by fearandfartleks

I still remember my first experience ever in the ER.  It was 2007, and I was working as a patient care tech up on a medical/surgical floor.  I was sent down to the ER as a “float” tech, because the dayshift was short-staffed that day.  I was nervous, but excited as well.  Even though I had never worked in the Emergency Department before, I suspected that it was where I truly wanted to be.  This feeling was confirmed when I read room 17’s triage sheet and saw that, under “Chief Complaint” the patient had written: “There is a possum in my rectum.”  And that was it for me.  I was hooked.  From that moment on all of my energy, desire, effort was focused on getting. Back. There.

A few posts back I mentioned that, despite my frequent grumblings and bitter rants, I actually do love my job – and I promised that I would make public the reasons why I am thankful every time I punch in.  So here, in no particular order, are a few of those reasons.  As a disclaimer – every single one of the examples/anecdotes/situations I mention are real and have not been embellished in any way.  Enjoy!

Reason #1:  Working in the ER forces you to get really simple, really fast.  You learn to condense super complicated processes into a few basic, extremely palatable words.  It only took me a few weeks to realize that the vast majority of our patient population is either mentally/intellectually incapable of listening to a five minute explanation of exactly why their legs are the size of a coffee cannister and they can’t breathe,* or they simply just don’t care.  So you develop a sort of medical shorthand, and you find that life is much better when you don’t have to use words like “glycosylation,” “sodium-potassium pump,” or “anaerobic metabolism.”  For instance:

Hemodialysis: “They take all of the blood out of your body, clean it, and put it back in.”

Ascites: “Your liver hates you.”

Quadruple Bi-Pass: “Your heart is dying.”

Impacted: “You are full of poop.”

Catheter:  “A tube goes into your penis and urine comes out.” (My personal favorite)

Reason #2: There is no other place on Earth that makes you feel more normal.  So you’ve been married three times and your second husband was a circus dwarf?  Normal.  You bought a Sam’s Club membership simply so you could buy toothpaste in bulk and satisfy that Colgate addiction?  Normal.  You have a horn growing out of your back that requires bi-weekly shavings, lest it poke through your scrubs?  Totally normal.  Because, unlike your patient in room 19, you did NOT answer “I don’t know, but one thing’s for sure – I’ve got to get that mother-fucking space ship built by morning,” in response to the question, “Do you have any diagnosed medical conditions?”  Nor do you have a screwdriver lodged in your rectum (pointy end up) like the guy in room 6.  And you most certainly don’t have a raging heroin addiction like the pregnant patient you just discharged.  So, despite your weird quirks and poor life choices, you clock out of that place feeling AMAZING.  And then you drive home to clean and re-organize your collection of prosthetic legs.

Reason #3:  I have not always worked in the ER.  I did work for one year as a nurse in a long-term acute care facility, and one of my greatest frustrations while employed there was the fact that the physicians appeared to have absolutely no concern for their patients.  This was probably true to some degree, but the reality is that many of the doctors were truly unaware of their patients’ conditions – because they weren’t around to see them.  They did not go in rooms and actually talk to them – they chose to hover around the charts and check labs.  So it was a welcome change to work in the ER, where the doctors are right there in the mix with you.  Yes, there are a few who micro-manage and will ride you like a Mexican burro at the height of immigration season, but for the most part they are diligent, caring professionals who actually listen to nursing staff when we come to them with a concern.  And sometimes they even stand up for their nurses, which makes you feel all protected and warm and fuzzy inside.  Throw something at an ER nurse?  Hello, Baker Act.  Take a swipe at us?  In comes the ER doc to tell you that, if you “bother MY nurse again” the authorities will be removing you from our facility.  In short, Reason #3 = “collegial atmosphere.”

Reason #4:  In the immortal words of Forrest Gump, “Life is like a box of chocolates – you never know what you’re gonna get.”  Nowhere is this more true than in the ER, except that our “chocolates” are more likely to be filled with prescription drugs, stool, or booze than orange creme or caramel.  But it is this unpredictability, this variety, that I love.  Where else in the world would you have to deal with a patient who has voluntarily had an eggplant inserted into his bumhole?  (And who has just finished telling you about “parties” where people place all kinds of things – rolled up flip-flops being most memorable – into their rectal cavity.)  Few other professions entail wrestling a patient to the ground because, poltergeist-like, they have leapt off the bed, torn off their cardiac monitor leads, and are now swinging them at staff like Spartacus with a cat-’o-nine-tails.   It is both thrilling and terrifying that you truly never know what is coming in those doors.  This is why experienced ER nurses never let their guard down.  Because that lady in black spandex shorts who just signed in for “abdominal pain”?  That bulge in the crotch region ain’t her cell phone.  And despite the fact that she’s emphatically stating, “No baby! No baby!” in broken English, you’re pretty sure a full-term infant is crowning in your triage room.

Reason #5:  The ER is the most honest place I have ever worked, with a large caveat:  it is a deceptive honesty.  It is a brutal, painful honesty that is meant to deflect and protect the doctors and nurses who deal with life’s ugliness on an hourly basis.  For example, when giving report, a nurse might say, “The patient in room 5 is from Generic Name Nursing Home, here with a fever and UTI.”  Other nurse: “How old is she?”  “Oh, I don’t know, she’s old.  Like, she’s made of dust.”  What that nurse really means is, “Please God, don’t let me end up here, having some young girl taking off my bra and catheterizing me for urine.  Please don’t let me be old and alone and abandoned.”  And when a nurse refers to an overdose patient as “gorked,” what she’s hiding is a deep and abiding fear that this young kid laying before her with scrambled eggs for brains could be one of her children.  And you just can’t face it.  So you squeeze your eyes tight and tell yourself that you don’t work in reality, that not everybody ends up a medical disaster.  But there is always a small part of you that doesn’t believe it.  This is why, when a nurse is taking care of a “total,”*she tells her co-workers in a calm, matter-of-fact voice that if she ever ends up in the ER trached-vented-PEGged,* please put a pillow over her face, snow her with all the narcotics known to man, or somehow manage to “accidentally” disconnect the ventilator.  We exaggerate the truth in order to hide it, we put a smiley face on hideous situations and cross our fingers that they won’t happen to us.  We take a deep breath and move on because we have to, because if we didn’t we’d have a psychotic episode or wind up in a catatonic state, sucking our thumbs and clutching the call bell like it was our child.  And then they’d admit us, send us to the psych ward.  And the nurse giving report would simply say, “She’s crazy-cakes.”

*…can’t breathe:  Classic symptoms of Congestive Heart Failure.  It’s gonna take too long to explain that here, just suffice it to say that your heart sucks, your legs swell, and your lungs get full.  And, you’re probably gonna die sooner rather than later.

*”total”:  A patient who requires TOTAL care.  As in, a machine to breathe for them, a tube to feed them, and bags to collect their urine and stool.

*trached-vented-PEGged:  See above.  To simplify it down to ER-speak: your body hates you.