Emergency! (11 page)

Her blood pressure suddenly began to drop, so I ordered X rays. They revealed a tree branch lodged diagonally through her torso. The surgeon later told me what he had found. The branch had entered her left flank, caught her spleen, punctured her diaphragm, and was pushing on her right chest wall.

She was right. Prior to that jump, she didn't have no bump on her side.

KENNETH A. WALLACE III, M.D.

Detroit, Michigan
                

O
ne night while I was working in a trauma center in Detroit, paramedics brought in a young man who had been hit in the head with a pipe. He looked dazed and smelled as though incontinent of stool. We undressed him, and our eyes confirmed what our noses had suspected. We were surprised to find a car key in the stool in his shorts. We asked him how this key had happened to find its way to such an unlikely location. He replied, “They were trying to steal my car, so I put my key down there and shit myself. That's when they hit me in the head.”

Commending him on both his quick thinking and his ability to defecate at will, we agreed that without a good cup of coffee and a newspaper
we
would be pedestrians.

CHRIS PFAENDTNER, M.D.

Janesville, Wisconsin
    

I
t was a busy afternoon at the Emergency Department, Saint Mary's Hospital, Knoxville, Tennessee. The department doors opened and a pretty and prim young lady walked up to the reception desk. The receptionist, as was her custom, not looking at the patient asked:

“Name”—and typed.

“Address”—and typed.

“Zip code”—and typed.

“Phone”—and typed.

“Religion”—and typed.

“Sex”—(no answer) …

“SEX”—(no answer) …

“SEX”—(pause) …

Finally, the young lady said, “Well, if it's any of your business—two times in Chattanooga.”

A. L. JENKINS, M.D.
    

Knoxville, Tennessee

T
he request has come from hospital administration. The gift foundation is planning a fund-raising event for the emergency room. They need some heartwarming ER nursing stories to share at the program. Sounds easy. I've been here a long time. I've kept a journal of my experiences. I'll just flip through and pull out some good ones.

Heartwarming stories from the ER. I search. I read. I'm stunned. I can't find any.

There are scores of stories in the ER every day—heartbreaking, heart numbing, heart tickling, heart stopping—but heartwarming? Not really, not the warm fuzzy kind. It's scary. Have I become so cynical that I can't see anything warm in my work?

I read them again, seeing them as they are. I cry. I laugh. All my memories and the feelings they revive begin to warm my heart.

It feels good.

Here are some of the stories I found.

A
bout the best feeling I have is when we get a “save.” A guy walks in—obvious heart attack. Pale. Clammy. Chest pain. Looks bad.

The team kicks in. Get him in bed. Heart monitor on. Get vital signs. Start the IV, oxygen. Get a second IV. Blood for labs.

We're working on both sides of the bed when I hear a funny breath. I glance up at the patient. He's fading. Glance up at the monitor. He's in VTach.

No chance to speak, just react—
thump!
Hit him in the sternum.

Glance at the monitor. He's converted. Regular rhythm restored. Breathing goes back to normal.

We look at each other across the bed. Surprise. Relief. Success!

I look at the patient. There's confusion on his face. “Hey, are you OK? Sorry I had to hit you.”

And back we go. Start the meds. Call the cardiologist. Get an EKG. This guy got here just in time! Yeah, team!

It's not always like that.

Sometimes someone comes in talking to you and then just dies. You're doing the same things. You hear the funny breath that tells you the breathing is stopping. You react, do all the right things, and he dies anyway.

It's harder then. Different than when someone comes in dead or near dead. More personal.

You always hear the same comment, “He was just talking to me!”

Maybe he was just hanging on till he got someplace where he felt safe enough to let go.

When someone comes in with resuscitation in full swing, we usually just jump in, do a job. We don't think of the person—at least not till later, when we face the family's grief.

I
t was a week before Christmas during the coldest spell we'd had in years. Three little brothers, ages one to four, were brought in by the sheriff. They'd been alone in their unheated house for possibly five days. Their dad was in jail, and Mom was who knows where.

The oldest one, a chatty kid, said they hadn't eaten for at least two days. The baby's wet feet were white with cold. The middle brother's feet stank so bad when we took off his shoes that I felt nauseated. I wondered what their lives had been like during that cold December week. We hustled those boys into a warm bath.

A message was sent to the kitchen that we needed food for three kids who hadn't eaten in days. Usually it takes thirty to forty minutes to get a food tray from the kitchen. This time, in less than five minutes, three ladies personally delivered food to the room.

The four-year-old gobbled it down. Baby brother cuddled up with his bottle. The three-year-old just fell asleep after his bath. I called a friend with kids near their ages and asked for some hand-me-downs. She hurried right over with clean clothes for all.

Charting our treatments for them brought tears to my eyes. The treatments were so simple, something every kid deserves. Heat. Nourishment. Hygiene.

But the warm fuzzies end there. The deputy came back later in the week to tell us Mom was in jail and the brothers were placed, separately, in foster homes. They'd stuck it out for a cold lonely week but they wouldn't be together at Christmas.

S
ometimes our duties extend beyond life.

We have just completed a Code Blue, a resuscitation attempt on a youthful senior citizen.

It was a futile effort. We knew that when we started.

She was the innocent victim of a drunk driver.

She'd been hit and dragged. The sheriff said sixty feet. Her injuries were indescribable.

Even trauma-hardened ER personnel were disturbed by the violence inflicted on her body.

Now I look at her still form and think of her husband sitting in the small waiting room reserved for grieving families. He'll probably want to see her. We usually encourage a family to see their loved one before the body is permanently altered by the neat perfection of the embalmer. It helps bring home the reality; helps start the grieving process.

But this time I'm not sure. We can cover her body, but her face …

Bouncing under the car has ripped her scalp open. The tissue covering her forehead has been split apart, exposing her glistening skull.

We begin to clean up the room, to clear the evidence of the struggle for life.

I leave for a few minutes to attend to some other patients. When I return, I observe a miracle in progress.

The nurse in the room has carefully cleaned this woman's head and is using clear tape to gently pull her face together. I am amazed at the difference. She has been changed from an unrecognizable form to an identifiably attractive woman. A simple towel turban to hide her wounds completes the transformation. Her elegantly manicured hand is placed casually on top of the sheet.

Now the grieving husband is able to face her. He probably will always carry the memories of this room, of this moment.

But at least in his memories he will recognize his wife.

I
t's 7
A.M.
, a new shift. Not even time for coffee before the radio alarms. Auto accident. Two kids headed for home two hours away. Their truck flipped off a bridge into a wash. Now they're on a detour to the ER.

He looks worse than she does, an obvious candidate for a few days in the ICU.

She doesn't look too bad. She's awake, knows what's happening. She moves her arms and legs. She says her neck is sore.

She lies patiently, her body immobilized on a hard board, waiting for X rays.

I call her mom and dad.

How do you tell parents two hours away that their daughter's been in an accident? You want to convey calm without lying about the seriousness of the situation. And you know nobody's calm after a call from the ER.

I tell mom she looks pretty good initially, a few aches and pains but we're just getting started, no X rays yet.

Parents are on their way.

Neck X rays are completed first. The radiology report's negative, so off come the cervical restraints. I check her over again and find a couple of new aches. Back she goes to X-ray to find a fractured knee and shoulder.

Her neck is still hurting. I feel uneasy. The X rays have been checked by the doctor, she has no numbness, no tingling, no loss of movement, but I have this nagging voice mumbling deep inside.

She asks for a pillow. The nagging voice sputters. I compromise with a small folded towel behind her head. Five minutes later she tells me her hand is tingling. The voice inside me explodes with an accusation! Why didn't you listen to me!

My calm exterior remains. I slide the towel out and grab the doctor. We reimmobilize her neck.

The films go back to the radiologist with the new symptoms. Another look shows a break in her second cervical vertebrae. Nerves to her entire body pass through this bone. Nerves that control breathing, movement, feeling. Nerves that control her present and future.

Inside I am screaming. Outside I am calm.

Without the towel, the tingling is gone. Relief! Sensation and movement are normal. Whew!

Mom and Dad arrive.

I have good news and bad news. Your daughter's alive—but she has a broken neck. Your daughter's not paralyzed—but she has to wear a brace screwed into her head for the next few months.

Inside, I am drained. I'll remember this girl forever. Daily in this job I see the frailty of life. Today I am slapped in the face with it.

I wheel her to her hospital room. I stay with her while the neurosurgeon places the head screws.

She is great, very brave. She thanks me for my care. Sends me flowers. Promises to keep in touch.

That night I don't sleep well, haunted by what might have been.

H
e looks about fourteen or fifteen. It's hard to tell with the animation missing from his face. One thing is sure—he'll never be any older.

We know him only as John Doe. We need to find his real name. We look for a wallet, a card with a phone number—hopefully an address.

All we find are three pictures—yearbook photos of pretty girls. There's writing on the back of two: “Luv ya always” and “To Spanky, Love, Maria.” It's a start at least.