Which is the number of ambulance patients we received between 0715 and 1030 or so.

So this morning, I noticed on my drive to work that we were having a bit of the dreaded “wintry mix”, and that driving was, um, dicey. The roads I was on had all been treated, but still, it was clearly icy out. Which always means an extra helping of the clueless people who have forgotten what winter driving is about since last winter, or who have moved here from Florida or Hawaii, and thus slide their cars out into some other car or stationary object. Or roll them over.

First up, Ramon, who was unrestrained in the back of a van, and bounced around, sustaining a lovely set of lacerations to his eyebrow and nose area, including a small but persistent arterial bleeder. Well, he needed a CT scan, but CT gets all shirty when the patient bleeds all over the scanner, not to mention that it just looks bad to not fix that. Given where it was, it needed a pretty closure, so he got a set of subcuticular sutures (under the skin, using absorbable suture; it’s a way of closing lacerations, and to make them look nice (it’s one of the several plastic (cosmetically pretty) closures. it takes a little more time, but it looks good, and it’s sort of satisfying. I hadn’t done one in a while, so Ramon gets subcuticulars. He also gets my lecture on seatbelts-turns out this s Ramon’s *second* serious car crash-you’d think he’d learned, but apparently he didn’t get the talk last time. Well, he got it in spades this time.

Meanwhile, the place is filling up with blockheads. Now, that’s not a comment on their mental acuity-much-but when you’re in a car crash, you usually get immobilized on a long board with a collar and blocks on either side of your head to keep it still. So, blockheads. Most are essentially uninjured-they’ll be sore in the morning, but not really hurt. One lady had a nasty ankle fracture (not from a car crash-she just slipped and fell). A lot of hip fractures. A *lot* of hip fractures; the orthopedic surgeon made his nut today, and can probably buy a new Ferrari 🙂

Only one really injured lady, who goes to Boston Medical Center, after Tufts farts around a bit too much. When I call for a transfer, I need to hear “Send her on down”; I know enough people at BMC that that’s the answer I get, while I don’t know anyone at Tufts, yet. (Tufts is the preferred provider for transfers, mostly because they’re cheap compared to other providers). As you can see, a lot of things factor into the decision of where to transfer people, one of the most important of which is “How convenient is it?” Note to tertiary facilities: if you want the transfers, make sure you have one call shopping. At Tufts, I need to call lots of people: for most of the other centers, one call does it all. In the case of the BMC, I can often call one of my former residents, who I can, for that reason, browbeat 🙂 Thus it was today; Dr. Tahouni did a resident rotation at QMC when I was there, and gladly accepted my transfer.

Towards the 2pm hour, it started to slow up to the regular pace. And I started to recognize that, for all the suck we’d had, it hadn’t really sucked that much. It had been **busy**; we’d been hopping, but the nursing staff had risen to the challenge, and called in people from upstairs and from home to spread the load. And stuff had gotten *done*, with good (if trenchant) humor, proper dispatch, and it had been overall a good day, for all the suck.

At the end of the day, several things happened. The housekeeper (the *housekeeper*) stopped by the desk to thank me. Now, be clear; she’d been working just as hard as the rest of us. I was touched. The charge nurse stopped by my desk (well, the one I was using), to thank me as well. And when my shift ended, I went round to all the nurses to shake their hands and thank them. They made the shift bearable; they took initiative, did the right thing, plowed the road for me (by, for instance, ordering films and tests which they knew I’d want but hadn’t gotten to yet), and generally did the things I want professionals to do. We were *BUSY*, but never out of control, and never in any trouble in terms of patient safety. Things got done, people were cared for, and it all just *worked*.

It was a good day.

I sent an email to my boss, to hopefully pass along to the nursing management, letting him know how it had been, and hopefully to give a shiny buff to the staff. I don’t mind working hard taking care of people; I dislike working hard just to make the minimal care happen. In this case, we all worked hard, and people received excellent care, and it all just worked.

Booyah.