A Switchblade and A Combat Flashback

(It’s All In A Day’s Work)

The small, rural hospital in the small Texas town about 40 miles from Houston where I had my first job as an RN in the late 1970s, had a heavy, wide double door with a doorbell. This door was the ambulance entrance to the emergency room and it was locked after sunset because the ER was in an isolated area of the hospital and I was often alone there. (this hospital didn’t have security guards)

One night when the doorbell rang, I opened the door and 3 frantic looking adult children rushed in and said, “Come quick, Mama’s  had a spell.” I said, “Where is she?” She was in their car parked right outside the door. So I told them to not let the door shut behind me because it would lock and I ran out and threw myself in the backseat of their car where Mama was. She was sitting upright, but seemed to be unconscious. I spoke to her, jostled her a bit, tried to feel a pulse or breath and got nothing.

I yelled at her kids to grab a wheelchair that was just inside the door and as they dragged her out of the backseat, I ran in and called the physician. He arrived in the ER from his sleeping quarters just as they wheeled her in and we lifted her onto the stretcher in Room 1. I knew the respiratory therapist was still around, so I paged him. He arrived in less than a minute, just as I was cutting off Mama’s clothes in order to have immediate access to her chest with the defibrillator.

The Dr. had intubated her and the respiratory therapist immediately slid into the Dr.’s place at the head of the stretcher. As he suctioned her lungs, I cut into her bra, and a heavy metal object fell out of her bra onto the floor. That was a “first” for me. I had cut off patients’ clothing before—many times—but I had never encountered any weapons falling out of underwear, so I was a bit startled.

When you are relatively new at a job requiring technical knowledge and support, there’s always a dilemma between not wanting your coworkers to lose confidence in you by asking a lot of questions and the need to know the jargon of your profession so you don’t make a mistake. In addition, when you’re trying to get a patient’s heart started again, there’s very little conversation because everyone in the room is concentrating on what they’re doing—which is how it should be. However, when lives were at stake I tended to go with asking questions.

I got distracted for a few seconds from trying to make sense of the metal thing that had fallen out of the bra onto the floor, (it turned out to be a switchblade—but having never before seen a switchblade, I didn’t recognize it and kicked it out of the way) just when the respiratory guy said, “She’s directional.” Not wanting to waste time wondering what that meant, I risked seeming dumb and asked, “What does that mean?” He responded, “Keep standing there and you’ll find out.” Whereupon I swiftly moved back a bit as I prepped her arm for an IV and then promptly stabbed my thumb with the IV needle.

When the heart and respirations stop, the circulatory system collapses, making it quite a challenge to start an IV. In other words, if there’s no pressure pumping blood through arteries and veins, gravity takes over, veins flatten and the blood starts to pool in various areas of the body. But it’s absolutely necessary to get an IV in because you have to inject the necessary medications to get the heart working and keep it working.

When you’re in that situation as a nurse, it’s best if you can keep yourself from panicking. I happen to be good at not panicking, but most nurses don’t know if they’re good at not panicking until they’re in a situation that requires them to not panic.

Fortunately, I was able to get an IV in and we shocked her heart. We injected the usual meds to get her heart started, but it didn’t work. So, the physician and I traded off doing chest compressions and the respiratory guy continued clearing mucus from her lungs, then we shocked her heart again. This time it worked and it wasn’t long before she was stable enough for transport to a larger hospital with a cardiac unit.

The Dr. called the receiving hospital ER to tell them what was coming. I called Life Flight, then talked to the patient’s grown children to explain the situation and hand over their mother’s switchblade. The physician then answered their questions and a few minutes later they were in their car on the way to the hospital where Life Flight would deliver their mother. While the respiratory therapist monitored the patient, I grabbed the flashlight I needed to guide the helicopter pilot to the vacant lot next to the hospital, and the Dr. decided to walk with me. We went down a long, dark, empty hall and made a right turn to walk down another long, dark, empty hall. As we turned the corner we heard loud helicopter noise as it approached.

Then suddenly the Dr. grabbed me and threw me down on the floor as he yelled, “Get down, get down!” Then he immediately said, “Oh my God! I’m sorry, I’m so sorry. . .” as he helped me up. Obviously, the sound of the helicopter rotor blades had triggered a flashback to when he was in combat. He kept profusely apologizing as I straightened my uniform. Although I was startled by being thrown to the floor, I wasn’t hurt, so I said, “It’s okay, I’m not hurt.” Then to get him to stop apologizing, I said, “Look, I understand why you did that. I’m not hurt, so let’s just pretend it didn’t happen and never speak about it again, okay?” He nodded and we went out the door toward the vacant lot and the helicopter waiting to land.