Sunday, December 17, 2006

Life and Death in Darkness

Last Thursday night/Friday morning, more than a million people in my region were plunged into darkness by one of the worst windstorms in modern Washington State history. Whole cities were still, dark and lifeless. Other than the drivers around me, not a single person was seen outside. The atmosphere was made all the more strange by the moaning of the wind through the power lines that bowed, dead and useless, from their poles. Huge old-growth trees were ripped from the ground by the thousands, blocking roads, demolishing houses, and killing drivers.

And of course, I had to drive to work that night.

My work does not stop when the weather comes up, no matter how severe. If I don't show up, the poor nurse whom I am to relieve has to stay put at his section and take up the slack, which is a lot to ask of someone who has already spent twelve hours working in a level 3 disaster setting in an ER packed with humanity. So I drove to work, picking my way along detours and around fallen trees, and nearly getting killed myself on four separate occasions by drivers who simply blasted through blacked-out intersections instead of treating them like 4-way stops. Seattle has more than its fair share of weather morons. These were probably the same dilrods who parked their cars in the middle of the road during the winter storm (of which I wrote a couple of weeks back)- but I digress. At any rate, having finished an hour-long drive that must have left my guardian angels shaking their heads in dismay and mumbling to themselves, I pulled into the hospital parking lot.

The hospital was an oasis of light in wasteland of utter darkness. The Interstate stretched out for miles either way, a brilliant white-red artery coursing through the black. I zipped up my parka and trudged to the entrance. Every main floor public-access area was simply packed with people from the local region who were not sick but were just looking for some warmth, light, or hot food. They milled around, sat in the cafeteria, parked themselves in corners as far away from the entrances as possible, and tried- many quite apologetically- to stay out of the way of hospital personnel. We gave people blankets and pillows, hot tea, coffee, cocoa, and as much encouragement as we could.

As difficult and hazardous as the evening had been thus far, I still felt a charge of excitement as I contemplated the potential challenges that I as a nurse would be called upon to meet this night on a professional and personal level. The ER was full of some very sick people, and the horrendous weather and power failures compounded the challenges we had to overcome in order to care for our patients. Now, it was not merely a matter of treating the patients and sending them home. "Home" may be blacked out and freezing, or flooded, or inaccessible due to downed power lines; getting "home" may not be a safe endeavor, either. So we all worked together to find some place to put these people, and the lobbies were filling fast. Other area hospitals faced the same dilemma. But this is part of the reason that many medical professionals choose to specialize in emergency/trauma care. You never know what's going to happen next.

As I walked through the doors into the ER, I immediately noticed the distinctly thick and pungent smell of wood smoke that permeated the place. As if the darkness and freezing cold were not bad enough, a thermal inversion had formed over the region, holding the pollutants close to the ground like a foul blanket. The asthmatics are going to be flooding in tonight, I thought. I clocked in and walked over to the nurse whom I would replace. She visibly relaxed, gave me a hug and said, "Thank God you're here!" She gave me report and I briefly paused to consider what I had just gotten myself into.

My patients I inherited were sick, sick, sick. The least severely-ill was a 30-year-old man with propane burns to his hands who would do alright with some minor debridement, silver sulfiadazine cream and a bulky "softball" dressing. The second worst was an 80-year-old with CHF and pneumonia who was simply waiting for a room upstairs. The worst was a 19-year-old college girl in the middle of a severe asthma attack who was looking minutes away from being intubated because she had been working hard to breathe for hours and was rapidly running out of steam.

The hours ripped by. The girl was intubated, put on a ventilator, stabilized and sent up to the Unit. The older lady was sent upstairs to MedSurg, and the burn victim went back "home" to his nice warm RV. No sooner would I discharge a patient than another would occupy the room. And as I returned from taking yet another very sick patient up to the Unit, I noticed that the briefly-vacant room had been filled by not one but four patients who had carbon monoxide poisoning- a whole family that could easily have died had not the oldest daughter come home and seen what her mother, who lacked a little something in the common sense department, was doing to heat their house. Thankfully, they all were fine and five hours later were discharged. They, too, found a corner in the lobby to park themselves for the night.

The rest of the night, all two hours of it, was occupied by a couple of GDFDs who somehow managed to find one another in a night blacker than Hitler's heart. They shared some booze, and then found enough reason to get mad at each other. One had the bottle broken on his head, and the other had his face smashed into a tree, breaking his nose and blackening his eyes. Keeping them separate was a real joy.

My shift finally over, I drove once again through the wasteland, going ten miles out of the way to avoid downed power lines, roadblocks, and managing once again to dodge the weather morons who blasted through the intersections. On the radio, I heard that one woman had drowned in her basement as rescuers struggled frantically to reach her. They could hear her screams, and finally, they heard no more. They broke through fifteen minutes too late. Those guys will remember this night for a long, long time. Say a prayer for them, will you?