basric

Welcome to week three

PROMPT: CORPORLITE
Middle-age Crisis versus Granny Raptor

John stood with three high school friends in the center of the rock quarry. Twenty years and 25 pounds ago they’d scaled the rock sides finding hand and foot holes as they went, no gear back then, just hands and feet. As they reached the top they’d heft themselves over, run to the back of the quarry and jump a hundred feet into the icy quarry lake below—good times.

Now the quarry lake was gone to evaporation or re-absorption into the earth and erosion had filed away the handholds.

He’d added twenty-five pounds and yes, he wasn’t a kid any more, but by damn he could climb the gravel heap to the top. His friends, two who were now fifty pounds over-weight and his single friend who was still athletic marched toward the heap -- a hundred feet of loose rock piled against one granite wall. . .his wife called out for him not to be a a damn fool, when she said he was getting a little paunch she meant he needed the gym not do some idiotic stunt. It just made him even more determined. He shot the wives a dirty look when his friend Tom's wife yelled out asking if his life insurance was paid up to date then laughed hysterically.

At the base the four look up, up, up. “Are we sure about this?”

“Well I am,” and John began his ascent. The others followed. A third of the way up two of the most over-weight gave up and slid back to the granite floor. John and Dave kept climbing. John felt a rush of adrenaline as he neared the top. . .he’d show his wife, he reached for the grassy top to pull himself up and over, thinking he was going to lay and look at the sky until his wife drove up here and got him.

He didn’t have it in him to make it back down. It was hard to breath and his heart was trying to escape from his chest. Unfortunately the grassy edge crumbled beneath his fingertips and he felt his footing slip and he started the terrifying slide a hundred feet down the mountain of crushed granite rock.

Paul made a grab for him but missed.

Though it happened in seconds, it seemed forever for John since he felt every tiny shard of granite embed itself beneath his skin. About halfway down he tumbled over on his back, so now the shards had new soft points of tissue to enter. He covered his face and prayed.

John would have ended with a granite rash and embedded rock and a trip to the an E R., but when his feet hit the granite floor he flipped in the air and landed with great force backwards his head thrown back the single little sapling that had taken root in the quarry, broke up his fall and now a stake of sapling trunk impaled him to the ground in the right side of his neck.

As LifeFlight took off to retrieve John, things in trauma were prepared.

My wonderful boss, who hires people for reasons known only to herself, hired a seventy-two year old nurse. She was VERY old school. She still wore her white dress, white hose, white nursing shoes (no cross trainers for her) and even her nursing cap. She refused to wear the black and gold of the unit. She was rigid, did not approve of change of the last fifty years or any manner in which the Trauma unit was run. She didn’t walk—she shuffled bent over.

My beloved boss put her on the regular trauma floor—patients start in Triage, surgery, ICU Step Down then end on the Trauma floor before going home. We are self-contained department, so you reach each unit by making the huge circular floor. She had been told when things were slow for her she could lend a hand elsewhere.

Tonight in triage I have three externs (the nursing equivalent to interns) the clinical part of their Master Degrees. Our head resident tonight was a very competent Asian doctor, Dr. P. We were gowned and ready. I reminded my girls they did not touch unless the resident or I instructed them specifically.

John was brought in, leaves still dangling from his sapling. He was conscious and talking. His clothing was bloody, we cut everything away. Paula came to assist placed the Foley catheter and instructed the externs on how to remove the shards, drop into the metal bowl irrigate, pat dry and if no bleeders, spray the antiseptic and use the hospital superglue to pull the gashes together then steri-strip them (special short pre-cut strips of tape). If they find a bleeder let the resident know. There were dozens of shards to be removed.

I assisted with intubation and sedated the patient, while the resident, reluctant to put a Central line in his left subclavian, because of the position of the aorta, placed a PICC line (peripheral intravenous catheter) in his left Brachial vein in his upper left arm.

Into the midst walks let’s call her “Granny Raptor”.

“Gown or get out, you are going to contaminate the sterile field.

Dr.P. and I trimmed the stake through his neck while trying to keep it stable. He had arrived with a neck cushion holding his head back and secure. (FYI if you are attacked by some knife wielding lunatic throw your head back. This moves the carotid arteries and jugular veins on both side of the neck back, this is why assassins pull the neck forward, they can use a thin stiletto and make a quick kill.)

When John fell back—-he was very lucky. No severe bleeding just capillary blood from the puncture, the sapling either missed the vessels or scraped into them and were keeping them sealed. I registered the oohs and ahs of the externs as they removed this or that sliver of stone. Then the surprised "OH" when the glue worked.

“Granny” looked him over and said, “Waste of your time, he’s as good as dead.” My externs gasped. I exchanged looks with my resident and Paula, thought of her age and swallowed the scalding set down she deserved, “If you want to be helpful go and assist Paula and the girls.

Granny, “Don’t believe in this newfangled glue crap, stitches are what he needs."

I heard my very patient friend Paula’s rarely frustrated voice, “JUST DO WHAT YOU’RE TOLD OR GET OUT.”

I assume she did as told since there was silence. We finished stabilizing the impalement and had the charge nurse call surgery to come get him. “You have fifteen minutes to finish."

One of the externs found a bleeder between his toes and the resident moved to clamp it.

This is about the time “granny” found the hemostat (clamp) on his inner thigh and as she unclamped it said, “What’s this doing here?”

Ever seen a garden hose on full blast dropped—-watched it rise like a snake and spray everyone with water in a whipping circular pattern. That hemostat was clamped on the femoral artery in the field—-forgotten to be noted to us in report by the EMT. About six inches of the vessel was exposed and I’d say the lumen (Hole, tube, inside the vessel) was wide open for the artery rose up like an angry cobra, all six inches and had made at least four circular wide open sprays of blood around the room spattering everyone and everything within reach including walls and the ceiling -- with probably two pints of bright blue/red arterial blood (oxygenated). De-oxygenated blood (venous) is red.

I'd heard Paula yell "Duck" and the three externs went down to the floor with Paula saving them from most of a blood shower.

Still being painted with blood, I handed the resident a clean pair of goggles and a sterile hemostat, John lost another pint while Dr.P. struggled to grasp the whipping vessel and clamp it without destroying the integrity of the vessel. I had a bag of O negative blood hung by then (Universal donor is O-).

Dr.P. removed his goggles, looked at Granny and said in a deceptively mild voice, “Please leave my triage."

She sniffed and huffed and remarked she knew more about medicine before his daddy was an itch in his granddaddy’s pants. I believe the word whippersnapper was used but I'm not certain.

Dr.P. looked at me, “I have been raised to honor my elders . . . but must admit that
woman. . . even my mother would have a difficult time with respect.”

Paula tossed her bloody debris in the trash, “She's dangerous.”

“But that was some fancy moves capturing that artery without shredding it." He bowed to us and retreated to the doctor’s lounge.

We hurried to wash away the blood and change the sheet before the techs arrived to take him to surgery.

I walked the family down to the surgical waiting room, where his wife told me how this started and ended.

“He’s entering that middle-aged crazy stage. I hope this cured him.”

Back in trauma I found “Granny” regaling tales of the horrors of nursing to my young, wide-eyed externs.

She shuffled out to go back to her patients with a nasty look sent my way.

“WOW! She really knows stuff. Fifty years! What do you think of her?”

Taking a sip of coffee I opened the door and looked back at them, “I think she’s one of the last of the nursing dinosaurs edging toward extinction, medicine is about change -- daily, hourly, by the minute, the second and I think she’s prehistoric in her thinking of our purpose in nursing. I think she’s full of coprolite.

“What’s that?

“Look it up.”

The accident is my fictional account based on facts told by his wife.

The final word, our prompt, I am ashamed to say was not in my vocabulary, but the word I actually used was.

I used the prompt instead of something metaphorically because I like to use new words. I wish I’d known it then.

John survived for those who wondered. “Granny” moved the medical floor.

Names were changed and even the Dr.’s initial to protect the innocent and not so innocent except my friend and cohort Paula and she gave me permission.