Snippets from the ED

Clearly we're always very serious in the ED

     When I returned home after my junior year of college, I sought out ways I could spend my summer volunteering and gaining some medical experience. I soon found out that even most volunteer positions require some sort of medical training or experience, which certainly limited my options. Fortunately, I was able to begin volunteering at a local community hospital. Since I started I've worked at the front desk, the birth center, and the emergency department, but the latter has certainly been my favorite. Today I present to you a few of the things I've learned and/or seen in the ED. They're kind of random and might not flow very well, but I hope you enjoy them anyway.
      One night a patient had been asking repeatedly if he could get a referral to a mental hospital. When the doctor came in to ask if they could draw some blood to do a toxicology screening, this conversation happened: 
Patient: "Doctor! If they draw some blood can I go to a mental hospital?"

Doctor: "No I don't think that'll guarantee you a spot."

Patient: "Well what will?"
Another time a patient was just trying to get some drugs, and kept mixing up his story. When the doctor confronted him on this and told him that what he'd just said directly conflicted with what he'd said earlier, the patient's response was, "stop living in the past, doctor!"

     As you might guess from the previous paragraph, there are often patients who are a bit off who come into the community ED. Some legitimately suffer from mental health problems, and we try to help those the best we can. However, it can be hard to tell who those patients are because we have many patients who fake problems. Some are merely drug seekers who roam from one ED to the next looking for a prescription, some are homeless people who just want a warm place to sleep, and some pretend to be suicidal either to gain attention or medications. For the record, that last idea is a very bad one, which the fakers soon discover. If any medical professional hears a person voicing suicidal thoughts, even if they may have seen this person do this many times before and are pretty sure they're not serious, they are still required to keep them under watch for a certain length of time. This is not pleasant for anyone involved. Firstly the patient's room must be stripped (everything but the bed and monitor is removed), and then the patient is put under constant surveillance, so a nurse or guard must sit in a chair outside the room with the door open and the patient in view. This lasts for hours and is awkward for everyone involved. I don't know how many times a patient has joked about being suicidal but later recants their statement after just a few minutes. It's too late then though, because we have to be prepared for the possibility that this time the suicidal ideations are real.
     Some nights in the ED one problem is fixed, only for another problem to be discovered. That happened one night when a 70-year-old woman came in because she fell and hurt her wrist. It seemed like it was just a basic case and the woman would simply need a splint. However, upon hearing that the woman had hit her head as well when she fell, the doctor ordered a CT scan to see if there was any cranial bleeding or fractures. He didn't find either of those, but he did find a very large a brain tumor. That was a tough message to deliver, and you could see it all over the doctor's face. Of course, there was another night when we thought we'd be delivering some tough news (that a man had diabetes), but then the nurses realized that his blood sugar was just really messed up because he'd been drinking and hadn't told them right away. 

There's almost always Juanita's in the break room.
I pity the people outside Oregon who have never
experienced these chips.

     With all the crazy things that can happen in the ED (though frankly the ED is rarely as hopping and dramatic as you see on TV), you sometimes need reminders to slow down and take a breath. I usually stay by the ED techs and secretaries whenever I don't have anything else to do, and whenever their computer goes to screensaver, it simply says "Breathe...." Humor is also pretty important in the ED. However, people unused to the humor of medical personnel, particularly those who work in EMS or EDs, could be rather thrown by the jokes since they are often rather dark. Occasionally doctors and nurses will play a game of "high-low" and try to guess anything from the number of meds a person is on, to the number of times someone has been to the ED recently, to the length of the object a person has shoved up their rectum (true story -a guy can in with a large shaving cream can stuck all the way up there. The x-rays were impressive and there was a long discussion about the best way to remove it. When asked how the can came to be there, the patient simply replied, "I sat on it.").

One of the most common ways to handle stress
in the ED: eating sweets. Seriously, people
should get stock in this company because the
nurses and doctors eat so much.

     The most stressful day I've ever experienced in the ED was in the week between Christmas and New Year's. Apparently this week is well-known for being the worst time of the year for EDs and I soon saw why. The night I came in, I had been there less than three minutes when I was asked to strip a room for an incoming patient with suicidal thoughts. Just a short while later, all the beds were filled (something I'd never seen before) and an arriving team of paramedics had to wait with their patient in the hall. By the end of the night we were in "full deferral" which means that we'd told the dispatcher not to send us anymore ambulances because we could not handle more patients. Apparently that had happened the night before as well and when other hospitals in the area became similarly overloaded some patients were sent all the way to Vancouver, WA. Luckily that night we were able to discharge and admit some patients and accept one last ambulance, the most serious patient of the night. 
     Although I've practiced CPR many times, I had not yet been able to actually see it in practice. That night we received a call from paramedics in the field telling us they had a 37-year-old woman in cardiac arrest and were bringing her back to our hospital. The thing is though, she'd already been down for 40 minutes before she arrived, and some of the nurses were annoyed that her death hadn't just been called in the field. No one thought she would be resuscitated, but they were willing to try since she was so young and her death had been caused by an overdose, not preexisting heart problems. The paramedics had also been performing CPR the entire time, so that was a point in her favor. Although I could not help because I was only there in a volunteer capacity, I was allowed to watch the entire process. The doctor and nurses performed CPR for about 10 minutes (with a break every 2 minutes to check for a pulse, which only one nurse reported and no one else confirm) before the doctor asked if everyone was ok with him calling the patient's death after the next check. Yet again no pulse was detected, however, much to everyone's surprise and disbelief, the heart monitor showed a tiny bit of electrical activity. The doctor called for a shock and suddenly the heart that had been still for almost an hour began to beat again. Unfortunately I had to leave to run samples to the lab shortly after, so I never got to see the woman wake up, but I did find out that she was later admitted to the hospital, so she stabilized at the very least.  
     I have more tales from the ED, but I'm realizing that this post is already rather long, so I'll end here and continue on with more stories (most of them a bit more humorous than these here) in a later post. Now it's off to work on scholarships and housing once more.