Tales from an Ambulance: Episode 2 - E.R.

The first thing you notice is the smell. Disinfectant, like how you would imagine the factory where they make the stuff smells. The second thing you notice is the chaos. Patients in various states of intake. Staff barking out orders to anyone who will listen. Nurses scurrying purposefully from task to task. Doctors looking shell-shocked as they stare blankly at a clipboard. And then there was me, doing my best to stay out of the way but failing miserably. I stood in front of the triage desk at Franklin Memorial Hospital, hoping to catch the eye of someone seated behind the counter.

My car was parked a few blocks away, on the side of the road in one of the sketchier parts of the city. I was just an EMT student, and I wasn’t sure about the rules for the staff parking lot. Even the walk over gave me a tiny rush of adrenaline. The crumpled paper in my pocket had only the most minimal instructions: report to the triage nurse in the Emergency Room.

How funny would it be if I got mugged on the walk over and needed to actually go to the Emergency Room?

I was in the final stretch of class. The school where I was enrolled had an agreement with this particular hospital that allowed them to send one student over at a time to complete the 8 hours of clinical hands-on training required to graduate the course. When I finally caught the nurse’s attention, there was no system for her to consult or any other record of me being scheduled for that evening. I could have shown up completely unannounced as a random civilian interested in just hanging out and gotten the same result.

I caught the nurse’s eye and could tell she was flustered and in no mood to deal with me. “Can I help you?” she said.

“Hi, I’m from Emergency Training LLC, here for my clinical time shift--”.

She looked down at what I presume was a schedule as she cut me off. “What kind of student are you?”

“Uh, EMT student, ma’am,” I said.

“Right, just stand over there.” I dutifully complied, shrinking into the space between an empty stretcher and a supply cart. Before anyone had come to get me, I had to relocate to the opposite side of the stretcher as a pair of EMTs came to retrieve it.

That’s going to be me one day. Assuming I can make it through today.

Eventually, a young woman in maroon scrubs approached the triage desk. I saw the nurse point in my direction without even looking away from her screen. The woman turned toward me. She was tall, attractive, and presumably college-aged. I could see her name tag said “ER TECH,” which I would learn was the career-ladder equivalent of an EMT inside the emergency room. In other words, a more or less entry-level position.

She introduced herself and guided me over to the workstation she shared with several of the other ER Techs on duty. She was very kind, and struck me as being too intelligent to be at the bottom rung. She spoke four languages, and her English was flawless. She was just biding her time doing this while she figured out what to do with her life.

I also came to find out that she fairly regularly received students doing their clinical time, and there was some sort of incentive for volunteering for it. To her credit, I could tell she was not doing it for the money. Over the course of our shift she did her best to answer all my questions, get me involved in the most exciting things both inside and outside of her assigned rooms, and just generally tried to ensure I was having an enjoyable and enriching experience. I could have just as easily been plopped in a corner and told to make beds and refill linen closets.

I hope I can find a way to repay her for this. It’s so frustrating that people like this just pop in and out of your life in the blink of an eye.

Those were the shortest 8 hours of my life. There was no break. There was no downtime. The relentless crush of incoming patients never abated. True to her promise, my tech let me drift around the entire ER, being present for the most interesting bits of each patient encounter and skipping most of the mundane discharge, logistical, and administrative parts.

The Franklin Memorial Emergency Room was organized into a ring of regular rooms with a two-bed trauma bay and two intensive care rooms in the center. The most critical injuries or illnesses went directly into one of these three central rooms. Everyone else waited in the hallway or the lobby until they were assigned a regular room.

Every patient was unique. Every case was tinted with a different emotion from the one before. I learned a lot over the course of that shift. Each new room provided me with a fresh lesson.

I learned that the ER Staff can be heart-warmingly empathetic to deserving patients… but brutally critical of the ones who are not. After she had been “treated” and sent home, the staff mercilessly mocked a woman who had come in with a bad sunburn on her arm.

Note to self, do not go to the ER for anything you can treat with a trip to the pharmacy.

A teenager was brought in at a period of the night where all the rooms were full. She was left on a bed parked in the hallway. Her problem? Extreme intoxication. They gave her a plastic contraption which looked like a feed bag for a horse that hung from her neck. I saw, heard, and smelled her vomit into it repeatedly. An hour or two later I passed her bed again to find her completely asleep under the bright fluorescent lighting in the midst of multiple medical crises.

That must have been some party.

A woman who spoke no English was confined to the bed in her room due to some condition or potential diagnosis I was never able to ascertain. When she told the nurse taking her vitals that she needed to pass a bowel movement, I was the only other “staff” around. After a brief discussion with the nurse about who would wipe and who would roll her to her side and hold her, I lucked out and got the assignment without a view. Both of us still got to experience the smell, however. I think the woman tried to apologize. I made the universal gesture for “forget about it.”

Dear karma, remember this moment.

Another man who could not speak English was surrounded by family members when he was given the news that this particular trip to the ER would not end with a discharge home. His disease had progressed to the point where he needed to be admitted. Language is a funny thing – even without understanding a word that family was saying, I could still clearly hear their pain and sadness.

It took several hours, but the emergency tone in the emergency room finally sounded, indicating that someone was inbound to one of the central intensive care rooms.

My mentor for the evening interpreted the voice coming over the intercom. “Head to bay 2, make sure you put on a gown first!” she said to me with excitement.

I had no idea what to expect. A whole platoon of medical personnel descended on the cabinet that housed the protective gear. I was awkward and slow in donning the coveralls, and as a result was one of the last people to enter the bay.

No big deal, I’m just here to watch. Wait, what am I even watching?

A young man was being lifted from an ambulance stretcher to the bed in the trauma room. I quickly scanned him from head to toe. He was shirtless, and a tech was currently in the process of cutting off his pants as well. I was expecting to see something exotic: exposed bones, a gunshot wound, a gaping hole somewhere in his body. All I actually saw were some bandages around his wrists. He had a look on his face like he had just woken up from a deep sleep and was taking in the scene around him and trying to decide if he was actually awake or not.

So what’s wrong with him?

I moved a little closer to hear the report from the paramedic to the physician running the show. “. . . is fine, but the other wrist went a little deeper. I didn’t see any arterial bleeding, but after I covered it up I haven’t checked again. That’s the original bandage from about 20 minutes ago.”

He slit his wrists! He’s obviously not in critical condition, though. Probably just a cry for help more than a serious attempt.

The cynical assessment that had flashed through my brain shocked me for a second.

Just a few hours here and already I’m getting jaded? It’s no wonder nothing phases these people.

In spite of the mostly superficial wounds, the patient remained in the trauma bay. Most of the medical professionals, however, did not. The room emptied except for me and two others. With nothing between me and the patient, the nurse waved me over to help.

“Can you start cleaning him up?” she asked.

“Uh, sure, what do you want me to do?” I asked.

“Just start cleaning him up,” she repeated with a hint of irritation in her voice.

I realized that I was dressed identically to everyone else now and offered some more context. “I’m just a student here observing, you’ll have to show me where everything is.”

Without a word she stomped over to a supply cabinet, retrieved a basin, a bottle of serile water, and some washcloths. She thrust them at me and I solved the equation for myself.

I began wiping his body. He was still sizing up the room, and he looked down at me as I rubbed at some dried blood on his stomach. I tried to make small talk to lessen the palpable awkwardness of the situation. “Sorry man, this doesn’t mean anything. I’m happily married.”

He smiled and chuckled. “No worries, it’s whatever.”

Neither one of us knew how to continue the conversation, so I continued cleaning in silence.

The doctor had removed the bandages before leaving, and so the wound on his wrist was now totally exposed. The upper layer was completely sliced through, and the skin had spread open to reveal the tissue below. A single drop of blood was pooled at the edge of the cut, like a tear about to fall from the corner of your eye. I caught myself staring and turned back to the dark red crust I was removing from his legs.

Thank goodness they give you plenty of gloves.

Another student, probably a medical resident, came in to stitch the wound closed. I slowed the pace of my cleaning to ensure there would still be a reason for me to stay there to watch. I had never seen sutures go in before. I was riveted as I watched the entire process. Skin is remarkably durable, and you have to apply some real pressure to puncture it. The tool you use to do it looks like a fish hook. The resident did a fine job and left about the time I was finished cleaning.

That’s some pretty cool stuff.

While the resident was finishing up, another trauma alert came across the intercom. I found myself excited to already be properly attired this time and secretly hoping for something more serious than Mr. Goth over there. A minute later, an elderly woman was rolled into the room with the accompanying gaggle of medical professionals.

I stood in the space between both beds to watch. It was immediately clear that this woman had some sort of mental condition. Whether she was born with it or whether it was a product of severe dementia was unclear, but the takeaway was that she couldn’t tell anyone what was wrong. I caught bits and pieces of the multiple conversations occurring simultaneously around her and was able to piece together that she had taken a pretty bad fall at her nursing home, and they suspected a neck injury.

10 minutes and a mobile X-ray later, they determined that nothing was seriously wrong with her and began preparations to move her to a regular room for observation.

I feel terrible thinking this, but it’s kind of disappointing how anti-climactic that was.

Just then, commotion from the opposite side of the room as the skeleton crew attending to the young man called for help.

“Doctor, can you come over here? Something happened to our patient.”

I pivoted to look at the man I had just finished cleaning. He was slumped over, eyes closed, and the nurse was shaking his shoulder.

“What happened?” the doctor asked.

“I’m not sure, I was just bandaging his wrist and he just passed out.”

The doctor put a hand on the patient’s shoulder and squeezed. “Mr. Hewitt? Mr. Hewitt!” He started shaking the shoulder somewhat vigorously.

The young mans eyes flickered open.

“Hey, welcome back,” the doctor said. “You can’t go doing that, you gave my staff quite a scare.”

The young man looked around again and nodded. “Sorry,” he managed.

“You gotta stay awake, OK? No sleeping in the ER.”

The doctor took off his gloves and tossed them in the trash bin as he left the room. I hung around for another couple minutes and then did the same. After I removed my coveralls, I went to find my mentor.

With any luck, there will be a real emergency before I leave.

Later that shift, I learned that you need to be careful what you wish for.

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To be continued.

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@DollarsAndSense is a father, veteran, participant in the rat race, freelance writer, and volunteer EMT. Want to read more of my EMT posts?

Tales from an Ambulance: Episode 1 - D.O.A.
A shift on the ambulance
What it's like to be a volunteer EMT

Unless otherwise noted, all text and pictures in this post are my own and may not be reused without my permission.

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