Crazy Saturday night in the ER

I went into the ER yesterday for my second preceptor session with Dr. Vaughn Browne. It started off rather slow in the afternoon but turned into quite the night.

There was the guy who came in with possible neck and intracranial injuries after he was hit repeatedly with a blunt object in a drunken fight. It took four security guards and a team of doctors just to keep this guy down, he was thrashing around so bad. "I'm a human being, not an animal!" The decision was finally made to intubate him (sedate him with assisted breathing) in order to protect his neck and head injuries. During all of this, I stood by as a passive observer, shocked.

Then there was the Pentacostal preacher who prophesied the night before that God would inflict him with pain so that his congregation would Believe. He came in with ambiguous chest and flank pain and brought with him half his congregation camped out in the waiting area. The whole work-up was done on him, just in case there was actually a medical basis for his pain, but I'm not sure how that turned out.

Learning how to insert an IV line

Toward the end of the night, I spent some time with Vicky, a nurse who taught me how to insert an IV line. After all of the passive observing I had done so far, I was eager to actually do something and to pick up a new skill. My first patient was a sweet old man who called himself a "professional patient." He was having a tough time of it with kidney problems. His veins were particularly difficult because of his chronic illness, but I was able to get the line in on my second try with minimal fumbling.

My last case of the night was a drunk driver who got in a minor accident that didn't involve anyone else. This guy was very, very drunk. "I'm not sure if this is the best person to practice on," I told Vicky, wary of him becoming belligerent and uncooperative in the middle of my novice attempt to stick him with an IV. Two security guards were in his room, and two more were hanging out outside in case he got out of control. "Come on, he's the perfect person for you to practice on!" Vicky replied with a twinkle in her eye.

At this point, the two security guards were arguing with the patient, trying to get him to lie down. "Watch this," Vicky whispered, "I'm gonna sweet talk him. I'll put on my mommy-face, and he's gonna give us his veins." Vicky has been doing this whole nursing thing for quite some time, and she's good. She calmed the man down in no time, introduced him to me, and before I knew it, I was this guy's best friend. Of course I could take some blood, no problem! In the middle of the procedure, my best friend started thrashing around. All four security guards descended on him, but I had already lost the vein. "That was his fault, not yours," Vicky reassured me. With security holding him down, I got it on the next try. Adrenaline was pumping when I left the room, and I didn't really calm down until I got home.

"Now try doing that in the back of a speeding ambulance."