I'm not sure when the term PTSD came into broad usage and even now the definition seems quite vague, and overused. Everyone agrees the soldier in active combat, the cop involved in a shooting, and the assault or rape victim will experience various symptoms of PTSD at some point. But what about the Paramedic who responds to automobile accident and sees an entire family dead, viciously mutilated and encased in the twisted metal and broken glass that was formally the family mini-van? What about the nurse who has to listen to a mother she has become friends with wail in agony from the ICU, as her precious child is taken off of life support because they are brain dead? Going back into the hospital I used to work at to see my great grandson (g-g-son from now on) brought back many, quite profound, memories from a life I used to live. I'm going to relate my PTSD experiences as a respiratory therapist and how I treated it with cannabis.
I was 19 years old when I saw my first dead patient. I had just began working at a trauma center in Miami as an equipment tech while I was going to school for respiratory therapy. After a Code Blue (most hospitals name for a cardiac arrest), I was responsible for collecting the used, dirty equipment, cleaning and sterilizing it, then putting it back together again. The body really didn't affect me that much. I had been to a funeral or two as a kid, so dead bodies weren't new to me and the patient looked pretty much like you would see in a casket.
As my career progressed, that would change, quite dramatically.
During the course of my career as an RRT, I have had every type of bodily fluid, drainage or exudate dropped, slung or sprayed on me, except for semen. Yeah, even as an RT I got shit, piss, puss, vomit, amniotic fluid, spinal fluid and GI drainage on me, in addition to the more common blood, snot and boogers, which kinda comes with the job in RT. When you work in direct patient care, these types of incidents come with the territory. That's the easy part.
Here are some of the things that I experienced that weren't so easy.
A 9 year old boy whose head was crushed in an MVA (motor vehicle accident... medical people, like military and police, absolutely love acronyms) in addition to having his trachea (windpipe) severed by a seatbelt. He was making these God-awful sucking/slurping/bubbling sounds as his breathing became agonal. Unfortunately, his heart was occasionally still beating and since there was no M.D. available to pronounce him DOA, we had to keep going. Since I could not ventilate him with an AMBU, I reached down into his neck with my fingers, grasped his trachea and put an ET tube, which usually goes into the mouth, through his neck and down into his trachea.
The room became silent.
Working 2nd shift on New Year's Eve when a self-inflicted GSW to the head rolls in to the ER. Tiny hole on right side, brains exuding from the left. Even though it's hopeless, you have to go through the motions. I bag this guy (manually ventilate him with an AMBU) so we don't have to put an ET tube in and commit to putting him on a ventilator. I do this for almost an hour before he finally gives up the ghost. I go home to shower and change before going to a New Year's Eve party when I notice I've got chunks of his brain on my Earth shoes.
I didn't make it to the New Year's Eve party.
A Code Blue is called in the Labor and Delivery unit but instead of being in the Delivery room like they usually are, this one is in a patient room. I run into the room where an morbidly obese woman with her legs splayed wide open is in late stage labor, with just her baby's head protruding out of her vagina. The umbilical cord was wrapped around the baby's body like a noose, preventing it from being vaginally delivered. Every time the patient would have contractions, the baby's color would change from normal beet red to dark blue to jet black, as the blood supply from the placenta was cut off. Regardless of the repeated attempts at manual manipulation of the baby inside the mother by the resident, the cord was preventing delivery and it was too late for a normal cesarean section.. After 5-10 minutes of this, the decision was made to intubate the baby, in a desperate attempt to keep it alive until we could transport to the OR. I had to lay on my stomach, on the bloody patient bed, with my head in between her legs, and try to put a 3.0 ET tube (which is about the size of a straw) into the baby's lungs by putting a laryngoscope into the baby's mouth, sucking out meconium (Google that), trying to visualize the trachea and place the tube in between the vocal cords. Ordinarily, to determine you've put the tube in the right place, because it can go into the stomach, you place a stethoscope on the patient's chest and listen for air movement. It was kinda hard to do in this case, as the baby's chest was still in the mother's vagina. I couldn't have heard anything anyway, as the mom was screaming with every contraction, which were almost constant at this point. My hands were covered in blood and amniotic fluid, so it was impossible to secure and stabilize the tube normally. I had to pinch the tube into the baby's cheek with only my fingers, so I could bag with my right hand. That's how we rolled into the O.R.
The baby did not survive.
Working up in Pediatric I.C.U. when I get a call from the therapist covering E.R. He says they got multiple trauma's coming in, two are kids and he needs help setting up a Siemans Servo vent in case they need it. I get down there as the ambulances scream into the entrance. We got 9 year old twin sisters and their mother, who have O.D.'d on an unknown substance. Unresponsive, with labored breathing and frequent vomiting equals buying an endotracheal tube. I bag one of the twins while central lines are started, various x-rays are performed, and blood samples drawn. Not a good sign when a kid is stuck with a needle and doesn't respond, especially when the needle goes under the collar bone and into the subclavian vein. As we're prepping the girls for transport up to P.I.C.U., one of the E.M.T.'s gives us the backstory. Their mother and father were going through a bad divorce, the mother wanted to "get back" at the father, so she put some kind of insecticide in their food and took a fistful of Valium. My youngest daughter was about their age and I was surviving a divorce as well, so to say I personalized this situation would be an understatement. This time, I could not compartmentalize what I was witnessing. As we're transferring her from the trauma bed to the gurney, I notice what the t-shirt that hadn't been quite cut off of her yet said, "If you think I'm cute, you should see my Mom". When I came to work the next day, I learned both girls died, their mother had survived with essentially no adverse effect and was transferred to a Psych hospital.
I resigned, left the hospital two weeks later and have not treated another patient since.
For a very long time after I left, I would have frequent dreams about working in a hospital. I hate trying to describe dreams almost as much as I hate hearing other people tell me about theirs. Dreams are only relevant to those who are experiencing them. Almost always, my dreams had me in a traumatic, critical care setting and being completely unable to intubate a patient or operate a ventilator. No doubt a shrink would say this is symbolic of my feeling helpless at the thought of death and/or trying to prevent it but I don't think that's it. When you've seen as much death as I have, you realize we're all helpless when it arrives. One thing I learned during my career was death was not something to be scared of. One of my most vivid dreams was of me standing on a smoky mountain top, shaking hands with a seemingly endless line of patients that I had treated who had died. They were all thanking me for what I had done while taking care of them in the hospital. They were like they used to be, not like they were in the hospital. It was then I realized that of all the people who I had seen die, not one of them were scared. I have looked into many patients eyes when the spark goes out and not one of them were frowning. There's nothing to be scared of or feel helpless about. It's how you deal with life that really matters. I used cannabis to cope and I'll get into how and why it worked for me in the next post.
I'm a bit tore down now after writing this and I'll probably have critical care dreams tonight.
