turbulence

I have found the first four shifts in the emergency department to be a strange mixture of excitement and tears.  I saw a woman with stage 4 ovarian cancer crash, and because the ER did not have a DNR (do not resuscitate) order, they tried over and over to place needles and IVs into her neck (jugular vein and carotid artery) and her shrunken arms, desperately trying to get blood access to take labs to check for sepsis (a blood infection).  She was moaning and crying out, and the nurses and doctors held her head and limbs firm even as they apologized to her, "Just one more stick, one more stick."  When the flurry of commotion ceased, she asked, "Why did you do that?  My arm hurts."

Another older woman with dementia crashed, and the intensive care senior physician tried to get the family to understand that anything we did in the ER was not going to save her life, only prolong her death.  Her heart was failing, kidneys were failing.  The woman there was the niece, not the daughter or healthcare proxy.  She needed to ask her husband to ask the rabbi whether they could sign a DNR.  The attending was so upset she wasn't able to listen long enough for the family members to express their thoughts and feelings.

Some of the time I find myself asking, "Why are we doing this?"  I had to step away from the woman with ovarian cancer because I wanted to cry.

* * *
Today, the resident supervising me drained a tonsillar abcess.  Literally five minutes later, the woman was smiling.  She could open her mouth and swallow and looked positively better.

Working in the ER is a weird combination of boredom, brief periods of intense focus, weeping, and the immediate gratification of seeing someone feel better literally minutes after a procedure.  Yesterday, I hated working in the ER.  Today, I enjoyed it (possibly because nothing very acute or emergent came in.)

I am seesawing between tears and thankfulness - the former because we cause people pain doing things that will not fix them, and the latter because sometimes we can fix things easily.