(If you don't like the music, scroll down and you can control it on the right side. But I like it, so there! )

Thursday, July 1, 2010

The Real ER

Remember this music? I used to love ER, as in the show. Every night in that ER was an adventure in medical rarities. We medical people love that shit. Stuff you may only see once in a career, and when it really happens, you are in awe and try to remember all of the stuff you learned in school about it. But in real life? It never happens.

Tuesday night started out uneventful. I was assigned to the ER, and was handed the ER pager by a therapist eager to get home. She told me she had only received 2 pages all day, both of which were for patients who ended up being discharged. Beautiful for her,bad for me. She jinxed me. For the first four hours of my shift, no calls at all. Then all hell broke loose.

After 11 PM, our staffing cuts down and the ER therapist covers other areas also. At 10:35, 5 minutes after getting report, I was called to a crashing patient's bedside. The therapist who had her during evening hours doesn't do critical care, and the patient was in a severe respiratory acidosis. She started her on BiPAP (non-invasive ventilation that is used non-aggressively for sleep apnea and more aggressively for this). After an hour, the patient was mine, and I start the first minutes of the 11PM leg of my shift fielding a call from her nurse, who had her pulmonologist on the phone, demanding to know why her acidosis had not improved on the machine. He wanted immediate intubation, but I managed to hold him off while he let me (experienced in critical care) get more aggressive with the equipment. Beautiful. And it worked.

But in the throes of all of that, I get a page: respiratory distress in the ER. I respond immediately to the little girl in pretty bad distress, get her settled on a continuous neb, and off I go to answer the call I get for respiratory arrest in another ER bed. An intubation, and 2-hour fiasco while I try to ventilate an obese woman with a physician who simply refused to give adequate sedation, making my job a nightmare. Then it is off to another unit in the hospital for a patient who aspirated a chocolate milkshake that was supplied by family members who did not understand that nothing by mouth means just that: nothing. I suctioned his lungs free of the chocolate goop, and off I go to a cardiopulmonary arrest in the ER, which resulted in me bagging a patient while running to the cath lab to fix a blockage in a 34 year old man. As soon as I get him hooked up to a ventilator and my hands are freed, I get called for another crashing patient. While responding to this one, I get 2 calls. An employee at a local factory wrecked a forklift while drunk. I had to do a breathalyzer, which is a legal process and I hate doing them. But as soon as I get there, the ER calls me for a cric kit. Seriously? Never in my career have I been party to an emergency cricothyroidotomy. A true life-saving measure for someone whose airway is closed, but we avoid it at all costs. And we have all kinds of airway tricks up our sleeve to help us do so. So why does the ER need a cric kit, and if there is that bad of an airway emergency, why was I just then getting called? Severe allergic reaction, and a resident tried to look at that throat with a scope. Bad move. Really bad move. Because anytime there is that much swelling, ramming a scope down there is just going to cause the airway to close up. Lovely.

So I think my shift is ending. It it 5:45 AM. I finally sit down to chart everything I have done in 8 hours from my scribbled notes in my pocket (Incidentally, the paper is damp with my sweat: The huge exam lights we use for codes get damned hot, plus I have been running fo 8 hours.) I am also trying to stuff my face with the sandwich a kind coworker got for me when it became apparent that I would not be getting a lunch break. I take the first bite and make the first entry into the charting software when I hear the dreaded pager. Another code, full arrest, meet the patient in the cath lab, where EMS is taking him. I was relieved when I heard he was already intubated. That means I just set up a vent and go on about my day. I am having dreams about finishing my sandwich, of getting my charting done so I can leave on time, when I hear the dreaded words that lead me to the most Holy Shit Moment of my career.

"We need an OB kit NOW!!!!!". Ha. right. OB kit? Whatever. I sarcastically ask the ER doc if we are now in the business of delivering babies in the ER when OB is right down the hall. (Think of Gone With the Wind: "I don't know nuthin' 'bout buthin' no babies!) Yes, we are. And before I can even think, we are running. I am simply following. But wait! We are running to the waiting room. Why are we leaving the hospital?

Oh. Oh holy CRAP! We are delivering a baby in the ER parking lot. In the back of a Chevy Equinox. Seriously. And I am the only one there with experience in neonatal resuscitation. And the baby is blue. And all I have is a bulb syringe that was taped to the OB kit. Before I know it, I am barking orders. And I am running through the halls of the hospital with a blue baby girl in one arm and an oxygen tank in the other while the nurse runs alongside me, holding the blow-by near her face. Before we can even get to the NICU, she is pink. I did my job well. She doesn't even go to the nursery, but straight to her mother's arms. And I go straight to my department to hand off that damned pager and go home.

So there you have it. I love cool Rockstar moments in my work. But I don't like having them all occur in one night. That was not cool. I don't think I will be watching ER reruns ever again. And I am still wondering if that night was a dream. Did I really do all of that? Did I really resuscitate a baby at a parking-lot delivery?

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