Physicians frequently get the choice roles in prime time television (if that's even a thing any more in the era of Netflix), so it's easy to forget that working in the Emergency Department is a team sport, where emergency nurses comprise the front line.
One of our docs put up a saying in the doctor's lounge long ago: ER doctors save lives. ER nurses save ER doctors. Experience continually reinforces this truth.
(Time has passed and details have been altered to obscure identities).
It's 1:30am on an incredibly busy shift as an obese female in her late teens is wheeled in by paramedics. She is screaming and writhing on the gurney. She won't answer more than one or two questions or even let me touch her abdomen due to pain, but at my insistence she reveals that her last menstrual cycle was 2 weeks ago, and she swears she's been regular like a Swiss clock.
The patient's mother arrives a couple of minutes later by car and relays the only additional history we are able to obtain: The patient complained of a stomach ache that morning that appeared to go away, ate lunch and dinner with her mother, and went to bed without incident.
She then awoke around 11pm vomiting with horrible diffuse abdominal pain. It was the worst of her life, and she'd had no prior similar episodes before that morning.
She is afebrile, with a systolic blood pressure in the 150s, and a heart rate in the 90s.
As a wise and trusted nurse coaxes an IV into her, I order labs and pain medication and the patient requests, not unreasonably, that once she's more comfortable she'll let me examine her abdomen.
I return to her bedside repeatedly over about an hour as I await lab results, but despite my ordering additional doses of pain medicine, she's still miserable. Each time I gently reach over to examine her abdomen, she grabs my hand using a white knuckle kung fu death grip.
Rebuffed, I move on to see other patients. Even from far away rooms, I can hear her screaming every few minutes. I run the mental list of problems in young, non-pregnant, otherwise healthy women that can cause severe episodic pain: Kidney stone? Ovarian torsion? Finally, as I am placing orders at the central work station, she screams something like, "I think I have to poop!"
My wise and trusted nurse looks over at me with a glint in her eye and says, "You know what this reminds me of?" She doesn't need to complete the sentence - I take off at a trot and wheel over the ultrasound machine - a surge of adrenaline at last allowing me at last to overpower her kung fu grip. The monitor reveals a term fetus.
After informing the stunned patient and mother, the daughter finally allows me to do a quick inspection of her pelvic region, which reveals yahtzee! She's crowning.
A quick heads up to the on-call obstetrician and our team is wheeling the gurney full speed to Labor and Delivery. Thirty minutes later a healthy baby is born.
Happy (belated) Emergency Nurses Week!
With highest regard, thank you for who you are and what you do.
Comments 10
Wild and memorable story.
You are right that the front-line staff can make or break a physician. I quickly learned in medical school that nurses can be your best ally and if they like you they are happy to pass on tips and make your life so much easier.
It was the individuals who thought that magically an MD behind their name automatically made them better than the nurses that struggled as their false confidence and subsequent arrogance drew the ire of the nursing staff who then proceeded to remind that doc in not so subtle ways who really was more experienced.
She named her kid Yahtzee?
Author
If she were to have had twins, the other was to be named Boggle.
And if she were to have triplets, the third would be named Bogle.
Author
Touche!
Wait. Was she lying about her periods? Or was she spotting? Why did she have abdominal pain, vomiting, and hypertension? Did she have pre-eclampsia? Did she need an epidural?
If the ER nurse didn’t mention anything, you probably would have been the one to catch the baby 🙂
I’ve seen an IUP diagnosed on x-ray and CT. Not the best way. U/S is preferable. Nice post.
Author
Unfortunately, so have I, and it breaks my heart every time. Our quest for rapid throughput needs to avoid coming at the cost of careful H&P, even when in patients who repel docs with kung fu death grips. Then again, maybe it’s a sign I just need to return to weight-lifting.
Thanks for stopping by, MD.
ER nurses have the power to make or break you.
If you are kind and respectful to them, they will save your butt time and time again. They’ll cover for you with angry patients, come to you with the good cases (bring you the STEMI EKG when you’re sitting in a row of 4 docs, tell you the patient the medics just brought in needs to be tubed). They’ll even bring you a cup of coffee when you’re nodding off after hitting the dreaded 5:30 AM wall.
If you’re a disrespectful jerk they will give you just enough rope to hang yourself. They won’t put a patient at risk, but they will use their superpowers to teach you a lesson in manners.
Rule number 1: Don’t piss off the nurses
Rule number 2: Airway, breathing, circulation
For what it’s worth, I think Yahtzee is a perfectly fine baby name (assuming it has snake eyes).
Author
SHS,
First off, thanks for the consistently hilarious posts – you’ve definitely been in a state of flow with the blogging, and I for one can’t get enough. I elect you ambassador for life of our specialty.
Second, the RNs are half the joy of the job. You get killed together, and it hurts a little less. You support one another, and it hurts a little less. No matter your personality – introvert, extrovert, blunt, gentle, thick book reader, pop culture junkie, indie musician – there’s a nurse in the department that gets you and resonates, has a streak to match yours.
Finally, I almost overlooked the additional category of heroes – our unit secretaries. I’ve got my home wife and my work wife, and when the former worries that I haven’t shown up on time after an overnight, the latter reassures her I’m still charting away after a killer night.
In retrospect, it seems we go to work to be cared for by folks we deeply care about. Nice problem to have.
Off to go sleep train a crying Yahtzee,
CD