#I took my meds normally this morning and everything but I just feel weirdly tired

[gcldfanged]

@shotgun-blonde

The restaurant was converted from a building that was once an older style of housing- The type meant for poor people with run down, paper covered windows fluttering in the breeze and creaky steps. That evening, the windows were flung wide open, hinges squeaking not from airflow (which didn’t exist at all) but under the tension of old rot and humidity. Place looked like a dump, but it was sheltered, protected from the elements, and far cleaner than some of the alleyways Jae-hyo had the misfortune of camping out in during their wayward youth. Small luxuries like not waking up to the sinus-burning, acrid stench of urine were things that most normal, well-off people rarely- if ever- considered.

Waterfalls of chintzy beaded curtains tinkled in each doorway while a rather impressive (for the surroundings, anyway) aquarium cast an eerie blueish glow over the tables of chairs filled with a veritable gauntlet of old people- all lounging around and fanning themselves as they clipped their toenails and played mah jong.

The Commis was hacking away at a none too small pile of. Well, by the looks of it- Some kind of meat. That in itself wasn’t out of the realm of normal, but the irritated bob and bounce of a lit cigarette between their lips spoke otherwise.

“Jian dresses like a fat walrus covered in shit and I make more gil a week than he sees in an entire year. I don’t care what he offered you, you made a deal with me,” they enunciate with a few extra hard slams of the enormous cleaver in their hand into the juicy, oozing pile of what was starting to look less like a flesh brunoise and more like bloodied paste.

“Trying to stir up trouble now’ll just land you in jail. It’s not a good place. The food’s terrible and if I’m the one saying that, you know it’s bad.”

The chime of bells strung all over the backs of the double doors of the entryway made them turn their head, a dark brow arching when Freyja walked in with a disgustingly smug expression. That meant something was going down and as much as their suspicions disliked that, their ears were practically burning for some new gossip. Or work, whichever came first.

“Yeah, you do that! Fucking chump,” Yoon growled in parting, near chucking the PHS out the kitchen window.

A cracked porcelain plate laden with snowy pillows of flour-dusted dumplings was slid across the pass to the other agent.

“Okay, you look way too happy. Spill it.”

[scriptmedic]

Disaster Medicine--Brittany’s Personal Experience

Hey there everybuddy! Aunt Scripty here. Everyone’s favorite Brittany (of previous masterpost fame) is back on the block with a story from working in an ER during a flood!

Keep in mind reading this story that Brittany was a medical student when these events took place, and names have been changed to protect the guilty (I almost just typed “donkey” there; I’m tired. But protect the donkey!!)

Also, this post confirmed a suspicion I’ve had about Brittany for a while.... she doesn’t actually have a tumblr. THat’s why I keep not knowing what her tumblr handle is and scouring Medblrs looking, unsuccessfully, for her.

Clever, Brittany. Very clever.

And now, on to the post!

Hey y’all!  Brittany, back again.  I really do need to bite the bullet and get myself a Tumblr one of these days.  I wanted to do a quick post on something that’s more a personal experience than a medical overview this time, so we’ll see how it goes.  It’s not so much general writing advice as what I saw, but I figure at least parts of it should be universally applicable to a character in a disaster.  Feel free to steal whatever suits your fancy!

Earlier this year, I worked in the ER during a substantial flood that put about ¾ of the city underwater—the kind of thing that made national news, with people getting rescued off of rooftops, the National Guard swooping in, all of that.  I don’t have enough experience to speak to the entire disaster response, but the healthcare side of it was fascinating, so I wanted to write a little bit of that.

Our particular flood was so bad because it was a steady, heavy downpour that lasted for more than a week, rather than one really bad flash flood scenario.  That meant that it started off subtly enough.  That first morning, I kept getting flood warnings on my phone that pushed back later and later, and on my way in to work I saw a puddle on the way to my car, thought it was small enough I’d just splash through it… and before I knew it, I was knee deep, and not even halfway through.  After a quick trip back inside to change scrubs and switch shoes, I headed in in time to start the afternoon shift.

The ER that day was interesting; fewer people came because of the weather, but then, fewer nurses were able to make it in because they were dealing with closed roads and flooded houses. Weirdly, though, you still kind of feel distanced from everything there—no one was coming in for flood-related injuries, so it felt like the flooding got put on hold. Finished up around 10 PM, stepped outside, saw that it was STILL raining, and when I got home, my parking lot was flooded.

The next day was when it really started to hit that we were in trouble.  My hospital already had a minor nursing shortage, and as the weather got worse, there was a risk of them leaving for home, and being unable to come back.  So, right at their shift change, when maximum staff would be present, the hospital called a “Code Grey,” which was where certain personnel (ie nurses) had to stay at the hospital until further notice due to weather.  It was a problem for a lot of them because they had kids at home or in daycare, not to mention it’s not as if their own homes were immune from flooding.  Things settled into a strict structure for them; nurses who were absolutely sure they could make it home and back were allowed to leave briefly to grab an overnight bag and arrange things for their kids, and everyone was put on a regimented schedule of shifts and breaks with mandatory sleep times in the hospital’s auditorium.  “Non-vital” staff, on the other hand, was sent home and told not to come back until things improved.  (Petitions to count the hospital’s coffee shop as ‘vital’ were shot down.)

And from there, we basically had to roll up our sleeves and deal with what came to us.  We started to get more flood-related injuries that second night, with a lot of people who had slipped and fallen in the water, breaking bones/hitting their heads, hypothermia from staying in cold water, car accidents from the driving conditions, that kind of thing. I guess in movies or whatever, it’s always direct drowning, but it’s the indirect injuries that are actually worse/more likely from what I can tell. Even more notably, there was the delay in getting run-of-the-mill patients to us. One guy had your standard chest pain, but the ambulance got stranded in the floodwater—not drowning, just couldn’t move—and it was two hours before they could get a chopper to him and pull him out to the hospital.

I wasn’t sure if I could make it home and back that night, and even though I’m a student and could be excused, I didn’t want to.  It sounds selfish to say but, well, it was great learning for me.  Plus I wanted to help.  I stayed in one of the resident call rooms (think a teeny tiny hotel room for residents who are at the hospital for 24 hours; if their patients are stable at night, they go there to nap), and from there the days start to blur.  The major events I recall include:

—A major hospital near us closed its ER.  It was surrounded by water on three sides, with their ER about to go under.  They started evacuating all their critical patients to us in anticipation of things going south.  I don’t think they actually flooded, but to be safe, they had most of their patients moved to us, plus we were hit by more ER patients because there were fewer places for them to go.

—The National Guard moved in to help.  A friend of mine actually got some really cool pictures of the Blackhawks landing at our hospital, but the main result for us was they were ferrying in patients with a lot less thorough handoffs.  Normally, we get paramedics that will tell us about the patient, what field medicine’s been done, a list of conditions/medications the patient has, and so on.  It’s not until those are all missing and you’re staring at a delirious, blank slate patient that you realize how nice you had it.  And, hey, they were doing what they had to to make sure everyone got to safety, I’m not blaming them, but it did make our job more difficult.

—As time passed, we started to get more sequelae of the flood as well.  Someone who had cut their leg as they walked through dirty flood water on the first day, and came in four days later with a suspected infection.  A lot of dialysis patients who couldn’t get to dialysis and had their electrolytes all out of whack.  Patients whose seizure or heart failure meds had all gotten wet and/or been lost in the water and were now suffering from the lack of them, that kind of thing.

As things eased up a little and I hit a couple of scheduled days off, I decided to volunteer at the shelters as well, where there were medical facilities set up, and that’s a whole other ballgame.  First of all, I should say that the people who figured the whole thing out were awesome.  I think a couple residents who were supposed to be on vacation started the whole thing, basically roping off a couple of side rooms for a makeshift clinic in each of the major Red Cross shelters.  In those first few days, while national medical disaster teams all geared up, it was the local doctors who kept things running, and the response was surprisingly efficient/informal.  They basically all connected through social media, set up shifts, and asked for volunteers.  I know some doctors who didn’t go home for days because they were swinging between the hospital and shelters, but a lot were also outpatient doctors who, with their clinics closed, were able to devote a lot of time to the shelters.

And, as much as the doctors did, the other personnel there did just as much.  We had two teams of paramedics standing by to transport any critical patients to the hospital, pharmacists who were getting in touch with all the local pharmacies to get any meds we might need, nurses on triage, and so on.

About the same time as the rain stopped, the state/national disaster teams arrived—the thing about a flood is it’s hard to get into the area if you’re outside of it.  They definitely provided a lot more manpower, which everyone was very grateful for, but kept a very close working relationship with the local people.  The locals all knew the hospitals, knew which pharmacies were still open, and what the patient population looked like.  The two of them working together was absolutely critical; no heroic swooping in from the outside and taking over, it was a huge joint effort.

And… that’s pretty much it.  As always, I’m up for answering any questions!

(Also, re-reading this, I worry that it’s going to sound like I’m some hero or martyr or something.  No.  I was in a bad place at a bad time.  I’d like to think I responded well, but I was in no way critical to the response.  The actual doctors, nurses, techs, and paramedics—not to mention the search-and-rescue workers—were vital and amazing, but I was more an observer than anything else.)

And here’s your favoritest Aunty again! I hope this post was helpful and useful for all of you about what an ER might look like during a disaster.

I left the last paragraph in to show you all something interesting (I hope Brittany doesn’t mind). Med humans are less likely to give credit for good things happening than we are to take credit, at least in some situations. We often both blame the patient “I can’t get this IV, he’s got terrible veins”) and credit them (”I literally do not know how this guy pulled through”).

Take some credit, Brittany. “All hands on deck” means everyone from environmental to nurse’s aides to pharmacy to, yes, even students, pitching in, doing what they can, and Making Shit Run during the disaster.

xoxo, Aunt Scripty

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