Anthony @ 2200

another long night...it's been a rather long week...anthony sighs in place of breaths...a bit pathetic, but no one to impress.  school work is hanging with a since of failure, like a carrot suspended by a string held by a stick.  but he must not give up.  

lots of sick people, normal.  lots of drunk people, normal.  it started raining so it has damped morals around here, also with depleted health.  sniffs and coughs echo the halls during the night.  anthony thinks to him self, "if i get stick now, i might as well just kill my self."  spring brake on the tip of his schedule, but still too far to reach.  focus.

one pt, near comtose.  88 y/o male.  family at bed side.  found on the floor of his home, alone.  found on the floor for about 72 hours!  skin ulcers have formed all along his left side, from face to feet.  also he laid there in his own fecal matter and urine.  his skin was blistering, puss filled and falling off.  besides the fact of the fall its self, hematomas, bruised bone and deep tissue, atrophied muscle...the list continued on through COPD, congestive heart failure, every one is surprised that he even survived this long!  his family stated that he was a stubborn man, "well stubborn or not, he has a long road to recovery," anthony thought to him self...

"i just want to go home," sleep has been hard to come by this week.  one more hour.  2300 could not come any sooner.

anthony post saturday shift

it was any normal day for anthony.  it was a saturday, so he did not have class.  he got to sleep in, finally.  finally.  feeling well rested, he makes his way to work.  no traffic and smooth sailing all they way there.  anthony arrives a bout forty-five minuets early so he grabs a cup of tea at royal cupcake just down the way from the hospital.  gets more reading done and home work.

it was a warm day, and the sun was out so people were walking around and enjoying it. anthony kept his eyes on his work, but looked up to see all the smiling faces, people holding hands and kissing.  he goes back to his work.

forty-five minuets blow by and he's changing into his scrubs in the locker room.  a moment of thought passes through his head.  a deep sigh and off to clock and report in.

the ED is not busy, not yet.  its a saturday and things will kick off as soon as the sun goes down.  

as soon as the sun hides behind the olympics the drug users, drunks, chest pain, coughs, and the "funny" feelings come out to spend a few quality hours in the ED.  

anthony filing out paper work and jotting this and that into his patients charts.  he hand cramps up and he shakes it out and upon looking up he sees another admit.

 "another fucking transient looking for a warm bed and to waste our time" 

anthony shakes his head when he realized that his just had his first "heartless moment" of the night.  

whilst anthony brings another warm blanket to this cute speech pathology student in bed 9, the new admit, a 40+ something male into bed 10.  the social worker right behind.  he gives them a few moments and talks to the student.

anthony:  so mono...not fun huh?

student:  not fun at all...so since im a speech path student, i can diagnose whats goin on...but didnt come in till i started feeling crappy.  

anthony:  hope mono doesn't put you out for too long, grad school isnt gonna wait for you right?

student:  thats why i brought my books.

she points to her huge backpack...

anthony: you might want to see a chiropractor...like i can say anything, you should see my bag...

she laughs and then coughs.

student:  ugh...

anthony: yeah, mono...thats what you get for making out with strangers.

she laughs again.

anthony:  cause mono IS the kissing disease.

student:  cause that IS exactly what i do on my spare time...hello, grad student here...equals no life whats so ever...just work and studying....and repeat.

anthony: i hear ya, man, sounds like my life, this is just your body telling you to slow up a bit...

student:  fucking mono...

anthony tucks her in and tell her that he'll be back in a while.

anthony then pokes his head into the room where the new admit sleeps.  the homeless guy, drunk and out cold.  

the doc wanted a routine lab work up and a blood alcohol level.  

anthony stands over the patient and checks his wrist band to id the man.  he smelled like an alcoholic. 

anthony tries wakes up the man to tell him that he is going to draw labs. 

the man nods and grunts.

green light and anthony proceeds, but half way through the man shoots up and nearly out of bed, pushing anthony back.

the needle still in his arm, with vacutainer attached.

he screams and shouts incoherently.  

the needle still in his arm, and now the patient sees it and tears it out and wields it, angrily.  

the next few moments was a whirl wind.  anthony tried to keep the patient calm, and at a safe distance.  the room is small and help too far, anthony takes the needle hand of the patients and tries to wrench it free, but fruitless.  the needle is embedded into anthony's arm...

security rushes it and tackle the patients and anthony leans back against the wall, and yanks the needle out... the blood of the patient mixes with anthony's right before his eyes.  

"god damn..." anthony whispers as his colleagues rush him out and into an empty room to be assessed.  

"god damn it"

dear abigail

brush passes through his fingers, ruff and jaggedly.  sand and rocks muffled under his boots.  the night air scented with a perfume of oil and rot.  uncertainty hangs just above his head, which he refuses to look up at to see.  his eyes are fixed upon the pending doom at his front, flanks and rear.  his heart is racing, not new to him.  his palms, clutching hard plastic and metal perspire, again not new to him.  he is scared, not frightened.  his been here before.  this place, this moment where seconds are the difference between breathing or a long box home.

  

this is not what sanchez expected out of an well educated life.  his parents loved him he was part of a great community, he had the perfect life.  wanted to be a physician assistant.  but now, thousands of miles away his hopes are fleeting, but he does get to practice medicine.  his daily routine is in the infirmary, treating the snake bite, or some GI infection, and mostly, home sickness.  but every now and again the trama found on a battle field. 

iraq is not a destination for anybody with out a rifle and kevlar.  he shakes his head to rid the thoughs of a beautiful girl from his home town, seattle washington.  Abigail.  she is a nursing student.  they met and spent a life time together in about four months, then his time came.  made the choice to go before he meet her.  

again shakes his head to get Abigail out of his head.  just in time.

*crack**crack**crack**crack*

"GET DOWN, GET THE FUCK DOWN!!!"

"CONTACT FRONT CONTACT FRONT!!!"

"GET THE S.A.W UP!!!"

bullets and tracer rounds clapped by, dangerously close.  dirt kicked up into the faces of members of the platoon that automatically returned the fire. 

sanchez buries into the earth but cant stay long.  his is completely exposed.  cover is close but death rained down on his position.

he was always a fast kid, played football and soccer.  played rugby for 4 years for the university.  but this is different.  clutching his m4 he scrambles to nearby cover.  the first sergent on his heals.  

"LIGHT EM UP!!!"  first sergent barks.  

flares pop and the night sky turns into day as the illuminations float back to earth.

laying on his back, sanchez starts to count the tracers as they blow just inches above his position.  

one, two, three four five, six seven...

"SUPPRESSIVE FIRE!"

eight, nine, ten eleven twelve...

sanches turns and pops up to empty his clip. 

*crack**crack**crack**crack**crack**crack*

bullet casings fall at his feet, with muted clinks. 

back into coverage.

"BRADLYS BEEN HIT, HES DOWN!!!"

"MEDIC FORWARD!!!"

the sergent looks at sanchez.

"your up pal...COVER FIRE!  COVER FIRE!"

sanchez forgetting all that his known in life, forgetting all the friends and Abigail.  dropping them like a heavy pack after a long march.  his mind, fuzzy, incoherent and muffled, but his body, like a machine picks up speed and crashes next to bradly.  

blood pools and clots on the earth.  his guts splayed open.  hes dying and with little chance of survival.  

sanchez and a couple others grab him by his harness and pulls him away from danger.

quickly, pressure dressings applied and IV fluid started.  vitals taken, they are not good.  feathered and weak pules, and BP an alarming 50/30.  hes not gonna make it.

"BLUE NINER ONE, EXPEDITE, CRITICALS DOWN IN THE FIELD."

sanchez watches the chest of bradly rise and fall.  his respirations are quick and labored.  body trying to survive.  inhale and exhale.  blood starts to run from his mouth and sanchez tries to reposition so it pours out and not back into his lungs.  inhale and exhale.  his respirations slow, inhale and exhale...

inhale exhale...inhale....exhale.............

pulse taken, non, no breaths.  

sanchez starts to give chest compressions and rescue breaths...over and over and over...and over...waiting.  nothing...empty...

Abigail flashes into his mind.  She smiles and kisses him on the cheek.  

"hurry home to me."

"i will."

anthony @ 2218

anthony sits at a cluttered desk, its 2218, he always starts to wander. the endless amount of contact information strewn his eye line about this doctor or that doctor. different units of the hospital. pt. names and their charts and coffee cups, half full, or empty, mostly straight black, hard to find decent creamer around.

these are not his deep pondering thoughts though, distractions mostly. staff member shoes squeak by and it brings him back to the ED.

...a deep breath pulls him away...

anthony had a room mate who is has moved out recently...they have gotten close to say the least...he could remember the day that they did; matador happy hour, just when he got off work.  she almost rain checked, and so did he... rarely does anthony stay out past his bed time...

but there they sat, just the two off them, over a glass of spanish wine, rioja, a must have at that time of night.  the conversation delving deeper and deeper and deeper.  the air getting thick with anecdotes and personal histories.  

it must have been the wine, or fatigue that got anthony to tell the tail of recent events that he has kept buried to almost every one... 

to tell this short story one must visualize perfect beauty.  and that perfectness add trust and honesty, then add absolute love.  not the kind you buy in bulk as some people do.  but that one, true blue as the sky, love.  

and then take it all away... and bury it 6 feet deep.  hodgkin's disease, cancer depth.

its been months now...

people have asked anthony, "why aren't you seeing any body", or "why aren't you happy with who you meet."   ... there is no reply.  anthony loves coffee conversations, and dinner dates, and a pint or two, but thats tends to be it... commitment issues?  or just the fact that he is busy in his own world with out a throw rope too any things or anybody.  or its just too damn short.

the squeaky shoes walk by again... back to this world.  the only world that is constant.  anthony tug on his scrub bottoms and realize that they have been tucked in his left sock... 

ED Chart #1

due to HIPAA, names and locations will be edited to protect those involved.

about an hour into my shift we recived a elderly pt. who is presenting with severe COPD (chronic obstructive pulmonary disease) she also had a tracheostomy,and the stoma (the physical hole in which the tracheostomy as applied too) looked and smelled very infected. the tubing has loose and the MD wanted to replied. also due to the physical presenting factors, the pt. breathing was labored and painful. the pt. had fluid build up and mucosa build up so RT (respiratory therapy) can and suctioned off about 200 ml of fluid, and gave the pt. a breathing treatment.

x-ray swung by to gather data and my self and RT worked on her. i drew her labs as RT tried to negotiate the tracheostomy back into working order. it just would not fit in, and it hurt the pt. the stoma had necrotic tissue all around externally and what i could see, internally as well. if touched, the dead tissue would sluff off a bit.

this was all uncharted and untreated while the pt. stayed at a nursing home, or adult home.

between the time i wrapped up on labs the the last time RT suctioned the pt. it all went wrong. from a pt. responding and smiling to the moment in which she gaged coughed and from the corner of my eye, caught what seemed to be shinny red fireworks...it was not, from the pt. stoma sprayed, with every heart beat, ruby red blood, four foot long spurts. i cover the pt. stoma with my hand, while grabbing suction, RT called out the door and the admitting MD and staff rushed in. i suctioned blood off, then punched off what ever ruptured in the pt. trachea.

MD: move your hand.

me: it's bad.

MD: move your hand.

i did and again blood spurted out, the MD moved in and felt around.

MD: more suction, i need a intubation kit! more suction...

while all this was going on, the pt. spouse was standing at the door, watching all of this go on... nurses quickly walked him out. he face, burned in my memory.

some body then came back, with the pt. chart and stated "DNR" (do not recesitate)

efforts ended, except for suctioning and positioning...

blankets were placed to cover the pools of blood on the pt. gown. blood was wiped from the pt. face and what blood that made it to the floor was moped up just in time to let family in...

they went right up to her...

"we are here momma, we are here"

one looked up...

"can she hear me?"

it takes the human body about 3 min to bleed out, but seconds when ones lungs are saturated with blood, and when one cant breath, not enough O2 reaches the tissues that need it...every thing comes to a halt fairly quickly in these situations...

"can she hear me?"

RN: as nurturing as any good mother " Of course, she can..."

the MD already called time of death 1820, family was at the pt. bed side at 1822...

pre-sleep thoughts

02/20/08

01:46

its about 1:46 in the morning...its freezing and ate too much before bed...watching the same movie that i have been watching for the last few days...it puts me to sleep so why change a good thing.  i wanted to start to "file" away some stuff on my mind, but it might have to wait.  sleep is far more important then spilling my guts.  ill just leave a few notes to fill the void of what's running through my skull...

fatigue (long weekend, filming a music video and book work)

melancholy (room mate moving out...and anna is over seas)

disappointment/anger (cause of my lack of focus on my class)

excitement (kinda always have that going on...i guess gradschool is on my mind currently)

ED Chart #2

due to HIPAA, names and locations will be edited to protect those involved.

only had one major trama today...MI (myocardial infarction). the pt. came in by SFD, and had all the symptoms of a MI.  we revived report before the pt. arrived.  the pt. was ashen, had a gray complexion. his breathing was labored and upon arriving he was put on the bag. he was not my pt. but just from what i saw while i was at bed side assisting the admitting nurse.

we just stabilized as quickly as possible, and he was sent right away to the cath-lab.

my shift was over before i could hear more of this case.