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The first week is over, more or less. No blood, no foul -- right? Not that there aren't a lot of scared wild eyes meandering around the hospital in a daze, but as best I can tell, most of the incoming interns are doing okay.
On the other hand, I ran into a 'tern from another department a few days back who looked crushed. He was down in the E/D, writing up admit orders on a hit.
"How's it goin'," I asked in a sorta conspiratorial whisper, as I sat down next to him to do some charting.
"Aw man - I think I'm outta here. I've got to find another program."
The poor soul looked up at me with injured deep-ringed eyes.
"What did you say?" I asked quietly, reeling.
"They're killing me. I don't know where I'm going. I'm lost. I need help, and my upper year doesn't want to be bothered. I can't take this."
"Brutal," I thought. "That sucks," I said, referring to the upper-year who evidently thought sleep to a higher priority item than patient care or teaching. "Ah - " I looked away for a few moments, then back. Frustration and pain were scrawled on the 'tern's face as he turned back to his admit orders. "One of the chiefs down here might be able to help if you're really deep in it," I said, at a loss for anything more helpful. No response. "You'll be okay -- really." It felt lame even as I said it. I keep hoping that things leveled out a bit for the poor guy...
Worked the high-acuity side a few days back - had a blast, but didn't handle anywhere near the volume of patients I should have. That'll come with time, I think. (I hope...)
About midway through the day, one of the upper years asked, "You hear about that trauma coming in on the helicopter?"
"Well yeah, a little bit," I responded.
"You're running it. Get ready."
I looked back with big eyes, suddenly numb to everything but my ringing ears. "Don't worry, you're not going to be alone."
The kid came in about ten minutes later. I helped wheel the stretcher into the room, transfer the patient to the bed, and started reciting the trauma mantra to myself. Airway, breathing, circulation, disability, exposure. The kid was talking, so I knew the airway was okay, at least for the moment. Went to listen to breath sounds, checking several times back and forth to make sure they were equal, and next thing I knew the upper year was running things. I immediately dropped back into the role I'd become accustomed to in medical school: Get monitors connected, make sure lines are running, report what you see, listen for orders. Within several minutes we knew the score, and the kid was in the pipe for definitive management.
"I'm sorry I took it away from you," the upper-year told me afterwards.
"No, no - it's okay," I said, meaning it completely. Apparently folks had been asking me what was going on, if breath sounds were equal and the like, and I simply didn't hear the questions, intent as I was on making sure I didn't fuck something up. Its not so much that I froze up as became autistic, trapped in my own nervous little world.
I knew what I needed to do, and how to do it. As a bonus, the child wasn't hurt too badly, but there's really no way we could have known that until the initial evaluation was complete. Even so, I dropped the ball. I'm not happy about it, I'm really not; and what's worse is that I feel like I let the upper-year down. The child, you see, was never in any danger of suffering from my incompetence because I had backup. The upper-year gave me a vote of confidence though, and I didn't do too well. I don't like that at all.
I can sum up working July fourth in six words:
BOOM! "Ouch. Where's my fingers at?"
Of course there was a lot of routine stuff as well, but that's what sticks in my mind.
8 July, 1996
Rode with Wilkinsburg EMS today. Prehospital care is part of emergency medicine, so the Powers That Be have arranged for us to get some exposure to it. I'm all for it - Emergency 'medical Services is a blast.
As I was driving out to the station, I passed a car accident. I thought about stopping to offer assistance, but decided against it. The headline blazed in front of me: "Well-Meaning but Stupid Intern Gets Aced Trying to Cross Six Lanes of Freeway Traffic" Nah. Got to the station three minutes later, and was told to toss my stuff inside and get in the ambulance.
"We're heading to exit such-and-so, inbound on the Parkway," I said. The EMS guys looked at me as if I were radioactive.
"Ah yeah, but how - "
I interrupted him, grinning. "I passed it on the way here."
"Oh."
Some time later I finally got the chance to tell them what I'd meant to say on arriving. "I'm very new to this. I don't know what I'm doing. I want to help you guys out and learn as much as I can, but if I get in the way, fer chrissakes tell me to move."
They smiled and laughed. "Don't worry - we will."
Our second run was another car crash, with several injured. As we piled out of the unit at the scene, Mike said, "help them." We'll handle this over here.
"Them" was the two 'medics working with what was clearly the most seriously injured person there. The one 'medic looked at me and said, "go to the truck and get an IV set up."
I take direction just fine, especially from experts, so I trotted over to their ambulance and rooted around for what I needed. In the process of spiking the bag of saline I managed to poke a hole in it. Lovely. Now Marcus has soaking wet pants and a useless IV setup. A bystander chose that moment to walk up to the back doors and ask, "Do you have anything I could use to clean my hands?" I yanked the spike out and tossed the bag at her. "Here, use this and please step away. I'm busy."
After I finally got the first bag set up, I did another one just for good measure, then went back to the car. The woman inside was accordioned down on the floor, trapped by the wedge her badly broken leg had made under the dash.
"Please don't cut my legs off. Please - OW - please, I want to walk again - Ahhh, fuck, my fuckin' leg -- "
Seat-belts are Good Things.
Her face was cut very badly, and she had a hell of a gash on her arm. She was scared out of her mind.
"You have to hold still Frannie - don't move your head, okay? We're not going to cut your legs off, I promise."
The 'medic who was in the car with her tried to start a line and missed it through no fault of his own - she was flailing about like mad. Through some strange beneficence of the gods, I managed to get one started in the back of her hand on the first try.
"Showoff doctors," I heard from somewhere behind me. There was laughter in his voice as I turned around to present the hand to him so he could tape the IV in place while I protected it.
About a minute later the fire-fighters showed up with their hydraulic nightmare tool to bend the car apart so we could get her out of it.
"Hey, hey! Don't mess up my beautiful line, dammit!" I said as they were setting up. I rushed around to get it out of their way. The 'medic crammed into the car with her looked up at me, and tried not to giggle.
"That's priceless. Best phrase of the day. `Don't mess up my beautiful line.' I love it!"
She screamed non-stop for forty seconds when we pulled her out onto the backboard. I looked at the fire-fighter behind me and said through the din, "well, at least we know her airway is okay..."
He scowled and shook his head, "yeah, and her lungs too."
In the ambulance on the way to the hospital, she got kinda quiet. A minute earlier, she'd been saying again and again, "I don't want to die, please don't let me die." Now nothing. Quiet is worrisome - she had some very severe injuries, and I was scared to death that she could be losing a lot of blood internally.
"Hey Frannie! Frannie, talk to me!" Nothing. I was just getting ready to do the ol' sternal chest-rub when a bump in the road caused her leg to move a bit. "Owww! My fuckin' leg!" Good.
When we got her into the trauma bay at the hospital (not my hospital, by the way - there are several trauma centers here in Pittsburgh), the medic started giving report. He said at some point, looking at me, "...and the doctor - "
The person who was heading the trauma team turned away from him to look at me and said, "doctor?"
I said, "Ah, yeah - "
"Good. What happened?"
I didn't know what to say. "Well, it's just like he said. Umm - I got a pressure of one-ten in the ambulance."
"Did she get any blood?"
I looked back, dazed. "Blood? No." I was thinking to myself, "how the hell would we give her blood on an ambulance? Ambulances don't carry blood -- do they?" and then, "why the hell are you asking me this? I'm just an intern, and these guys are pros..."
Anyhow, we left her in their incredibly skilled care, and went to a restaurant near the station for dinner. Some hours later my shift ended and I grabbed a beer down on Southside. Came back here to scribble this down, and now it's time for bed. Hell, I gotta work later today, two to midnight.
Hey - drop a line if you're reading this, okay? Take care, all of you. See you next week.
Names and pronoun note: This is real stuff about real people, in real time. As a general rule, I default pronouns regarding residents or attendings I work with to "he" or "him" or whatever. This should not be construed as meaning that all the people I work with are men; far from it. I really, really don't want to identify folks who I haven't asked about this though, so there you have it. I also realize that the folks I work with have names, and believe it or not, I actually remember most of them. If I name a patient, you can rest assured that I made it up. If I name a co-worker, it'll be made up unless I asked about it first.
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