanity. Thank God for that!
As for what to say to the father, there is no easy answer. It will hurt. Try to find ways to make the world a better place.
If you have parents or children or grandchildren, tell them you love them while you have the chance. We always have all the time in the world, right up to the moment when we don’t.
Noway2 · October 6, 2024 at 10:16 pm
“ When the charting nurse said, “Time of death, 6:17” the wife let out the most anguished scream. It was something that you felt all the way to your soul.”
I am sorry you had to experience that. It would have kept me awake at night too. People like you are truly the heart of the machine and unfortunately you also get to see the dark side. How to put it, it’s a burden you shouldn’t be asked to bear, but you do, and I hope the positive you receive is at least threefold in magnitude.
Boneman · October 7, 2024 at 5:04 am
Hang in there… and be safe. This is gonna be a rough ride I think.
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