A not-so-average shift

Last night was one of those nights were I got worked hard, and put up wet, but was actually had a Hell of a time.

It was hard, demanding and stressful work, but I actually felt like I was 'living the dream.'

To give you an idea of what it was like, here is a list of the patients (sans personal info, of course) that I tended to:

• A 21 year old male who was involved in an MVA and shattered his pelvis. Got props from the family for spending a few minutes outlining what would happen in the next few days; apparently, they were nonplussed with the lack of communication from my surgical colleagues
• An 80+ year old male dying from cancer who was admitted for anemia and hospice consultation
• A 30 year old female with Fibromyalgia and Polymyositis presenting for the 179th time to the emergency department for nonspecific abdominal pain. She was on high dose steroids and immunocompromised, so when I actually found some stuff, I admitted her, although I came to suspect she is a drug seeker. 
• A 20-something thrown from his motorcycle with a cervical spine injury. A 9mm pistol fell out of his waistband when we stripped him. More on this later...
  
• A 70-something non-english speaker who had a total knee arthroscopy last week, and is now infected.
  
• A 12 year old boy who was unrestrained in an MVC, and broke his leg
• A 30 year old male with a shunt who came in for concerns about shunt failure. Workup was negative, but Neurosurg wanted huim watched. Again, I came to suspect that he was a drug-seeker.
• 60+ year old female noncompliant with her psych meds and a UTI brought in because now the voices were telling her to do stuff to herself and others. At least she has good insight.
• A 30+ year old male in a rollover MVC. Admitted for pain conctrol
• A 70+ male who was brought in for mental status changes. Afebrile, falling more. He was admitted for TIA. He spiked a fever 5 minutes after he was sent upstairs. I got called about that, and told them to start antibiotics. I will have to review his case when I get back, and see if there were any clues I missed.
• a 50+ former Marine who epitomizes those patients that are too tough to die. Metastatic Cancer, Heart failure with an EF of 10-15%. He had gotten dehydrated and his kidneys failed. We got along well; he would call me a quack with a wink and a smile, while I called him a wimp with the same snide grin. We both laughed at the mortification of his family.
• A drunk who was found trying to hang himself with his shoelaces. He was a complete a$$hole to the staff until I hit him with a5mg shot of haldol. He is an excellent example of why we should give people with psych issues the choice between a prescription for zoloft and a subscription to guns & ammo.
• A 94 year old lady with acute Congestive heart failure. I managed to pull out all the stops, and took this patient from being ready for intubation to pretty stable in an hour and a half. She would probably have not gotten off the vent once she was put on. So, I guess I managed to buy her one more trip home.
• 12 year old girl struck by a car. She was actually in remarkably good shape considering the mechanism of injury. She was psychologically in shock, even though she was hemodynamically stable. Poor kid, I tried to comfort her the best I could, but it's kind of hard to do when she is in a scary and alien place where all she knows is all kinds of people poking and prodding her, and sticking her with needles, and her parents are nowhere to be seen.
• On top of that, I was involved with a patient who went into V-fib . She got a pericardial thump (no, not by me; that would have taken her from dead to buried), and then we shocked her, and brought her back. After she woke up, she had this kind of confused look on her face (no wonder, there), and the attending said (I kid you not): "don't worry; we just had a little problem there, but everything's okay, now." Excuse me? A 'little' problem? is that what we call it when a patient's heart stops?

It was an eventful night. About the 9mm..

So, just last week, I had given a presentation to the residents and attending physicians of our Emergency Medicine program concerning ballistics, gunshot wounds, and forensics. Included in this lecture had been a very short piece on what to do if a patient comes into the trauma bay, and a gun is found during the course of an exam. Yeah, yeah, yeah; the paramedics should have found it already and handed it off to cops on the scene. BS. As much as some docs will chew a paramedics a$$ for missing something, the fact of the matter is that they have to operate in difficult and chaotic environments, and while I can forgive a medic for not seeing and important finding on examination, I cannot forgive them for trying to do everything by themselves before the patient shows up, burning valuable an irretrievable time in order that they can show me what they know. These paramedics did a great job. the guy was alive, even if he was paced externally, and not intubated. Anyway, while this guy was getting log rolled to inspect his back, a 9mm S&W fell out of his waistband. The poor nurse that was right there, who is a little sweetheart allmost fainted when that happened.  Having just given this lecture on what to do, I expected that someone would do what I had just instructed a week before. 

Well, of course that didn't happen. No, they took a live pistol, and placed it on a desk being used by the charge nurse, and everybody else. Even worse, the barrel was pointed straight down the line at the trauma team! In the spectrum of firearm safety, you have everything from nazi safe; where you can't train because you can only shoot one bullet at a time between making the pistol inert, to the reasonable safe, which is the usual, to the reasonable unsafe, where you have stuff like 360 degree live hot ranges, to the unreasonably unsafe, and then there is the suicidally unsafe. Well, this practice stops just short of suicidal, but only just. SO, I scooped up the pistol, dropped the mag, and locked the slide ot the rear. Turns out the gun was in condition three, so there never was a real danger, but man....that was just shocking stupidity.

Anyway,  to hear one of the nurses relay the story, everyone was kind of unsure about how to proceed, then I grabbed the gun, and a few seconds later it was in several pieces. It's very amusing to hear.

Anyway, last night was a Hell of a shift, and almost makes me love my job.

Respectfully submitted,
-doc Russia