In one piece

From my long absence, you may have guessed I was out of town…you’d be right. Now I’m back, but there’s a problem…my back. Remember the sciatica I mentioned a few weeks ago? Well, it worsened to the point that I’ll be having surgery this thursday. I hope I can continue blogging. Maybe a play-by-play version of what it’s like on the other side of the knife? I could start with my ordeal visiting an emergency department about 500 miles away from home, alone, in pain, with a dead cell phone, not enough change for the vending machine and too light headed to even make it back to my car to wait for my dad to pick me up from 3 hours away. That was just the start.

Getting home, being seen in my own ED, getting an MRI and seeing the ortho doctors who all know me was a much more pleasant experience. They didn’t make me feel like a criminal for being in pain.

Maybe while I’m recovering, I can post stories from my vacation. I really did miss you guys while I was gone, it’s nice to be able to post whatever’s on my mind. I constructed posts in my mind while sunbathing, seabird watching, dune climbing & flower browsing…but as of yet, none of them have made the LCD screen.

Big Cats

Finally finished work, dications paperwork. Relaxing in front of The Animal Planet, watching “Big Cats” at 3 AM. As I watch, Jasper & Louise are playing their own game of Big (House) Cats. Louise is being especially predatory tonight, currently perched on top of a chair, halfway hidden in a duffle bag. Her whiskers slicked straight back, ears perked, eyes wide open, hindquarters twitching side to side. Jasper is clueless, vulnerable. She races into the carpeted room, pounces on the catnip stuffed tigers tail, the same tail they’ve stalked, poucned and killed counltess times. Then she turns and sprints away. Louise watches…and finally…ATTACK! THen they roll around and lick each other on the face and get bored.

Indecision

Once again, indecision is the biggest factor in my enjoyment of working in the ED. Anger, frustration, headaches and long patient stays can all be tracked down to the same factor, or at least the only factor that I have control over…indecision. Usually it stems from not wanting to let patients down, or knowing (thinking) that they’ll be disappointed or upset by my diagnosis, or more commonly, lack of diagnosis. So I set the chart aside thinking (hoping) that something drastic will happen to them at which time I can happily present them with a medical solution to a medical problem.

The problem arises when there is no problem. Nothing I can fix. patients get sent and referred by their docs, family, neighbors thinking they’ll get fixed tonight. One guy we even flew in from about 100 miles away. he wasn’t sick. Now he’s stuck in the ED with no pants, no wallet, and 2 1/2 hours from home. Had the outside doc been a little more aggressive in thinking about his treatment and diagnosis, rather than being quick to call me, tell me he’s sick, he’s bleeding, he just had bypass surgery, etc…we could have saved a few thousand dollars in a helicopter ride, not put people’s lives at risk flying the thing there and back, and saving his son a five hour car ride. It all could have been taken care of at an outpatient visit for colonoscopy. Oh well.

I pretreated myself for today’s shift with cuban espresso from my favorite coffee shop. The Coffee Jerk reads my blog now so I have to say nice things about it! 😉

Anybody remember what flight number I was on? I have one to add that will be a nicer post than this.

Parkland Formula

Imagine a little girl reaching up to a pot of boiling water and pulling it down on top of herself. Can you see the water splashing against her chest, running down the front of her stomach and her chest?

Imagine a little girl climbing into a bath or sink of hot water. How many limbs do you think she’d stick in on her own before crying out in pain and pulling it back out? Probably just one hand or one foot.

Now imagine someone picking her up and trying to drop her, facing down, in a sink or tub of scalding water. She would have no choice but to extend both arms and legs trying to protect herself. Her hands and legs would have burns circling the limbs, not like the splash of pulling a pot down on top of yourself. If she was able to get into a crouching position, pulling her knees in towards her chest, then perhaps the backs of her knees would be spared, but her buttocks would still be exposed to the hot water.

Imagine skin peeling off her limbs like sheets of thin wax. Like a snake shedding it’s skin, with a brand new, unproteced layer of bright pink painful tissue underneath.

I aksked everyone who was touching her to put on sterile gloves. The first 20 minutes was spent trying to get an IV started. I didn’t have luck, but eventually Mark, the RN did. I had our tech help me hold dressings in place while I wrapped gauze around and around her legs. Keeping the sterile dressings on her feet was the hard part. Once her burns were all covered, We gave her several warm blankets to prevent hypothermia. I grabbed a reference picture for pediatric burns and calculated the percentage body surface area. I scribbled down numbers and rates and calculated the Parkland formula. 125 ml per hour of fluids for her ride to the regional burn center an hour and a half away. The most perplexing part of it all was why wasn’t she crying?

I went to our cupboard of crochet animals made by a local church group as part of their outreach. I picked out a small, colorful bunny and placed it on her chest.

Next to a space labled Valuables on her transfer sheets I wrote “Stuffed Bunny, Binkie.”