Friday, December 29, 2006

Recovering from Christmas in the ER

Christmas Eve was a solid-gold nightmare. We had one open bed in the entire hospital, and the private ambulance services were bringing in critically-ill people without calling us, because they knew if they did, we would divert them to hospitals that we knew had open beds. But they make their living on calls, not on mileage. (This may differ in other states. Armed & Christian may correct me on this point.) So after the fifth "patient dump," the staff in my ER and the private ambulance services were not experiencing a lot of good will toward each other. And of course, the practice of patient dumping so saturated our ER that we had to place the hospital on "divert," meaning we were so full that there was neither room nor staff to care for any more patients until we cleared out the patients we had. There was no room at the Inn.

Most of the patients we had on Christmas Eve were genuinely sick. On my shift I cared for two patients who had had strokes, one patient who had a heart attack, a family of four who had carbon monoxide poisoning (a non-English-speaking family), one patient with acute appendicitis, two female patients having miscarriages, one elderly female with a hip fracture, and one psychotic female frequent flyer who neglects herself in order to get attention and pain medications. (This time she nearly killed herself by laying in her bed for nine days without getting up to go to the bathroom. She was, of course, a frigging mess. All this to get attention. She was also one of our private ambulance "patient dumps.")

That was one long, long Christmas Eve. I dragged myself to bed, sore and tired, at 9PM and awoke, sore and tired, at 5AM on Christmas Morning.

Man, this is going to be a long day, I thought to myself. Christmas in the ER usually is. I was not worried that someone would die in my ER on Christmas; people die every day (but as it turned out, none died in my ER on Christmas). I suspected that if Christmas Eve was any indication, Christmas was going to be a rough ride.

Boy, was I right.

It started off ominously. I schlepped in at 7AM to find only one patient in the entire ER. I went through my area checklist (trauma cart inventory) and sat down, sipping my coffee. Nobody dared say the word: "Quiet."

That one word, when uttered by an on-duty ER staffer, can send the whole day spiraling into hell. The whole staff sat in uneasy silence. Then the medic line rang. Five minutes later, it rang again. And again, and again, and again. And then the aid cars began calling in with short reports; six in a twenty minute period. By 9AM, the walk-ins came flooding in. By 9:30, the ER was full, and the triage area was filling fast.

Now, let me acquaint the reader with the demographic of the Christmas day ER patient, because it is not comprised of the usual crowd. Nobody in their right mind wants to come into the ER on Christmas, for the love of Pete. So what we see are the really, really sick people, the people who slice their fingers while preparing the meals, the people who slip and fall on whatever causes them to slip and fall (ice, gravy, beer, etc.), the people who get together when they shouldn't, and of course the absolute lunatics.

In the morning, the usual crowd comprised of the genuinely sick ones. Heart attacks, appendicitis cases, one full-term lady in labor (on Christmas- cool!), a couple of strokes, a couple of really sick kids, a seizure, and a bowel obstruction. But as the morning wore on, we got more and more lacerations (knife vs. finger). And then the psych cases began rolling in.

We had one obese young woman with the classic hallmarks of Meth addiction who insisted she be classified NIK (no information known) because the Mafia was after her. Never mind that she dragged her whole family with her. They also decided to check themselves in for various reasons. Her mother began loudly and obnoxiously retching in the triage area (BLEEEEEEAAAAACHH!!!! BLEEEEEEEAAAAACCCCCHHHHH!!!!). She didn't produce anything, of course. She just sat there and retched, loudly and with great flourish, whenever she saw someone looking at her. She fell strangely silent when nobody acknowledged her. Situational nausea, I guess.

As the day wore on, we saw the usual assault victims.

"Usual assault victims," you ask?


You see, Christmas is one of those holidays that brings families together, even when they have no business being anywhere near each other. Uncle Phil arrives, gets drunk and obnoxious, and someone decides to tell him to pipe down. He declines, and rudely so. He takes a swing at Cousin Ed. Ed parks a left hook in Uncle Phil's mouth. Uncle Phil arrives at our ER drunk, belligerent, swinging, spitting bloody froth at us, and with a BAC of 384. I'm not making this up.

Never mind decking the halls. Somebody "decked" Uncle Phil, I thought.

So the twelve hours I spent in the ER on Christmas Day were not idyllic. Guess who had the Mafia runaway, her mother (BLLEEEEAAAAAAHHHH!!!!!!) and Uncle Effing Phil?

Where's the frigging eggnog?