Life
There are two rules in medicine that those in the Emergency Room should understand:
1. People will die.
2. We can’t change rule #1.
This is a hard story for me to tell. I was encouraged to tell it, though, as a way to help me work through what happened, and to “come to terms” with these things I see.
Every day I go to work, there is a tragedy of some sort. I see it every time I walk through the doors. I go for only twelve hours, three times a week. When you ask an ER nurse how their day went, the answer is usually dependent on how many people died. If I’m lucky enough to make it twelve hours without a death, it was a great day. When I have three die in my short time there…
My hospital is about 100 years old. It’s been worn, and the linoleum always looks dirty, no matter if it was just cleaned or not. The emergency department is divided up into zones. Zone One is the biggest, meanest zone, and is where most of the action goes. The department is always full, and the waiting room is always worse. In front of the Patch Phone is a plasma screen TV that keeps track of each room in the department, and in the corner, reads how many are waiting to get in. On this day in particular, there were 19. We were on divert, and even though we told the ambulances not to come… they would come regardless. My hospital is a Level One Trauma Center, and one of the top 10 hospitals in the nation for neurological injury and diseases. Anyone with any type of brain problem comes to us, no matter how overwhelmed we are. We are the best, and we take them. This day was no different.
There are four nurses in zone one, and one physician. When the patch phone rang that day, all the nurses tried to ignore it. We were closed to ambulances, and the hallway was lined up with patients. I answered the patch phone with the typical line, and the paramedic told me about the patient on the way. She was eighty years old, and was cooking dinner for her family when she fell to the floor. Not a word uttered, just down to the ground. Her granddaughter had just came to the United States from China, and remembered hearing about how to dial 911 in case of an emergency. When the paramedics got there, Mrs. A wasn’t breathing. With family anxiously waiting, the paramedics intubated Mrs A with a 7.0 ETT, taped at 28/gums. Airway, breathing, circulation. This is the creed we are all taught, and it is hammered into us throughout school. Without an airway, breathing doesn’t matter. If you aren’t breathing, we don’t care what your heart is doing, because without oxygen, it won’t be doing anything before too long. Mrs A’s airway was secured, and she was on the way to us.
Paramedics stated a 10minute ETA, and needed no further orders. We were closed, but it didn’t matter. When someone falls down and quits breathing, it’s one of two things: A heart or a brain. It wasn’t her heart, because her heart was still beating. That meant we were taking her, because we are the best at brains. I had rooms 1, 2, and 3 that day. These are three of the worst rooms. They are the rooms where we code patients, rooms where the sickest of the sick go. I moved a patient who was about to miscarry out to the hall, and pulled a curtain around her. We would use room 3 for Mrs. A. In a situation such as this, two registered nurses are needed. One documents things as they happen, second by second. The other RN takes care of the patient. Two of us were there. When a case such as this comes in, everything else stops. The stretcher was prepared, an EKG machine, rolling laptop, glucometer, and a million other supplies were prepared. To anyone watching, situations like these seem like utter chaos. To us, it is a symphony, composed second by second. All of us play our parts, and it comes together beautifully.
The physician was at the foot of the bed, and I was on the right side. I knew this time it would be more organized than most, because I was with my favorite doctor and a battle-worn expert nurse, who has served as my mentor. It was her, in fact, who encouraged me to write this down. Phoenix Fire wheeled the patient in, and transferred her to our gurney. At this time, a sort of zen took over in me. I noticed, of all things, Mrs. A’s hair. She was frail, and looked like a glass doll. For a woman of eighty, she looked so young. She had barely a wrinkle on her face… and her hair was beautiful. It came down to the middle of her back, and was jet black, streaked with silver. Asian women age so gracefully, and Mrs. A was no exception. She had a tube down her throat, providing her oxygen. She was in a mohair cardigan and blue shirt, which had to be cut off. I have always thought this is the worst part. I have to cut off these clothes, and I know that if I couldn’t save Mrs. A, her family would take those clothes home, carelessly cut apart, and that would be their last memory of their mother, grandmother, aunt, sister, and wife. I never like to cut the clothes off, but it has to be done, so I did it.
I’ll finish this later.
