Sometimes You Don't Want to Know
Life In the ER Can Be Dull
Life in the emergency room tends to be either feast or famine. Your shift might drag interminably with nothing to do. You don’t want to hope for a multi-car pile up on the interstate, but you wish something would happen. It could be just plain dull sometimes.
Then there are the other times.
Things were quiet on the psychiatric floor so I went down to the ER as I often did, to see what was happening and keep my medical skills honed. Dan the triage nurse dashed into the room where I was helping quiet a four year old who needed stitches.
“Rich said to let you know there’s a problem coming in,” he told me. Rich was the ER attending that day. I glanced up and nodded. “ETA?”
“Five minutes give or take.”
I nodded again. “Almost done. Please let me know when he gets here.”
Dan rushed away.
The Patient Was In Shock
The staff were triple timing. A self inflicted GSW (gunshot wound) to the abdomen would arrive soon.
The ambulance guys called a few minutes out. “Profuse bleeding from the left lower abdominal injury. Shocky. Heart rate 150. Blood pressure 60 over 40. Gonna need blood so be ready to match and cross some for him.” I could hear the driver, Keith I thought it was, over the microphone.
“Yeah, he’s awake. And talking. And belligerent,” came the answer to our question about whether or not the patient was conscious. “Oh - and just so you know,” Keith added, “the smell of stale beer and whisky is strong enough the whole crew has a contact high.”
We were ready as they unloaded him.
“All yours, Doc. Have fun” Keith said to me as he and his crew gathered up their safety belts and stretcher and took their leave.
Rich the ER attending was barking orders as the gurney was moved from the ambulance into the single large room that was our rural ER. I was on one side of the patient trying to find a vein to run an IV into, not easy to do when someone is going into shock. A nurse on his other side was cutting off his pants.
Stabilizing the Patient for Surgery
Because of his gunshot wound the patient had lost a considerable amount of blood. When you lose enough blood “shock” occurs. The body pushes blood as fast as it can to every part of the body in order to keep the vital organs and limbs intact. Therefore, the heart rate rises. Because there isn’t enough blood to go around though, the blood pressure falls. It was clear that our new patient was in shock. He would also need surgery to clean the wound and stop the bleeding once we had him stable.
Jack, one of the surgeons, happened to be in the ER at that moment and stopped to check in. The man would be in his care before long.
It was our job to get the patient stable enough to be put under anesthesia. Then, whatever amount of bowel was left could be reconnected, the abdomen explored for other perforations and the hole closed.
Jack moved the heavy gauze bandages, now soaked with dark blood. A small amount of brighter red seeped out from underneath as he observed the damage. Then he stood back, lifting his right arm bent at the elbow and cocked his fingers as though holding a gun. “The way I see it, you’re right handed, held a semiautomatic and you aimed down at your left side, right guy? Kind of a clumsy way to hold a gun. Obviously not going to kill you very fast, if that was your intention.” The man mumbled something I didn’t understand.
Jack walked away while we worked to get our new patient’s blood pressure up and his heart rate down. “I’m going to take a nap. Call me when he’s ready,” he said over his shoulder.
The bleeding was a slow steady ooze now, not a pulsing flow, so we knew we were heading the right direction. Things were settling down and our activities eased up a bit.
It was almost quiet.
A Lot of Alcohol on Board
Some of the lab test results were back with the blood alcohol level (BAC) highlighted in red marker.
”BAC 0.37,”Dan read out loud.
“Better give him a shot of Vitamin K,” I said to Rich, who nodded. We all knew that if he was an alcoholic, likely since he was still awake and belligerent with a BAC that high, his blood would clot poorly, making his bleeding last longer. Vitamin K is an essential part of the clotting pathway and was routinely given to help coagulate the blood.
It looked like it was time to put on my other hat, the psychiatrist one, and find out where the patient’s head had been. That is, if I could make him understand through the alcohol-induced haze. By now we knew the man’s name. One of the nurses had found his driver’s license in his pocket and confirmed that he was Mark S.
Finding Out How It Feels
“Mr. S,” I said, “Mark, can you hear me?”
He grunted something.
“Mr. S. I want to ask you some questions. Is that alright?”
He responded with a slurred “yeah.”
“Mr. S., did you mean to shoot yourself?” A cardinal rules in this business is to not assume you know the answer to a question when you ask it. You may have an idea of what the response will be, but you may be surprised.
“Yeah,” he confirmed.
“Why did you do that? Were you trying to kill yourself?”
One of the nurses muttered under her breath, ”Why else would you do it?”
“Naw,” he said. “I don’t wanna die…” his voice trailed off.
I look at the nurse who had spoken, one eyebrow up. I didn’t say “See?” but my expression showed it.
“ Did you just want to injure yourself, or what?”
His eyes looked over at me for a moment before he closed them again, the strain obviously too much. “You really wanna know?” sounded more like “ya rilly wanna know. ”
I assured him I did.
“Wanted to see what it was like.”
“You wanted to see what it was like?" I repeated, to be sure I’d heard correctly. "To shoot yourself?"
Several of my co-workers within earshot looked disgusted, just as I felt. I looked around at all the equipment, the number of people who had worked so hard to keep this man alive, the IVs, one pouring blood into a vein while another was pouring in medications to reverse the shock and reduce the risk of infection.
I shook my head. “Well, how was it?” I asked with more irritation in my voice than I intended to show.
“Great, man. Beautiful. Just beautiful.”
Image of ER by: digidreamgrafix
Image of ambulance crew by: michaeljung
Image of patient in bed by: Antonio_Diaz
Image of bottles by: Bialasiewicz