ER: Thirteenth Day

Today I worked a 3:30 pm shift with Dr. D, one of the younger attendings (mid-30s), who willingly let me do as much as I was comfortable with. Several of my patients were interesting. One was a 16-year-old kid who looked really sick, and he said that there was a "funny smell" in his urine. Naturally I asked about his sexual history thinking he had an STD, but he said he always used protection. Turns out he had a pyelonephritis. Another woman came in with a complaint of "I think I swallowed glass," which sounded alarming until I got the whole story: she was in an MVC in which the window broke and she'd coughed up glass fragments. Fortunately she had no cuts in her mouth. When I saw the name of one of my last patients, a girl about my age, I thought, "Uh oh" b/c it was the same name of a girl I knew in the 2nd grade. She'd gained a lot of weight, naturally, and her face was rounder than I remembered, but it was her. Nevertheless, I introduced myself and asked her what brought her to the ER. She had abdominal pain, which of course required a lengthy workup. But I don't think she recognized me, thank goodness.

Around 10:00 pm, Dr. D was asked to put in a central line on a woman who'd coded en route to the hospital. She was a dialysis patient and there were scars on her neck from catheter insertions or previous IJ lines. The biggest fear was that we'd hit scar tissue. Dr. D let me glove up to assist, but one problem after another soon happened. The sonogram wouldn't work after Dr. D slipped on the sterile covering for the probe and he had to find the vein blind (which is how they do it at JPS but not at Harris). Then while advancing the wire, blood suddenly started pouring from the incision site in pulses, so he had to apply a lot of pressure to the neck to stop the bleeding. What was weird was that this was venous, not arterial blood, that was coming out. Deciding to give up on the IJ, we tried a subclavian next, but again, the veins were not good. I felt a small thrill just by placing my fingers against the vein and it felt like an artery. AV shunt maybe? The last option: an art line in the femoral artery. This, again, was no easy task. First Dr. D hit the vein, and then when he got the artery, I accidentally dropped the tip of the guide wire and they had to get a new kit. Then, on another attempt, Dr. D accidentally pulled the wire out before he could thread the catheter over it. It took another try or so before we finally got it in, and by then it was 11:30 pm. Prior to that, the scribes had done rock-paper-scissors to see who could go home earlier, and before the art line Dr. D had discharged the rest of his patients. Either way, I didn't get home until midnight. This had to be my longest shift yet.