THE EMERGENCY ROOM

(This took off in 1990. You have not really lived until you are haunted by tenacious chronic violent nightmares such as suffered by the Burn Psychologist after Uncle Al. Well-earned, bitch.)

It was my misfortune as a chemist to be, from the waist upwards, engulfed in a Class D fireball. Class A fires are burning paper and wood. Class B fires are burning oils or fuels. Class C fires are electrical, and you generally avoid using water for obvious reasons. Class D fires are the champions, being "burning metal/organometallics" which cook at about 3000°C and melt the crown of your wristwatch. I had a Timex, and true to the advertisements it took a licking and kept on ticking. Amazing. The blackened and bubbled lenses of my safety glasses fell away to reveal unharmed eyes, and somebody was kind enough to call for an ambulance.

When paramedics arrive they are trained to do things to keep the patient alive long enough to submit a bill, if not to the survivor, then certainly to his estate. I suspected difficulties to come when they in their most professional manner attempted to start an intravenous line, and were faced with the formidable task of finding uncharred biological real estate in which to do their digging. They found a vein, and to our mutual relief we could now proceed amid flashing lights and sirens to the hospital Emergency Room. It is a wonder of biology that throughout all this there really was not any pain to speak of. Nature has a deferred payment plan.

The Emergency Room has a standard dance. Get the patient onto a table. Cut off all his clothing. Locate a physician to risk his malpractice insurance by starting therapy. In my case the attending M.D. was a cute-as-a-button 4'9" second-year Resident of Japanese ancestry who was very reassuring and expert in her discipline. The fun really started when she yelled "PLOSTATE CHECK" and unreeled a pair, or possibly a fistful, of nine-inch fingers into a very private southerly orifice heretofore labeled Exit Only. Having pronounced the remains of my pitiable palpated prostate gland to be within normal expectations, a 900 pound intern was then instructed to thread a Foley urinary catheter into an even more jealously guarded orifice until it bottomed out. Three magnificent shoves later that hollow rubber tether found a home. They were well and truly certain I was not going to do anything untoward, like run at full speed through the nearest open door, or roll over unaided.

The bidding began. 60% second and third degree burns echoed from one side of the slab, 40% resounded from the other. They debated. They compromised. They went with 40% but wrote off my right forearm as an overcooked shank roast, and went looking for a pulse to see if the remains of the right hand were worth their concern. It was rather inconsiderate of me to have burned all ten fingernails black, thereby denying the attending physicians and nurses the opportunity to see if they were turning blue.

Third degree burns swell grandly, and if they were to save the hand they would have to relieve the increasing circumferential pressure compressing shut the blood vessels of the arm. They do this by taking a scalpel and an electric cautery, with a grounding plate under your ass, and make long slices down the arm along the major muscle groups. This is a fasciotomy. The cautery burns closed slashed blood vessels because a patient who bleeds to death is a terrible mess, and the orderlies complain to their union representatives. When the doctor hit the juice, the pain was TREMENDOUS. I cannot say much for the smell, either. Fentanyl and morphine are nothing compared to being simultaneously diced, recooked, and shocked.

If anybody has a body temperature below 93°F, you win. That is as low as Uncle Al went before he died and the nurses began yelling. Death is overrated as an experience. They turned on a giant infrared heater to warm Uncle Al like an odious MacDonalds mammal divot. Therapeutic personnel were complaining about cold-chapped hands.

One set of nurses was wrapping me in yard after yard of gauze saturated with wonderful, cool burn cream, and slathering on more by the handful. Not believing that I had avoided cooking my eyes and lungs in the bargain, inquisitous folk peered into my baby blues and counted the hairs in my nose, and took a second set of blood gas samples to look for inhaled carbon monoxide. At the instant of thermal destruction I had reflexively clamped my jaw shut and breathed out mightily, just like they teach you in chemical safety instruction, breaking eight teeth in the bargain. At the moment I was less concerned with my teeth than with my groin. Unlike paramedics, doctors can sink an intravenous line anywhere they want to, and they were hungrily eying my femoral veins as the last major readily accessible blood vessels. They went for the left femoral, which does not feel at all pleasant, and concluded that they had, ah, sort of missed and made a bit of a mess. They went for the right femoral. We are talking pain in a privileged place. Within 24 hours it was clear they had missed that mark as well. They went for the left femoral again and - missed. This does bad things to the morphological esthetics of your legs. This is really rough on your poor catheterized weenie and associated anatomical baggage.

They hung my arms from IV stands and told me everything was going to be all right. The hospital representative from Accounting then wandered over with some forms for me to sign. Now there was an optimistic fellow. When I resigned the forms a week later, I concluded that my rather illegible handwriting was not improved by holding the pen in my mouth - burned lips and broken teeth - while he held the clipboard. The first attempt, using my cream-soaked flippers, had been suitably messy and depressingly hopeless, even for Accounts Receivable.

They rolled me into Intensive Care/Burn Ward. The Emergency Room was just the preliminaries. The Burn Ward was the main event!


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