In Chicago, where I was certified, we were required to do two 5-hour ER clinicals instead of ambulance ride-alongs. This was at the end of the 5 month class, and I was going to Northwestern Memorial, right downtown.
My clinical started at 8am and I got there at around 7:45am just to look good. I walked in to the ER and met my contact there who quickly dismissed me by passing me off to an ER tech. He told me to wait right there behind the registration desk and he'd come by and get me when he wasn't so busy. I said sure and just hung out for a second. This was all by about 8:05am.
In class the instructor told us that there was a possibility we'd see something interesting, but most likely not. He said there would probably be some drunks, a homeless guy or two, an old lady with a hip fracture maybe, but probably nothing great. Five hours was just not enough time, especially on a Tuesday morning at 8:00. So, while I was hanging behind the registration desk, basically just picking my nose, thinking that I was just going to wind up getting put somewhere out of everybody's way, a Code 3 ring down from Chicago FD came in for "70 y/o female, pulseless and apneic for unknown period, CPR in progress, defibrillation not advised, ..." Immediately, the MD who was on duty pointed at me and said "EMT student, come on over and get ready to start compressions when she gets in".
So about 2 -3 minutes later, paramedics brought her in and they were already giving her compressions. When they got her into the ER they had me get on a little foot stool for leverage right above her, and start compressions. Since I was nervous as all hell, and my sympathetic nervous system was really kicking out that adrenaline, I was yelling out my compressions like a quaterback. "Twenty-one!!! Twenty-two!!! Twenty-three!..." The MD in the ER told me to count to myself and that I didn't even really have to count if I didn't want to, he would just tell me when to stop. I said yessir like he was a drill sergeant and just kept pumping away. It was at this point that I noticed that our patient had pooped her self. And that she was naked.
I overheard the medics tell the MD that they were not sure how long she had been down because it was unwitnessed. Whoever called 911 heard a thump or a scream or something and Chicago FD had to kick her door in. Then, straight out of the Hypothermia and Enviornmental Emergencies chapter of my EMT book, the doc said "Well, she's not dead until she's warm and dead. EMT student, stop CPR." I did and peeled the back of my glove off to touch her cheek with the back of my hand. They took a temp, it was normal, and they pronounced her. I was dripping with sweat and shaking. The doc told me, "good work" and I nodded. My ER tech contact was there the whole time bagging, or getting supplies or whatever. He gave me a look that said "Wow, you are lucky."
So within 15 mins of my first experience in healthcare, I saw and touched my first dead body, I did CPR on a real person, I was really, really close to some poop that didn't belong to me or my dog, and I was part of a team that was providing emegency care that we were trained to give.
It took me a couple of minutes to calm down. The ER tech told me that I could step out if I needed to. There were a couple of nurses cleaning and wrapping up the patient. I was watching them sort of wipe the poor lady's backside while they were talking to each other like they were at Starbuck's. One was saying to the other "Yeah, we just finished the deck and it's beautiful. You and Rob should come up..."
I went outside and smoked 3 cigarettes in 3 minutes.
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ReplyDeleteWhile in nursing school at Binghamton University, I did a six month internship at Crouse in the intensive care unit. I was paired with a veteran nurse to care for a 21 year old diagnosed with acute myeloid leukemia. He was stuck in a formidable pattern, common in the ICU: sepsis ->acidosis
->kidney failure. The way to treat acidosis is to push fluids, but since the kidneys were shut down there was no way to eliminate them, so his body just filled up like a giant human water balloon, ready to burst (anasarca). To compound matters worse, he had severe thrombocytopenia, or low platelets, so blood gushed out of every orifice.
In the morning I had to change his sheets which were saturated with sweat, blood and runny, foul, shit. It took about a half hour to change everything since he was so heavy, intubated, and had so many IVs and monitors. Then as soon as I was finished, he shit again.
A few of his friends came to visit at one point, smelling of weed, and they were shocked to see him looking like a bruised, bloody, beached whale. They didn’t stay long. His parents, however, didn’t leave his side.
About halfway through my shift, his pulse oximeter alarm went off and his sats fell into the eighties…then his heart rate plummeted. My preceptor ordered the family to leave the room and had me push the panic button. Doctors and nurses streamed into the room. One of the residents started compressions, and as soon as he did, the patient’s eyeball popped out of the socket and blood gushed out of his mouth. I just kept drawing up syringes of bicarbonate, epinephrine, and D50 glucose to push in his IV line. At one point I notice his mother looking wide eyed and horror-stricken in the window, then led away by his father.
We were able to get him back a few times before he finally expired later in the shift. More compressions, more emergency medications, more fluids pushed. Each round left him more battered and less recognizable.
Only two months ago he was healthy, complaining only of fatigue…RIP.