Halls of Blood in Tomorrow Land

Every now and then I get a good glimpse of what we might expect in tomorrows ER's because every now and then it is tomorrow. I have worked in cities like New Orleans and I am not unaccustomed to long delays, blood dripping from beds, and staff rushing from room to room after a surprise hit by multiple pt's, but all that pales to a third world war zone that will by its purpose, a self feeding blood orgy, will one day swoop in on our first world hospitals with its own shock and awe. We will either adapt quickly or exhaust ourselves under a flesh colored wave of carnage. I expect both, and I don't see the stamina for it for more than a few weeks. Coffee can only do so much and compassion has a fuel tank. Once depleted I see dusty corridors and rodents crawling in and out of the red hazardous marked bags lining the walls and corners. There will be echoes and emptiness that only the shades of the dying hear and see.

"Memorial, I'm bringing in a 49 year old female that is confused and restless after falling in the bathroom. She has a open fracture of the left tibia with the bone protruding through the skin, good pedal pulses distal to injury, swelling of the calf and tissue with blood and edema. Bleeding is under control and leg splinted. Pupils are equal and reactive to light, skin cool and clammy, and pt is vomiting enroute. I have been attempting to establish an IV without success. Blood sugar was 127 mg/dl. Oxygen saturation levels on 91% on room air, oxygen being administered via non-rebreather  facemask at 15 liters per minutes. ECG shows sinus tachycardia at 122 beats per minute. Respirations are 28 and labored," repeated to the charge nurse via hospital net. "Be advised we have no ICU beds available at this time, advise to divert to Shoring hospital" the nurse said. "We are less than thirty seconds from your ER and the other facility has no ortho capability tonight." I replied. The nurse in disgust hangs up. We pull up to the ER coming in hot *lights going* and rush the pt into the crammed ER. The hospital has 12 ER beds total, and only 7 acute beds, beds that are in rooms big enough for a small team of providers, all of which were occupied this evening. Additionally, two ambulance pt's were ahead of me waiting against the walls on their respective stretchers for a bed. One was an old man with a head injury and a blood pressure of 93/40 oozing blood from behind a wad of bandages. Pt was barely conscious. Nurses were paying no heed to the medics standing hopelessly by their gurneys. My woman began to projectile puke at the nurses threading their way from one room through the line of stretchers to another. One of them tossed a large emesis basin our way to give her something better to aim at. In true macob fascination I watched the corn kernels float in the sour puke filling the pink basin and counted the blood drops dripping off the end of our stretcher. "One, two, three, four...." A coping diversion for what was going to be a long wait. We could not leave our pt until a report had been given to a nurse and the pt moved to their ER bed. A tall Indian doctor (by Indian, I mean India), who I did not care for, came strolling up to the gang of stretchers for some playful teasing. The game was, which one of us could convince the doctor and nurse that our pt needed priority bed placement. We all spoke at once until it became an auction of blood pressure and morbid coefficients. I came in second with the head injury sliding into first. They had already been waiting 20 mins for a bed. The doctor laughed that I had "just" a open - now bleeding again - fracture of the leg with a woman doped on benzo's.

Minutes passed as I struggled to hold up our heavy fat woman from continuously shifting on the narrow stretcher. She nearly fell twice, and if not for my dedicated partner she would have surely suffered another injury. Our stretchers are four feet in the air when in push position. A commotion down in bed 2 caught our attention as a ring cutter flew through the door striking the crash cart across the way. A skinny cute nurse dodged the tool with skill before yelling for security, while others stood frozen in pale colored fear. More loud bangs and sheet tearing noises were heard coming from the exam room. Was someone shape shifting into a werewolf in there, I wondered? It was a full moon. I didn't dare leave the stretcher to assist since I left my silver at home, and American coin today has no silver at all. I was being funny of course, but that's a coping mechanism. It was a better technique than walking around in a "I don't give a fuck" bubble that some poor unsuspecting family member might accidentally pop, and thereby unleash a torrent of over-worked hysterics. You can guess which technique the hospital workers were using because none of them were laughing, except maybe that doctor.

A badged guard rush into the room looking too old to do much good but thankfully accompanied by a haldol welding nurse and a set of leather restraints. My woman's distal pulses were getting fainter as the blood swelled the foot and leg, but it was steady as we went on with our unperturbed lengthy wait watching our oxygen bottle trickle down to zero. Hospital registration wasted no time getting her insurance information, and the clerk almost got giddy upon seeing she had medicare AND medicaid. She acted like she was getting commission or something. By some coincidence we were shortly shown a trauma bed after only waiting 50 minutes. Our stretcher was out of oxygen by that point and my pt moaning that she had to shit. "Hun, do what you have to do." I told her. An aid began to dig for a bedpan while the red shirted vampires began their vain search for a vein. The whole time I help hold the woman down who is now uncooperative and fading in and out of consciousness. A woman doctor, who I did like, showed up to ask the pt questions. She was not as oriented as she once was, and the doctor was beginning to think her leg injury might be the least of her concerns. She was thinking a head bleed - confusion, nausea, slurred speech. She was setup for a scan but was in a long line to do so. God knows when. Probably another thirty minutes. More screaming and moaning heard in the rooms around us. The air was warm and muggy instead of the characteristic coolness that generally fills the halls of a hospital. Everyone was sweating, and my uniform felt too used long before the end of my 72 hr shift. Dispatch squawked a warning that our county needed us, and since coming into the ER I suffered a longing for the road. This would not be granted for another thirty minutes and seven IV attempts by the blood team.

Finally released I came out of the room to see two more stretchers wheeled in, one with a ten year old dripping skin from a grease burn to the hand and the other a foul smelling GI bleed. Their misery adding to the moaning orchestra and yelling instruments of the suffering. A big war in todays crowded immiserated world will be worse, and collapse of any sort will not be endured for long.

A glimpse into tomorrow, I thought, as I came out to our rig to wipe blood and puke up for another roll out. What will be my limits when that day comes?