Emergency Room!

Posted on September 13, 2011. Filed under: Uncategorized |

A day in the ER

Professional life as I knew it changed forever when I made my entry to work in the emergency room of McKinney Medical Center only a short few weeks ago. The first day is supposed to be “Orientation” and Triage, in which you assist at the front desk helping decide which patients are priority, and which are less urgent. As I headed into the entrance and asked where I was to go, a friendly staff member pointed me down the hallway, where I was met by a quickly-walking nurse who asked: “Do you have your trauma shears? Follow me.”

Down the hall and into a room we went, to be confronted by a young woman moaning in severe pain, with her right leg bent up and out at an impossible angle. Immediately we went to work cutting the tattered remains of her trousers off her twice-broken leg, to prepare her for a through examination and placement of her leg into what’s called a traction splint, which holds the leg and broken bones in place, and relieves much of the pain. The removal took only seconds, and within another minute or two several nurses both male and female had the splint ready to be placed. Try as we all might, there was just nothing pretty about it – her thigh bone had been broken in two places as she had desperately jammed on the brake trying to avoid hitting the woman who had pulled out in front of her as she drove her usual route to work, on a country road just north of McKinney. The impact at 50 mph was incredible, with her leg taking the brunt, though she had also been placed in a cervical collar as a precaution.

Several minutes passed as we pulled, help, and tugged – and finally we were able to place here leg securely. Amazingly, soon after her leg was stabilized much of her pain subsided, and soon family members were showing up to offer support. Her stay wasn’t long though, as shortly after x-rays revealed the damage that had been done she was once again transported to Dallas, where trauma orthopedists were preparing to insert a metal rod into her snapped femur.

Welcome to “Orientation!”

As I walked back up the hall and introduced myself, all hell was breaking loose near the ambulance entrance, as several paramedics were working furiously but calmly to transfer a flatline patient into the cardiac room – one managed a bag to keep the man breathing, and the other was pumping and compressing his chest to keep his heart moving.

The cardiac room was like a scene from ER. Nurses, techs, paramedics, and a very calm and confident doctor guiding the action. I was performing the chest compressions, standing on a stool to get better leverage, with several of us rotating as the exertion took its toll. Inject epinephrine here, start an IV there, stop CPR, administer a defibrillation shock, resume CPR, start bicarb…..   The patient – an overweight diabetic with open sores on his partially bandaged feet had experienced cardiac arrest – would get a pulse, lose the pulse, get a pulse – while for part of the time anxious family members stood at the doorway. After 20 minutes he finally established a pulse that took, and then his blood pressure began to rise to a normal level. The floor of the ER was a mess from all the wrappers of equipment that had been used, and as the doctor and nurses moved on the other cases, I assisted in helping the patient breathe while the respiratory therapist hooked him up to a ventilator.

All this by 10 am. A very, very different experience than in my serene, Oriental-motif clinic which acts as a healing sanctuary for patients who often come in for chronic conditions. In my clinic I never rush, and we take what time we need. Not so in the ER!

These were dramatic moments, and much of the other work involved patients in various stages of long-term health degradation, so much apparently self-inflicted and the product of long negligence and outright denial of personal responsibility for taking care of one’s own, God-given body.

ER lessons are very hard, on both patient and doctor!

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