The "Little Baby"

 *I have written this blog for another publication but since I can never seem to get 2 separate blogs written, I am posting it here... It's not a feel-good, positive post, but it is very raw and real. Enjoy. 

        While the Covid “Delta” variant wave recedes and positive cases become fewer and farther between, another pandemic rages on. For those of us in the ER, we see evidence of a global disease almost every day. Some regions of the world seem to be less affected, but some areas, like my area, is consumed by this disease called addiction. We see patients daily who are struggling with addictions to opioids, methamphetamines, cocaine, alcohol, and spice. Many of them are marched, kicking and screaming, into the ER in handcuffs by 2 or 3 law enforcement officers. The opioid users are often found blue, unresponsive, and not breathing. They are given Narcan, an opioid antagonist, on-scene by EMS personnel and brought to us, angry and yelling obscenities, because EMS just ruined their “high.” I can’t count all the times anymore that people have driven their vehicles, wheels squealing, into the ambulance bay, and begged us to help their loved one or friend who lies passed out in the passenger seat, barely breathing. It’s become almost habit just to yell for Narcan on the way to the trauma room.

Several months ago, when I was sitting at the nurse’s station in Pod 1 and heard someone banging frantically on the ambulance bay doors…We opened the doors, and a young man ran through yelling for help. He was carrying an older man in his arms whose face was a very ominous shade of gray. We all scrambled to grab a stretcher and supplies and shortly, the patient was in a room with IV access and was immediately given Narcan. Within 2 minutes, the patient was awake, breathing normally and starting to talk. He vehemently denied taking any substances, even when we told him that we had used Narcan, and he soon tried to leave the hospital. The young man who had saved the patient’s life turned out to be his son. He was so disappointed in his father that he turned and walked away, leaving his father at the hospital to find his own way home. He told us that his father was an addict that had recently gotten sober. Apparently, this was one of many relapses. He, the son, had gone against his own better judgement and given his father a job with the condition that he remain clean. He said this time, he was done. He promised to never speak to his father again and walked away.

Several times, EMS have brought young mothers that have overdosed with their children in the house. EMS brings the children and the patient, and we, the nursing staff, double as babysitters until the Department of Children and Families (DCF) can come for the children. Once, a 5-year-old told our ER nurse that she had called 9-1-1 when her Mommy passed out.

Amphetamine and spice users are in a class of their own. They come to the ER complaining of “bugs crawling out my skin” and have an almost superhuman strength at times. These people often are so convinced that everyone is trying to harm them that they become very aggressive and combative. It will often take 4-5 people just to hold them down long enough to place them in restraints. The restraints keep the patient from harming the nursing staff and themselves until they can be medicated. Here is a typical scenario in the ER, sometimes repeated multiple times in one day: EMS wheels the patient in on a stretcher, escorted by multiple law enforcement officers. The patient is cuffed to the stretcher and may be actively trying to jump off the stretcher or spit and bite the people around them. Once in an ER room, the patient is taken off the EMS stretcher and cuffed to the ER bed. We will put them in 4-point restraints and put a mask over their mouth to avoid the spit. It will take multiple people to get a simple set of vital signs and to remove their clothes. Side note: I have learned to be very careful when assisting with this process. We have found drugs, syringes with needles, and weapons in pockets and shoes. I recently emptied a patient’s pocket and pulled out a broken “crack pipe” with the broken edge against my fingers, but, thankfully, no cut. Usually, the doctor will take a quick look at the patient, get the story from law enforcement and EMS, and then tell us to “B52” the patient. “B52” stands for Benadryl, Haldol, and Ativan. Haldol is a powerful antipsychotic and Ativan is a sedative used for anxiety. The combined effect of all three of these medications will usually “snow” the patient for a few hours and allow them to return to their mental baseline. Sometimes, if the patient has been awake for several days, they will sleep for 10-12 hours straight. Almost always, the patient will wake up hours later and have no memory of their behavior. They will be humble and cooperative and quietly ask why their throat is sore and their arms hurt. They will be escorted to the Behavioral Medicine Unit for a psych evaluation and a referral to rehab before being released to start the whole cycle over again.

Alcohol addiction is the worst of all because an alcoholic who can’t get their “fix” can die. Patients with an alcohol addiction will present to the ER sweating profusely, nauseated, and often confused. The longer they go without alcohol, the more confused they become. They have uncontrollable tremors and hallucinations. If they are not treated with medication, they can have a seizure and suffer permanent damage. So often, the patients we see suffering from alcohol withdrawal symptoms are the homeless population, especially homeless veterans. They use the effects of alcohol to treat their PTSD and to keep them warm in the winter, but when their “stash” gets stolen or they can’t get their hands on any alcohol, they become very ill. A few months ago, I triaged a patient picked up by EMS after someone called for help for a “burned man.” This poor homeless soul had picked the wrong place to pass out drunk and someone had poured lighter fluid on him and tossed a match, then stole all his belongings and left. He ended up being transferred to our local burn unit. Also recently, I had a patient who had been released from rehab. She was unable to walk due to hip or knee issues and had been released to the care of her “boyfriend.” He had taken her home and given her alcohol. Several days later, when the patient’s sisters were unable to reach her on the phone, they sent law enforcement for a welfare check. The officer found the patient lying in a pool of alcoholic vomit. She had been lying there for so long that the skin on her left arm and torso had been severely burned. She also was transferred to the burn unit. One of my nurse friends knew this lady years ago. She had once been married to a physician and lived the “high life.”

As an ER nurse, I find that I often lose my compassion for these people, especially in the heat of the moment when they are screaming curse words at you or loosing their bodily functions on the bed and on the floor. The stench of days old urine and feces is almost unbearable even with a healthy layer of essential oil in my mask. Sometimes they have been in the rain for days and their feet are beginning to rot. That is an indescribable smell. And all because of their life choices…

Then, almost every time, as I drive home from work, I imagine those patients as newborn babies, small and helpless. I imagine them as toddlers, already learning that there is no one in the world that they can really trust. They may have been beaten, yelled at, molested, and abused. They were probably told that they were “stupid” and made to feel worthless. They grew up believing that they didn’t deserve to be happy. Then when they were a teenager and given drugs at a party, well, they found the “numbness” they craved. I think of the veterans and the atrocities they saw and how there are still so few resources for them today. One thing I know for sure; these people who choose addiction over and over are not happy to be addicts. They are always ashamed and angry at themselves and the world. But the alternative is just too difficult. They are unable to face the demons in their life when they are sober, so they turn to substances. I always feel reproved when I could have spoke a word for Jesus and I don’t… when I give way to irritation and disgust instead of seeing that “little baby” in my patient.

The truth is, we are all given trials to bear in life, some greater than others, but you and I have been given the Greatest Gift of all. In this Thanksgiving season, say a prayer for the millions around you struggling with addiction and for their families and don’t be afraid to say a word for the Lord or a word of encouragement the next time someone asks for money at the gas station or begs on the street corner. Think of the “little baby.”

 

Kum Ba Ya and Other ER Tales from Yours Truly

 

    Hello! I'm back! It's closing in on a year since I updated this blog! So much has happened in life and in the ER since I last wrote, I hardly know where or how to start...

    Of course, the Covid saga rolls on but, on the bright side, we are seeing WAY less positive cases these days. The Covid units are now integrating non-Covid patients and the makeshift plastic negative pressure rooms are completely gone from the ER. We still wear surgical masks daily, much to my chagrin, but I haven’t broken out the N95 mask in months. Some people have asked if the Covid vaccine is mandatory at my hospital, and, no, it’s not. I chose not to get the vaccine and have had no negative feedback at all! Several of the nurses I work with opted out while many chose to get it. People have varying opinions on the Covid vaccine, and everyone is entitled to their opinion, however, for me personally, having already had the Covid in December and not knowing the long-term side effects and length of immunity, it didn’t seem necessary.

   One thing I love about working in the ER is the unexpected people. I encounter a lot of so-called "urban survivalists," aka, homeless people, but I met one such lady a few months ago that I will always remember with a smile. I came into work one morning and the night shift nurse told me that my patient in ER 23 was a B&B. That means that the patient is intoxicated and needs sober up before discharge. I glanced in the room and noted that my patient was snoring softly and was vitally stable on the monitor. Moving on to my other patients, I basically forgot about her for a while. Sometime later, I heard strange noises coming from ER 23 and went to investigate. My patient was awake, out of bed, and taking herself off the monitor, talking loudly in some language I did not understand. She was obviously of African descent, all of about 5 feet tall, with a close-shaved head and a particular "smoky" body odor that immediately took me back to my days in Africa. She had obviously decided it was time to see what lay outside of ER room 23, and she couldn't understand what I was saying when I said slowly, loudly, and with lots of expression, that, "No, we don't allow people to roam in the hallways naked." The whole episode was getting the attention of my fellow nurses and they were coming to lend a hand. Marissa, a feisty redhead from the Midwest, said, "Oh, I know what she's saying! That is Swahili!" So, while I watched (and made a mental note to ask Marissa how IN THE WORLD she knew Swahili), she and my drunk little patient started an animated conversation. Soon, both of them started singing and chanting in Swahili and dancing!... Clapping and stomping in true African fashion, my patient and Marissa and a few other happy nurses danced and sang all the way around the ER! The doc looked on warily and decided that if our little friend was sober enough to dance on one foot, she was sober enough to be discharged. I helped her pack her clothes into a tight little bundle which she immediately settled on the top of her head in true African style as she sang all the way out the door. I couldn't help but feel such an odd sense of de' ja' vu as I watched her go and remembered my time spent in Africa years ago. I learned later that my little African lady had been killed when she stepped in to a road way in one of her drunken rambles, such an unfortunate ending for such a fun little person. 

   In September, Hurricane Sally made her way through the area, being far more destructive than many residents anticipated. As a result, I had some interesting days in the ER. I particularly remember an elderly couple who had set up their generator inside the house. They were both unresponsive and hypoxic when they were found by their daughter who called 911. The EMS crew had been successful at reviving them with oxygen but brought them to us for further evaluation and monitoring. I had one of them as a patient and the other was directly across the hall, so I spent a lot of my time relaying messages back and forth. The poor old gentleman was so worried about his bride and was so angry with himself for causing the whole situation. He had set the generator by the back door and left the door open for ventilation. Unfortunately, the generator was on the ground floor and the couple was on the third floor, so obviously the fumes must have traveled up and not out. Both made full recoveries and were discharged home. While they were fortunate, some people were not. Many people who relied on home medical equipment such as oxygen condensers or IV pumps ended up in the hospital due to the power outage that lasted for the better part of a week in parts of our city. This situation stressed our already crowded hospital to the absolute max. Holding unit patients in the ER for days became a reality. In an unprecedented move, our director lined up ambulances and shipped patients over to our sister hospital across the bay.

   It’s pretty common to hear a call come over our radios for “assistance to the ambulance bay, please!” and most of us like to go check it out if we aren’t too busy, because you never know what you might find. Most of the time, the call is just for someone that needs help getting out of a vehicle, but occasionally, it is a little more entertaining. Several months ago, security called for help in the ambulance bay, and this time, there was a SITUATION… A big blue pickup and trailer had stopped just short of coming through the glass doors and was smoking rather ominously. There were numerous bullet holes down the side of the truck and the glass was shot out of the driver’s side. A young African American male was sitting almost in the middle of the truck with blood oozing from multiple gunshot wounds to his chest and abdomen. The ER team sprang into action and he was soon lying on a stretcher and on his way to a trauma room. The ambulance bay became a crime scene and was taped off for hours. The ER went on lock down as law enforcement hunted for the shooter. I never found out with 100% certainty, but we were left with the understanding that the patient had possibly stolen the truck as a get-away vehicle and ended up in a shoot-out. 

   How many of you enjoy cheese pizza? The cheesier, the better, right? We had a patient the other day who was found in the bathroom by her husband, unresponsive. Panicked, he called 911 but by the time the EMS crew arrived, she was responding and vitally stable. By the time she reached the ER, she was very awake and lying in the bed screaming “I have to POOOOOP!!! Get me a bedpan! I got to POOOP!!!! Ross, her nurse, put her on a bedpan which she promptly filled, completely... But the patient wasn’t finished, so Ross thought the easiest thing to do would be to put her on the toilet and let her finish her business. A few seconds after he got her on the toilet, she turned gray and became unresponsive! He pulled the bathroom call light and I happened to be the closest nurse, so I walk in the room to see Ross holding this lady onto the toilet, covered in poo and vomit and looking rather dead, to be honest. I quickly hit the code button and the calvary arrived a second later. The patient was quickly lifted into the bed, not an easy task since she was stripped naked and covered in slippery substances! We were checking for a pulse and about two chest compressions in when she started waking up… Hours later, she kept saying, “It’s all because of a cheese pizza… I ate the whole cheese pizza!” When I left work a couple hours later, she was still pooping! That must have been one LARGE cheese pizza…

   One morning this week, I had 3 stable patients and was waiting on doctor orders when I heard an EMS report come over the radio; the crew was coming in “emergent” with a “large laceration.” I decided to step into the trauma room to help when the patient first arrived so I could see what this “large laceration” was all about. Soon the EMS crew rolls in with a 300+ lb gentleman on the stretcher… one paramedic holding pressure with gauze on the right flank and lots of bloody gauze on the stretcher. After we successfully transferred the patient from the EMS stretcher to ours, (not an easy task, even with 5 people) we pulled back the gauze for a peek. The large laceration appeared to be maybe 5 inches long and 3 inches wide with visible subcutaneous tissue, not exactly a “large laceration” but, ok, it did look rather deep… initially, the bleeding was controlled but after a minute started to stream blood again. I put a pressure bandage back on the wound and the doctor finished his initial exam and began to ask the patient questions. The patient, who liked to talk about himself in third person as “Daddy,” stated that he had gotten out of bed to use the bathroom and upon return, had tried to “line up with his bed” but ended up sitting down on his glass night stand instead, ending up a large glass shard stabbing him on the flank. When the Dr. told the patient that we would be taking him to CT to check his internal organs, the patient replied, “Oh no, you aren’t! Daddy don’t go in one of them things!”

    Also, this week, my patience and PR skills were put to the test when I had a patient who was intoxicated, rich, and extremely rude. She was well into middle age with obvious signs of Botox and carrying a Burberry bag. The EMS crew that dropped her off in my room looked frustrated and kept rolling their eyes at me over the patient’s head. It was soon obvious why. The patient obviously believed that we were her slaves and that we should act accordingly or else she was “going to administration.” I had the unfortunate position as her primary nurse, so I had to get my face right each time before I went into her room and faced the music. During triage, she proudly told me that she had lied to the paramedics, saying that she was going to kill herself, but that, really, she wasn’t feeling at all suicidal… she had just said she was to get EMS to take her to the hospital. She stated that she was there for detox from alcohol and that she needed a room and food now! Also I needed to get her a phone charger immediately because “all hospitals should have one.”  I felt rather vindicated when the doctor came in and told her that there were no “detox” beds available and that she was going to be discharged with follow-up instructions. Boy, was she livid! She proceeded to curse at all of us before taking out her own IV and leaving. The next day, she was back, still drunk, still belligerent, and ended up winning a spot in the behavioral med unit for a mandatory 3 day stay. Thankfully, I was not her nurse this time! This lady really made me thankful for my normal ole’ poor people, even the smelly ones!

   Every day in the ER is an adventure, to be sure, but, I find that my days start to run together sometimes and situations that I may find remarkable one day I often forget the next. One of my aunts recently asked me, “Vanessa, do you ever feel honored to be there when people die and are having the worst day of their lives?” I’ve thought about that question a lot since then, and, yes, I do! I feel so blessed to have a job that I love and a supportive husband and family. I feel honored and humbled to be called to this crazy mission field we call nursing!