I always had to check the pockets of my scrubs before I put them in the laundry. Inevitably I would leave a roll of tape or IV tubing in my scrubs, especially on a busy night shift. By 7:00 am, you're thinking more about your head hitting the pillow than what the hell was in your pockets when you make the sleepy drive back home in the morning.
Your brain gets numb after dealing with 8 trauma alerts in a 12 hour shift. The trauma surgeon is the juggler in charge. It's their job to mitigate and assess risk, prioritizing the most critical from the least. Not to mention performing mentally demanding surgery on top of that, at 3:30 in the morning and they've only had 6 hours sleep in the past 36. Trauma surgeons are fucking crazy. They have one of the most mentally and potentially emotionally stressful jobs, and work anywhere from 60 to 100 hours a week. They don't do it for the money, but the adrenalin and passion for what they do. But after being up for 48 hours straight, it becomes a grind like anything else.
They dedicate at least 12 years of their life, and hundreds of thousands of dollars in student loans, to do a job that pays 26 times less than your average corporate CEO. Consequently nurses and all other medical staff really don't get paid what they're worth. Six of the trauma alerts are from a bad car accident. The other two are gunshot wounds, one self inflicted and the other probably gang or drug related. To give you some perspective, the trauma bay is designed to handle two trauma patients at a time. I can handle four in a pinch. To accommodate 8, you start cannibalizing normal rooms and converting them into trauma rooms. The rest of the emergency room comes to a grinding halt as critical patients require double or triple the staff to monitor and stabilize. It was times like these that the team you worked with became close to you. You had to learn to anticipate their moves, react and work as a team under conditions that were less than ideal and where time was short.
An an EMT, part of my job was to anticipate the equipment and setup the docs would need to handle for whatever comes through the door, often with little more than 20 minutes notice. In many ways it operated very much like a little platoon. The trauma surgeon gives the orders, the nurses and medical technicians carry them out, the social workers, x-ray technicians, and respiratory teams all had to maneuver around each other and the patient at just the right time to get the job done. The trauma surgeon decides who is the most critical and needs to go to imaging first (usually CT scan), or if they're really fucked up (they're going to die in the next 30 minutes without surgical intervention), they go straight to the operation room. In cases where we're handling eight trauma alerts at once, it becomes a cacophony of organized chaos. Trauma doctors love that shit, but I suppose that's what makes them good at their job.
Patients that would come in got assigned a number on something called the Glasgows scale. Any number less than 12 and it's a good bet at least one of them will need a chest tube because they have a punctured lung and it needs to be drained before they drown in their own blood. Trauma surgeons could be picky on the size of the chest tube they preferred and each one had their preference. It was our job to learn the little preferences of each surgeon, some preferred big chest tubes while others preferred smaller, some liked to get a CAT scan first, while others preferred just a chest x-ray before going to surgery. When they say medicine is an art, this is what they mean. Medicine is an art in very much the same way Sun Tzu calls war an art. In emergency medicine, your enemy is death and it's your job to outmaneuver the various ways death can take the patient until they're stabilized.
I always found a strange sense of purpose in knowing that the only thing keeping someone from crossing into the arms of death was some idiot like me, getting paid $12 an hour to repeatedly squeeze a rubber bag of air into someone's lungs, because all the available mechanized respirators are in use because the hospital budget got slashed last fiscal quarter. Great, here I am stuck in a room with the suicide guy, pumping air into his lungs that he tried to deprive himself of only hours before, waiting for a respirator to be freed up from another floor. The trauma surgeon decided he was brain dead from the mechanism of injury alone (a bullet to the brain), and we were just keeping him alive until next of kin could be notified. It's difficult not to become emotionally jaded after doing this job for years, and the medical staff had their own unique black sense of humor that I came to embrace. We would pass around emails entitled "Suicide: Doing it Right the First Time" listing the various ways one could end their life using good sound medical techniques that were by comparison, far easier and much less painful than using something as sloppy as a gun. Medical staff all have one thing in common: they're mostly overworked, underpaid and have finite resources. Suicide attempts would inevitably earn the scorn of medical staff who had to delegate precious resources to someone who didn't even want to be alive. The first dozen suicide patients you take care of, you have sympathy and empathy still left in the tank. When that number goes over 100, you start wondering if you're just wasting your time. Which is the perfect opportunity for a poop joke
This might seem abhorrently inappropriate, but dark humor is a common way to cope in otherwise fucked up situations, and it's probably the norm in every emergency department.
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