It's days like this that I wonder what in the hell I'm getting myself into. Let me explain. I just got out of my clinical for 301, which is basically Med/Surg. Normally I'm not too fond of these clinicals, they're okay, it's just that we don't do much - vitals, baths, assessments, pass meds, etc. The basics. And they're all pretty much older clients, mostly pneumonias or stuff. And a fair amount of them are dementia or confusion patients. Anyway, all of that to say that I don't really enjoy them usually, which I know sounds awful. But we rotate around to see other departments. Last week I was supposed to be in the OR, but because of the snow, I missed it. Well today I was in the ER.
I'm not even sure where to begin. All of this is probably going to make me sound really naive or just I don't know, young? Over reactive? And it's silly, but the person I would most like to talk to about all of this I can't talk to. And then thinking about all of that just gets me going again. Sorry.
Okay. I got to the hospital ~0645, went to the floor for pre-conference, yada yada. Everyone else got their patients and such and then my instructor took me down to the ER. I asked her on the way what all I could do - like if I was more observing or participating - she said anything that I've learned, I could do, same as if she was with me. Then she dropped me at the ER, without much instruction or anything, without really assigning me to a nurse. But I stuck mostly with the one who she had talked to for a minute. Not even five minutes later we get this patient by ambulance that has a trach stoma - he had a tracheostomy and used to have a trach in. Trach stoma = hole in his neck. Anyway, he had an arterial bleed and it was bleeding into his trachea....which had a stoma....which meant it was gushing out of his throat. He's rolled into the room and is automatically surrounded by several people - like 5 nurses, the doctor, the medic, someone from respiratory, myself (though I was standing back, trying to stay out of the way). I thought they were moving so slowly, inside I was saying come on, do something! But it's silly for me to think like that, they were moving as fast as possible, had to get pprwk and anesthesiology and such in. I wish I could describe the picture to you adequately. Every time he drew a breath, it sounded like he was drowning. He was gurgling his own blood.
Good grief, there's no way I can write this all. There's just so much, so much that happened today, so much that I'm feeling. I'll just do my best to recap it I guess.
So they have him there, they intubate him, start suctioning the blood, blood goes spraying across the room - I was at least six feet aaway and I had to jump out of the way, finally "finish" what they're doing, and the whole time they had him bagged. They had to use a ambu-bag on the end of the tube they had just stuck in his stoma to make him breathe. That means that someone had to stand there and squeeze it every about five seconds to make his lungs expand, or else they wouldn't have. Mike was doing it for a while (from respiratory, worked with him on the floor before too) but then another patient came into the next room and needed tubed too (he's important, come back to him later) which respiratory has to do, so Mike had to go over there. A nurse took over, but then there was too much junk to do, everything was happening at once, so I found myself with the bag in my hands, breathing for this man who is laying before me, covered in his own blood. Oh, didn't say this, he was about 5'11" and weighed about 115 lbs. That's just a little more than me, but almost a foot taller. Skin and bones. Literally, it was hard enough to look at without even considering all of the other stuff. I don't know how long I was doing that, then the flight team showed up - they were flying him to Carle. They got him all moved onto their stuff and hooked up and bundled up, but the nurses weren't sure that the ventilator they had would work well on him because his tube was sticking up like a foot - not really an exaggeration - in the air. So I found myself putting on one of the flight nurse's jackets while she bagged, then taking back over bagging, and walking with all of them down the halls, out the door, across the parking lot to the helicopter, all the while breathing for this poor man. They got him in the chopper and I ran back inside, back to the ER. None of the nurses think he'll make it.
After that things got more routine, I followed my nurse around; she was doing triage which means she saw each person as they came in, did vitals, and decided their level of priority. It amazed me what some of the people came in for. I went from the previous situation to a man with a toothache. Sharon (my nurse) said that he's a frequent flier though - he comes in all the time, pretty much just drug seeking. There are a lot of those. But there were some legit ones. I'm not going to list off all the patients I saw today, don't even think I could count them if I tried. But one more that's huge.
I went with a different nurse a few times to see some things: IVs being put in, foleys, etc. Well we went to put a foley catheter in a man who was in the priority room - where the patients are severe enough to need cardiac monitoring. He was the one who got tubed earlier this morning, said we'd come back to him. He was a nursing home patient, had the whole gamut of things wrong with him already. Well now he was on a respirator (that's why they tubed him) and watching him "breathe" honest terrified me. His whole body heaved, and not in a regular pattern, but in a jerky, twitchy, really labored way. He had wrist restraints on - protocol if they're on a resp. We tried to get a cath in him, even tried a pediatric one, but couldn't get it. I had ahold of him, had talked to his brother and wife earlier that morning when we were in the room to give him meds, stayed in the room and talked to him - though he couldn't respond - while the nurse had gone to get a different size cath, etc. Shortly after the failed cath attempt, ICU came to get him because he was being admitted. It was later on, while we were in the middle of working with other patients that the charge nurse - who can't be out of her twenties, she just looks so young, but I guess she's married and has two kids - got a phone call about him. They were transferring him up to ICU and when they got him up there, he was dead. Dead. Sharon said well he'd been trying to do that all morning, they just wouldn't let him - I think she could tell I was a bit shook up. I just didn't know how to react. I mean, I've had several people in my life die, several people whom I love and was close to, but this was just....different. I had just seen him, just tried to care for him. Maybe that's why. But I shocked.
The day, however, continued. Maybe that's what shocked me, no one really reacted. I mean, that doesn't make them bad people, they very obviously care, but maybe they've just become so used to stuff like that. It is an emergency room. The charge nurse left to make a call on her cell phone and when she came back she seemed like she had been crying a bit. But other than that, there wasn't really any change. Patients kept coming in, the nurses kept caring for them, life just kept moving. That's how my day ended, it was close to the end of my clinical when all this happened. I spent the last like twenty minutes helping try to get an IV in a very dehydrated two year old. Poor thing, she was cute as could be, but absolutely miserable. Didn't help that three different places of trying IVs on her just ended in three blown out veins.
I missed post-conference because I was too caught up and not watching the time - left at 1300 instead of 1230. So I drove straight home and wasn't quite to my door when the tears started. It doesn't help that I'm tired and my sinuses hate me, but still. I didn't really realize how much today took out of me. Makes me hate living by myself on days like this - I kind of want to be alone, but I kind of want someone with me. Doesn't make sense, I know. But all this has made me think way too much. Made me think about my support system, and how much I need and want someone to be able to just spill to on days like this. I am terribly thankful for my friends. I'm also terribly sad about the people who aren't in my life anymore, for various reasons. My coping mechanisms: forced myself to eat some soup, listening to some city and colour, amos lee, and brett dennen, and now I'm going to try to rest for a bit.
(Title is a song by Amos Lee, check it out)
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