Wednesday, September 20, 2006

Street Hockey

I was doing tracheostomy care for the patient in room 8. They were doing much better today than yesterday. Their cough was more effective basically because their secretions were far less thick; thin actually, and clear as the fresh cold waters of a mountain stream. Except with methicillin resistant Staphylococcus aureus.

The Foley catheter tubing that I had clamped was still bone dry. The residents wanted a repeat urinalysis but there was only a drop of urine in the bag. The patient had already been dialysed that morning and they were pretty much anuric. Then I heard other staffers yelling my name.

"Yeah, yeah, yeah," I said loudly enough to be heard out in the hallway. My invisible psychic clue-detectors had already told me exactly what to expect.

When I eventually got to room 4, Mr. Crazy Big Guy was standing naked by his bed, foley catheter tubing stretched well, quite q bit. Enough to extend his paltry manliness somewhat beyond his usual Chihuahua stature when in repose.

And his WoundVac tubing was okay but me and nobody else wanted to see that damaged.

Mr. Crazy Big Guy had been bitten by some nasty critter, a spider or a scorpion, on his inner left thigh and he'd developed compartment syndrome. A couple days ago he had gone to another hospital where they did an extensive fasciotomy of the thigh, leaving three 4-inch-long open incisions along it, complete with intact Penrose drains.

He wasn't happy with the care he was getting at the intensive care unit at the other hospital so he'd ripped out his intravenous lines and stomped away against medical advice. When he got home his family members took a look at his wounds, each profusely draining copious amounts of serosanguinous fluid. So they brought him to our hospital.

Everybody likes our hospital. They say that we "know what we are doing" and "the nurses are so nice there." Whatever.

Since his wounds had been draining like mad and soaking up gauze and even chux, requiring changing constantly all night long, the wound care nurse specialist put a nice WoundVac on his thigh to drain the blood and goop into a nice little container instead of these going all over the bed linens all the time.

Anyways, I'd heard the yells and there he was standing naked next to his bed, surrounded by a team of residents. I could excuse the pregnant lead resident, but the guys standing there with that deer-in-the-headlights look could probably have been doing something.

The bedrails were up. Mr. Big Crazy Guy had crawled out over these. "Heye dude, what's up?" I asked him. His speech was crummy but he managed to get out something about how he had to get to Tucson to go to the hospital because he had to pee.

Me: tiny baby gazelle.

Mr. Big Crazy Guy: draft horse.

After a quick calculation, to determine that his head wouldn't hit anything, I pushed him backwards over the bedrails and he flopped onto the bed. I heaved his legs in after him and muscled him into a straight position laying in bed. The residents looked at all this as if they were background characters on the streets in a fight scene from a Spiderman movie.

"What the fuck are you guys doing!?" the patient asked. "It's a long story," I said.

We put his oxygen on and settled him in. I had just dosed him with enough Haldol to knock out a donkey about half an hour prior to this, because he'd been starting to get antsy then, and now he was going with it, not fighting it. In a few minutes he was snoring.

The lead resident was writing orders when I approached and she said "that was the most amazing thing I've seen in quite a while."

The case manager nearby said "Remind me to never play hockey with you!"

All in a day's work.

1 comment:

may said...

all in a day's work indeed. we wear innumerable hats really.