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Friday, August 31, 2012

The Springs: E.R.

When weeknight or weekend call duty rolled around, there were often some interesting learning experiences to be had through the Emergency Room. Not all patients would need x-rays taken but when they did, the doctors liked to make it a time of sharing information with me, too. Our uniforms, with the plain, white cap gave our student status away on first glance. Perhaps that made the trip to the Emergency Room a bit more interesting for them, since most of our doctors liked teaching.

Sometimes the information shared helped me to take better x-rays; but, just as often, the information had nothing to do with x-ray technique or positioning.

For example, when the boy came in with his shoulder dislocated, the doctor, carefully, showed me the proper way to reduce a dislocated shoulder. The teen was able to go to the Radiology Department right next to the E.R. so I didn’t need to drag the 500-pound behemoth out for a portable of his shoulder. The whole time I was working with the injured soccer player, the doctor was instructing me about the injury and treatment of same. The funny thing is, I never forgot what he said. If I had run into anyone with a dislocated shoulder at any time in the next four decades, hey, I was ready! Unfortunately, I never did manage to be on any soccer field when this new skill was needed. Well, unfortunately for me, not the players, that is.

Then there was the Saturday the little girl fell out of her swing, right onto her outstretched palm. Snap! Broken arm just above the wrist. The small arm presented with both bones of the forearm slid to the outside of the arm, straining the skin covering the area.

“Now, just look at that.” The white-haired orthopedic specialist pointed to the break. “Right there is a classic fracture. You can already know it’s going to look like that when the mother phones you. If she says the child fell right on her outstretched palms, you can believe that one of the arms is going to look like that. Classic.”

“Would you like me to bring the portable over, Sir, or can I take her to the Department?” The doctor had already put himself down on the stool next to the exam table.

“How ‘bout you fetch that machine of yours. We can just wait here for you and I can get to know this little gal a bit.” The kid looked pretty frightened behind all those tears, so it was likely a call as much for her benefit as for his. The mother was there but totally silent unless spoken to directly.

Once the films had confirmed the break, the doctor turned his attention back to me. You go ahead and move that thing back out of the room now until we need it again, and I’ll just give Missy here a little deadening. Local is enough for this job, no need for a block. I’ll wait for you before I reduce the fracture.”

When I returned there were, indeed, a few more fresh tears. The mother had elected to step out of the room before she fainted, so I gently took hold of the little girl’s tiny hand. Slowly stroking her back, I listened to the doctor. He was preparing the things he would need for a cast as he unburdened himself.

“They say I’m too old to keep practicing medicine. Well, they’re wrong about that, little lady. You’ll see; I’m as good as I ever was and that’s pretty darn good. Who are those young pups to say I should step aside for them, humph!” The surgeon took hold of the petite wrist with one hand and the area just above the break with his other hand. “Just look at that, will you? In just a snap… “ The sound of a loud Snap! was heard, with the child as surprised as I was. “There you go, Sweetheart, good as new.” It was, too. Perfect alignment of the bones; it didn’t look like it had ever been any other way. “Now, Sojourner, you get that monster on in here again and take another picture of this arm before I cast it. It’s just fine, I know that and you know that, don’t you? But, the goll-darn lawyers need their backsides covered so let’s play their game.” He stepped away from the table, lifted the little girl to the adjacent stool and gently laid her arm flat on the exam table.

The x-ray did, indeed confirm the exact alignment of the two little bones. “There you see a perfect job from this old workhorse. Back the beast off now, will you, but don’t take it out of the room. This cast will be on in a flash and we don’t want to wait on you; we all want to go home, don’t we, Honey?” The little patient nodded, wearing a big smile under her dried tears.

I didn’t learn how to reduce a fractured wrist in a child that morning, but I did learn that even in medicine, the young upstarts were trying to make the seasoned practitioners feel like useless relics. I had not even given a thought to how much that would hurt the docs struggling to stay afloat in their rapidly changing world.

Then, there were those trips over to the Emergency Room that had major shock value. One Friday, right after everyone else had gone home, I ambled on over to the desk of the E.R. The off-hours nurse was fun and always had interesting stories to pass along. My department’s reception desk was in an open area nearby so it was no problem to whip over to catch any phone call directed to that desk. Besides, after-hours calls usually came from the E.R. anyway, so I was already there, right?

In the middle of one gripping saga, I glanced up, catching sight of a man standing just inside the E.R. entrance. He was dressed in workclothes and had, obviously, just come from his jobsite.

“Hello, may we help you, Sir?” My friend stopped talking and turned her swivel seat to the direction of my attention.

“Yeah, well, I hope so. I just got off work and I have a problem.” He did look a bit pale but his problem was not apparent.

“Did you get hurt at work, Sir?” My friend was reaching for the clipboard with forms to fill out for the patient while I continued my questioning.

“Yeah, I did, about half an hour ago. I reckoned it was close enough to closing time that I’d just wait to come here until I punched out.”  He seemed to be trembling a little so I offered him a chair to fill out the form.

“Are you feeling okay? You’re looking a bit pale? Would you like to lay down and have us write on the form for you? You’ll need to sign the form but we can fill it out.” The growing pallor of this man alarmed me. I directed him over to the examination cubicle; and, while the E.R. nurse wrote his answers on the form, I reached up to help him take his jacket off.

“Wait a minute. You might need this.” Pulling away from me, the patient withdrew his right hand from the jacket pocket. There was a bloody object of some kind wrapped up in his cloth handkerchief.

“What’s that?” The nurse and I asked in unison.

The man quickly unwrapped the object as he told us. “It’s my big toe. I cut it clean off today.” Sure enough, his palm held the entire big toe, looking even paler than the patient did.

When the workboot had been carefully removed, the bone protruding up from the foot was clearly seen, in part due to the retraction of the surrounding skin. “Hmmm? Do you think I should take an x-ray of this? I mean, you can see the end of the bone with your eyes; I‘m not sure an x-ray would add anything at this point, would it?”

From the end of the phone line, the on-call surgeon agreed. Since the doctor had not yet left the hospital, the man and his toe were successfully re-united within a couple of hours. X-rays were taken in the Operating Room to confirm alignment and position of pins to hold the bones together until they had time to knit.

Not sure about my E.R. friend, but I was certainly glad not to have had a call while he was in surgery. I needed to lie down a bit, myself, from the shock of seeing that white toe in his hand and the bloody bone protruding from his pale foot. What a way to start a night on-call!

In these last days of my second decade of life, God was, certainly, giving me opportunities to see what life as an adult would be like. No more of the “Wait out here; you’re too young to see this” stuff. It was time to grow up and take my place in the helping profession, even with the occasional blood, guts and gore.

****Have a fun Labor Day weekend!

1 comment:

  1. Dannie,

    Your wisdom, stories and heart are so amazing and filled with God. I loved this post. Thank you for sharing yet another valuable message.

    God bless & love,

    ReplyDelete