Are Batteries Included?

Working the night shift in the ER one gets to see the most interesting patients. You also get to work with an assortment of odd characters young and old. Physicians who are a little too friendly with respiratory techs, nurses who spend more time smoking than working, unit secretaries who spend hours talking to others on the phone, ignoring all incoming calls forcing the nursing staff to answer the phones.

One character I worked with was a truly ancient nurse who still wore her hat with the black stripe on it. She was always impeccably adorned in a white nursing dress, white stockings, white nursing shoes, and black horned rimmed half glasses suspended on a chain hanging from her neck. She was probable in her late 50’s but looked as though she could wrestle Hulk Hogan to the mat with an icy stare. Cool under pressure, professional at all times, and absolutely committed to making sure she never questioned the doctor’s orders. She was from a different era of nursing and I assure you I have the utmost respect for her. I can picture her sitting ramrod straight at the nurse’s station, signing off the physician’s orders with her black horned rimmed half glasses perched precariously on the end of her nose and tilting her head back so she can peer through her glasses and down at the world. She was the model for Nurse Ratchett from One Flew Over the Cuckoo's Nest.

Enter a young couple unwilling to tell the triage nurse why they had come to the ER. “It’s of a personal nature” was all the young couple had to say.

Well, who is the patient, the triage nurse asked?

Hanging her head the young blond pointed at her boyfriend and responded, he is.

The triage nurse encouraged the patient to sit down so she could get his information.

He refused all attempts to get him to sit down and requested to speak to a physician. It’s of a umm, uhh, Ooo.. personal nature, said the young man.

The doctor on duty that night was a collector of vintage automobiles, muscle cars. He had married Nurse Golddigger, who did not share his affinity for the finer things in life. Well, the need for extreme horsepower anyway. Nurse Golddigger had recently been injured at work by grabbing the ankles of a suicidal patient when she tried to jump form the window of the hospital (but that’s another story). Dr. Muscle worked as an emergency room physician, although he is actually a board certified surgeon. I asked him one time why he did not pursue a career as a surgeon and he responded, “I wasn’t a big enough prick.” That was typical of his attitude, totally unassuming, truly humble, a gentle and gifted man of medicine.

Dr. Muscle was an easygoing physician who took his time with each patient. His approach to medicine was to allow the patient to tell him what was wrong. He subscribed to the theory that if you didn’t know what was wrong with the patient after taking a complete history, you had not taken a complete enough history. His easygoing attitude spilled over onto the nursing staff who looked forward to working a stress free shift with a competent and gifted doctor. For those of you who are not in medicine it may be hard to understand, but the competence of the doctor makes all the difference in how the rest of the staff approaches their jobs.

One night I was called by the telemetry nurses to the bedside of a patient who had coded. When I arrived, they were standing around the dead patient staring at him and doing nothing. Gee, do you think it might be a good idea to perform CPR guys, I thought. Get the BVM and start bagging, I directed one nurse. You, pointing at another nurse, perform compressions. Of course, this was after I had applied the monitor, checked the rhythm, and checked the patients pulse, don’t get ahead of yourself.

The patient remained dead as CPR was performed. Moments after I arrived the doctor strolled through the door. The patient had visible IV saline locks in his left external jugular and right forearm. Which IV is the best one? The doctor asked.

I don’t know. One of the floor nurses responded.

Whose patient is he? The doctor asked.

None of the nurses responded. Well who is supposed to be taking care of this patient? The doctor demanded!

Finally, one of the tele nurses spoke up. Cyan is his nurse. She went to get the patients chart.

Does anyone know anything about this patient? The doctor asked.

Not a single nurse spoke up.

The code proceeded rather haphazardly. The external jugular IV was worthless, but the 22-gauge forearm IV worked. Totally inadequate for giving code drugs, but it worked.

Running a code is scary to many people who don’t do it on a daily basis. That’s why in this hospital one of the ER nurses would always go to the code with the ER doctor. We know each other and are used to working together. Unfortunately, the doctor I was with this night was rather poor at reading EKG strips and had not really ever run a code by himself. He had not taken advanced cardiac life support (ACLS) because it is not required of the physicians, only allied health. To top off the whole scene the patient who coded was in a triangularly shaped corner room to small to get the code cart all the way into the room.

Running a code is like baking a batch of cookies. You follow the recipe and the patient either stays dead or gets better. The basic recipe for running a code at the time of this patient’s ventricular fibrillation was: shock, shock, shock, Epi-shock, lidocaine-shock, epi-shock, lidocaine-shock, epi-shock, are you seeing a pattern here?

So, Dr. Codeless learned the patient was a cardiomegaly/cardiomyopathy patient and had not been doing well. The doctor ordered epi to be given. A nurse standing in the doorway directly behind me handed the epi to me, and I pushed it through the little IV. The room was so small only four of us, crowded together, could fit around the bed. I stood next to the bed on the door side of the patient. The doctor stood next to me, so close I probably would have felt better had I been wearing a condom. At the head of the bed stood another nurse bagging the patient. The last nurse stood on the other side of the bed performing compressions.

I gave the epi and strained to turn and see the monitor. Nothing yet, the doctor said. Give it about 30 seconds and we’ll shock him, the doctor ordered.

Cyan, standing directly behind me, was holding the paddles millimeters from my back. Over the sound of the BVM and compressions, I could hear the whine of the capacitors in the monitor beginning to charge. Damn woman, are you trying to kill me, I thought. I was trapped, I couldn’t move forward because I would have had to crawl in bed with the patient. I sure as hell couldn’t move back because these nurses couldn’t handle one code, let alone two.

Hold those damn paddles over your head, I demanded.

What? Cyan asked.

I don’t want you to defibrillate me instead of the patient! I told her.

She just stood there with paddles charged to 200 joules, ignoring my request to move the paddles away from my back. The doctor twisted himself around, grabbed the paddles from her hand, and handed them to me. He briefly tried to place the paddles on the patient’s chest himself, but he couldn’t stretch across the patient and not touch the patient and bed at the same time. The doctor handed me the paddles and three successive shocks brought the patient into a pulse producing rhythm.

I handed the paddles back to Cyan and told her not to charge them- EVER, before handing them to me.

The patient was in a junctional rhythm. This means that the cells in the heart setting the pace of the beats were not the normal beat setting cells. A patient in this rhythm is susceptible to having the rhythm stopped if you give them lidocaine.

Lidocaine, I heard the doctor order. I turned to the doctor and said I didn’t think we should give him lidocaine because he is in a junctional rhythm.

Lidocaine, He repeated.

Why don’t you give a patient in a junctional rhythm lidocaine? Lidocaine is the same stuff that dentists use to numb teeth. It does the same thing to the heart muscle. It will numb the cells that are producing the signal for the heart to beat. When a patient in a junctional heart rhythm is given lidocaine, the result can be the cessation of the heartbeat.

Lidocaine, I heard the doctor say a third time. I could have stood there and argued with the doctor, but he was not in a mood to change his mind. I hear my mother calling, I told him. I twisted around and pushed my way past the code cart by turning it sideways. Cyan, holding the amp of lidocaine, approached the patient. As I was walking down the hall, I heard the doctor yell, he’s coding again. Yep, the lidocaine had really worked well, I thought. About eight minutes after I left the patient regained his rhythm and was moved to the ICU.

I spoke with the ICU nurse the next day and she told me he was shocked 52 times. I asked her if that was medium well or well done? Unfortunately, the patient died the following day. In spite of the fine job the ER doctor did.

Anyway, back to the meek young man with the problem of a personal nature. The triage nurse took Mr. Meek to one of the treatment rooms along with the young woman. The chart was placed in the rack and the couple awaited the arrival of Dr. Muscle.

They pondered what to tell the doctor about what happened. Mr. Meek finally agreed that his girlfriend would tell the doctor the problem. Shortly after, Dr. Muscle entered the room.

What can I help you with tonight? He asked. The young blond women spoke up. We were having sex and Mr. Meek wanted me to stick a dildo up his butt. At first I didn’t want to do it but he said he really liked it. Everything was going ok until I lost my grip and it just disappeared. Dr. Muscle listened carefully. The young blond questioned if he was going to need surgery? Dr. Muscle said he did not think so and told them how he could probably remove it by just palpating it out through the rectum. The young couple looked relieved. Dr. Muscle left and went to get Nurse Ancient.

A few minutes later Nurse Ancient and Dr. Muscle entered the room. Dr. Muscle donned gloves and began to palpate the dildo down the descending colon and toward the rectum. Nurse Ancient, ready to help, squirted some water-soluble lubricant on Dr. Muscles left fingertips. Carefully he inserted two fingers into Mr. Meeks rectum.

There, I can just feel the tip of the dildo, he thought, as he pushed the dildo down the colon with his right hand and felt for it in Mr. Meeks rectum with the left fingers. After considerable effort, he was able to get the blunt end of the dildo to protrude ever so slightly from Mr. Meeks rectum. He tried over and over to get the dildo to protrude far enough to get a good grip on the end and pull it out. Nurse Ancient stood stoic and quiet throughout the entire attempt to pull the dildo from Mr. Meek’s rectum. After watching for about 20 minutes Nurse Ancient, white nursing cap, white dress, white stockings, white shoes, black horned rimmed half glasses perched on the end of her nose, hands akimbo on her hips, tilted her head down to look over her glasses at Dr. Muscle. In a clear loud voice she asked, “Well, are you going to pull it out or just change the batteries”.

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