It’s A Wonderful Emergency
Ah, Yuletide once more, which has got to be my favorite time of year in the ER (and while we’re on it, what gotta-change-it-to-show-my-usefulness idiot got everyone to saying “ED”? We all knew perfectly well what the ER was, what it did, and even the drunkest could somehow find it. That, and “ED” recalls another connotation with which I’d rather not be associated, ahem…)
And so the usual silly stuff will be trimmed in sparkly red and green, smell like stale eggnog, and as is tradition, I will irritate the staff by playing Christmas tunes right up until New Year’s (which serves right the nurses who started playing them BEFORE Thanksgiving…blecch). The silly mishaps and unfortunate consequences will shine all the brighter in the ER during the holidays – like we all haven’t treated some foolish elf that snorted crushed up ribbon candy, put on “Rudolph the Red-Nosed Reindeer: The Director’s Cut” with all those risqué’ scenes cut from the original, felt … lonely…and before it’s over, a candy cane get broken off and you have to call surgery in the wee hours. Hey, it happens.
There is plenty not to like about the ER even on a good day. The smells, the delays, making consultants mad, consultants making you mad, trying to tiptoe around the EMTALA landmines, patients with a years-long problem that just “decided to get it checked out” around midnight because their sister who is a CNA three states over told him to come in; the inevitable turkey-fryer flash-up and the closest burn center over three hours away, the well-children who still will not stop screaming and their parents who encourage it, the traditional pre-holiday gomer drop-off (he’s got a packed suitcase and the family already drove off??), and did I mention the smells? Coding and pronouncing dead a patient, and informing their family in the lobby on Christmas Morning is an experience I could have gone my whole life without, and I’ve done it more than once.
And yet one aspect that has always been pleasurable, even inspirational, and especially during the holidays, are the people I get to work with. Like everyone else, the nurses and the rest of the staff would just as soon be home with their families taking a leisurely few days off to make merry. And God bless ‘em every one, they throw themselves into a celebratory mood all through December. We are regularly bombed with homemade cookies, cakes, peanut butter balls, deli trays, and we can access all the regular insulin we need. After a past year of virus panic gloom & doom, topped with government bully edicts, and slathered with patients and families no less angry and entitled than before, our nurses and staff smile and (mostly) laugh through it, and keep right on taking care of everyone no matter what. This year they really threw themselves into the celebration, putting up more lights and tinsel than ever before, hanging angels made out of those silly paper masks all around the halls, and had an excellent door decorating contest. It takes a unique appreciation for dark humor to go from a drunk with an explosive GI bleed to a quick Christmas dinner, and then dive right back into the nuttiness, and my favorite of the decorated doors exemplifies that, with Santa gobbling Xanax to quell his fear of flying. Like the pros that they are, they combined absurdity, goodwill, and heartfelt holiday cheer on a single decorated door.
Here’s hoping for a joyous holiday for one and all. Be careful running through the house in those fuzzy holiday socks, especially if you are holding a candy cane, and maybe you won’t have to visit our workshop (and if you’re extra good maybe Santa will leave some Romazicon in the bottom of your stocking – but you’ll have to supply your own syringe).
Good column, Pat! The worst Christmas I ever spent in my 73 years was working in a North Carolina emergency department about 25 years ago. The nightmares are barely fading after 7 years of retirement!
My worst time was in the trauma unit at Cook County Hospital in 1984. Never had to extract weird s#it from somebodies rectum but I did 7 open heart resuscitative massages in dead people they brought into the trauma unit. Two of them were monitored by a senior resident and the last five I was on my own. On one patient, “holy s#it,” his heart started beating again.
I remember the routine. Slash the chest open. Take down the inferior pulmonary ligament so you could flip the lung up. Dig your hand down, grab the aorta and rip away the fascia. Then grab the cross clamp the nurses had at the ready and cross clamp the aorta. Flip the heart up and do a circumferential stitch in the right atrium and once that is done, poke the knife/scalpel into it and shove a foley catheter into the hole for I.V fluid infusion. Cinch up the suture and start hand pumping the heart while the I.V. fluids are flooding the right atrium. If it’s fibrillating, shock it with internal paddles. If the heart was dead, we’d shock it anyways just to complete the protocol.
Most folks were “really” dead when they brought them in but I had one guy I did the routine on and holy f#ck, his heart started beating again. Now what the h#ll am I supposed to do! This guy’s heart was beating in my hands! I lucked out as somehow word got out to the “second” surgical team and they grabbed the gurney and took the guy up to the O.R. as I was standing there not knowing what to do. I later found out he died in the O.R.
I was really relishing the idea of going up to him on the ward if he survived and say, “You G.D. mother efffer, you better be good from here on out as I busted my balls to save your life!” That would have been nice. Especially if he turned his life around thereafter.
It was 45 minutes later and another trauma full arrest came in. This time it was a black woman who was shot with a hole in the heart. She was stone cold dead when she got to County. The ambulance guys said they picked her up and it was 45 minutes before they got to the hospital with no CPR. I had to slash her chest open by protocol and do the routine but her heart was absolutely purple and dead. I did a short show for the surrounding folks and announced she was dead. End of discussion. I didn’t want to defile her body any further.
Kurt Savegnago, M.D. (retired)
Sounds like Harlem Hospital back in the day, except I was the medic bringing them in, who the resident offered to let do the heart massage. Naturally, we never had one come back.
As they used to say (don’t know if they still do): “Survival rate for traumatic arrest in the field is 0%.”
Yup, they all died except the one I got a heartbeat on but died in the O.R. upstairs. Suffice it to say when I was in Peoria, Illinois and we got blunt trauma patients from car wrecks and such, we were able to get them off to surgery and many were saved and I had the satisfaction of visiting them later when they were recovering. I did have a disdain if their wrecks were cause by their alcohol intoxication but at least we kept them alive to face the legal consequences of their actions. Some folks were the result of innocent accidents and it was very easy to remain very sympathetic to their situation.
Kurt Savegnago, M.D. (retired)
I never trained to do open-chest heart massage. I’m embarrassed to admit on that Christmas Day I was just swamped with URIs, lacerations, and broken bones! When cardiac arrests arrived after 30+ minutes from the call going out, and the paramedics were sweating from doing closed-chest massage, I knew bloody well the patients were always D.O.A., but in deference to the paramedics (and usually the family) I would go through the motions with the drug protocol (often just to delay going out to the lobby and informing the family!). Merry Christmas everybody.
Ho Ho cough, wheeze, sneeze, spit, puke, fart, scream, cry, ….. Ho !! What a great nostalgic trip down memory lane. I could even smell all the familiar noxious ER fumes as I read your post. I do miss the speculum reindeer that were always present in every ER I worked in. Thanks for a great post. Watch out for the gomer’s suitcase on your way out the door. Ho Ho Whoops !! “Need a stretcher over here !!”
That door would never pass JCAHO. All that stuff on there is a fire hazard, as it might spontaneously combust.
It all has to be taken down immediately, or the staff involved will face disciplinary action.
Only decorations that are drawn onto glass surfaces with non-toxic water-based paint are acceptable, and must reflect all of the different religious celebrations of the season.
[I’m not making this up. This is what we were told by our employer a couple of years ago.]
And as for Christmas celebrations — All celebrations, pot lucks, etc are strictly forbidden this year, as they might spread COVID among the small group of people who spend over 12 hours a day jammed together (and stuffing down sandwiches and reheated leftovers) in tiny nurses’ stations and stuffed into little unventilated patient rooms.
[Again, not making this up.]
Merry Christmas everyone!
LOL
Pat, your piece made my day (like all of them). But I must disagree on one point. We start Christmas music in my office at midnight, Nov 1. To the ever-loving moaning and complaining by staff. Or should I say “Team” in the spirit of the new nomenclature such as ED. It just makes me happy. And I consider Thanksgiving as the half-time extravaganza.
I LOVE Christmas, and to shoe-horn it in between Thanksgiving and Christmas is displeasing to me. And I must not be displeased!
And aprpos of all of this, Christmas ends at noon on Christmas Day. (My kids are grown and away…)
“apropos”