Residential Space A creative outlet during residency, turned ongoing virtual soap box

What I have learned from the Harborview ER  1

Posted on March 28th, 2006. About Health Care, Ramblings.

The city of Seattle is in shock over what is now being called “The Capitol Hill Massacre.” In a city where acceptance and tolerance are a given, Capitol Hill is the neighborhood reflective of Seattle’s welcoming attitudes. Rainbow flags fly from many businesses, people talk openly on the streets while waiting for buses, and the area’s high street features everything from Indian cuisine to handmade fabrics. It is generally considered one of the more desirable places to live. The thought of seven people dying violent, tragic deaths in a home there recently is a bit surprising, to say the least.

Just prior to the shootings, I finished my overnight shift in the Harborview Medical Center emergency department. When I returned later in the evening for another shift, the residents and attendings who had been on during the day looked emotionally and physically drained. The surgery residents seemed unable to comprehend that they were resuscitating these trauma victims featured in the national news media. As has been reported publicly, another victim died after reaching Harborview, and two others made it to the intensive care unit. During the night, I saw a stabbing victim, several young people in a horrible motor vehicle collision (one died), multiple injuries from fist fights, “car vs tree,” “pipe vs head,” cardiac arrest, and of course countless overdoses and intoxications brought in by the police. Everyone left feeling depressed and tired.

This past month has been a frustrating one. I have “treated” some of the same intoxicated individuals on five or six different occasions within a four week period. I have been sworn at, had to order restraints on meth overdoses for taking swings at paramedics, and seen people who come to the ER at 4AM for indigestion they have had for the past two weeks.

Over the past two nights, though, things have come together for me. I have really learned to care for these patients. For example, intoxicated patients get an IV and a good dose of thiamine (a vitamin those with chronic alcoholism are often lacking from malnutrition). Then, they get IV fluids as they sleep for a few hours. Eventually, from all of the fluid, they have to go to the bathroom. When I see a patient walking to the restroom, I know he/she is stable enough to walk safely out of the hospital. When they go back to sleep, A) I take his/her blanket away. He/she gets crabby, but some can still sleep. If this is the case, then, B) elevate the head of the bed to a 90 degree angle and withdraw the pillow. This may help someone wake up, or make him/her even crabbier. C) Speak in a kind, but firm tone about how it is going to be a lovely day in Seattle and you would hate for them to miss out on it by lying on a gurney in the ER. If all of this has still been ineffective, D) swing his/her legs over the side of the bed and get him/her on his/her feet. No one who has walked to the bathroom will fall from this; everyone wakes up. Ninety percent of these patients (once awake) are very pleasant, thank me for the care they have gotten, and leave willingly.

This is not the medicine that I learned as a medical student, but knowing people’s behaviors and understanding how to negotiate realistically was a crucial part of surviving this past month. Knowing how homeless shelters and detox programs operate was also very important. I also got to run my first ACLS (Advanced Care Life Support) code and experienced what it is like to give orders to a room full of providers during a cardiac arrest. I placed numerous central IVs into jugular and femoral veins, performed lumbar punctures for spinal fluid sampling, and learned how to throw a quick IV into superficial neck veins. Looking back, while the experience was stressful and exhausting, I feel like twice the physician I was a month ago.

What can I say? There is bad stuff out there. But I finish my ER experience hoping I am better able to deal with it.

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