The Affair

Another night in the ER. I think it was a Friday or Saturday night and as usual, around 2 am the victims of heavy partying start to trickle in. Most people that come in by ambulance are black out drunk and we see the occasional overdose. The ambulance crews have created what we now call the “party bag” for the drunks who are expected to vomit at any second. They take a biohazard bag and cut a hole near the top big enough to fit around the patient’s head. They slide their head into it and the bag sits, open, in front of them so that when they puke, the vomit goes into the bag instead of all over them. It works pretty well and I think it’s a great idea.

We usually keep our drunk patients in a hallway bed or in an area we call the vestibule. That way our patient rooms can be utilized by seriously ill patients. The vestibule is a small area in between two sets of doors that is right across from where our Paramedics manning the EMS radio sit. The vestibule is usually reserved for the louder or smellier drunk patients and I try and stay clear as much as possible. Part of the paramedic’s job is to man the radio and part of their job is to be in charge of the care of our hallway/vestibule patients in order to free up nurses to be assigned to more sick patients. I do not envy their job as most of their patients are hard to work with.

This particular night the ambulance brought in a young female in her mid 20’s. Her girlfriend rode in the ambulance with her and the two made an interesting couple. The patient was blacked out and we slipped capnography on to make sure she was still breathing effectively in her sleep. We put her in the vestibule because it gave them more privacy short of an actual room. Her girlfriend was definitely irritated that she was ending her night in the ER watching her partner sleep instead of being wherever they were staying. It only took a few minutes of her answering questions to detect a European accent in her voice. I guessed they were here visiting, but something seemed strange.

The Paramedic working these patients that night was an attractive female and sweet as can be. She was doing what she could to help make the patient comfortable and making sure the girlfriend got some water or coffee. She had it all handled without needing any help which was pretty typical of her.

At some point later on in the night the patient woke up. She was still drunk and pretty oblivious to what was really going on. She didn’t like the fact that she ended up in the ER but was too drunk to get up or even make basic sentences. I watched as the paramedic went into the vestibule to go answer a question that the girlfriend had and all the sudden heard a lot of yelling. I couldn’t make out everything that was being said and moved closer to see if it was about to turn violent. All the yelling was towards the girlfriend and I couldn’t figure out why. It seemed the yelling was in half English and half some foreign language. Soon, more staff had gathered to watch the show.

Out of nowhere, the patient stood up. She yelled, “You cheating whore!” Then, she slapped the living daylights out of the girlfriend. Right across the face and almost knocked the girlfriend to her knees. Next, the patient yelled at the paramedic and then sat back in the bed, vomited, and passed out. It was such a confusing scene I think it took a few minutes for me to process what happened. I saw the paramedic ask if the girlfriend was ok and then she walked back over to where some of us had gathered and were trying to make sense of what just happened.

“It was like a scene out of the Jerry Springer show!” she exclaimed. “I’m not really sure what just happened. The patient woke up, started yelling and thought her girlfriend was cheating on her with me. I was so shocked I didn’t even know what to do. Of course we denied it, but we couldn’t convince her that I was just working at the hospital. We’ve never even met before! As much as we tried to calm her down it didn’t work. So, she just slapped her and called us whores!”

At that point, I couldn’t help myself. I busted out laughing at the crazy things alcohol does to your mind. Shortly after the incident, the girlfriend came up and stated she was leaving and that her girlfriend could find her own way home from the hospital. Something told me that this was not the first time something like this had happened with them. She gave us the patient’s personal belongings and then walked out the door into the night.

The rest of the shift we kept asking the paramedic how her new girlfriend was doing. She laughed it off and was already over it.

The patient slept off the rest of the alcohol’s effects and was still there when I left that morning. I don’t know what ever happened when she woke up. I’m sure it was pretty confusing for her to try and piece together all the events of the night before. I’m sure the hardest part was trying to figure out how to get to wherever she was staying during their visit. I would have liked to seen her trying to patch that relationship up and what it took to get out of the doghouse.

-The Witch Doctor

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A Drunken Bet Gone Wrong

I had just walked into the ER for my shift. I went into our break room that we call “the bucket” for reasons unknown to me. My only guess was because it’s the place to go when all you want to say is “fu$&-it”. But ya know, we can’t call it “the fu$&-it”, so we call it “the bucket”. I sat my stuff down in the corner and asked somebody if it was a busy night. So far so good and I was optimistic to how the night would go. Then someone said to hurry up and get out there because something good was coming in.

“Something good” to me is a trauma alert, or a code, or a red medical patient. However I wasn’t seeing anything like that or hearing anything like that on the radio. I went to the trauma room and didn’t see anybody really busy so I turned to walk back out. At that moment a young male was being pushed in on a wheel chair and was doubled over and looked very uncomfortable. I went back in and helped the patient move from the wheel chair to the hospital bed. I thought I could smell alcohol on him but I wasn’t sure. He wasn’t walking very well and I couldn’t figure out what was wrong with him. Drunk? Alcohol made him sick?

After he was in the bed, I walked with the tech that brought him in and when we were out of ear shot I asked, “What’s wrong with that guy and why is he in the trauma room. I don’t see any trauma and he looks pretty stable.” The tech looked back at me and smiled without saying anything. “Why don’t you go over there and ask him?” the tech said. Then the tech walked off.
Well now I’m really curious. Probably more than I should be about a patient that I’m not even assigned to. But, naturally I couldn’t help myself. I walked back over there and very casually asked, “So buddy what brings you in to see us today?”

“Well, it’s an embarrassing story,” says the patient. I can tell he’s been drinking.

“Well, I’m not here to judge,” I respond.

“Alright. Well. I guess I should just go ahead and say it….. I have an apple stuck up my ass.”

Silence.

More Silence.

“Excuse me?” I somehow manage to say.

“Yah man. I can’t get it out. It’s stuck.”

“I see. Well…. If you don’t mind me asking. Why did you choose an apple?” I’m too curious not to ask this.

“Well… It all started with me and my buddies drinking some beers. Then we started betting each other on different things. Then one of my buddies said, ‘Bet you can’t stick an apple up your ass!’ and I bet him I could. Only problem is I couldn’t get it back out. So here I am.”

“So what did you win? How much was the bet for?” I asked.

“You know… I don’t even remember. I was so focused on getting this thing out I forgot. And I don’t think my buddy paid up either.”

I can’t remember where the conversation went after that but that’s the gist of it. I will say that his x-ray was one of the more interesting x-rays I had ever seen. The most confusing part, in my opinion, is how he was able to get it up there in the first place. I mean, we’re talking about a Granny Smith style apple here. I don’t think you can go from nothing straight to an apple up the rectum. So, either the story is a lie or the apple was not the first foreign object to make that journey.

Naturally, the whole ER knew about it and was talking about it. Don’t tell HIPPA that. Later on that night when I had a few minutes I went down to the cafeteria and bought an apple. I came back to the ER and walked around with the apple saying, “Anybody want an apple? I found it in the trauma room and it looks like it’s still good.” I got some pretty good reactions to that one.

-The Witch Doctor

Expanding Your Scope of Practice

It was a normal night in the ER. Busy, crazy, and fast paced. I was assigned to 7 rooms, 3 of which we reserve for our most medical sick patients. Those three rooms are set up with more capabilities to treat sick patients in the most efficient way possible. Typically, it’s our stroke, septic, respiratory, and cardiac patients that come here. The patients are normally strictly medical, since our trauma patients go to our designated trauma room. We usually know ahead of time when a seriously sick person is on the way to one of the rooms. That gives us a chance to be waiting and prepared by the time the patient gets there.

On this particular night, we get a call that a respiratory distress patient is being brought by ambulance. One of my rooms was open so I knew the patient would be brought there. I started prepping for the patient’s arrival. Got the EKG machine ready, turned on the O2 in the room, called the respiratory tech, called x-ray, made sure the room had supplies for any scenario, got an IV kit ready with tubes to draw blood, and etc. The ER doors opened and without even looking up I knew the patient was here.

The sound of high flow O2 was the dead giveaway. Number two, was the sound of someone working very hard to move air in and out of their lungs. Number three, was the sound of yelling in between breaths in a language I didn’t understand. I looked up as the ambulance stretcher was coming into my room and I saw an overweight Haitian woman being wheeled in. She was yelling in Creole as best she could while struggling to breathe at the same time. Her arms were moving around frantically. None of us spoke Creole and the language barrier made things difficult.

We moved her over to our hospital bed and I noticed purple goo everywhere on the sheets and around the patient’s head. The ambulance paramedic saw my puzzled look and said, “Oh yeah. By the way, she was dying her hair when this all started so we just brought her here with it.” The dye was everywhere. Thick and everywhere. All in a chaotic symphony (the term I use to describe actual efficient team work done in the ER) chest x-ray, EKG, blood draw, and assessments were done. Respiratory put the patient on BIPAP. That did not go over well.

Creole is not like Spanish where you can catch a few words here and there and figure out what someone is generally saying. Creole is also definitely less common where I worked. We didn’t have anyone who could translate and trying to get our translator phone service in a time critical scenarios was usually impossible. As you can imagine, putting a BIPAP mask on someone who has no idea what we were saying or doing, is no easy feat. It’s like a medical Darth Vader mask that forces hair into the patient’s lungs at different pressures. The mask covers most of the patient’s face and straps wrap around the head to secure and seal it. It’s uncomfortable, loud, and probably overwhelmingly scary to someone who has no idea what it’s for.

The patient was not happy. She was yelling in Creole against the air that was being forced in her mouth and kept pulling the mask off in order to continue to yell in Creole. We finally get her to settle down and leave the mask on. She wasn’t happy but she wasn’t shouting anymore. Content that we may have made a breakthrough in calming down the situation, I left the room to attend to other tasks for my other patients. My nurse did the same. Every so often I’d walk by, peak in, check vitals, and move on. I thought the hard part was over. I was wrong.

I’m not sure how long the silence lasted. At some point the patient started shouting in Creole again. The nurse and I went into the room to find that the patient had ripped the BIPAP mask off and was trying to say something to us. I called for someone to grab the translation phone. Out of nowhere the patient said in broken English, “Head. Hurts. Fire. Help.” I looked at the nurse who was as confused as I was. After a few more minutes of trying to figure it out, the nurse figured it out. The patient still had all that dye in her hair. The dye was irritating her scalp and was making it feel like it was burning. Being a guy, I would have never thought of that.

The nurse says, “We’ve got to wash out her hair. But we can’t take the BIPAP off. I’ve got to go do something in the other room. Could you go get everything we need to wash her hair out?” Before I could answer, she walked out. I’m a guy. What do we need to wash dye out of someone’s hair? I’ve never done this before in my life and now I’ve got to do it without removing a BIPAP mask, without standing the patient up, and without making a huge mess everywhere. I went to the supply closet and stood there for a good five minutes just thinking. Co-workers came in and out as I’m just standing there staring at the wall.

A few minutes later, I came back out with 5 basins, a handful of hand towels, a stack of large towels, small bottle of shampoo/body soap, some 60cc syringes, 2 protective gowns, and one idea. I went into the patient’s room with the nurse. I wrapped the patient in the big towels. I put a bunch around her shoulders and neck. It was a cross between a spa and mummified look. I filled one basin with soap water. I filled another with regular water. I put both on the table at the bedside. The nurse decided she was going to be the one who held the BIPAP mask on the patient’s head since we had to take the straps off. That left me with the job of hair washing. I got a hand towel and soaked it in the soap water. I brought it up over the patient’s head. I paused for a second with uncertainty. I wrung out all the water from the towel onto the patients head. Purple hair dye and water began streaking down the patients face and head. It had begun.

One big flaw in my plan was using cold water instead of warm water. The thought never even occurred to me. I wasn’t sure what the patient hated the most. The burning sensation from the hair dye, or the cold water now being wrung out on her head. The facial expressions and the tone in her Creole told me it was probably the cold water. For 10 minutes straight I would wring out soap water on her head and let the water wash down into either the towels or the basin I held by her head. Then I soaked hand towels in the regular water and wrung those out. I would take my gloved hands and try and pull the dye out of her short hair without pulling her hair itself. It was almost like using my hand as a comb. It was not very effective but it was all I could come up with. I felt like we were getting no where. My overall idea was to saturate her head with the soapy water to break up the dye. Then I would “wash” it out with regular water. The goal was to do it without making a mess. I wasn’t anywhere close to achieving that.

The nurse was watching the whole process as it drug on and was slow. She’d give little ideas here and there and try and comfort the patient. She came up with an idea and thought it might work better. So I took over holding the BIPAP mask and she took the 60cc syringes and drew up the regular water. She then aimed it at the patients head and pushed the plunger full blast. Water shot out of the syringe at 100 mph and went straight through the hair, to the scalp, then was ricocheting off the scalp covering everything and everyone in purple water. Shocked at what she had done, the nurse looked over at me in silence. I lost it and started laughing. The nurse started laughing. Even the patient started laughing. It was such a mess. Everything in the room had purple on it. The syringe trick had done nothing to help rinse the dye out. There was still a lot of dye in the patient’s hair and we had been at this for what felt like an hour.

Finally, we got enough out where we felt comfortable that we had done enough. I was covered in purple dye. The patient’s bed sheets were soaked. All of us were a mess. We cleaned up everything and got the patient dry with new sheets. The patient seemed a lot more comfortable and was not as agitated anymore. We finally left the room and the whole staff was smiling at us. I grabbed water for the nurse and myself and sat down next to her. People would walk by and laugh. I wondered if I still had purple on my face. Then the nurse got up to go do something and her chair turned. On the back of the chair, now facing me, was a sign that read, “RN and Head of ER Beauty Salon.” I looked at my chair and it had a sign that read, “Tech and Beauty Specialist.” Cute, I thought, very cute.

Looking back on this event, the whole mess was a miserable experience. Definitely a learning experience I never expected to have. But, the more I think about it, the funnier it was. I was still new to the ER and would soon find out that there would be a lot of situations that I wouldn’t be prepared for.

-The Witch Doctor