#the struggles of a young 20 yo with a divorced family who live 2 hours away from eachother | Explore Tumblr Posts and Blogs

boredguz · 4 years

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As promised, here's the translation of my first post:

As my mandatory field rotation comes to an end, I'm still reflecting on the kind of physician/person I was when I came, who I am now, and who I'll be when I return. And, just as promised by this kind of life stages, all those personality changes and tunings come catalyzed by unique experiences, with varying levels of trauma.

No doubt, many of the events that'll stay engraved in my memory long after Ixmiquilpan dust leaves my shoes happened on May the 31st, while on Sunday call day.

The scene couldn't be more perfect: two nurse students on their very first practical learning (with no RN to supervise them due to lack of personnel, such are the rules of places like this), whose will to learn and help matched their nervousness, one Emergency medicine resident, one Family medicine resident, and the ER full of the regular crowd of late pregnant women, diabetic people with more faith on the family friends than common sense, elder people that tried to pull out a Tarzan and stumped upon gravity, and (cherry on the shake) an 8-month baby with aspiration pneumonitis (because, of course, every 8 month old know how to chew and swallow tortillas, this one just got distracted for a second).

It was on this scenario where ocurred an epic episode of a late first-pregnant whose placenta, otherwise well placed, decided to fill an unannounced divorce of the body; and a whole swarm of nurses (who responded the call from inpatient care), physicians and family members struggled to identify the fetal heartbeat (wich we saw fall from a happy 140 to an ominous 65), bandage, catheterize and (most sacred of the sacred) fill up the patient's paperwork for an "it was 2 minutes ago and it was too late" c-section. Heavens be praised, the outstanding surgical and intern team managed to get ahead the binomial (APGAR score: 1/5/8).

Not even 90 minutes after this, and not even 10 after gladly hearing the situation's outcome, we found ourselves again in saturation, with an increasing patients line and struggling to tell real from felt urgencies, thinking than nothing crazier could happen...

And then we heard it

The unmistakable sound of someone running while pushing a wheelchair, joined by two (male amd female) voices begging for help. Looking to the entrance, I couldn't help the mental comparison with those Pulitzer winning photos that went around the world on war times: a half-aged man, with a vacant gaze, reflecting an indescribable pain that kept him semi-connected to reality, half his face burned and bloodied, with his pants torn and scorched and his left upper limb enveloped with a makeshift tourniquet made out of his hoodie.

It wasn't the horrific vision, however, what made me turn my face... It was the smell; an almost obscene impact that, even cushioned by my (extremely protective) KN95 mask, flooded my nostrils: blackpowder and brimstone. That gave us a good idea of what we'd find upon uncovering the hidden limb.

Inmediately we jumped to action: exposing the patient, removing and cutting unnecessary fabric, identifying wounds, telling (in temple, yet firm voices) to our young nurses how much SC buprenorfin give, what solutions use for the IV, how to prepare the opioid infusion; getting someone to clean and prepare one of the (recently vacant) observation beds to put the wounded man... Once his pain got a little less infernal, we proceeded to expose the major damage caused for the explosion: the biggest identifiable structure was a shard of bone (I still can't decide if it was radius or ulna) approximately 10cm long, located way up and... Transversal than it should be. Everything else... Was a mole of blood, muscle, tendons and powder. Not even a trace of what should have been the hand.

One of the biggest disgraces of the times we're living is that, when many units became CoViD centres, we lost our support units for non-insured patients (in this case: Traumatology and Orthopedics); situation that our weekend surgeon -the kind that is very scarce now, the kind You have to convince of not performing, instead of having to beg for a consultation- was aware of, and tried, by his own means, to get a consultation, an external transfer, any light to guide the way. Meanwhile, me and my partner centered ourselves on stabilize the wound and stop it from bleeding, while trying to keep our nurses from freak out: "E, go get 2 compresses packs and iodine; I, get X buprenorfin on Y of saline solution, and bring cast and wadding, we'll make a ferule". I have to say: they performed wonderfully, despite their obvious nausea.

As expected, there wasn't a single chance of transfering the patient, and, given his clinical status and the explosion aftermath, there was an only option: amputation. Our surgeon, showing some pretty good (and scarce in this times) humanity and empathy, talked to the relatives (brother and wife) and explained the situation to them, heard their doubts and grieves, and assured them that everything would be done the best possible way. Yo to that point, the man had a ferule, was dressed, in bed, efectively calmed and aware of the situation.

Almost like a perfectly timed stage, our lab manager appeared with the study results that were delivered one hour earlier, as well as the papers showing 3 blood units ready for use. We had green light. Less than 5 minutes later, with informed consents signed, he entered the operating room.

I fell on a chair, and let go a long, relieved, tired breath; I couldn't believe the events that I had just partake of. I felt amazed by the power of teamwork and the compromise of everyone involved. How we turned a disaster into an orderly directed situation with a clear course and resolution, how two nurseblasts, still shaky, were up to the emotional (and gastrointestinal) challenge, and followed instructions and were decisive. Breathe taken, I told them: "well, let's continue with the others, let's check vital signs..."

At that very moment, a woman who had witnessed everything from the door broke in, upset, demanding immediate attention because "you've taken too much time", for her (20 years old) "poor little boy" that had "serious internal wounds" after tripping and hitting his abdomen with a rock 3 hours earlier... It was a painless 2cm bruise...

#crazyday #emergency room #medicine

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