Buried Acorns and other nuts

Last night I get called to the ED, It was a BS call, but as I.m hustling through the waiting room, a small Spanish dude in a pony tail comes running in from the parking lot carrying a baby and runs up to triage. They baby looks to be about a year old. He goes right in back and in seconds the kid is in code room 4 and they are calling respiratory STAT. The kid was a code. Dad's a junkie and is on methadone. Some of the staff recognized him. There is no mom in this picture, dad has custody. The kid found the methadone. Not breathing and intermittent pulse. They find out what happened and narcan the kid, whatever the narcan dose is for an infant. The kid comes around. About an hour later I walk by the room and the kid is sitting on the bed all alert, with dad sitting next to her. Someone expressed concern for brain damage, as they didnt know how long the kid was out, but she was discharged later on in the evening.

"We" lost a baby the other day (I was off). Young mom gave birth. Social worker is on the phone with DCF discussing taking the baby. Mom overhears this , creates a diversion, and when no one is looking, scoots out the door with the baby. Half hour goes by before baby is discovered missing. Mom had managed to defeat the infant abduction alarm system (details will not be posted).

The story ends OK. Mom, who went home, answered her cellphone and agreed to give back the infant. Baby comes back, DCF gets it the next day. Mom was not charged criminally, because mom had been discharged, and DCF had not yet taken custody. It could have gone a lot worse.

In other news, a patient at another hospital smuggled in a lighter and set fire in a room in the ED. We know what that's like.

I had just returned to the Emergency dept waiting room and was opening the door to the office when I heard someone at triage announce loudly "I have a knife and I am going to hurt myself if I don't get help."

I look up and see a soaking wet ( its raining out) homeless guy clutching a large knife to his chest. I approach him and he retreats to a corner of the room, still holding the knife to his chest. A male tech and I have him cornered and start to talk to him, calling him by his name as he is known to us from numerous past visits. He repeats that he will hurt himself if he doesn't get help, adding that he has been off his meds for a while. We negotiate with him and he eventually drops the knife. I grab it off the floor and secure it in the office and we escort him back to a waiting psych room. As he is changing and they are getting vitals, he explains that a friend had come into some money so they spent all night drinking and smoking crack.

Someone had called 911, as the police showed up. I turn the knife over to the cop. Its a large sheath type knife that would make Rambo proud. The patient claims he found the knife under an overpass in town.

He was tired, wet, homeless, and hungry and didn't want to wait in the waiting room all night, as most drunks who come in for detox do. The staff makes the drunks wait until they get tired of waiting and leave. Unless they are so obnoxious, they have to bring them in back. Its not uncommon to have a drunk sitting in the waiting room wet himself all over the floor. This guy was able to get a direct admit to a warm room with his little drama.

Someone later told me the story on this guy. He was a normal kid, but his parents always compared him to his overachieving sports star older brother. They used to berate him with "Why cant you be like him?" He finally snapped one day and tried to burn the parents house down, and its been all downhill since. The person telling the story ended with "Its amazing how bad parents can fuck their kids up, isn't it?"

I played back the video of the incident recorded on the waiting room camera. It was funny so see the other people bail out of the area as this was happening. All but one poor woman who was so sick in her chair, I don't think she cared what happened.

So we get the call to meet the inbound ambulance. I was mobile and pull into the ambulance bay. As I am getting out of the car I hear sirens coming closer, not unusual at a hospital. A black and white pulls up loud and kills his lights and siren, right at the door. This is unusual, as the busses usually shut off at the beginning of the driveway entrance and come in silent. So I figure this might be a bad one. The cop jumps out. I ask him what's coming in. He says "I got him in back, he has a plug in his throat." I figure airway obstruction and call for a stretcher. Cop pulls this old skinny dude with long gray hair out of the back. The dude is handcuffed. I ask "can you speak?" trying to determine if its partial obstruction and he can get air. Dude honks at me. Then I see the trach hole in his throat and I recognize him as an occasional flyer, usually ETOH, sometimes suicidal, a wife beater. Cop says he's drunk too and was combative in the cruiser. He had picked him up on a warrant and the guy started faking breathing problems on his way to booking. His BAL was in the 300 plus range.

The only problem we had with him all night was when he was in a room. We had restraints on the bed in case we needed them, but we didn't have to hook him up. He go up 4 hours later to pee and peed in a wastebasket in the hallway outside the room, then went back to bed in the wrong room, across the hall. Fortunately that bed wasn't already occupied. He also has been known in past visits to smoke cigarettes through his blow hole. Not a poster boy for wellness. Drain material.

First half of the shift was real quiet. Then, we got 7 victims from two crashes in the adjacent town. They were minor injuries, but the ED filled quickly. Shortly thereafter, local PD brings in a suicidal ETOH IV drug user, on a committal paper. He didn’t want to come, so they cuffed him and dragged him in. I go into the room and remove the cuffs, which were in front. The tech comes in to change him. The patient announces he has TB and is now coughing. I’m thrilled with this.

We give him the mask and we mask up. We look for a negative pressure room, but I am told they are all not working. Patient is refusing to wear the mask, although he will cough into it, and keeps coming out of his room. We end up restraining him. He threatens to spit and tries to bite, but we secure him. The clinician checked his file. He was seen last week for an upper respiratory infection. She doesn’t believe he has TB, but of course can’t say for sure one way or the other.

While this is going on, an ambulance patches in, stating they are at our back door with a full code. The code goes to code room 2. A few minutes later a nurse comes out of room 3 shouting she needed a tech. I can see the doc pumping the patient. Room 2 was not saved and room 3 was saved, so they were 50%.

A mope comes running into the waiting room, face all bloody, yelling “he’s trying to kill me,” and literally dove over one of the Registrar’s desk. The Registrars scattered out of the way. Of course the waiting room is full. My partners get him down and secure him on the floor and we walk him back to a psych room, where he continued to be emotionally out of control, but was in restraints. Someone called the police and 9 cruisers showed up. His buddy said the mope sucker punched him so he bit him in the nose. He said they mope is on PCP. Patient later denied PCP, but he tested positive for ETOH, marijuana and cocaine. The suspicion was that he had smoked some “wet.” It’s hard to believe but he has no previous police record or psych history in the system.

Last night was my first day back from the weekend. I had 3 whole days off. I worked Friday night and we ran all over all night long. One of the psych patients, a felon, had been scaring the staff so they had him snowed and restrained. The shrink was able to get him into a forensic facility. Everyone breathed a sigh of relief when he left, except the EMS guys that had to transport him. There was a woman burned 80% in a car fire that got diverted. Thought it was an accident, but The EMS guys said she left a suicide note back at the house.

I managed to be sick on my days off, never a good thing. We were busy last night, but nothing particularly profound, just the usual flow. The weekend was pretty bad across the area. One nearby city has had 20 people shot in the last week. Its getting like the wild west or the early nineties.There was a five victim fatal crash and burn MVA a few miles up the road from our place. Four were ejected, one was pinned and burned. They all went to OCME. They were way beyond medical help. Over the weekend we got a youth that was racing his brother down a mountain on a bicycle. They told me he didn't have brakes. His brother got home and he never showed. They went back and found him. Broke his neck. It was his birthday.

Its also motorcycle season.

It wasnt a terribly busy night. One assault came in after being tuned up about the head with a belt buckle. Another AV came in kicked in the throat. A rollover was brought in fairly ealy in the shift. On one of the highways he fell asleep at the wheel, went off the road and rolled over. He was in the car when it caught fire. Another motorist pulled him out and saved him. Injuries were minor. Death by burning was avoided. Traffic jam made the TV news.

Lots of empty psych beds. Where are they all?

An unidentified unresponsive came in. No ID. He is only known as T (how do you spell that?). ETOH on board. Found at a local bowling alley. Cops say he likes to fight when he wakes up. Vitals, foley cath, trip to CT scan and back. he never woke up. Sleeping like a vodka baby.

We had the usual stuff for a friday night, the regular drunks (one with a BAL about 450, which isnt that high for an ER), a female in Inpatient psych didn't want to take her meds because she is allergic to everything (not), and the male in ED psych who was masturbating and exposing himself to female staff at every opportunity. Police brought a crazy female in from the shelter, complete with luggage and a large bag of dirty laundry, who threatened to punch someone if she wasn't admitted overnight, so she could go to jail and get a bed for the night (its cold out there, might be frost). We had to escort another ED psych to CT scan ("Do you think they'll find anything?" "no, probably not") in a search for answers. We had to stand by outside the gyn room as one of the nurses explained to the mother and boyfriend that she was going to do a sexual assault kit on the one year old because the baby has anal tearing. She was afraid the boyfriend, who had been with the child, might flip when he found out she was going to call DCF. We had the intoxicated transgendered bicyclist with a head lac, who got blood all over the wall phone handset in the room as she made phone calls.

At one point in the night we actually had no one in the ED waiting room, but only for about 5 minutes, as it quickly started reloading. It always does...

Just before we started, day shift had a combative out of control 9 year old. He was given benadryl. It didnt put him down but whatever his issue was must have got out of his system, as we had no problems from him.

We got called for an eloping patient. An area town ambulance brought in an ETOH male in his late 20's with numerous facial contusions including a shiner on one eye. He got beat up by his brother. He decided to walk out to the ambulance bay to have a cigarette. The charge nurse, a lttle thing, told him if he lit up, she would have him arrested. He came back. His brother came in later, boarded and collared, so I'm not sure who won the fight. The brother was also ETOH and cleared himself off the board and just walked out and left. The Emergency dept was so busy no one noticed. Charge had enough sense to separate the brothers at different ends of the department, so they wouldnt be easily able to continue their physical bonding session.

We got dispatched to the north lawn of the hospital, by Administarative offices, for a person down. We found a highly intoxicated male who couldnt stand, half in the roadway. This as very dangerous as it was just before 7 PM shift change, when the departing day shift has their NASCAR moments, as they all race out of the lot at high rates of speed. We got him a ride to the ED. Of course the second floor administration crowd was watching out their windows enjoying the show.

Last night, one of the area PDs brought in a prisoner who had swallowed an unknown quantity of crack. They bring them in to make sure they dont code and to recover the evidence...Someone who used to be an addict winced when he heard about it and said what a waste of good crack....

One of our dirtbags came in last night though triage. He is fond of Yukon Jack and crack. He was here last week. The police brought him in. They arrested him for family violence after he threatened his girfriend. They released him and turned him over to us as he was "jacked" (ETOH). He was very obnoxious. Our rule is once you are cleared medically you can leave even though you are ETOH, if a sober adult picked you up. He calls the girlfriend for a ride. She comes to pick him up. He starts in on her about having him arrested and starts a domestic right in the hallway. I separate them. I dont want her getting pissed off and leaving him with us. She took him. Apparently she got a restraining order against him after that.

Last night he got "jacked and cracked" again and went to her apartment and violated the order. He must have realized he was going to get pinched, so he decides to come down the hospital. He signs himself in saying he is hearing voices. I think he figured he could beat the pinch this way. But he cant control himself, he threatens the nurse. Two cops come down. We have a conference. The doc is willing to clear him so he can go to jail. The LT wouldnt take him because he made suicidal comments. So we got stuck with him. But there is going to be a warrant with his name on it.

Also, the night before, two brothers got in a bar beef. Apparently one stabbed the other. The stabbee went out side and cranked off 1 or 3 rounds, depending on who's version. He then drove off and jumped on the highway. Cop stopped him on the highway. He was bleeding. Said he tossed the handgun out the window as he was headed up the ramp. Cops couldnt find the gun. One of the cops told me last night they came back in the morning and found it, before some neighborhood kid did.

Returned to work after a few beautiful days off in upstate central NY. Its a whole different habitat than the one I work in. When I left to start the vacation, some mope had crashed his ride and snapped a pole on one of the side streets and took off, leaving the hospital without incoming or outgoing phone service. This affected everything, even the med radios.

While I was gone nothing unusual occurred. Busy ER. a skel was upset because his girlfriend was miscarrying and staff wasnt responsive enough for him, so he started threatening people. A family tried to attack staff on one of the floor after their beloved coded. A car was broken into in the employee lot and another one was stolen. Just the usual weekend stuff.

Little League opening day had to be cancelled at a nearby field. The dads showed up early to get the fields ready and found a homicide victim with a GSW to the head not too far from home plate. So instead of a ballfield it became a crime scene.

Last night just before midnight, 3 cruisers came racing into the Emergency Dept, following an ambulance. The Lt advised me they had just brought in a psych patient, a 4 year old. The kid was having the mother of all tantrums. I looked in on him as they held him down. He has a mullett and a pierced ear. Nice start to life. The nurse tranked him and he eventually quieted down. Someone said he is adopted and has a history of behavior problems. We also have a a 5 year old psych in the room next to his, and a 7 year old across the hall.

Earlier, the mid shift had a walk in GSW, 9mm, just grazed, nothing serious..

last night I was just getting ready to eat dinner when when of our regular psyhs ran out. She is a hooker who is HIV and has psych issues. She has been in ICU a few times for suicide attempts. I was mobile, and caught her near the main entrance gate and walked her back. I returned to my dinner. Apparently staff was changing her and knocked off her wig which upset her and got her restrained.

Another regular was brought in by police. He is known for decorating the walls of a psych room with his own feces, known as the mud pie incident, among other deeds. He was brought into psych last week after another area hospital kicked him out for being an inappropriate (dangerous) patient for their facility. Our psych unit had him for a week, and released him Tuesday to an outpatient detox facility. He walked away from the facility last night and got tooted up. He punched some glass fighting with his brother and came in papered and with a hand lac. He was all fired up, pacing around dripping blood on the floor, yelling, doing push ups etc. He broke off the tip of the IV pole on the stretcher and was waving it around like a weapon. Medical staff finally decided he had to be restrained. He backed into a corner and got ready to go at it with us. He was tasered by two cops, 100,000 volts. We went in and hooked him up. There was copper wire everywhere in the room.

He is a big guy, he is crazy, he is an ex con, he has a long history of crazy violence. I know some people think the taser should be re-evaluated, and there have been some injury and death associated with its use, but it worked great last night and no one got hurt, not the patient, not the police, and not the staff...There is nothing worse than a combative patient who is bleeding.

I was off the last two nights. I was expecting a quiet night as it was rainy. It was a fairly quiet night except…. I was reading the reports of the last two days and several were generated about a 10 year old in the ED psych unit. He had struck a tech and had bitten a CRISIS therapist. They had removed his bed because he was jumping all over and trying to trash it. My first round through I checked on him and he looked like a normal quiet kid, playing in the corner. A couple of hours later we got the STAT call. He had thrown his mattress and was all agitated. We had to go in and take his toys out of the room and then had to go back in and hold him down while he was medicated. While waiting for the meds he was yelling, screaming and calling anyone within range “fucking assholes’” and saying how he is going to kill us. He was punching and kicking the door, and head butting it. We went in and got him medicated. The MD came in and observed his behavior and ordered another round of meds. We went in again. We would bring in the mattress, and place him on the mattress and hold him down so the RN can IM him. He punched each of us, but he is only 10. When we took back the mattress he grabbed my arm and dug his fingernails in and broke skin. It was minor but everyone said to sign in. His parents were IV drug users. They abused him and he was taken from then when he was five and he lives with foster parents now. The damage has done and his wiring is all wrong. They were testing him for the alphabet (HIV, HBV etc) because he bit the crisis Dr. Everyone said I shoudl sign in to cover myself, so I did. There have been numerous references to The Exorcist and people were looking for a priest and holy water. I’m glad they didn’t have pea soup for dinner in the cafeteria.

While this was going on, in between rounds of med, we got called to another part of the ED. Nurse found a patient snorting oxycontin. He is a medical patient and they don’t have to change into a johnnie and be searched. My partners searched him and got the oxy and a large knife and removed his clothes and personal effects. We went back in and searched the room. He has tracks and looks like he might be getting dopesick.

We have a police portable radio in our office in the ED. Just before end of shift we heard a pursuit. A guy had flashed a gun in a road rage incident. The police located his car and he rammed the cruiser when they tried to pull him over. A pursuit ensued and ended shortly later with “shots fired” coming over the radio. Then they called for an ambulance and started a crime scene. According to the morning news he wasn’t shot, only his car, but I will find out more tonight.

Most nights I just don't feel like writing...Either there is nothing going on to write about or its the same routine with only the faces changing...

Tonight I came home feeling good. We had a female come in through triage for suicidal. She lost her mother yesterday, she said, and she was here with her father and sister. She was getting cold feet and decided to leave. The nurse begged her to stay but she walked out. She had not been cleared medically or seen by CRISIS. With a nod from the nurse we would have hung onto her and done what we had to to keep her safe. Nurse allowed her to go but said she would call the police to go to her home and bring her back on a PEC (police emergency committal). I caught up with the patient in the parking lot and told her she would be brought back by police if she left. The nurse came out and together we were able to talk the patient back in voluntarily. Many people talk suicide, threaten suicide, make suicidal gestures. The overwhelming lot are just that, gestures. But unfortunately, a few actually do go through with it and nobody wants it to be their patient, even though for some, it has. We had a gunshot suicide not to long ago where the wife left a guy so he went outside and head shot himself in the front yard. The wife and her family were at the hospital and his family was also there and we had to keep them all separated, as they blamed her. Lots of guilt and anger going around.

It was a strange night. Started with the trucker on the highway who decided he was having a heart attack. He called 911. He wouldn't pull over for police so he drives his rig to a grassy area next to the hospital entrance. Police call an ambulance. He refuses, saying he is not going to pay $700 to be taken a hundred feet (it was longer than that.) He is going to walk. He makes it a few feet and goes down, but is still conscious. Some of our suits are out there waving their Nextels, trying to look important and I am called to bring out a wheelchair. So I go out and load him and bring him in. He is a big unit and its 90 degrees out. He refuses to give insurance info to the registrar. We think he doesnt have insurance. When I left end of shift he was still there. They said later he did have a heart attack.

Had a female approach me saying she was a patient over the weekend and was here for her meds. We don't handle meds so I take her to the pharmacy. They don't have them. I take her to the ED and there is no record there. I take her to medical records and there is no record there. This took about 45 minutes, all over the hospital. So she says she will go home get her receipt and come back tomorrow. She said she was admitted for ETOH. Later I find out she was admitted Friday night, my day off. She ran out of the ED trying to escape and was caught in the employee parking lot and brought back and restrained. She was admitted under a different name, so its no wonder no one could find her meds. Correct name usually is need to know information. What a waste of time. Yesterday on day shift a psych patient ran out of the ED. The guys chased him, as he was a keeper. He swung at one of them. The other guy took him to the ground. They got PD to help bring him back. One of our guys ended up with a broken big toe. Sometimes you feel like its us vs. them.

We got called to a floor room 18 to assist staff. Yesterday I was called to another floor room 18 for a 91 year old who punched a nurse. I am wondering if the dispatcher got it wrong and we need to visit the old guy again. She didn't. This one was a male a few days into detox who was shaking like mad and wanted to leave. He was in no medical condition to leave. Detoxing is pretty nasty and it takes a few days.

Waiting room is packed, SRO. Female comes running in wearing a restaurant uniform. She has another female in the car who is having an allergic reaction to shellfish and cant breathe. I go yank her out of the car. She is gasping and groaning. I wheel her through the full waiting room and notify the triage nurse. She takes her right away. A little while later the patient is fine sitting in the wheelchair waiting to go in back, talking on her cellphone.

2 DMR patients come in after duking it out in the group home. They come in about five minutes apart by ambulance They go to opposite ends of the ED. Each has a DMR worker with him. Around 2300, one is discharged, but his worker brings him over to the other so she can chat with the other DMR worker. Both workers are obnoxious and become verbally abusive to staff. We escorted the discharged one and his worker out the door. Its too busy to be putting up with their verbal abuse, and nobody wanted to see round two of the fight.

Hope it quiets down for the midnight shift.