ok, first of all- you guys, as always, are so amazing and although i couldnt get my damn phone to work for most of the day i got everyone's messages/fb posts and tysm for thinking of me. a special shout out to april for ingenuity in stalking, LOL. i think the only person that knew for sure where i was was mom, of course. as soon as the shooting started, the towers were jammed or whatever you call it.

i only just got my damn debit card replaced and thus have not been able to do that premium thing, and initially noticed a lot of traffic was in the private section (of course) so i'll have to square that away sometime this wknd. i work tomorrow so i still wont be home

and dammit, i *really* wanted to call in tomorrow

buried deep in this AAR, i went out with a guy from work who was getting stationed somewhere else. he asked me out and after inquiring as to the delay (his ass is so fab in scrubs..but he is actually one of our army medics) he said he doesn't date ppl from work. so..we go out, have the best time and continue to have the 10 most fabulous post alex (pre-alex?) days of my life...i'm so sprung on this dude. its actually quite terrible in that we seem to be equally into each other. when this mass cal rolled in today i was actually thinking about how much i miss him. :( but anyway...i guess we have plans for me to visit him in january and ihni if that will happen. he is paying so if nothing else, i get a mini-vacay out of the deal. but i do seriously, seriously dig this dude and semi-serious conversations were had. we are like legos people! legos! all the pieces just click together and ive been working with him for a whole year never thinking about anything besides the fact that he is hot and it is TOTALLY INSANE the way we hit it off. i could go on ad nauseum, there still wouldnt be a better way to describe it and as much as i miss him and really wish things were different, if all it ever is is a fabulous week then thats still ok. because it was just so good. soooooooooooo refreshingly wonderful and lots of other great sappy adjectives.

on to what you came for

(i know you were hoping i'd post)

(right?)

so, typical busy morning and i'm putting a pt in a room when i hear the charge nurse say "15 gsw en route" (gsw=gunshot wound) this particular nurse is a bit of a spaz and initially i thought we had one patient presenting with 15gsw, NOT 15 pts with multiple gsw. she goes hollering thru the dept about we have a major trauma, pulls docs and nurses from the quick care area, tells the clerks to page everybody in the damn hospital and i'm still listening from behind the curtain trying to dodge her insanity.

but then i hear all this yelling and i know its whatever trauma they are bringing in and i can tell (because EMS is not prone to excitement) that something more complicated than a guy with gsw is coming in. (granted, we get very few gsw in our ER).

i tell my pt that i think its going to be "awhile" before he gets seen and i walk out and hear this yelling and when i get to the ambulance bay they are carrying in guys with bloody uniforms, i have a few dudes in chairs with blood all over them and i'm still trying to figure out wtf is going on when the guy i'm cleaning blood off of says "we were just sitting there when some guy yelled in arabic or something and started shooting"

oh shit

we have a shooter!

on the biggest military installation in the united states!

omfg!

and this is where civilians and military ppl are so different. its hard to explain. but this moment, when i realize somebody opened fire on an army base on a bunch of soldiers is pretty much exactly like the moment i heard a second plane hit the WTC. this moment of clarity when you realize something bad has happened and frankly, standing at my checkout at the riverside heb on 9-11 i knew someone was attacking us but right now i'm like pulling this guy's boots off, hearing what he said and realizing that idk if we have a sniper, if the post is going to be attacked, what the hell is going on and at the same time, that ingrained sense of unity that a military community has in a time like this, or on 9-11.

so, moving right along, Guy With Story is fine and goes out to wait for somebody. they are still bringing ppl in, all kinds of hell is breaking loose and im realizing its my first mass cal and ihni what to do! but patients always have a need and its easy to direct yourself by tackling one pt at a time.  i start this by running to the blood bank to get a bunch of emergency blood... the ER is a great place for autonomy in nursing and doing things you know you need without someone telling you that you need it. everyone is running everywhere, they are overhead paging to secure the exits, i grab a chaplain looking lost by the blood bank, tell him someone opened fire on a bunch of soldiers and to hot foot down to the dept.

 i get back and the next guy is on his stomach with a gsw to the back, stable and getting dispo-ed to a hospital clinic. again, cleaning off the blood to check for wounds, no idea where my gloves are and frankly in a time like this all that technical crap flies right out the window. no charts, no documenting, standard precautions, sterile technique...we are trucking through these patients with a bunch of non ER staff and running down the hall tv style with pts in beds so we can get back faster. although i did procure gloves at various points during the day.

next one, 4 gsw, arm fx, blue nails on the affected arm, semi conscious, losing some blood, but not anything too serious. and this is where it gets really good because i end up being the only person from the ER in this pt room. keep in mind we have 2 trauma rooms plus 25 others and we were seeing pts in all of these rooms and prolly 14 or 15 of them were "traumas" that we were clearing. they were running a code in one bed, cracking a chest in the bed next to mine and i'm here with an OB doc, a sgt from somewhere and a volunteer.

i do not usually work a lot of traumas and i have very rarely worked any "good" traumas where we are actively working to stabilize and save somebody. honestly, they come around so infrequently that although i know what *my* role is, and i have my nifty ACLS certification, you only retain the skills you use. ex: in the middle of this i draw a complete blank on the chest tube set up, another nurse magically appears to do it, i think to check for the "return" or blood in the collection tray, but completely forget to turn on the suction (doi) which is not really helpful at all.  its possible that this took place because i, with my painfully limited trauma experience, find myself managing several aspects of this trauma.

one of the functions in a trauma, the part that tv doesn't illustrate, is your team leader and your recorder. the recorder writes down everything that happens. how they present, what tests are done, when we do them, what they show, vital signs, meds, etc.. and unlike tv, the team leader (dr) providing directions is usually not actively working the trauma, they are watching everything and providing instructions. so there are atleast two people removed from the action who will call attention to things we need, not done, etc.

today, no such set up exists and we have people from all over the dept, many of whom do not work in an emergent setting and doctors who, like anyone else, are best at what they do and not necessarily what we do. my OB doc does not know to review the systems and my sgt helping doesnt know how to work our monitors and the volunteer doesnt know (literally, and i dont mean it in a derogatory way) which end is up on the chest tube tray.

so this is me, brain exploding, summoning every ounce of trauma knowledge i have, and i literally am trying to direct this trauma from a nursing perspective while letting the doc do his thing. i need a set of vitals, for one, so i ask for that, ask for an IV, tell the sgt that a manual bp is not going to work because we need continuous monitoring and that the royal blue (yes, i really said that) is the small adult size and that will fit her. where is the IV? i need that IV i'm stuck holding up a boob and trying to numb this poor lady up with lidocaine using a giant 18g needle because its really all i could find and the dr is telling me where to put it while she sets up the chest tube and i'm cringing at the thought of using an 18 to inject lido. but,  the alternatives suck more and chest tubes hurt no matter what you do so i'm holding a boob up with my left, injecting with my right, trying to figure out if we have a sterile field, if it even matters, looking at the vitals now that i have them and staring across this pt after im done  with the lido trying to talk my sgt thru this IV start. "go for the blue!"

they cut this girls chest, a relatively small incision, the doc is fishing around for where to insert the chest tube, a sad little baby shoe falls out of a bag somewhere and the pt is in pain because we have no pain meds on board and im trying to keep her calm and talk her through this whole thing. blood is everywhere, giant clots actually and even though all this crap is going on, this girl is actually pretty stable and satting great. chest tube goes in, line is in, time to review. ABC...airway, breathing, circulation

you learn this pretty soon in school and as monotonous as it becomes, in practice this saves your patient. if you forget every neat little trick, knowing to check your ABCs is still the most important thing. 

the nails are kinda blue in the arm with the fx and the gsw. gsw still bleeding a bit. i ask for a splint. idk how to splint an arm with an actively bleeding gsw. i get handed plywood planks for a split. wth? idk what that is, how to cushion it, how to use it, nothing. the sgt is better at this than me and we manage to cushion the splint, apply the splint and hold pressure on the wound all at once. we roll her and check for wounds. we get xray. we forgot a temp. we always do rectal temps on trauma pts. always.

it is a testament to the insanity of this day that when i got handed this temp probe, i performed a rectal temp with no gloves on, and i  want you to know that the ass on an adult is much harder to find than you would think. it really is, and i know that but its even harder with no damn gloves on and trying not to touch someone's business district in said unprotected state.

we do everything. we are pressure bagging fluids. pt is stable, need a dispo, grab an ER doc for dispo

idr where she went

next up, bad looking guy, blood all over everything, trying to put this guy on a portable monitor to run him somewhere. mission: do not fuck up the chest tube. it must not be injured or yanked in anyway. hang more blood, get on monitors, start running down the hall, everyone get the hell out of the way except the chaplain who is running down the hall with us, holding this guys hand, praying with him. over and over the pt wanted someone to pray with him and we find this chaplain as we are running out, and as we are flying down the hall towards the  elevators they are praying. remove brain from this moment to avoid being overcome by the profound emotions this job sometimes involves. we laugh and joke and sat around watching the news and eating bush's chicken after it was over, but stuff like that will screw with your mind no matter how the pt is. that young soldier was afraid to die. not in a war, not anywhere but at work on a regular day and now his blood is all over the floor, the equipment, our clothes and he is so scared to die. and honestly, he was rapidly headed in that direction barring rapid surgical intervention.

he was the last mass cal pt i had before it was essentially over. the whole time we keep getting reports of a shooter at the PX, on other parts of post, no one can get ahold of their loved ones on post, the post is locked down and there are MPs with M16s standing at the doors. we did such an incredible job. clerks, people i don't recognize, everyone working together to save these soldiers. as far as i know, we lost two and saved several more. we cracked a chest in the bay, which is as crazy as it hopefully ever will be and better yet, they cracked his chest and he was still alive to get transferred.

a doctor shot these ppl, and i'm not clear on how many shooters we had and we have watched the news with great interest. the SRP site, as the news has no doubt explained, is a place where soldiers prepare for deployments. a routine part of SRP is psych eval/counseling. this man not only shot fellow soldiers, but he shot his *own* soldiers, the soldiers that he was trusted to care for in his capacity as a doctor and as an officer. it makes it even worse than it already is. the news will paint it as a deployment stress issue, but officers, esp doctors, do not endure the grueling, relentless deployment schedule that NCOs sand juniour NCOs have. the news has been reliably inflammatory and its so aggravating. why rationalize the incomprehensible?

there are several other little stores, tidbits, etc. none that i feel comfortable sharing in a "public" forum so to speak

i think the beer kicked in and im tired and i have to get my crocs out the wash.

i put them in there to get the blood off and it wasnt until i was home that i realized blood had gone through the holes in the top and sunk into my socks.

so there's the story of what happened today