Hard and Fast - That Emergency Life

I attended public school in upstate New York; about 100 miles north of New York City.  My high school had less than 800 students for grades 8-12 but we had a pretty diverse student body... different races, religions, etc.  Sure, everyone had their little group of friends, but we crossed into different groups and pretty much all got along.  I thought I was pretty well-rounded. And then I started riding on the ambulance in my hometown. The majority of people who call 9-1-1 are calling because they need help.  They are at their most vulnerable, asking strangers to come into their home.  Can you imagine vomiting for three days, still wearing the same clothes, not showering and asking someone you don't know to come get you off your bathroom floor?  Imagine watching, helplessly, as a loved one is struggling or dying in front of you... you have three numbers to dial and a bunch of strangers come into your most private space, into your life.  We see a lot ...

I delivered the placenta.  Said in the same way Baby said "I carried a watermelon" in Dirty Dancing. My shift was over.  I was heading to the lounge to collect my things.  My NP colleague came out of the room across the hall in a scurry.  "She's about to have a baby."  I didn't collect my things; I stayed to help.  We were already busy and we were running short staffed.  Besides, one of the coolest things one can ever do in life is witness a life being born.  The patient was a teenager.  She presented to the ED with her mother complaining of stomach pain.  Her mother was worried sick.  The patient spent a lot of time in her room and could barely stand or walk because the pain was so bad.  Mom was legitimately concerned for her daughter's health. The patient never told anyone she was pregnant. Mom was just finding out now that she was about to be a grandmother. A 17 year old about to become a mother, crying and saying "I...

27 year old male.  When you hear that, you have a picture in your mind.  I do too.  Strong, robust, healthy, athletic, smart.  Prime time.  The world yours to capture! I quickly looked through his chart.  Only one prior visit to our ED.  No medical history, surgeries, allergies or medications listed.  Being seen today for an abscess.  No big deal.  I've incised and drained many on many different parts of the body.  Yes, even breasts, scrotums and rear ends.  This guy was going to be in and out of the ED without a problem! Then I read his last visit.  He was seen for thrush.  Not common in a healthy 27 year old.  Now my investigator hat was on and I went into the room. This was not the robust man I imagined.  This was a frail, ill appearing man.  There were stains on his bottom where the abscess was draining.  His sweatpants too baggy and just fell over his bony knees.  This was not a well m...

Hard and Fast.  That's how you do appropriate CPR.  Hard and fast is also how working in the field of emergency medicine usually feels.  My first shift as an emergency medical technician was in August 2002.  I was going to save the world.  All people were good.  All people were created equal.  People were going to appreciate what we could do to save their lives.  I was only going to do it for a year and then go to PA school.  Emergency Medicine wasn't going to change me.  I was going to have a career... healthy relationships... a husband... children... a house with a picket fence and a dog... I was naive.   I still see the blue eyes of the old gentleman laying on the side of the road.  Staring up at me blankly.  My first trauma arrest.  He took a pickup truck doing about 55 mph into the driver side of his car.  His bloodied head laying on his wife's lap.   I see every pediatric code...