Wednesday, March 19, 2008

Entry: Medical Scene #3

This entry comes from our New Zealand friend, Debbie Roome:

Hi CJ,

I would appreciate any comments about inaccuracies or anything that doesn't ring true in this piece.


The ER was quiet the day Dennis Riley was admitted. Maybe that was why he attracted more attention than he normally would have. He was secured by four point restraints to the gurney and alternated between screaming in pain and whimpering like a whipped dog.

“29 year old jumper.” the paramedic rattled off as they rushed him in. "Jumped three storeys at his place of employment. Heart rate 98. Bp 160 over 120. Pupils dilated. Multiple contusions, suspected fracture to left thigh."

Dr Lee Stratten, flanked by interns and nurses took charge of the case. “One, two, three." Dennis was successfully shifted onto the ER bed and once again restrained.

He was battling to make sense of where he was. Thoughts flashed erratically through his mind. He remembered feeling depressed. Deeply depressed, as though he was trapped in a pit; a mine shaft, narrow, close and suffocating. And then he had been sitting at his desk, sweating and clammy. Some one had been after him. The only way out had been through the window. A strangled scream forced its way out of his throat. “Please.” he begged. “Don’t let them get me.” He struggled beneath the restraints and a searing pain shot through his left leg.

Someone was bending over him. Stabs of light. Cold hands pulling his eyelids open. “Calm down Dennis. We’re trying to help you.” Voices asking questions he could not answer. His tongue was a wedge of cardboard, swelling like a bloated sponge and slowly blocking his airway. The questions continued: “Can you hear us Dennis? Have you taken any drugs today?”

A new voice in the background. A woman this time. "I’ve spoken to his employers, Dr Stratten. He seems to be a stable person. Single. No relatives in town.” Tears began to roll down Dennis’s face as he battled to suck in air. Alone. he thought to himself. Alone and worthless.

The doctor was giving directions. “Chest, head and leg films. Drug screen. Call his employers back and try and locate his GP. This looks like a drug problem. If he tests positive, call the cops and get them to check out his background.” Dennis could hear his heels clicking away.

Help me! he wanted to call out, but his mouth refused to respond. He felt numb, paralysed. With great effort he forced his eyes open. The bland fluorescent tubes above his head were the last thing he saw before his back whipped up and thrust him brutally on to the bed again. Help me! he cried again in his mind. White hot pain engulfed his entire body. In the fog he heard someone shouting “Code blue!”

Submitted by
Debbie Roome

1 comment:

CJ Lyons said...

Debbie,
Loved how you captured his confusion and disorientation!!!

A few things jumped out at me. I'm going to tackle them in pieces.

First of all, a 3-story jumper is by any definition a trauma alert--no way in any ER is this guy not going to be the center of attention, so your opening paragraph doesn't really jive with reality.

Also, it's the trauma that will be treated first, not worrying about the psych stuff or drugs (although they'll check for drugs of course).

Life threatening injuries always have priority--Airway, Breathing, Circulation.

He's going to be c-collared and fully restrained to the back board--they won't release the restraints and then tie him back down, they actually move the entire back board he's tied to onto the hospital bed.

Traumas should be carefully choreographed and well practiced ballets--the team knows what they're doing and gets the job done.

They'll check his airway, level of consciousness, make sure he's breathing okay, check his heart and circulation, signs of shock, while starting two IVs, drawing blood, and stabilizing his injuries (at least one broken leg, I imagine).

If he's totally combative, they're going to assume he also hit his head and sedate and paralyze him, intubate him (put him on a breathing machine) while they complete their assessment--which will also include a CT of his belly and head.

Many times "crazy" trauma patients aren't really crazy, they're in shock or have a serious head injury. Of course this is hard to tell just from exam as you also often have drugs and psych problems adding to the presentation.

So you do what you need to do to make sure there's nothing life-threatening going on. Then you worry about the psych stuff later--preferably far away from the ER, lol!

Also, the vitals signs you gave him make no sense unless he does have a severe head injury--did you do that on purpose? His heart rate should be much higher if he's in pain and agitated. And his BP was very high.

That combo--relatively low heart rate and high BP is a huge, huge red flag to any doctor that there's serious, life-threatening swelling going on in the brain. Any doc seeing that in a trauma patient would sedate, paralyze, intubate, hyperventilate, call for the neurosurgeon and an immediate head CT and use drugs to decrease the swelling.

So, I'm not sure if you were trying to paint the doctors and nurses as incompetent (if so, then it worked, lol!) or if you were sowing red herrings that something else was going on, maybe a strange drug intoxication???

Again, all depends on what you need for your story--then you can find the medicine to fit.

Hope this helps,
CJ