Don’t want to wear a helmet? Sign up as an organ donor.

Originally published on KevinMD

I walk out my front door today to do my obligatory walk around the block with my pups.

Two police cars with blue lights flashing, lead a caravan of over 100 motorcyclists to a funeral for one of their fallen brothers. They revved up their motors in the procession, I guess, as a sign of love, of brotherhood, of kindred spirits in the motorcycle world.

I choked up. I was ready to cry. It reminded me of that 23-year-old male I once had while I worked surgical-trauma ICU.

A young man riding his motorcycle with no helmet, no protection, flying freely down the highway. Superman. “I’m going to live forever.” Not a care in the world with angel dust (PCP) in his system. Feelings of freedom and forgetting any troubles.

No troubles — until it happened. He crossed the line. Killed an innocent man in a car — a deadly collision.

He came to us from the emergency department. He was paralyzed from the neck down and on the ventilator with chest tubes, fractures to legs, ribs, arms — eyes wide open. But he couldn’t blink. He couldn’t track, his pupils were irregular.

His poor mother called me every morning at 6 a.m. with a crackle in her voice.

A motherly voice of sad surrender.

“Is he any better?” she would ask.

And sadly, I would have to tell her no. He wasn’t better; he was worse.

Eventually, a conference was called with the intensive care trauma team physicians and the mother. We would withdraw life support.

And that was it.

Maybe he would have been saved had he not done drugs. Maybe he would have been saved if he had a helmet on.

Maybe.

An emergency department physician once gave us ED and ICU trauma nurses a seminar. I’ll never forget.

Don’t wear your helmet — then make sure you register as an organ donor.

In the U.S. 19 states do not require a motorcycle helmet.

Motorcycle helmets reduce the rate of head injuries by 69 percent and reduce the risk of death by 42 percent.

According to the CDC, close to 2000 lives were saved due to helmet wearing in 2016.

The blue lights passed by me. His buddies of over 100 in single file, revving their motors … and not one with a helmet.

The patient with a pocketful of IDs

Originally published on KevinMD

All of us nurses and physicians in the ED and ICU knew him well.

He was a young, 21-year-old. A smart, articulate guy who kept going from one hospital to the next. He had a system down … almost.

This young man was a drug seeker. He knew all about seizures and how an Ativan IV push felt during the “seizures” he allegedly was having.

Even though he had several identities and different names, we knew exactly who he was. He would wait for an ICU nurse to assess him at the beginning of the shift.

After the nurse assessed this seemingly charming man, she’d exit his room but wouldn’t get too far from the door when she’d hear shaking from “Randy’s” bed. When she’d turn around, she’d see Randy in a full grand mal seizure. A chaotic quiver, clenched teeth, followed by rigid body and blank stare.

Damn. He was good!

His physicians were fooled for quite some time. They’d give him the EEG, the CT scan, and then the Ativan IV push … and the old standbys Dilantin and phenobarb, too. But “Randy” preferred the combo of Ativan and attention the most.

Eventually, he was diagnosed with “pseudoseizures,” which are not the same as a seizure. There are only two types of seizures: epileptic and nonepileptic.

We knew him well.

Epileptic seizures occur when a sudden electrical disturbance in the nerve cells in the brain causes the person to lose control of their body.
Psychogenic nonepileptic seizures (PNES), are seizures that occur as a result of psychological causes such as severe mental stress.

Pseudoseizures may be caused by: anxiety, OCD, panic attack’s, ADHD, traumatic injuries, ongoing family conflict, substance abuse, PTSD or physical or sexual abuse.

How do we treat of pseudoseizures?

Cognitive-behavioral therapy (CBT).

There was a conference: Randy and the intensivist. The doctor explained to Randy that his seizures were not from a neurological disorder. But the seizures he had developed were after multiple or acute stressors that overwhelmed his coping ability.

Randy was angry. Though he had many stressors in life, homelessness, non-compliant with his antidepressant medications, no-shows with therapy, Randy refused to listen to the doctor.

And so he continued aimlessly jumping from one hospital to the next — a new name for each hospital. No family. No home. An aimless wanderer.

Police found a young man in a fetal position at a bus stop. A tourniquet wrapped tightly around his arm. An empty syringe in his hand. Heroin.

Dead.

And with a pocketful of IDs:

Randy, Scott, Jeremy, Michael, Tim, Ryan.

We knew him well.

A nurse was attacked in the emergency department. This is her story.

Originally published on KevinMD

Victim: Female nurse, age 25

Time: circa 1980

Place: A hospital in a sleepy Southern town with fifty beds, six emergency department beds, one nurse, one doctor and one secretary.

It was an unusually quiet Friday night in this small emergency department.

We all knew Friday was “party day”: pay day, play day, alcohol, pills, drugs, loud music and lots of really bad decisions.

Not only did we cover the entire city, but we also covered many surrounding small towns and all of the conditions these locations imply.

When women came to the ED with “abdominal pain,” we had to break it to them that they were pregnant and ready to deliver. There were gunshot wounds, heart attacks, respiratory arrests, stab wounds, and many a church goers’ “done fall-outs.”

Overdoses, alcoholics, and drug seekers were migrated to the ED equally with snot-nosed kids with colds.

Fridays were the worst nights. But this Friday was different — it was completely quiet.

Then, the radio transmitter called in:

Rescue squad: 19-year-old male, attempted to put his mother’s house on fire. Superficial razor marks to his right inner forearm. Use of PCP — angel dust, Ketamine, horse tranquilizer, hallucinogenic.

The rescue squad came bursting through the ED doors in their normal fashion. He’s young and naked under the sheet. His razor marks … I’ve seen worse. They’re just superficial. His voice is soft and polite pepper with “yes, ma’am” and “no, ma’am.”

An MD suggests to put betadine on his razor marks and send him home. No stitches required.

As I apply the betadine, he sits up on the stretcher, stares me in the eye and loudly yells, “I’m gonna f**k you, b***h!” Before I knew it, he grabs my scrub top and tears open the snaps on the front. My bra is in full view, and he gropes my breasts with both of his hands and clutches my vagina.

I was violated.

His incessant squeezing of my breasts and vagina and his repulsive chanting about how he wanted to molest me made me feel as if I was in the darkest side of hell.

I screamed for help, “Call the police!” There isn’t an alarm or a security guard.

The MD kicks the patient’s ankle saying, “Stop that boy,” and the patient continues to “dance” with me across the ED. The secretary notifies the local police to come to our hospital stat.

I was assaulted over and over again until I was backed into a corner. My world stopped. It was me in the corner. And this naked man with his enlarged appendage was starring at me.

This was it.

I did not know any self-defense or survival skills. I knew my nursing pledge to “do no harm,” but I also knew that that “thing” was not going to go inside of me.

I had one hand free and grabbed his naked scrotum. I squeezed as hard as I possibly could and twisted them until I could twist no more.

His eyes rolled upwards, he went limp and fell to the floor. He fainted. I shut him down. I sat on his back, the MD sat on his legs, and finally, a fat-bellied policeman walks in.

“Y’all need some help?”

They carted him off to jail. I was obviously traumatized and started to cry. Dr. X said, “I’m so sorry, I’m just not used to this situation.”

It was Christmas time. It was the season to be jolly.

The hospital gave me three days off and workmen’s comp.

I felt violated and dirty — the nearest thing to being raped.

I was distrustful, angry and I even had a difficult time sleeping with my husband. I thought don’t touch me. Don’t anyone touch me.

But in the midst of all of this, I grew stronger — almost fearless — to where I could stare a man in the eyes and say, “Don’t even try. I will destroy you.” I felt like Superman.

When my attacker fell to the floor, I saw stars and stripes — victory.

But it doesn’t always turn out this way. Blame it on mental illness, alcohol, the wrong people with guns, the epidemic use of opiates or the mere frustration of waiting to be seen in the ED and waiting more than 15 minutes is 15 minutes too long.

The fuse is short in the ED.

Emergency departments across the nation are a haven for violence and abuse. The ENA (Emergency Nurses Association) reported that 80 percent of ED nurses and health care personnel were physically/verbally attacked in the ED 2014-2016. MDs reported being attacked in the ED by 75 percent.

I’m not sure what it will take for our protection.

I do know that a hospital CEO typically makes $3-14 million per year.

Priorities. Go figure.

One and done: a heroin and fentanyl cocktail

Originally published on KevinMD

There was her 28-year-old daughter lifeless in an ICU bed.

Her name was Tricia, and she had dabbled with drugs since she was 15. As a child, she was artistic, adventurous, and always found excitement with other kids who tended to do risky things. She’d justify their behavior and say they were more fun and had better personalities.

Eventually, her mom and dad moved to a small town thinking it would be a safer environment. But when Tricia started middle school, she again sought friendships with those “bad kids” on the edge.

It was as if she was heading down a path of destruction her whole life.

But her unsavory friendships didn’t keep her from excelling scholastically. Tricia was quite the student: she was smart, absorbed information in a flash and had a mind like a computer that was always on. And she was especially good at biology and chemistry. In fact, she obtained a bachelor’s degree in chemistry — she was that smart.

After college, she landed a decent job. A job that paid the bills and her drug habit.

Heroin costs less than Percocet pills on the street. But there was also a new way to get high in town. The “ultimate high.”

The combo: Heroin laced with fentanyl.

ER docs and nurses call this mixture “one and done.”

But that didn’t matter to Tricia or the crowd she hung out with. Even though they heard that this combination killed, they were willing to take a chance. They knew it wouldn’t happen to them.

After all, weren’t they invincible?

Apparently, they weren’t.

A car sped up to the ER entrance, and Tricia was pushed out right before her “friends” put the pedal to the metal and took off. Workers later said it was too late to capture the license plate. All they knew was that it was a red Mustang. Other than that, the occupants of the vehicle were a mystery.

There was her body on the cold pavement. No pulse. No breathing.

“Code Blue” blared throughout the hospital.

CPR, intubation, central line, loads of normal saline, Levophed, and vasopressin — it took over 20 minutes to gain a pulse on Tricia. They found opiates in her blood.

Her “friends” had thrown her wallet out when they dumped the body. That’s how the hospital identified her.

But her mother already knew something was up. It was a week since she last heard from her daughter, and Tricia usually called every other day. After dealing with Tricia’s friends who “knew nothing,” mom called the police who heard of the dump and referred her to the hospital.

The ICU nurses understood she was dead. It was just a matter of time after so many hours of ineffective “Code Cool” protocols. We lowered her temperature to preserve her vital organs, but it was too late. She was down for too long.

Her mom rushed in, shook her beloved daughter’s arms and screamed, “Wake up, Tricia! Wake up!” The only movement was a decerebrate response.

Tricia moved her mom thought.

“She’s moving!” her excited mom yelled to the nurses. But we had to explain to her that movement from decerebrate response is one of the worse signs of neurological damage.

Tricia’s body was rigid with head and neck arched backward.

After EEGs, MRIs, cold caloric tests and failing “Code Cool,” the promising, smart, adventurous woman with a chemistry degree was pronounced brain dead.

Another one down.

One and done — the ultimate high.

Death.

Was it really worth it, Tricia?

Heroin and fentanyl. They call it “Theraflu,” “Bud Ice” or “Income Tax.” And it’s happening across the country in cities and town big and small. Some are lucky. Some get to the ER in time. Naloxone (Narcan) IV push can reverse heroin. But when it’s laced with fentanyl the chances are much slimmer like Tricia’s case.

Should you know someone or YOU are that someone, get help. Get treatment. Go to rehab. You can start over.

Do something or accept and expect that you might be six feet under.

Remember, it’s one and done.

This is what heroin addiction looks like

Originally published on KevinMD

What can I tell you? It started out innocently. College exams were over. And that meant one thing — party time! Bubbly, shots, beer, cocaine and Percocet. Everyone was happy. It was a celebration.

Pam came from a pretty strict religious family: no alcohol, no premarital sex and no crazy music in her house growing up. It was church every Wednesday and Sunday. And if you missed a Sunday, you were destined to hell.

So when Pam graduated from high school with top honors, she was set free and off to college. While there, she learned a lot about different cultures, different religions and different languages. She learned that not everyone was white, Christian and middle-class. This was a whole new world to her. And she loved it.

After several parties she learned some non-academic things one learns about in college. With her discovery of alcohol, pills and cocaine — she was ready to conquer anything. She had her wings and was ready to fly. And fly she did. Even with the partying through four years of college, she walked across the graduation dais with a diploma in her hand.

Then she found an amazing job in Manhattan far away from her provincial life. New York City: Bright lights, big promises and John.

John was Pam’s handsome, smart and, well, perfect manager at work.

Boy, did they have fun. There was dance, dinner and drugs … and even more drugs.

The fun went on for months, and then John proposed. Together they shared a taste for adventure, travel, exotic food, music and sex …

Eventually, they had a baby boy with blue eyes and blonde hair just like John. Pam’s family was complete, and Baby Jack was the apple of here eye. He was perfect in every way — except for his colic which made him cry and cry as Pam would rock him and rub his back. But what really calmed this baby down was warm baths — he loved them!

One day, John came home early. And he had a surprise for Pam. Although it was inexpensive, only around 80 bucks, it was precisely what the couple needed — a new high. The gift was black tar heroin and gave them the hit they were looking for after oxy and coke lost their lustre.

John tied his belt around Pam’s upper arm. The syringe was full, and he interested the needle into her vein and pushed. The rush was on. Pink clouds danced along side of puppies, kitties, unicorns and cotton candy. And life became painless.

Pam’s memories of her mother screaming, “Come home, you don’t know what you’re doing! You’re damned to hell,” her father’s rejection of her, the taunts, the damnation, the screams were all gone.

Pam was comfortably numb and free. It was pure euphoria.

Her head flopped down as she fell into the abyss.

She couldn’t wait to have more, she was rapacious and desperate for that feeling. But she knew she couldn’t keep doing this. Pam stopped eating and taking care of herself. Jack ran around in dirty diapers, and John came home later and later — Pam’s life was spinning out of control.

In a lucid moment, Pam knew she had to stop. Heroin took over her mind and body. So, she stopped using — cold turkey. She told herself that she could do it without help. 18 hours later, without the drug in her body, she started to sweat profusely, her body shook, her muscles ached, her legs were restless and the stomach cramps and vomiting were excruciating.

She wanted to feel good … to be normal. She just wanted the pain to go away. And her son just wanted to be held, to be fed. So he cried and cried.

Pam needed to fix this — to fix everything.

She knew she could calm Jack with a warm bath. So she put him in his baby seat, placed him in the bathtub, poured in bubbles, and turned the faucet on as she sat on the toilet seat and tightened up her belt. She injected deep into her vein and watched the bubbles rise … those beautiful bubbles.

John was out of town. He tried calling multiple times, and Pam wouldn’t answer.

When the police arrived, the door was locked, and they tore it down.

After two weeks, Pam roused but didn’t know where she was. She was in a strange bed in a strange place with a voice hoarse from an endotracheal tube.

She squeezed my hand and asked where she was.

I told her she was in the intensive care unit.

She didn’t remember a thing.

How do I tell her that she stopped breathing? How do I tell her that CPR was started on her? How do I tell her that she had a needle sticking out of her arm? How do I tell her that her bathtub water was overflowing onto the floor?

How do I tell her that her little boy is dead? How do I tell her that he drowned in the tub while his mommy shot up?