“The Price is Right!”

Once I had departed the employ of Da City, I worked as a RN in one of the little ERs dotting Da City. At that point in time, there were perhaps 18, maybe 20 hospitals big or small serving Da City. I worked at one of the middling sized ones, at that time around 300 beds.

Working midnights in ER, well, you commonly find yourself spending time with folks who make poor life choices. Those of you who have worked nights, or do presently, bear with me. Alcohol is a commonly abused drug. Shocker, right? Moreover, those who use alcohol to excess, commonly also do other, similarly, stupid shit. Said stupid shit, typified by the admonition, “Hold my beer, and watch this!”, places the stupid shit performer at significantly higher risk of ER visitation eliciting injury.

In retrospect, that all makes sense. Well, those of our neighbors who fail to contemplate consequences, readily foreseeable consequences at that, PROSPECTIVELY, well, those folks are why my children slept indoors, ate every day, and got suitable shoes regularly. Thanks for the business, my friend!

Later in the night/early in the morning, the flow of sick/injured tends to slack off. When all the stuff that needed doing, had been done, we got to thinking. From those deliberations arose the night shift game of The Ethanol Is Right!

The goal is to appraise a given patient, without any lab work reported as of the time of the prediction, and then write down your vote for the patient’s blood alcohol level. The vote closest to the lab reported value, but not over, “won”.

MAST Trousers

A long, long time ago, in a galaxy not so far away….no, wait. That is not quite right.

So, TINS©, TIWFDASL©, with my partner Doug, and we caught a run for a stabbing. This was a bit out of the ordinary, inasmuch as the preferred mode of interpersonal interaction (based exclusively upon my skewed sample of EMS patients in Da City) was labeled as “a GSW”, or less cryptically, “a shooting”.

In any event, we arrived to find a gentleman who was talking, kinda sweaty, but able to tell us the chain of events that led to our meeting, along with niceties such as his allergies, medications, and previous medical history. Oh, yes: with a solitary stab wound in his chest, just left of center, and around 4-6 cm removed from his sternal margin. (Yep, that means just what you suspect that it means).

We packed him up, after Doug, thinking ahead, had laid out the MAST trousers on the cot.

So, back in the mists of time, shortly after the demise of the horse drawn ambulance (I kid! I kid!), there was this tool, based upon the fighter pilot’s “G Suit”, called the Medical Ant Shock Trousers, or MAST Trousers (Yep, that does, indeed, stand for “Medical Anti Shock Trousers Trousers”. Go figure.) The principle was thought to be that, when you inflated bladders in the legs, and overlying the lower abdomen, you would increase venous resistance, and thereby minimize the amount of blood remaining in the lower extremities, and thereby increase venous blood return to the heart. Since that would increase pre load, and preload is one component of cardiac output, the thinking was that, if we could increase preload, we could increase cardiac output, and that would increase blood pressure. Generally, within certain limits, increased blood pressure in a trauma/shocky patient is held to be A Good Thing.

We were coding merrily along to TTBTCIDC (For those of you keeping score at home, that would be “The Third Best Trauma Center In Da City”). Mr Stabee and I were having a lovely conversation, after a fashion, until he got really quiet. Concerned, I checked his pulse and breathing, finding a considerably weaker, and faster, pulse than previously, along with diminished rate of respirations.

I hollered to Doug that our new friend was circling the drain, and both more alacrity on his part, as well as a heads up to the receiving facility might be really appreciated.

I wrapped him (the patient, not Doug) up in the MAST trousers, and inflated the bladders. Now, we had a protocol of inflating the bladders to pressure “X”, re- assessing the patient, and then either holding there, or adding more pressure. In the spirit of Spinal Tap’s Derek Smalls, I bypassed the intermediate steps, and inflated the bladders, metaphorically, to 11.

To my surprise, out stabbee awakened, and began to converse, asking “What happened?”I obtained a new set of vitals, and wrote them down, as we stopped at TTBTCIDC.

We trotted our friend to the trauma room, and, as I wheeled the cot out of the room, I heard the physician order, “Take those things off of him, now!”

I started to offer our valves and suchlike, in order to wean the pressure off of the bladders, rather than precipitously deflating them, but the sound of ripping velcro was my reply.

Shortly afterward, the code was called, and everybody who had not crowded into the room, now entered.

Before we were done cleaning up the truck and restocking our medic bag, the code had been called. Unsuccessfully.

Things you learn in your early jobs….

Before I was a medic, full of derring do and beating back the scourge of death and disease, I was an orderly at Da City General Hospital. There, I shuffled bedpans, obtained vital signs and generally attempted to do all the routine stuff that did not require the skills nor education of a nurse. I learned a lot, particularly among those things that I learned, was that I did NOT desire to become a floor nurse on a med surg floor.

One day, I was gathering the vitals on our guests, working my way through the wards. One particular gentleman had recovered, sort of, from a stratospherically elevated fever. In most regards, he was on track to recuperation, although the fever had done malign things to his brain. He appeared to have a rudimentary understanding of his surroundings, and did not engage in conversation. We were feeding him each of his meals, although he had (re)mastered chewing and swallowing.

So, bright and early, before my coffee had had the opportunity to effect therapeutic caffeine levels (in my bloodstream, that is), I was bent over at his bedside, both siderails up and secured. For some reason, I was having difficulty establishing his BP, and went through several retries.

On one of them, I had failed to note that he had scooted himself over to the rail, rolled onto his right side, and introduced his penis through the slats of the siderail. That, of course, placed me downrange of the volley of urine he was about to produce.

It is never good to be downrange when that range is hot. I received quite the baptism, and reacted smoothly, suavely, and effectively: I cursed, and attempted to leap, from a standing start, over the bed. Didn’t work, but the other patients in the ward certainly found it amusing.

Later on, on a night shift, I was working on the orthopedic floor, and the nurse requested that I provide a suppository of one sort of medication or another, to one of our male patients. Sure, no prob. She bade me pause, before I left the nurse’s station to administer this to the patient, and asked me, “So, Mr. McFee, how are you going to do this?”

I recited, “I’ll inform the patient that this is the suppository of (whatever it was) that your doctor ordered, and the nurse handed to me, so if you would be so kind as lay on your left side, I will lubricate it, and, with my gloved finger, insert it into your rectum.”

She paused. “You missed a step.”

Huh? “Uh, what step would that be, ma’am?”

“You did not include removing the suppository from it’s foil wrapping.”

Huh? “Uh, OK, ma’am, I’ll be sure to remove the foil from the suppository, before I administer it.”

Another Winter Tale

One night at Medic 7, Doug and I were whiling away the hours. For this house, in this city, it was a slow night. On the other hand, it WAS winter, and it WAS snowing it’s ass off. I was finishing my Nursing school studies for the next day’s class, and Doug was reading the book he had brought along for slack times.

We caught a run, and off we went. As we headed east on Warren, we noticed a young woman walking back and forth in front of our fire house. Strikingly enough, she was not dressed for the weather. The heels alone presented a slip-and-fall hazard, and that is not mentioning the short skirt she was wearing.

When we had completed that batch of runs, we returned to quarters. The lap walking woman was still there, and had walked a clear circuit in front of the engine doors.

Hours later, another run, same woman parading in front of the house.

Returned an hour or two later, and there she was, still walking circles on the sidewalk.

She was gone when we caught our next run in the wee hours of pre-dawn. I mentioned her departure to Doug. He, being more wise in the ways of the street than I, opined, “Likely, it took her that long to make her quota, so her pimp would let her back indoors!

“Hey, look! I’m fine!”

Winter in Da City is a special time. The snow, late enough in the season, covers up the litter in the gutters, the layabouts tend to lay about indoors, and generally you can almost convince yourself, if you squint just so, that there is hope for, and in, Da City.

And, then you meet people. Kind of an occupational hazard of being a medic for Da City’ fire department. Most of us held to the TRUTH! Of the aphorism that “sick people suck”. Daily (or nightly- kinda depends on your shift, amirite?) we encountered folks who, well, sucked. Both as people, and at life. Because, after all, the lottery winners infrequently phoned 911 to regale our dispatchers with tales of wonderfulness. Face it: nobody calls the fire department, to gush about he/she just now met The Love Of Their Life, and how this soul brought sunshine into their every day.

So, with that thought in mind, TINS©, TIWFDASL© one lovely wintry afternoon and we (Doug and I) caught a run for a man with a broken leg. Arriving on the scene, we noted the usual choreography of the “He’s In Here!” dance, oh so very popular in Da City.

We entered to find a gentleman on the sofa, ethanol fumes emanating from his every pore. One of the (more) sober bystanders informed us that our guest had fallen while shoveling snow, and broken his leg. I turned to the named patient, and he obligingly illustrated the point by waving his (no shit, notable from across the room, articulated in an unnatural spot between his knee and ankle) leg in the air, declaiming, “Hey! Look! I’m fine! There’s nothing wrong!”

As you may have already surmised, he likely had already been well anesthetized. Then, there was the question: if he broke the shit out of his leg, as he manifestly had, how, and why, had he made his way into the house? And, what parts of this tale remained untold?

I attempted to orient him to current events. “Uh, sir? It sure appears like you have broken your leg. We would very much like to take you to the hospital, to get that fixed up for you!”

“Naw, I’m fine!” was the reply, accompanied by more broke-the-shit-out-of-it leg waggling.

The citizens on the scene were ever so helpful. Or, not so much. They contributed, “He broke his laig! Y’all cain’t leab him here!”

Thank you, Dr. Schweitzer, for your orthopedic consultation. Certainly gonna have to factor that into our clinical decision making!

I looked at Doug, and he looked at me. He handed me the handie talkie, and went to the ambulance to retrieve the cot and assorted helpful goodies. I attempted to elicit something along the lines of allergies, medication and medical history information, figuring that sort of information would be kind of mission critical to our friends in anesthesia. I was certain that a tour of the OR in the presence of the orthopedist was in his future. Oh, and vitals. Vitals would be nice.

Once Doug returned, and I noticed that he had preplanned the upcoming goat rope, including a long backboard, backboard straps, and plenty of roller gauze.

We approached out new friend, and pinned him to the sofa. Doug bandaged his arms…yeah, THAT’S the ticket! Bandaged, not restrained! Once he was hindered from “lending a hand” to the festivities, well, we rolled him onto the spine board, secured him with straps, and, laying a nice wide rigid splint between his legs, secured bandaged them as well.

The foregoing accomplished a couple of things. First, he quit flapping that grotesquely fractured leg around. Secondly, he was a considerably more stable package to carry out to the rig. Finally, all the citizenry was placated by how thoroughly their friend had been splinted. Everybody won!

Once we arrived at TSBTCIDC, and debussed Mr. Leg Fracture, well, the nursing staff couldn’t help but unsecure him, since they simply HAD to evaluate the fracture. That set off an entirely new round of protestations that he, the patient, “was just fine!”, accompanied, again, with the semaphore wig-wagging of the demonstrably unfine fractured leg.

Cool story. I finished my trip sheet, and completed and signed a “Petition for Involuntary Hospitalization”, citing my new friend’s manifest unconcern for a clearly broken leg, documenting his inability to comprehend his need for hospitalization.

All in a day’s work!