Week(s) in review

So it's been a busy couple weeks. I like the ER because I get to do stuff, but I think it's too stressful for me for a career. It is tempting to be done at the end of a shift and not have call, though. :)

ICU: pretty boring, a little sad, although interesting to see such a different side of medicine. tubes and wires and monitors on every body part imaginable.

EMT Ride-a-long: hung out with the medics and firemen from 9-5 and the only trip in the truck we took was to go to Jimmy Johns for some sandwiches (we didn't use the sirens though). I decided to stick around for rush hour to hopefully get a couple runs in. We first picked up a drunk homeless man to take to the VA (where he was very well known) and then we picked up a rather large lady who fell down a few steps in her house and thought she broke her back. Neither was too exciting but it was kind of fun to ride in the ambulance!

My CRAZY second shift in the ER: there's just too many stories so I broke it down
-The guy who took lortab and xanax and clonopin and amitryptiline and laid face down in the snow:
Had this guy not smelled quite so bad I might have given him a hug. We have these "task lists" for ER (stick 4 IVs, 1 foley catheter, 1 NG tube, etc) and I did practically everything on the list for this one guy. I stuck him with needles, shoved tubes in multiple orifices, and attached all sorts of monitors to him. And he didn't even complain one bit. Probably because he was unconscious, but whatever. It was awesome.

-the drunk guy who broke his ankle and almost coded:
OK so this guy was pretty intoxicated and we think he fell off his porch resulting in his ankle pointing 45 degrees laterally (enough that he broke the skin on the medial side-it was gross!). He was hilarious, though, because every few minutes he would say "what the hell happened to me?" and we'd tell him his ankle was broken and he'd say "well shit, how'd I do that?"...as if we knew.
Anyway, we were preparing a splint for him and the doc ordered some pain meds to give him before we pulled his ankle straight. He soon became completely unresponsive (in front of his family) and everyone panicked because he was in a hallway (not even a real room) and wasn't attached to any kind of monitor (for heart rate, BP, etc). Fortunately, the expert ER docs gave him another drug to un-do the pain medicine and he came-to, but not before we'd thrown somebody else out of a room and prepared three airway kits. And made my own heart stop for a minute or two.
Anyway, so he got himself a nice little room and we hooked him up to everything we could find, then decided to splint his leg. The ER resident pulled the ankle straight and then turned to me and said "hey can you hold this?" and handed me his ankle. I almost vomited. At least I got another check-off on my task list.

-the truck driver who's truck was hit by a TRAIN so he jumped out of the truck and walked away
This story is pretty much summed up by the title. His back hurt a little so he went to the local ER (about 30 minutes from our ER) and told the docs there that he just crashed with a train and they panicked and sent him to us. Without even checking him at all. Thankfully, he was okay, although he did tell me that he thinks his truck-driving career is probably over.

-a car wreck lady whose BP was down to the 50s and she was mad they had to cut off her clothes
I wish I could have followed up on her case. We had a report that there was a lady coming in from a motor vehicle crash whose BP was way down so everyone geared up in gowns, gloves, etc, we got surgeons, respiratory techs, the x-ray machine, and everything primed and ready to go...and she came in (with normal BP by that point) and was just jabbering away. They still insisted that they cut off her clothes because that's trauma protocol (apparently) but she was irritated "well I could have taken those off myself without you ruining them!" I'd have to agree. As soon as they wheeled her into another room, though, we got another report - one that was a lot less humorous and scared the crap out of a new-to-the-ER girl like me:

-A man with a gunshot wound to the chest:
First of all, this freaked me out because it happened here. Just by the mall. near the park. People don't get murdered in Lexington!
Again, we got on all the gear. A nurse told me to gown up because they may get tired doing CPR and I needed to be ready to step in. Uh, what? Me? doing CPR? in real life?
Anyway, we were told that there was one guy coming who'd been shot in the chest, was found down by paramedics (at least 20 minutes ago) and they were on the way, here in about 6 minutes. They finally wheeled him in (that 6 minutes seemed like at least half an hourm with all the activity going on) and he definitely didn't look good. Not a normal-person color. They immediately started doing CPR, hooking things up, cutting clothes off (I helped take off his shoes/socks and they smelled SO BAD. If you ever plan on getting shot, please, wear clean underwear and wash your feet)
Person #2 was doing CPR (I was 3rd in line) so I asked him if he was getting tired. He said no, but then another nurse said "oh no, stop and let the student do CPR!" Thanks, lady. Thanks. I'm already freaked out enough as it is and to think that I'm going to be pounding his ribcage trying to make a heart with a bullet in it start beating is more than enough for me. But, I stepped up on the box and started doing compressions. Probably only seconds later, they told me to stop so they could ultrasound his heart. Still no activity. I started pounding away again but one of the nurses called out "Time of death: 23:20" and then it was over.
I don't really remember much after that. I didn't want to give up and admit that he was dead, but looking back, not having a heartbeat for 30 minutes probably indicates that you're not going to have one again. And the color of his face indicated that too. I tried my best not to look at his face. I actually tried to not look at anything. I sort of have flashes of pictures in my mind - watching the nurse doing CPR and re-memorizing every movement I was going to make when I stepped up on the box, pulling off his dirty shoes, and making my gloved hands into the fist that I used to push on his chest, but that's about all that I remember. After they gave up, things happened just as fast but I sort of blocked it all out, trying to figure out my emotions (I think it was like the stages of grief - denial, anger, barganing, depression, and acceptance - all rolled into a 30 minute time frame).
It was nearing the end of my shift so I walked around the ER a few times. There was another guy who got shot (in the leg or arm) but was stable and was talking to police. I wanted to go in his room and find out what happened, but I figured that was just being nosy. I did read about him in the newspaper the next day, though. The story is here.

Kind of a lot to handle for one shift in the ER. It also made it difficult to sleep that night.