My last ER shift was a 4 a.m. shift, so I thought things would be relatively slow like the previous 4 a.m. shifts I'd worked. Hardly. When I arrived at the ER, I was surprised to see both the 9 pm and the 11 pm attendings still there. This was the first time I'd seen any 9 pm doctor still in the ER at 4 a.m. (they usually leave before I arrive), so when Dr. L asked what was going on, they replied that they got swamped around 3 a.m. The 9 pm doctor passed along two patients to us so he could go home and get some rest, while the 11 pm doctor stuck around b/c he had a meeting to attend at 7:30 a.m. anyway. At first he asked us to watch over one of his patients, a young black guy who pulled over to the edge of an overpass to "take a piss" after a wild night of drinking and fell over the overpass to the ground many feet below b/c he was drunk out of his mind. He landed on his back and head, yet was well enough to walk up the hill back to his car where his sister had called an ambulance for him. At present, he was sometimes sleeping, sometimes awake and cussing at people, including his mother (who was in the room with him worried to death). *sigh* This is one of those stories of stupid people that'll be passed down from doctor to doctor, student to student.
One of the first patients we saw had "altercation, shoved cocaine into officer's mouth" as the chief complaint, and we wondered what the heck that meant. It turned out that the patient was a police officer who was trying to break up a fight when one of the perps shoved a ball of crack cocaine into the officer's mouth as a defense mechanism. First time I ever heard of anyone using crack as self defense. Aside from some tachycardia and numbness around his mouth, the officer said he felt fine and wouldn't have come unless he "had to"; his partner had forced him to come to the hospital b/c he was worried that the crack may have been laced with rat poison (warfarin). Dr. L said she'd run tests, but we all knew that even if the crack DID contain warfarin, it wasn't going to show up in the officer's blood after a few hours. Still, it made for an interesting story, and even the nurses had fun with it. "What are we going to do about the crack-in-the-mouth cop?" one nurse asked at one point? LOL.
Then we got a fresh trauma case: a 68-year-old guy suffered a stroke while driving and hit a wall at around 40 mph. I went with Dr. L and Henry (the scribe) to see him, and what we saw was 4-5 nurses trying to hold down a man visibly struggling against them (altered mental status, anyone?). He looked to me like he was moving all four limbs fine, and I wondered if he really did have a stroke. As Henry and I watched one nurse struggle to put a Foley in him while the others tried to keep him from squirming away, I said, "I feel like we should help." Henry agreed and gave me his laptop so he could help the nurses hold the guy down. (One guy there makes a difference). In the meantime, I'd seen a patient for abdominal pain but because traumas kept rolling in Dr. L couldn't get a chance to see him. I poked my head into his room and apologized, but he said he'd heard the trauma announcements and understood why we were running late.
Around 7:20 a.m., one of the nurses ran over to let us know that "T2" (the stroke patient) was crashing, but that one of the other doctors was running to code so there was no hurry. We still got to the patient withint 3 minutes just in time to watch the patient get a shock. A sonogram machine was wheeled into the room so that the other doctor could look at his heart and see if it was beating well. At first the patient seemed to be responding well to the epi; his heart rate shot up to the 130s and then gradually slowed down. I kept my eye on his heart monitor and watched him go from sinus tach to V-fib in seconds. Uh oh. Once again he was shocked, and after about 10 minutes I saw one of the chaplains bring the patient's wife into the room to see him. When she saw her husband lying on the stretcher with the techs pumping on his chest, she looked shocked. Calling him by name, she told her husband that she was here and begged him to open his eyes. The other doctor (surgeon) was looking really beat down at this point; I think he knew this wasn't going to end well. Dr. L quietly said that she always dreaded telling patients' families that their loved one wasn't going to make it, because that moment will forever be etched in their minds as "before s/he died" and "after s/he died." Finally, around 7:58 pm, time of death was called. The nurses and techs left the room in tears, and the wife stayed by her husband's side.
No one could be absolutely sure what had happened to our patient. Dr. L thought it was likely he had suffered "the one," the first and final heart attack that hits a lot of men, but when his blood work came back about an hour after he died, we found to our chagrin that cardiac enzymes hadn't been ordered. At any rate, he didn't have any electrolyte abnormalities to speak of, so it looks like his cause of death will be found on autopsy. It's strange; I saw more deaths in the ER during my surgery month at JPS than in my one month at Harris. Does that mean Harris has a better survival rate b/c of their care, or do more patients arrive at JPS too far gone to be saved?
One last memorable case happened later in the shift: a 24-year-old girl and her husband came to the ER after she developed an abscess on her butt and he "sterilized" a knife with a lighter's flame and opened the abscess to let the pus drain. She admitted to feeling better after the abscess was opened, but said she still needed antibiotics. I can't imagine how much that must have hurt, opening that abscess without anesthesia, and Dr. L later quipped, "You did my job for me." The girl had just been too embarrassed to have someone else (other than her husband) looking at her butt b/c "it was so gross." Yeah, but still...
At the end of the shift, Dr. L said I did well and wished me all the best. And now...on to allergy/immunology at Baylor in Houston!
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