Bonne Nuit

i've been pretty bad about logging my daily stories. but i realize that after my shifts i am successfully exhausted and the last thing on my mind is to relive the events by logging them for a second time on my blog.

tonight i will simply tell of the events i encountered in my 8-hr stint in the ER.

My shift begins at 1800. As soon as I walk in, the physician ushers me over to a patient brought in by ambulance who was asystolic upon arrival due to a cardiac arrest. The patient was a 99-year-old female who was found in her home unconscious 35 minutes prior to arrival. Patient was full code. After 3 rounds of epinephrine en route to the hospital, 2 more rounds of epi in the emergency room and 20 minutes of CPR, patient was pronounced approx around 1825. Patient was cachectic and looked like a skeleton. I have never seen a body so thin and frail. Her arms and legs were bent and stiff in a pseudo-fetal position and her skin hung loosely around her bones. Her skin was pale, thin and dehydrated. The most shocking part to me were her boobs. They looked like saggy, shriveled, thin latex bags that stretched and drooped around her chest. There was no fat or muscles in her body. Literally skin and bones.

This was my second death I encountered in the ER. The first was last Friday when an elderly patient was taken off life support. The family was brought in to say their last goodbyes and the priest administered the last rites before disconnecting the patient.

Around 2100 tonight I experienced my third death in the ER and my second death of the night. This was more impressionable because he was only 54-years-old and was brought in with no significant signs of immediately life-threatening symptoms. His daughter said her dad came home from work today feeling dizzy, light-headed and tired. He began to feel weak to the point of being slow to respond so the daughter brought him to the ER. Upon exam, the patient was lethargic but responsive. However, his blood pressure was extremely low around 59/87. While in the ER, the patient was bradycardic and began having bradypnea with labored breathing. He then proceeded to show signs of cardiac arrest with no pulse. The staff administered up to 20 rounds of epinephrine and 50 minutes of CPR with intermittent low heart beats but ultimately pronounced an hour later. Family was at bedside. I think the hardest part was watching the family watch their father pass away in front of them with the medical staff surrounding him helplessly. He was awake and breathing (albeit unhealthy) only an hour ago. It didn't help to think of my own father who is only a few years older than the patient. Life is short.

This reminds me of the 5-week-old baby boy I saw in the ED on new year's eve. His mother brought him in for a fever and cough but while in triage, the baby stopped breathing and turned blue. The nurse called a code white (pediatric emergency) and the entire emergency room staff was at bedside in a matter of seconds as the nurse administered mouth-to-mouth resuscitation on the infant. Thankfully, the infant regained oxygen and began breathing. The patient was given respiratory treatment and worked up for tests. A lot of his tests were abnormal and he was transferred to CHOC. His mother was tearful at bedside the entire time, understandably in shock. For me, the most surprising and saddest part was that she was by his side alone. During the entirety of their stay in the ER for about 6 hours, there was not a single visitor for the child or the mother of the child. It is likely that the father of the child is not present in his or his mother's life. Another interesting anecdote: the nurse that administered the CPR did the old-school direct mouth-to-mouth instead of using one of those things you use to help administer the CPR. Afterwards, she popped a listerine strip in her mouth and said to me, "sweet baby but boy did he have bad breath!" LOL who would've thought of all things, babies have bad breath too! especially when they are not breathing o_o
Also, there was a bit of a discord among the nurses because of the old-school way the nurse performed the CPR. Apparently, you can get into a lot of trouble for doing that. But she's also one of my favorite nurses so I was sad that the other nurses were lowkey talking behind her back. Her husband is a pastor and they served as a missionary in Bangladesh for several years before moving back to the states. She has 4 kids: 2 boys and 2 girls, how perfect! Such a kind and nice lady. One of my favorite nurses to work with for sure.

This story also reminds me of the other day when we had 2 intubation patients back to back. That was pretty cool (the intubation procedure, not the need for intubation AKA patients not being able to breathe). I've also been seeing a fair share of lacerations which are actually my most favorite thing to observe in the ER. I get so tempted to practice sutures. Today I also got to see an I&D (Incision&Drainage) of an infected abscess that was pretty much a ginormous pimple-popping type of procedure on a teenager's knee. I have no idea how it happened but it was grossly infected and the doctor had to cut it and squeeze out all of the pus. I low-key was scared that it was going to squirt on me so I stood as far back as I could while maintaing a good view of the procedure.

That's all for tonight. More fun stories to come next time! I hope to get better at writing these things and collecting my thoughts more frequently. For now, bonne nuit.