Shotgun Trauma: Whodunit?

Receiving a Trauma patient...back in the day.

It was 1991-ish at around 5:30 am when the 'Bat Phone' rang. The phone itself was red with teensy photographs of a gun and knife taped to the handset and it was our hotline to Biotel - a centralized Emergency Dispatch center. in Dallas, Texas. " male, multiple gunshot wounds, Code 1, Priority 4, five minutes out”, cautioned dispatch. This was bad.

A five-minute ‘heads up’ was a blessing.

Our patient arrived alive. Oxygen, fluid resuscitation, blood and diagnostics were all being done simultaneously. He was shot with was not just a simple handgun but, a shotgun. A shotgun typically uses a ‘shell’ and when fired, shoots a number of pellets which is why his abdominal x-rays looked like stars in the night sky - almost too many pellets to count from the multiple shots. His injuries were devastating and he was drifting in and out of consciousness. The ER doc made it clear to me that he would not survive.

Suddenly it seemed as though everyone lost interest in this case except for me and a cop who was left sitting in the corner of the room, making notes. He told me that when our victim left for work that morning, someone was waiting for him, across the street, with a shotgun.

My patient would most likely die soon. I maintained his blood pressure (and consciousness) with blood transfusions and oxygen, while waiting for the surgeons arrival. This was before we had designated Trauma Response Teams, Trauma Centers, Trauma Case Managers and the like. This was how it was done. Hard to believe.

I didn’t know how much longer my patient would remain conscious, so it was critical to me that family be given the opportunity to be with him. I opened the door to 'The Family Room' where it was filled with distraught family members and friends. The doctor had explained the gravity of the situation and they were clearly heartbroken. His parents. siblings and friends came forward to be at his bedside. Recalling the tearful, anguished sobs, followed by prayers of strength and validations of love, it was a powerful moment and told me how much this man meant to everyone. The only person who had not stepped forward was his wife. She, still in her nightgown, wearing pink sponge curlers in her hair and staring blankly overwhelmed by grief.  I asked everyone to leave his room in order to provide the couple privacy. 

She stood beside him with tears streaming down her face. She didn’t speak a word and barely moved. He told her that he loved her. She did not respond. After a few minutes I brought her back out to the waiting room where she was comforted by her friends and family.

My patient died that morning. He was 28.

A few weeks later, while out shopping, I saw a familiar face in the store but just couldn’t place him. So, I approached him and said…”You look so familiar, do we know each other?” He paused for a moment and then said, “You’re the nurse.” I nodded. He said, “I’m the cop.” The cop from my patient's trauma room.  I asked, “So did ya'll find out who did it?”

I was totally unprepared for his response,

“His wife", he said.

A promise of  $500.00 to kill her husband - to be paid when she collected from his Life Insurance policy.

It just affirms the fact that you can't judge someone in our business.

#TheIsolationJournals - Write about when you were dead wrong about somebody

The Seven Dwarfs of Menopause

Disney's Seven Dwarfs in Snow White

A few years ago, Oprah had Suzanne Somers on as her guest, promoting her latest book, "The Sexy Years". This was how I learned of Suzanne's take on menopause. She alluded to what she called, "The Seven Dwarfs of Menopause. Itchy, Bitchy, Sleepy, Bloated, Sweaty, Forgetful and Psycho". And I recall thinking that her remedy to banish the little fellas by taking 40 pills in the morning, 20 pills in the evening, intravaginal estradiol and applications of topical bioidentical estrogen and progesterone indicated that an 8th dwarf "Squirrelly", had joined the group.

Comforted in the thought that I was one of those fortunate women who experience little (if any) discomfort associated with the hormonal shifts of menopause...BAM! With little advance warning,  I was as surprised as the next guy when I suddenly became an itchy, bloated, sweaty, bitchy, forgetful psycho.

The good news: The dwarfs would exit within minutes of their arrival.
The bad news: I was left to sheepishly explain just why the dish towel folded over the oven handle incited WW III at the Spotswood's.

A word of warning: It was not in anyone's best interest to discuss my displeasure of trivial matters during a hormone surge. I'm just saying.

YOU JUST WOULDN'T GET IT!

Sorry for shouting. It wasn't me. It was "Bitchy and Psycho".

So, as 'Mr. Something' scrambled to turn on a fan, provide me with a glass of ice water and a cold pack, I can't help but reflect on his wistful reminisces of what he refers to as, "the good ole days of PMS".

#TheIsolationJournals - Choose a line from a book to inspire

The Train

Recently, I've been thinking of the words of a friend who is an ER Nurse, in the frontline during this COVID19 Pandemic...

"I look into the eyes of my coworkers and wonder which of us will lose our lives in this battle. It will happen. We all know it will happen and yet we continue to show up...shift after shift...This isn’t political. This isn’t a hoax. This doesn’t discriminate." - Kimberly Wainwright-Morrison RN

These words stirred my soul. I reflected on all of the friends and colleagues I had surrounded myself  throughout my career in healthcare and paused to think of who will we lose. 

In times like these, I rely on the wisdom of my husband who introduced me to the concept of The Train... "My life is a lot like a train trip and I've been lucky enough to get the window seat in a comfortable car. Undoubtedly, there will be a few bumps and curves along the way, but the train will stop at destinations that are colorful, fun and terrific as well as other destinations that are grey and difficult to navigate. But, neither lasts and I will eventually re-board and continue on. One day, I will reach my final destination and know that by and large, life has been a great ride in a comfortable window seat." 

His view comforts and speaks to me. I add another aspect to the train-ride of life.
It concerns family and friendship...

We will meet fellow passengers that board the train. 

Some of us have been travel-buddies since the beginning of life, some of us have traveled together for years, and some have to depart early for different destinations, but sometimes will board our train again. Sadly, some will reach their final stop.

We will laugh and talk, eat and drink together. We will comfort and support one another during arduous journeys and celebrate our successful trips together.

We will love each other.

For what ever reason, there will be travelers who we might not see 'eye to eye' with, but yet, they remain on our train. They don't share the same car anymore but we see them from time to time. Is their presence to remind us of how others travel in life? 

In the final analysis, it really doesn't matter. As my husband had said, "One day, I will reach my final destination and know that by and large, life has been a great ride in a comfortable window seat." 

#TheIsolationJournals - Close Your Eyes...What Do You See?

The Shoe

Fresh out of ER orientation and really wanting to prove myself to be a competent nurse. An unconscious petite young woman was brought in by DFD* ambulance.

She had a high fever and had experienced a seizure PTA*. She stood about 5 feet tall and may have weighed 100 lbs. As a team, we stabilized her condition and were preparing to send her to the ICU when a resident announced that he had to perform a spinal tap first.

Well hell.

The spirit of the ER was to “Treat & Street” meaning…“Stabilize them and get them out of the ER”. Our rationale was (since you never know what will come through the ER doors at any time) a bed must be available for the care of the next patient. It made sense to me and was a priority of the ER nurse to facilitate transfer to another area of the hospital as quickly as possible.

So, I (reluctantly) set up an LP* Tray for the resident and left him and three other residents to their own devices while I took care of other patients – this was my first mistake. About a half hour later, I couldn’t help but notice that they hadn’t finished the LP yet – the procedure usually just takes a few minutes. So, I poked my head in the door and saw that all four of them were still inside. “What’s up?” I asked. The senior resident replied, “Dr Surly (a pseudonym) is coming down do it.”  Another delay.

On a good day, Dr Surly, a tall, imposing doc was grumpy. Today, he was grumpier. Being summoned to ‘the pit’ because no one on his service was successful in performing a simple L.P. put him in ‘a mood’ to be sure. He walked into my patient’s room, and without saying a word, rolled up his sleeves and began the procedure. The tension in the room was palpable. Everyone, including myself remained in the room, silent.

I took this opportunity to quietly create a written inventory of my patient’s belongings - a hospital requirement prior to transfer – and (as I was told) one of the signs of a good ER nurse. I found her bag and began my list…

• 1 pair of shorts
• 1 pair of socks
• 1 towel
• 1 bottle of unmarked blue pills - “I should mention this later – after the tap is done”
• 1 bottle of unmarked white pills - “Wow. This is critical information, but it can wait until after he’s finished” thinking to myself. 

Despite 4 Residents, 1 Staff Doc, myself and a sick lady, the only sound heard in the room was the ticking of the clock. Back to my list...

• 1 set of keys

It was then I made my second mistake.

Reaching into my patient’s bag, I removed a HUGE tennis shoe. It must have been a size 13. Unable to stifle myself, I held the shoe high in the air and blurted out, “Holy Cow! Would you look at the size of her feet!” With that exclamation, everyone looked at our petite patient's feet. Without missing a beat, Dr Surly (with the spinal needle still in the patient’s back) said, “May I ask just what you are doing in my gym bag?”

One by one, the residents filed out of the room. We could hear them howling with laughter in the hallway. Then, Dr Surly’s eyes met mine - I burst out laughing, tears streaming down from my eyes. Dr Surly, ever the professional - successfully completed the LP. All the while, his shoulders quivering and biting his lip. As he was leaving, I handed his bag back to him and without a word, he walked out of the room.

I wonder if he got a kick out of finding the completed "Patient Valuables Record" I had left inside.

#TheIsolationJournals - Glorious Awkwardness

*DFD - Dallas Fire Dept
*PTA - Prior to arrival
*LP - Lumbar Puncture (Spinal Tap)

Home

"Home"

It's really quiet here.

Wait. What was that?

A sigh? A yawn?

It really doesn't matter. I suppose I could play a little music or turn on the television, but the silence is somewhat comforting today.

"Home" is the townhouse we bought about four years ago in the 'burbs'. Downsizing was our effort to decrease the carbon footprint and free up some travel-time. Newly retired from firefighting and nursing, we had a bad case of wanderlust. Travelling the world while we were young and healthy enough was a priority. And travel, we did. Asia, Europe, North & South America. Not the cruise-ship type, we enjoyed travelling with a back pack, map, currency calculator and translation app. That was then.

For now, we are at home. "The Villas of Westridge". A small, gated community in McKinney, Texas.

Looking outside, through our living room window, it's an overcast day during the COVID19 pandemic in April. My view of our orchard (plum, peach and pear trees) is temporarily obscured by an elderly dog-walker. He's a regular around here with two little dogs. Strangely, whenever I've said 'hello' - he hasn't responded to me. Maybe he has hearing issues. I call him 'Ove', (from the book, A Man Called Ove) but have since learned his name is Steve. He'll always be 'Ove' to me.

His dogs bark. And then, silence. Again.

Tick. Tick. Tick. It's peaceful here but c'mon. The silence is deafening.

And just like that, without any provocation or discussion, the love of my life, travel-partner and best friend, 'Mr. Something', excitedly hollers out... "CAR!" just to break me up - along with the tranquility of the place we call "home".

#TheIsolationJournals -  A travel journal entry from home.