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First Year- Chapter 10
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I stood at the door of his room and watched the activity. The GI attending, Dr Sherry Harper, a low keyed unflappable, sharply dressed, Trinidadian woman, began to bark a bunch of orders to the nurses in the room, “Open his fluids wipe open. Begin octreotide 50 micrograms/hr, give 2 units of packed RBC’s wide open and have 4 on hold, hang 4 units FFP and 1 unit single donor platelets, call respiratory we need to intubate him.”
Bette looked stunned at the amount of blood that came out of this man. She questioned Dr Harper, “Why are you intubating him, there is nothing wrong with his breathing.”
Dr Harper looked at Bette with total contempt and responded, “Dr Porter, would you like to manage this case?”
“No I am just trying to understand why you would intubate him.”
“We are protecting his airway. Sometimes in these cases of major bleed they can aspirate the blood and end up with a severe pneumonia.”
“Yes, I see. Thank you. I wasn’t questioning your judgment Dr Harper. I just wanted to understand.”
“That’s okay. Understanding is a good thing. Did he receive any blood since he got admitted?”
“No, I didn’t see a need. His hematocrit was stable when he came in.”
Dr Harper answered sarcastically as if she was the bell on Jeopardy, “BAAAAAAAHHHHHHP, wrong answer!”
The GI fellow, Dr Tonie Runyan, shook her head and ran through a list of issues, “Dr Porter, what were his vitals doing when he was admitted?” Before she could answer Dr Runyan answered for her, “He was tachycardic and hypotensive. You can’t rely on the admission ‘crit. His vitals already said he’d lost a lot of blood. He should have been given blood already. Now we are behind and will have to play catch up before we stabilize him enough to scope him.”
As they were taking turns bashing Bette, the patient wretched again and up came more blood, this was bright red and was it like a faucet had opened up. His blood pressure became immeasurable by standard methods. A horrible foul smell emanated from his room. His bed became full of a black tarry stool that smelt like something died and rotted in the room.
The GI fellow turned back to the patient and started yelling at the nurses, “Ladies, he’s hosing out. Get that blood up here STAT. Get those 2 units packed cells up now and run it wide open. Make sure he has at least 2 large bore IV’s and a third for meds.”
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Hmmmmmm, I’m sorry but I don’t like Helena or Carman at this point. I wish Helena would just let Dylan go instead of being a backstabbing slut. It amazes me how they don’t mind being deceitful and screwing behind Dylan’s back but if the shoe was on the other foot they would be pissed. Well hopefully that saying what comes around goes around will come back to bite them in the ass.
oops! I meant to say what goes around comes around.
S what a great chapter, I loved how things can go from worse to worse in a hospital and then a ray of light happens. Bette finally let her guard down and let Helena come in and help her and that is great cause we all need HELP and a FRIEND. And I have to admit I like Helena thinking she needed a Carmen friends with benefits. Cause Carmen can see that Helena and Dylan are not making it, who can’t seem to see it herself is Helena.
Woohoo! I must have been exceptionally good lately because I was treated to some Belena moments! Woot! Woot! You can’t help but love how Helena was having a “hot” moment in the “close quarters” of the call room with Bette. Oh, yeah! I know its coming… particularly now that they are “friends”. It won’t be long before the “with benefits” gets added. But c’mon, Squirl. You can’t hold me hostage for more of my story. I have to write the next chapter from scratch because I changed course so it’s going to take a while (a long while for me). I swear…if I had a chapter in the works, I would post… but seriously, it’s gonna be more than a week. I can’t wait that long for some more Bette and Helena action so if I promise to post as soon as it’s ready will you reconsider? Now, back to the story. I’m a little shocked that Carmen and Helena are falling into a pattern (not that I mind as a reader because its really hot) but I’m starting to feel for Dylan (unless of course she is getting a little action of her own on the side). Now details of Carmen and Helena’s date post haste! Just chalk me up as a ‘ho lover! :>)
Excellent chapter! I felt bad for Bette, but hopefully Helena’s good advice will be used. We all love a happy Bette. PPS!!
Wow…just wow! I was thinking ooooo a long chappie! I should go get a snack! However, with all of the action and emotion…it just flowed so “effortlessly”. I don’t think it is possible for me to pinpoint one emotion on this one…because it was so full…and literally ran the gamut! Let me say that I can imagine how experiencing such things would absolutely have you searching for some insight….answers toTHE big questions and I think it is awesome to see the ladies continue to share and support each other. How powerful is that? I can only imagine the thoughts running through Carmen’s head…but I’m glad Helena was there to comfort. I definitely can relate to the difficulty Bette is experiencing…with coming face to face with her imperfection…her need to pay attention…to understanding that there is a significant difference between theory and practice….embracing the fact that her success relies on her stretching in new and profound ways. The whole thing had to be traumatic on many levels. I do have one question regarding the patient with the severe upper GI bleed: it said that his stomach was otherwise full of blood. Is that ok…since it wasn’t in his lungs and I suppose wouldn’t lead to pneumonia? Did his stomach have to be pumped? or would it come out through the normal “relief” process? Btw, I…I was thinking that the ladies probably could limit their touches to ….ah…friendly touches and once a week join in a circle to sing ‘Kumbaya’ *ducking* lol! Thank you so much for sharing…PPS!
Niki-You had me cracking up. The blood will be passed through natural “relief” methods. The black tarry blood stool described is an example of blood that has passed through the digestive tract. It is INCREDIBLY foul smelling. You cannot even imagine how foul it is. It will bring you to tears. I can smell a GI bleeder down the hallway. It’s that bad. The poor nurses will have to content with it for a day or so. The use coffee of all things to neutralize the scent. So sad to say but the mistakes made by Bette are often made by docs who have long finished their residency. She really shouldn’t be too hard on herself but it is a good teaching case for her…..I like the Kumbaya idea…
Opppppssss, looks like I’m late for the party here, ok, such intrigue and drama, such sorrow and pain, such awareness and insight and so many comments that sum up my thoughts for me already here, I agree with almost everyting alredy said. I must comment on the church though, sometimes I find that the answers are there and sometimes it just makes things more confusing. At least we know one thing, I think, thats that they’ll stick together and hopfully all make it out at the end of the year. Thank you, Md, aka Oma
Oh well, just another day at work. I’ve observed a few critical situations where teams of people were working to revive someone, but so far, no blood/shit fests like that, thank you. But you deal with the situation, whatever it is, you don’t pick and choose and you don’t run away. Helena’s advice about making friends with the nurses was excellent. The doctors make the decisions, but nurses really run the show. They can be just as smart as the doctors and have their own expertise. Besides, who wants to work in a hostile environment when it can already be a very hard environment? And once Bette learns to smile at the nurses, she can start smiling at the patients. Who wouldn’t feel better after that? Now let’s get the details about Helena’s date with Carmen. Cause who doesn’t feel better after a good NC-17? OK, I have a dirty mind.
Oh, with all the excitement in ICU, I almost forgot about Carmen’s patient. I’ve watched relatives die long, slow, lingering deaths. I have a friend who works as an administrator in a cancer hospital who told me of a patient that was furious at waking up from surgery because they didn’t want to live anymore in intractable pain. I also recently accompanied my aunt when her terminally sick dog was put down. The dog was lucky. I looked at the vet when it was over and said “We should all go so easy.” He agreed. I know euthanasia is a touchy subject and has the potential to be abused not for the benefit of the patient, but I believe there are times, when medicine can do no more to help and the only inevitability is pain and death that it is the best thing for the patient. At Carmen’s age I hadn’t seen as much of what people can go through, but I hope she can make peace with herself as she truly did alleviate the patient’s pain.
Ahh, so Bette got that butt spanked. And guess who was there to make it all better. I bet she will think about listening and asking for help next time won’t she? It was a lesson that needed to be learned. Be careful how treat people, because these same people maybe the ones who may save your ass one day. Great update!
Yeah! Duh!
Funnyone-“Now let’s get the details about Helena’s date with Carmen. Cause who doesn’t feel better after a good NC-17? OK, I have a dirty mind”Would you be let down if they just held hands and gave each other back rubs.
It seems for her fancy Ivy League education, Bette lacks common sense and humanity. Nothing like seeing someone almost die under your care to make someone humble and happy that skilled individuals are around to pull your ass out of the fire. Bette needs to get in touch w/her feminine side to learn about true caring. I love the realistic detail in this story.
You know you are so wrong to tease…but that’s okay because I am patient and I know in the end – you will do the right thing with this pairing (Kool-aid kid smile). Amazing how stuff happens in hospitals…missing one small thing really does mean life or death! And you are so right about the nurses – they are like Admin Assistants – the gatekeepers, so don’t piss ’em off!!! Looking forward to your update!!!!