That is how the shift ended.
On one hand, it feels good to be able to write about work again, but on the other I am remembering that it was a long time to be out, and I am desperately out of “work condition”...
I wrote yesterday during the day about how the shift was going, and at that time is was okay. Steady, but good. We weren’t horribly busy, and it had potential to be a good day to return to work. But sometimes things aren’t always as we would either like or expect them, and yesterday turned out to be no different. In retrospect, I should have seen it coming, and that I didn’t, at least to me, is no big surprise. I should have realized that it would become an episode of “Welcome Back Sucker” as soon as evening shift change rolled around at the hospitals...
We didn’t go out for the evening after about 1800 yesterday. So Corey (the other big bald guy) and I grabbed dinner and went back to the base to hang out. We returned to a relatively uneventful early evening, and Corey went to his car for his bedding so he could sleep. From about 1900-ish on nothing big was going on. We had 6 crews working: 3 BLS crews, two of which were dedicated to Partners, two P/B crews (until 2300 when one of them shut down) and us. All good. We were sitting around, watching baseball, chit-chatting. Makings of an easy evening. That all changed at about 2130.
First, within the span of about 30 minutes, all hell broke loose in various corners of the Boston area. One of the BLS crews got sent out to take a pediatric Psych patient from Children’s to the Franciscan Children’s Hospital. A few minutes after they left, we got sent to the Hebrew Rehab (I refer to this facility as “my favorite nursing home” from time to time) for – get this – a 102 year-old female with a chief complaint of chest pain.
At the time of the dispatch we didn’t know our patient would be 102, but we were both in for a rather interesting experience.
We arrived up on the floor and got to the nurses’ station to see the two nurses who were working watching this tiny, ancient woman sitting on a wheelchair yelling into a telephone at who I presume was a family member on the other end. The conversation from her end of the line went something like this:
“I’m not going! No, God damn it, what part of ‘I’m not going’ did you not understand? I told you, they aren’t going to do anything for me at the hospital. Don’t you understand, it is a holiday weekend (emphasis is mine), and there will be nobody working! I told you, I am not going!”....
And on it went, for a good three or four minutes. The two nurses were both trying to get her settled down, but this woman would have none of it. And while she was on the phone, Corey got a look at her chart and a sense of her medical history, which was rather extensive. Considering her age, this wasn’t a real surprise, but the big potential for trouble was the history of A-Fib. I got a look at a 12-lead ECG that had been done earlier in the day, and the irregularity nearly reached out and slapped me across the face.
So while he was doing that (it was his tech that time), I went around the back of the nurses’ station to talk to our patient and find out why she was so adamant about not wanting to go. By the time I got to where she was she had hung up the phone, and I leaned down next to her to introduce myself. By the look she had, I thought she was going to slap me across the face. So, I started talking to her. Found she was alert and oriented to person, place, time, and situation – pretty impressive, I thought. She was also pretty uncomfortable but unwilling to admit that to us. She’d taken 3 of her own sub-lingual Nitro tabs over the hour prior to our arriving and she’d apparently gotten some relief, but from her presentation I suspected her pain was returning. It wasn’t sub-sternal or retro-sternal pain, however; it was located more in the area of her left flank or in the mid-axillary space, and she had radiation up into the back of her shoulder. She was a bit pale, but she was dry and warm. And she wasn’t having difficulty breathing; she was speaking (actually, yelling is a bit more accurate way to describe her speech) in full sentences without a lot of effort. But I think she was probably more scared than anything else; I got the impression that it wasn’t that she thought she’d not get seen but that she thought she wouldn’t be treated properly because of her advanced age.
I have to admit that this occurred to me during my assessment of her. Unfair as it may sound, I’m inclined to believe that sometimes this happens, whether we like it or not.
In any case, I found that her doctor had called the ED at the BIDMC, making them aware of her impending arrival. The doc also spoke with her son, and he was going to meet her there as well. She’d spoken to him also (her son, that is – that was who she was yelling at) and he’d convinced her to go with us.
So we got her packaged and ready to go. Placed her on the stretcher, got her down to the ambulance, loaded aboard, and got on the road. As I said, it was Corey’s tech; he asked me to go at a Priority 2 pace, which I was happy with, simply because things could change with someone in that age category in about the time it takes to snap one’s fingers. When we arrived at the BI, we found that it was insane; there were 5 ambulances at triage ahead of us, patients on stretchers out in the immediate area, and no beds to be had in the ED proper. However, they managed to get her into a bed for us and her son arrived (a young looking 74 – I was impressed) not a moment too soon.
She was still there two hours later when we arrived back to transport a patient to Oncology at the East Campus (where it all started back in October), and another 90 minutes after that when we went out back to pick up the vented patient with multiple meds, positive for C-difficile, a bleeding femoral line, and a cast of thousands to transport him (including a nurse and a brand-new respiratory therapist who was scared out of her mind).
That was how the shift ended. When I got home and crawled into bed this morning, I had set my alarm to go off at 1:00.
It did. I ignored it and got up at 4:00. And I will get to do it again tomorrow.
Welcome back, me...