November Notes, Day 2

"One Hour"

 You're going to need a drink after this one... I sure did...

It all started with a patient brought in as a transfer from another hospital after being found unresponsive at home, CPR being performed, and concern for a cardiac event.  The other hospital got the patient back and then transferred them to our facility.  Ten minutes out from our Emergency Department, they coded again and CPR was restarted.  When I got the patient, they were still performing CPR, and I ordered various medications, and we got the patient back.

While this was going on, another patient had been brought in by ambulance for some side pain and concern that they missed their dialysis appointment three days prior.  Initially, they were stable, but as my patient was starting to have a pulse again and we were stopping CPR, that patient decided to have a cardiac arrest and another code was called.  The other ED doctor went to take care of that patient, and all of the staff that had been at my code, ran to that code, and suddenly we had two critical patients in the department.

About this time, we got word that two trauma patients were being brought in "lights and sirens" and we prepared for a Code Trauma.  As this was going on, my patient decided to code again, and anyone who wasn't helping with the other code ran to my code.  We got pulses back again, but were now using multiple medications and a transcutaneous (on the skin) pacemaker.  The dialysis patient got pulses back at this time, and the other physician was free for a moment which was good because we were still waiting for the two trauma patients.

Suddenly, an ambulance showed up at the back door with a patient in cardiac arrest, we thought it was the trauma, but it turned out to be yet another patient.  The other ED doc took that patient, and started to run the fourth code of the moment (my patient twice plus the dialysis patient plus the new patient.)  At about this time, the first of the trauma patients was brought in, and the surgeon who had responded to the Code Trauma said they would go look at them as simultaneously, the second trauma patient rolled in the door with paramedics performing CPR on them.

I ran the trauma code with the surgeon who had since returned while my colleague got pulses back on their patient who then proceeded to code again before she'd had a chance to leave the room.  Unfortunately, my trauma patient died, and as I pronounced them, my initial patient started to have worsening vitals requiring adding medications and some more attention.  My colleague's now twice-coded patient got pulses back around the time her dialysis code patient was trying to code again.  She went to take care of that patient while I finally had a chance to sit down and write some orders on my initial code.

One hour had passed.  We haltingly joked that we were running 75% on our codes.  Someone pointed out that our average was better as 7 codes had actually been run, so we were at 86%.  Regardless, still a passing grade.  Then our attention turned to the 15 or so people that had filled the waiting room during that time and were still waiting to be seen;  not to mention the other dozen or so patients that had been in the department when all of this unfolded.  So much had happened in one hour... but there was still a lot of work to be done.

Day 24 - Breaking News

Grissom:  That's not what the evidence says.

Catherine: Well, maybe the evidence is wrong.

Grisson:  You can be wrong, I can be wrong, the evidence is just the evidence.

Like a lot of people, I was watching the live feed of the decision of the grand jury regarding an officer-involved shooting in Ferguson, Missouri.  Unlike a lot of people who only get their facts from mainstream media and social media, I expected that the grand jury being a group of intelligent people who when presented with the facts would find exactly what they did... that the police officer involved acted within the scope of his duties.

What I couldn't then fathom, were the politicians who stood up afterward and said how "disappointed" they were that justice wasn't served.  Really?  Did you not sit and listen to the evidence as presented by the prosecutor in the case?  No?  I guess you were too busy reviewing your cue cards.  I guess you were thinking about the great, "It's just like Selma" speech you had your advisors write, since I would think you were at least somewhat intelligent enough to understand that this case had nothing at all to do with the fact, but more how you wanted the public to perceive the facts.

So, let me sum it up for you:  A teen decides to rob a convenience store for some cigarillos.  We know from the tox screen that he was positive for marijuana, and cigarillos, especially Phillies, are known to be favorites for making blunts.

He assaults the cashier during the robbery.  He and his friend (who by the way, gave the most unintelligible and laughable interview about the case) then walk down the middle of the street in disregard for public safety (and their own I guess).  When the police officer asks them simply to get on the sidewalk "words are exchanged."  You can imagine what those might have been.

The police officer drives off, but then reverses the car when he realizes that the teen is carrying merchandise similar to that which was just reported stolen.  He then calls out to the teen and his friend.  Things get muddled as everything happened very quickly, but what can be discerned by the evidence is that the teen goes to the police officer's car and there is some kind of a struggle in which shots are fired.  The teen runs after getting hit in the hand.  The officer gets out of the car after calling for back-up.

At some point the teen stops running and turns around.  More shots are fired as the teen possibly starts coming back toward the officer without stopping.  When the teen stops, the shooting stops, and then starts again after the teen comes again toward the officer.  If you're shot in the back, blood spatter would show a different story than the one presented by the forensics team.  And three separate autopsies don't lie.  They corroborate the evidence.

Am I sad about the youth?  Not really.  He was 18.  Supposedly accepted and planning to go to "a technical college."  But he made several bad choices that resulted in his death, none of which had anything to do with the color of his skin:  he decided to rob a store, assaulted a cashier, walked down the middle of a busy street, and did not follow a police officer's instructions.  Shot up to this point?  No.

But wait, he tussled with the officer, had his thumb shot and ran.  Why didn't he just keep running?  Why did he turn around?  If he put his hands up, it would have been over, but he came toward the cop who then fired.  He stopped, the cop stopped, and again, put your hands up... but, he didn't.  And, that's why we're here today.  And, probably will be for the next several days as the media fuels the racist flames once more and politicians keep trying to compare what's happened to their ancestor's plight during the 1960's and the fight against segregation.

This is nothing like that.  This is just another story in the continuum that this current administration has kept on their agenda to promote separation and division in the country.  Take away color and this is just another punk kid who thought he was above the law and could do as he pleased.  But, you can't take away color because this kid probably thought he was protected by it;  as most of the protestors probably think they are now.  Because what cop in their right mind would go against them?  What white cop anyway...

Full Moon, Saturday Night...

There have actually been medical studies performed to disprove the notion that E.D.'s become more crowded on Full Moons.  However, ask any E.D. physician or nurse, and they will tell you that the crazies do seem to come around more during the full moon.  Add a busy Saturday night, and it's a recipe for complete chaos.... if you're the superstitious sort.  Which I am... I'll let you be the judge.

I came on shift last night to a full board, a child continuously crying, a patient in the corner room yelling out, "Nurse!  Doctor!  I need something for my pain!" and a bevy of police officers.  Looking around,  I put my stuff down in our work area and started picking up charts to see patients.

The Screamer is a regular who comes in demanding narcotics and has a "pain specialist" that prescribes a large quantity of pain medications on a regular basis.  So, I don't quickly rush into that room.  I go see a patient with an injured shoulder.

The crying child got into some of her grandmother's medication and is sitting around waiting to see if she has any lasting effects.  She's screaming because she's been in the E.D. for 2 hours... and has 2 more hours to go.  We'll see if her lungs last that long... or our ears.

A radio call comes out that there's been a rollover accident on the highway 30 miles south of us... three injured.  They'll be at our doors in about an hour.  I haven't even been in the E.D. for an hour.

My colleague who worked the day shift signs out her one patient... who's supposed to go home.  However, the patient's heart decides to go into an irregular rhythm which means more tests and an admission for me on a patient I really don't know a lot about.  But, ok.  I have a patient who shot off part of their finger;  which explains the police presence.  I go see them.

The Screamer starts to yell in a more fevered pitch, and the RN takes a call from the Screamer's Spouse demanding to know why we haven't treated their spouse.  I sigh looking at the still-full board and waiting room and walk into the room.  To say that things did not progress well is an understatement.

The Rollover Trio arrive.  They are supposed to be evaluated for their traumas.  They are all gone within half an hour.  The E.D. staff and the arrival of law enforcement forces them to answer a lot of questions they don't want to.  So they all disappear.  One with what I could guess is a broken arm based on my fleeting vision of them as they made their way out of the E.D.

The Child is still screaming and the Screamer wants more of anything we are willing to give them.  I deal with a tooth abscess on a patient with bad teeth, who's a smoker who has a history of heroin abuse.  Then another abscess on a patient visiting family in the area.  And a child who dropped a rock on their foot and broke a bone.

The Screamer's decided they have had some relief with the non-narcotic cocktail I gave them, and they leave.  I check out the Child and get them going.  The E.D. is emptying out.  I sew together the cheek of a patient who fell while riding their motorbike, and then I finally finish treating the missing finger part.

Around this time I get a child who is very ill and who will tie up most of the rest of my shift.  I see a patient who thinks they got broken ribs from a tight hug, and another who was seen six hours before at our sister hospital who thinks their rash was getting worse.  I spend my last hour dictating the charts from the night, and a few I had left over from my previous shift.

Morning comes, and my relief comes.... I sign out my sick child who is waiting for transport to another hospital and go home.  I think those studies are trumped by anecdotal evidence.