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    Twelve from Hell
    Twelve from Hell
    Twelve from Hell
    Ebook145 pages1 hour

    Twelve from Hell

    By Francesco Carmine MD

    ()

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    About this ebook

    Twelve From Hell is the story of one twelve hour night shift in a busy ER. With single physician staffing the volume of work was often overwhelming. All of the patients recounted were seen by the author in the ER. The exact time and date of presentation could not possibly be recalled but suffice to say there were numerous nights over a twenty-two year span very similar to what's depicted here.
    LanguageEnglish
    PublisherBookBaby
    Release dateOct 11, 2017
    ISBN9781543914962
    Twelve from Hell

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      Book preview

      Twelve from Hell - Francesco Carmine MD

      Author

      Preface

      The following chapters recount a fictional twelve hour night shift in The Room.

      The cases are for the most part real, but the fiction is in recounting exactly which patients came in and when. There were scores of nights like this in which the acuity level and volume of work was just about overwhelming but I could never give an exact reckoning of a specific night because it would be like trying to recall every car you passed on a long road trip. Suffice to say this represents a typical night from hell. If the truth be told, there were also nights from heaven, but they were rare and became less and less common as the years progressed.

      I was blessed to find a profession that I loved. In reading the account of this shift it will at times seem as though I hated the work but the fact is Emergency Medicine is a high stress difficult profession that challenges you. There are not many fields in medicine that test you both mentally and physically the way a night in the ER could. I tried to give the reader a feeling for the difficulty encountered during a particularly bad night shift but in so doing there are times when it must seem like the patients were enemies rather than people needing help. When a shift wore on and on with no relief in sight it was easy to become frustrated with having to deal with non emergencies that taxed your resources and your resolve. But nestled and hidden in the middle of the many that used the ER for inappropriate reasons were the critically ill who needed The Room for what it was intended for-to save their lives.

      I have had the pleasure over the years of working with wonderful and dedicated men and women who spent years serving their fellow man. I know it sounds trite and cliché to say it but there simply is no higher calling than serving others. That is not to imply that there are no other professions that warrant recognition but when you consider that for each of us there is no greater concern than the health of ourselves and our loved ones, then the role of the Emergency Room staff as the protectors of that health becomes obvious.

      Lastly, I’ve moved on. Emergency Medicine is a profession for the young and I’ve aged out. In the last few years the stress of the profession started to erode my desire to take on the challenge and I found myself fearful of missing a significant illness that resulted in patient harm. In all high stress jobs there is always the danger of losing your edge and when that happens it’s time to go. It was time.

      6:50PM

      I pulled into the ER parking lot and heading out of the lot were the Paramedics. That’s a bad omen because that ensures I’ll be getting at least one ambulance patient to start my shift. Not necessarily a bad thing but if you’re starting a shift, I’d rather I started it with my feet up, eating a cream donut than with a critically ill patient. I know I’m there to take care of patients but human nature abhors four letter words like work and cream donuts have a lot of letters and taste good. 

      As I passed them, I gave the medics a headlight flash to let them know I’d be waiting to hear from them and made my way to the ER parking lot. The first thing I noticed as I rolled up to the rear of the hospital was an overflowing parking lot. (I have no idea why most ER’s are in the rear of the hospital since it’s counter intuitive to make patients that need the ER drive further to get there) Next was a huge full moon that illuminated the lot which was featuring something I’d never seen before, double parking only. A full lot means no room in the inn and that’s never a good sign. At this point, I said my prayer. I said it every night I’ve ever worked, just before I entered the hospital. I asked Him to help me to handle whatever came through the door in the next

      twelve hours. Implied but not requested was the converse prayer to be able to recognize what I could not handle and not miss something potentially life threatening. Tonight I added an addendum and prayed that all these cars belonged to a huge family, visiting one ER patient. That’s an ER equivalent of tossing up a Hail Mary.

      No such luck. As I walked into the building I glanced at both the standing room only Waiting Room and stole a quick glance into the Room as the double doors swung open to allow the departure of a stretchered patient surrounded by two nurses, an ER volunteer and two hospital transporters on their way to the ICU. One of the nurses made brief eye contact with me and muttered, It’s not too late. Save yourself. Go back.

      Nights. ER nights. In twenty-five years of working them intermittently I never worked a single night, glad to have been there. Like everything else in life that is unpleasant, there are degrees of misery. The best nights on-call, I would get to lie down for an hour and manage to fall into a rotisserie sleep, tossing in place waiting for the phone to ring. But more often the shifts were measured in night- years, an endless passing through a microscopic hourglass a single grain of sand at a time. A night- year is defined as the amount of wear and tear inflicted on your body by working night shifts, with a single night equal to one year of bodily harm occurring for every night worked. A good night on- call in the ER (an oxymoron if ever there was one) that passes with relative ease is equal to one night- year. A nightmarish one could easily be five night- years. The longest and darkest ones were fraught with frustration, anger and angst. 

      It was the anger and angst that turned me into a serial pillow abuser. One night I was having a particularly bad night shift and I had to go to the on-call room for something and there was the pillow in the very place I wanted to be- in bed. So I hit it; and then I hit it again and soon I was really wailing on it. After that if I was having a bad night I would beat up my pillow whenever I entered the on-call room. (It actually feels good getting this off my chest after all these years.)

      The obvious question you may ask is, Were the nights that much different than the day shifts? The short answer is definitely. A chief complaint of sore throat at three in the afternoon was a cold with no place to go but the free Emergency Room. That same sore throat in a single physician on duty ER at 3 AM was an impending airway obstruction until proven otherwise. My rational side tells me that the chance of it being something dire is as likely as there being a surprise solar eclipse, but my training and experience tells me that if I assume that every time I hear hoof beats I look for the common horse, eventually I will not spot the uncommon zebra. The medical profession spends billions of dollars annually looking for zebras.

      But the fact that the Room was jumping was not that unusual. After all it is an ER. But when you started a shift with the Room jumping, it’s not unusual to spend the next twelve hours getting hammered. The hard part was not knowing. I’ve had nights start out insane, only to have it calm down and turn into a decent shift. Conversely I’ve also gone from cream donuts to wholesale slaughter. If you love surprises, and I hate them, ER’s are the place for you.

      I made my way into the on-call room to stow my stuff which included a pair of scrubs which I would don later and occasionally I’d bring a late night snack. Out of my locker I retrieved my stethoscope and lab coat. The Room is way too hot for me to wear a lab coat but stuffed in its pockets were countless pieces of ER medical gems which were used over and over in the care of patients. I referred to it as my what to do till the doctor gets here stuff. It ranged from drug dosages for critical meds to algorithms for various life threatening conditions. Over the years I came to rely on these pieces of information more for the mental comfort they provided than the actual need to refer to them. As I exited the on-call room I glanced to my right and saw the bed which I hoped I’d get a chance to use at some point during the night. Another bad sign for this shift was the fact that I had not been able to fall asleep during the afternoon. It’s never a good thing to show up in the ER for a night shift needing a good shift because you’re exhausted. I purposely would not make eye contact with the pillow since even I would not beat up a pillow before the shift even started. 

      I entered The Room through a side employee door and my senses were immediately assaulted. Sound: a child screaming as a nurse tried to give him medication. Every intervention with a terrified child sounds like life and death. Smell: the distinctive odor of a GI bleed. The amalgam of blood and stool is like no other smell. Sight: every stretcher is filled. There were three attending physicians admitting their patients while an ambulance crew waited for a stretcher to become available so they can drop off a car accident victim. As I traversed the Room I heard a commotion in Room 10 and I heard Kathy, one of our nurses yell, he’s seizing and then, Dr. Grant. Grant, the ER doc I’m relieving, rushes past me en route to Room 10. 

      Grant called over his shoulder to me, thank God you’re here. Start seeing people and I’ll give you report when I can. He’s gone before I can respond and I hear him ask Kathy for ten of Valium as he blasted through the curtain.

      I got to the nurses’ station at the same time as two of our night nurses, Julia and Beth. They, like I, would spend the next twelve hours dealing with whatever comes through the door. Both are excellent nurses and if you have to spend twelve hours dealing with all kinds of problems, best to have quality nurses who are good at their jobs to make it easier. I can’t emphasize enough the importance of good nursing. Doctors and nurses who work our nations ER’s are a different breed. People talk about team work in all branches of medicine but nowhere in the medical community is the team concept more important than in the ER. Nurses for the most part run hospitals since rarely are doctors present twenty four hours a day. In the ER, however, the work load is spread between doctors and nurses, with each having a well defined role. Though Emergency Medicine has evolved over the past several decades, the basic job of caring for the sick and injured is still linked to nurses and doctors working together to get them better.

      That sounds pretty straight forward, but here’s the problem. It’s not two professions, doctors and nurses caring for patients. It’s human beings, and there in lies the difficulty. Human beings bring a whole lot more to

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