May 15, 2013

• My Top 5 Most Gruesome Patients

  

  Some of you know this about me, some don't. Before I decided to stay at home with my two children, I worked in healthcare. I carry initials after my name and I maintain them (even though I'm not currently working in the field) through course work and requirements (12 credit hours a year).

  For giggles, my signed professional name is Sarah ****** R.T.(R)(CT)

  I worked in radiology, first in trauma X-Ray and later in emergency and cardiovascular CT. I worked in the field for about 10 years. I started my professional career (after college) in Boston. I worked the overnight shift at Boston Medical Center. My primary job was as part of the trauma team, X-Rays are an essential part of the initial assessment and treatment of every trauma patient. The trauma series includes a chest, pelvis, and lateral c-spine X-Ray. Usually that's what was performed, but occasionally there wasn't enough time for all that and we moved straight to vitals, the chest and c-spine for life support (the neck because patients were likely either already or about to be intubated).

  Some of this might be too much to read for some of you. Here are the 5 most gruesome cases I was personally a part of. (I will have another post where I write about the 5 patients whose stories touched me the most, whether positively or negatively.) Most of them are from my work in Boston, but some are from my work in Florida.

   

  *WARNING: GRAPHIC

  _____

   

  5. I knew it was strange when I was called to the trauma bay for only a chest X-Ray, not a full series. It was stranger still when I got there and before going behind the curtain, the trauma team advised me to put on contact precautions gear because of excessive blood. I quickly got ready and walked through the curtain not knowing what to expect, and certainly not expecting to see an awake, alert woman sitting up on a stretcher looking normal, but tucking her chin WAY down. But then, she answered a question from the Dr, and her neck moved a little. Suddenly I understood. Blood came pouring out of her neck. She had been sliced from ear to ear, a victim of attempted murder. So long as she kept her chin tucked to her chest, the bleeding was mostly controlled. But as soon as it moved, it was like a fountain, all the way across the front of her neck. It was pretty tricky getting her chest X-Ray, but with minimal bleeding we accomplished it, and soon after, she was taken to surgery for repair. No simple stitches would do. She survived. This one always bothered me, and I still tuck my chin when I remember her, in fact as I write this, it's tucked to my chest in memory.

   

  4. The winter I worked in Boston, we had a crazy Christmas blizzard. I ended up working for almost 3 days and nights straight because of it (I napped on a stretcher in an unused Ultrasound room when I could). Eventually, the snow plows were allowed to start clearing the roads. The snow was thick, and conditions were still not the best, but even emergency vehicles could not pass. And so, they began their dangerous trek. Visibility was very low. There was a man in the road, God only knows why. He must have heard the snow plow at the last minute, at least there's that. He tried to jump off to the side, but didn't completely make it. His legs were destroyed. When he came in (via Life Flight, because those heroic SOBs will do anything in any condition to save any one of us), one of his legs was already gone, lost mid thigh. The other was a mangled, barely distinguishable mess that was hanging on by ripped flesh. He was not awake (I wouldn't want to be either). I took a pelvis x-ray to see if his pelvis was fractured too, as well as any obvious internal bleeding, and x-rayed his remaining "leg." The "bones" were just chips. Hundreds of fragments, nothing that could be saved. He was then taken to the OR, and his remaining "leg" was amputated, if you want to call it that. But his life was preserved.

   

  3. I touched on this story in my 16 facts survey. A homeless man was brought in, unresponsive, by rescue. They had been administering advanced cardiovascular life support (CPR, defibrillator, etc) for quite some time, and Drs and staff continued their efforts once in the trauma bay. The special circumstance: He had frozen to death, and that was presumed to be the reason for his unresponsiveness. They set up heating lamps all around him, they put warming blankets on him, all as they continued their efforts to revive him. I was called for a chest X-Ray (yes another strange one, I knew it before I got there because it wasn't the "protocol"). Again, before walking in the room, I was warned about contact precautions and given full gear. They did not, however, warn me about the smell. Dear God In Heaven. Death plus heating lamps would be bad enough. But there was another factor. You see, since he had died from hypothermia, and God knows how long he'd been dead before someone saw him and called rescue, he was internally "frozen." That includes his bowel contents. So as he was warmed up, and they called his death while I was in there, but still wanted the X-Ray anyway (bastards), his bowel contents began to warm and thin, and then melt out of his deceased body. It was the worst fricking X-Ray I ever took. But they didn't have the heart to tell me to do it again. Hooray for small favors.

   

  2. I was on-call for CT one night in Florida. My pager went off, I rushed to the hospital. I was told I had to get a head CT for a "drunk combative kid." That was as defined by the nursing staff who were evaluating him at the time. I went to his ER room and he was laying, still strapped to the orange ambulance board, on a stretcher. He was 17. His quick blood toxicology showed evidence of some alcohol, but it wasn't a crazy amount. I walked over to him. He was mumbling. I greeted him softly by his first name, I told him my name. I stood where he could see me, his head was turned to the side. He smiled, and said hello. I told him I was going to take him to get a "CAT scan" of his brain to make sure everything was OK, since he'd bumped his head. He mumbled something that didn't make sense. He smelled strange. Not like normal drunk patients. I saw some kind of bodily function up by his head, but didn't look into it, his nurse told me he'd vomited. I took him in the stretcher to CT. Since he was still on the hard orange board, it was easy for me to slide him over onto my table by myself. I pulled him into the scanner, he would go in head first, and then got behind him to get him into the right position. That's when I saw it. It was not "puke." The nurse was being an obnoxious, negligent bitch. He had an open skull fracture and there was a handful of brain matter mixed with pink blood on the sheets and on his head. It was the first time I'd seen traumatic brain matter. My heart began racing. As I quickly did the scan, I was on the phone with the ER physician informing him. He ran over to watch the images as I took them.

  I'm shaking. (Breathe)

  It was very bad.

  His brain was filled with blood. The ventricles inside his brain were displaced. The images also showed that yes, his brains had been "mushed out." The physician used my phone and called the nearest Neurosurgeon and initiated life flight which he knew was useless. He looked at me and said, "His family isn't even here yet, they probably won't get to say goodbye."

  This 17 year old kid had a drink or two. But then he fell on a slippery concrete stair. I had spoken with him, and smiled with him. I'm glad his bitch nurse wasn't the last person to talk with him, I was. He was unconscious when he left my CT room. He never woke up again.

   

  1. This is one for the books. You might not even believe what I tell you. I'll take that chance; it's true, and it's possible. The patient: a man with severe facial trauma after being hit in the face with a metal pipe. I was supposed to get a Facial Bone CT to see the extent of his fractures, because he was REALLY swollen and it was hard to tell what exactly was under the swelling, he was pretty deformed looking. My co-worker and I got him in the room, and he suddenly said he felt sick. We hurried and got him an emesis pan, and he proceeded to vomit. But WTF was in that vomit!!! Me and my co-worker looked at each other like, holy s***. It looked like ground meat. Pink and white, mottled, and kind of solid. Similar to raw hamburger meat. But not exactly. We called the ED staff, it just wasn't freaking normal. You'll never guess what it ended up being. Are you ready for this?

  The trauma, the impact to his face was so great, particularly to his eye socket and maxillary sinus (the sinus where your cheek is, right under your eye), that it not only fractured his orbit and his sinus cavity, but it also ruptured his eyeball. His eyeball was then basically squeezed down through the broken orbital floor, through to the sinus cavity, and then drained like mucus would, until he swallowed it. Which is when he vomited. He vomited his own ruptured eyeball and surrounding tissues.

  Yummy.
   

  So, those are my top 5 most gruesome (or horrifying to me) patients. But really, these stories are a part of who I am because I've experienced them and they have profoundly impacted me. 

   

  • 9:36 pm
  • 21 Comments