Who links to me? X-ray Rocks: Dr. Happy

Wednesday, April 30, 2008

Dr. Happy

As I exit the elevator, the stench of fresh diarrhea and diesel fumes hits me like a wall. There is an ambulance, pumping out thick, oily fumes, idling in the ER garage.

I park my portable machine in a corner and watch the paramedics unload a stretcher, from the back of the yellow striped ambulance. There is a paramedic, on each end of the stretcher, and an EMT, seven months pregnant, perched on a little rail above the wheels.

The EMT continues chest compressions on the half naked man strapped to the stretcher. The two paramedics, in navy blue jumpsuits, wheel them, as a unit, into the emergency room. Four or five nurses flock around the stretcher and start calling out orders to each other.
A nurse yells at the patient, “Frank? Frank you’re in the emergency room. Frank? Can you open your eyes for me?”
I catch a glimpse of the patient over her pink scrub covered shoulders.

The patient is a middle aged man with thin balding hair, his bare chest covered with monitoring leads. He has a jiggling belly that wriggles, like a laughing baby, with each chest compression that the, now sweating, EMT presses into his chest.
Sweat runs down the EMT’s face and her ponytail starts to fall apart. Faded dirty blue jeans cover the patient's lower half and a worn brown leather billfold peeks out from behind his hip. One dirt clogged boot is abandoned in the middle of the floor. The other boot leaks black soil onto a bedside table's sterile silver surface.
I pick the boot up from the floor and put it next to its mate.

A compassionate nurse takes over chest compressions from the EMT.
They have an AMBU in place and another nurse takes charge of the man’s breathing.

Dr. Happy, the on-call doctor, arrives in the ER.
Dr. Happy isn't his real name.
It's an alias for a real doctor's nickname.
Patients find Dr. Happy's given last name unpronounceable.
He is from Africa by way of Russia.
When he speaks, patients look confused and then turn to the nurse, who translates Dr. Happy babble into Mid-western English.

Dr. Happy rushes into the trauma room and starts gesturing wildly and yelling out undecipherable orders and questions.
He is never calm during an emergency. He is never calm, period.
One nurse, Martha, who can usually understand his accent, starts translating the orders and answering his questions.
The patient had IV’s in both arms and Dr. Happy ordered the nurses to administer some drugs.
While they were busy with that he gestured at my corner of the trauma room and yelling, “S-ay! S-ay!”
I took that to mean x-ray and punched my machine into the fray.
The enormous elephant body of the portable x-ray machine made the over crowded room claustrophobic.
Gently edging toward the patient, to avoid any spare feet in my path, I lined up my positioning for the x-ray.
Before I can shoot it, Dr. Happy changes his mind.
“No! No! Ab irst! Ab irst!” he shouts.

The lab tech, Steve, moves forward and steps in front of me.
Dr. Happy starts running around the body grabbing the man’s arms and pinching them.
He shouts something and then runs down to the man’s legs and starts pulling on the patient’s jeans.
Steve and I looked at each other and shrug. Now what?
The nurses ignore Dr. Happy’s antics and continued compressing the patient’s chest and squeezing air into the patient’s lungs.

Martha translates.
She turns to Steve and motions toward the supine man, “He doesn’t have a pulse, so I don’t think you can use the arms. Your welcome to try, but Dr. Happy’s going to look for a femoral vein for you.”
Dr. Happy shouts a question and Martha asks, “Do you have a really big syringe?”
Steve digs around in the basket of needles and tubes he carrys, pulling the biggest one out and handing it to Martha.

Dr. Happy has, by this time, given up trying to pull the blue jeans off the patients flaccid limbs.
He jabs frantically at the fabric with a pair of blunt nosed scissors.
Finally, tearing the fabric away and sniping off the man’s white underwear.
Except for his socks, the patient was now entirely naked.
“Col ip! Col ip!” Dr. Happy shouts at Martha.

She dashes to a cupboard and returns with a small one inch by one inch alcohol wipe.
Dr. Happy swabs at the man’s groin and then shouts again, “Un or!”.
Martha hands him another wipe, followed by an extremely long thin needle.
Dr. Happy feels around in the man’s crotch and starts mumbling.
Martha translates, “He can’t find the femoral vein either. Oh, now he thinks he found it, but it might be the femoral artery. He’s not sure. No, that’s definitely the artery. No, it’s the vein. He’s sure it’s the vein. OK get ready, he’s going to try it.”

Steve steps forward, with his vials ready to collect blood.
Dr. Happy stops for a moment, poised above the patient’s crotch, and then he jabs the needle into the skin.
A long thin fountain of blood arcs from the white tube attached to the needle.
The blood arcs through the air, hits Steve’s chest and paints a thin red strip down to his knees.
Martha said, “That was the artery.”
Everyone, except Steve, who needs new scrubs, laughs.
Dr. Happy shrugs and smiles, “Oh, el. Is til bud.”
He gives Steve a large sample of blood and then removes the needle.
Every time the nurse compresses the patient’s chest a thin squirt of blood shoots out.
Dr. Happy motions to a nurse standing near the patient’s feet.
She compresses, with a white square of cotton, the offending artery.

Now it's my turn.
I push the portable machine closer to the body and unfold its giraffe neck. I point the small box, its head, at the patient and move up to the patient’s chest.
He is still on a yellow plastic backboard.
The nurses lift the backboard up. I estimate the location of the man’s lungs and shove my white plastic portable grid and cassette underneath the backboard.
The man’s cold, clammy, sweat covered arm brushes against my arm.

The extra nurses and Dr. Happy leave the room.
The nurse performing compressions pauses and the nurse with the AMBU fills the patient’s lungs.
I spread out my lead apron to cover us both, take my x-ray and pull the grid from beneath the man’s body.
I push my machine rapidly out of the room and back to my department where I develop the film.
Everything is digital.
Shove the cassette into its dock in the processor.

I return to the ER to show Dr. Happy the x-ray image.
He is running around trying to find the man's name.
A policeman stands, in the middle of the ER, dumbfounded at Dr. Happy’s antics.
The lieutenant watches Dr. Happy with his eyes, while quietly explaining to Martha that the man’s family knew he was in the Emergency Room.

The police notified the family twenty minutes ago, when the man hit the ER door.
The lieutenant called them again, five minutes ago, they told him they would come to the hospital when they were good and ready.
And his name isn’t Frank it’s William.
I step into the trauma room.

Dr. Happy bounces into the room.
Anyone object to him ‘calling it’?
They could understand this, with or without Martha.
Everyone shakes their sweaty heads.
Nobody objections.

“OK” he announces. “Time o det sex fiftin.”
Time of death six fifteen.
The nurses sigh with relief and step away from the body, rolling the stress out of their tired shoulders.
On her way out of the room, one of the nurses pats the body on the shoulder, “Sorry, Frank”, she says “We tried.”

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