5th night in the ER series

[guest042302019, BSN, RN]

3/14/10 (5th night)

My fifth night in the ER was relatively laid back. I haven't been there yet when "all h$$l breaks loose" as they say. It seems everytime I greet Tera, the charge nurse, that she says "boy, you should've been here last night or you should been here 2 days ago because we had this and this and this happen" I'm thinking great, I've missed it again. Even though I look forward to these happenings, I don't wish ill will on anyone but I believe a majority of people in there some what thrive off of the fast paced, excited, emotion provoking, environment. But none the less, there were some things that happened tonight that were new to me, atleast in the ER. I walk in, greet Tera, and go immediately to work. Clean, Clean, Clean. It's funny how that works out. Me constantly cleaning that is. It's like I've signed up for a lesson, that normally I dont want to do. I don't particullary care for cleaning and yet, my job in the ER primarily is cleaning. I wipe the beds. Actually, now that I think of it. I believe I wipe down the beds better than a majority of people there. I'm not saying I'm better than them because that would be different. Cleaning the beds over and over again seems so arbitrary, and yet, it is almost just as important as the medications one receives. A basic concept comes to mind, cleaning beds prevents infections by killing the bacteria on the bed. But, some of these people just wipe down the beds and change the linens and call it quits. I wipe down all counter tops, bed, bed rails, chair tops, even if they aren't seemingly dirty. However, we don't see bacteria but the are probably there. And in a place of infection, and resistant infections, cleaning and santitation seems to be a vital process that to me, gets some what neglected.

After I was done cleaning various rooms and stocking the linens as well as the cabinets, I sat down to soak in the environment. A pair of new doctors I have never seen there before we chatting away about a patient, can't remember the details now. One doctor in particular seemed somewhat laid back and joked with the nurses, which told me he was relatively easy going. He sat down, I watched him gaze into the computer screen with intense deliberation. I then heard Tera was going to help insert a catheter in a women, so I immediately followed her to the stock room and asked if I could be of assistance. She let me tag along, but I was instructed to put on this yellow smock that was to do 2 things; cover my volunteer name tag to ensure that the patient didn't feel uneasy about my presence and in case fluids decided to "squirt." I understand the latter, but quite a few people mistake me for nurses, I don't think they look at the bold "volunteer" label on my tag-oh well. The women that was to receive the catheter was alittle over 500 lbs and from my previous experience, I knew to breath with my mouth. We walk in and once again, another person was consumed by their own weight. This women had a towel over her face, I would assume she was ashamed of the way she was. She needed help and yet, she didn't want it, likely due to the sheer embarrasment, for I saw this in her teary eyes. It's a vicious cycle with people of this size. They need to eat bare minimun to have the chance at losing weight, but they can't help but to eat and eat. I don't understand how one could get so large but it's vividly real, and happens more often than unfortunately not. I stand there and was asked for towels by a male nurse, there were 4 of us all together in the room. I was further instructed to stand to the womens' left and hold up her stomach "fold." I do so while Tera eases the catheter in the women's lady parts. The smell, dispite my mouth breathing, is horrendous. I could see the male nurse turn away, while I stood my ground, which made me feel good like I was able to handle this and he wasn't. But, everyone has something that "grosses them out" and I may have not found mine yet. I'm sure there will be something. Tera did a great job, and the women had little pain or at least, she didn't groan too much. The legs of this women were so large and lacked circulation that her skin dried out, I have never seen anything like it. He skin was literally white, like a pasty, dry skin white. I was like scerosis of the legs but she didn't have scerosis, she had 400 extra pounds that sucked the life clean from her legs and entire body. Before the catheter insertion, the women had wet the bed repeatedly and Tera insisted on changing the absorbant clothes beneath her. I was ready to lend a hand but the nurses decided to wait for a larger bed for the women and change them then. Plus, the women was in severe discomfort and wasn't willing to coroperate, so we waited. As everyone left, I stayed and briefly talked to this women. I asked if she wanted some more blankets and instead, she asked for some more Ice. I go get some ice for her, roll a cart next to her bed so she could set the her cup on it when she was done. It amazes me how the paramedics could lift this women or even transport her. They must have some tricks up their sleeves to pull that off. Body weight is much more difficult to move and the paramedics I've seen aren't large, muscle bound people, the "lift" would be an interesting and puzzling sight I'm sure. She thanks me for my help and walk out of the aromatic room.

Later, I saw this nurse with a "I need help look" and I walk in her direction. She waves me and asks me to stick around in case of a "rumble." I assumed she meant fight instantly, and nodded while I walked in. I stand in the back and wash my hands to put gloves on. Behind the room high drapes I was asked by 2 state police officers for a medium and large pair of gloves. I hand both of them their requested gloves and wondered why they stood behind the drapes as apposed to exposing themselves. Later, I realize why stood behind hidden. They stood there in a seconds notice in case this guy flips out and also, I would assume their presence would aggrevate this man far more than he already is. They stood there, smiled at me, and I turned around. Immediately, the feel of the room changed and as I glanced at the man in the bed, I knew this was going to be a task. I acknowledge the nurse and look at the man. He was covered in tattoos, of tribal and harley davidson nature. He wore a harley davidson shirt, black pants, and had long boots with flames on the tips. He was clearly drunk, and had openly expressed to the nurse he took a whole bottle of pills and wanted to die. This wasn't my first encounter with someone "far gone" but it had been awhile for me, so I didn't say much. He explained that he had recently been through a divorce, and lost his kids. He merely wanted to die. This man was in a world of pain and agony, and was also unable to cope with his hardships, hence the alcohol and pill binge. I stand there not sure what to do but I try to carry myself like I have some purpose for being there. I watch the nurse and she talks to him while she takes his blood pressure and observes the machine that monitors various bodily functions. I then helped the nurse with the EKG, and I was so surprised yet not, at the nurses ability to move beyond the situation when the man taunted her and myself. He looked straight into my eyes, "Have ever thought about suicide?" I didn't back down. "No." He smiled and gave me guff for my response. It was apparent that no matter what I said, he wouldn't approve. I can't stress enough that this man is hard to describe in words. I lack that capability to do his justice, and to put one in the moment as I was. I can say that he had a shell of toughness, but an inner pain that was easily detectable if you understand people. He then asked,"Have you ever been hurt by someone?" This I didn't know what to say, I have been hurt, but should I have said yes to emphasize, or say no, in order to not relate. I said "no." Once again, I feel like no matter what I said, he was not in the moment nor in this reality to care what I said. The doctor came in and began a smooth, non-threatening line of questioning.

"Hello, Im Dr. Barr."

"What the f*** do you want?"

"I'm here to help you, I was wondering how many pills did you take, as well as would you mind if we could take a urine sample?"

"Why?!! So you could tell I smoke pot? So what if I did?"

"That's not why sir, we just want to help."

"Bull ****, Fine, I smoke pot!! You don't care with your big $200,000 salary, Do you know what happens to poor people? Its terrible. I lost my kids. I lost my wife. I lost everything. I just want to die."

Needless to say, this line of questiong pursued until the doctor convinced him that we needed some urine for the labs. At one point, I was called a fat-ass. I was alittle surprised because I haven't been called this for some time. But, not surprised this remark came from this man. I think he needed someone to talk to bad. The remarks he was saying to the nurse, the doctors, the police, and myself were a product of pain, suffering, alcohol, pills, and no will to live. He didn't care. Hopefully, he will eventually find some help. I wonder what the nursing classes teach in order to deal with this kind of experience. Should be interesting to find out.

I didn't really learn a lot this evening. I dealt with a man that was going through some really difficult times and seemingly, wanted to drag anyone he could down with him. I look back at how I've carried myself in these situations and I see good things.This evniroment is still foreign to me and yet, I am working through it. I feel like I can work in this type of place. I feel comfortable, and probably, more comfortable than most would ever feel. I think anyone could do this, but dealing with profanities, awful bodily smells, blood, tears, crying, hate, and everything in between probably requires a special mentality, which I believe I have. I also wonder what the others nurses and doctors think of me. All I think of is that they still let me come back so this must be a good sign. Plus, I am thanked for my help even though I feel like I dont do a whole lot but I apparently do enough to be noticed and help out some. I guess a take a small portion of what the nurses don't have to do and they get to focus on their patients more so. In this respect, I am indirectly affecting these patients because every extra second the patients get cared for, the better it is, I believe.