What a week.

Sunday night was my last night shift for a week in the ER. I slept all day yesterday, spent all night on the phone, so now I’m tired, and haven’t converted back to days yet. Too bad, as there is stuff that needs to be done today during business hours, so I need to stay awake. Tomorrow I need to be at the flea market, too, so it looks like I need to try to get back to days.

I digress. I love working nights. I’m thinking about asking my supervisor to put me on nights permanently. I love the diversity of patients walking through the door, the drunks, the little kids with scared parents, even the adults coming in for another antibiotic treatment, because sometimes things have changed.

E.g.: When someone is diagnosed with cellulitis, we usually start them on q8h IV antibiotics, and they just come back to the ER for their treatment. It takes about an hour, and it’s nice for the patient because they don’t have to be admitted to a hospital away from home (and sometimes home is an hour away from Kayenta as it is). A man came in this week for a second abx treatment for cellulitis on his leg. The doctor took one look at his leg, and said, “What hospital do you want to go to? We’ll send you to Tuba or Chinle, but if you want to keep that leg, you need more than outpatient.”

It was a good call. The leg was massively inflammed, almost purple, and covered in open, cracked sores that were weeping blood. Blood just slowly ran down his leg as he stood in our doorway.

He was SUCH a nice guy. In retrospect, ALL of my patients have just been SO nice, which is a nice change from an urban hospital of involuntary admissions. Even the drunks. I have treated five of the nicest drunks I’ve ever met, including the kid with the fractured skull. Two more had skull lacerations – one was attacked with a pipe, and the other one was trying to be “MacGyver” and had leapt from his truck while it was still moving (why? why? I don’t know). Another was a young girl who weighed maybe 100 lbs soaking wet, and had blown a .26 after a cop found her by the side of the road covered in her own vomit. She continued to throw up in the ER, and every time I wiped her face she smiled at me and said, “Thank you!”

The injuries here are quite varied, many more singular to this kind of area:

–A head laceration…from a 2×4 that got caught up in a tarp (that got caught up in a dust devil) and flipped back and caught him on the head as he worked to fix his roof.
–A head injury from a fall…off a horse…two days ago, because they didn’t have a car, didn’t have a phone, and couldn’t hitch a ride in to town any earlier.
–A comminuted tibia fracture…from a fall off a motorbike…that was completely contracted under the leg muscles because it took them 3.5 hours to get from the rural area where they were riding to the ER. By the time we got authorization from the Tuba ortho surgeon to set it, it had been broken for five hours. For all the nurses out there: he got 30 mg of Toradol, twice; 2 mg of Demerol, and 2mg of Ativan, and he was STILL in agony.

Speaking of broken bones, in the middle of the day on Sunday, as I was up getting a drink of water and getting ready to go back to sleep for a few more hours, I heard the whap-whap-whap-whap of helicopter blades. Turns out that it was the lifeflight from Farmington taking off with a man who had also fallen off his motorbike, but was not only very overweight but wasn’t wearing any protective gear. He had a compound fracture of his femur — it was sticking out of his leg at a 90 degree angle, and the nurses told me later that there were little bone fragments on his pants. He also had a broken hip, but he didn’t even feel it compared to the femur.

I helped remove grossly ingrown toenails, took blood draws on infants, administered IM, SQ, and IVP and IVPB medications (we mix our own meds here…it seems so primitive compared to the always-present-pharmacist on every floor in Froedtert), calmed down panicking children and adults, and generally had a fucking blast.

This is bliss.