Tuesday, November 18, 2008

Panties

The other day, a 50-something year old male came into the ER, guarding his abdomen, hunched over due to pain. I introduced myself and started an IV, and told him I needed him to give a urine sample. I offered to put a robe on him so he wouldn't be flashing his backside. He commented, "Oh, that's okay. I have panties on."

I waited for a second, then looked at his wife and smiled, and she smiled back. I asked, "Did you just say you were wearing panties?"

He said, "Um, yeah." We all started laughing.

A few hours later, when I was discharging him, he asked, "You're not going to tell anyone that I called my underwear 'panties,' are you?"

I replied, "Oh, you bet I'm going to tell people!"

Wednesday, November 12, 2008

Death

The movie that came to me from Netflix this week happened to be "Beaches." A poor choice to watch tonight, as it turns out, given the timing of events this week.

Yesterday, we received a medic call to alert us that in less than 10 minutes, they would be bringing a 50 year old male who was pulseless; CPR in progress. This is never a happy prognosis. Upon arrival, the pt. was a big, strapping, overweight black man with cornrows, still wearing his waterproof construction pants. He had been on the job site, and had collapsed, vomited, and was unresponsive. When the medics arrived, apparently he had no pulse, so they commenced with CPR and then got a pulse back, and a shockable rhythm. They shocked him and followed the ACLS algorithm with the appropriate drugs and electricity. Twice, they were able to "get him back," as we call it. Probably his soul was gone, but his heart responded with a normal rhythm for a few seconds, and a palpable pulse. That's plenty to give us hope to keep working on a pt.

Our team got the pt. transferred to our gurney, and kept doing CPR and using the bag-valve mask to oxygenate the intubated patient while we got him hooked up to our monitor and defibrillator. He was in V-fib, so we shocked him at the maximum amount of electricity. No response. He was still pulseless, with an agonal rhythm. We pushed amniodarone, and epi, and atropine, to no avail. Finally, the Dr. called us to hold compressions and ventilations, and he used the ultrasound machine to detect any cardiac activity/movement, and there was none. So he called it. Family had not yet arrived. I listened with my stethoscope over the heart for 60 seconds and heard only silence.

Since I was the primary nurse, I was charting furiously the entire time. I prayed for his soul and his body. I was the one that had to write the words, "Time of death 1339." About 5-10 minutes after we ceased our efforts, his significant other arrived alone, not knowing what was going on. I don't know who let her into the ER and directed her to the room, but the Dr. was not in the room at this time. Only I was there. So I was the one who had to let her into the pt. room and try to explain what had happened. She was hysterical, weeping, shouting, throwing herself on him. She cried, "How could this happen? He was fine this morning! He promised he wasn't going to leave me! What am I going to do?" Then in her anguish, she started vomiting.

I could not hold back the tears. It was strange--I could NOT bring myself to say the words, "He is dead." I just told her that we and the medics had worked on him for a long time, had given him every medication we could think of, had shocked him, and that we could not save him. The chaplain showed up then--thank God--and began to comfort the woman. I ran and got the Dr. to come into the room, which he did, and he explained everything that had been done and how sorry we were. By now, the significant other was able to compose herself and she thanked us for trying, in the midst of her tears.

She was able to spend about 10 minutes with the body, and then other friends and family started arriving. Probably 50-60 people flowed in and out of that room all afternoon. Their pastor came and prayed a beautiful, comforting, eloquent prayer in the style that only an African-American pastor can voice for the family for peace and hope. Thankfully, it was decided that it was not a coroner case, so I was allowed to pull out the IV's, the endotracheal tube, and the nasogastric tube that had been inserted by the medic. I washed his face with a cloth and invited the family back into the room, now being able to see his face clearly--no tubes.

After a few hours, it was obvious that no one would leave any time soon. I had to tell the family that the funeral home had been called, and that they had 20 more minutes with him for goodbyes. Everyone was respectful, and quietly crying.

Finally, the time came, and I told them we had to prepare the body. They all left, and I and another nurse and a tech put him into a bag, tagged his toe with his name tag, and zipped him up. His body was still a little warm.

At this moment, a friend came by and said that one of the man's sons had not been able to see him yet--could they please come into the room? I felt awful. So we unzipped the bag, and tried to cover up the bag and zipper with blankets, and let them back into the room for a few minutes. He really looked like he was simply asleep and could wake up at any moment.

There is no moral to this story. I felt incredibly sad for the family. I wondered if I should have spoken up to continue working on him until the significant other arrived, just so she could talk to him while we breathed for him, and so she could see how hard we worked. They had a three-month old baby together.

I pray God will give them peace and comfort. I came home, kissed Nate, and went to run on the treadmill for a while.

Tuesday, October 14, 2008

Oct. 14, 2008

Today is the birthday of one of my first big childhood crushes--Ben Lee. He was tall, older, dark, handsome. And ever since I was 9 years old, I've remembered his birthday. I wonder what he's up to today. I hope he's happy:)

And hopefully not visiting an ER. Like one of several interesting patients that came through triage today, where I was assigned. One was a 50 year old male with a dildo stuck up his rectum. Obviously, he was unable to retrieve this accessory on his own, and after 10 hours of trying and straining away (talk about an urge to go), he showed up, shamefacedly, at my ER. Embarrassing....but not an automatic surgical case like the guy from a while ago who came in with that long, flat-ended vacuum cleaner attachment stuck up his rectum into his intestines which were necrotic by the time he checked into the ER, with poop coming out of the vacuum end.

Another patient after being discharged immediately checked in again. Hoping for a better outcome, I guess. Or, more likely, a doctor who would give her Dilaudid. She's morbidly obese, stinky, "dead behind the eyes," and shows up at the ER in spurts of several times a week, then a month will go by, and then she'll be there all week again. Today, she had her usual complaint of flank pain caused by her nonexistent kidney stones. 16 CT scans prove it. Multiple US confirm no problems. Bloodwork and urinalysis are WNL every time. I've watched her fake passing out twice. Apparently, while I was at lunch, she did it again in the waiting room, and my fellow nurse told her to get off the floor. Which she did. Maybe got MRSA in her mouth in the process. We can always hope. So after she checked in for the second time today, I eventually took her back to a hallway, where she proceeded to tell me that her IV was not taken out from her previous discharge. Nice. So the doctor comes to see her and blatantly tells her he will not be giving her any pain meds. She cries, she yells, and finally decides "I'm getting the hell out of here." She rips out her IV, starts bleeding onto her shirt, and when I try to put gauze on it, she grabs the gauze and blows her nose in it and refuses to let me dress the site.

And of course there were bright spots--the Irish priest with a lovely lilting voice, with gallstones.

The depressed, suicidal young man finally coming in to get some help.

The ridiculous girl complaining of rib pain, nausea, vomiting. She ate a doughnut while I was triaging her.
 
Designed by Lena