If you aren’t listening to the Annals of Emergency Medicine Audio Summary – you should be. I’ve been privileged to be part of the team since January. Subscribe!
My bio on the Annals website:
A few years ago I became a CPR instructor for no real reason other than I wanted to. My very first CPR class had a half dozen students from the theatre department where I was doing my undergrad.
Fast forward a few years.
I get a text from one of the students in that class.
“Thank you for teaching me about CPR and choking. I just saved my 6 month old’s life.”
It stopped me dead in my tracks. Whatever it cost, however much time it took, however annoying the AHA is to deal with it, it was all worth it in that one moment.
Although I’m working an extra long graveyard shift tonight, I’m really looking forward to teaching CPR to a bunch of Scout leaders tomorrow who approached me because they wanted to be better prepared.
I have spent literally hundred of hours with cadavers – either as a students in the anatomy lab or dissecting them for those students. I’m comfortable with cadavers. Really, they don’t bother me.
But this week working in the ED I had an experience that unexpectedly shook me.
It was a fairly busy night like any other; I was working as the EKG tech – running from room to room getting 12-Leads on the usual mix of chest paineurs and overdoses. With a break in the incessant buzz of my pager, I sat down at my computer behind the nurse’s station to enter orders and do assorted paperwork. I barely noticed the Vocera announcement that a trauma one was coming in. I’m not a regular ED tech, and I’m not signed off to work on a trauma team, so it’s only something I notice in passing.
My computer is next to the telemetry screens so that when I’m doing paperwork I can monitor what’s going on in the ED. Halfway through entering an ordering a red flash and a chime caught my eye — ***VTAC***. It was in a trauma bay.
In that moment I became aware of the huddle of nurses and techs behind me. Apparently the trauma one had become a traumatic code en route to us. Not good. We watched holding our breath as the rhythms bounced through various iterations of ACLS badness. My pager went off and I was torn away to do more 12-Leads.
I passed the trauma bay a few minutes later in the course of my normal duties. CPR was in progress. I casually noted that the compressions were probably a bit faster than the AHA guidelines of 100 per minute and wondered if there was any data to suggest that there were better or worse outcomes for faster compressions. I didn’t think much about the code; I was a good three pages behind.
Later I sat down at my work station to do more paperwork. I looked at the trauma bay on telemetry: ***LEADS DISCONNECTED***
That’s either really good or really bad. Statistically I knew what do expect.
At that moment I overheard one of the nurses mention that they had called it just a few minutes before and were preparing the body for viewing by the family. My heart sunk.
Even though I knew that she was basically dead before she hit the ED doors, even though I wasn’t on the trauma team that worked to save her, I felt culpable. It felt so wrong, knowing someone’s daughter had died before her parents did. I honestly felt a little sick.
The familiar nagging of my pager brought me back into focus. Off to do another 12-Lead…
It wasn’t long before I needed to cross the hallway by the trauma bay again. As I approached it somehow seemed longer..emptier… lonelier than I remembered. As I got closer I recognised one our social workers standing outside with her back to the bay and her head hung low. I could make out muffled whimpers and cries from the inside. My heart sank again. I took a detour through the imaging department to avoid walking past. It seemed like the right thing to do…this was a very private moment for someone else. I went about my business for the remainder of the shift, avoiding the trauma bay like a crack in the sidewalk or the path of a black cat.
Toward the end of the shift I had some chores to do – namely refilling the blanket and fluid warmers. This includes the trauma bays. I did every other part of the ED first. Then I did all the other trauma bays, hoping that I would run out of clean blankets before I got to where she was so I wouldn’t have to see her…no, so I wouldn’t have to disturb her. I swore in my head a little when I still had blankets as my cart squeaked up to the threshold outside her room. I carefully and quietly peered in to make sure no family were present. It had been hours, but who knows.
She was on the table, laying there peacefully with her arms unnaturally still at her sides. The ETT tube was still in place. Her face and hands were ashen. The room was dark except for a single light above the table that illuminated her white draped form. Two empty chairs from the lobby flanked the table. I quietly slid in to refill the blanket and fluid warmers. The hair on the back of my neck was standing on end. My heart was racing. My mind was going even faster, calculating all the reasons that this shouldn’t be happening. Every ounce of my being cried out “this thing should not be.” I realised that what I’d felt earlier was not sickness, but sadness.
I apologised for disturbing her, and not just in my head. You might think it’s weird, but if you’ve spent any significant amount of time working in a cadaver lab, you’ve likely started talking to them. It’s probably more to put me at ease, but I like to think they can hear me. Well not the physical-them that I’m working with, but the spirit-them that’s now out there somewhere.
I finished my task and took one long last look at her before my pager went off again. Someone had ordered another EKG on the panic attack.
This experience genuinely spooked me. When I got home I needed my fiance to come over just so I could hold her tight and tell her I loved her. I needed to know she was okay. It took every ounce of self control not to call her and make sure she was okay the second I’d head that the code was called.
But, why did it bother me so much in the first place? Like I said I’ve spent hundreds of hours with dozens of different cadavers. What made this so different? I’ve narrowed it down to a few things.
1 – She was young. Younger than me. And that’s just against the natural order of things.
2 – While most don’t choose death, at least cadavers in a lab have chosen to be there. A certain serenity comes from knowing that everyone is there because they want to be. That wasn’t the case here.
3 – I’m used to working on a cadaver, and then learning about who they were as a person by reverse engineering their medical history and listening to family members at memorial services. To me, cadavers become people. I’ve never had to mentally transition the other way from person to cadaver.
I hope in some small way that writing this out will be therapeutic and help me organise my feelings. I know this is just the first of many of these experiences that I’ll have in emergency medicine. It has to be a valuable lesson – of what I’m not sure yet.
I just hope that when I close my eyes to go to sleep tonight, that I can stop seeing her face.
My passwords for every online account are different. Many of them are randomly generated strings that are stored in an encrypted file. Common things like gmail and facebook I have memorised.
Understandably, I am a little leery of using a shared terminal at work to access any of my personal accounts (on my breaks of course). So what’s a nerd to do?
Ladies and gentlemen, may I present to you the wonderful world of portable apps.
You can run Google Chrome from your own personal flash drive. Chrome’s incognito mode will prevent any trace of your browsing from being stores on the machine you’re using. It will not mask your browsing from whatever proxies or monitoring your company is using – after all if you’re using their bandwidth I think they have every right to know what you’re looking at, just not to store your passwords and the like.
So download it here and put it on your flashdrive. Incognito mode is accessed by hitting control+shift+n. A new window will open with a guy who looks like he’s from Spy v. Spy on the upper left corner.
If you’re looking to store your passwords securely and take them with you, try Keepass portable.
And now for my last trick, let’s talk about long distance codes.
If you’re like me, you may have been seduced by Apple into buying an iPhone. Which also means, that like me, you’re often unable to make or receive phone calls. Using the phone at work (on your break) may sound appealing, but you might have a problem if your employer uses long distance codes to (rightfully) control outbound phone access.
The solution? Google Voice. GV let’s you place free long-distance calls by calling you on a land-line (so the inbound call is free) and then connecting you to the other number once you answer.
So to make calls at work, with a long distance code and at no expense to your employer:
Make a Google Voice account. I suggest getting the new number just so you can have free SMS.
Log in, click settings > voice settings.
“Add another phone”
Enter the direct dial for your work number, with a name, change the type to work, and make sure the texting box is unchecked. Click save.
A box will popup. Click connect and it will call your work phone. When you answer, enter the code on the screen to confirm that you actually have access to this line. Back at the setup screen, un-check your work number so calls do not forward to it.
Now when you place a GV call, you can have it connected to your work phone! No long distance code required, no cost to your employed.
Just be responsible. Hope you enjoyed this tip!
In EMS and the ED many situations involve “2 beers.”
Similarly, in the outpatient clinic when you have a patient that doesn’t speak English, they will bring a family member to interpret. That family member will, however, have 2 kids.
They will cry.
They will touch things they shouldn’t.
Why do such things come in pairs? The world may never know.
Sometimes it sucks to fly, especially with “that lady.” Maybe she’s realted to sumdood. Here is an open letter to, “that lady:”
Dear “that lady,”
I kow you need to get places, because you seem to be on every flight I ever take. It’s odd, because you never look the same. Must be expensive to change your appearance so radically that often. Let me offer some friendly advice to make your next flight more enjoyable – mostly for me, because I know you’re blisfully unaware of the effects your behaviour has on others.
If have the need to transport something the size of a dead yak, kindly check it. it will not fit in the overhead bin. PS – It also freaks me out when you try to slam the plastic bin shut to make it fit. I feel like it’s going to break.
You don’t need to be in the first boarding group, so stop throwing a fit when you aren’t. If your bags are appropriately sized we can all fit. And try sitting somewhere other than the front for a change – that way you can hold up less than the entire plan while struggling to fit your animal carcas into the overhead bin.
Once you’ve thinned out your bag a bit so it can be crammed into overhead storage, that junk on your lap also has to go. Don’t get combative when you’re told it needs to be stowed. This includes any protest about needing “my knitting” or snacks for “my blood sugar” – this of course spoken between fist fulls of said snack. If you lost some weight, I can almost guarantee your blood sugar would be less of a problem.
When the flight attendant poked you to see if you were alive for the drink service, I was secrety hoping you weren’t. I think she felt the same way, since when you didn’t rouse initially and she asked me to be her “witness.”
One last thing, if you have an emergency, I am so not helping you.
PS – I’ll call ahead to make sure we’ve got extrication and heavy rescue when we land so there’s a chance of getting your bag out of the bin.
Tonight I had the opportunity to shadow my medical director while he was working in the ED. I leanred many things:
Every blog I’ve read about how drug seekers present in the ED is completely true.
Every blog I’ve read about faking a seizure and “status dramaticus” is completely true.
Healthcare is a strange mash-up of completely differently evolved professions
A litre of NS and a dose of zofran will cure almost anything.
There are no mean paediatricians – even when you call them at 0100 for an admission. This particular saint actually drove in an hour to evaluate the child, and still left with a smile on his face.
Doctors don’t actually talk to or touch patients. They mostly read labs and sign things.
My pre-hospital calibrated BS-detector is apparently as well refined as anyone who works in the ED full-time.
Medical patients appear to get better pain management and sedation than trauma patients.
Healthcare professionals do not wash their hands or use gloves nearly enough.