Patient Experience Lab: A Night in the Trauma Bay
For the Trauma Bay of the Future project, our embedded reporter observed several shifts in the Emergency Department Trauma Bay. What follows is a fictionalized account of real events and people. For patient privacy purposes, many of the details have been changed or generalized.
The burly Warwick EMT yells at me as I walk through the door of the Rhode Island Hospital Emergency Department: “Coming through! Make a path!” He is walking back-ward, pulling a gurney. I jump out of the way, amazed that my observation round at the Rhode Island Hospital Emergency Department has taken less than 10 seconds to become a nuisance and an impediment to people doing their jobs.
“There you are,” says Dr. S., looking at my hard-won research volunteer badge. “You’re late.”
“I’m sorry, I–”
“Let’s get a move on, shall we?” he says as he walks into Critical Care Room 3. I follow him. The smell of human feces is immediate and overwhelming. The patient from whom the smell is ostensibly emanating is lying motionless on the gurney, a tube out of his nose and a larger-than-normal neck brace around his neck. The room is totally quite but for the occasional off-key beeps of different monitors.
Dr. S. checks the chart and shakes his head. “Alright, let’s get our friend here a CT scan as soon as possible. Has he moved at all since he came in?” he asks the room.
The scattered nurses are silent for a moment till one says, “He hasn’t done anything.” There is a tension in her voice that does not sound like it bodes well.
“Right. Let’s go this way...” he trails off to me as he points out the door and walks away down the hall towards the ambulance entrance.
Dr. S. approaches the triage nurse and asks if there’s anything on the way. “One trauma to the thigh. EMTs say there’s no arterial damage. Should be here in 20.”
He nods and walks back down the hall and into CC6, the smallest and oddest shaped room in the ED. “Hi, I’m Dr. S.,” he says to the patient. “Quite a night you’re having, sir.”
“Quite a night.” And with that, the patient launches into his story, which involved fainting at a family party and waking up on the floor. Dr. S. asks about his medical history, his family medical history, stress levels and the like. A nurse comes in asking which tests to order for the patient. Another nurse comes in wheeling a strange-looking monitoring device with leads dangling down the sides.
As Dr. S. leans over the patient, who is now sitting up, and asks him to take a deep breath, I’m struck by the integration and simultaneous utility of both the high and the low-tech implements used in diagnosis and treatment of patients. The strange-looking monitor could easily cost $30,000. The nurse at the computer station doing documentation is using a new Dell computer and an extremely expensive networked software suite. Dr. S. is using an aged stethoscope. The nurse taking the patient’s pulse is using her fingers and a Mickey Mouse wristwatch. All these things: computer, software suite, expensive monitor, old stetho-scope, watch, fingers, are acceptable tools for treating patients.
I hear a woman scream behind me and instinctively move farther into the room. I am extremely leery of getting in the way of these professionals. Dr. S. calmly finishes with his stethoscope on the patient’s chest and orders some tests. He says “See you in a little while. Duty calls,” to the patient, and walks out of the room to follow the screams now interspersed with painful moans.
This patient is not the one the triage nurse had mentioned. This one had not been called in. The woman doing the shrieking is writhing in pain, her eyes closed, opening occasionally to try and look down at her leg past the neck brace, then closing as she falls away back into the gurney. I’m no doctor, but I’ve broken a lot of bones. This patient has clearly broken her leg and, if I’m not mistaken, in two different places. She also has a nasty scrape on her head.
“Motorcycle accident. She flipped over somebody’s hood in a parking lot,” the exiting EMT says. “Alright, girl, you’re gonna be fine. These doctors are the best. We took you to the best.”
“Thank you,” the woman says between cries. “Thank you.”
“Hello, ma’am. I’m Dr. S. Can you tell me what happened?” he says, as he starts lightly pressing on her abdomen. She tells her story as he moves his hands around. He hits one spot on her abdomen and she stops in mid-sentence to yell out in pain. “Does that hurt, ma’am?”
“Uh-huh,” she says.
He looks down at her leg, and her half-torn jeans. “Those have to go,” he says. An intern appears with scissors in hand and cuts off the remainder of her jeans. And here we are, in one of those intense, random, intimate moments that characterize so much of the activity in the ED. No one in the room knows this person, but we are all forced to be professional about and, to a certain extent, remote from the situation.
Dr. S. examines her leg with help from a nurse. “Ok, get x-rays of her leg and abdomen,” he says to the nurse. “Ma’am, I know you’re in a lot of pain, but I think you’re going to be ok. I’ll be back in a bit.” He turns back to the nurse, “And give her morphine.”
He walks out of the room and back down the hall to CC1. A nurse is awkwardly hoisting a monitor onto a bed where an elderly woman is laying with her eyes closed. The nurse utters, to no one in particular, “It’s amazing they can’t make these damn things lighter.”
“How’s her BP?” asks Dr. S.
“Not where you want it.”
“Keep the fluids going.” And he turns around and walks way down the hall to the CT/x-ray room.
“Hi guys,” he says as he walks in the room. It is quite dark, illuminated by low side-wall lighting, the flashing green and amber leds of a server across the room, and by 6 monitors showing various digital slices of patients. The radiologist and a young doctor I assume to be his student are sitting, looking at three of the monitors. “I’d like to see my patient, the one in CC3.”
“Bringing it up,” says the radiologist. He clicks around and, on each monitor, a differ-ently angled image of the patient is brought up. As the radiologist scrolls his mouse wheel up trough layers of the patient’s brain, all three doctors say, simultaneously, “Ah, crap.” The young doctor whistles and says, “That... is bad.” I have no idea what they all saw. To me it’s all just gray and white shapes. Nothing looks out of place because nothing really looks in place to me.
“You see that?” Dr. Becker asks me, pointing to the screen. “That is a huge pool of blood in his brain.”
“That’s not good,” I say, like an idiot. “How did that happen?”
“If I were to guess, I’d say someone beat the crap out of him. He’s got the bruises on his face. Looks like someone just smashed him back and forth. With a stick or something, maybe.”
“Oh my god,” I say. I wonder what, exactly, would be the eloquent response to some-thing like this?
“Ugh,” he sighs. “Thanks, gentlemen. I’ll be back,” and he angles through the door back into the hallway.
He goes back into another exam room where a woman has just been wheeled in. She speaks no English, but is clearly having an asthma attack. Her face is screwed up in what I think is terror. Every time she takes a breath in, she pulls her legs up towards her, as if she could push away from what ails her. A nurse quickly comes in with some kind of respiratory aid and tries to calm her down: “It’s ok, honey. It’s ok. Just breath this. It’s ok.” The woman looks at the nurse as if she is trying to trust that that is true. This, to me, is a quintessential moment of the ED: total strangers thrown together in a room, one is terrified and isn’t totally sure what is going on, and the other is professional, knowledgeable, and the quintes-sence of care.
The night goes on. I see some things I’d rather forget. Reminders of the upper ranges of human folly and cruelty, as well as intelligence and compassion, are ever present. As I walk to the parking lot in the early morning, taking deep breathes of the cool summer air, one thing truly hits home: these people, this institution, and the work they do are truly awe-inspiring. If this project ultimately helps them to do this work in any small or large way, it will be a worthy endeavor.
Posted September 4, 2007 08:23 AM by Allan Tear | Permalink
