A blunt instrument

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If the television show "ER" were to take place in Seattle instead of Chicago, it would be set at Harborview Medical Center, the trauma center for the entire Northwest region, including Alaska. The Harborview ER is a blunt intrument, set up to handle major trauma (a subset of patients that occasionally includes "normal" people who live otherwise non-chaotic lives) as well as care for the area's malcontents: prisoners, drug addicts, street people.

I just finished my first 24-hour shift in the HMC ER, so the implications of what the next four weeks will do to my psyche are still sinking in, but I can say that I found during my first day there that it was pretty much as advertised: one trauma code after another after another, punctuated only by the steady stream of less acute human tragedy. It was one of those times where I did feel like I was on the set of a TV show--except without all of the inter-staff romantic side-stories.

My first patient was a heroin addict with hepatitis. He had a triceps abcess from where a buddy had "muscled" him with some heroin a week prior. He needed IV access and of course he had none (hence the need to inject your heroin into the muscle instead of the vein). The nursing staff of HMC are decent clinically but there is enough work to do that they are completely unwilling to assist in doing anything that a resident hasn't at least made an attempt at doing him or herself. This means you have to draw your own blood, and sometimes even give your own meds (this is the 1950's model of resident training and it's not the only way that HMC is like stepping back in time.) I'm far from proficient at these tasks (they are, in fact, taught at nursing school). So here I am, getting an IV on a drug addict--they way all good needlestick stories begin. My supervisor, a resident known as the "Trauma Doc," came by to see how I was doing. I told him I was going to try and get an "EJ" (an IV in a neck vein) and he sort of smirked and told me I should just get an arterial stick (more reliable but painful) for labs and fiddle with IV access (for antibiotics) later "unless you think you can get it." I told him I thought I could. I got it, and with no needlestick. After that the Trauma Doc started advertising my services "have Westhoff help you, he's a wiz at EJs." Fortunately I was only actually asked to help another resident once, and I did get the EJ--keeping my new-found reputation intact.

All in all, it was a bizarre and sad but amazing 24hr blur. I did manage to get one and a half hours of sleep in the early morning, which was amazingly refreshing. Of note, I put in a chest tube (exactly what it sounds like, you cut a hole in the chest wall and put a tube in beside the lung). I'd done it several times before but usually in ICU type settings where there is more time. In this case there were 20 people standing around looking at me, and the plan was "as soon as Westhoff gets the chest tube in, we'll take this dying patient to the OR." All went well--for me that is, I got the tube, I don't know how the patient did, he'd been stabed in the back. I'll talk to a buddy of mine on the surgery service tonight, he should know as his team was on call last night.

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This page contains a single entry by John published on February 11, 2003 4:49 PM.

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