Induction

The one thing we all had in common was a kooky sense of humor. Some nights in class something would strike us as funny. One of us would end up leaving the room because we’d be laughing too hard to contain ourselves. We frequently disrupted the classroom and garnered disapproving looks from our instructors.

Ollie grabbed my arm, pulling me back to the present and laughed, “I ran into Kat while I was waiting for your ass,” she giggled again. “She pulled Ortho tonight.” We laughed all the way into the conference room.

* * *

Five hours into the shift, and seven Foley catheters later, and an elderly female patient was brought back to the emergency room from triage. She held her left arm close to her body, blood spattered her shirt, and she had a blood-soaked towel wrapped around her forearm. The triage nurse directed her into one of my assigned rooms and I went in to do an initial assessment.

“Hi, Mary, my name is Emma Rossi. I’m a nursing student with Jackson State College, and I will be assisting your nurse with your care today.” I put on a pair of gloves and removed the towel from her arm. The first thing I noticed was the odor. It was a pungent, almost rotten smell, and it was strong enough to make me lean backwards away from her arm. “Can you tell me what happened to your arm?”

Mary winced as I moved her arm to better examine the wound. “I was in the drive-thru at McDonalds on my way home from Joanne Fabrics and had my window down waiting for my turn to place my order. I reached over to the passenger seat to get my wallet from my purse, and when I came back up there was a man reaching his head through my window.”

I could feel Mary trembling as she recounted the attack. Her fear-filled eyes were wide and stood out against her pale skin. I gave her hand a little squeeze for support and smiled compassionately back at her.

“He scared the bejesus out of me, and I threw up my hands in defense. The next thing I knew, he was grabbing at my arm and bit me.” She stopped talking and closed her eyes, looking frail. Sucking in a ragged breath, she continued. “I panicked and just started hitting him over the head with my wallet until he let go. He was crazy. I screamed for help and begged him to stop. He didn’t even react. Then I sped off and came straight here.” I looked over to the bedside table and saw her wallet. This thing looked more like a brick then any wallet I had ever seen. Mary caught me eying her weapon of destruction. “I have a lot of coupons, so I need a big wallet.”

I covered Mary’s arm with some saline drenched four by fours and began charting.

My nursing instructor came into the room and snatched the chart out of my hands. “Tell me about your patient,” she snapped at me. What was it about those old-school nurses? Did something strip away their humanity over the years? She always gave off this air of annoyance, like we were putting her out by forcing her to do her job.

“Mary Jennings, sixty-seven-year-old female presenting with a malodorous circular laceration to her left forearm, approximately six centimeters in diameter and one centimeter deep. The wound is not actively bleeding but is oozing purulent discharge. Patient is alert and oriented to person, place, and time. Complains of ten out of ten throbbing pain in her arm and a severe headache.” I relayed the clinical information as I’d been instructed. It always felt cold and somewhat condescending to talk about a patient like that in front of them.

My instructor stood at the foot of the bed going over the chart, nodding while she listened. “What assumptions can you make from your initial assessment?”

“Patient has been bitten,” I said at first, not believing that someone could do such a thing, but then I caught up with my instructor’s meaning. “Patient is ambulatory but complaining of dizziness and fatigue. Skin color is pale, heart rate elevated, respirations are increased, and she is hypotensive. I suspect she may be in hypovolemic shock and will require electrolyte replacement. There is a potential for transfusion, depending on her hemoglobin levels once labs are returned.” I looked at my instructor for feedback and was rewarded with a curt nod as she put down the chart and promptly left the room.

“The physician will be in to see you shortly, Mary. I’ll go check to see if your labs are back. Lay back and try to relax.” I assisted Mary to lay back, covered her with a blanket, and left the room to check on her labs. On the way to call the lab, my assigned nurse caught up with me and informed me she had already called them. Results wouldn’t be back for about thirty minutes so she suggested it was a good time for me to take a dinner break. I promptly texted Kat to meet me in the cafeteria.

* * *

“I so hate you right now,” she said while we waited in line to pay for our food. “I wish I was in the ER. I hate Ortho. It’s total poop patrol!”

After paying, we walked our trays to a table in the corner and I chuckled, glad someone else felt my misery from the night before.