I'm almost through with another week-long stretch at work, and I'm feeling pretty good. I'm slowly becoming accustomed to the odd sleep schedule, and I'm starting to understand exactly how much sleep I need as a minimum. Night shift is the fine art of arranging your lifestyle around sleep, which I admit makes one appreciate sleep quite a bit. Not too much noteworthy has happened recently in the sleepy little ER. A handful of true emergencies, a parcel of urgent issues, and a whole truckload of mostly unnecessary visits. I signed in a patient yesterday who had a chief complaint of "sunburned face". He had a little bit of reddening around his eyes and cheeks - he rated his pain as an 8 out of 10. This would sound completely ridiculous but for the fact that he's a known drug seeker, so I suppose any excuse would do. Because of the sunlight, we have had several patients check in with sunburns, which doesn't make much sense to me. I can understand how it can be painful, but I'm curious as to what mentality would make someone think of the ER as a place to go for it. I suppose I can blame popular culture and commercialism, where everything and everyone should be medicated (at least according to the pharmaceutical companies).
In other news, with the fiance applying for (and likely to be accepted to) a radiology technologist program, things are up in the air. The school is a three-hour commute from where we currently live, so we're going to have to figure out whether we need to move or if we're going to keep our home base here. There are many arguments for both, so crunch time will be later this week when we get word back on acceptance. I will either keep this job, or apply for another ER position at a hospital in that other town. Either way, I'll work while she gets edumacated, and then we'll switch off once she graduates.
In even other news, I recently attended an in-house tournament at my judo club and attained yonkyu rank (blue belt). Now I need to start really training my butt off so I can get to brown belt! With no schooling to distract me, I can focus on work, the kiddos, and physical training. It's pretty nice. When I'm not working I'm either playing with the kids (we made some cool little bonfires last weekend!), sleeping, or training. Five days a week of lifting/cardio/judo/jiu-jitsu is pretty good, it tends to balance out well with the rest of my schedule.
Monday, June 8, 2009
Tuesday, September 23, 2008
Alternative Beliefs and the ER
Since starting my job, I've very often encountered dualities that challenged my methods of thought. The protocols surrounding procedures creates a grounded and solid lens through which to view anything out of the ordinary (which tends to include everything in the ER). It's insidious enough that I don't even notice until I mentally review the day. Checklists that I unthinkingly tick off form a very rigid structure to view the oddities that pass through, especially the psychiatric patients. I've wondered time and again - how would I (or the nurses or physician) view a Therianthropic patient in a deep mental shift? Similarly, how would we appreciate a metaphysical causality for conditions such as possession or psychic attack? The usage of sedation and restraint in a monitored room is very clumsy-handed, and I'm not sure whether this is because I work in a rural hospital with limited resources, or if it's a standard by which most work off of.
On a different note, it's interesting when we have actual emergencies come rolling through the door. The feel of the department changes from tolerant calmness for minor complaints to a sense of excitement and urgency - this is what everyone has been trained for. Everybody works closely as a team, and the already sharp focus of the nurses and physicians becomes almost razor-like. The most recent and notable occurred at midnight, and involved a patient who fell from a height (about 30 feet) onto his side. He was responsive but confused when the medics picked him up, but was completely unresponsive when he arrived at the ER. A quick chest X-ray revealed a tension hemo-pneumothorax (he had both air and blood in the pleural space, and it was worsening with each ventilation). The ER physician attempted to relieve some of the worsening pressure via an IV needle between the ribs, but it didn't do much - the viscosity of the blood was probably clogging it. The surgeon on call decided to place a chest tube. He prepped the area and then used hemostats to open up an area between the ribs, and was subsequently exploded upon.
The blood and air was at such a pressure and volume that it managed to get the surgeon and cover much of the floor and side of the gurney. Units of blood were hung to replace the volume, and many meds were pushed, but the patient's body was overwhelmed and decided enough was enough. I heard the very distinctive and jarring "code blue" bell from the room (it's the alarm that signifies a cardiac arrest, which means a mass influx of nurses and physicians to the indicated room) some time later, and we spent about half an hour performing CPR. Since someone started the chest compressions before me, I didn't break any ribs when I took over. If anyone tells you that CPR isn't hard work, call them a liar. The ER physician eventually called the time of death, and we kept the patient in a room for the family to visit later. They had to drive three hours to get here, I don't want to imagine what kind of drive that must have been.
I'll see if I can update this more, but I'm about to start night shift in earnest next month. I'm about to work a seven day stretch, we'll see how much energy I have!
On a different note, it's interesting when we have actual emergencies come rolling through the door. The feel of the department changes from tolerant calmness for minor complaints to a sense of excitement and urgency - this is what everyone has been trained for. Everybody works closely as a team, and the already sharp focus of the nurses and physicians becomes almost razor-like. The most recent and notable occurred at midnight, and involved a patient who fell from a height (about 30 feet) onto his side. He was responsive but confused when the medics picked him up, but was completely unresponsive when he arrived at the ER. A quick chest X-ray revealed a tension hemo-pneumothorax (he had both air and blood in the pleural space, and it was worsening with each ventilation). The ER physician attempted to relieve some of the worsening pressure via an IV needle between the ribs, but it didn't do much - the viscosity of the blood was probably clogging it. The surgeon on call decided to place a chest tube. He prepped the area and then used hemostats to open up an area between the ribs, and was subsequently exploded upon.
The blood and air was at such a pressure and volume that it managed to get the surgeon and cover much of the floor and side of the gurney. Units of blood were hung to replace the volume, and many meds were pushed, but the patient's body was overwhelmed and decided enough was enough. I heard the very distinctive and jarring "code blue" bell from the room (it's the alarm that signifies a cardiac arrest, which means a mass influx of nurses and physicians to the indicated room) some time later, and we spent about half an hour performing CPR. Since someone started the chest compressions before me, I didn't break any ribs when I took over. If anyone tells you that CPR isn't hard work, call them a liar. The ER physician eventually called the time of death, and we kept the patient in a room for the family to visit later. They had to drive three hours to get here, I don't want to imagine what kind of drive that must have been.
I'll see if I can update this more, but I'm about to start night shift in earnest next month. I'm about to work a seven day stretch, we'll see how much energy I have!
Thursday, August 21, 2008
Experiences in Washington, and Thoughts
Well folks, it's been a while since I've posted anything of substance. So here goes nothing!
I have a tendency to let my occupation define my existence - which may or may not be beneficial towards growing as a person. I've gained a lot from my foray into the medical field, and I feel as though this is the right path to be taking, at least for the time being. There are lots of interesting stories, patients, and occurrences to be had in an ER, as well as complete chaos. I work in a small (14-bed) emergency department. We keep track of which patients are in which rooms via little paper cards in slots on a wooden board. Some days, I am the only emergency room technician. Our EKG tech doesn't work nights, so I have to perform all stat EKGs in the hospital during night shift. We only have one physician in the department, and sometimes we get a midlevel (physician assistant or nurse practitioner) or two. All in all, it's a small and cozy environment. We get anywhere from 50-100 patients a day.
Like all ERs, we have our frequent fliers. Some of them, in a bid to get the narcotics they're looking for, will collaborate with a friend. One even called me today, posing as a private-practice psychiatrist calling ahead for his "patient".
"She's totally not going there to get drugs. I swear." was basically the gist of his conversation. I have to admit he was pretty smooth; must have run into questioning ERs before. I told the "psychiatrist" that the patient he was talking about had quite a lengthy history in the ER. A few hours later, he called again, this time pretending to be working at another ER.
In other news, I'm going to get some sleep now. I'll try to post a bit more often to this journal.
I have a tendency to let my occupation define my existence - which may or may not be beneficial towards growing as a person. I've gained a lot from my foray into the medical field, and I feel as though this is the right path to be taking, at least for the time being. There are lots of interesting stories, patients, and occurrences to be had in an ER, as well as complete chaos. I work in a small (14-bed) emergency department. We keep track of which patients are in which rooms via little paper cards in slots on a wooden board. Some days, I am the only emergency room technician. Our EKG tech doesn't work nights, so I have to perform all stat EKGs in the hospital during night shift. We only have one physician in the department, and sometimes we get a midlevel (physician assistant or nurse practitioner) or two. All in all, it's a small and cozy environment. We get anywhere from 50-100 patients a day.
Like all ERs, we have our frequent fliers. Some of them, in a bid to get the narcotics they're looking for, will collaborate with a friend. One even called me today, posing as a private-practice psychiatrist calling ahead for his "patient".
"She's totally not going there to get drugs. I swear." was basically the gist of his conversation. I have to admit he was pretty smooth; must have run into questioning ERs before. I told the "psychiatrist" that the patient he was talking about had quite a lengthy history in the ER. A few hours later, he called again, this time pretending to be working at another ER.
In other news, I'm going to get some sleep now. I'll try to post a bit more often to this journal.
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