Читать книгу Confessions of a School Nurse - Michael Alexander - Страница 16

I like Sunday nights at the school, because they’re usually pretty quiet nights to be on call. There are no activities, no drinking (that we know of) and usually little chance of the kids getting into trouble because they’re back in their dorm preparing for the week.

But when the phone rang at 8pm one Sunday I received a rude awakening.

‘You have to come quickly, there’s blood everywhere. Come now, quick!’

The line went dead. I was about to press redial when the phone rang again. ‘Sorry, it’s me, Brian. I’m in the gym; you have to come quickly, Steve’s real bad.’

Brian was the coach of the school basketball team. He was normally a level-headed guy, but like many people involved in nasty looking accidents, when the adrenaline kicks in, they’re not the most coherent. I told him to slow down, take a couple of deep breaths, and tell me what happened.

After a pause: ‘We were playing basketball, practising for the tournament next weekend. Steve took a fall. It’s his arm. There’s blood everywhere. I don’t know what happened; it’s real bad.’ An arm injury with lots of blood didn’t sound good at all. The worst-case scenario I could think of involving bones and blood was a compound fracture, that is, a broken bone that is also poking through the skin.

I could hear screaming in the background and grabbed my first-aid kit and car keys and headed out the door.

I walked into chaos. There were two adults with Steve, and a horde of boys surrounding them all offering advice at the same time. Yet through all this noise I could hear Steve screaming in agony.

I was the only medic on the scene and it was up to me to do the right thing.

‘Don’t move him.’ As I pushed my way through the crowd, the kids were yelling their diagnoses.

‘It’s his back, he’s broke his back.’

‘Oh shit, there’s blood everywhere, I think I’m gonna puke.’

As I reached Steve and knelt beside him, I grabbed the shoulder of James, the assistant coach, and ordered him to remove all the boys from the gym. Some resisted, determined to help, others were happy to be led into the foyer, speechless, helpless, but grateful for some direction.

In any situation where there’s a crowd, the best thing you can do is to have someone remove the onlookers. I’ve seen a lot of people with what initially appears to be a serious injury calm down and walk away without any problem once the jittery, frenzied bystanders have been removed. It’s also impossible to do an assessment with a screaming horde of onlookers.

Steve was sitting on his backside, clutching his right arm, the front of his shirt covered in blood. I breathed a sigh of relief when I realised the blood wasn’t coming from an open wound on his arm but from his nose.

I imagined myself back in the triage room. One of the basic rules of triage is the ABC:

A – his airway was clear, although his nose still had a trickle of blood coming from it.

B – judging by the groans of pain his breathing was fine.

And as for his C – well, he hadn’t passed out and he was able to sit so he had an adequate circulation.

Clearly something was wrong and causing a lot of pain, but it was probably not life threatening just yet. I asked him what had happened.

‘Please just do something … it’s killing me.’

I promised Steve I would do something shortly, but stressed that I did need to know what happened.

Steve had been jumping for a shot when he received an elbow to the nose and came down on his right shoulder. He said he hadn’t hit his head or lost consciousness.

It’s tempting to tackle the most obvious injury first, and while I could see him clutching his arm, I wanted to be doubly sure to rule out any possible head injury and anything more substantial than a bleeding nose. Alongside the A, B, C is an often unknown little addition, another C, for C-spine.

C-spine, in other words, the bones that make up your neck, should always be checked for injury before moving a patient. The problem is, I’ve only ever assisted the doctors when they do such things. I’m the one who leads the ‘log-roll’ when turning patients with possible back injuries. I’m the one who holds the neck still while the doctor gently prods his finger around the back of the neck. If I stuff up and make a sudden move, it can mean a patient is paralysed for life. But now it was up to me to decide the best course of action.

‘Is your neck sore?’ I asked.

‘It’s my arm, please just fix the bloody arm, please do something,’ he begged. But I didn’t get a definitive ‘yes’ or ‘no’, and I had to be sure.

‘I’m sorry mate, I’ll get to the arm next, but I have to know for sure. Were you knocked out at all, and is the back of your head or neck sore?’

‘Geez, they’re fine, the arm, please …’

To be 100 per cent confident, I placed my fingers on the back of his neck and he denied feeling any pain when I gently pushed. I moved on to the arm.

I asked Steve to sit up straight and he tried, but he wouldn’t let go of his right arm. ‘It’s too painful, I just can’t.’ He had straightened enough for me to see that his right shoulder was not the same as the left. It was obviously dislocated. I checked the pulse on his right wrist and felt his hands. His pulse was strong and his hand warm. No circulation problems there … yet.

Not all shoulder dislocations are obvious, especially in the hospital setting where we see people of all ages and sizes. The size of a person can make it difficult to tell. Often frail people don’t even need to have an accident or any overt force involved to dislocate a joint, and their statures make it hard to see if something’s out of sorts. But a seventeen-year-old boy on the basketball team is likely to be tall and skinny. The poor lad didn’t have enough flesh on him to hide anything.

My clinic was only 100 metres away and with the help of Brian and James we managed to get Steve lying on the examination table. I tried calling Dr Fritz but got no answer. I remembered that this was one of the few weekends he had off; we were alone.

‘Fuck!’ Steve was trying to find a comfortable position but not succeeding. ‘Just fucking do something, fuck, fuck, fuck …’ He carried on screaming, pleading, while I didn’t have the courage to tell him that there was no doctor.

Steve had found the best position to ease the pain a little. He was lying face down on the examination table with his right arm hanging down off the side. ‘Please do something soon. I can’t take this anymore.’

In such instances the emergency call was directed to the next village over, usually a thirty-minute drive away. The next option was the ambulance, but the nearest ambulance was forty minutes away, which would mean at least an hour and a half before he got to hospital. My other option was to take him by car, screaming all the way. With such limited and unappealing choices, I opted for driving.

‘Please, I can’t move. Don’t touch me. I can’t move.’ We couldn’t get Steve to move off the bed let alone into a car. He’d found himself in a slightly less agonising position and was not going to budge. I needed some advice.

I try to avoid calling my colleagues, Justine and Michaela, when they’re off duty because time off is supposed to be just that, and like all nurses, I know, when you ask someone for help, they will never say no. Michaela was no different and was happy to help out. In fact, Michaela relished the challenge of a decent trauma. I instantly felt reassured by her upbeat tone when she arrived.

‘Don’t worry about a thing,’ Michaela said and quickly began examining Steve’s shoulder. ‘I’ve put dozens of shoulders back in place.’ What the hell was she talking about? Nurses don’t relocate limbs. At least, not nurses in Britain or New Zealand. I knew Michaela was extremely experienced and supremely confident; perhaps this is what nurses did in the States.

‘What do you mean you’ve put in dozens of shoulders?’ I whispered, thinking I was out of earshot of our patient. ‘You can’t do that. You’re not allowed.’ I know my limits, and I know what is within the scope of my practice, and what is not. Relocating the shoulder myself had never occurred to me. Steve chose that moment to scream in pain.

‘Let her bloody fix it. I can’t take this anymore. Just do it,’ he managed to shout.

Watching someone in agony never gets any easier, and it’s a whole lot worse when you don’t have an IV line to insert with a whole lot of morphine or midazolam.

I was trying to think of what could go wrong if Michaela went ahead and fixed his shoulder. She could worsen any possible fracture or nerve damage, although there was no way to judge how much damage we could do by leaving him as he was – there were possible circulation problems to worry about – and this was without even considering the possibility of the relocation not working.

‘We can’t leave him like this for the next hour and we can’t take him to the hospital. We have no choice.’ Michaela was in total control, and not in the slightest bit fazed by the chaos. ‘Honestly, don’t worry, I’ve done this lots of times with the docs at work. It really does look like an uncomplicated dislocation. I know what I’m doing.’

I stood back and watched.

She rolled up a sheet, wrapped it around her waist and Steve’s shoulder, and gently began to pull. ‘Fuck-fuck-fuck-fuck-fuck …’ Steve’s screams reached new heights. I was just about to stop Michaela when … ‘Thank fuck for that. Oh, thank you, thank you, thank you so much.’ The relief was instant and the whole procedure over in less than ten seconds. After checking Steve’s circulation and sensation in his hand, Michaela placed him in a sling and gave him some analgesia. ‘I can’t thank you enough,’ he said repeatedly.

Part of me felt more than a little envious, the childish part that wanted to be the hero. But that was nothing to the relief I felt knowing that he was feeling so much better.

Steve was taken to the doctor the following day where an x-ray showed no fracture, and the doctor congratulated Michaela on a job well done. ‘You’re OK with us doing that?’ I asked. I had been prepared for him to be angry with us for doing something that was a doctor’s job. ‘Why would I be angry? You did a good job.’

His words were not helping me to figure out what was right or wrong (if there really was any such thing), or what my exact role was. I was doing more than the average nurse, a bit of diagnosing, and administering treatments and medicines like a doctor, as well as playing detective … but nothing as practical as what Michaela had done.

Michaela’s brave actions on that surprising Sunday night taught me a few lessons that I’ll never forget. To act or not to act? Indeed, that is the question.