Prince Charles

When I was gathering information in the triage area from Prince Charles, He said something that has always irritated me. I cannot for the life of me, understand why people like him who never work always make the same statement, he asked, “Are you hard at work or hardly working?” then he chuckled, thinking himself the most original, witty,  and amusing man in the world.

Let me say this, a person like him irritates me to no end. Not only do they not work, but they have no respect for those who do. I think that at one time he saw what work was, didn’t like it, and went on public assistance to avoid it.

That day, I did manage to restrain myself from playing “Kick the Can” with the Prince Charles, but I was still seething when I took him inside to be treated.

 

Several days later, I had volunteered to pass out surplus food to the “needy.” I was talking to another volunteer at our volunteer fire department and shared my “conversation” with Prince Charles from a few days earlier. He laughed when I told him “I just wanted to punch the Prince in the mouth.”

The doors opened and holding out a paper sack, the very first, toothless, dirty, male recipient commented as he took his place in line, “Are you guys hard at work or hardly working?” and of course he chuckled.

I felt like hitting him in the head with the five pound block of cheese or feed it to him in one quick thrust or maybe I could force the block of cheese up into his other end. These evil thoughts burst out of my mind, as I gritted my teeth. I paused, took a deep breath, and handed him the cheese. When I glanced to my side at my fellow volunteer, coworker, of course I saw his whole body shaking with silent laughter.

I tried to hand the freeloader the surplus, but he couldn’t even take the cheese from my hand, he held out his sack for me to put the cheese inside. Apparently even reaching for and taking the cheese from me to place it in the bag for himself constituted work and was too much exertion for him.

Coffee Anyone?

One physician, not one of the emergency room doctors, would often have his office patients report to the emergency department for him to see. He would order the testing that he thought needed to be done. Without any inconvenience to him, he could extend his office hours on the backs of the emergency room’s nursing staff. There was no policy to prevent him from doing so.

We would have to make a chart for each patient, do their assessments, disrobe them, gown them, and take the patient’s vital signs. Once the person was settled in one of the beds, we would call the doctor for orders. When he thought the results would be back, he’d stroll over to see the patients. Usually we would have two or three beds tied up for just his clients until he finished rounding in the hospital and came to see them.

Eventually, he got tired of answering our telephone calls as each patient would arrive. He knew how many patients he had advised to come and meet him at the hospital. He would make us wait until he thought that they had all arrived before he would return our calls. We would then have fill out the needed requisitions for the ordered tests and wait for the results to come back. All the while, our beds were being tied up with his patients, waiting for him to come and to see them. Once the all of results were back, we would again have to page him and he would eventually decide to stroll over to see his patients.

We heard through the grapevine, that each morning, he liked to grab a cup of coffee and talk with the radiologists before he visited his in-patients, so we started to call x-ray to see if they could prod him into answering our pages.

This worked well for awhile until one day someone called the radiology department and asked if the doctor was there. Apparently he had told the technicians and the secretaries not to interrupt him or even tell us whether he was in the hospital or not. He obviously didn’t want bothered until HE was ready.

He was married, but it was also rumored that he had a girlfriend on the side who worked in the radiology department as well. Do you think it was a coincidence?

It was a very busy morning and we had four of his patients filling our beds. The emergency department had a total of eight beds at the time. We were trying to work around his patients and take care of those arriving for emergency treatment. The limited number of beds that we had available hampered us and made our jobs so much more difficult. Of course, this was one of the days he refused to answer his pages.

I got frustrated at his lack of concern for his patients and for the emergency room in general. I felt the devil crawl out of me and climb up onto my shoulder. I snatched up the telephone and dialed x-ray.

“This is the x-ray department. How may I help you?” a female voice demurely chimed.

I said, “This is Tom from the emergency room. Would doctor Malden happen to be there enjoying a cup of coffee and a honey bun?”

Now a honey bun could have been one of those sweet, sticky, swirled pastries or….?  Well you get the idea.

I heard a small gasp on the other end of the phone and then a soft chuckle before the super sweet voice said, “Hold on, I’ll check for you.”

Dr. Malden returned my telephone call shortly thereafter. I don’t know if she ever told the doctor or his honey bun what I had said, but when I called the x-ray department from then on, someone would always check to see if he was there. They would do it for me and no one else. I guess my “innocent” comment had gotten passed along to her fellow employees.

A Deep Cut

An ambulance brought in a man who had fallen through the glass window of a storm door. The sharp edges of the broken glass made a deep laceration in the crook of his right arm.

The ambulance packed the wound with several ten packs of 4 by 4 dressings. The bleeding slowed slightly, but kept pouring from the wound. They tried direct pressure, but couldn’t keep it constant. Instead, they applied a blood pressure cuff above the wound and like a tourniquet, they inflated it until the bleeding stopped. If they dropped pressure, the bleeding would start again.

The emergency room doctor asked that we slowly deflate the cuff. The bleeding started almost immediately, coming out through the multiple layers of the 4X4 dressings. We pumped the pressure back up to stop the hemorrhage.

 Because this incident happened on the daylight shift, the surgeon on call was in the hospital and was quickly summoned to the emergency department. He arrived in short order. He asked us to slowly deflate the blood pressure cuff. When we slowly released the pressure, the bleeding stared again. We pumped more pressure into the cuff.

We set up a surgical tray while the doctor gowned and gloved. He began to remove the packing from the wound, placing them in an emesis basin. The wound was very deep and wide. He removed five packages of the 4x4’s that the ambulance crew had stuffed inside the gaping laceration to control the bleeding. The cut was almost as wide as the man’s arm.

“Now,” he said. “Let off the pressure of the blood pressure cuff, slowly.”

I had just started to slowly release the pressure when a geyser of blood shot high into the air. It arched about two feet above the surgeon’s head, reached its apex, and started back down towards his upturned face. His eyes widened and he managed to step back out of the way just in time to dodge the descending fountain of blood.

I pumped the cuff’s pressure back up.

“Let’s try that again, but just let it out a bit and stop. Let’s do it in stages.”

I dropped the pressure just a bit and stopped; nothing. Again I eased out a bit more air. A vessel in the wound began to leak. Seeing the general area of the bleeding, he reached into the laceration and pressed on the vessel until he could clamp it with a hemostat.

“ Again.” He said. I eased the pressure a bit more.

We continued to slowly ease of the pressure off the cuff and the doctor applied hemostats until the wound only oozed blood and the surgeon was able to repair the deep laceration at his leisure.

Armed with a sling, a prescription for antibiotics and pain medications, the patient was discharged about an hour later.

Dr. Vandyk was on duty when a woman appeared at the triage area. She had wedged a folded towel between her legs, it was covered in blood. Immediately we thought that she was having a miscarriage and hurried her back to the gynecology examination room.

She was pale and looked like she’d lost a lot of blood. We started an infusion of fluids after we’d established an I.V. site. Another nurse got her into the stirrups waiting for the doctor to examine her.

As we worked, she started to tell her strange story. She said that she and her boyfriend were hiking and decided since the weather was so beautiful outside; they would have sex in the woods. Making a huge pile of leaves, they disrobed and quickly got down to business. When they had finished, for some unknown reason, the boyfriend slipped a knife into her vagina and cut her. They quickly dressed and left the woods. He became afraid when she started to bleed heavily and brought her to the emergency room for care.

 

Dr. Vandyk came in and examined her.  Her vagina was filled with blood, clots, dirt, leaves, and small twigs. The amount of debris inside her vagina required that she be taken to the operating room to do the extensive amount cleaning and debridement necessary before her laceration could be repaired.

After her surgery, she was admitted to our hospital for I.V. antibiotics to prevent an infection. She had a Foley catheter inserted to allow the area to stay dry, clean, and start to heal before she was discharged several days later.

We never learned whether or not she wanted to prosecute the boyfriend or whether stayed with him after she was discharged.

We had a nursing assistant named Kurt. He was a prankster with an extremely wicked and perverted sense of humor. Nothing was sacred to him and his quick mind would exploit any opportunity that appeared. He would go out of his way to play a joke on fellow employees.

Our head nurse on the med/ surg. floor was a short, full figured woman while the assistant head nurse was thin and tall.

When they stood near each other, they looked like Laurel and Hardy. They rarely stood beside each other. They had a mutual dislike for each other. It was only because they had to work together, that they tolerated the other. They worked on the same shift and Karl often played jokes on both of them. He would do something to one nurse that would upset her and made it look like the other nurse had done it. It spurred their rivalry.

The head nurse still wore garters and a rubber girdle. She kept a container of talcum powder in the restroom. She used it to powder herself so she could more easily squirm back into her girdle after using the toilet.

Kurt found out about it and Sara, the head nurse, became the target of his next prank. He pried the cap off her talc container and poured a layer of Ajax powdered cleanser onto the powder in the container. He popped the lid back on and set the talcum back in place on the restroom shelf. He did it on the afternoon shift when the head nurse was off duty.

The trap was set. It lay in wait for the head nurse to come in on the daylight shift the next day.  It waited for her to use it and she did. After she used the bathroom the next morning, she applied her “pussy powder.” That’s what she called it and a few minutes later, she began to squirm. It took the second run to the bathroom before the itching became a nuisance. She told one of the other nurses, “I don’t know what is wrong. Something is making me itch.” She never did find the reason for her itch or that she was again the butt of one of Kurt’s warped jokes.

Dr. Vandyk had developed a very bad habit, besides his constant smoking. In the event that he had to intubate a person, he would not wait to have an Ambu bag attached to see if the tube was correctly in place, he would use his mouth to blow into the tube to watch for the chest to rise. It was a very bad habit.

An elderly, obese woman arrested in the emergency department. She had presented with the complaint of chest tightness. We had started an I. V. and done an EKG when she gasped, clutched her chest, and her monitor went asystole. Asystole means her heart stopped. For whatever reason, the electrical impulses which cause the heart to beat weren’t being transmitted.

Her bed was right next to a crash cart. Dr. Vandyk yanked open the intubation drawer and pulled out a laryngoscope. He opened her mouth and asked for a 6.5 mm endo-tube. Dr. Vandyk slid the scope into her mouth and inserted the endotracheal tube. Not waiting for the balloon of the tube to be inflated, he leaned over and blew into the tube.

I thought I saw the woman’s abdomen move. If the tube is in the esophagus instead of the trachea, air will enter the stomach and not the lungs. The nurse listening shook her head. I placed my hand on her abdomen to see if I could feel her belly move as the doctor attempted to intubate a second time.

He slid the tube down her throat. Dr. Vandyk leaned over for a second breath, before he could blow the second time, I felt the abdomen move. I tried to warn the doctor, but all I could get out of my mouth was “Doc….” before an eruption of stomach contents poured out through the tube. It went right into the doctor’s open mouth. He leaned to the side of the bed and spat onto the floor the woman’s stomach contents.

He spat a few more times saying “Fish!” Pfttt! “Fish!”

You’d have thought this incident would have changed this habit, but it didn’t. Nasty as this incident was, it was not enough to change his habits.

Another incident happened in my days of student training and I have kept it a secret for all these years. It occurred while I was in my obstetrics rotation. One of the doctors decided to do a saddle block on a young woman in labor. The other student nurse who was with me was in her early forties while I was twenty-three.

The doctor eased a long metal tube into place inside the woman’s vaginal canal. Next, he picked up a syringe. Attached to the tip was a very long needle and when I say long, I mean at least ten inches. As he started to insert it into the tube, it made a rasping, grating sound of metal on metal.

I saw movement out of the corner of my eye. The sound was too much. It had caused the nurse beside me to start to faint. Fortunately, she was standing between me and a nearby wall. As her knees began to buckle, I leaned my weight against her pressing her tightly against the wall, keeping her upright. And let me add, I am no light weight person.

There is little more embarrassing than to faint as a student nurse. It is a bane to a student’s name to have “passed out’. It’s not a black mark against your training, but you can be certain you will be teased about it for a long, long time.

I turned my attention back to the procedure at hand and watched the doctor complete the block. He had just finished and had removed the needle and the metal tube, when I felt a stirring of the weight on my shoulder. The wilted nursing student began to rouse. She shook her head, once, twice and then reclaimed her weight. As she straightened up, I leaned away from her as she stood back onto her feet.

A few seconds later, she leaned close to me and whispered into my ear, “Thank you.”

It was something that I never shared until now.