Sunday, September 30, 2007

Sex, Lies, and Gunshot Wounds

Theresa was carried into our ER in the arms of a big giant teddy bear. He was a few inches over 6 feet, a few pounds over 300, and one of the hairest men I've ever seen. His chest hair morphed into his beard like the joining of 2 great nations. He set Theresa down on the stretcher like she was a precious and fragile sculpture. She smiled up at him and he faded into the corner of the room.

I asked Theresa why she had come to the ER today. She pointed at her left leg, which had a red bandana tied tightly around the thigh. "I shot myself," she replied.


"I shot myself. It was an accident. I was being careless."

I initiated my assessment while cutting away her jeans. Vitals - stable. Pulses - intact. Swelling - minimal. Skin - one small open hole in the anterior portion of the thigh just above the knee. Cap Refil - brisk.

"How did you do this?" I asked

"Well, I had my pistol in my hand and I was switching it from one hand to another. All of a sudden - snap! I shot myself in the leg."

I looked at her a little strange.

"What position where you in when you did this?" I inquired.

"I was standing up."

"Hmmm......" I said.

Her wound had an abrasion ring on the lower half and had an upward trajectory. No powder burns were present on her jeans or her skin. This wound did not match her story at all.

She looked at me sheepishly and ducked her head. I completed my assessment and looked at the Teddy Bear in the corner. He was staring at her leg and becoming paler with each passing second. I saw sweat beaded on his forehead.

"Do you need to sit down, sir?"

"Yeah, I think I better," he replied. I noticed tears in his eyes.

I went out to speak with Dr. Q. I gave him a quick history on the patient and my current assessment.

"You think she's lying?" he said.

"I think she's not telling us the whole story," I replied.

Dr. Q went in to see Theresa. I followed closely behind and heard Teddy Bear repeatedly telling Theresa he was sorry. He was crying by this time. He furiously wiped the tears from his face as we walked in the room.

Dr. Q examined her, then ordered an radiology studies of the area. The results came back that the bullet was in many pieces in her leg and did not appear to be near any major vessels. Teddy Bear made a sound like he was gasping underwater when the results came back. I looked over my shoulder at him and his head was in his hands.

"Your husband seems pretty relieved," I told Theresa.

Her head snapped up and she gave me a nervous smile. "Umm..he's not my husband," she replied.

AH-HAAA! I knew something wasn't right.

"Did he do this to you?" I asked

"Not really - it was a joint effort. I was sitting in a chair by the campfire when he walked by. I lifted my foot to kick him in the butt, but I hit the pistol in his holster instead. The gun went off and hit me in the leg."

"Well, why didn't you just tell me that in the first place?" I asked her.

"Because I'm not supposed to be here," she replied. "My husband thinks I'm at the beach with my girlfriends. Instead I'm in the mountains with my boyfriend. I don't know how I'm going to explain this one."

I didn't know how she was going to explain it either. She left on crutches as she had a difficult time bearing weight related to the pain. It was not an injury she was going to be able to hide. I wonder if she ever came up with a plausible excuse.

Nursing Voices dot com

Well, I've joined the ranks of Nursing Voices I spent the last hour reading all the posts and putting in my 2 cents every so often. There are some really neat people posting on there. Check it out! It is an extremely easy message board to use.

They also have a cool contest going on for a free iPhone. It's all about posting and contributing to the community. The contest is sponsored by Nursing Jobs (again with the whole link think - sheesh).

Come join the community!

Saturday, September 29, 2007

It's a Slow Day

This is what happens when you've reached your breaking point. 3 nurses with a sick sense of humor, one fake baby, a camera, and a slow moment........

I'm Baaaaa-aaaaack!

WOW! It's been foreeehhhhver since I've posted anything. What a loser.

Actually, I have been so unbelievably busy I can barely take care of my family, much less post on the blog. Things are getting better though, so I should be able to pop my head in more frequently and throw out some more stories.

We moved into the new hospital in June. Can you define high stress? I can - 8 trauma's in the first 3 days of occupancy. 8. Let me repeat that - eight. We're not used to 8 traumas in three days. Maybe in 3 weeks, but not 3 days. And then - in a new hospital to boot. Finding supplies became an hour long scavenger hunt, which made our job considerably more difficult. I seriously considered leaving nursing and becoming a waitress at the local greasy spoon. The tips were looking better and better with each passing hour.

Lucy actually did quit - 4 or 5 times. No one would accept her resignation though. They kept throwing it back in her mailbox and writing "denied" across the paper. When I found her in a corner mumbling to herself, "mama dada mama dada" I knew it was time to send her home. I threw her into a cab, gave him a twenty dollar bill, and had her husband meet her on the other end. She did eventually return to work, though I think she's surviving each day with the assistance of Xanax and Alcohol.

Our first trauma was on the day of move in. Fifteen minutes after move in. I was arranging IV supplies when I heard the EMS radio go off. I ran out to the desk and heard "EMS, please respond to a Jeep vs. cow, one vehicle rollover with ejection on Hwy 6."

"Wonderful," I thought. I hit the trauma bay again just to remind myself where everything was. EMS report came in and Trauma Team was activated. Then EMS calls on the landline. "Julie? The patient is Sally Jo."

The blood drained from my face and pooled in my feet. My heart stopped. Sally Jo was a fellow nurse. One of our finest. Dr. Q saw my face, said "Oh shit", turned and walked out the door. Running a trauma or a code on one of your coworkers is the most emotional thing you can do in healthcare. You have to make a concentrated effort to not let your emotions take over when providing care. I looked down at my hands. They were trembling uncontrollably. I dropped my pen on the floor.

"What's up?" Lucy said as she walked by popping her gum.

"Sally Jo is coming in as a trauma," I replied

Lucy choked on her soda. Coughing and sputtering, she set her Diet Coke down and grabbed a paper towel. "Seriously?" she finally managed to say.

"Yes, seriously," I replied.

Soon, EMS arrived with Sally Jo. She was in complete immobilization, actively bleeding from somewhere on the back of her head, and complaining of intense back pain. She also had passed out twice on the way into the hospital and was incontinent of urine. Our trauma resuscitation began.

The team surrounded her and completed the primary and secondary assessments. Labs and Radiology were ordered. Vitals were stable at that moment. Sally Jo kept repeating herself, asking the same questions over and over. She had no memory of the wreck or the moments leading up to it. Her last clear memory was dinner earlier that evening.

I could see her watching us and wondering why we were all working on her. She would alternate between laughing and crying. She couldn't understand what was going on. She screamed "What the hell are you doing?" when I started to put her catheter in. "Stay the hell away from my crotch!" She tried to kick at me, but was suddenly distracted by the urge to vomit. Blood was pooling under her head and she was starting to have a bit more difficulty maintaining a good blood pressure.

Dr. Q had to redirect the team quite a few times to pull us together. "Damn it! Let's go! Pay attention!" We were so easily distracted by our emotions, it was hard to keep on task.

We ended up flying Sally Jo out to a larger facility. Her initial diagnosis included a head injury, a couple of fractured vertebrae, a pelvic fracture, and a bladder fracture. We had a quick debriefing after we flew her out and then I went home and crashed for the night. I was completely exhausted from the emotional rollercoaster we had been on.

The following traumas consisted of 3 horse wrecks, 2 car wrecks, one fall from 30 feet, and one assault. Now I admit that I am a trauma junkie, but I like them in my place of comfort. Not a brand new facility where I'm not quite sure where anything is yet. That was very difficult for me.

The rest of the summer has pretty much been the same. I do have some good stories saved up for you. I'll try to be a bit more committed to this blog than I have been over the last few months. Depends on what comes rolling through that ambulance bay though!