" MILAN WAKE UP!" Aaron shouted
As if I didn't already know it was morning and time for me to wake up. It was a pretty good morning despite the fact that I was on call all night and will be on call again tonight. The thought of it annoyed me even more. I decided to put my frustration aside and get ready. As I was getting up I could smell the aroma of pancakes and burnt bacon. I walked out of my room only to find Aaron preparing breakfast.
" I see you've finally decided to get out of bed,"
"Why are you cooking breakfast? You don't cook" I questioned
" I'm doing something different, you have to change it up every once in a while, " He admitted
"I hope we get good cases today," Aaron says
"Not wishing bad on anyone but a couple stabs wounds, a blow to the head, or maybe a severed leg wouldn't be bad" I laughed
"Ok! relax since when did you like blood?" Aaron asked
"I'm a doctor blood is my life" I rolled my eyes
" Whatever you say," He chuckled pushing me a plate with pancakes and bacon
"I needed this so bad" I mumbled stuffing my face
" Well enjoy it while you can, we're running the ER all day " He spoke annoyed
After breakfast, I and Aaron retreated to our room to prepare for our twenty-hour shift and in thirty minutes we were on route to work. I and Aaron had made it a habit to listen to ER cases on our ride to work to sharpen our skills and understanding of our ever-evolving career field.
After quite an entertaining drive to work, I and Aaron walked into the Emergency Rooms doors and just like most days in the emergency room, I was briefed by the previous doctor on call on the current patients and their conditions, and soon after began rounds with our residents. We paged all ten of our residents along with our nurses and after a few minutes the hallway quickly filled up with our team. Each emergency room doctor had a group of resident doctors and the residents were lead by two attending doctors. In our cases, it was I and Aaron.
" Good morning everyone I'm Dr. Robinson and to my right is Dr. Ropper we are your attendings for the duration of your shift today" I began
" Everything you do you must be reported to myself and Dr. Robinson such as CT scans, Ultrasounds, Medications, MRI's. Any ideas of any sort should be taken to us" Aaron added
"Any questions?"I asked the group
The groups nodded there head negative, and we proceeded to our first patient of the morning
" Dr. Flora present our first patient," Aaron says
" Laura Wilson was admitted to the emergency room one hour ago with symptoms of fatigue, dizziness, rapid heartbeat, and the feeling of her chest tightening" she explained
" Hello Mrs. Wilson, I'm Dr. Robinson I'm going to ask you a few questions if that's alright with you"
" Go ahead," She says
" Where do feel pain on your chest?" I asked
" The left side of my chest," She says rubbing her torso
" With the pain in your chest does it hurt to breathe?" I asked
" Yes, and it feels as if my heart is racing" She described
" Dr. Flora have a listen for her heart and lungs," I said stepping aside
" Her heart is beating rather fast, and her lung sounds are irregular" Dr. Flora explained
" What do you suggest we do?" Aaron asks
" I suggest doing an echocardiogram as well as performing an EKG test, and depending on the results I will administer doses of nitrates to allow blood flow and ace inhibitors but since we haven't performed the tests I will have her on oxygen" She states
" Very good Dr. Flora, Mrs. Wilson do you have any questions for us?" Aaron asks
" No questions for now " She spoke softly
We continued rounds with our residents and the nurses and by midmorning, all the residents were assigned to patients. I sat behind the desk filling out paperwork and updating charts whilst checking in on patients every once in a while. The ER was running relatively slow compared to what it felt like on most days.
"Brigham and Women's Hospital Emergency Room Dr. Robinson how may I help you?"
" This is engine 4067 EMT Madison ten-minutes out with Leo Forest thirty-nine-year-old unconscious patient with an entry GSW to the left jaw. The patient is stable with normal vitals signs" The EMT spoke
" ER will be prepped, " I said hanging up the phone
I paged Aaron, my residents, trauma, and orthopedics all while having the room prepped for the incoming patient. Within minutes the entire team was in front of the emergency room doors dressed and ready.
" What's our incoming?" Aaron asked
" Incoming is Leo Forest thirty-nine unconscious patient with an entry GSW to the left jaw who is stable and has normal vital signs. Though he is stable with normal vitals signs we need all hands on deck in case the bullet continues to travel towards vital veins and arteries in the neck" I explained
Just as I finished updating the team on the incoming patient the paramedics came in with the patient.
"Thirty-nine-year-old Leo Forest was shot in the left jaw with an entry hole. The patient is stable and his vitals are normal" The paramedic says
"Let's move him in ONE...TWO...THREE"
" Dr. Flora and Dr. Victor check for injuries anywhere on his body," Aaron says
" Patient breaths sounds are full and equal bilaterally"
" BP 90/60" I state
" Mr. Forest can you hear me"
" No further injuries," A resident says
" No exit wound"
" Normal abdomen resonance," A Nurse says
" Mr. FOREST, THIS IS DR. ROPPER CAN YOU HEAR ME?" Aaron shouted
" Mr. Forest needs an MRI of his neck, page radiology tell them we're coming," I said to the residents
" MR. FOREST, CAN YOY HEAR ME?" Aaron shouts again
" My neck," He says trying to move
" BP and heart rate are dropping," The Nurse says
" Mr. Forest we need you to keep still," Aaron tells him
" My Neck!" He speaks louder
Without warning, blood begins gushing out of his neck
" GAUZE STAT!" Aaron shouts holding pressure
" BP 60/40, BPM 150" Dr. Flora says
" Patient is gushing air, I need a trach kit !" The trauma doctor shouts
I pass the kit to the doctor and continue helping Aaron pack the patient's entry wound with gauze.
" Trach tube is in"
" Dr. Victor page trauma were transporting him to the OR" Aaron instructed
Aaron and the rest of the doctors transported Mr. Forest to the OR for urgent surgery and following that trauma the emergency room had become very busy. I, Aaron, and our entire team were busy running up and down to ER floor tending to patients, and when we had the opportunity we would stop for a five-minute bathroom break before we were back on our feet.
After what felt like an eternity I finally had the opportunity to sit and relax before I started paperwork and Charts. I now had a bucketload of patients and in just one hour both I and Aaron had to gather our team together to have evening rounds. At this point, I was starving, extremely tired, and more than ready to have some sort of substance fed to my stomach.
" Aaron, what time is it?" I asked rubbing my forehead
" Have you heard of a device called a watch?" He sassed
" Aaron" I whined
"It's 4:30, why?" He quirked his eyebrows
" I'm hungry do you think we could go and get late lunch?"
" Well, we have an hour till rounds and I've finished my charts why not," He said shrugging his shoulders
I grabbed my wallet and we made our way to a nearby noodle and company across from the hospital. This had become our every day eating house as busy doctors. If we had time we would come and grab some food before we never had the chance. I and Aaron stood patiently waiting and as we were waiting I couldn't help but notice a handsome man standing behind me. I had been staring for so long I didn't notice that it was my turn to order.
" Milan?" Aaron called
"Ma'am, your order please ?"
"I'm sorry, I'll have pesto cavatappi with chicken please," I said to the cashier
"Anything to drink ?" He asks
"lemonade will be fine," I smiled
I handed him the money and went and sat next to Aaron. Aaron was my best friend and the expression on his face showed that he had been watching me stare at the man behind me in line.
"Ehm do you want to explain something?" He asked clearing his throat
"SHUT UP! he was attractive and caught me off guard that's all," I explained blushing
" He looks like a filthy rich player," Aaron says eying him
"Whatever" I mumbled
" Anyway, has your daily dose of blood been fulfilled?" He asked sarcastically
"Yes, I had about fourteen patients today So yes my daily dose of blood has been fulfilled" I sassed
" Tomorrow I have a date with Julia the nurse that works with us," He says changing to topic
"She's amazing, you really like her don't you" I smiled
" Yeah, I really do she's very different from what I've seen" He laughs
"Do you want a serious relationship with her? I mean it sounds like this could actually work out" I said to him
" I do, she isn't like any of my other girlfriends...a serious relationship is a possibility," He says
"Your speaking so passionately Aaron I'm proud, but as much as I'd like to talk about this it's almost time for rounds," I said
~~~
It was now 3:45 am, the 'wee' hours of the morning and we weren't finished with work till 4:00 am. The Emergency room had slowed down after we had our evening and late-night rounds, and I was ever so thankful for that. After things began to slow down we had a hand full of patients come in for stitches, vomiting, or the flu. Nothing of which was severe. I sat at my designated spot at the desk updating charts and placing in new medication orders for patients'.
Since my shift was slowly drawing to a close I decided to sweep through every room checking in on my patients before they had a new doctor overseeing their case.
" Hello, Mrs. Timothy, I'm here to clean and dress your burn," I told her
She nodded her head and I began. I washed my hands slipped them into gloves and began removing her old dressing and applied the new dressings. It had been roughly eight hours, and her burn was healing nicely. It took under twenty minutes to redress. Before I knew it was on to the next patient
" Hello, Mr. Rodgers how are you feeling?" I asked
" Oh, I'm fine my chest just hurts," He said
" Has the pain worsened?" I ask
" It has" He sighed
"Let me take a look"
I put my stethoscope into my ears and begin listening to his heart and lungs. His lungs sounded healthy. His heart, on the other hand had a slight murmur. It was steady but not rapid.
" Mr. Rodgers have you had any nausea, sweating, or shortness of breath at all since I last checked you?" I asked him
" I have, but I haven't vomited" He admitted
" Ok, I'm going to run two tests on you. The first being an EKG test and the second an ultrasound of your chest because your heart seems to have slight murmur" I informed him
" Sounds good"
I stepped out of Mr. Rodgers room and continued to finish my rounds. Thankfully all my patients' were doing well. After finishing my rounds I ordered to have a portable ultrasound brought to Mr. Rodgers room and paged for Dr. Walker head of cardiology to consult Mr. Rodgers.
" Dr. Robinson good evening," He greeted
" Good evening" I replied
" Mr. Rodgers this is Dr. Walker head of cardiology," I said
" Nice to meet you, Mr. Rodgers I heard you've had a bit of uneasiness today" Mr. Walker spoke
" That is right," Mr. Rodgers said
"Mr. Rodgers came in today for a burn from an explosion and his heart stopped. He was given epinephrine to strengthen his heart and had been monitored all day. Approximately fifteen minutes ago when doing rounds he had expressed he had symptoms of nausea, sweating, and shortness of breath. Upon further investigation, I had found he had a slight murmur of the heart" I explained as Dr. Walker listened to his heart
" Mr. Rodgers just like Dr. Robinson has said your heart does have a slight murmur so we're going to perform an ultrasound and EKG test, and take you to have a CT scan of your chest so we can better understand your heart" Dr. Walker spoke
" Sounds good," The patient said
There is a good chance that Mr. Rodgers aorta is dissecting as we speak. Considering the symptoms he's had and the murmur his heart has his probably going to be in surgery within the next hour.
" Alright Mr. Rodgers the ultrasound is ready if you will just lift up your garment so I can apply the gel" I instructed
" That's really cold" He laughed
" I know, I'll be quick and thorough," I assured him
I began maneuvering the ultrasound stick around the area of his heart and quickly noticed the free blood around his aorta. The dissection was roughly the size of a dime. 17.9 millimeters long.
" Mr. Rodgers, do you see the blue and red flashings on the screen?" I asked turning the screen towards him
" Yes, what does it mean?" He asked
" It means there is free blood surrounding your aorta the hole is about the size of a dime which explains why your heart is beating so abnormally" I explained
" What do we do now?" He asked worried
" I'm going to page Dr. Walker and I'll take you for a CT scan," I told him
I along with a group of nurses moved Mr. Rodgers from his bed to the wheelchair to transport him to the CT room. Any average patient can walk on their own but because Mr. Rodgers aorta is slowly dissecting we want him to have as fewer movements as possible to refrain from placing any additional stress on the heart. We moved him from the wheelchair onto the CT scan table and the radiologist began the scan. Just like the ultrasound had shown he had an aortic dissection the size of a dime that was now half an inch bigger.
" Mr. Rodgers, how are you doing back there?" I asked over the intercom
" Fine thank you"
" Milan what's the update on Mr. Rodgers?" Dr. Walker asked walking into the room
" He has an aortic dissection dime-sized as I said before, but it has grown half an inch bigger. He can't feel pain because I've given him morphine" I told him
" Great I'll scrub in, and you can prep him and transport him to OR 3," He said walking to the elevator
We again moved Mr. Rodgers back to the wheelchair and wheeled him to pre-op for his operation
" Julia prep Mr. Rodgers for surgery and transport him to OR 3," I said
The theory I had was that he had already had a small hole in his heart, but when the debris hit his chest stopping his heart the defibrillators placed stress on his heart resulting in the expansion of the hole.
After having Mr. Rodgers transported to the OR for his operation, I checked in on patients and administered each patients' medication, and finished the last bit of charts for my remaining patients before checking in one last time. I briefed the incoming physician for the morning. I sat in the office chair with my eyes shut waiting for Aaron to come so we could finally go home.
" HEY !" Aaron shouted
" WHAT THE HELL IS WRONG WITH YOU?" I shouted back rubbing my head
" What?" He laughed
" It's damn 4:00 am in the morning how are you happy," I said throwing a pen at his head
" That wasn't nice, come let's go home" He laughed grabbing my arms pulling me out of the hospital.
We pulled an all-nighter shift...it was finally over