That’s Just The Way It Goes: A Primer

I haven’t sprung fighter jets from nuclear-powered ships off Minorca, but over a couple of years working in clinical medicine I’ve collected stories and thoughts that have stuck with me, and I am reminded of them from time-to-time in different, often subtle ways.  Some stories, undoubtedly, should be left where they are, and shoved into my brain’s trashcan.  They are often graphic, often sad, sometimes funny.  But they are true.

It is normal in large hospitals (I cannot speak to small ones, I’ve never worked in one and try to avoid visiting any type when and where possible) to have ED Technicians. No, no…they aren’t there to cure the occasional case of erectile dysfunction, the emergency it is; they are Emergency Department Technicians, and in my hospital they were always an EMT or Paramedic who has chosen to work in a clinical setting rather than in the more traditional field role, on an ambulance.  On the inside, what the common public refers to as the ER, we call the ED where there are many rooms and if you showed up and said you’re looking for the emergency room, we’d ask which of our 70+ rooms you were needing, exactly.  Which we’re really busy, so speak up…

Still, that was me.  The ED Tech.  An ED Tech.  There were a bunch of us, and we were denoted by our royal blue scrubs.  Many of us were transitioning to higher roles in medicine: some to the fire service, some to med school, many to nursing.  I began as the former, though my path has changed and now finds me away from it completely.  Still, it’s nice to know your correspondent, izzinit?

Our job was to be the Jack of all trades: to provide ancillary critical care and all the rest, from holding down patients during procedures (children don’t generally take well to IV needles and sutures and wound debridement, etc., and we’re trained to hold them down without hurting them or exposing them to more harm from the very procedures intended to help them) to blood draws for labs, point-of-care tests (pregnancy hCG, rapid strep, hemoccult, etc.), orthopedics (mostly splints as casting in the ED shortly after an acute injury won’t properly allow for swelling and has a higher risk of compartment syndrome), and chest compressions and other support during traumas and resuscitations (what we would refer to as a Trauma or Code, respectively).  There’s a lot of other crap we do as well, but this is just a general overview.

Each Level 1 trauma center (Level 1 being the highest designation, meaning it is staffed at all times by a team capable of providing services to all traumatic injuries or life-threatening events) has a dedicated team for every shift.  The tech (in our department called the “D” tech, for his position during a trauma/code; “A” being the Trauma Nurse Lead, “B” the chart nurse, etc.) generally has one of two roles: to get the Zoll defibrillator pads onto the patient after he or she is moved from the gurney to the bed and then trade off providing chest compressions, or to help the TNL with IVs (“lines”) and labs.  From there a tech will be the one to push the bed to the next destination, often CT, and help with moving the patient.  Again, jack of all trades.  Do what is asked, and try to anticipate what your nurses and other staff will need.  If you don’t know what you’re being asked for, speak up and/or find someone who does.  Often, though, Techs are a go-to source for finding items.  Me?  I’m good at delegating, which in a pinch can make up for not being a subject-matter expert.  Don’t know?  Find someone who does.

Most of the day-to-day is mundane and largely thankless, and the 12 hours of a shift can swing from one end of the crazy-fun spectrum to the other in an instant, and then back again.  Each day is different, most days kinda suck, but they are littered with brief moments of sheer adrenaline and hope, often followed by a heartache that each person experiences differently.  I’ve seen nurses cry during events, or immediately after, and I’ve seen some get angry; I’ve felt absolutely sick by what we saw, and other times felt nothing at all.  Sometimes it takes hours, days, weeks, or even months to feel something about a particular case, and other times it never comes up again.

That’s just the way it goes.

C|P