Some Badasses

This is about some badasses I know.

They walk amongst you in the grocery stores, libraries, you may see them in coffee shops or more likely, bars, you may be sitting behind one right now in hot, sticky, Atlanta traffic. Eyes up!

They can get a 14 gauge IV in a hypotensive, tachycardic, essentially dead person, whose veins are more like wet tissue paper, rather than tubes of blood. They will sneak an NG tube and a foley in the patient in about 5 seconds between inubation and the CT scanner. You can’t even put your gloves on that quick.

They don’t wear capes, just stock blue scrubs, and sometimes bedazzled name badges. They have access to the trauma elevators that take you exactly where you need to go. You don’t even have access to the staff bathroom. Nor should you.

They can stop pain. Literally. They can make it stop. Your femur may look like a bad jigsaw puzzle, and your pelvis may be split in half, where your motorcycle tried to slam straight up through your body, and your chest may be caved in like you were made of play-doh when an industrial forklift tried to punch through you, but these people, they can make you feel like you’re floating on the Chattahoochee on a sunny Saturday. With fentanyl and ketamine. But still. They can do it. I’ve seen it.

They can take your clothes off before you can say your name, even if your name is just “Bob”, like Madonna, just the one word, “Bob”. They may do it with comically large shears, but still.

You may have uncontrollable diarrhea from c. diff, and you may be incontinent, but I know people who can put a clean femoral line dressing on you and keep it that way despite your uncooperative bowel and bladder. They can do it. I’ve seen it. They can keep it pristine all night with some sort of witchcraft that has not yet made it to the rest of the hospital system.

I know someone who can do chest compressions on you, and make your arterial line look like a normal pulsatile heart beat. They may ask someone else to open the pickle jars at home, but here, they will break your ribs to keep you alive. You never even suspected they could push so hard.

They work at night, during the day. They worry about if you can eat and if you’re ever going to make it to the OR. They want your pain controlled. They know your labs before I do most of the time. They mourn your broken body. They laugh when you say silly things after you get the drugs, before we try to fix you up. They talk to your family to help them understand what is actually happening, translating the medicalese we casually throw at you into something you’ll understand. We try. But they usually fix it for us.

These are the nurses and techs who work the trauma bay.

You find them in other places, but these undeniable badasses are the ones who taught me in the bay. They can smell fear on an intern. They call bullshit on the atttendings. You may have just killed someone, just shot someone, maybe just a block down the street, but now you’re in the bay, and sorry Dorothy, we’re not in Kansas anymore. You may have just stabbed someone in the face, but these nurses will look you dead in the eye and tell you that if you need to pee you’ll have to use the urinal or just hold it, but no you cannot walk to the bathroom rght now, and to keep your voice down. You may be a hardened criminal but these nurses will make you cry for your mother if you step out of line. I’ve seen it.

You may be bleeding in your chest, your belly, out of your open bilateral femur fractures, but i know someone who can dump blood in you faster than you can put the transfusion order in, or heat up a lean cuisine.

These badasses work in our trauma bay. Sometimes you’ll find them in the OR, burn unit or the ICU. They provide your hands on education, how to actually take care of the patient. You may know the krebs cycle but you don’t know the first thing about taking care of someone until you’ve been yelled at for not restarting a diet. That’s when your education really starts. You may know the parkland formula, but you haven’t learned a thing until you’ve been taught how to properly do wound care, and leave zero evidence of the mess. Honestly, you haven’t lived until you’ve seen someone get a peripheral IV line in a bleeding, diabetic, smoker, with heart failure, end-stage renal disease while you hold pressure on their bleeding fistula. Becoming a doctor is a lot of things, but the most unexpected gift is all of the teachers you find who don’t have academic titles, they just, you know, know how to take care of patients. They’ll show you, if you let them, that magic of caring for someone with your own two hands and a small measure of your humanity. In ten years, we’ll be re-writing the guidelines on how we treat traumatic brain injuries, but the wisdom, the healing you learn to administer by being there, with the family of a kid who suffered a devastating brain injury when he slipped off his motorcycle, that’s a special knowledge that won’t change, and might make all the difference.

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The word patient, comes from the latin word meaning “suffering”. Despite the advances in medical science, and maybe due to those advances, we have found ourselves wandering further and further from the patient, and closer and closer to scans, charts, labs, machines and computers. Who can blame us? We put out money where our mouth is. We throw billions of dollars at the computers. We should probably stare at these screens all day and night with our eyelids taped back to our skulls. Some of us probably do.

But the people who remain near the patient, those with the suffering up close, like boulders in a river of human trauma, they can teach you how to see a sick person, really see them, not just evaluate them. You need to do both. They can give you that priceless gift for free, maybe just for a small share of your heart.

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“I’m worried about him.”

Get up. Go see them. Nothing will teach you how to spot a sick person like seeing one.

"Do you think they need a unit of blood.”

Give them blood.

“She’s in a lot of pain”

You haven’t put the orders in yet, so just sit down and do it.

“Can you talk to the family.”

Yes. A thousand times, yes.

“Don’t you dare cut that bra. I will cut you.”

Ah. Okay.

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Just some badasses I know, and am so thankful for.