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 Surprise Retirement Luau...The Prep

In April of this year, Mr Something announced that he would be retiring after thirty-six years with The Dallas Fire Department. Sounded like a great excuse for a party to me, but knowing him as well as I do, a safe assumption would be that he wouldn't be so keen on the idea.

A generous, caring and thoughtful man - I've often referred to him as "Burnt Toast Guy". You know the type. Everybody is gathered around in the kitchen for breakfast and sure enough, there are a few pieces of burnt toast. He's the guy who says with enthusiasm ... "Mmmmm. I like burnt toast!" as he snaps it up, slathering it with jam. He does this, not because he really likes burnt toast, but because he wants others to have the good stuff. That's just the kind of guy that he is.

And cheap. I would be remiss if I didn't include "cheap".

Once, while my sister was in town, we gave each other Indian-names (long story). He chose his own..."He-Who-Speaks-Like-Bird" (cheep).

While visiting Washington, DC,  he pounced at the opportunity to have his picture taken in front of "The Office of Thrift Supervision".

Although those that know him, tease him about his penny-pinching ways - I know for a fact that he would give away his last dollar - he would just have trouble spending it on himself.

Party planning would have to be under his radar.

Choosing the date and venue for the party was first priority.

Great place for a luau...don't you think?

Then it was time to make some difficult guest list decisions. Mr. Something's closest friends, fellow firefighters, their spouses and our immediate family were given the heads-up to save-the-date.

The rest was fun.

• Invitations were from vistaprint.com

• Stamps were ordered from the US Postal Service online. Hawaiian Shirts. You can get any kind of stamp - who knew?

•  Food: Traditional Hawaiian Barbequed Chicken, Rice and Macaroni salad. Pork Ribs were added (smoked by Mr. Something's talented son, Brian). A green salad and skewered fruit finished off the buffet.

• Pina Colada Machine: The Pina Colada guy said that the machine should dispense 60 Pina Coladas. What he failed to say was...those would be very small drinks (4 oz). Our guests had 12 oz cups. Note to self...order more Pina Colada mix and/or supply smaller cups in the future. We ran out of Pina Coladas soon after the party started but had beer, wine, soft drinks and water as backup...so everything worked out OK.

• Entertainment:  DJ vs. Hula Dancers - DJ vs. Hula Dancers  ...Definitely Hula Dancers. A quick Google search found a nearby Hula Dance troupe. Music responsibility was assigned to Mr. Something's eldest (and equally talented son), Ben

•  Cake:  Maryann out-did herself.

 Stay tuned for the next installment of The Surprise Retirement Luau...The Party.

 

ER 101

In 1983, a doctor that I had worked with suggested I transfer to the Emergency Room at Baylor. I had planned a lengthy tour of Europe and would be gone for a couple of months, so transferring sounded like a good idea. I secured my transfer to the E.R. before leaving for my trip.

When I reported to the E.R. for my first day of duty, I was all bright-eyed and bushy-tailed (so to speak) and didn't get why the E.R. staff weren't exactly thrilled when introduced to me by the nurse educator. I certainly didn't miss the subtle eye roll and yawn when they were told about my (non-ER) nursing experience and I was blown away by the blatant rudeness of a more experienced E.R. nurse when she snapped "get me a real nurse" after I had entered the room where a patient wasn't doing so well.

In the eighties, nursing academics began discussing how ‘nurses eat their young’, a phrase used to describe an epidemic of how many times 'seasoned' nurses would not be kind or helpful to new or young nurses but rather, teach through intimidation, fear and bullying. Believe me, those nurses were most definitely in the ER and gave me a new understanding into the naming of 'nurse sharks'. That being said, without any ER experience, the truth of the matter was that I knew I had to ‘prove’ myself and that I needed them more than they needed me. Fortunately, the practice of 'nurses eating their young' has gone by the wayside. Nurses are generally more supportive and helpful to the newbies.

I accepted the challenge of Emergency Nursing and did my best to present myself as a self confident, skilled and knowledgable nurse and made every effort to befriend even the most bloodthirsty of nurse sharks. Humor helped alot and I learned that when you swim with sharks you'd best not let them see you as bait.

The following are just a few of the new terms and phrases that I had to learn ...

ER Vocabulary

• ABC – Airway, Breathing, Circulation


• Biotel – a central communications center that is staffed with nurses, doctors and paramedics who communicate and advise with various ambulance services. They are also responsible for designating the hospital that receives the patient based upon predetermined criteria.


• Bat Phone – a red telephone in the ER that is a direct line to/from Biotel


• Blunt Trauma – hit with a baseball bat or crunched in a car wreck


• Code - normally a respiratory and/or cardiac arrest but there were many 'codes' used in the hospital. If someone "called a code" it could mean starting or ending CPR


• C-Collar – Cervical Immobilization Collar – neck brace


• DFD – Dallas Fire Department (and ambulance)
  Code 1 – lights only Code 4 – lights and sirens
  Priority 1 – easy Priority 4 – see train wreck


• ETOH – Blood Alcohol or just alcohol as in “ETOH abuser”


• FB – Foreign Body


• GCS – Glasgow Coma Scale


• Gomerade – 1 liter of Normal Saline with Multivitamin, Folic Acid and Vit B12 added – used for ETOH abusers (gomers) - Now the term is "Banana Bag" - much more politically correct.


• GSW – Gun shot wound


• LP – lumbar puncture (spinal tap)


• LOC – Level of Consciousness


• LOL/LOM – Little old lady/man


• MVA – Motor vehicle accident


• MVC – Motor vehicle collision/crash … around 1995 MVA was changed to MVC. According to the Board of Trauma Surgeons “There are no accidents. Every crash is preventable.”


• MCA/MCC – Motor Cycle Accident/Crash


• POPTA – passed out prior to arrival


• Pit – the ER


• PTA - Prior to arrival


• Penetrating Trauma – stab wound, projectile wound, gun shot wound, puncture wound etc.


• Ruptured triple A – see train wreck (ruptured abdominal aortic aneurysm)


• Ruptured ectopic – see train wreck (ruptured pregnancy gestating in a fallopian tube)


• SW – Stab Wound


• Thumper - A mechanism used to deliver chest compressions to a patient in cardiac arrest


• Train wreck – any really bad trauma or pt in really bad condition.


• Tox Screen – Blood or urine specimen to determine presence of opiates, amphetamines, cannabis etc.  

Knife & Gun Club - Part 1

"The Knife and Gun Club" - Part 1

Circa 1990, I was an ER Nurse at a hospital situated in a (less than) desirable neighborhood of Dallas, Texas across the street from an apartment complex referred to “The Projects” - a government assisted  apartment complex for the very poor where many occupants were armed to the teeth. See ER 101

Consequently, walk-in or dump-off trauma was commonplace. The ER Team was expert in managing 'penetrating' trauma as Gun Shot Wound's (GSW) and Stab Wounds (SW) were fairly routine.

The majority of our patients originated from The Projects but an additional source of blood and guts was from 'The It'll Do' nightclub located about three blocks away from the ER and notorious for late night stabbings.

The “Knife and Gun Club” would kick off on Thursday nights (payday) around ‘closing time’ (2 am) and continue until Sunday evening. Most of the victims were drunk or stoned, poor and under-educated.  I was told a long time ago that the ‘club’ name began by way of the differentiating members. The weapon of choice and modality of maiming and/or killing were determining factors on whether or not you were a member of the ‘knife club’ or the ‘gun club’. Divided by nationality, American citizens could legally purchase a gun to shoot one another. Undocumented aliens, were unable to legally purchase guns, so knives were the preferred mechanism of assault. Who knows?

It took me years to learn how to create strong boundaries between the patient and myself without losing my sense of compassion for them. After all, many of our ER clients were not the nicest of people.

The secret was to view their reality separately from mine and treat them as I would want my own brother or sister to be treated. It was the healthiest way for me to deal with some of the most horrific people and witness some of the most disfiguring trauma. But it took some time to get there as they don’t teach you this stuff in nursing school.

It was just after midnight on a Friday and “The Knife and Gun Club” was running full tilt. The ‘Bat Phone’ rang and we were told to prepare for an unconscious, hypotensive male with multiple GSW’s to chest and abdomen.

Within minutes, the patient arrived by DFD. An African American male, wearing a African print “doo-rag” and jeans, he was bloody and appeared lifeless. I could tell just by the look of him that he was a gangster.

Next:Knife & Gun Club - Part 2