The Grande Finale

WARNING: It's very long, but i hope you'll find it interesting :)

Place: Emergency Room, which has 7 beds for "regular" patients, and 6 beds for critical patients (we call them "resus bays")
Time: Late night friday, technically Saturday Morning
Significance: My last day of training

Well, "nights" start at 12 am, and end at 8 am, and it's quite calm; we usually spend them chitchatting and joking about until around 6 am. where people with sickleavitis start showing up, especially on Saturday You see, sick-leave-itis is a very common disease, usually affecting young males who haven't slept all night and have to go to work in a few hours. It usually presents with abdominal pain, as it is the easiest to fake. It's usually very easy to spot them. They rarely cause much trouble.

As I pranced into the ER at 12 am, Dr. M2 (as in, M-square), was the one in charge. There was only one other doctor with him. Strange, since there usually are at least 4 or 5 physicians. He said as much, smiling and adding, "especially in my shift". He told me how, for some reason, during his 40 years working in various ERs, patients tend to just show up in unexpected numbers, whether it was day or night. I laughed it off, and he just smiled and said you'll see. And I did see..

When we started the shift, there were quite a few people, but nothing out of the ordinary.. A couple of kids with vomiting, a guy with abdominal pain, .. you know, the works..

1 a.m.
people were still coming..

2 a.m.
people were still coming, including a kid who broke his arm while jumping (why aren't these kids sleeping?!).. we had to keep him in the critical area and call the orthopedists (the bone people).. The ortho dr kept joking with Dr. M2 that he would not appreciate it if he woke him up again that night.. he kept telling him "don't u wake me up at 4 am!"..

3 a.m.
the number of people we have just wouldn't decrease.. the moment discharge a pateint, at least one more comes in.. a guy came with a "bite", he has no idea what bit him.. might be some wierd insect.. gotta keep him in the critical area..

4 a.m.
a really sick woman came in.. never in my life have i seen someone so pale.. must be kept in the critical area..

4.15 a.m.

I took a look at the board (where they keep "score"; number of patiens in each area, plus additional info).. people were just flooding the ER.. i decided to go on a coffee break

4.50 a.m.
Dr. M2 went to the board to "pick" a patient, wanted to see a "crying baby" (yup, that's the parents' complaint!).. I noticed that a new name was put in "resus".. it read "MVA" (Motor Vehicle Accident).. It had arrived a minute or two ago.. so we decided to go there..
We saw a little kid, around 10 years old.. He had an accident on those little "motorbikes" (دبابات) on the Corniche.. he looked okay, ws fully conscious and oriented, just a few scratches and bruises, but you have to make sure.. (especially since the kid wasn't wearing a helmet.. these places should be banned!!) we asked the dad about worrying signs, he said he had to call the mom to check (she was with him when it happened).. we arranged for x-rays to be urgently taken.. and ofcourse he too was put in resus.. (Again, why is a 10 year old child playing at 3 am??!)

5.10 a.m.
I'm leaning on the desk, talking to Dr. M2 about his plan regarding one of his patients, when a couple of the Red Crescent guys come in rolling a guy in a trolley.. The guy was covered with blood and dirt, and the look on their faces said it all.. Car accident.. and not a simple one..
As i moved closer, I heard the Red Crescent people inform the doctor that there was another one on the way.. which is a little but more than the ER can handle with just 2 doctors present, especially that the first guy looked pretty bad, and there was a good chance that the other one was just as bad..
From a few meters away, with one look, Dr.M2 expected that the guy was gonna crash soon if a tube wasn't put down his throat to help him breathe.. He made the necessary calls and jumped to check on the patient, instructing me to answer the phone and ask the people he paged to quickly come to the ER.. (including the bone doctor who was jokingly complaining earlier, hehe)

5.15 a.m.
The second victim arrived, and Dr. M2 was just making sure everything was "okay", when the "Trauma team" came.. The trauma team are usually a buch of surgeons and nurses, each assigned to do a specific thing.. Man, aren't they organized!! (Which also reminds me; tall, tanned surgeons are usually very hot especially when they just wake up, with their hair all messy and stuff.. ;) )
CONCENTRATE
So i go check out both guys, and to spare you all the gory details, let's just say they were in really bad shape, especially the second one.
Apparently one of the nurses was "new" to the ER, so she kept shaking and dropping things back on the tray.. So i just tried to get her to concentrate back on her work (i.e. i "yelled" her name so she could just divert her attention for second, offered my help, smiled, then let her get back to work.. this actually works when people are panicking, try it!)

5.30 a.m.
The place officially looks like a an ant farm.. The room that previosuly had around 3 or 4 of the staff now held at least 17 people.. each doing his job so perfectly, somewhat calmly, yet frantically.. it's so difficult to explain.. It's that if you disengage from the moment and just observe each person, you'll notice the look of calm concentration on their faces, the smoothness of their procedures, the preciseness of their documentation.. Yet, the buzzing was continuous; everyone was talking, yelling or shouting.. It was professionalism in all its beauty...

5.45 a.m.
Another guy gets rolled in on a trolley.. the paramedics tell Dr.M2 that there are at least 4 more on the way..
I look at him and smile :)

5.50 a.m.
Another guy gets rolled in (the 4th for tonight), like the last one, he is conscious , with a few broken bones and a few cuts and scratches.. much better off than the first 2..

5.55 a.m.
The first guy who was rolled in is relatively "stable" but in a very bad state, so he's taken to the CT scan (to get a picture of his brain, make sure everything is still in place).. from there he will be taken to the intensive care unit (ICU) where they will continue monitoring him and making sure he's fine..
1 down, 3 to go :)

6.00 a.m.
the 5th guy for tonight gets rolled in.. he looks bad.. just as we rush off to check him out, they roll someone else in. Now, Dr. M2 starts to get mad.. the last guy they rolled in was NOT critical.. he had clearly explaied to the Red Crescent that the ER's capacity can barely tolerate (at this specific day) more than 2 or 3 MVAs, and here they are rolling in the SIXTH!
The doctor was totally right; what they're doing is against procedure.
No. 1: they have radios in the ambulances, they should use them and CALL. That's what they're there for.
No. 2: technically, they're not allowed to just "roll" patient in.. It's not a walk-in market! One of the doctors (preferrably the one in charge) should sign on a paper and "Accept" them.. Ofcourse no one really does that in really critical patients (as in, dying), but when they roll in a patient who is perfectly fine except for a broken leg, now that's just pushing it!
As Dr. M2 was explaining this to the extremely rude Red Crescent guy (so rude I wanted to slap him!), a guy from the accident walked in, sat on a wheel chair, and rolled himself to the critical area! Now that's just.. umm.. unconventional..
Dr. M2 calmly told him that we don't have time for this; he will not sign that he received these patients, so he might as well pick them up and go to another hospital.. and then he turned around to go check on the other patients.. The guy kept following him and yelling that this was unacceptable and he kept on rambling about how he wants to talk to his supervisor bla bla bla.. like it was the time for this! then he stormed off to God knows where. The rest of the Red Crescent guys just silently took those two "extra" guys back to the ambulance and probably took them to another hospital..

6.15 a.m.
By now all the patients that were in bays were now either in rooms or out in the hallway.. more and more medical staff were flooding into the resus area, each with something to do.. The buzzing was continuous, and i was still observing..

6.30 a.m.
All hell is breaking loose around the 2nd guy.. He is in a very horrible shape.. He was injured all over.. and the scariest part was.. he was bleeding.. and no one could figure out where from.. solution? some emergnecy fixing! Procedures I haven't seen in my life were being carried out, machines so odd I couldn't even guess what they were for were being brought in.. He was connected to all sorts of tubes and stuff.. And it was way too crowded for me to observe anything.. so i moved on..
I checked on 5th guy; he's stable and was taken to CT san.
2 down, 3 to go..


6.45 a.m.
Back to no. 3 and guy no. 4.. Their xrays werent taken yet, their blood wasn't drawn yet.. It's just that when things get this critical.. you start with the worst off.. Dr. M2 asked me if i could take the blood of one of them.. and i said sure..!
ehemm..
I DID IT!!
It's not like it's my first time (I've been doing it once or twice every couple of days for the past month), but this is the first time when it's actually a critical patient.. It was a big deal to me.. And my "toughness" amazed me, becuase in situations like this patients are not very cooperative, and you have to find just the right balance between being nice and empathetic, and being professional and strict.. Because this has to be done NOW.. yay me!

7.00 a.m.
Time for changing the nurses' shift.. theyt're not required to stay a second after 7 am, yet none of them even moved! They just wouldn't leave the pateints and doctors until someone else was right there as to make sure that everything is alright.. It's not exactly what you expect after 12-hour shifts.. Now if that's not loyalty, then i don't know what is..
Still, changing shifts was a bit confusing, so i ended up drawing the blood of another pateint,, and it just felt wonderful, to be a part of such an efficient team..

7.15 a.m.
I took a peak at guy no. 2.. apparently while i was "busy", they literally surgeoned him., you know, opened him up, and did the works, in the emrgency room (!!). umm.. wow

7.30 a.m.
My feet were aching so much i wanted to cry.. Things were calming down.. There wasn't much to do.. I leaned back on the desk and started chitchatting with Dr.M2, just laughing at the irony of the "night" we just had.. He was telling me some anecdotes, and cute surgeon guy joined in.. Ofcourse, I was floating above the clouds, when i noticed the damned thing.. The ring on his finger.. aaahh.. oh well.. he still is cute :)

7.45 a.m.
Things were looking bleak for guy no. 2; he might not make it beyond noon.. they were taking him to the operating room to try and save as much as they can..
The rest of the guys were relatively fine.. Most of the other pateints were discharged..
with 15 minutes to go, Dr.M2 gave me permission to leave.. but i told him that i wanted to wait and see the faces of the next shift as they strolled in, assuming it was a quiet night..
I had to wait til 8.15, but i t was worth the wait..

There are somethings that can't be explained by writing.. things which you have to be there to experience.. that is the spirit of everyone.. During this turmoil, people were still joking, laughing, and smiling.. The nurses kept excaliming that all this was happening on my last day, and I was smiling back and saying that this was my Grande Finale.. That i couldn't leave without a big fuss.. They were wishing me good luck, asking me about my plans, and I even got to meet someone whose first shift was today.. The one word i could think of to describe all this, is "human".

One of the lessons i learned was: in the face of crisis, you can either laugh, or cry. I choose to laugh. :)