Fail, fail, fail, fail, succeed

It Wasn’t His Day To Die

All ER’s have their resident alcoholics, it’s just a weird phenomenon endemic to this very peculiar environment. When we triage them their chief complaint will be “EtOH intox,” which is medical-speak for “drunk.”

The odd thing for outsiders to understand is that, even though these people are abusing the system, over time they evolve to being viewed as sort of your dysfunctional uncle – you know, the one that can’t stop drinking. Sometimes they actually come in more than once a day (yes, you heard that right), by ambulance no less.

We check their vital signs, listen to the EMS report, give them the once over to make sure we didn’t miss anything, and then we give them some food, a urinal, and a blanket. They eat a little, maybe yell a few inappropriate (and often incomprehensible) things, spill their food and juice on themselves and the floor, try to hit the urinal when they pee (often missing), then go to sleep. I won’t say we actually tuck them in, but we make sure they are sleeping safely and don’t choke on their own vomit. If they are particularly worked up and won’t stay on the stretcher, we have a security guard “watch them” until they are asleep. When they sober up, they are usually a little sheepish, often actually saying “thank you for taking care of me.” Nothing gets to the heart of a battle-tested ER nurse like that line.

Remarkably, maybe because they are always there, the staff begins to treat them as if they were family. I know this makes no sense, it’s just the way it is. If you work in the ER long enough, they will eventually die, only to be replaced by another one, and the whole cycle repeats itself.

So yesterday we got a notification of a cardiac arrest, ETA 5 minutes. I go into the trauma room to make sure everything is set up, and the ambulance bay doors open to reveal the all-too-familiar sight of two medics performing CPR while quickly wheeling the stretcher into the trauma room. I look down at the patient and my heart sinks – it’s him! Not just any homeless alcoholic, no, he’s our goddamn homeless alcoholic. I immediately think the same thing everyone else is thinking – fuck no, please don’t die.

So we all go into our cardiac arrest dance, the one we’ve all done so many times before. But then something miraculous happens – we get him back! No pulse when he comes in, but he’s got a motherfucking pulse now! It’s ROSC baby! I remember feeling a sigh of relief when the doc says “We’ve got a pulse!”

Suddenly, I hear a loud round of what sounds like a sizable crowd cheering and applauding! WTF? I think, knowing he has no family.

It was the rest of the staff, standing just outside the trauma room doors. The only family he has, the workers in this constantly overwhelmed inner city ER. Clapping and smiling. We’d snatched our homeless drunk back from the jaws of death!

It was, at least for a moment, a good day. Other people would die that day in the ER, just not him.

In an environment that that seldom gives you anything to celebrate, it’s important to take a moment and savor life’s little victories.