13 3 / 2013
I’m sitting on my couch in my sunlit front room, dozing cats on either side of me. I had coffee and cinnamon rolls for breakfast and I’m still in the gnarly sweatpants and sweatshirt I slept in (since the boyfriend is out of town, I don’t have someone whose body temperature is hotter than 1000 suns keeping me warm at night). And I’m having trouble not dwelling on last night.
It was my first time shadowing in an ER. My second time shadowing ever. I scheduled it for 4pm to midnight in hopes of seeing something interesting,
It started out slow enough. I learned how to tie sutures on a laceration on an inmate’s face. I helped hold down a thrashing panicked man who was in the depths of a severe respiratory distress, eventually the sedatives kicked in and he was still enough to be intubated. There were a few drunks, and a couple people faking strokes or seizures (why?). Took a food break with a third year and, at his request, critiqued the composition of his vacation photos. Protip: rule of thirds, and have a way for the eye to enter and exit the composition. He advised me on getting through first and second year. The five hours I had been there felt interminable.
Then John Doe arrived, an unidentified victim of a hit and run, and no one was sure how long he had been outside. Two days of teaser spring weather gave way to a chilly nighttime reminder that winter wasn’t over yet. He was unresponsive, blown pupils; cold skin, feeble pulse, low heart rate. Broken wrist (hands aren’t supposed to, well, dangle like that) and broken femur in two places, fortunately nothing piercing the skin. Upon noticing a distinct lack of lung sounds, bilateral chest tubes were put in by a trauma resident who materialized out of thin air. The patient was promptly intubated. Surrounded by a whirling team of medical professionals, injecting epinephrine and calling out vitals and shouting for this or that his pulse… stopped.
There was a pause in the madness, and someone started doing chest compressions and the fury of movement around the motionless man resumed, faster than before if that was even possible. As a mostly useless first year medical student, I was holding up and squeezing bags of fluids when the attending asked if I knew how to do CPR. In theory, yes. On dummies, yes. In a classroom, yes. On a mostly dead person? No. He took the bags of fluids from my hands and told me to try it.
It was all very slow then, but fast at the same time- like only what I was doing was slow and reality around me sped up. I told the third year doing compressions that I was ready to take over whenever he was tired, he stepped aside and said with a smile, “Just do the beat of ‘Stayin Alive’.”
And suddenly my whole being is focused on pushing on this man’s chest as hard as I can; I’m pretty sure his ribs are already broken because sternums aren’t supposed to go down that far, and there’s so much blood, and his broken wrist is bobbing up and down like a sick conductor to the beat of my compressions. They told me to slow down a little and I did. They told me to step back for a pulse check.
And there was a pulse. A weak, faint, pulse, but a beating heart nonetheless. More activity, I help the respiratory therapist by squeezing the balloon while she sets up the ventilator (“Every 6 seconds,” she told me).
On to a CT scan to check out his organs. I go with, because I’m really good at holding/squeezing fluid bags (this guy has an epinephrine drip, a few bags of fluid, some platelets, and a unit of blood going all at once) and for whatever reason, the fact that blood is consistently dribbling out of his nose causes me great consternation and distress. The trauma attending told it’s because his body has been cold for so long his clotting factors aren’t working as well as they should. The bloody nose really bothers me, it runs into his mouth and down his face, pooling in his ears and dripdripdripping on the bed. There’s blood everywhere at this point. I grab a wad of gauze pads and for whatever futile reason keep wiping his face and whispering, “I’m so sorry this happened to you.”
He’s on the bed for the CT when one of the technicians recognized him by his tattoos, but doesn’t remember a name. Beneath the jungle of IV drips and chest tubes and catheter tubes and bruises and smears of blood, the patient looked mid 30s to late 40s, judging by his plethora of poorly done tattoos (I was struck mostly by the solitary letter on his neck, the crude Tweety Bird, and the marijuana leaf) he had lived a hard life. No one deserves this though, to be struck down and abandoned in the cold night, no way to identify him, a subdural hemorrhage blooming on the computer screen before us.
A bed opened up in ICU, the patient was stabilized enough to transport upstairs, and then we were done. Elevator back down to the ED, time to go home. As I was leaving, I heard a code announced in the ICU over the loudspeaker. I bet that was him. That would be the third time.
As I was falling asleep, I wondered if the patient was alive or not. I wondered where he had left before he was hit by the car, who he said goodbye to- if anyone. Did the driver know they hit a person, that they killed somebody? I had a strange basket of feelings in my chest as I drifted off, one that has stayed with me the whole day.
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