Promotion day (Romina)

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Promotion day (Romina)

Post  Malakiel on Fri Oct 26, 2018 3:27 pm

Jacobi Hospital in The Bronx Borough of New York City is one of the largest arrays of behavioral health services for adults, children, adolescents, and seniors in New York City includes inpatient care, emergency services, ambulatory addiction treatment, and more. This public hospital as in the entire New York City's HHC public hospitals are well known for providing emergency care to uninsured individuals, undocumented immigrants, as well as people who have non-immigrant visas.

The professionals there are not as well paid as their collegues in Manhattan but certainly show more commitment and sacrifice to carry on with the hippocratic oath. The medical staff is well suited to face any kind of health problems as their nurse staff as well. The infraestructure is in fine state and ready to attend all cases, however it's not as modern and probably half of the equipment have one glitch or two to make it 'run' properly.

Glitches that many times were solved as a part of the rutine, as recurrent as they were. The ER room was also called 'crazy town' many doctors tried to stay the fuck out of there and hopefully afford a private practice or if fortunate enough to be promoted in what is known as 'The Promotion Day'.

Once per year, the medical board of the institute decide to promoto or retire many of the medical staff. Vacancies are open in consequense to allow the lower ranks to rise. There was a certain order of things in the Jacobi, time of service as well as evaluations from your supervisors assure the promotion when time came to it. As it had come to Romina Passaglia a daughter of the second generation of italian immigrants to the US.

With four years and three good evaluations with 'above average' results, she was the perfect candidate to the dominoes effect vacancy that just opened as Leader of the Trauma shock team, whom was now ER Chief. This could mean an increase in her already diminished and grinded salary due to debt and morgage, as well as many opportunities for her in the future.

With all this in mind Romina was covering her second shift in night hours to get some extra money at the end of the month. With her in this shift were the ER Chief and two other physicians to attend to the madness that a full moon night meant for the ER, along with ten nurses and twice that in support personal as security, administrative, cleaning and coffee shop.


Last edited by Malakiel on Wed Dec 05, 2018 8:00 am; edited 1 time in total

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Re: Promotion day (Romina)

Post  Romina Passaglia on Sat Oct 27, 2018 4:55 pm

It was not a new experience, too do a second shift, and it was not a new "job", so to speak, but to get some extra cash.

That would be worth the hassle and the tiredness that tomorrow will bring. At least I know most of the people here, and they tend to be quiet and proffesional, even when some of our patients deserve no kindness at all.

I put a slight smile in my face as I started and so far, I had keep it, even when screaming, bleeding, vomiting people were screaming for attention.

The worst part is that the ones that yell the most are not the patients themselves, the screamers are often the ones with them that do not understand that you cannot yell here, because you make all patients, including yours, nervous.

But it has been a normal night, so far. Even the cops that brought suspects to be patched up are kind of relaxed tonight.
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Re: Promotion day (Romina)

Post  Malakiel on Sat Oct 27, 2018 6:01 pm

Not even at half the shift and Romina was already sweating even in this ice hell of air conditioner. Still she succesfully kept her composture and let the problems and situations just flow around her without letting any of that dig in. Suddenly a crew of paramedics came into the ER bringing a child of about 10 years old screaming on a litter despite the sedative and analgesic already running through his veins.

The child was with his mother a latin woman mid 30s crying worried about her son's knee. It was out of its socket heavily bloated and some movements made the bone show a little on one side. The boy was in the brink of shock to the pain and the damage itself to the joint.

The first of the paramedic an old coloured man of about 40 years old gave Romina the data table with the details of the treatment so far. Informing about the injury and the initial diagnostic of them while the other was holding back the mother despite her desire to hold her son's hand and the boy's screams in spanish as he got even more nervous as his mother was being taken from him.

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Re: Promotion day (Romina)

Post  Romina Passaglia on Mon Oct 29, 2018 4:03 pm

I am trying not to mop my brow, when the heat start to go up, even if I think that the hum of the air conditioner system is audible, even with the never ending noise always present in a hospital.

The smells are not that bad yet, so it must be working, and the complaints are mostly the usual ones, so...
the shift is becoming heavier. Or maybe I am getting older and tired? No longer a bushy tailed, bright eyed young thing..

When the area is informed that an ambulance is coming in, I brace myself, at the same time my body begins to move that way. Amazing what conditioning can do..go towards the danger, not away from it.

At least is not a drugged out man, fighting everybody. The ortho should be in, or at least on call.

I receive the patient, and before trying to reassure the mother, I try to reacah out to the kid. If he starts screaming it will be worse for him.

-Hey, Kiddo. We gonna get a Doctor to take a look at your knee ral quick, ok?-

I speak in English, injecting as much warth and reassurance as I can, hoping he understand as I do not want to hear about a complaint because I "assume" he should speak spanish because he looks latin. Stupid people.

Too hot. Going to have to get this child in a drip as soon as possible.
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Re: Promotion day (Romina)

Post  Malakiel on Mon Oct 29, 2018 9:42 pm

Rapidly enough after the first cares done by the paramedics to unmobilized the knee were provisionary and effective to a certain extent but of course certain adjustments need to be done to prepare the pacient for an X-ray. The first evaluation given by Romina was a dislocated knee with no internal hemorragy. She prepared herself to straight that leg with the help of a nurse from the staff.

The crying eyes of the boy didn't melt her heart because she knew this was the best for the boy and pain was just a part of the process. She didn't take pleasure from it, she was just brave enough to deal with life as it was. The first injection of painkillers was already in his system and all other medical messures taken before the procedure. An strong pull a crack and the boy fell unconciouss due to the shock leaving the cubicule again in silence.

The mother of the boy screamed in spanish several rigmarole at Romina but after the life signs stabilized and the screaming stopped she was happy and followed the paramedics back to the waiting room. The nurses started to clean the patient and order back the medical equipment while Dr. Strauss a traumatologist came to the scene.

"What's the status Romina?"

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Re: Promotion day (Romina)

Post  Romina Passaglia on Tue Oct 30, 2018 4:57 pm

-Hello, Doctor.-

I answer the physician as I remove my gloves to wash my hands, in part due to hygiene and also to refresh myself even if it is only a bit of fresh water.

-Patient is a minor that came in with a dislocated knee, with no bleeding or abrasions. The Paramedics inmobilized it, the patient was given pain medication and I straightned the knee just a moment ago. -

I finish giving an oral report, eyeing the cubicle to make sure all is in order, so I can do the written report and get back to work.

I glance again to the Doctor in case he needs something else.
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Re: Promotion day (Romina)

Post  Malakiel on Tue Oct 30, 2018 6:57 pm

Strauss looks at the patient and starts to do a first diagnostic of the boy checking other vitals like reflexes and pupils dilatation. He seemed concern about the boy with no appearant reason. Then he said.
"Add to the X-ray a full blood test. He has signs of dehidratation.

Let me know when I can see the results Romina."


Then the physician left the cubicle and she got the chance to take a closer look to the boy. He was indeed dehidrated but even more slightly pale. Curious about it Passaglia starts a more detailed review of the boy's body finding that, in the upper leg of the dislocated knee, the blood vessels were severely damaged almost like two hickies separated about an inch, indicating an strong suction in that area but no clue of what was the cause.

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Re: Promotion day (Romina)

Post  Romina Passaglia on Wed Oct 31, 2018 3:01 pm

I add the requested exam to the normal tests, snd try to figger out what could have caused those marks.

Some kind of localized allergy? Or was he playing with something with a suction strong enough to dislocate his knee? That would have broken the skin, most probably.

After writing the report and seeing that the battery of tests have begun, I go to find the Mother. Does she know what happened to this kid?

I hope is not abuse...
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Re: Promotion day (Romina)

Post  Malakiel on Wed Oct 31, 2018 8:35 pm

The father was already in the waiting room when Romina went to speak with the mother, closing up they both looked tired and very worried about their son. They were talking in spanish but when they realized Romina's approached the middle age tan woman stood up also very interested to talk to the doctor.

The man was a little older than the mother, eye bags, tan visage the kind you get for working many hours under the sun aside the ethic origin of the skin. Both were dressed as humble low middle class or workers, may be landscaping or doing home care labors.

The woman approached to Romina and very worried said in almost neutral accent.
"Doctor is Brian ok?"

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Re: Promotion day (Romina)

Post  Romina Passaglia on Fri Nov 02, 2018 3:36 pm

The knee jerk reaction of anyone seeing someone in scrubs is that they are Doctors. Sadly, most people either think doctors either walk on water or are idiots.

Me? I think they are regular people, some good, other not so good. I take in the looks of the parents and think that abuse is not likely. If they work so hard, they spend little time at home..

-I am the Technician that did the preliminary examination to your child. He is resting at the moment and we are doing his blood work...does he have any allergies we need to know of? The Doctor already saw him, and we noticed some bruising in his upper leg, like something sucked the skin, bruising it. Do you have any ideas about how he got hurt? -

I talk to both of the in the most soothing tone of voice I can manage. I guess that even if I told them my name they will forget it in a second, and I am wearing a name tag anyway.
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Re: Promotion day (Romina)

Post  Malakiel on Fri Nov 02, 2018 8:42 pm

The woman made the sign of the cross on herself and said, causing her husband to roll his eyes.
"That's la Marca del Diablo"

He man holds his wife gently by her shoulders and says.
"Please Maria, don't spook the doctor like that. There's no Diablo, those are superstitions."

but Maria replied.
"Those are not superstitions Humberto, it's the truth...

Doctor, little Brian is having nightmares about the devil comming at him at night. We even call Padre Bruno to bless the house but the power of evil was too strong for him."

Humberto says.
"Forgive her doctor, my wife is crazy. It may be a bug or something that stinged my son. Don't listen to her."
After this point there's just an argument in spanish of the woman forcing the man to apologize.

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Re: Promotion day (Romina)

Post  Romina Passaglia on Tue Nov 06, 2018 12:38 pm

I listen to what is being said without exppresion. I have been working with dying peope long enough to be an unbeliever and have seen things that cannot be explained by Science.

However that is something personal, that does not attain these guys..

-Ok, so this have happened before...but what about the knee?-

Because if you even had a Priest go to your home, this is something that have been going on for a bit now...but I doubt the knee happens all the time.


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Re: Promotion day (Romina)

Post  Malakiel on Tue Nov 06, 2018 1:03 pm

The couple argued for a couple for seconds about who will be answering the doctor. Eventually the husband said.
"Doctor we live in a flat in the second floor, is an old house here in The Bronx. The boy was having a nightmare and woke up scared and ran downstairs, the fall was very bad and he hurted his knee very bad."

The woman said.
"Yes... and how do you explain the marks huh?? did he made them himself? it is the devil!

Doctor I've seen shadows walking around the house! The devil is to blame he is hurting little Brian!"


The man started to move his head side to side in frustration and shame.

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Re: Promotion day (Romina)

Post  Romina Passaglia on Tue Nov 06, 2018 2:07 pm

I try my best to appease the man and calm the woman, even if I know for a fact that it will be difficult as both of them are nervous.

-He is going to be fine, ok? Brian is resting now and odds are he will be staying at least for a night under observation..but if he is so afraid that he is having nightmares, that may mean something is happening. Problems at school maybe? Is he having a hard time? Someone could be bullying him?-

Because if he was afraid enough to fall down so hard..something is happening.
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Re: Promotion day (Romina)

Post  Malakiel on Tue Nov 06, 2018 4:07 pm

After dialoguing with the couple for a few minutes Romina found out the boy's school name, rutine and general behavior which was to a certain extent normal. Except in night hours when the kid refused to go to his bedroom until forced by his father.

One of the nurses approaches to Passaglia to whisper in her ear.
"Doc, you're needed an eldery seventy something female with broken hip."

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Re: Promotion day (Romina)

Post  Romina Passaglia on Tue Nov 06, 2018 4:57 pm

Before leaving to continue working, feeling a bit tired and hot, I tell ask the couple if they are going to wait for news.

Strangely enough, some parents leave, perhaps hoping to avoid any inconvenient. But then, why have kids?

As soon as they tell me something, I go. I have many things to do, even if this case is particular.
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Re: Promotion day (Romina)

Post  Malakiel on Tue Nov 06, 2018 6:06 pm

The parents indeed will be waiting until their son was okey again.

After helping the eldery broken hip back on and attending to the third biker accident of this night alone, the results from little Brian blood test were ready. The kid had severe signs of anemia, in the clinic results at least however this was incoherent with the physicial diagnostic and observation, the weight of the kid was a little low but nothing that severe as the red cell count in the results.

The doctor asked the bioanalyst to repeat the test with the same results. Then he asked for a drugs and other substances detection tests that would be ready the next day.

<Very strange indeed.>

The kid was given a room to keep him in observation during the night. The mother stayed to sleep with him and the father went home since he had to attent to his job the next day.

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Re: Promotion day (Romina)

Post  Romina Passaglia on Wed Nov 07, 2018 12:32 pm

I complete the work, from the boy, to the broken hip, to the bikers in the same way, with the same approach. Clinical and a bit detached.

A woman doing this job cannot be too emotional, and she cannot be too hard, but a bit of distance is needed.

I find it curious, that the child is anemic. His mom does not seem the type not to feed him well, but maybe he is not eating well due to stress?

I check on them at intervals, when I have the chance, during the shift. There is something that does not sound right from all this. Something is wrong.
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Re: Promotion day (Romina)

Post  Malakiel on Wed Nov 07, 2018 6:51 pm

Eventually Romina's shift is over and she has sometime on her own to check on her only remaining patient, little Brian. The boy was in his room, talking comfortably with his mom, happy to sleep in the hospital.

On her arrival, Maria the mother stood up to receive the doctor. She was still worried.
"Hello doctor... are the blood test ready?"

The blood results came earlier but Romina didn't had a chance or the need to go and share with the parent the information. By the looks of it Brian was a little pale but not anemic, he seemed happy with his mother and all.
"Mama, is her the nice doctor?"

The mother turned in shame to see Romina saying simply... "Boys..."

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Re: Promotion day (Romina)

Post  Romina Passaglia on Thu Nov 08, 2018 12:14 pm

I simply tell the Mother.

-He just need to put on a bit of weight, He is still growing up, you know?-

Hoping that will be enough to put her at ease, as she is obviously worried.

-Hi, Brian. I was one of the persons taking care of you...how do you feel?-

I smile a bit to the boy. something I would not do to a grown man in the same situation.
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Re: Promotion day (Romina)

Post  Malakiel on Thu Nov 08, 2018 12:57 pm

The mother seems baffed by the weight but decides not to insist on her supernatural topic.

The boy smiles back.
"Thank you for taking care of me Doctora!"

Brian takes a breath and continues.
"I'm feel better... you've been nice to me."

He tries to smile again. Takes a breath and continues explaining that his knee hurts and tickles but not too much. It was now properly inmobilize so he can't reach the itching skin.

Romina takes a moment to look further into his health state, there were some signs of imsomnia, such as lip dehydration, mild eye bags and heavy breathing, probably worst by some degeneration process.

The mother says.
"Brian is been sleeping since you left him doctor."

Brian replies.
"Yes! I can sleep now."

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Re: Promotion day (Romina)

Post  Romina Passaglia on Thu Nov 08, 2018 1:34 pm

-I am glad you are feeling better, Brian. I know it itches, but your knee needs time to heal and you must try not to touch it, ok? -

I tell him, knowing that he may not listen, but hoping he will.

After I take a closer look, noticing he looks so tired, I decide to ask:

-Are you having trouble sleeping, Brian?-

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Re: Promotion day (Romina)

Post  Malakiel on Thu Nov 08, 2018 2:36 pm

-I am glad you are feeling better, Brian. I know it itches, but your knee needs time to heal and you must try not to touch it, ok? -

The boy nods trying to relax about it. Laying against his pillow.

-Are you having trouble sleeping, Brian?-
The boy seemed rather ashame to talk about it. He was starting to trust Romina, at least enough to test his luck in a middle ground, talking to her about his nightmares.
"I have nightmares... but only at home. I like to sleep in my granma's but she's old and my father says she can't take care of me."

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Re: Promotion day (Romina)

Post  Romina Passaglia on Thu Nov 08, 2018 3:50 pm

-Yes..if Granma is too elderly she may have trouble looking after you...-

I answer the boy, looking for a soft way to ask questions.

-Do you want to talk about your bad dreams? Sometimes that help..-

Because you need to rest, Kid.
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Re: Promotion day (Romina)

Post  Malakiel on Thu Nov 08, 2018 5:51 pm

The boy speaks softly, almost murmuring ashame to admit he is scared.
"My dad says are just dreams but for me are very real...

I dream about a demon..."
just the mention of it made his mother to do the sign of the cross.

"It is ugly and smells bad, no one can see it but me. My dad has entered the room and he can't see it. It's a monster ... and... and... it sucks my blood!" he says on the brink of tears.

His mom hurried to hug him and says.
"You see doctor! A monster, a demon! and no one believes me!"

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