ER

Final Entry for Journalworks……December 5, 95

A retrospective look at what I’ve learned and about myself and my surroundings.

This was intially thought to be an easily accomplishable task when I first read the Journaworks sheet. I am now pondering on what exactly did I learn if anything at all.

I suppose I could say that my knowledge has increased tenfold since the beginning of the school semester. I now know how to do basic algebra and I understand and can recite the principles of photosynthesis competently. My need for caffeine has increased as well, a small fraction of what my dependency will be after the many years of school that lie ahead of me. I have shifted in my religious stature, to a Buddhist flavor. It is the same as Wiccan in large aspects, but without alot of the mumbo jumbo that is with every Wiccan action. I have made peace with my life, ready to explore the wondrous afterlife, only to pause for a second and continue on my journey with the present. I have learned medical knowledge to save someone’s life, and I am increasing in confidence daily in the use of it. I have performed over some goals and expectations, and come very short of things taken for granted. I have gained in the ground of intelligence and abstract thought, and have at times lost in common sense and compassion. I have lost my faith in god, and found the importance of religion.
In forty years, I do not know where I shall be. Perhaps a scientist, dilligently working on a genetic cure for acne, or a singer/songwriter on a street corner whose lyrics hint toward the myriad of disciplines the universe has to offer. Perhaps I shall be a leader of men and introduce many great things into the community, or perhaps I will be corrupt and bitter in my later years. The key here is that I do not know what the future holds. I know what I would like to be………

loved by someone I loved.

Everything else is just a light as the commercial says.

0300 on a Saturday morning. The smell of coffee is rich in the small, comfortable kitchen. I am thankful that I remembered to wash a set of scrubs for ER duty. I am not in the mood to wear dockers all day long. The coffee smells absolutely delicious as I pour it into a thermal mug. With medical notes under one arm, my coffee in the other, and a lab coat around my neck, I quietly walk into the darkened bedroom. There in the warm shadows of the bed lies the sum of my happiness and desire, my beautiful wife. A tiny yawn escapes our child, tucked neatly underneath the covers beside her mother. A gentle kiss before I venture into the darkness. A smile appears on her lips and indistinquishable murmurs escape her dreams, she burrows her head into the pillow and drifts into sleep.

Outside, the chill September air greets me like a cool face wash. Standing on the landing to our apartment, I take a quiet sip of coffee and reflect on my life. I had almost ended it while starting my college career at UAM. How very thankful I am that I did not do so. It is only four blocks to the Hospital, perfect early morning excercise.

The loud humm of the electronic doors welcome me into the beautifuly chaotic sounds of the ER. I love this place. Nurses running back and forth from room to room, checking the flows of IV, medication schedules, lab reports, assisting with patient moval. How some doctors thought a nurse replaceable was beyond me, I needed them. They filled an important link that I could not fill.

I just get settled in, checking up on the latest gossip, when an ambulance arrives on the scene. Apparently a woman and her child were caught in a drive by shooting. The paramedics were shouting vital statistics to me as I donned BSI and nurses scrambled to prepare the EKG, the Pulse Ox, the BVM, and so on. BP 90 over 34, respirations 7 slow and shallow, pulse 55 thready and regular. Two penetrating punctures on the lower right abdominal quadrant with exit wounds on the posterior above the buttocks. Has sustained a loss of 20 percent of blood. LOC was normal until she went under fifteen minutes ago. She had a bottle of nitroglycerine in her pocket, don’t know if she took any or not. We administered 15 liters of O2 BVM en route…..

The paramedics continue their recount of the patients history when I look up and see the mother’s child standing in the hallway, covered in blood. The nurses and another doctor begin treatment on the mother while I rush to the kid. I can find no deformities on the kid, no punctures, lacerations, contusions, abrasions…nothing. I suppose the blood is from the mother and call for a paramedic or a policeman to give me a patient history on the child.
“The kid was just sitting there with his mom when we arrived. We could not find anything wrong with the kid, and so we put him in the front of the ambulance.”

I call for a nurse to take the kid to a bed to perform an indepth patient assessment and to clean him up.

I hear a loud “CLEAR” from the CR and I rush in. The mother had coded. The doctor handling the mother delivers 360 joules from a defibrillator to the mothers exposed body. She lurches upward and nothing happens. “Charging…..CLEAR” . Another shock delivered. Meanwhile, Epinephrine is administered to the patient. I jump on the patient’s chest and start performing chest compressions, releaving the now tired student nurse. Another doctor is inserting a oropharyngeal tube into the patient’s mouth, using a lighted blade to bypass the epiglottis.

one, two, three, four, five, seven, eight, nine, ten, eleven, twelve, thirteen, fourteen, fifteen, seventeen, I do the compressions, hoping for a pulse. I get V-fib and jump off, grabbing the defib leads.

“CLEAR” . Another shock. The patient does not respond. What was a shockable Ventricular defibrillation rhythm, now is a non shockable Asytole rhythm….or rather no rhythm at all. I start again on the CPR, more drugs are pushed into the patient. Nothing.

It seems like only a second or two, but in all actuality it has been twenty minutes since we shocked her. We tried everything known to medicine and still the patient did not respond. Time of death…..0530.

A bit of a grim future tale. What is brought to mind is…..what about the kid? I did not go into the kid’s future, it could be one of several things. What is important to notice is how very happy I am with a family and a career that pushes me to my limits of intelligence and thinking. In performing my job, I am also helping out my fellow man as well. Unfortunately there is the occasional death that must be met. It cannot be ignored or thought not to occur…it will. Perhaps this is but one of many futures in store for me, perhaps not. Whatever the fates hold in store for me, I look forward to with hope. Hope is all I have to build on…

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