Experiences in the ER
My days in the emergency room were very different from what they are today. I believe I worked in the ER during 1971-1973 or 4. I worked at local hospitals in Elmhurst Hospital and Central Dupage Hospital. In those days most of us were not trained in ER medicine and certainly did not do residency programs or were board certified. Qualifications included medical license, getting along with physicians and not having too many patient complaints. I wouyld not qualify today but then any physician potentially could serve. While I remember myself inadequate I was better than many and perhaps for the most part relied upon common sense.
My first job was Elmhurst Memorial Hospital and there was an excellent and experienced nurse who saw my inexperience and guided me through patient triage, exam, and treatment.
One night Hell's Angels had a fight in a local bar and the leader was brought to the ER unconscious. He was probably 5'9'' or so and relatively slight like myself. A combatant of his had taken a beer bottle and smashed it over his head rendering him unconscious with the skin split over the top of his skull. The rest of the group seemed big and rowdy and poorly dressed in the macho fashion of Hell's Angels. As I examined his head I had the sensation of someone behind my left shoulder and very close. As I turned I saw an obese unkempt male with a lather vest raising a gun to my head. and touching my left temple "Doc" he said. If this guy dies, you die". In a very bizarre way rather than being scarred I thought I was in a movie and I was rather in the body of a Clint Eastwood character. Without thinking I replied "If you don't put that gun away I will kill himj myself." Slowly he lowered the gun and I said" Now go to the waiting room while I take care of your leader". He slowly walked away and I sent the man for Xrays. There was no evidence of bleeding or fracture so I began to sew him up. He began to regain consciousness and although drunk slurred "Doc, you are the best doc I have ever had". At about that time 2 men were brought in from some kind of vehicular accident both in their young 20's. In those dayus patients were put into bays surrounded by cloth curtains. One guy stuck his head out of the drape and said"Doc, if you don't get over here I'm going to kill you". By this time my patient was sitting up and awake and the vested companion was at his side. "Do you want me to take care of them for you". The nurse had already pushed a button notifying the police we heeded help. AT that point the police were arriving and I turned to my vested now friend and said "why don't you get the hell out of here before you get in trouble". He and his companion then left and I never saw them again.
Such was the life in the ER then. Little skill. Little knowledge. Lots of common sense.
Another night while at Central Dupage Hospital I was called for a code Blue in the intensive care unit. On arrival I saw a man unconscious whose heart had stopped and was not responding to CPR. His EKG demonstrated cardiac arrest with no rhythm. I quickly learned he was 35 years old, married with several children, and had a lesion I believe in his brain. My only thought was he was not going to die tonight with several children and a young wife at home. Years ago before I had seen a TV show of Ben Casey MD where he had injected adrenaline into the heart of a dead man with a cardiac needle. Never having seen it in real life I asked for a cardiac need and epinephrine. I ordered ?1cc of what I presumed was 1:1000 epi and inserted the needle beneath the sternum into where I though the heart lay. I pulled back on the syringe and seeing bright red blood injected the epi. Less than a minute later the patient opened his eyes. By that time a cardiologist had arrived and after examining the patient came to me shaking his head. "Do you know what the odds of your injecting within the heart" he asked. Upon my negative response he said' one in a thousand. one in a thousand." and walked away.
New Years Eve was always a potentially difficult time to work in th eER. Xmas eve was bad, often characterized by sadness and /or depreession but New Years Eve was a time of drunkenness, brawling, and in general bizarre behavior. It was not unlike a full moon evening but worse. One new years Eve and man and his son brought his wife to the ER. She was perhaps 50 yearsold, a bit dowdy like so many patients and complained of back pain. Physical examination was not revealing and I sent her for Xrays which were similarly unremarkable. I told the man I could find nothing wrong with his wife and suggested over the counter rememdy, probably anti-inflammatories. The man insisted he wanted his wife hospitalized . I explained that I could not do that and that his insurance would not cover such a stay. All right , he siad, then I'll just have to push her down the stairs again. They left and I did not see them again.
Education in the ER is a 2-way street and I am sure I learned more than I taught. One night 2 children were brought into the ER after being in a car accident. The story was that the father and his friend had picked up the 2 boys while drunk. They drove down a road, probably at high speed, until they careened off the road and over an embankment whereupon the car rolled over and the younger of the 2 boys, perhaps 3 or 4, was thrown out of the car when the door flew open. The child was brought to the ER unconscious and I believe unresponsive though he was bleeding. The mother came to the ER. She was not well dressed as I remember and somewhat overweight. I took her to a room to tell her about her child. I was probably 25 years old and in retrospect immature and very unsophisticated though I was always evaluating people and rendering psychological opinions as I shall detail elsewhere in these pages. I sat down with the mother and told her the circumstances of the accident and then said that the chances were high her child would;d not be functional after recovery. To my utter surprise the woman shrieked and cried forcefully. I simply did not know what to do. I had had no empathy for the woman prior to talking to her and so her response was unexpected. In fact it was I whose response was inappropriate and in retrospect should not have been anticipated.
My first job was Elmhurst Memorial Hospital and there was an excellent and experienced nurse who saw my inexperience and guided me through patient triage, exam, and treatment.
One night Hell's Angels had a fight in a local bar and the leader was brought to the ER unconscious. He was probably 5'9'' or so and relatively slight like myself. A combatant of his had taken a beer bottle and smashed it over his head rendering him unconscious with the skin split over the top of his skull. The rest of the group seemed big and rowdy and poorly dressed in the macho fashion of Hell's Angels. As I examined his head I had the sensation of someone behind my left shoulder and very close. As I turned I saw an obese unkempt male with a lather vest raising a gun to my head. and touching my left temple "Doc" he said. If this guy dies, you die". In a very bizarre way rather than being scarred I thought I was in a movie and I was rather in the body of a Clint Eastwood character. Without thinking I replied "If you don't put that gun away I will kill himj myself." Slowly he lowered the gun and I said" Now go to the waiting room while I take care of your leader". He slowly walked away and I sent the man for Xrays. There was no evidence of bleeding or fracture so I began to sew him up. He began to regain consciousness and although drunk slurred "Doc, you are the best doc I have ever had". At about that time 2 men were brought in from some kind of vehicular accident both in their young 20's. In those dayus patients were put into bays surrounded by cloth curtains. One guy stuck his head out of the drape and said"Doc, if you don't get over here I'm going to kill you". By this time my patient was sitting up and awake and the vested companion was at his side. "Do you want me to take care of them for you". The nurse had already pushed a button notifying the police we heeded help. AT that point the police were arriving and I turned to my vested now friend and said "why don't you get the hell out of here before you get in trouble". He and his companion then left and I never saw them again.
Such was the life in the ER then. Little skill. Little knowledge. Lots of common sense.
Another night while at Central Dupage Hospital I was called for a code Blue in the intensive care unit. On arrival I saw a man unconscious whose heart had stopped and was not responding to CPR. His EKG demonstrated cardiac arrest with no rhythm. I quickly learned he was 35 years old, married with several children, and had a lesion I believe in his brain. My only thought was he was not going to die tonight with several children and a young wife at home. Years ago before I had seen a TV show of Ben Casey MD where he had injected adrenaline into the heart of a dead man with a cardiac needle. Never having seen it in real life I asked for a cardiac need and epinephrine. I ordered ?1cc of what I presumed was 1:1000 epi and inserted the needle beneath the sternum into where I though the heart lay. I pulled back on the syringe and seeing bright red blood injected the epi. Less than a minute later the patient opened his eyes. By that time a cardiologist had arrived and after examining the patient came to me shaking his head. "Do you know what the odds of your injecting within the heart" he asked. Upon my negative response he said' one in a thousand. one in a thousand." and walked away.
New Years Eve was always a potentially difficult time to work in th eER. Xmas eve was bad, often characterized by sadness and /or depreession but New Years Eve was a time of drunkenness, brawling, and in general bizarre behavior. It was not unlike a full moon evening but worse. One new years Eve and man and his son brought his wife to the ER. She was perhaps 50 yearsold, a bit dowdy like so many patients and complained of back pain. Physical examination was not revealing and I sent her for Xrays which were similarly unremarkable. I told the man I could find nothing wrong with his wife and suggested over the counter rememdy, probably anti-inflammatories. The man insisted he wanted his wife hospitalized . I explained that I could not do that and that his insurance would not cover such a stay. All right , he siad, then I'll just have to push her down the stairs again. They left and I did not see them again.
Education in the ER is a 2-way street and I am sure I learned more than I taught. One night 2 children were brought into the ER after being in a car accident. The story was that the father and his friend had picked up the 2 boys while drunk. They drove down a road, probably at high speed, until they careened off the road and over an embankment whereupon the car rolled over and the younger of the 2 boys, perhaps 3 or 4, was thrown out of the car when the door flew open. The child was brought to the ER unconscious and I believe unresponsive though he was bleeding. The mother came to the ER. She was not well dressed as I remember and somewhat overweight. I took her to a room to tell her about her child. I was probably 25 years old and in retrospect immature and very unsophisticated though I was always evaluating people and rendering psychological opinions as I shall detail elsewhere in these pages. I sat down with the mother and told her the circumstances of the accident and then said that the chances were high her child would;d not be functional after recovery. To my utter surprise the woman shrieked and cried forcefully. I simply did not know what to do. I had had no empathy for the woman prior to talking to her and so her response was unexpected. In fact it was I whose response was inappropriate and in retrospect should not have been anticipated.
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