On Saturday night/ Sunday morning last weekend, I had the pleasure and honor of working the longest, toughest, and scariest ER shift of my entire career. And I would love to do it all again. But not anytime soon! Here’s my diary from the adventure.
Saturday, October 10, 2009, 5:05pm: Arrive at the hospital, passing tailgate parties on the way in. Swoon over the forbidden aroma of peppermint schnapps and hot coco.
5:10. Collect ER doctor fuel (aka double mocha w/ whip) at the hospital Java House.
5:30. Walk across the street to Kinnick Stadium, check in for duty at the first aid station. Run inventory of the medications, especially checking on the quantity of ibuprofen available.
Iowa fans have a pathologic dedication to tailgating. I have actually done scientific studies on this and presented data on it at regional meetings. Most Iowa home games start at 11am. For these games, fans start drinking at 7am. Sometimes, the game is later, at 2:30pm. For these games, the fans start drinking at . . . 7am. Once in a couple of years, the Hawkeyes will play a special game at 7pm. For these games, fans will start drinking at . . . you guessed it . . . 7am. In 2006, Iowa hosted Ohio State in a highly anticipated night game. There was so much hype around the game that ESPN’s Game Day crew came to Iowa City, thrilling the locals. I worked the first-aid station that night, also. We stocked up on extra bags of IV fluids and arranged for an army of medical students to be ready to help with placing IV’s on all the hundreds of drunks we were expecting. Surprisingly, we didn’t see all that many. But we gave out more tablets of ibuprofen for fans with headaches than any other day in history (in fact, we ran out).
![]()
Why?
Iowans were so looking forward to the game that they showed up on campus at 7am, starting drinking, then stopped in the afternoon so they could sober up for the game.
We had 70,000+ Hawkeyes with hangovers!
5:55pm. Popped down onto the field to check out the new high-tech turf (not bad). While I was there, Kirk Herbstreit walked out of the tunnel, fresh off of his flight from Baton Rouge. I got to say hi and welcome him to Iowa while he chatted with Daniel “Lion Tamer” Murray, the place kicker.
6:00. I stood in the end zone, protected by the goalpost netting, under punting practice. Looking up at the little pigskin bombshell hurtling toward me, I marveled at skill and bravery of punt returners.
6:30. My very first patient of the long night arrives, after kicking his leg into the stands and getting a laceration to his shin. I start to sew the leg and show a medical student how to place his first-ever suture. He failed. In a quick pre-game rush, we see another laceration, this time on a finger, and 2 nose bleeds (one from trauma, one spontaneous).
7:10pm, Michigan kickoffs to Iowa with the temperature at 30 degrees and a wind chill 24 degrees, unseasonably cold for October 10th. I start seeing a man who is having frequent falls.
7:25. Finish with the man with falls (not a stroke, not syncope, and not an acute trauma, so nothing to worry about right now). He was the last patient in aid station; it emptied out right after game started.
7:36. Sit down in a wheelchair to enjoy the game on closed-circuit TV. The Wolverines and Hawkeyes exchange TD's. I am stunned by the Colorado- Texas score (14-3, 2nd quarter)
8:06. Patients start showing up again. I treat a broken toe and a man with SOB (that’s shortness of breath, not son of a bitch). Come to think of it, this patient was kinda of a pain. . .
8:36. Uh oh. Here come the hangovers. We treated three headaches at once. Also at this time, we discovered there is a 6 sec delay between the live game and our video. It sort of ruins the fun because we know before the play if the Hawks are successful.
8:45pm. Game at halftime, and we expect a rush of patients. I see that the Colorado - Texas score returned to reality. I treat a treat lip laceration from a fall in the stands onto the face, another headache, and a paraplegic with an upset stomach.
9:06pm. Halftime ends and the expected rush never materialized. Treat another upset stomach.
9:14pm. Watch a nice drive by Iowa, and treat a lady with back spasms.
9:36. I stepped out to the stadium tunnel to watch a series on the field. When I get back to the first aid station, we start an IV on a dehydrated drunk.
9:46. Another vomiting drunk comes in. Also, a woman brings her 10 month old baby in to change his diaper in a warm, comfortable place. She turns out to be Iowa TE Tony Moeaki’s sister and the infant is Tony’s nephew. I tell them that Tony is my favorite Hawkeye and I have met him a few times (which is not good when you’re a ER doc. That’s not a HIPAA violation, because Tony’s injury problems are a matter of the public record)
10:00pm. Uncle Tony scores the go ahead TD, his second of the night.
10:15. Florida beats LSU, which means I missed 2nd pick. Crap. Michigan driving, double crap. Forcier pulled by Rodriguez. Interesting.
10:29pm. Game winning interception by Brett Greenwood for Iowa.
10:30pm. My shift is supposed to start in the ER across the street, but I have to stay in the stadium until the fans leave. It can take a while for 70K people to file out, especially when they are celebrating their biggest win in a long time.
10:50pm. I arrive in the ER for the shift and take sign out from the person I am relieving. My first patient is the one patient I sent directly from the stands to the ER without evaluating him in the first-aid station. I love continuity of care! It turns out to be the right decision- he needed to be admitted, no question.
11:35pm. A patient with back pain and a herniated disc. And a nursing home patient with frequent falls
Sunday, October 11th, midnight: An older man with fever and cough. Probably has the “old man’s friend”, pneumonia.
12:30am. I saw a mom and her 6yo son with flu. Neither get Tamiflu prescriptions. Welcome to the rationing of health care.
12:50. Our first trauma “alert”, a man who fell 40ft out of a tree stand used to hunt deer. Both I and my resident wonder what he is doing in a tree stand when deer season doesn’t start for at least a month. (the last full moon was the Harvest moon when the fields start getting cut. The next full moon, still a couple weeks away, is the Hunter moon, when the cleared fields and bright moon make it easy to see the deer at night) Our head nurse, who is much smarter than both of us, remind us that bow-hunting deer season is in effect.
1:23am. I took sign out from colleague, the last staff physician on duty besides myself. I noticed that I hadn’t seen all that many patients and I have had time to chart and keep notes for this diary. It makes me think that it’s not all that busy. But these are dangerous thoughts for ER docs. We never say the “q” word or the “s” word while working. (quiet, slow)
1:45am. I supervise the anesthesia for aligning a badly fractured elbow. Around the same time, the paramedics arrive with a drunk who was found passed out in the bathroom of buffalo wild wings with his pants around his ankles. Not pretty.
2:00am. The ER is starting to pile up and I start to lose track of the patients (see entry for 1:23am, above), so I grab my intern and walk around to every room. She tells me about a cab driver who was assaulted by his customer. Rough job.
2:09am. There is a man here who walked into a metal sign, slicing his head open. An artery has been cut- it’s gushing down his face and I confirm the rate of pumping matches his heart rate exactly. I get my medical student to hold direct pressure on the head while I figure out how to stop it.
2:39am. A drunk student is brought in as a Jane Doe. Also, a crushed toe, another 3 drunks, and 2 young children with fevers. I am starting to feel a little anxious.
Approximately 3:00am. The gates of Hell, previously straining under the stress of the contained abyssal chaos, suddenly burst asunder. Yes, dear reader, at this point, all Hell breaks loose.
A mini-van with 5 teenagers swerved to miss a deer and goes tumbling into the ditch. Our helicopter and several ground crews have been dispatched to bring in the injured. We start seeing our department fill with injured teenagers on backboards, crying, faces crushed, and we do our best to keep up. One goes in trauma 3, then trauma 1, then room 23, then room 16, then room 11. We don’t even find out until over an hour later that they are all from the same accident.
At the same time, we have a woman who slipped and fell in the bathroom of the Union Bar, cutting her chin. And a patient with severe pancreatitis. And a teenager from a car crash with bleeding inside her brain (not related to the victims above). And, most frightening of all, a 6 month old baby in shock carried into the ER in her mother’s arms.
The baby is pale and listless. I am now officially scared shitless.
My mind went blank. My initial thought was, I have no idea what to do. But somehow, between the energy drinks consumed tonight and the milligrams of adrenaline coursing through my veins, I slowly calm down and let my training take over. His airway is open and clear. He’s breathing fine with a good oxygen saturation. But that color and heart rate is really, really bad. OK, so the problem is circulation. We can fix that. Does his heart need to be shocked? No, he’s not in an arrhythmia, his heart is just running really, really fast. Normal, but fast. I think. No, I know. I’ve got to know. I’ve got to be right about this. He needs fluids. Lots of fluids. As calmly as possible (concentrating with every word), I ask my nurse to start an IV and give a bolus of fluid. If she can’t get the IV with a minute or two of trying, I tell her, I am going to put an intra-osseous line into him (and intra-osseous line is a hard needle driven into the tibia to deliver fluid or medications. It’s extremely easy, fast, and effective, but we don’t line punching through bone if we don’t have to.) She gets the IV (her adrenaline level was pretty high, too) and we start treating the child. He starts to improve for now.
Remember that patient with the nasty head wound? Well, he’s still bleeding. Only now, he’s starting to go into shock. He’s getting confused, an elevated hear rate, and he’s starting to look a little pale. Unable to tie off the bleeder with sutures, I grab a staple gun and start shooting away into his head. I’m desperate, but amazingly, it works. I manage to get the bleeding stopped and we get an IV going so he can recover some of the plasma now decorating our floor.
The teenagers with the mini-van crash? They’re mostly fine. Just scared and a few cuts on their cheeks, chins, and eyelids. But one of them is having trouble speaking. Then he spits up blood. Then he starts coughing and choking on the blood from a broken maxilla (the bone for the upper teeth). We immediately put a tube in his throat to keep him from suffocating and the trauma surgeons, bless their souls, took it from there.
Our team was stunned by the onslaught of patients. Our resources were totally overwhelmed. But somehow we started to get a handle on the situation. The infant in shock had a line and labs and a bed in the Pediatric ICU. The head bleeding was controlled. The airway was protected from the broken face. The other boys and girls were bumped and bruised but somehow were safe. The two other children with fevers did not have dangerous infections. And I even found a moment to close the chin laceration from the Union Bar.
6:20am. I helped my intern perform a spinal tap on a patient who had been waiting all night for a diagnosis. The test was normal, thankfully. Meantime, my resident had a chance to revise my messy head staples so that it looked pretty good. And the patient was feeling much better.
6:30am. My relief starts her shift.
6:40. Closed another chin laceration on a teenager from the mini-van
7:05. The nurse of the really sick baby asked me to escort them up to the Pediatric ICU, “just in case anything happened”. The tests, so far, were normal. I started breathing easier when the baby was in the caring hands of the ICU nurses. I still can’t figure out what caused his problem. As of this writing, the case is still unclear, but a bacterial infection of the colon is the leading theory. If Gregory House were a pediatrician, this might be a good case for the show.
7:48am. I buy croissants from Java House for Sophie and Kristi
7:53am. Leave hospital 14 hours and 48 minutes after I entered it. It was the best croissant I’ve ever had.
Fight On,
Hans
