Troubled Path to Broken Medicine

By R. Sabol

"There is another patient being extracted from the other vehicle. They should be on their way in about thirty minutes." The charge nurse answered, "I will be standing by."

For Dr. Kirk Frei, this would turn out to be the worst shift of his ER career so far. He heard the radio and was thinking of what was happening with the first patient, what he would have to do.

Suddenly the radio crackled again. "We have the second patient from the accident, whose BP is 70 palpable. He has got chest and abdominal injuries, and we think a lung is down on the right. An IV has been established, his heart rate is 132, and he is having trouble breathing. We will be there in five." "Roger," said the charge nurse.

Holy Jesus, thought Dr. Frei. The first patient isn't here yet-a severe head injury that was called in earlier from an MVC, and they said it would be thirty minutes before this one would arrive. Now he would have to think and act fast. This book is a memoir of Dr.Sabol who was reared in a dysfunctional family,who overcame many adversities,disappointments,and heartaches and took a troubled path to becoming a physician after hard work and a career as an officer in the U.S.Marine Corps.This first book takes him from childhood to his entrance into the Marine Corps interspersed with medical cases that he has been a part.

• Language: English
• Publisher: Xlibris US
• Release date: Apr 8, 2014
• ISBN: 9781493177707

Book preview

Chapter One

There is another patient being extracted from the other vehicle. They should be on their way in about thirty minutes. The charge nurse answered, I will be standing by.

For Dr. Kirk Frei, this would turn out to be the worst shift of his ER career so far. He heard the radio and was thinking of what was happening with the first patient, what he would have to do.

Suddenly the radio crackled again. We have the second patient from the accident, whose BP is 70 palpable. He has got chest and abdominal injuries, and we think a lung is down on the right. An IV has been established, his heart rate is 132, and he is having trouble breathing. We will be there in five. Roger, said the charge nurse.

Holy Jesus, thought Dr. Frei. The first patient isn’t here yet—a severe head injury that was called in earlier from an MVC, and they said it would be thirty minutes before this one would arrive. Now he would have to think and act fast. The first patient would have to be intubated right away and, based on the vital signs and report, probably had a severe brain injury only, and intubation would be all that he had to do for him. The second patient would take more attention based on the vital signs, and Dr. Frei was thinking how he was going to handle both when they arrived.

The first came through the door, and Dr. Frei followed him to the trauma room. He appeared to be a young man in his early twenties and was breathing very slowly. He was fully immobilized and had only an oral airway in place. The paramedics said this patient had been the driver of a Chevy S10 pickup truck and was hit head-on by a big Chevy van. The hood had come off the S10, and this patient had gone through the windshield, hit the hood, and continued on with it as both crashed through the windshield of the Chevy van. Holy Christ, thought Dr. Frei, how can this kid be alive? Dr. Frei got all of his intubation equipment out and told the nurse with him that he would have to do an inline intubation because the patient’s neck hadn’t been cleared yet for a fracture. Dr. Frei took the oral airway out of the kid’s mouth and put the blade of the laryngoscope into his mouth and was looking for the vocal cords when he heard a scream of Dr. Frei! The other one’s here, and he ain’t lookin’ so well. He inserted the ET tube through the cords, secured it, and listened for breath sounds, which were equal and clear on both sides; he did a quick exam of this patient and found a massive left-sided head hematoma. Pupils were fixed and dilated, with a few scratches on the face, and at this point, he knew he was dealing with basically a dead person. He was beginning his chest exam when the charge nurse screamed, Dr. Frei, get out here right now! This guy is going down the tubes!

He left this young kid and walked out and around the corner to the next room and found the Michelin Tire mascot lying on the cart. At least, this was the first thought that ran through his mind when he saw what was on the cart. A middle-aged man with a white beard scattered with dried blood and his neck, arms, and legs swollen twice their normal size. Holy shit, he thought, this guy has punctured his trachea or a main bronchus in his lungs, and he is talking! The nurse said his BP was 80 with a Doppler and his heart rate was 132. Dr. Frei went straight to the guy’s chest and felt subcu air everywhere and into the neck and all over. There was an incredible amount of air he was feeling under this guy’s skin. He listened to the chest and heard gurgling everywhere, and the breath sounds were zero on the right. What should he do first—intubate or put in the chest tube? He was looking at this guy’s body build and getting a little uneasy. The guy appeared to be a short, fat person with no neck under all the immobilization devices, and he was praying to God for help in this case. The guy was talking, so the chest tube was decided upon first. He told the guy what he was going to do, and the guy nodded yes, so a chest tube was placed in the right, producing a big gush of air followed by bright-red blood. Dr. Frei, the blood pressure is still only 80. What fluids do you want? He has already got two liters of lactated, said the nurse. Bring me two units of blood uncrossed, and start this now on this guy and start normal saline wide open, Dr. Frei told her, with his attention now focused on intubating this guy. Give me 100 mg of Anectine and give it so I can get this guy tubed. He isn’t breathing good, he said. This would have to be another inline intubation like the first patient, and Dr. Frei was sweating it. This guy’s neck is short, he has got an immobilization device on, and once the Anectine was given, his breathing would stop. Here’s the Anectine, the nurse said. Do you want it given now? Dr. Frei was staring up at the ceiling in silent prayer and nodded his head yes. The nurse gave it, and in a few seconds, this guy’s body jerked a little and then went limp. Dr. Frei put the blade in the guy’s mouth, and all he saw was blood! He told the cardio tech to suction, but she was in an awkward position, so he grabbed the suction catheter and began suctioning out bright-red blood from everywhere in the mouth. He couldn’t see the cords for all the blood, and he knew that he only had a couple of minutes to get this guy tubed. He backed out and told cardio to ambu him. At this point, beads of sweat were popping out on Dr. Frei’s forehead. He told the cardio tech to stop the ambu. He put the blade back in the guy’s mouth and suctioned bright-red blood again, but this time the cords came into view, and he slid the ET tube between them. Thank you, Jesus, he thought to himself as he listened for breath sounds. Breath sounds were on the right now but none on the left. Shit, he thought, another chest tube. He called for another chest tube tray, and at the same time, the nurse who had the first patient came out of the room and said, Dr. Frei, his heart rate is only 38, but his blood pressure is still okay. Dr. Frei knew this wasn’t good and told the nurse to give him a milligram of atropine. He put the second chest tube in this guy now and got back a whole lot of blood again. The two units of blood came around about this time and were being hung to be given when Dr. Frei began his abdomen exam. The upper part of the abdomen was somewhat soft, but the lower abdomen was hard, and when he looked at the guy’s genitals, he found that his scrotum was the size of a large grapefruit and blood was coming out of the guy’s penis. Dammit, he thought, this guy’s fucked up. He yelled for the unit clerk to call the surgeon on call, and he was thinking about what else this guy had wrong with him. So far, the guy has two hemopneumothoraces, blood in the lower abdomen, and blood dripping from his penis. The guy reeked of alcohol when Dr. Frei intubated him, and now Dr. Frei was wondering how the wreck happened. He went over to the EMS people and asked them what happened. We think this guy in the Chevy van crossed the center line and hit the S10, said John, and he is drunker than hell, ain’t he, Doc? At this point, the unit clerk yelled, Surgeon’s on the line! Just tell him to get his ass in gear. I’ve got two critical people here, and I need him to come in now, said Dr. Frei. Okay, said the unit clerk. Dr. Frei walked to the sink to wash the powder off his hands and noticed a Foley bag with blood in it hanging on the Michelin Man’s cart. He thought to himself, Well, I didn’t tell anybody to put a Foley into him. He has got blood coming out of his dick. You’re not supposed to be putting Foleys in somebody’s urethra when blood is coming out of it. Who put that goddamned catheter in him? Dr. Frei asked the nurses around the bed. I did. He needed it, the voice said from behind Dr. Frei. He turned and saw Jean, a good nurse but at times a frustrated doctor who took on more than what she was qualified for. You don’t put Foleys in dicks that are bleeding, you ought to know that, he said. Jean said nothing. Dr. Frei went over to the Foley bag and saw the blood pour out of the tubing and yellow urine was starting to drain into it. He thought, Shit, I’ll just leave it in for now. The blood pressure is coming up and his heart rate is coming down, said the nurse. Dr. Frei looked up to the ceiling and said to himself, Thank you, God. All this commotion had taken about one hour, and the surgeon walked in and said, What have you got, Kirk? Dr. Frei thought to himself, Look around, you dumb shit, don’t you see the drains and chest tubes? but he said to him, I’ve got an isolated head injury here on the vent, and that guy has got two chest tubes which are still bleeding and he is bleeding through his penis and he is on the vent, and this place has been a zoo! The surgeon walked over to the other doctor’s desk, sat down, and started feeling his pulse. After a couple of minutes, he yelled to Dr. Frei, Kirk, I’m in atrial fib again. I don’t know if I can take care of these guys or not. You have to. Whether you are in A-fib or not, you’re the only surgeon in town, Dr. Frei said.

Then he began to have thoughts about how long he had known this surgeon and how damn lazy he was! At that moment, he remembered the night he had called him to come in to see an elderly man with an abdominal aneurysm which was leaking. The guy’s BP was low, and when he came in, he had done the same thing—sat down and took his pulse! After Dr. Frei got him off his ass, he came back after examining the man and said he was going to get a CT scan on him to see if it was an aneurysm. At this point, Dr. Frei just looked him in the eye and said, That’s a damn leaking aneurysm. You can see it pulsating through his abdominal wall from here, so I suggest you get him into surgery right now before he dies in front of us! If that happens, we’ll all get sued! The surgeon was a Jewish bachelor from New York and was very sensitive to the word sued. He had been involved in four or five lawsuits already and had only been practicing for about ten years. Well, I guess you’re right, Kirk. Call the OR in. I did already, said Dr. Frei.

Dr. Frei shook his head, remembering the current two guys. He went back to the younger man who had the head injury and just stood there waiting for the results of the head CT which he had ordered earlier. The young man’s lungs and abdomen were okay and didn’t require any intervention. He thought if this guy was going to be a vegetable, die, or does he have a surgical bleed. No matter what, Dr. Frei was going to have to transfer him to another facility because the neurosurgeon at the hospital wasn’t on call. It seemed the hospital had nobody on call anymore, and Dr. Frei felt lucky somewhat that the surgeon was on call. The CT report came back and showed a huge intracerebral bleed and contusion with extensive mass effect. This wasn’t good. He thought, This young man is going to die. He asked the charge nurse if any relatives had come in for these two guys, and he was told the wife of the S10 driver was in the waiting room. He asked that she be brought back so he could talk to her. When she came back, Dr. Frei’s heart just sank, and he felt nauseated. Here was this beautiful, blonde-haired young lady who was about six months pregnant! He couldn’t help thinking to himself what a shame this was that she was soon to be a widow and that his unborn child would not know his father. Dr. Frei sat down next to her and told her the gravity of this situation. The young lady began to cry softly, and Dr. Frei got tears in his eyes as he was telling her about her husband and transferring him to a tertiary care center. She asked Dr. Frei a couple of times if her husband was going to die. He couldn’t and wouldn’t tell her what he knew. He just kept emphasizing the fact that the young man needed transferred. When he was done with her, he walked outside the ER doors to have a cigarette and cleaned his eyes and cleared his thoughts.

Hey, Kirk, Dr. Frei heard as he came back into the ER. This guy’s got a Foley in, and he is bleeding around it. You shouldn’t be putting a Foley in when there is blood coming out of the urethra! the surgeon yelled from across the room from the Michelin Tire Man’s bed. Dr. Frei walked over to him and said, I know that. Jean here put it in without my orders, but I left it in when I saw yellow urine start draining out of it. It has to be in the bladder. Well, I don’t know, Kirk, sometimes— At this point, Dr. Frei stopped him in midsentence and said, You can give me a lecture later. What are you going to do with this guy? His blood pressure is still low and he’s gotten two units of blood and four liters of fluid. Blood is coming out of both chest tubes, blood is coming out of his bladder, and his belly has gotten harder and harder. Maybe I better get a CT of his chest and abdomen to see exactly where the bleeding is from he said. If you do that, this guy will die. You know how long it takes for radiologists to read the films, especially at night. This guy has got a busted spleen and probably a transected urethra. You better call a urologist and get this guy to the OR right now. You’re probably right, Kirk. The nursing supervisor, who had by now come to the ER to see what was going on and give her customary comment, Not too bad, like she always did, no matter if they had one or one hundred patients, said that the crew was in the OR. You did a good job with those chest tubes and intubating him, the surgeon said to Dr. Frei, who nodded his head because he was on the telephone talking to the tertiary care center to transfer the young head-injured man. He got off the phone with making the arrangements just as the surgeon was walking out the ER, and he told him to let him know what he found in the surgery.

Dr. Frei walked outside again to have a cigarette and calm down. To him, this was a terrible end to his shift, which had begun at 7:00 p.m. and would end in another forty-five minutes at 7:30 a.m. As he took a draw off his cigarette, he was thinking that in the past one and a half hours, he had saved one person’s life and at least given a chance to another. Now he was thinking how many other people are left to be seen before his relief arrived. The ER was only staffed with one doctor per shift, from 7:30 a.m. to 7:30 p.m. and from 7:00 p.m. to 7:30 a.m. Why the extra half hour for the night doctor, Dr. Frei never figured out. When he came back in, he asked the charge nurse how many people were left to see, and she said, Only one. A twenty-eight-year-old, and he’s mad. He asked why the patient was mad, and he was told that it was because it was taking a long time to get seen by a doctor. Dr. Frei asked if he had been told of the situation with the two trauma patients, and the charge nurse said, He has been told many times, but he doesn’t seem to understand. This patient had been waiting about one and a half hours; he had come in about the same time as the trauma patients. Dr. Frei took the chart from her hands and read the complaint of this impatient person. It read Cough and congestion × 1 week and aching all over. Seen by family doctor 3 days ago, given antibiotics but no better. Dr. Frei said to himself, It is seven in the morning, and this son of a bitch has been sick for a week. He has already seen his family doctor, gotten medicine, and now getting angry because he hasn’t been seen in a timely manner because of the trauma patients! Dr. Frei was getting madder and madder as he stood there looking at the complaint. He turned to the demographic sheet and saw where it was printed Unemployed. Under insurance, it was printed Medicaid. Dr. Frei got livid. He raised his voice loud enough so that this person could hear him and said, This guy is complaining that he hasn’t been seen for this and he has been sick for a week and he doesn’t care that these two trauma patients were a hell of a lot more important than his goddamned cold. He walked back to this patient’s room and asked him what was wrong with him, and the patient said, I have been here three damn hours. I’m sick, and I need to be treated with some cough medicine with that hydrocodone in it because it is a bad cough. Dr. Frei was feeling the urge to rip this punk’s head off, but he looked in his throat and ears and listened to his chest and lungs and said to the man, Sir, you have got a virus, and I am going to give you a shot for your congestion and you can finish the antibiotics your family doctor gave you. Then in a more stern voice and look, Dr. Frei said, "You haven’t been here for three hours, only about one and a half hours, and I am not going to give you any cough medicine with narcotics in it, and I want you to know that I was tied up with critical patients and that this is an emergency room and those were emergencies that took priority over everybody else. At this time, the man said, You have a duty to treat me when I come here no matter what is going on in this goddamn place because I’ve got the card, and the federal government says you have to treat me. Dr. Frei said, You’re being treated, and I told you what is going to be done and how I’m going to treat you. This isn’t how you’re supposed to treat me. You’re supposed to give me stuff that’ll help me, like the stuff I told you, and if you don’t, I’ll have your job and report you to administration and the government." Dr. Frei walked away without any further comment, wrote the man his prescription, and discharged the man. He left without the scripts, yelling that he would call administration.

Chapter Two

Dr. Frei thought silently to himself how the medical system had changed over the years and how people such as this one were abusing the system and how the government basically let it happen without tight supervision. He also thought how the legal system and administrative people fed off this kind of abuse and how medicine had become a catering business profession and why physicians’ care of human beings was being governed and being dictated by nonphysicians. He thought of these things, and it made him sick. He had traveled far to get to this point in his life. He was born in Northern West Virginia to a career army officer father and a mother from a well-to-do working-class family. They had been divorced before Kirk could get to know his father, and it would be years later that he would learn the rest of the story from his father. The only real father he got to know was his mother’s second husband, Chuck, who worked at a monument company owned by his father. Chuck was a pleasant, nice man who cared for Kirk’s mother, Kirk, and Kirk’s sister, Jenni. Chuck had one daughter by his first wife, Belinda, and when Belinda’s mom died, she came to live with them. This arrangement turned out to be a life-altering event for Kirk over time.

Shortly after Chuck and Kirk’s mother were married, the family moved to California. For what reason, Kirk never found out completely. He was told it was because Chuck had a better job opportunity and life would be better. Later on, Kirk had put the pieces together and come to his own conclusion. Anyway, all Kirk remembered about this move was living in a small house in a clean neighborhood and all the black widow spiders around the foundation of the house! Kirk’s mother was always telling Kirk and his sister to stay away from around the side of the house. He also recalled going to school with a packed lunch and how one day his mother had packed celery sticks with the leaves still on them and how the lunch monitor forced him to eat the celery and the leaves! The leaves were bitter, and to this day Kirk despises celery! He also remembers going to Disneyland once, and while he was there, he got to see Red Skelton, a TV personality at the time, and his son who had leukemia and would die within a few months. He also remembered how the ride that Mr. Skelton was on was roped off and that Mr. Skelton and his son were the only ones on it! Kirk felt that this was a big deal, and it was only because he had money that Disneyland did this. The only other thing he recalled was a teacher one day had the class make statuettes out of clay and fire them in an oven. Kirk made one of an angel—for what reason, he had no idea—and when they were cooled, he painted his green with a flesh-colored face and hands. Why this, he doesn’t recall. Maybe it was dictated to him by the teacher whom he remembers as being a big woman with a great, big belly! Kirk’s mother later told him that the teacher was pregnant, and the day after this day, she had a baby! The next thing he knew was his mother was packing him and his sister up and they were driving back to West Virginia!

We have a combative thirty-one-year-old male coming in, and he is suicidal and cut his wrist, and he is bleeding pretty good, the charge nurse said. It was another night shift in the ER for Dr. Frei and up until now had been pretty quiet, busy with the volume of patients, but nothing exciting. Oh, Jesus, Dr. Frei thought, not one of these. Dr. Frei enjoyed trauma and the life-threatening emergencies that ERs were supposed to see and what he was trained to care for, but these types of people taxed everybody’s nerves. The patient arrived, yelling and screaming profanities, with both his wrists bandaged, and, by the look of the paramedics, had been quite a handful en route. The charge nurse told them to put the patient in one of the psych rooms, and by the smell of alcohol in front of the desk, this patient was also drunk. After a few minutes, the nurse assigned to him came to Dr. Frei and said, This guy is a real asshole. He spit on me, took the bandages off his wrist, and called me a slut! Dr. Frei could feel his face getting flushed and felt this guy may be in need of some chemical relaxation. He just chuckled to himself as he walked back to the room. When he got there, he found a fairly robust young man, yelling and screaming. He asked him if he was suicidal, and the guy responded, What do you see here, you fucking blind? I took a goddammed razor blade to my wrist so I could check on out. Dr. Frei asked the man to sit down, which he did, and he asked him why he wanted to kill himself. I caught my fucking old lady screwing my next-door neighbor you know, so instead of killing her and him, I decided to take myself out. Dr. Frei thought this was pretty stupid but didn’t say anything to him and proceeded to look at the man’s wrist. He took the bandages off both and saw numerous small shallow lacerations still oozing a little blood, not much, and told the nurse to put some antibiotic ointment on them and bandage them back up. At this point, the man said I don’t need them fucking bandages, they’ll be okay. Dr. Frei said, Okay and told the man that he was going to get some blood tests to see how high his alcohol level was and asked him if he wanted