Thursday, September 15, 2011

the challenge.

"This is Calvin, he's 91 years old and called us after he fell while getting out of his vehicle this evening." The paramedic stood with clipboard in hand and watched us work while he gave "report" to the male nurse who was busy undoing the straps that held the frail old man to the plastic board that kept his fragile frame coldly rigid.
"Calvin reports that he may have hit his head when he fell out from the vehicle, although he's not quite sure. He said he has some neck, lower thoracic, left and right lower quadrant pain, pelvic pain, and when we hooked him up to our 3-lead we noticed an irregular heart rhythm, somewhat V-fib."
The nurse bent over the top of the bed and spoke directly, loudly.
"Calvin. Calvin, can you hear me?"
"Yep." The reply had only a hint of quavering.
"Calvin, how are you doing?"
"Oh, I'm alright." The old man's startlingly bright blue eyes glimmered tiredly as he responded.
"Do you know where you are?"
"Oh, I'm in the hospital I suppose."
"Good. Now Calvin we're going to take real good care of you, okay? Just sit tight and while we take you off this board I don't want you to move at all. You just let us do all the work."
"Okay." His eyes closed and the loose skin on his jutting chest slid gently back and forth as his ribs shot upwards and dropped back down often.
Six bodies worked in unison as only a healthcare team can. Hands, elbows and arms all bumped relentlessly as they glided over his elderly body. Feet stepped on each other, shoulders moved back and forth, and progress sped along quickly, propelled by a symphony of performances.

Straps on the left side undone.
Shoes off.
Straps on the right side undone.
The IV in his left AC was flushed and re-opened, checked to make sure it was good, and ready for more fluids or medications if need be.
Do you want me to cut his clothes off?
No, not yet. Let's not do that unless we have to.
Behind you with the EKG.
Hand me the BP cuff. 
Untwist the pulse ox.
Go ahead and draw labs for me, a rainbow (all standard-colored labs).
Glance up at the vitals monitor and notice the patient's oxygen level is at 99%, a very good sign. 
Gown placed over the patient's now exposed waist. 
Step around two people to reach the monitor, tweak the settings and hit "every two minutes" in the settings for how often the patient's blood pressure would be taken.

Words were very rarely spoken unless in the form of the question, answered each time by the nurse, who was in command of the room until the doctor arrived. It was only a few minutes.
"Calvin, this is Dr. --------. He'll be taking care of you."
"Hi Calvin, how are you?"
"Oh, I'm good."
"I bet you are."
The nurse looked at the paramedic.
Work continued.
"Do you want me to give report or do you?"
"I will, you can head out" the nurse answered, and the paramedics stepped out through the curtain, pulling it closed behind them.
"First, let's go ahead and take this board out from underneath him."
The nurse took over.
"Both of you reach here and here. Then we'll roll him up on his left side. James, you'll take the board out from under him and then I want you two to keep holding him so Dr. -------- can do his exam."
The two medics reached where they were told, and I held the edge of the board loosely.
The nurse stood over the head of the bed and looked at Calvin's eyes as he spoke loudly and clearly.
"We're going to move you and the doctor's going to take a look at you, okay?"
No one moved.
We waited, a synchronized pause.
The nurse looked up, then said "1, 2, 3 roll."
Lectures, notes, practices, tests, final exams, grades, on the job training, it was all so cold and clear in our minds as we moved, standing room only, around a hurting person.
We had all progressed to this. Work was a synchronized performance of triage; we all acted, communicated and moved in descending order of what was most important to the preservation of life.

A few minutes later after there was a lull and the immediate needs of the patient had all but subsided, I walked over towards the nurse's station to grab my Pepsi and heard a nurse call a medic over. "You have to see this. Check this out, watch how he falls."
Youtube flashed and glowed as it replayed the clip for what would be almost the three-millionth time.
"Watch what happens, this guy is going to go halfway down the stairs on his skateboard."
"No, no he isn't. ARE YOU KIDDING ME? Oh my God, that sucks so bad. Did you see his head, how it hit the railing? He's out cold. Damn, he's out."
"Eldridge, can you wheel "Charlie" (Bed C) to x-ray?"
"Sure." I set my drink down on the desk and greeted Calvin. "We're going to take some pictures now, there's some people who want to see how your bones look."
He smiled and nodded ever so slightly.

Unlock the bed.
Lift the monitor onto his mattress, the vitals come with.

As we moved down through the dark hallway the silence hung in the air stagnant and reluctant. Calvin was awake, aware, and waiting to find out how badly he'd been hurt.
"Calvin, I think you lied to me. Were you really just getting out from your car when you fell? Or were you trying to impress some young ladies with your skateboarding skills? Because I when I took your shoes off I thought your calves looked pretty athletic."
Calvin's mouth moved slowly upwards as he thought for a moment before answering slowly.

"If you have a skateboard with you we could find some ladies and figure that out right now."

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