Bed 1: 91 y/o woman, MVA (motor vehicle accident)
She's getting confused, isn't sure where she is now. "Mental status changes" as we call it. Soon she will be too lethargic to cough and deep breathe so the secretions in her lungs will grow bacteria, or pneumonia, as you know it. She will be intubated (get a breathing tube and ventilator) and wind slowly down to a long, miserable death. This isn't fact, but a pretty good educated guess. She's 91!
Bed 2: 46 y/o man, drunk driver, MVA
Meh. No pity for you! He has open fractures to both legs in the shin area (both bones of both lower legs, called a "tib/fib fracture" because the bones are the Tibia and Fibula. He has a C1 fracture, the first cervical (neck) vertebrae, but it doesn't matter, because the consensus among the residents who have seen the CT scans is that he has probably transected his brainstem. He is ventilated and unconscious so his family will watch the slow wind down to a long, miserable death. Whenever I see a patient taking this route due to their own stupidity, I always say this phrase. It is my own. Live like hell, die like hell.
Bed 3: Chick in a MVA with a pelvic fracture. She has an Ex-fix (external fixator) on her pelvis.
Bed 4: 79 y/o man, MVA with his wife. She was discharged last week to a rehab facility. He is doing fairly well.
Bed 5: 20 something y/o man coming to this bed has a severe head injury and is "probably going to be a donor" (meaning, organ donor).
Bed 6: 40 something y/o woman who had an accident on an ATV. She is blown up like a puffer fish, on lots of drugs and high ventilator settings, and doesn't seem to be heading in a better direction.
Bed 7: 22 y/o man, MVA
He is ventilated and has a plastic bag on his rear end to catch the copious amounts of liquid stool coming from his bowels due to the liquid tube feeding that he is getting at 2 ounces an hour through a tube in his nose, directly into his small intestine. Imagine this happening to you when you were 22. Nah, none of us could even have imagined it possible, right? He will probably get better and not learn any lessons from this. </cynicism>
Bed 8: 72 y/o man, tractor rollover. Yep, we get 2 or 3 of these a year. Men should not get on tractors after age 60 - PERIOD.
The tractor laid on his legs for several hours, cutting off the blood flow. As a result, he developed "Compartment Syndrome" because of the ischemia (lower blood supply than the tissue needs). That is, his muscles swelled so tight within their fascia, the covering, that they stopped their own blood flow, and a lot of his muscle tissue simply died. They had to do fasciotomies where they cut the inside and outside of both legs on the thighs and calves (for a total of 4 large wounds) to release pressure and allow blood to flow properly again. By virtually butchering the legs, they save the legs. It is hoped.
Bed 9: Drunk driver. Yada.
Bed 10: Currently awaiting the arrival of a 20 something y/o man who has fractured his C4 and C5 vertebrae (in the neck) resulting in quadriplegia.
He will be placed on a Roto-rest bed which rotates from side to side to keep the secretions in his lungs from pooling and causing pneumonia, yeah right, and to keep him from getting skin breakdown ("bed sores") from laying in the same position. He will be ventilated, and, if he is really lucky and successful in his rehab, will live a life much like Christopher Reeve did.
Bed 11: 14 y/o Hispanic girl. MVA.
I wrote a little about her here last week. She remains "bolted" though her head pressures are low now. She had an episode of extreme edema (swelling) in her brain last week and was taken to the O.R. emergently to do a craniotomy which is removal of a portion of her skull to allow the brain to expand. If they didn't do that, she would have herniated, meaning her brain would have been forced out of its proper position by the pressure in the unforgiving skull, resulting in brain death. I have seen brain tissue come out of the nose once from this, also out of an ear a couple of times. It isn't pretty. She will never "recover" and will almost certainly die. It will be worse if she lives.
When bed 2 came up, we had to put a Bair Hugger on him to warm him up. It is basically a hair dryer type heater that blows hot air into a plastic, tubular blanket that lays over the patient. We used a Level I fluid warmer which warms a liter of fluid and forces it into an IV under pressure all in about 3 minutes. It both warms the body and replaces much needed volume in blood vessels rapidly losing their blood. It keeps the heart pumping. We work hard and quickly, as if we are going to be able to save him; as if he was someone who deserved to be saved.
You can't make judgments like that and keep this job. Everyone gets the full treatment until they get better or assume room temperature. It doesn't matter if they are a skank, a drunk, a gangsta thug, a wife-beater, a suicide attempt; it doesn't matter. Of course later, like now, it matters; when I try to decide if I had as fulfilling and worthwhile a night as I felt when I walked out into the parking deck. I wonder, did I save the world heroically, or give a drunk another chance to kill my children? Sometimes, they really are thoughts that dark, though mostly not. Sometimes I wonder why I'm doing it. For the money, or the challenge? For the camaraderie, or feelings of purpose? All of the above. I am needed and I provide a service many people couldn't provide, to people who appreciate it (usually) greatly.
When I am trying to feel better, I think, "If it wasn't for me, people would have died over these last 5 years." And no matter who they are, who we are, we are all just people in the end. In our end time, we are all humans, and it is a tragedy to someone that we will die. I have contributed, worked, sometimes all out fought for the lives of people who lived because of those efforts. That's something, isn't it? I think, yes. It is that simple word that lets me sleep on mornings like this one in spite of the doubts, and in spite of the aches and pains and profound fatigue I carry with me.
Will rest find me in the cool sheets, I wonder? Will my dreams be pleasant and healing? Will I awaken to the sounds of my wonderful wife and amazing sons? Have I mattered at all? Yes, I think. Yes.
I look forward to the next three days off. I look forward to reading all your LJs after I've slept. See you soon!