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i have something i want to post about. i of course am not using the patients name. while it might not seem necessary to tell the story to get my point across, that i want input on, i sort of need to. i have a soft spot for cases like this because i was in this situation, so it hits me harder when nurses/doctors treat the patient like crap.
when you read this story (i will start it in a new post -- that way, if you do not want to read about it [it's somewhat graphic--but a lesson as to why you shouldn't drink/do drugs i guess] you don't have to) i want you to view it as if you were the patient, or the patient's family.
the question is this: i am not a doctor, i am not a nurse. my job in trauma situations consists of spending about 40 seconds to 4 minutes with the patient. then, i leave, and unless they are admitted inpatient and NEED routine labwork, i never see them again. i never know what happens to them and, sometimes, that is the hardest thing to deal with.
so, because i am not the sort of medical staff to ACTUALLY follow up on a patient, is it wrong of me to have stayed late/stayed behind to make sure a patient was okay? the nurses and doctor seemed annoyed by this (i did this one other time--same situation almost, and they physically MADE me leave), however.... the person's father and the patient seemed very, very grateful and glad. the primary job is to be there for the patient. i did this where it seemed like no one else was. i'm not a therapist, i wasn't trying to be one, i just... i had to stay. i had to.
would you have found this offputting, or "wrong"?
anyways, now here comes the story to follow. i am going to edit out language, some of my own as well as ACTUAL quotes from the other staff i was with on tuesday night. a pre-thank you for reading all this, if you do. i appreciate input. i know it's got nothing to do with this board, but.. i'd like to be a part of this board again... and this is what my life now consists of, three days a week for 36 hours straight.
my void does not want.
-- 2.13.61.
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(this comes out in story form, sort of. i typed it up on only 3 hours of sleep, 10 minutes after i got home after all this happened. i posted it last night somewhere else, privately. it's the only way i could think of to preserve it.)
"i spend 99% of my time waiting for that 1% where i feel like i've made a difference."
-- ER: current episode "Here and There."
this is tuesday night. 15 minutes before it was time for me to leave. this happened last week with a middle-aged woman; this time it was a 19 y/o boy (but i didn't know his age until yesterday--i had pinned him around 22) who had "OD'ed," but we found out when he got in it was actually an alcohol OD. he'd taken tylenol, but nothing significant--he'd taken them for a headache. i believed him; the rest of the staff did not. but i'm getting there; i'm getting ahead of myself.
he was conscious but in and out of strange stupors; he was writhing in pain, and going between shaking cold and burning up with sweat. he had huge blue eyes, rimmed in red and they were wet; he was crying but didn't want anyone to know. short, spikey brown hair. had a chain around his neck; it was held with an O-ring and i couldn't figure out how he ever got it on in the first place. came in just wearing jogging pants, and socks. had "unrest, mother" tattooed in script, in an arc over his belly button. had other tattoos on his torso and arm, but that's the one that stood out. he was there with his father, a man in mid 60's. the father didn't seem angry, rather, he seemed sad; scared (this is important for what i found out yesterday).
most of the staff (2 nurses, the doctor, the on-hand medic [m*** today, not hottie n***]) were being absolutely terrible to this kid. i knew why. "oh, another f**king OD, another stupid kid," but angelboy kept saying he wasn't trying to kill himself, it was an accident, etc etc etc. that was about the time i came in and he shifted his attention to me, the new person walking in... and then locked on. i lost my breath. i think maybe it was because i was closest to his age, and while i've toned down over the years, appearance-wise, i think the super red hair, the make-up had something to do with it. 2 minutes from initial entry, the tattoos on my arms made us friends. i waited for the nurses to finish their business (checking vitals; m*** was going to get an IV in for dehydration but wanted me to get labs first, because we needed to know what all he took and how much) and then i stepped in. the doctor asked his father to step outside the curtain with him, so they could talk. i heard, 'two entire bottles of vodka,' but averted my attention from them to the boy.
he kept writhing around and groaning, almost throwing up and then eventually, he did. i was still getting my stuff out and m*** just THROWS a puke-bag at him and snaps, "use this, not the damn floor." angelboy glares, then closes his eyes and groans, shakes his head and falls back. i'm about to start the blood draw. i step up and then take a knee on the floor; the arm i want is the one hung over the edge of the bed. he looks at me, opens his mouth to talk, whimpers and then pitches over again, and says, "f**k this" and then rams his finger down his throat, trying to force himself to throw up.
i know the feeling. you hurt so bad, you feel so sick, you drank too much you took too much, you panic, you want it out. the reality of what you did has hit you. you're in the ER, they are all treating you like s**t; you think if you make yourself suddenly "better" they'll let you go, leave you be, forget about it. when he's doing this, i almost cried. almost. i was in this exact same room, just the other bed. 1994; trauma room 1-2. i'm shaking. then, m*** comes back in, sees what he's doing, rushes up and SMACKS angelboy's hand and says, "DONT do that, don't let me SEE you do that again, don't FORCE yourself to puke, that helps NOTHING." i glared at m***, who stepped back out. i'm vaguely aware of the conversation outside the room--i hear something like, "so this has happened before?" but i brush it off. it couldn't have. he's way too remorseful, scared, shaken up for this to be a regular thing.
only three minutes have passed since i got there.
the whole time i'm on the floor on a knee. angelboy finishes puking for now; i got up, got a warm washcloth and cleaned up his face and his hand. this is not my job. i said nothing. i tried to avoid looking him directly in the eye because now he's staring at me, imploringly. he said, "god, are you a nurse?" i laugh slightly, say oh no, i'm not a nurse. he said, "you should be," and i said i'd have to disagree. he shrugs. he's cleaned up now and i say okay, i have to draw your blood now. he nods. i said, "will you be able to keep still for me?" he whispers yes. so i finally get the draw. four tubes--2 SST's to check for any/all drugs in his system. a plain red (like the ones i have here) to check for alcohol. purple for his CBC and BNP. during this blood draw, i finally manage to look at him, because he's still staring at me, unnervingly. i say, "what did you do tonight?" he says he doesn't know. i said, "are you telling the truth about what you took, or didn't take?" he says nothing, looks away. i say, "because this right here, that i'm doing? it's going to either validate you or make you the worst liar ever. whatever you did tonight, they'll know in about fifteen minutes." he laughed a bit, said that he just drank too much. he said, he swore it was not more than four tylenol he took, maybe two. he had a headache, he said. i raised my brows; popped the tourniquet and finished the draw. "well, of course you had a headache," i murmur. "two bottles of vodka will do that to someone." he laughed. i was getting his blood pressure cuff back on and he looks at my arms. "those are neat," he mumurs, miserably. "what's it say?"
i have never just up and told someone what they mean. usually i pussy-foot around it or brush it off. or i say, 'song lyrics roughly in russian,' but don't say much more. i put my s**t away, turned back, and offered up my forearms. "hide what you have to hide," twisting the right. "tell what you have to tell." turning the left. "depeche mode," he nodded. "that's awesome." he understood, i think. i smiled a bit and said i had to go.
now, it's been five minutes. he begins to vomit again, and starts twitching and shaking.
m*** and the ER doctor come back in, and i'm told i have to do an ABG on angelboy. i go run the blood back to briget so she can get going on the drug levels. i go back, and his father looks terrified and sad; angelboy is thrashing; his eyes are wet, wild and red. there's vomit everywhere, bile mostly. m*** and the ER doctor look absolutely disgusted. they're very short with him; the nurse says absolutely nothing to him while she starts an IV. she speaks to me, "what side do you want?" i say, "uh, well, obviously the side you haven't started on?" she chuckles--except, i wasn't being funny with her.
i'm angry at all of them for treating this kid like such utter crap. i'm setting up for the ABG: betadine, 2 cotton's and 2 gauze pads. the needle is out, primed so the heparin can spread on the inside of the syringe. it's in my teeth, i'm taking his hand and straightening his arm, a towel is beneath his wrist so it can prop up; palm-side up. "this is not going to be like the blood-draw," i said around the needle. "i won't lie, it's going to hurt." m*** rolls his eyes and leaves. were it not for the fact that i still am "new" around there (well, almost 5 months now, but still) i would've told him off. i instead ranted to laura yesterday morning (that is coming, yet) all the things i wanted to say to m***. about how anything he's saying to this kid isn't anything the kid isn't already thinking about himself and the situation. that treating him this way is NOT going to solve anything. that, if this IS something that happens more than once, treating him like s**t isn't going to solve the situation.
i'm so mad i can hardly see straight. i shrug it off, and look back up at angelboy. his dad is standing at his side, the bed is propped up so he's half-sitting up. dad's arm is around the boy. "i'm going to count off, and --" "no," angelboy chokes out. "just do it." i nodded, and kept his pulse marked with my left index/middle fingers. the pinky-side of my right hand is what's keeping his right hand bent back, so that the artery is stretched taut. right before i went in, he suddenly grabbed hold of my right wrist with his fingers, holding on so tight. i nodded, and went in. some twisted sound came out of his throat and his dad softly shushed him. i murmured to hold still; that i was sorry, i know this hurt, there's no easy way to hit an artery. i tried for three minutes and i couldn't get it. i was so angry; his pulse was so fast, so strong, there's no reason i should've missed it. ...except, when i called bridget in, she missed it too. she tried two times, and i tried one more time after her, and then i said that's it. if there were something wrong with the O2 level in his blood, we'd know by now just by watching him. i told m*** to tell the doctor to either have a nurse get the ABG, or else nix the order.
they nixed it. angelboy breathed a huge sigh of relief. by now, it's ten minutes to eight; my shift ended 20 minutes ago. i had taken all my things back to the lab, and came back under the pretense of double-checking on the status/nixing of the ABG order; of making sure i'd cleaned up all my garbage (there was some other joke between angelboy and i; either bridget or i had left a glove on the edge of his bed and he'd tossed it--but missed the garbage. he said oops, and i said god, don't worry. we've thrown s**t on the floor all the time. he looked confused. i pointed to the following things: a set of my gloves on the floor, the cap of the ABG needle i'd spit onto the floor when i'd uncapped it; some cotton, some gauze. "now, you're in the club." i said. he laughed). when i'd come back this last time, i got an odd stare from one of the nurses, from m*** (who, i never really cared for but after tonight i loathe) when they saw me heading for the curtain of bed 2. "i'm getting the rest of my junk cleaned up," i said, offhand. i went in.
by now, angelboy is shivering, freezing. he's barely wearing anything. his dad asks if there's a blanket, maybe. i nodded and ducked out, slipped out quick along the wall to the storage room. i grabbed a blanket from the big blanket-cooker. i rushed back and unfolded it, and put it around angelboy's shoudlers. his dad grabbed it from the other side and we wrapped him up. the second it hit angelboy's skin he murmured something, hoarse and appreciative. his dad looked relaxed, but still concerned. i stood there and then said that i'm sorry, i had to go. by now, angelboy is pretty much out of it; he keeps coming in and out, eyes rolling closed, rolling back open. he's murmuring things, we can't understand him. i said to his dad that i had to go; i was pushing overtime and besides, the labrats are supposed to be in and out, and i think i'm not supposed to be here. the dad shook his head, and said he was GLAD i was there, and waited around. "you've been so nice, thank you so much," he said, quietly. i smiled, wanted to cry.
i backstepped and angelboy says wait. i look, his dad looked. he stared, but he was also staring like, through me? he stared, and he said, "thank you.. fire-hair... you're a fire-haired angel. thank you." then, he was out cold.
his alcohol level via our lab test was 214. his acetaminophen level was well in the normal range. he was telling the truth about the pills. i hope the ER staff choked on it.
i am not sure, exactly, how you calculate a "BAC" from bloodwork, like what you'd breathe if you were pulled over (for instance, .08 is most states limit level; .10 is "obvious impairment and illegal in all states," and such) and had drank as much as he had. all i know is when the report printed it was in red, and listed as "stat critical high." and i've always thought 2 bottles of straight vodka would kill someone, or their liver. it wound up that angelboy was admitted inpatient to be monitored through the night, though. i didn't find this out until yesterday morning. tox screen monitoring, cycled alcohol draws.
i also found out that, when i peeked through his labwork history (thusly finding out how old he was and feeling sort of 'oops' though i'm not sure why... i know this is "illegal" but when i entered in his tests from tuesday night it was all right there in front of me, so it's something i DO have access to) that he has, in fact, done this before. three times before, in the last year and a half, to be exact. so... perhaps that's why everyone was so exasperated. rob is who drew him yesterday AM at 5.30, and when i asked how he was he rolled his eyes and bit back a sardonic smile, and said, 'oh, he'll be just fine.' his level that morning was 64.
on my break i went to visit him, i asked one of the nurses if it was 'allowed', if it was okay if hospital staff visited the patients. she asked who and i gave his name. she said, 'oh, do you know him?' i said no... but that i helped work on him in ER the night before and was just worried. she nodded and pointed to the corner room across from the nurses station. a private room, door bolted open so he could be monitored.
i stepped in, his dad was there, and angelboy looked much better. he smiled, and then said, 'oh no, are you here to poke me again?' i laughed and said no, i just wanted to stop in and see how he was doing. he said better... just drained. "i have a terrible headache, oh god.." he said, then paused, and said, "i know i know... two bottles of vodka will do that." i was surprised he remembered any of that conversation, for as out of it as he was. i wonder if he remembered how he stared. maybe it was beer goggles. or, vodka goggles. either way i didn't want to be creepy, so i just said i hoped he'd be ok, and that "i don't mean this how it sounds, but i hope i never, ever see you again." he grinned, said he knew what i meant. his dad thanked me again, shook my hand.
he was released at 12.30 yesterday.
i was also semi-attacked by one of the schizophrenic patients at oceana house, yesterday. or well, the mental health clinic. that's really not a big deal. shaken up but he must've been off his meds or they were adjusted. i'd drawn him countless times before and had convo's with him... this time, he screamed at me about 'stopping them all,' and his 'eighteen month trip to the moon' and how 'up there he could see everything' and how 'he'll stop all their bombs and that way armageddon won't come' and ... so i did as i was told, trained. talked to him like oh yes, what he was saying was totally normal. it was going surprisingly well, actually, until i was about to draw him and said something like, 'i'd love to see it up there, how could i get there?' and he flipped out; lunged at me and shoved me once, then twice so i was up against the wall. pinned by his forearm at my throat by the time his caseworker got him off me. said stuff about how YOU CANNOT GO THERE and ONLY I CAN and IT TOOK SO LONG TO GET THERE and HE WILL STOP THEM ALL. he was staring over my head the whole time. i almost pissed my pants, i swear.
ok, shi wants the computer now. i had to get angelboy's story down though. i still haven't mentioned the convo with laura... but she knows my history at that hospital, about the OD at orchestra camp and how i ended up there; that i turnt down the externship i could've had because of that... how the first time i went to that ER during training in october i hyperventilated and freaked out. she said i'm there for a reason. she says she doesn't believe in god but she does believe in fate, and she said something made it so i didn't get hired in anywhere in muskegon (aka not a 40 minute drive away from home) even though i'm just as qualified as anyone else. something brought me there, and now i'm here and something had it so that two ODs, now, have occured on my shift. she said yes, the first one was very hard; this one was also hard and more personal, but very different from the first.
she said, 'maybe next week, maybe tomorrow or in a month, there'll be a girl who is brought in who is fourteen and who has OD'ed, and if it's you who is working then you've got to put it aside, and help her out.' she said that there is a way to care without losing it, there is a way to be empathetic without it hindering your work. she said m***, and some of the other nurses, hit a mode when they're helping anyone out. she said to pay closer attention... and i HAVE noticed m*** will shout at heart attack patients (once i was trying to do a draw and he was HOLLARING at this 80 y/o woman to hold still for me and i was like "GOD she's not MOVING just chill out, i've got her just fine!" and .. he had no idea what he'd done wrong. still, i loathe him.) or anyone, really, when it's life-saving time. n*** goes on dead-eyed but soothing-voice autopilot. nurses become stone walls, working methodically. i don't know, though.... i can't do that. i don't want to.
and i told laura i'm 'just a phlebotomist,' it's not my job to be there and make sure they're ok and hold their hand and get them blankets and hang around longer than i should; that i wanted to for the woman a week ago, too, i wanted to stay until she became conscious but they MADE me leave. but before she could say it i said no, i don't want to be a nurse, i couldn't. i'd wind up having an aneurysm after a week. she gave me a hug and said she's so glad i came to work there. that i'd be fine.
we'll see.
my void does not want.
-- 2.13.61.
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timmy
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Has no life at all |
Location: UK, in Devon
Registered: February 2003
Messages: 13802
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I think you can be my phlebotomist any time.
We need to feel human. ER is not a meat packing plant, though I can see why the staff get angry at self inflicted stuff. It "wastes their time". Except it doesn't. Because self inflicted stuff is the symoton of what's wrong.
I'm glad you were there. Thank you for telling me about it. Not "us". "Me". Because I feel you were speaking to me directly.
Author of Queer Me! Halfway Between Flying and Crying - the true story of life for a gay boy in the Swinging Sixties in a British all male Public School
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cchd
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Getting started |
Registered: May 2004
Messages: 16
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I've been into ERs rather too often (not for myself but for family and friends). I've also had the opportunity to speak to various doctors there (while trying to pick up the occasional one or two  ) I've always felt that many of the doctors and other emergency staff treat patients the way they do as some sort of mechanism to allow them to cope. I'm not saying it's right, just the way it is. Personally, I think a job where maybe 20% of the people you attempt to treat die.
I also wonder what your 19yo was attempting to hide from? I recall being that sort of age and drinking a dozen bottle of scotch a week. Probably not good for me but I finally decided that hiding in an alcoholic haze didn't really solve anything.
Thankyou for sharing the story. One question, exactly what role do you have in the ER - I realize that things are different around the world, but down under only nurses and doctors are allowed to take blood (as far as I understand things).
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As a clinician, and yes, despite being someone who is not overly involved in direct patient care, you are a clinician, one of the most powerful tools you have is objectivity. It allows you to do the things that you know to be best for the patient, without coloring your actions with your own wants and needs--even if what is best for the patient is not necessarily what the patient thinks is best for the patient.
It could well be that what that boy needed was to see exactly how stupid he was being, as reflected back to him by the attitudes of the nurses and docs in the ER, because objectively speaking, what he was doing when he drank two bottles of vodka and put himself in the ER with alcohol poisoning, was really, really stupid. And if having a really lousy experience in the ER with docs who had no patience with his stupidity would help him to see that for himself, then what they were doing was the right response. And it might even move him towards getting some real help for his problem, whatever it was/is. Because let's face it--medical attention to a problem like this kid has is essentially just a bandaid over a gaping wound. He needs help with the root issue.
This is not to say that there isn't a time and a place in medical practice for caring, loving souls. I'm a LTC/hospice nurse. One of the things that makes me good at what i do is an ability to project loving care at my patients, and to help them with some of the loneliness and isolation that they feel when they're severely ill and/or dying. I know it sounds cold, but even as i'm fulfilling that need for them, in my head i'm observing and collecting data and testing theories on what i need to do to help them even better. It's a tool in my toolbox, and i use it to improve the lives of my patients, but I can also maintain my objectivity with it.
I don't know for sure, but i suspect the reason that the staff sent you away when you went to visit the woman in the hosp. that time, and the reason that they were reluctant to have you around this young man, is the fear that you would become "over-involved" and lose sight of your boundaries with him. I don't know about you, but i know that for me, if i had to draw blood on a close and dear friend that i knew was scared to death of needles, I'd have a harder time doing it than i would for a stranger, even if i knew he had a fear of needles.
In the final analysis, the question we all have to ask ourselves in these situations is this: who am i doing this for? Am i doing whatever it is that i'm doing because it benefits the patient, or is it about me?
cheers!
aj
"I promise not to try not to fuck with your mind/ I promise not to mind if you go your way and i go mine/promise not to lie if i'm looking you right in your eye/promise not to try not to let you down."
--Eve6
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aj, i definitely see your point here. and i know that a lot of times if someone does something "stupid," being shown such by way of how they are treated by those "treating" them, is necessary or the chosen option.
however, i've been in his position. that was kind of my point... and while each person is different, i know that from my experience laying right where that boy was laying (mine was an intentional suicide-OD, not 'oops i drank too much') that being treated like a horrible excuse of a human being, being degraded and yelled at, did not show me anything. it, in fact, only reinforced my feelings of being worthless and not deserving to live, and so a week later i tried to gas myself in my garage but was caught halfway through.
....
that's just me, though.
there is definitely more at the root of his problem, that a night in the ER or inpatient will not solve. i know that they don't want me to get too "close" to patients. i think that if M*** knew how i felt or that the situation was a personal one, he would've eased up, or wouldn't have let ME see him be that way. i was told by someone else at work who is friends with him that "he would've been heartbroken to know he had you so upset." strange.
for myself, i would not have a problem sticking someone who is a close friend or relative... i mean, it'd be FAR more nerve-rattling, yes, especially in a trauma/STAT situation, but i could do it.
the other day i drew on a lady who was as good as dead when she came in. had fallen on a shovel and laid outside all night long in 9 degree weather; somewhere through the night she had a stroke. like i had just pulled the needle out of her hand and she coded, and died. i sat there on my knee on the floor where her hand was hanging, covered in her blood (it was dripping down her arm from a stomach wound and how she'd been laying) with the draw tubes in my hand and just was in shock. i held it together, though, better than i would have say, a week prior, or 2 weeks ago. so, i'm getting there.
i wound up getting sick the second i left the room, and N***** (the other ER medic that isn't as jerky as M*** is) took me to the dining room for coffee. it was surreal. they all took it in stride and i wad shellshocked the rest of the day, but i at least held it together this time.
so it wasn't about me, and i put "me" aside for that situation. i did put "me" aside for vodka-angel-boy too... it doesn't seem that way, but i did. because i did the job i was sent there to do (i didn't get the ABG but my tech couldn't get it either--those are tricky to get) and i did it efficiently and quickly... i just also cared for the patient. i didn't baby him... he knew that i knew damn well what he did was stupid -- i simply coveyed it in a matter-of-fact way, not by degrading him, which i posted about. yesterday my coworker and i talked of all this; it came up because of another trauma situation last night. she said that they (the ER people) wouldn't think bad of it if she went back to visit/see/check up on random patient there, even if she's "just a tech". she said as long as you first do the job you're meant to, and you are not hindering care, then it is ok.
i really appreciated your input, aj.  thank you for answering me and giving me other things to look at and think about.
my void does not want.
-- 2.13.61.
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that lady who died on me the other day ('the other day' being last week wednesday) was the first time i'd had someone die on me. so considering that, i think i had done ok... the only other time so far i've been around death like that was having to pull blood from a body 12 minutes dead. the medical examiner said that we do it unless the body's been dead for more than 24 hours. had nightmares for a week after that.
my void does not want.
-- 2.13.61.
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That would be a little difficult. Death is not a little thing--it's a tough to face. I see a lot of it in my job, but it's not violent death, and except for the AIDS patients that i've cared for, it's all very aged folk who have lived long and fulfilling lives. In addition, my father was sort of the undertaker in my tiny little hometown, and i often went with him to help dress the bodies of those who had died before they were buried, so bodies are something that i've seen a lot of over the course of my life.
But, there's a big difference between what i do and working in an ER, so kudos to you for being able to handle the results of violence and accident that you see in your job. You're doing tremendously well!
Last point--I don't mean to say, in my first post on this thread, that you should be a cold and mechanical asshole who treats people like shit, even when they've done something self-destructive and what many would view as 'stupid.' A kind face and someone who cares in an ER is a wonderful thing. And i certainly didn't mean to say that kindness gets in the way of doing your job well. I'm sure if that were the case, the others at your job would have said so.
cheers!
aj
"I promise not to try not to fuck with your mind/ I promise not to mind if you go your way and i go mine/promise not to lie if i'm looking you right in your eye/promise not to try not to let you down."
--Eve6
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Re: the fine line between patients and medical workers.. 
