Wednesday, April 25, 2007

The Neighbor

I heard the EMS tones from room 1. I was in the middle of cleaning up a Code Brown (for those of you not in the know, a Code Brown is a poo-poo blowout), and I knew Lucy was taking a break in the report room. There was noone at the desk to listen to the call.

"Crap," I thought.

Out loud.

"Oh honey, I'm sorry, but I have the diarrhea, ya know," my patient replied.

"Oh no, Mrs. Smith. I didn't mean you. Sorry. I just need to hear that call."

I finished washing her up, snapped my gloves off, and threw them in the wastebasket as I headed out to the desk.

"Did anyone hear that call?" I said loudly - hoping any other nurse behind a curtain or door would hear me. I was met with silence. "Shit. Shit. Shit." I have an issue with not hearing EMS calls. I must hear them. I must. I HATE not being prepared. I know that ER nursing brings surprises every day, but I try to limit them with knowledge. If I don't hear the EMS call, I am sure to be cursed with a cardiac arrest, open chest trauma, or out of control schizophrenic. Maybe all 3 at once. It never fails.

Lucy heads out of the report room, licking the cupcake frosting off of her fingers. "Hey Lucy! Did you hear that call?" I ask, knowing full well she probably didn't, but hoping none the less.

"You missed a call?" she asked.


"I'm going on break," she said as she turned and went back through the door. "I know what happens when you don't hear a call."

"CHICKEN!" I yelled. She didn't hear me because the door happened to close in my face at that very moment.

I walked into the trauma bay and started checking the equipment. The static of the EMS radio caught my attention again. Stumbling over a mayo stand and running toward the desk, I reach it just in time.

"Dispatch to Nurses Station"

"Nurses Station, go ahead" I replied.

"Medic 93 en route to a 12 year old who has been thrown off a horse. Bystander states CPR in progress."

Shit. Double Shit. A kid.

"Copy Dispatch. Any further info?"

"Neighbor on phone with me currently. He says he is watching them across the pasture. He sees blood on the gate and the patient is on the ground. CPR in progress."

"Copy - NS out."

I called the Code Team in to prepare for a pediatric code. Kids in crisis are the worst patients - not because they are obnoxious, but because you never want to stop working on them. EVER. You feel like you are always missing something - that if you would just try one last thing, you might be able to save them. Kids are usually very resilient, but there is always "that one" that just doesn't pull through.

The Code Team arrived (meaning the second ER nurse, the ER physician, Xray, lab, and Respiratory Therapy - all of whom had been sitting in the break room with Lucy) and I gave them the information I had. Equipment was checked, ET tubes pulled and ready, the Broselow tape was out and open on the stretcher..............we were ready.

10 minutes - no report.

12 minutes - no report.

15 minutes - no report.

What the hell? SOMETHING had to be happening. Lucy and I stood reviewing the PALS cheat sheets, waiting for the radio to crackle again. The doc and the RT were getting antsy and wanted to get back to their snacks in the break room.

Finally - the radio makes a noise.

"Medic 93 to Nurses station."

"NS - go ahead"

"ETA 2 minutes, report upon arrival."

WHAT .................. THE ................ HELL? It must be bad if they can't even give us a report.

Everyone looked a little on edge. Last time this had happened, we were met with an 11 year old with a flail chest who ended up with a couple chest tubes and quite a few units of blood.

We heard the loud beeping reverse tones of the ambulance. We were ready - hands on equipment, ready to go. Hearts beating just a little bit faster, breathing a bit shallow. My fingers were just starting to shake. I really didn't want to see another bad kid.

The ambulance door popped open.

The lead paramedic jumped out of the back and threw open the second door. He grabbed the end of the stretcher and started to pull it out. I saw 2 feet (always a good sign), a couple of IV lines, and ........................................

A cute little blonde girl sitting up talking to the crew.

My body sagged with relief. She was sitting up talking. Phew.

Then I was pissed.

"You get us all psyched up, ready for the worst, expecting a pedi code or trauma and you bring us a cute bubbly little girl? ARE YOU SERIOUS?????" I (politely of course) yelled.

"What? Huh? What do you mean?" he replied.

I told him about what dispatch had told us and how not receiving any report just confirmed our assumptions. He looked at me like I was stupid. "I never said we were doing CPR," he said.

"The neighbor did. The neighbor saw them!" I replied.

"The neighbor was 60 acres away Julie. He was also 92 years old and couldn't see anything further than the sagebrush 10 feet in front of him."

"Well, time give me a report," I stuttered.

"Next time, don't rely on the neighbor," he shot back.

A lesson learned.

Wednesday, April 18, 2007

Hey! Watch This!

We've all heard those famous words "Hey! Watch this!". We know we shouldn't turn our heads and look. We know that if we do, we will only see something that should be featured on late night cable shows - something that makes us cock our head to the side, converge our eyebrows, and say "What the hell?" Shows that make us literally gasp in horror (or amazement) at what humans do. Humans are not the smartest creatures on the planet. Emergency nursing taught me that in my very first day.

Friday night, two ........ um .......... wonderful (and I say that not in jest, but in awe at the entertainment that they provided) men arrived in our ER. Jim walked in with bloody towels wrapped around both of his hands. Jay, following behind, was an exact replica, even down to the attire he was wearing. But that is a completely different story. What is it about drunk men on a Friday night in rural USA? Do they all grab clothes out of the same closet? "Hey JimBob - Can I borrow your red wifebeater?" "Sure BillyJay - but the blue one might go better with your eyes."

"Hey Miss!" Jim yelled, waving his bloody mitts in the air. "Hey Miss! Can we get some help here?"

"Hey, me too!" Jay, not to be outdone, yelled across the hallway, pushing himself in front of Jim.

"Shut up Jay! More of my fingers are missing than yours, you pussy."

Fingers? Missing? Oh, this was going to be good.

"Jim - you're a prick," Jay replied. "I outta kick your ass."

"Oh yeah? I'd like to see you try it. You can't even make a fist. Whacha gonna do? Punch me with your thumb?"

Jay started toward JIm, hands (what was left of them) in the air. The towels fell off and blood ran down his arms and spilled onto the floor. "Shit," I thought "I'm gonna have to clean that up."

"SIT DOWN!" I calmly shouted. They simultaneously dropped their butts down onto the stretchers in the room. "What did you guys do to yourselves?" I asked. Now, I've talked about this before. Asking people what happened or what they did to themselves often takes you to areas of human intelligence you never knew existed. It's like walking around a corner in some little town you are exploring and coming upon a man walking a Great Dane dressed in a tutu. You're just not quite sure if what you are experiencing is real.

Jay and Jim started talking at the same time, arguing like little kids. "It's your fault!" "Nuh-uh! It's your fault!" "I thought it was a stupid idea!" "You did it too!" "Nuh-uh!"

"SHUT UP! You guys sound like a couple of 5 year olds," I said as I grabbed Lucy and had her help me examine the wounds. Both men hung their heads low, but continued to whisper insults at each other. Rolling my eyes, I threw Lucy a few extra packs of 4X4's. Upon examination, I noted that Jay had lost the 1st through 4th fingers on his right hand, and half of the 1st and second fingers on his left hand. Jim had lost half the height of his 1st through 4th fingers on his right and left hands.

During our exam, Jim said something to Jay about his mother and I thought maybe some type of relationship with her brother. I'm not 100% certain what he said, since Jay jumped up off the stretcher and started towards the other side of the room, pushing me out of the way as he went. Luckily, the clatter of the metal mayo stand hitting the floor was enough to make him think twice. He called Jim a few choice names, sat back down on the stretcher, and then politely said, "Sorry Miss. I didn't mean to curse."

"All right boys. I'm going to have to separate you," I said.

"NO!" They both yelled. "I gotta stay with my Jim," Jay said. "He's my best friend."

"Oh man," Jim replied. "I love ya man." Then he started to cry.

"I love you too man!" Jay said. "I'm sorry man. I'm sorry!" Tears were flowing from both of them.

(And they say women are complicated and emotional.)

We finally got the story out of them. Jay had apparently thought it would be a great idea to use a lawn mower to trim a hedge. What's so bad about that, you ask? Well, let me tell you. Picture the scene: family BBQ, drunk men, kids running around screaming, Jay and Jim discussing how the hedge needs trimmed. Jay's wife yells something about how he can't even mow the grass, how the hell is he going to trim the hedge? The lightbulb goes off above Jay's head. Jay talks Jim into helping him.

"Hey! Watch this babe!" Jay yells.

His wife hears the engine of the lawnmower start. She slowly turns and watches as the men position themselves on either side of the mower. "I wouldn't do............." she starts to say.

They reach under the mower to pick it up. Yes! They picked the lawn mower up with their hands sticking under the machine. Under the machine that has rapidly rotating, extremely sharp metal blades. Metal blades that cut things - things like grass, sticks, FINGERS!

They were successful for about 2 seconds. Two seconds and 2 inches (sounds like some other things we're familiar with, huh ladies?) before fingers started flying.

"Why the hell were you picking it up like that?" I asked.

"Well," Jay replied, "I thought if we each got a side of the lawnmower and picked it up, we could just carry it down the hedge while it trimmed the top off."

I stood in stunned silence. Lucy snorted in the background.


"Yeah, I know. Stupid huh? When my wife mentioned the lawnmower I just thought, 'Hey, let's use it to trim the hedge.' I suppose it's a good thing we've had a few beers, huh? Helps with the pain."

"Helps with something....." I replied.

The ortho docs were called, came to see the patients, and closed and repaired what they could in the OR. No fingers were salvageable for replacement. The men were admitted under ortho services for IV antibiotics and observation.

It took less than 2 hours for a drawing of a lawnmower with fingers flying out of it to be posted at the nurses station. The caption read 'Hey! Watch This!'