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WEEK 14 LJIDOL "CRACK"
WARNING: NOT FOR THE SQUEAMISH--MEDICAL STUFF though I've really toned descriptions down it still may upset some readers.
What makes a good, true friend? Someone who is there when you don’t realize you need them. I am so lucky that I have five such people in my life especially since I really do not like most people. They get on my nerves; make me furious with their behavior towards others and themselves.
Family and my friends (those I love) are not considered “PEOPLE.”
A note here that I never look at a patient as “a PEOPLE.” They touch a current deep in me. I tolerate their misbehavior.
As I have said before we wear black scrubs with a gold tee beneath. My friend Paula had a few shirts made for me with “DOES NOT PLAY WELL WITH OTHERS”, “I HAVE NO TOLERANCE FOR LAZINESS, DO YOUR JOB” and “THEY ARE PEOPLE NOT FILE FOLDERS.” She said it was because I always said these things at least ten times every night.
It was a Friday night we’d been that terrible word ‘Quiet’. This is always scary. It usually meant we’d get slammed. Also the Trauma Attending was in house to assess his residents-- their rotation almost over.
It started with a man and woman brought in together. According to the policeman the husband came home drunk, didn’t like his dinner and beat the hell out of his wife. As she lay bleeding on the floor he sat and ate that same dinner. She struggled to her feet and with all her strength slammed an iron skillet on the back of his head cracking it open like an egg, (this she told us later). She had broken bones and lacerations. He ruptured her spleen and she almost bled to death before we got her to surgery.
His skull was crushed; there was a lot of blood, lots of capillaries so lots of blood around the skull, bone and brain matter. The residents worked furiously but we lost him.
We heard LifeFlight take off. Still after all these years that always gives me a shot of adrenaline. The whomp, whomp, whomp of the blades slicing air.
They radioed back from a three car MVA (moving vehicle accident). One causality (no seat belt-ejected head first into a tree. Tree versus human skull--tree wins every time, two would go to the E.R. and one to us. A forty year old male with a crushing chest wound.
While we wait for the arrival: A side bar here that Trauma loses millions each year. We are never in the black. Foundations and donations keep it open. But we never have to worry about being shut down because the University must have a trauma unit to have a medical school. And at $40,000 a semester not counting dorms and books with students coming from all over the world they’re not about to shut the medical school down.
LifeFlight touched down outside and spilled out its contents of paramedics and the patient on a gurney.
He was in too critical to move, and as soon as we cut his clothes away the Attending took over yelling for the charge to get a CT Surgeon up here, NOW. (CT=Cardio-Thoracic).
He put in a central line and intubated him. We were losing him, his heart stopped beating but due to his injuries we could not do chest compressions. The surgeon was there. Being one of the more modern guys he opened skin and muscle over the wound and instead of sawing the sternum (chest plate) in half he clipped the ribs and took the bone out, placed it in ice then used the rib spreader.
Somehow I found myself lifted and straddling the patient at his orders with a hand full of hemostats. I immediately began clamping veins and arteries. One nurse had a bag of blood and was squeezing one bag after the other through the line into the patient as quickly as she could.
Dr. CT looked at me took my gloved hands and put them where he wanted them around the heart.
“You’ve done it in the field. Left thumb, left palm, right palm, left thumb--this much pressure each time. That’s it. Continuous, don’t stop.”
I found myself in this position because the patient was on a gurney and I was the only one who fit around him. Having long legs made it easy to straddle him my knees pressed into his side resting against the hard cold metal of the gurney‘s edge.
The night manager came screeching into triage that I couldn’t do that. Then Dr. CT had to go and tell her that I was a licensed P.A. so I could. It was something I had for the U. S. Trauma Team not something I did for the hospital. She stood with her mouth open.
Time slowed; my world existed in thumb, palm, palm, thumb. Apparently he stabilized enough; for a sterile sheet was thrown over covering me, the patient and David the respiratory therapist using the AMBU BAG to send oxygen to the man’s lungs.
We were moving, stopped and turned into an elevator. I registered the door whisked close. Thumb, palm, palm, thumb. I felt sweat trickle between my breasts, heard the whoosh of the oxygen in- out, in-out, and the voices of Dr. CT speaking with his residents who had joined us in trauma.
After what was probably thirty seconds--a long time when you count it out--go ahead, I’ll wait. One Mississippi, two Mississippi...I knew we were on eleven going to the second floor but really?
“Dr. CT?”
“Barbra, you alright?”
“Is the elevator moving?”
"Did none of you push the damn button. PUSH IT!"
There was swearing and shuffling and we began to move. My eyes met David’s and rolled he smirked. I just was thinking blood in through the big vein the Superior Vena Cava into the atrium, pacemaker not firing, my thumb THE PACEMAKER--pushing blood into the ventricle through the valve into the lung to oxygenate through the mitral valve into right ventricle-palm, through the valve into the atrium and thumb out through the major artery--the aorta. Thumb, palm, palm, thumb. It was like massaging a large chunk of beef. “God,” I thought, “Please don’t let me damage his coronary arteries" that lay on top of the heart--though I guessed he’d have to have a by-pass anyway.
I heard the swish of giant automated doors and felt the burst of cold air from the surgical suites. There were lots of noise, lots of voices, things clattering, and then the sheet was gone.
“Get ready to connect to by-pass, steady, steady. . .AND NOW. The sheet was gone and I released the heart and was lifted off and to the floor. The male nurse held me upright, my legs shaking from the abuse; then assisted me outside the automatic doors to the bench against the wall.
I don’t know how long I sat there, my hands continuing their massage on a heart no longer there. Then Paula was there; my little five foot friend helped me up and led me to the elevator.
“Let’s go get some air.”
We went out into the plaza and sat on a bench. A few moments later my friend Patsy who worked NICU with newborns and France a med/surg nurse joined me. Paula had been busy.
They gathered close about me, Patsy took one hand, Paula the other and pressed fingers flat and massaged my hands. I suddenly realized they were cramping. And my knees hurt. I was feeling again. France hugged me from behind. Just held me and whispered comfort words.
No one asked if I was okay or any of those other ridiculous, redundant things people tend to ask and say at such times. They were just there for me. When I WAS okay I hugged each one and went back to finish my shift. I am not a hugger.
All night long I caught myself going through the motions with my hands. I could FEEL the heart.
So three cracks in one night. . .a cracked skull, a chest cracked and I nearly cracked up.
It was mentioned to me that since I tend to use names and situations I should make a disclaimer to protect myself. Here it is--Any resemblance to any person, place or thing is a coincidence. Nashville, Tennessee is a made up city, Vanderbilt University and Vanderbilt University Medical Center are just my fantasy world. If you think you recognize yourself or the situation it isn’t you, AND I am not a nurse I am an space traveler. . .Beam me up, Scottie.
Maybe I've been watching too much SGA.
What makes a good, true friend? Someone who is there when you don’t realize you need them. I am so lucky that I have five such people in my life especially since I really do not like most people. They get on my nerves; make me furious with their behavior towards others and themselves.
Family and my friends (those I love) are not considered “PEOPLE.”
A note here that I never look at a patient as “a PEOPLE.” They touch a current deep in me. I tolerate their misbehavior.
As I have said before we wear black scrubs with a gold tee beneath. My friend Paula had a few shirts made for me with “DOES NOT PLAY WELL WITH OTHERS”, “I HAVE NO TOLERANCE FOR LAZINESS, DO YOUR JOB” and “THEY ARE PEOPLE NOT FILE FOLDERS.” She said it was because I always said these things at least ten times every night.
It started with a man and woman brought in together. According to the policeman the husband came home drunk, didn’t like his dinner and beat the hell out of his wife. As she lay bleeding on the floor he sat and ate that same dinner. She struggled to her feet and with all her strength slammed an iron skillet on the back of his head cracking it open like an egg, (this she told us later). She had broken bones and lacerations. He ruptured her spleen and she almost bled to death before we got her to surgery.
His skull was crushed; there was a lot of blood, lots of capillaries so lots of blood around the skull, bone and brain matter. The residents worked furiously but we lost him.
We heard LifeFlight take off. Still after all these years that always gives me a shot of adrenaline. The whomp, whomp, whomp of the blades slicing air.
They radioed back from a three car MVA (moving vehicle accident). One causality (no seat belt-ejected head first into a tree. Tree versus human skull--tree wins every time, two would go to the E.R. and one to us. A forty year old male with a crushing chest wound.
While we wait for the arrival: A side bar here that Trauma loses millions each year. We are never in the black. Foundations and donations keep it open. But we never have to worry about being shut down because the University must have a trauma unit to have a medical school. And at $40,000 a semester not counting dorms and books with students coming from all over the world they’re not about to shut the medical school down.
LifeFlight touched down outside and spilled out its contents of paramedics and the patient on a gurney.
He was in too critical to move, and as soon as we cut his clothes away the Attending took over yelling for the charge to get a CT Surgeon up here, NOW. (CT=Cardio-Thoracic).
He put in a central line and intubated him. We were losing him, his heart stopped beating but due to his injuries we could not do chest compressions. The surgeon was there. Being one of the more modern guys he opened skin and muscle over the wound and instead of sawing the sternum (chest plate) in half he clipped the ribs and took the bone out, placed it in ice then used the rib spreader.
Somehow I found myself lifted and straddling the patient at his orders with a hand full of hemostats. I immediately began clamping veins and arteries. One nurse had a bag of blood and was squeezing one bag after the other through the line into the patient as quickly as she could.
Dr. CT looked at me took my gloved hands and put them where he wanted them around the heart.
“You’ve done it in the field. Left thumb, left palm, right palm, left thumb--this much pressure each time. That’s it. Continuous, don’t stop.”
I found myself in this position because the patient was on a gurney and I was the only one who fit around him. Having long legs made it easy to straddle him my knees pressed into his side resting against the hard cold metal of the gurney‘s edge.
The night manager came screeching into triage that I couldn’t do that. Then Dr. CT had to go and tell her that I was a licensed P.A. so I could. It was something I had for the U. S. Trauma Team not something I did for the hospital. She stood with her mouth open.
Time slowed; my world existed in thumb, palm, palm, thumb. Apparently he stabilized enough; for a sterile sheet was thrown over covering me, the patient and David the respiratory therapist using the AMBU BAG to send oxygen to the man’s lungs.
We were moving, stopped and turned into an elevator. I registered the door whisked close. Thumb, palm, palm, thumb. I felt sweat trickle between my breasts, heard the whoosh of the oxygen in- out, in-out, and the voices of Dr. CT speaking with his residents who had joined us in trauma.
After what was probably thirty seconds--a long time when you count it out--go ahead, I’ll wait. One Mississippi, two Mississippi...I knew we were on eleven going to the second floor but really?
“Dr. CT?”
“Barbra, you alright?”
“Is the elevator moving?”
"Did none of you push the damn button. PUSH IT!"
There was swearing and shuffling and we began to move. My eyes met David’s and rolled he smirked. I just was thinking blood in through the big vein the Superior Vena Cava into the atrium, pacemaker not firing, my thumb THE PACEMAKER--pushing blood into the ventricle through the valve into the lung to oxygenate through the mitral valve into right ventricle-palm, through the valve into the atrium and thumb out through the major artery--the aorta. Thumb, palm, palm, thumb. It was like massaging a large chunk of beef. “God,” I thought, “Please don’t let me damage his coronary arteries" that lay on top of the heart--though I guessed he’d have to have a by-pass anyway.
I heard the swish of giant automated doors and felt the burst of cold air from the surgical suites. There were lots of noise, lots of voices, things clattering, and then the sheet was gone.
“Get ready to connect to by-pass, steady, steady. . .AND NOW. The sheet was gone and I released the heart and was lifted off and to the floor. The male nurse held me upright, my legs shaking from the abuse; then assisted me outside the automatic doors to the bench against the wall.
I don’t know how long I sat there, my hands continuing their massage on a heart no longer there. Then Paula was there; my little five foot friend helped me up and led me to the elevator.
“Let’s go get some air.”
We went out into the plaza and sat on a bench. A few moments later my friend Patsy who worked NICU with newborns and France a med/surg nurse joined me. Paula had been busy.
They gathered close about me, Patsy took one hand, Paula the other and pressed fingers flat and massaged my hands. I suddenly realized they were cramping. And my knees hurt. I was feeling again. France hugged me from behind. Just held me and whispered comfort words.
No one asked if I was okay or any of those other ridiculous, redundant things people tend to ask and say at such times. They were just there for me. When I WAS okay I hugged each one and went back to finish my shift. I am not a hugger.
All night long I caught myself going through the motions with my hands. I could FEEL the heart.
So three cracks in one night. . .a cracked skull, a chest cracked and I nearly cracked up.
It was mentioned to me that since I tend to use names and situations I should make a disclaimer to protect myself. Here it is--Any resemblance to any person, place or thing is a coincidence. Nashville, Tennessee is a made up city, Vanderbilt University and Vanderbilt University Medical Center are just my fantasy world. If you think you recognize yourself or the situation it isn’t you, AND I am not a nurse I am an space traveler. . .Beam me up, Scottie.
Maybe I've been watching too much SGA.
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