Tuesday, December 31, 2013

Just A Day, Just An Ordinary Day

New Year's Day
Seventh Circle Of Hell Hospital
0300 hours - Once upon a time

It's been a pleasant, and even abnormally q-word night. Every section of Main ER has open beds, so nobody's stressing. Homeless Hangout, AKA triage pit, is blissfully unoccupied. Someone, one of the clerks likely, has a battered boombox streaming out soft Christmas and seasonal music, in open defiance of policies. Good for her.

Then the Batphone rings.
City paramedics bringing a GSW victim in, in full arrest.
Virtually the entire staff, having nothing better to do, swings into action.
The Trauma Team is roused from their lair, and assemble too.
At 0302, in the softly jumbled glow of the flashing red and yellow lightbars on the outside wall, one of our gurneys comes in, bustled there by a beefy wave of firefighters, the smallest of them atop the victim doing chest compressions that would amply circulate King Kong.

Three nurses swarm IVs, getting both antecubitals and a hand, and saline and Ringer's go pouring in, while blood type and crossmatch, labs, blood sugar, and hemoglobin tests get drawn and run stat. In about 60 seconds, the monitor leads are attached, there's an ET tube in place, along with a foley catheter, and a femoral stick by the younger resident and med student team.

As I'm crawling through, over, and under the humanity to take over bagging, they're preparing a chest cutdown while the code progresses through the steps like a machine.

In fact, it ends up being bilateral chest cutdowns,  because blood is pouring out of this guy. He's essentially being cut in half from both sides to try and cross-clamp the aorta, trying to save his heart and brain until better work in surgery can save his life. And, failing that, it's good practice for young surgeons, since he's effectively dead anyway, despite the two three four units of O negative pouring into (and out of) his chest cavity even before he's cracked open.

The Chief Attending for Trauma calls it in about 60 seconds after that.
"This guy is done. My left and right index fingertips are touching through the entry and exit holes in his left ventricle. Non-salvageable."

Mr. Unlucky has been well and truly 10-ringed, right through the heart.

Before anybody can even peel gloves off, triage nurses bustle another delivery from the ambulance ramp, this one delivered by Homeboy Ambulance: two dudes in a Chevy saying "Our homie got shot." It's now 0308.

And judging by the amount of blood coming off and out of him, yes, he has indeed.

Contestant Number One in tonight's game of You Bet Your Life is literally pushed, still on the gurney and gutted like a fish, to one side, to give everyone a chance to pivot 180 degrees and start work on Number Two. Helpfully, they're all warmed up, and this one actually has a pulse and respirations, albeit with several more bullet holes in him than our unfortunate first contestant.

He looks good for stabilization, and the Trauma Team are excited to have someone they can actually have a chance of saving. As the arrangements for the surgical suite are being made, and he's being rigged for transport, the Batphone has gone off again. Another gunshot wound to the chest, another full arrest, inbound and 1 minute out.

At 0312 they arrive, pushing Contestant Two and his transport team aside, and wedging Contestant One, now with a sheet - rapidly becoming blood-tinged red - pulled over the body from head to toe, firmly along the far wall of the trauma bay.

Vulture's Row, the overhead observation area, now has a number of paramedics, cops, EMTs, etc., arrayed along it equal to the number of doctors and nurses working on the now third victim.

As we're doing the third version of IVs, ET tubes, central lines, foleys, blood tests, hanging O negative blood, CPR, and yet another chest cutdown, there comes the unmistakable voice of tonight's Queen Of Triage:

"There's another car on the landing all shot up, there's more gunshot victims inside, and I can still see the gunsmoke in the car!"

I stay in main trauma, while another bunch hustles outside to scoop up whatever Homeboy Ambulance Number Two has deposited on our doorstep.

Just as Contestant Number Two gets hustled out to surgery, they're calling the code on Contestant Number Three, despite his chest cut-down. No chance, and no blood left in him.
But then Contestant Number Four is wheeled in, turning out to have unfortunately stopped bullets to the abdomen and leg after they passed through her car door. Another guy in the car caught one in the arm, and is taken to a side treatment room. Most of the blood on the other occupants was from Number Four, but that's not apparent to us right away.

As most everyone shifts to the newest thing to play with, the two corpses sit along opposite walls, draining out every drop of blood, until we have time and staff to deal with the dead instead of the living. Everyone at this point is treading deliberately, as the floor is quite literally three quarters of an inch deep in the approximately six or seven gallons of blood and additional blood products which have drained all the way to the floor, and now cover the surface of the entire 20 by 35 foot trauma bay, not counting a huge liver-sized clot and numerous smaller coagulations plopped and strewn hither and yon in all the fuss. Every step makes the never-forgotten "shhhhwuck! squish! shhhhwuck! squish!" sounds of rubber-soled shoes pulled out of and placed back into the coagulating ocean of blood with which the entire bay is now carpeted.

It's 0315.

Contestant Number Four is stable, conscious and coherent, and apparently the bullets that hit her didn't hit vital organs or vessels. Fortunately there's no free fluid showing on the bedside ultrasound, and she's not in any distress except pain and shock at being in car full of people shot up by other folks.

Paramedics shuffle back to their firehouses, cops are everywhere, and we separate the belongings and blood-soaked clothing into piles for "evidence" versus "hazmat garbage", and a seemingly endless number of phone calls to coroner, relatives, and organ donation banks begins.

We begin mopping up, rather literally, filling large Roughneck trashcans full of oxygen and IV tubing, trash, and debris from three chest cutdowns, three intubations, three central lines, twelve IVs, four foley catheterizations, and four remaining units of O Negative blood from partial transfusions. Housekeeping is using the wall suction to try and tame the tsunami of blood, before they get down to the tile, and then bleach-disinfecting everything to the bloody grout. Body bags come out, tags are tied to toes and affixed to belongings, and a stream of labels are made for the pages of charts, documents, and other office work of sending someone to the Eternal Care Unit. Twice over.

It's now incredibly only 0320.

Sometime later, before sunrise signifies the impending end of shift, trauma surgery calls to let us know we're batting .500 for the night, 2 out of 4.

The two failures are now coroner's cases, bagged in white plastic zippered shrouds in refrigerators across the street, and the floor looks like none of it ever happened. The only traces left are the spreading ripples on the souls of those who were there, or friends and relatives who are just finding out about how the New Year started for those four people - none of them over thirty years old - this morning, after embarking on a New Year's Eve that certainly must have started for each of them so full of promise. Clearly, being around for the beginning of a day is no guarantee you'll see its end.

So much for the quiet New Year's Eve shift that wasn't.
I hate love hate love this job.


  1. Goodness gracious. And I will stop whining about my "magnet" status, effective forthwith. And I can't call in. . .I have to bring goodies to share. . .after all it is New Year's Eve.

  2. I think you're my favorite writer out there. This is the reason I love nursing, hate nursing, and sometimes have trouble explaining why to people.

  3. Thanks both.
    I write 'em as they happened. But obviously, I save some of the stories from, say, New Year's Eve until...another New Year's Eve.

    My perpetual regret is that when I started this gig, neither blogs nor head-mounted HD cameras existed. Dammit. I could be pulling down 10 times my base rate for writing scripts instead of decoding resident's orders.

    But I'm in negotiations with the local nursing college to get 2 credit hours of foreign language for life experience in Modern Hieroglyphics, so I've got that going for me.

    Best Wishes,

  4. After your long gap in December, I thought you'd stopped writing.

    Please don't ever stop writing.

    Thank you!

  5. That's the sort of activity that makes me question why I shouldn't be an ER nurse - love the activity and codes (ya I know I"m weird) HA

  6. Actually, the qualifier for being an ER nurse is being weird.