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LJIDOL WEEK 16 "FULL MOON"
Mar. 4th, 2011 08:08 pmA FULL MOON NIGHT IN TRAUMA or BRING ON THE CRAZIES.
(warning: REGULAR MEDICAL TRAUMA STUFF)
It was a warm, summer evening where the sun had dipped below the horizon but the sky was still brightly lit. As I got into my car I looked east and saw the moon had risen--a FULL MOON.
I dug out my cell and called my manager and asked that everyone he put on call to be brought in for the shift. He replied we only had three patients out of 32 beds.
“One, its Friday night, two ninety percent of those on call live over ninety minutes away, three it’s a Full Moon. If we got hit hard I’d have to put us on diversion until the nurses arrived which means LifeFlight is grounded. (We cannot accept admissions, until we get nurses in to care for them). I can always send them home if the night is “quiet” HAHAHAHAHA.
He sighed, "The first night of full moon. The night the sane go wacky and the wacky go wackier and the wackier go bonkers. Okay."
So for the night I would have twelve nurses, two triage and myself. There were three trauma residents.
By eight we were fully staffed. The new night manager was hired for administrative purposes only and she had no say about how the floor was run.
Our three patients were all on respirators, so most of their care was done by the RT. The nurses monitored vital signs and reinforced bandages and gave pain meds.
The sounds as LifeFlight geared up, then the other three--all going out, one after the other to four different locations. No matter how long you’ve been here those sounds release your adrenaline begins.
I helped Paula recheck all the supplies in triage with Rene. We were ready.
First came two victims of a MVA (two cars versus an eighteen wheeler). Patient one presented with a fractured clavicle (collarbone), left femur spiral fracture (the long leg bone), a ruptured spleen and serious internal injuries--he was hard to stabilize but finally, tentatively sent down to surgery. The second man, they were working on had gone up under the back of the truck. He had serious head trauma with brain swelling. A neurosurgeon came up and assisted the resident to drill into the skull to release some of pressure. We hung Mannitol to decrease pressure internally and sent him down for the surgeon to handle.
Next came a GSW to the lower back received while he ran from a convenience store robbery where he shot the guy behind the register. Ended with a shootout with the police. Stabilized even though hand-cuffed to the stretcher and sent to surgery.
They called from surgery and rushed back with patient number one. Could not save him, too much damage, the patient was probably brain dead now his body was catching up. Unlike shows like “Grey’s Anatomy” (which I like) patients (if possible) are not allowed to die in surgery. If the surgeon sees they cannot save them they bring them to the floor to die.
This is done so surgery insurance costs stay down.
Next we had four young people around nineteen and twenty who were drinking and missed a curve then hit a tree. None wore seat belts. As they were being stabilized; the driver with crushing chest wounds; the others traumatic head wounds as they went through the windshield.
Both LifeFlights on the pads whirred to life again.
A frequent flyer was brought in next, let’s call him John. John is a psyche patient who goes off his meds and decides to kill himself by walking in front of a small pickup truck on the interstate. This was the fourth time. John is the only person I have ever known that takes 30mg of Valium four times a day. That would kill the average human.
Once I asked him why he didn’t just step in front of a semi instead of a small truck and he told me he wanted to kill himself not be 'splattered'--his words. He had eight fractures this time and a concussion--stabilized and off to surgery.
In the meantime patient two had returned to the floor and was giving the nurse a difficult time. He was the one who cut off the eighteen wheeler then slammed on his brakes and caused the accident. The resident had ordered an NGT (nasogastric tube). Clarice had tried three times to place it, another nurse once and the patient was uncooperative.
I talked with him, he was a big guy about three-hundred pounds, he was belligerent coming out of anesthesia. I measured the length, sprayed Lidocaine up his nose to deaden it and in his throat to deaden the gag reflex and inserted it. Just as I was going to tape it to his nose he reached up and jerked it out, screaming he couldn't stand it.
I went looking for the resident who wrote the order and told him we could not place it. A first year resident informed me that my nurses and I were incompetent. I invited him to show us how to do it. He stalked to the patient and did exactly what I did, only he only got it halfway down before the patient jerked it out; his beefy fist clipped the resident’s chin and hit me in the face.
CRACK.
BLACK.
FUZZY.
I woke in the CT getting a head scan. Everything was okay. The other resident wanted me to go home--I maybe had a mild concussion but I refused and went back to work an hour after the incident.
The first year resident had a bruise on the right side of his face I had two black eyes and a cracked cheekbone. He made a serious mistake of not apologizing to my nurses for his rudeness. You don’t screw with your nurses when you are a resident.
Early Monday morning they come to me to get in depth updates on their patients for Grand Rounds on Monday with the Attending. They can answer all his questions; once they learn to take the time to listen to my report. This guy would have to read the charts and do the best he could from this point forward. (I told you I could be a vengeful bitch).
And the hits just kept on coming; a gangbanger pair with knife wounds had just been brought in and were still trying to get at each other over some girl. Before another of my nurses or docs got clocked I had security brought up until the cops got there.
A woman was brought in from an MVA where some kids on an overpass dropped a rock the size of a football through her windshield. It took almost an hour to stabilize her enough to send to surgery, her prognosis was not optimistic.
Next, we received a patient from a psyche hospital who had jumped through a third floor window after he stabbed another patient with a scalpel????? then jumped through the window we were told. The large print on his chart that came with him weren’t encouraging words--”PATIENT'S SUICIDAL AND HOMICIDAL IDEATIONS HAVE NOT BEEN RESOLVED”.
All he had was a fractured femur and a cracked ankle. He was violent and we read schizophrenic. We had his hands in leather restraints but if you got too close he would pinch you or try to head butt you. Finally, one resident gave him a psychotropic cocktail that should have knocked him out or at least calmed him, but he raged on; he kicked a nurse with his broken leg and screamed in pain.
Finally, the fourth year resident chemically restrained him, and knocked him out. They hate doing that because of the paperwork; but the nurse fills all those out and do the fifteen minute checks; they are just inconvenienced by having to sign it. EYEROLL
Mr. ‘I don’t want an NGT’ coded at four. I won’t take you through a code again, but this time we got him back.
We had a floor filled with screaming mimis by five. Funny thing is the crazier they behave, the harder it is to calm them; the less medication works.
I took four more Advil for my pounding head. Only two hours to go when they brought in a drunken man, 4 times over the legal limit--he had lain on the top of his drunk buddy’s car and “Air Surfed” on the interstate at fifty miles per hour. Friend slammed on brakes; he went three hundred feet over the smaller, slower car in front of them before he slammed into a concrete divider. His injuries consisted of fractured disks in his neck and massive internal bleeding. We lost him--injuries were too severe, though one team worked on him for over an hour.
Meanwhile, they brought in a boy, well twenty-years-old; the woman in the car didn’t see him on the motorcycle beside her and slammed into him knocking the bike over onto him at sixty mph. Left arm and leg were severed, found and brought to us in a cooler. He had road rash over his entire body and gravel deeply embedded in his torn skin. I will spare you the grim details of preparing the stumps for re-attachment and the debridement of gravel along with his torn skin.
Finally, he was off to surgery. The woman who hit him was in the waiting room in hysterics. One of the residents sedated her and admitted her to the medical floor for the night.
Six o'clock and Mr. Homicidal & Suicidal Ideations returned from surgery. First thing, he extubated himself. How? The nurse turned her back, he was after all restrained in leather restraints; but he managed to breathe on his own. He fought the restraints screaming obscenities vying with the drunk two rooms down for loudness. Then he would suddenly lie still and talk to his auditory and visual hallucinations about how they wanted him to kill the nurse taking care of him in great detail. It was very disturbing.
When my manager came in at seven, the motorcycle victim had just returned, they had been able to reattach the arm but not the leg.
We had six screaming patients that medication would not calm. David stopped and stared at me. Over the noise level he yelled, “You get in a fight?”
“Me and Dr. G. had a round with a patient.”
“And the patient?”
“Probably the only one on in TIC-U asleep.”
“Wanna go home? I’m doing charge today. Give me report and go. Should you be here?”
"Well, yeah."
After reviewing every patient, so he could make the staffing assignments, “We only have two empty ICU beds, but I think four can soon be moved to step down. You are fully staffed as of now.”
We both paused and raised our heads at the noise from the pad outside-the whirrrr of multiple blades rising up then their sound receding.
We exchanged a look of understanding. I joined Paula and Rene in the breakroom to collect out things and headed out to I.H.O.P. for wind down and breakfast.
This has just been an average full moon night in Trauma minus the cheek hair-line fracture.
**NOTE: There have been several studies done most agreeing that since the moon affects the tides, that it may also have effects on the fluids in the brain and over-stimulation of glands and increasing hormone production causing erratic behavior. I myself have been working in L & D and seen the delivery suites fill on full moon nights.
***I also wish to apologize if some sentences are short. I am so accustomed to writing in a few words as possible I try to edit and make sure I have a subject and a predicate, but sometimes I miss one.
(warning: REGULAR MEDICAL TRAUMA STUFF)
It was a warm, summer evening where the sun had dipped below the horizon but the sky was still brightly lit. As I got into my car I looked east and saw the moon had risen--a FULL MOON.
I dug out my cell and called my manager and asked that everyone he put on call to be brought in for the shift. He replied we only had three patients out of 32 beds.
“One, its Friday night, two ninety percent of those on call live over ninety minutes away, three it’s a Full Moon. If we got hit hard I’d have to put us on diversion until the nurses arrived which means LifeFlight is grounded. (We cannot accept admissions, until we get nurses in to care for them). I can always send them home if the night is “quiet” HAHAHAHAHA.
He sighed, "The first night of full moon. The night the sane go wacky and the wacky go wackier and the wackier go bonkers. Okay."
So for the night I would have twelve nurses, two triage and myself. There were three trauma residents.
By eight we were fully staffed. The new night manager was hired for administrative purposes only and she had no say about how the floor was run.
Our three patients were all on respirators, so most of their care was done by the RT. The nurses monitored vital signs and reinforced bandages and gave pain meds.
The sounds as LifeFlight geared up, then the other three--all going out, one after the other to four different locations. No matter how long you’ve been here those sounds release your adrenaline begins.
I helped Paula recheck all the supplies in triage with Rene. We were ready.
First came two victims of a MVA (two cars versus an eighteen wheeler). Patient one presented with a fractured clavicle (collarbone), left femur spiral fracture (the long leg bone), a ruptured spleen and serious internal injuries--he was hard to stabilize but finally, tentatively sent down to surgery. The second man, they were working on had gone up under the back of the truck. He had serious head trauma with brain swelling. A neurosurgeon came up and assisted the resident to drill into the skull to release some of pressure. We hung Mannitol to decrease pressure internally and sent him down for the surgeon to handle.
Next came a GSW to the lower back received while he ran from a convenience store robbery where he shot the guy behind the register. Ended with a shootout with the police. Stabilized even though hand-cuffed to the stretcher and sent to surgery.
They called from surgery and rushed back with patient number one. Could not save him, too much damage, the patient was probably brain dead now his body was catching up. Unlike shows like “Grey’s Anatomy” (which I like) patients (if possible) are not allowed to die in surgery. If the surgeon sees they cannot save them they bring them to the floor to die.
This is done so surgery insurance costs stay down.
Next we had four young people around nineteen and twenty who were drinking and missed a curve then hit a tree. None wore seat belts. As they were being stabilized; the driver with crushing chest wounds; the others traumatic head wounds as they went through the windshield.
Both LifeFlights on the pads whirred to life again.
A frequent flyer was brought in next, let’s call him John. John is a psyche patient who goes off his meds and decides to kill himself by walking in front of a small pickup truck on the interstate. This was the fourth time. John is the only person I have ever known that takes 30mg of Valium four times a day. That would kill the average human.
Once I asked him why he didn’t just step in front of a semi instead of a small truck and he told me he wanted to kill himself not be 'splattered'--his words. He had eight fractures this time and a concussion--stabilized and off to surgery.
In the meantime patient two had returned to the floor and was giving the nurse a difficult time. He was the one who cut off the eighteen wheeler then slammed on his brakes and caused the accident. The resident had ordered an NGT (nasogastric tube). Clarice had tried three times to place it, another nurse once and the patient was uncooperative.
I talked with him, he was a big guy about three-hundred pounds, he was belligerent coming out of anesthesia. I measured the length, sprayed Lidocaine up his nose to deaden it and in his throat to deaden the gag reflex and inserted it. Just as I was going to tape it to his nose he reached up and jerked it out, screaming he couldn't stand it.
I went looking for the resident who wrote the order and told him we could not place it. A first year resident informed me that my nurses and I were incompetent. I invited him to show us how to do it. He stalked to the patient and did exactly what I did, only he only got it halfway down before the patient jerked it out; his beefy fist clipped the resident’s chin and hit me in the face.
CRACK.
BLACK.
FUZZY.
I woke in the CT getting a head scan. Everything was okay. The other resident wanted me to go home--I maybe had a mild concussion but I refused and went back to work an hour after the incident.
The first year resident had a bruise on the right side of his face I had two black eyes and a cracked cheekbone. He made a serious mistake of not apologizing to my nurses for his rudeness. You don’t screw with your nurses when you are a resident.
Early Monday morning they come to me to get in depth updates on their patients for Grand Rounds on Monday with the Attending. They can answer all his questions; once they learn to take the time to listen to my report. This guy would have to read the charts and do the best he could from this point forward. (I told you I could be a vengeful bitch).
And the hits just kept on coming; a gangbanger pair with knife wounds had just been brought in and were still trying to get at each other over some girl. Before another of my nurses or docs got clocked I had security brought up until the cops got there.
A woman was brought in from an MVA where some kids on an overpass dropped a rock the size of a football through her windshield. It took almost an hour to stabilize her enough to send to surgery, her prognosis was not optimistic.
Next, we received a patient from a psyche hospital who had jumped through a third floor window after he stabbed another patient with a scalpel????? then jumped through the window we were told. The large print on his chart that came with him weren’t encouraging words--”PATIENT'S SUICIDAL AND HOMICIDAL IDEATIONS HAVE NOT BEEN RESOLVED”.
All he had was a fractured femur and a cracked ankle. He was violent and we read schizophrenic. We had his hands in leather restraints but if you got too close he would pinch you or try to head butt you. Finally, one resident gave him a psychotropic cocktail that should have knocked him out or at least calmed him, but he raged on; he kicked a nurse with his broken leg and screamed in pain.
Finally, the fourth year resident chemically restrained him, and knocked him out. They hate doing that because of the paperwork; but the nurse fills all those out and do the fifteen minute checks; they are just inconvenienced by having to sign it. EYEROLL
Mr. ‘I don’t want an NGT’ coded at four. I won’t take you through a code again, but this time we got him back.
We had a floor filled with screaming mimis by five. Funny thing is the crazier they behave, the harder it is to calm them; the less medication works.
I took four more Advil for my pounding head. Only two hours to go when they brought in a drunken man, 4 times over the legal limit--he had lain on the top of his drunk buddy’s car and “Air Surfed” on the interstate at fifty miles per hour. Friend slammed on brakes; he went three hundred feet over the smaller, slower car in front of them before he slammed into a concrete divider. His injuries consisted of fractured disks in his neck and massive internal bleeding. We lost him--injuries were too severe, though one team worked on him for over an hour.
Meanwhile, they brought in a boy, well twenty-years-old; the woman in the car didn’t see him on the motorcycle beside her and slammed into him knocking the bike over onto him at sixty mph. Left arm and leg were severed, found and brought to us in a cooler. He had road rash over his entire body and gravel deeply embedded in his torn skin. I will spare you the grim details of preparing the stumps for re-attachment and the debridement of gravel along with his torn skin.
Finally, he was off to surgery. The woman who hit him was in the waiting room in hysterics. One of the residents sedated her and admitted her to the medical floor for the night.
Six o'clock and Mr. Homicidal & Suicidal Ideations returned from surgery. First thing, he extubated himself. How? The nurse turned her back, he was after all restrained in leather restraints; but he managed to breathe on his own. He fought the restraints screaming obscenities vying with the drunk two rooms down for loudness. Then he would suddenly lie still and talk to his auditory and visual hallucinations about how they wanted him to kill the nurse taking care of him in great detail. It was very disturbing.
When my manager came in at seven, the motorcycle victim had just returned, they had been able to reattach the arm but not the leg.
We had six screaming patients that medication would not calm. David stopped and stared at me. Over the noise level he yelled, “You get in a fight?”
“Me and Dr. G. had a round with a patient.”
“And the patient?”
“Probably the only one on in TIC-U asleep.”
“Wanna go home? I’m doing charge today. Give me report and go. Should you be here?”
"Well, yeah."
After reviewing every patient, so he could make the staffing assignments, “We only have two empty ICU beds, but I think four can soon be moved to step down. You are fully staffed as of now.”
We both paused and raised our heads at the noise from the pad outside-the whirrrr of multiple blades rising up then their sound receding.
We exchanged a look of understanding. I joined Paula and Rene in the breakroom to collect out things and headed out to I.H.O.P. for wind down and breakfast.
This has just been an average full moon night in Trauma minus the cheek hair-line fracture.
**NOTE: There have been several studies done most agreeing that since the moon affects the tides, that it may also have effects on the fluids in the brain and over-stimulation of glands and increasing hormone production causing erratic behavior. I myself have been working in L & D and seen the delivery suites fill on full moon nights.
***I also wish to apologize if some sentences are short. I am so accustomed to writing in a few words as possible I try to edit and make sure I have a subject and a predicate, but sometimes I miss one.
