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Saturday, February 20, 2010
My day started with a dose of Cipro for the upset stomach, and a trip to the local pharmacy. For the cost of <$30 I was able to purchase about 2 days worth of supplies for the ED. The residents were really happy, and put them in their "Emergency Supply". (However, the day before we needed needles and vials, today the bigger need was face masks and Foley catheters.....you can't win here.) I also was able to take some photos and video of the ED.
The morning started off pretty slowly, though I was able to get some IV practice and blood draw practice. Then, all of a sudden, a woman came in limp and unconscious - she had been like that for a while. The husband laid her on the floor and the residents told me that I'd be intubating her. I was successful, but we were unable to revive her. She died there on the floor, though in actuality, she was probably dead before. The poor husband had traveled with her on a boat, then with cab from another island. The poor man knelt beside her and was brushing her hair and kissing her face. It was so sad, yet the business of medicine still had to take place and the residents interrupted him to sign some forms and take care of her body. It was brutal to watch. Luckily, he recognized me and I was able to help him out later on - and to give him my sincere condolences. That will be a long boat ride back for him. She was only 44 and had some sort of heart failure, not really sure.
Little did I know that was only the first of 4 codes we would have before I left at noon. A young suicide came in tachypnic (breathing fast) after drinking lye. He was intubated as well. Then I had a break with codes and was told to go draw blood on a HEMOPHILIAC . Well of course he had scarred veins and I couldn't get it so I asked the resident rather than keeping on poking him. She, in return, punished me and made me do a rectal exam - luckily he and his dad understood English well enough to explain the procedure. The next patient with that resident ALSO needed a rectal exam - but when we got there she didn't have a pulse. Thus, another code began. I attempted intubation for her but the laryngoscope light wasn't working so I tilted her head and the resident blindly intubated her. Then I was part of the chest compression team - it's sad but I'm getting good at that. The only problem is that I get all sweaty - it's just not right that my sweat drips down onto her, but what am I going to do?
The final code happened at about the same time, on the floor right beside this lady, and you had to literally step over the man to move around.
The final sad part was seeing a woman with extensive fungating metastatic breast cancer. The resident wanted to teach, so we had her husband remove the large dressing over the caner. Indescribable. Unfortunately, she wasn't able to afford surgery when it was recommended nearly a year ago so it has literally taken over her chest, entire body, really. I realized that it would take a lot to work in these conditions every day, and give the residents and clerks my fullest applause. They are taking the best possible care of people in dire situations.