When life outside of the hospital is filled with sunshine, dogs, gymnastics, and everyday adventures, stepping into the high-stakes, fast-paced world of the Emergency Department (ED) at St Joe's Hospital brings a different kind of thrill.
I have finally started working in the ED, and from the moment I stepped in, I knew this place was much more my kind of rhythm. I thrive in busy, chaotic, and unpredictable settings where a fast pace is necessary for survival—not just for the patients but also for the healthcare professionals. It takes a certain breed of human souls to thrive in the ED. It takes a little pinch of crazy, a scoop of backbone, and a sprinkle of empathy to be good at your job in an emergency department.
Stepping into the Chaos
Working in the ED is like fighting an aggressive forest fire—we put one out, and a new one flares up in an unending influx of patients. During my first four 12-hour shifts, I encountered various patients, including:
The YMCA Shelter Fire
One memorable incidents was dealing with patients suffering from smoke inhalation after a huge fire at the YMCA shelter in Hamilton. Eleven people were taken to hospitals, with four of them coming to St Joe's. The shelter is one of Hamilton's biggest, leaving a number of 173 people displaced after the fire. A big shout out to the Hamilton Fire Department, who ladder-rescued 5 people and search and rescued another 19. Luckily no one was killed but two patients were in critical condition. It was interesting to be at this end of the care, compared to being part of fighting the fires back home in Sweden.
A Life-Threatening Overdose
On the same day, a young woman came in with a heart rate in the upper 180s after an overdose. She was given adenosine, an anti-arrhythmic, and metoprolol, a beta-blocker, to slow her heart down. A number of healthcare professionals watched the medicine work its magic over just a few minutes. Surveillance is crucial, as you don't want the heart rate to drop too much.
Critical Dehydration and Stabilization
Another patient arrived with a critical situation: she had been vomiting and experiencing diarrhea for an extended period, which caused her veins to have too little fluid to create sufficient pressure. As a result, her heart wasn't getting enough blood to pump around. After administering fluids and potassium, she stabilized and was admitted to a medical unit for further care.
Seizures from Alcohol Withdrawal
A few hours later, a man came in experiencing seizures due to alcohol withdrawal. He was given benzodiazepines to help his body cope. Benzodiazepines are sedatives that can calm the nervous system, reduce the risk of further seizures, and help alleviate the symptoms of withdrawal.
Unique and Memorable Cases
The Stubborn Chicken
Another intriguing case involved a man who had chicken stuck in his throat. The physicians decided to use an endoscope with a camera to push the chicken down towards the stomach. The procedure proved more challenging than expected, and despite the patient being sedated, he was still moving, so I had to help hold him still. Various attempts to scoop, push down, and suction the chicken were unsuccessful. It wasn't until the physician performed numerous excavator-like maneuvers, essentially digging a hole through the chicken-meat-esophagus barrier, that the food finally passed. The camera then revealed the inside of the patient's stomach, and his airways were cleared once again. If I weren't already a vegan, I can confidently say this experience would have made me swear off chicken for good!
The Stoic Bicycle Accident
St Joe's specializes in mental care, and most trauma patients go to the general hospital on the other side of Hamilton. With that said, we got a stoic man who had been cut off by a car while riding his electric bicycle and crashed right into a pole. The man had then walked home to store his bicycle so nobody would steal it and walked to the ED himself, only to find out his jaw was completely broken, essentially splitting his face into two parts. We were a group of nurses and doctors who looked at his X-ray with astonishment.
A Chance Encounter
Another moving experience involved a missing person who was found by paramedics after lying in the same spot for two days. After receiving some food and water, the patient was released to return to their shelter home. That same day, as I was heading home from the hospital, I stumbled upon the person sitting under a bridge. I stopped and spent about an hour talking, offering water and asking open-ended questions about existence, guilt, connectedness, redemption, and the willingness to do better. I don't know if I made a difference.
A Second Fall and an Orbital Fracture
Another patient was unlucky enough to have fallen a second time after breaking his rib on the first fall. He got an orbital fracture the second time, causing the physician to fear that his eyeball would sink out of the socket. The patient was scheduled for acute surgery to save his eye.
Dangerous Overdose of Medication
Another patient was brought in after feeling the beginnings of an epileptic seizure and, in a panic, overdosed on his daily medication sevenfold, causing his Carbamazepine level to rise to dangerous levels. After drinking doses of activated charcoal every hour the patient was admitted to the step-down unit for observation to monitor his condition and ensure that his body cleared the excess medication safely. Active charcoal binds to carbamazepine and prevents the absorption from the gastrointestinal tract.
A Heartfelt Goodbye
One of the most poignant moments so far was when a patient, who had suffered a stroke and was picked up by paramedics, went into cardiac arrest in the ambulance on the way to St Joe's. Despite around 40 minutes of intensive resuscitation efforts, the patient did not survive. I was honored to be part of the team that cleaned the patient up before the family arrived to say their goodbyes.
Reflections on the Differences
There are big differences and many similarities between the Swedish and Canadian health systems. I will continue to grow into my role here in Canada and elaborate on my thoughts in another post. One thing that I really appreciate is that the ED provides its staff with scrubs, just like in Sweden. This feels both more sanitary and fresh than bringing them home at the end of your shift. I think all units should adopt this practice, not only for the patients but also for the health of the professionals, to reduce the risk of bringing contaminants home.
My first week in the ED at St Joe's has been an eye-opener, reaffirming my passion for working in such a dynamic and challenging environment. It takes a special kind of resilience and dedication to thrive here, and I feel privileged to be part of a team that makes a difference in the lives of so many people every day.
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