Sunday, July 31, 2011

Curiosity Satisfied

I had a patient last night- a youngish man, very thin, with the most beautiful eyes I had ever seen. They were blue, cat-like, full of things unsaid, and fringed with jet black lashes that were long and straight. He came in for his swollen foot and was polite when I asked him if I could take his blood pressure and then take a blood sample.

When I looked at his veins, I found a long, wide streak of brown over one. It was the width of a quarter and a few quarters long on his skeletal arm near the crease of his elbow.

"What's that?" I asked with wide eyes.
"I used to use heroin."
"Oh..." I looked at it again. I couldn't help myself. "Can I touch it??"
"Sure." He was bemused by my request. I am not sure if anybody had asked him that before.

It felt like a large bubble, later I learned about how shooting-up can cause pseudoaneurysms beneath the skin, covered by a thin sheath of brown, leathery callous.

Some people who lose their peripheral veins from shooting up too much will go and use major vessels. The doctor on duty told me a story about seeing someone who had destroyed the skin and flesh in the upper thigh, creating a perfect funnel exposing the femoral vein.
My patient with the beautiful eyes had stopped using 3 months ago, but he already contracted hepatitis. I hope he stays off.


Friday, July 29, 2011

There's a Little OCD in All of Us

"Um... Um, nurse... I think I'm going to try again."
Mr. Antsy Pantsy looked so forlorn, disheveled, with worry etched in every line of his face.

"S, are you busy? Can you walk this gentleman to the bathroom?" the nurse asked.
"Sure, why couldn't he go before, just so I know?" I asked, looking over at the twitchy man.

Mr. Pantsy: "Um, excuse me. Did you want me to go in the cup? Because I just... can't. I can't. I can't. It's hard. I think the bottom of the cup touched the sink... do you think that makes a difference? It got dirty! It's too small. I just can't. Just can't."
S.(to the nurse, a knowing look): "Well, sir, how about this urinal? Do you think it would work better?"
Mr. Pantsy: "Well, I don't know. I don't think I can go. It is too much pressure."
S: "No pressure at all, sir, if you'll just walk with me..."
Mr. Pantsy: "I can't. I can't. You know, I don't think I can do this..." Nurse gives me an exasperated look. I try again, by walking forward. Mr. Pantsy follows reluctantly.
Mr. Pantsy: "I feel dizzy."
"Do you want me to hold your hand?" I grasped his cold little hand. He was shaking. "Your fingers are cold!"
Mr. Pantsy: "They're always cold. I don't know if I want to go back to the home."
S: "Why not?"
Mr. Pantsy: "Last night, the temperature wasn't set right. It was too hot. I kept thinking about it all night. I couldn't sleep much. I mean I did, but it wasn't good. I want my temperature to be lower. Oh God, I can't do this."
S: "Ok, sir, this is the bathroom, the urinal is right here."
Mr. Pantsy: "Can you put that right there? No, just there. Ok. I really can't do this. This is so stressful. I can't, I just can't."
S: "Please try, Mr. Pantsy, it would be really great if we could get a sample for the lab."
Another tech walks by, shuts the door, yells through it, "Just do it!", then says to me "I've had him before. He's always like this. In a few minutes, you'll hear a knock on the door and he'll say he can't do it. He can't help it, and it's sad, but it's a pain in the neck to deal with."

After standing outside the door for about 15 minutes, I got worried and knocked on the door. Are you ok in there??
"Yes, almost done. Can you come in?"
Mr. Pantsy was standing by the sink, staring at it.
"Mr. Pantsy, what's wrong?"
"I don't like water that's too hot or cold. My hands are always cold."
I turned on the tap and felt the water. It was cool. "What do you think, Mr. Pantsy?"
"It's cold! I want it lukewarm."
I turned the tap a little warmer. "How's that?"
"A little colder."
Third time was the charm. He began washing his hands. Looking fretfully at the soap dispenser, he gingerly pushed the button and a small dollop of soap went into his hand. He examined it closely and held it up to me, "is this enough?"
"I think it's just right, Mr. Pantsy"
"No, it is too much! Too much!" He began scrubbing his hands over and over. "I can't get it off!"
(about four minutes later, still watching him scrub) "I think you've washed all of it off."
"No, no! I haven't. It's still on my hands!"
"Sometimes, when your hands are clean, they feel slippery in the water..."
Finally, he turned the tap off and stared at the paper towel dispenser. "I don't want to touch it."
I moved the lever so he could take a towel and he ripped it out in a very ritualized way. "Did I do it right?? I have OCD, you know. By the way, I need two more towels." I obliged and pulled the lever again, twice.
"You did it just fine, Mr. Pantsy. Let's go and I will send this sample out to the lab."
"Wait," he looked down at his pants where some water had splashed, "I got soap on my pants!! Oh noooo."
"I think that's just water, Mr. Pantsy."
"No, I think it's soap! What do I do now? Oh God, I need to take them off and scrub them."
"That's really just water, Mr. Pantsy, I watched you splash it there."
"How could it be water? It's soap! I need to wash it off!"
"Mr. Pantsy, really, it's going to be ok. The water will dry and you won't see it."
He considered this and walked toward me, beckoning him out of the bathroom.
"Wait. I don't think my hands are clean. I'm going to wash them again."
And he rushed back to the sink and we repeated the ritual. He tried to wash his hands a third time, but he very reluctantly let me talk him out of it. I would have indulged him, judging how upset he got, but I had other patients to see!

Mr. Pantsy managed to get a sandwich and a ginger ale during the course of the night. The sitter who was watching him needed to go on a dinner break, so I sat with Mr. Pantsy for almost an hour. During the course of eating, he rubbed the bottom of the can of ginger ale. "I have to check for spikes every time I drink it," he explained. When he set his ginger ale down, three drops sprayed on him. It was barely noticeable to us, but a horrifying experience for him.
"I need a towel right now."
"For those three drops, Mr. Pantsy?"
"I need a wet towel! I need to clean this off!"
"Mr. Pantsy, I'm sitting with 3 people, I can't leave this area."
Another tech walked by at this moment and wet a towel for him.
"It's warm!!!" wailed Mr. Pantsy, startling the other tech, who mumbled something about ungratefulness and did not come back. "Can you get me a towel with cold water?? I can't use this. Take it away from me."
"Sorry, Mr. Pantsy, I really can't leave this area..." I said. "Maybe if you waited a few minutes, the towel will get cold..."
Mr. Pantsy looked crestfallen. He placed the towel gingerly next to him and burst into loud sobs.
"Mr. Pantsy, don't cry... Look, the doctor is coming to talk to you."

Mr. Pantsy was becoming increasingly agitated and began to pace around the hospital floor, ignoring any entreaties to sit down unless it was a specific, barked order with a sharp tone. He was miserable- so much so that the doctor ordered a tranquilizer cocktail to calm him down. With his discharge papers in hand, Mr. Pantsy declared he couldn't do anything with the paper and wanted me to take it from him because he couldn't read it without his glasses. He didn't like the idea that he could carry it back with him or put it in his pocket. He kept trying to hand it to me, so I instructed him to put it down next to him (and the towel). He couldn't help himself, though, and kept picking it up to try to read, then hand off to a person walking by.

Disturbingly, I understood him. I felt terrible for him, because I feel like I have been in the same paralysis and looped thinking at times. An hour after he was discharged, I saw him in the ambulance bay again.
"You're joking," I said to the ambulance drivers.
"Nope," they replied. He's back.

Thankfully, it was the end of my shift.

Thursday, July 28, 2011

To Be European?

Perhaps it reinforces bad behavior, but I can't help but scramble toward any commotion that I hear in the ER. I am drawn to the dramas that unfold as a person loses rationality. Everyone has a different way of acting out and it is difficult to tell how any one individual may be. For example, the quiet middle-aged man in the corner could suddenly jump up and attack a passerby without warning, the bratty college student might begin to scream in one pitch until she gets her way (or shut in the ambulance bay by herself), or the little old lady (LOL) might suddenly decide to throw out a few F-bombs, rip her neck collar off and yell at a nurse to get out of her room.

Today, it was the last one- My LOL, Ms. Stick, was making a fuss. She managed, with a thick accent, to curse several nurses out of the room after ripping her C-collar off.
The C-collar (cervical collar) is an uncomfortable but necessary device that holds a person's neck still to discourage nerve damage from shifting/fractured bones. She had fallen and broken her leg, and also previously complained of neck pain. The doctor went in to check to see if the C-collar needed to be re-applied.

Doctor: Hi, Ms. Stick, my name is Doctor and-
Ms. Stick: Are you the top doctor?
Doctor: Yes, I am the senior res-
Ms. Stick: Oh good, because I don't want to talk to anybody else. Doctor, I'm in so much pain!
Doctor: Yes, I know that. I have to make sure your neck is ok.
Ms. Stick: I did not break my neck, see? (starts to roll neck around)
Doctor: Don't do that! Just relax and I will check you out. (puts hands on c-spine) Does it hurt here?
Ms. Stick: A little...
Doctor:... well, we might have to put it back o-
Ms. Stick: NO! It doesn't hurt!!! It doesn't hurt!!
Doctor: ... does it hurt here? (continuing) Here? Here?
Ms. Stick: No, no, no.
Doctor: Touch your chin to your chest, like this. Does that hurt?
Ms. Stick: (grimace) A little.
Doctor: Well, now I have to put it on.
Ms. Stick: !! NO! NO WAY! Do the test again. I will answer correctly this time. It doesn't hurt here, here here here, or here! (waves arms emphatically)
Doctor: ... can we just try it for a little whi--
Ms. Stick: No!!

Ms. Stick was one of those unfortunate patients that has no visible or palpable veins. It was impossible to get an IV on her and Doctor had to come in again to use an ultrasound machine to find an artery on her ample arm in order to draw labs. I accompanied him as an extra pair of hands.

Me: Hi, Ms. Stick. I'm S and I am a technician, nice to meet you.
Ms. Stick: Nice to meet you.
Me: I would like to verify, is your first name "Hard"?'
Ms. Stick: Yes, it is.
Me: And your birthday?
Ms. Stick: April 1, 1930
Me: Thank you for answering my questions. We are going to draw some labs, Ms. Stick.
Doctor: It will be the last stick, promise.
Ms. Stick: They always have trouble with me. I like her, she is polite, unlike everybody else here. She must be European, like me!
Doctor: What about me??
Ms. Stick: I don't think so.
Doctor smiles at me- he is fresh from Eastern Europe, I am obviously not.
I held Ms. Stick's hand as we pierced her radial artery to get labs. It was like squeezing blood from a radish. We got most of them, but even with the artery, there was very little blood coming through.
Ms. Stick: They've done this before too. It is nothing they hadn't done to me before.

Ms. Stick had to go to CT scan, which would not take her without a collar. After another hullabaloo, we managed to send her there with it on. I give her credit: she is extremely spirited and independent. She had her own ideas and things were going to be done her way, because she is her own advocate for comfort and care. I liked her, despite the fuss- maybe because she reminds me a little of my mother.


Wednesday, July 27, 2011

Topsy-Turvy Tuesday

Returning to work today was a much smoother transition than I expected; people knew "my tech" and I were close, but as very private people, we never let them know how close. I am glad for our prudence and forethought. It would have been a nightmare otherwise, with prying minds and inappropriate questions asked of me all the time. I am thankful for all the kind souls who gave me hugs and acknowledged my silent smile as enough information.

It was also, for some reason, crazy-person day- not suicidal, just straight-up crazy. Everyone had a bad headcase in addition to whatever physical malady or ailment. For example, CP1 (crazy person 1) swallowed 2 checkers and a golf pencil. Later, he managed to spit one of the checkers up. The pencil has to be surgically removed, however. It had a very clear, very funny picture on the x-ray and ct scan. Something like this:

CP2 came in screaming. It was the kind of screaming that sends people running to see what is going on, but after a few seconds, sends them running the other way so they don't have to deal with the melodrama.
"My stomach!! It hurts so bad!!!" (GROOOAN), while she rocked back and forth a few times for effect. Then, she looked up, and would try again,
OMG it hurts sooooo bad!!!!
After being ignored for about 10 minutes, she saw me walk by and said,
Hey, I've been waiting ****ing forever and WHERE IS MY NURSE IT HURTS SO BAD HELP MEEEEEEEEEEEEEEEEEEEE!!!!!!!
I walked away just to see what she would say-
"tsk, forget you all", and she ran to the pediatric section of our emergency room, from which she was promptly wheeled back to be reprimanded by our charge nurse.
Sorry, when we have more than twenty-five people in our waiting room, you're just going to have to wait like everybody else. Especially when you're obviously being hysterical for no serious problem.

CP3 came in a bit drowsy and became progressively more narcoleptic as the afternoon turned into evening. The only time she woke up was when we drew blood, where she almost jumped on the tech who was doing it. I helped draw the blood as he held her down, but she thrashed around so much I was afraid to burst a vessel or be stuck by the needle. She said she would urinate, but kept falling asleep. At this point, it was determined that she must have taken something funny, so we had to insert a urinary catheter to do a drug-screen. It was relatively easy to undress her. Any protest stopped quickly because she would fall asleep, and one sleeve would slip off. Then she'd wake and start again, fall asleep, and we'd slip the other sleeve off. The best part was yet to come; we found out she is a genetic anomaly. Between three nurses, 2 techs, and a doctor, we could not figure out where her urethra was. It was a smooth surface from the top of the clitoris to the vagina. There was no hole!! Our lady had inserted two large tampons in her vagina for no apparent (menstrual) reason. The nurses bullied the resident into removing them. ("Well, I've never done this before!"=awkward male resident "Neither have we, hehehe"=nurses) At the smell, he excused himself from the room, thoroughly traumatized and in search of Zofran (anti-emetic).
We managed to find the urethra after half an hour of poking (If she didn't have a UTI then, she will now), we found an internal entrance to the bladder. How funny is that? CP3 kept blinking in and out, so she didn't feel much.

CP4 was one of our regular drunks. He is totally incomprehensible because he has 2 teeth left. It is difficult to tell when he is slurring and when he is trying to talk. He makes hand motions, but that doesn't aid comprehension in the slightest. Last time I got him a sandwich, he ate it, then urinated in the box as a present for me. Never again! Tonight, I ignored him to the best of my ability.

CP5 was Mr. Catch. He wheeled into my drunk tank section during my drunk tank shift and was passed out for a little while. Then, suddenly, he screamed, startling everyone in the room, "NO NEED TO CROWD, LADIES, THERE'S ENOUGH OF ME TO GO AROUND, THOUGH WHY YOU'D WANT A PIECE OF THIS IS BEYOND ME."
He fell back asleep and we sat in stunned silence before bursting into laughter.

What a night...

Edit: Saw Mr. Catch on the street. He asked me for money.
"Sorry, I don't carry cash"
"I take credit card"
(Smile) "ok"
"I was making a joke! Laugh a little! C'mon!"
Looks like he's been hitting the sauce again.

Tuesday, July 26, 2011


“Please, please don’t let me die”, she said clutching my hand. “Mandy, you’re in good hands, you’re in the best of hands”, was all I could say. This soothed her, but did not placate her fears. Her heart was beating over 140 beats per minute on the monitor- it had been for more than half an hour since she came into the critical care section where I was working that day.

A young woman a few years older than me, Amanda came in with terrible chest pain. When I placed her on the cardiac monitor and a pulse oximeter on her finger, we found that her heart rate was rapid and oxygen saturation very low. Unsustainably low. She was gasping for breath and bathed in sweat. Her large eyes locked mine and I couldn’t look away. Although the day was very busy, I stopped in her room every minute or so to silence the alarms that sounded for her elevated heart rate and breathing rate.

Soon after, worried about the effort it was causing her to breathe, the attending physician gently spoke into her ear. Amanda, we want to help you. We are afraid your body won’t be able to sustain the effort of breathing anymore, so we want your permission to put you to sleep for a little while and let a breathing machine help you. She did not have the energy to resist. There was something seriously wrong with her and she knew it. She had to put faith in the system, in us. Keep this safe for me, she said removing her engagement ring from her finger, S, thank you so much for being here for me.

She grasped my hand as I heard “Push the etomidate.” Help me, she murmured dizzily, help me, I don’t want to die. “Twenty of sux,” and her hand went limp in mine. Her sister and fiancĂ©e came in a few minutes later. Seeing her on a ventilator, he began to wail, baby, baby, I love you, oh God, throwing his arms around Mandy’s sister as the world spun around them. When they calmed down to soft sobs as we transported Mandy upstairs, I gave him her ring. I will never forget the look he gave me as his eyes welled up once more- "thank you so much for all that you all have done for her."

Finding out she died that night was like a physical blow. I was winded. I was with her at the last moment of consciousness she ever knew. What did I do to deserve that honor?

I am not sure, but in the months since I briefly flitted into the life of Mandy and others like her, I have found that there is too much in this world to live for and too many people who want to live who can’t.

Live, love, and appreciate the people you have. Anything can change in a moment.


Thursday, July 21, 2011

Now I Understand

I loved you. But it was not enough to move you. Now I know that no one was enough to move you.

The tech who taught me most of what I know is gone. He helped me get this job and tonight, he shot himself in his house. The whole department wept at the news.

He was gentle, he was strong, he was handsome. He had a heck of a sense of humor, always a smile on his lips and a glint in his eye.

He was a romantic, a real ladies' man, protective of the weak and persecutor of the lazy. He was always working, which is why he liked me, because I never stop moving when I work.

From him, I learned how to set a proper EKG, and how to apply cardiac leads. From his gentle manners, I learned how to approach an angry patient, how to lower my voice to calm them, how to be firm to establish command with a drunk. I learned how a long-term ER worker can maintain a sense of humor and composure. I learned how PTSD can ravage a soul. His eyes sometimes looked far away. I loved the way they refocused back onto me and crinkled into a twinkling smile.

We parted because I could no longer be content with being anything less than stuck to him. He gently affirmed his need for space with a sad, but firm resolution. He had demons, I knew, but I respected his choice to spare me from dealing with them. I would have traveled the world just to glimpse him again, but I accepted his choice.

Tonight, I think back to all the happy moments I spent with him- he, who taught me what chivalry is supposed to be, who taught me what it means to be brave, who taught me how to grin and bear it all. I'd cried countless tears for him, but tonight, the meter is reset- there are more coming.

Rest in Peace.

I'm Tellin' duh Troof

Mr. First-timer:

S: So it says on your triage note that you came in for back pain that you've been having for a month. Did you fall or lift heavy objects? How did your pain start?
Mr. First-timer: Well, when I was a kid, a car hit me.
S: That's when it started??
Mr. First-timer: Then, last year, I slipped and fell on some ice, y'know. Like, it was slippery.
S: Ok... anything happen recently? What made you come in today?
Mr. First-timer: Well, I went to the dentist last week, to get a toof pulled (points), and I got some percocets. And when I took them, I noticed, my back pain went away too... (expectant eyes)
S: ... I think I see. I'll let the doctor know.

This rookie obviously has not trolled for pain-killers before- that or he's just really honest.


Wednesday, July 20, 2011

Internet-Age Hippie

Mr. Pesto was an old hippie patient of mine who kept drinking protein shakes before he was admitted and went upstairs. He forgot his walker in the ER, however. I ran upstairs with it for him and he brightened to see me again. His wife had gone home and we joked for a little while about college basketball until his doctor came in.

S: Well, Mr. Pesto, have a good night. I wish you the best of luck.
Mr. Pesto: You too. Do you have my screen name?
S: What? No...?
Mr. Pesto: Well I'm pesto-something! Message me sometime so I can have yours! Maybe we can hang out. ;-)
Awkward S: Oh, haha- that's funny, um, ok. Good night!
The doctor grinned at me, apparently bemused. Needless to say, I won't be taking him up on that. No to long romantic strolls (alongside his walker), no to getting (protein) drinks with the bearded man and his wife.
What would Mrs. Pesto have thought!


Tuesday, July 19, 2011

Mondays are Crazy

I look at the chart. Chief Complaint: Pt states that the facility staff is Hitler and is trying to kill her.
I look at the patient: A heavy-set woman reading the Holy Bible out loud.

I walked by her bed in the hallway...
Ms. E: Hey Nurse!! Can you come here?
S: Sure... What's going on?
Ms. E pulls up her shirt. DOES THIS LOOK PREGNANT TO YOU??
S: I can't see by just looking. They'd have to look inside or you could give us a urine sample.
Ms. E: Ok. Can you look anyway?
S: Ms. E, let's pull that shirt back down. There are gentlemen around here!
Ms. E: Oh, ok! I'm sorry. I didn't realize. I don't want to scare anybody with my ugly body.
S: No, no, not ugly. They just don't expect to see it, that's all.
Ms. E: Not even in the emergency room??
S: Oh no, usually that happens behind closed curtains.
Ms. E: Ok! Thanks!

I walked by again, Ms. E is pulling up her shirt, scratching on her chest.
S: Ms. E, what are you doing?
Ms E: I gotta rash! One is between my legs and the other is under my breasts. Can you take a look for me?
S: I'm not a doctor, I'm sorry- can you let him know that when he walks by next?
Ms. E: Oh, Ok ok. But can you just feel it for me? The one between my legs is real bad. I want you to feel it.
S: How about I just let your doctor know now? I'll grab you a blanket too.
Ms. E: Ok! That way I can cover up when I scratch! You know (looks around) for the gentlemen around.

While taking vital signs:
S: Are you feeling pain right now, Miss Exhibitionist?
Ms. E: That's Exjhibitionistahh, but yes, only a little.
S: Ok, so on a scale of 1-10, 10 being the worst pain you've ever felt in the world, how much do you feel?
S: (Ok, I'll round down and say 10)...

Ms. E: Nurse, nurse! Can you help me?
S: What can I do for you?
Ms. E: Last time I was here, I brought a book called The End of Everything. Something like that. I left it upstairs. I was wondering if you could go up and find it for me.
S: I'm sorry, I don't think I can leave here. But what floor were you on?
Ms. E: I don't remember. Not even a lost and found?
S: There are lots of floors and lost and founds...
Ms. E's eyes start welling up with tears
S: But you have a book with you today, where is it?
Ms. E had clutched her bible close to her chest.
S: That's your bible, isn't it?
She smiles and nods.
S: You keep it close to your heart?
Ms. E: It is the good book.
I patted her on the shoulder and she seemed temporarily contented, flipping through her bible once more.

Suddnely, I hear a wail:
Doctor: We won't be doing an ultrasound. It's unnecessary.
Ms. E: BUT I WANT AN ULTRASOUND. There are babies in there!!
Doctor: We can figure out the same thing by urine.
Ms. E: Oh, ok. But I can't pee!!!
But after asking nicely, she was fine peeing into the cup.
Ms. E: (cheerfully) I'm paranoid-schizophrenic, you know. Thank you for everything! Here's the cup.

She had such a childlike innocence and I liked her. I hope they figure out what is going on with her.

Monday, July 18, 2011

Evening on the Helipad

I love working on the helipad. I am not there very often, but I always get a rush when I hear "lifestar tech report, lifestar tech report" on the intercom.

Escaping my normal vital-sign/ekg/bathroom duties with my moderately ill patients, I escape to the world above, with a special set of elevator keys and sprint onto the helipad. The weather has been gorgeous lately- though it is humid, it is always balmy and perfect up there.

My first lifestar was an adult trauma patient, who was driving unrestrained on the highway when she crashed. The second was also a trauma- a child, who when vaulting off a trampoline, fell on her head. She subsequently had tonic-clonic seizures at the hospital, requiring her to be intubated. Both patients were transferred very smoothly. It feels good to know that our lifestar medics really know what they are doing.

Watching the lifestar helicopter fly into the glowing sunset is my favorite part, though. As the pitch of the blades escalates, I wait for the note they hit when they start to lift off. Waving, I hope I could experience that, just once, sometime in my life.


Saturday, July 16, 2011

Drunk Tank Therapy

"Eww, he's here again," a tech near me wrinkled her nose. I sniffed the air- yup, Mr. Reen is back. (FYI Gross Little Fact: most of us can recognize our regular drunk folk by odor.) Soonafter, the familiar middle-aged man rounded the corner on his 200-something-th visit to our facility, curled up on a stretcher.

During my ordeal with Mr. Sunglasses, Mr. Reen was being medically cleared for the drunk tank. He was soon wheeled in and left in the corner spot, where he watched me from behind the see-through panel. I had seen him many times but never had direct contact with him until today.

"Hey Nurse." He peered at me, "hey Nurse!"
"What can I do for you, Mr. Reen?"
"I'm so hungry, can you get me a sandwich? But I can't eat turkey."
"Why can't you eat turkey?"
"It makes me sick and I throw up. Don't you have something else?"
"Oh, all I have is this turkey sandwich and some saltine crackers..."
"Not egg salad or tuna or ham and cheese?" This guy knows what's up. These usually come in the dinner trays that come at about 1800 in the back hallway.
"I don't think the dinner cart is here yet."
"Could you check for me?"
"In a bit, ok?"
He looked at me, "ok."

I returned to my seat. He watched me carefully.

"Nurse, hey Nurse," he called, "I'm gonna leave now."
"You know you can't leave. You just breathalyzed .273 about 5 minutes ago. You need to get down quite a bit more, near the legal limit."
"Hah, it won't any lower. I'm always drunk. If I get that low, I will have a seizure."
"Well, that's why you're here, so they can prevent that from happening."
"I have a seizure every other day. I drink non-stop."
"Ok, well you know the rules, you can't leave yet."
"Well, can I have a sandwich now?"
"I've got turkey."
"Never mind. Can I walk to the bathroom?"
"Sorry Mr. Reen, you're drunk and shouldn't be walking. You're going to have to use a urinal."
"You think this is drunk? This is how I always am. Usually I would still be drinking. But I guess I'll wait on that. But please, can you check to see if the dinner cart is here?"
"I'll have someone else fetch you a sandwich."
"Thanks, Nurse."

I barely sat down when I heard...
"Nurse, hey Nurse!" I ignored him this time.
"Nurse! Hey!"
"Nurse! I'm going to put my ******* fist through that glass."
I looked up at him.
"Don't do that"
"Can't you get me a sandwich? I swear I won't be a problem. I'm just really hungry."
I looked at him. Bedraggled, eyes half-closed, I couldn't help but wonder if the hospital system has been the only thing keeping him alive for a long time.
The security guard stuck his head in and asked if I needed anything. Sure, can you watch him for a minute while I grab him a sandwich?

When I returned, he looked so surprised that I really got him that sandwich. He thanked me profusely and scarfed it down, smearing the egg salad all over his face in his haste.
"Can you get me another one?"
"Not right now, there's nobody here to watch you when I'm gone."
"I won't run away, promise."
"You're going to have to wait, I'm sorry."
"I really appreciate it though, it was the first time I ate anything in weeks."
"Why is that, Mr. Reen?"
"I just drink. I use all my money for drinking. You can call me Lister."
"What is your drink of choice? Dubra?"
"Yeah, and mouthwash. I hid a bottle of it outside so when I get out of here, I can start drinking again."

"You hid a bottle of Listerine outside the Emergency Room?? Doesn't it burn going down??"
"Doesn't it make you sick or throw up?"
"Where did you hide it?"
"In the construction site. With my gun."
"Why do you have a gun?"
"I have lots of guns. I used to be a marine so I know my way 'round guns. I hated that ****. But today, I put the gun to my head, just like this, and it misfired. Twice."
"What do you mean by misfired?"
"I missed. I was drinking and decided it wasn't worth living and held it up to my head. It fired the first time, but the second time it didn't go off normal."
"So what happened, how did you get here?"
"My daughter was there. She started crying and called the cops. That's all I remember."
"How old is your daughter? Aren't you worried you scared her?"
"(shrug) She's 12. She screamed and started crying."
"How does your daughter feel about your drinking?"
"We hang out and drink together. Vodka."
"Has she ever come here?"
"No, she usually goes to (other hospital in the city)."
"Oh. She's pretty little to be drinking, no?"
"I started when I was 9 years old with my father. (shrug) I mean, she's 12, so she's not old enough for me to let anybody have sex with her or anything, but she's old enough to take care of herself."
"Does she live with you?"
"Yeah. I mean she's my daughter, you know?"
"Yeah... I guess... but whatever."
"Why whatever??"
"I don't like the way she treats her mother. I get mad at her when she tells her mother to **** off. (shrug)"
"So how did you get the gun back from her?"
"I pulled her by the hair. She screamed real loud. When I get out of here, I'm not gonna miss this time."

Lister was the only one in the drunk tank with me. He was happy to open up to me and stopped asking to leave (as if he had a choice). I took an interest in him and asked little leading questions as he told me about his life. A successful athlete and a naturally gifted mechanic, he won a lot of prizes boxing, regularly taking steroids and drinking. Showing me the large tattoos on his arm, he proudly proclaimed that he did them himself- drunk as a skunk, of course. He also had a pet project building and souping up his car. Drag-racing through the quiet suburban streets in a nearby town at 180mph a few years ago, he hit a pedestrian, killing him on impact, and ricocheted into another car pulling out of a driveway, T-boning and killing the driver in his own driveway. Mr. Reen, himself, was ejected through his windshield, breaking his spine and injuring several internal organs. Since then, he has broken numerous bones from falling or tripping in his inebriation. Both his parents were alcoholics; they and three of his siblings have already succumbed to death by drinking.

"My liver is already done. They told me. Last time, I turned yellow, then it stopped, and now, I'm starting to turn yellow again. I hope it kills me soon."
"How much do you drink?"
"Well, I can buy 4 gallons of Dubra for like 15 bucks, and I can finish that in 4 hours."
"(wide eyes) so, how do you end up here?"
"I don't know. I don't want to come here. I guess I just pass out on the ground and somebody calls. Once I woke up with 4 ******* IV's in my arms. They said I blew .780. I just want to end it all. It's not worth going on for."
"Have you seen our psychiatrists?"
"Yeah, but they don't do nothin'. I get sent here or there and get pills, then they let me go. I take the pills all at once when I leave and that's that. 18 vicodins, 20 dilantins. Whatever."
"Lister, why do you take them all at once??"
"I don't care. I just take them. Makes no difference anyway. Hey, can I go to the bathroom?"
"You can use a urinal."
"Look, my numbers might be higher than other people, but do I look drunk to you?" Not really, I decided.
"Can you walk?"
I took a chance on him.
He walked fine to the bathroom and back. A nurse looked at me, horrified, "I can't believe you're letting him walk." I ignored her and watched him dutifully go back to his bed.

"Listen, you're a real special girl. Just beautiful. If I had a nice girl like you, I'd quit drinking."
"I mean it. I'm not a bad guy. I just have a drinking problem. I just want somebody, somebody like you, to hold hands and walk down the street with, ya know?"
"You've been through a lot in this life, Mr. Reen."
The tech to relieve me from drunk tank duty came in.
"Will you come visit me?"
"Sure, Mr. Reen."
"Can you get me another sandwich, please?"
"Ok. Good luck, Mr. Reen."
"Ok, honey. Thanks for listening."

I visited him again half an hour later. He opened his eyes wide and said, "you actually came!"
"Yup- I looked in the cart, the sandwiches are gone. We only have turkey."
"That's ok, honey, I usually don't eat anything for weeks. Just alcohol. Thanks for the one earlier today."
"You're welcome. Hope the psychiatrists come for you soon."
"Ok, you have a good night, honey."

Walking home that night, I felt very uncomfortable; it's not the first time one of our regular drunks was released from the drunk tank one day, and blasted his brains out that afternoon. I was working in trauma when Mr. Crackers did just that. He left a mess of saltine crackers in the drunk tank that morning and was released. When he rolled in a few hours later, he had put a gun in his mouth and fired, brains spilling out when we moved him from the EMT stretcher to ours. I felt so sick- not because of the gore. We fed him! We were the ones keeping him alive all this time. Our sandwiches and saltine crackers was what was coming out of his stomach as we inserted a breathing tube. All the nurses who snubbed and kicked him around, the same ones that laughed when they sent him many times to the drunk tank were all of a sudden gung-ho about making sure this guy was kept alive, pushing me aside and rushing him upstairs... because he was an organ donor. My stomach turned.

Something just didn't sit right with me as I left Mr. Reen that night. I hope he's the type not to keep any promises.

EDIT: At work last night, I saw Mr. Reen. He had tried to kill himself by injecting himself with morphine, showing me the burst veins from where he missed. He was tied down in 4pt restraints, but smiled at me and asked me to come visit him again.

The Most Terrible Threat Recieved

"I'm going to find you after work and rape you. (salacious details) All of it will be recorded and sent to your parents."

He got reported and arrested.

In Which I Finally Pass Drunken Standardized Testing

In my first hour or two in the drunk tank last night, I had a colorful row with a regular drunk patient, who wore sunglasses all the time. He'd never seen me before, or, rather, he does not remember seeing me and immediately tried to test me.

"What is this? The ******* drunk tank?? I am not ******* staying here."
"Sir, you have to stay. You've been here often enough know the drill."
"I haven't been here in 11 years, you obviously weren't here so don't tell me what I know."
"Actually, I saw you last week. And I know that you know that if you get up, you will get tied down to the bed by security."

He made motions to stand up and leave. I looked him coolly in the eye and issued a final warning. He defiantly stood up, at which point, security came bursting through the door. Slinking back on his stretcher, he waited until they left to spew a series of curses, epithets and threats pointless to type out here for interpretive purposes with all the asterisks necessary to keep this story PG-13.

Then, he said, "now do your job and give me a m-f sandwich."

There was a time in the not so distant past that I would have been disgusted and upset. However, I had already met some of the wilier and more terrible patients, so I summoned the presence of mind to just keep my affect very flat, and replied, "Only if you ask politely."

"**** you. You dare disrespect me. I have to kiss your *** to get a ****** sandwich? **** you. I have diabetes!"
"Your sugar was checked as you were rolling in here. It was 115 half an hour ago."
"You smart**** ******* *******. **** you. You better watch your back. When you least expect it, you'll get what's ****** coming to you. My woman and I will give you what you ***** deserve. The city's a small place and one day, you won't see it coming, but you'll get your ******* mouth shut for you when we jump you after work one day."
"Well, ok. But don't get off that stretcher."
"Don't tell me what to ******* do, c***, **** you. You should learn your place as a woman, to respect men. I'm gonna kick your *** so hard and you won't know it's coming. Don't let your guard down, little girl, we're gonna get you."
"(sigh) I warned you not to get up. Now I have to call."
I reached for the phone. He stared, daring me to call, so I did. As security came through the door, Mr. Sunglasses scrambled back on the stretcher.

The conversation continued in a similar vein for a few hours. It took a lot out of me to keep it impersonal. When people lash out in these situations, I have found that they play good cop/bad cop, usually focusing on one person to treat poorly as an example to everyone else- today, that person was me. Every nurse, doctor, social worker that came in was told that I was a ******** ******** ******.

For example:
Doctor: so how did you hurt your head?
Mr. Sunglasses: Doctor, you're all right. I ******* hate her. (points at me) she probably was the one who did it because I don't like her.

Of course, such statements as this and others really helped articulate his irrationality much better than any report I could have given the doctor. Mr. Sunglasses obviously needed much more time to sober before any evaluation can take place.

Luckily for me, he described enough alarming symptoms to ensure his return to the main treatment area- chest pain, shortness of breath, severe headache, hypertension, hearing voices, uncontrolled diabetes, etc etc. So many apparent maladies... Unfortunately, none of them were deemed legitimate, because a little while later, after I heard his many loud curses protesting blood draw/urine samples/etc coming from the treatment area, he was back in the drunk tank.

"They want you to take his vitals, because I couldn't do it." The tech informed me.
"I don't like her," he said, pointing at me. He was noticeably calmer, so I decided to try my luck.
"Blow in this straw for me, Mr. Sunglasses, maybe your numbers are getting lower so you can get out soon."
He blew in the straw for me and after a bit of cajoling ("This is for your own health!"), he allowed me to take his vital signs.
I slipped a blood pressure cuff on his arm and he got a good look at me. Maybe he meant to intimidate me and make it look like he was going to remember my face in order to jump me on the street like he promised a few hours ago. Increased sobriety really calmed him down, however, and he was not as combative as before. (or maybe he received calming medication from the doctors in the treatment area... I'm not sure)

The nurses soon changed their minds again and wheeled him back to the treatment area for good. I felt a little giddy; I didn't let him get to me. It was the first time I officially passed the drunk tank test... and that's when Mr. Reen, on his 270something-th visit rolled in. To be continued...


Friday, July 15, 2011

Cute Comes in All Ages

My 90-something year old trauma cutie. Sweet as pie. She was gardening, when she fell forward, hit her head and broke both wrists. Ortho doctors put both her arms in casts and when they were done, she laughs and says, don't come too close now, I can karate chop you with these things.
My other trauma patient was a very worn-looking middle-aged woman who got punched in the face and passed out. She was a heroin-user who used 3 whole bags a day and wanted to go to detox. Compare this with my hipster kid a few posts back who took 30 bags/day. If you want to age well, heroin is definitely not the right elixir of life for you.

I was helping take vital signs, when I heard a high voice behind me. "Excuse me, my mommy needs to use the bathroom."
"Where is your mommy?" I asked the young boy.
"In room 5, miss."
He joined his sister when we walked in the room, and I asked "Mommy" if she could walk. Only with assistance, she said.
"Would you prefer a bedpan?" She shook her head. "Then how about a commode?" Yes, she nodded, that would be great.
As I left the room, I heard "Mommy, what's a commode?"
These things are ridiculously hard to find when you need them. They're the kind of supplies that pile up in a corner somewhere because they're everywhere and get in the way. Then when you try to find one, there are none in sight. I ran around the department for 10 minutes looking for them, before I finally found one tucked in the back of the decontamination room.

I set it up and cleaned it, taking it in the room. "Now you two goobers get out," the mom said.
The boy and girl left the room, not before the boy pulled the curtain for her.
"Now would you two like some juice or something while you wait?" They nodded excitedly, "Yes, miss, thank you."
As I grabbed a few apple juices and graham crackers with peanut butter for them, I thought about how innocent they were, how they didn't know the patients they saw around them were our rude-mouthed homeless drunks and surly psychiatric patients. What a stark dichotomy of good manners and poor within a few square feet.
When I cleaned up and left the room, I heard the little boy whisper "mommy, that lady was really nice to us." I hope I never forget to be.

Thursday, July 14, 2011

Urgent Nonsense

Patient 1 had her toe stepped on 3 weeks ago. The pain was suddenly unbearable, so she came in today, wearing really cute sandals, baring all her toes. I can see how they got stepped on...
X-rays showed nothing, so she went home with a post-op shoe. Very cute, but a bit clunky for my taste.
Patient 2 had an abscess on her buttock. She hyperventilated to freak herself out, then screamed before the lidocaine (numbing agent) even went in. She didn't want to admit she didn't feel the pain anymore, so she screamed at times she thought were reasonable for pain production. If she is like this for popping a pimple in her (well-padded) butt-cheek, I really feel bad for the nurse on duty the day she has a baby.

Patient 3, Ms. Excuses, wasn't really our patient, but she said she was here last week. She needed a work note to replace the note she had "lost."

Me: Hmm, Ms. Excuses, let me check for you... How do you spell your last name?
IE: E-x-c-u-s-e-s.
Me: Ok, that's what I thought. What date were you here?
IE: July 6, and the doctor gave me the whole week off.
Me: Hmm, Ms. Excuses, I don't see you in our database.
IE: (Wide-eyed) Oh! But I was really here. I was here twice for the same thing... The first time was in April, where they gave me prescription xyz, and I came back last week to get another one.
Me: Ok, Ms. Excuses, I'm looking at all records with your last name through April. Is your first name "Illegitimate"?
IE: Yes, that's me!
Me: Ok, you're right. You were here two times. The first time was May 3, where it says you eloped. You left without being seen.
IE: Oh yeah, that's because it just took so long and I was feeling better... (trails off)
Me: (continuing) You were also here on June 1, and the x-ray did show you had a small amount of fluid around your knee.
IE: Yeah, so I was wondering if I could get a work note for when I was here last week. I can't believe I'm not in the system! Computers these days! (increasing nervous pitch) But yes, I had a note for the whole week.
Doctor: Well, we can write you one for when you were actually here. (writes note for June 1, able to return to work on June 2, gives to Ms Excuses)
IE: Ok, thanks Doc!
(returns 5 min later)
IE: I just wanted to make sure- is this a 6 or 7? I see you wrote over the 6, and I just wanted my employer to know for sure that it's the right date.
(Doctor writes new note with "JUNE" and hands to her.)
IE: Thanks Doc! Have a great night.

You, too.
(Thanks Dave H. for image sources)

Wednesday, July 13, 2011

Catch Ya Next Time

There is a sizable population of "regulars" in our Emergency Room. Usually, they come in every day or so for a spell, then drop off to visiting every once in a while, as if to remind us they are still around. What happens to them in this time in between? Where do they hang out? What do they do?

I was jogging in my fair city today, when I caught sight of Mr. Catch walking around carrying a large backpack, perhaps with all his belongings. He looked at me, but I looked away and continued jogging the way I was going.

Mr. Catch was once probably very much so a catch. Tall, lanky, handsome, he had the deep, steady gaze that might have palpitated many a fluttering female heart before his eyes glazed from too much drink and hardened from homelessness.
The first time I saw him, he had just woken from a nap and talked to me comfortably. Because he was well-known as an elopement risk, I was to be his sitter. He was shivering, so I made sure he was warm enough with a blanket and slipped a pair of hospital socks on his feet. He was very polite and called me miss, apologizing for being in his state. He was determined to quit drinking, he said, and was feeling great.

A patient's family member walked by carrying a Gatorade. Mr. Catch asked the kind man if he could have it- I raised my eyebrow at the resident who was watching. The resident nodded and Mr. Catch enjoyed his gatorade, giving me a smile and wink. He decided he was feeling so well that he got up before I could stop him and tried to ask the resident if he could leave soon. As he was standing up, he suddenly contorted and I caught him before he hit the ground as he began shaking uncontrollably in a grand mal seizure. The resident joined me and together, we lowered the rest of him to the ground, turning him on his side.
We transferred him onto a spine-board, then stretcher, and he was carried off to the critical care section to be treated.

Three days later, Mr. Catch was back, with plenty of alcohol in his system this time. It had been raining those two days and he was still wearing the socks I placed on his feet. They were soaked through, as was he, and a foul smell emanated from them, permeating the whole hallway. An exasperated nurse asked me to do something about it.

Peeling off his shoes, then socks, I definitely made the problem worse for a little while. Another tech came by with soapy wet wipes, and we both attacked the source.
Then, I took a few bottles of peppermint spirit:
The first I hooked up to the compressed air chamber with a nebulizer, to disperse the odor eliminator in the air. The other I placed on the countertop near his feet, using gauze as a reed dispenser of sorts. This worked well, until I walked by later and saw him awake and sniffing the peppermint spirits. "Just like peppermint schnapps!" I moved it out of reach.

A few nights later, I went with a co-worker to a local bar to de-compress after a stressful day. I thought of Mr. Catch and told her the story about when we caught him before he hit the ground during his seizure. I stopped dead during my story because the man walking outside the panoramic bar front window was very familiar. He turned and looked into the bar before walking off. Mr. Catch was looking for his next drink, perhaps.
I have since seen him several times on the street and always wonder to myself if he recognized or remembered me. I hope not. Fortunately, so far, we've never made more than cursory eye-contact.


Tuesday, July 12, 2011

Jailbreak Week: What Else Did You Put Up There?

I knew it was too good to be true. It has only been a week since I've been in the drunk tank; I've been stationed there several times since, but people have been nice enough to take that shift from me, knowing my particular dislike for being there all the time.

Alas, last night, I wasn't to be spared.

It happens to be jailbreak week, for whatever reason. Police are patrolling our halls instead of the streets, keeping an eye on those in custody. When prisoners flip out and give themselves health issues, they can come to the hospital to be 'coddled and catered to', as one cop put it.

My first few hours were in the drunk tank, which was converted to psychiatric patient overflow. For some reason, they are pouring in this week (and it's not a full moon yet). One of my patients put me on edge; she had been there before, violent, verbally abusive, manipulative. Luckily (for me) or unluckily (for her), whatever drugs she had taken were making her delirious and nonsensical. She couldn't keep her concentration long enough to make any real demands or implement any plans.

Then, I took my dinner break, was yelled at by charge nurse for doing so, since she needed me to sit. Were you on dinner break? Yes. Did you tell anybody? I wasn't assigned on the sheet, so no. I've been looking 45 minutes for you. That's absolutely incorrect- I took 30 minutes. 45, she insisted. Ok, well, where should I be sitting? She chided me some more, then sent me to the obgyn room. (Nurse power trips are so sad to watch. Don't bully techs!) Lucky I took my break; I wouldn't have gotten one if she found me a minute sooner.

My lady Tina was in custody. I was instructed to never take my eyes off her and to take any wires or cords away from her. She had apparently tried to hang herself in our ambulance bay. Tina, upon seeing me, demanded a sandwich. I said, I need to ask the doctor. Oh no, I can't wait, just get me one since I've already had one! It's ok! The other tech came in and gave her a sandwich. I looked in the trash pail, she had already eaten at least one. She snarfed it down in less than 2 minutes.

She then settled under her blanket and proceeded to masturbate. The blanket was thin, she was naked under it (for fear she'd hang herself on a hospital gown with laces), and the stretcher was moving. When I walked over, she stopped, then after a few seconds, started again.

Great. Now I feel like a pervert.

The OB-GYN resident came in and needed me to stay there to do a pelvic exam. The drunk, non-English speaking trauma patient I was also watching had to be watched by someone else as I stayed in that horrific room.

"So how many partners do you have?"
She shrugged. "I don't even know"
"20? 30? 50??" as she shook her head.
"More?" She nodded.
"Ok... any history of STD's?" She didn't answer.
"So what else did you put up there?"

Tina had taken a whole box of tissues and stuffed them one-by-one into her birth canal. The resident took a large speculum and some speculum tongs and fished out the foul, blackened plugs. Upon irrigating the area with water, all of it splashed out onto the sheets and the floor.

"Whoops, looks like I made a mess," he exclaimed and hurriedly left the room, never to return. With the help of a nurse, I cleaned the room of the water from Tina's netherparts and returned to sit down. "I want a sandwich! Can I please have a sandwich? I'm so HUNGRY. They don't feed me in there!"
"Tina, you've had 2."
"One," she corrected me. I rolled my eyes.
She kept pleading, nonstop, and at this point, I was really annoyed. After a few hours of this kind of slow abuse, it really adds up!
I asked the volunteer to go fetch a lunchbox, which she also scarfed down in less than 5 minutes.
She then proceeded to her after-meal exercise, which is to say, the sheets started moving again and the stretcher started shakin'.
Edit: Mind you, one of her hands was cuffed to the stretcher, so she only had use of one for eating... and other purposes...

The resident came in to give her discharge instructions and an antibiotic. They were set to go, but the officer needed hospital-jail paperwork, so we asked the resident, and again, and thrice. An hour later, I left my sitting duty (against my credo) to ask one more time, to see the doctor chatting with others. He dismissed me in an annoyed way and said, I'll get to it in a minute when I'm not busy. His minute just to print out a sheet of paper was 3 hours of time- mine, the officer's, and the patient's, who was still enjoying herself this whole time.

These are the nights that will make me burn out. I don't think it's ego- I'm not averse to working hard or under people- it's just that one can only stand for so much mental abuse such as sitting without repercussions.


Monday, July 11, 2011

Jailbreak Week: The Smiling Hipster

According to
Hipster \hip-stur\n.
Definition 1: Hipsters are a subculture of men and women typically in their 20's and 30's that value independent thinking, counter-culture, progressive politics, an appreciation of art and indie-rock, creativity, intelligence, and witty banter.
Definition 2: Usually has some degree of monetary conformability, although sometimes only because of their parents, due to cost of living...
Definition 3: The Hipster walks among the masses in daily life but is not a part of them and shuns or reduces to kitsch anything held dear by the mainstream.
Definition 4: Aged indie kids, Hipsters still maintain the air of snobbery, still shop atsalvation army, and still have a completely astonishing array of knowledge when it comes to obscure music, pop-culture non-sequiturs, and political sneers.
Definition 5: Referring to young people of around 18-30 years of age, who drink cheap beer (most often Pabst Blue Ribbon, on occasion Budwiser), smoke Parliaments, Lucky Strikes or hard to obtain foreign cigarettes (such as Gauloises) and take recreational drugs, coke being the most popular. Use a great deal of sarcasm, claim to be ironic. Are usually less than 5% body fat, drink copious amounts of coffee and eat children's cereal.

Check check check x5.
He was smart, he was well-spoken, and he was also a heroin addict. He informed us of this in a nonchalant, sing-song-y tone. He was in custody when he tried to hang himself and ended up as a trauma patient on my shift. Because he had "suicidal intent", I was stuck sitting with him, even though I was supposed to be working in the trauma bay.

Alex was very thin, younger than me, with translucent skin. His long eyelashes made his face look innocent, but looks can be deceiving.

He listed all the things he had done as if none of it mattered- in addition to heroin, he took cocaine, but he wasn't worried about the cocaine, just the heroin. So how did he pay for it all? (He looked around with wide eyes- this is all off the record, right? The cop chuckled.) He sold drugs in order to buy drugs. He also lives in an extremely affluent neighborhood with a good friend whose father was a millionaire who owns a successful local business. He had been through college, partially, till he discovered his predilection for narcotics.

He also added serious points to my street cred: So, a bundle of heroin is 20 bags. He takes a bundle and a half to two bundles each day. In each bag, there is about 50mg of powder. In the northeast, the purity rate, according to various online sources, is about 75%. Therefore, if he is taking 1.5 bundles, he is using 30 bags, which is 1500mg of powder, of which 1125mg is pure heroin. >1 g of heroin a day. Mein gott!

Alex had never thought about detox or trying to get better. He described drug-euphoria for us and charmingly made everyone laugh. He keenly grilled the cop about various checkpoints and code names in the city, even offering to help him bust drug dealers.

"Oh Alex, we got to get you out of this life." Nurse 1
"Oh Alex, you don't belong to that world." Nurse 2
"Oh Alex, you gotta find new friends, we can help you get to a program. You're too smart for this." Nurse 3

Everyone was so charmed, but I had a few pointed questions for this young gentleman who answered everything with a smile. I sensed a hint of triumph in his face- one that said, that was too easy.

"So, just between us, did you really want to kill yourself?"
"No, actually," answered the honest lad, "I made sure my feet were partially on the ground when they found me."

I heard a mental gasp from everyone around me as the facade of honesty and pure youth lifted from their faces.

"What? I just didn't want to detox in jail. I figured the hospital was the best place to be."

The injuries he sustained on his neck were from the warden, who really held him up the wall and punched him for faking it until the ambulance arrived.

"So," Alex tried his luck, "Officer, you're a good guy. Can you turn around, I'll take this neck brace off and take off, and you can tell them that you never saw me."

Ah, the hopeless romance of youth. He simpered, smirked, and made love to us all (who knows the reference?), but to no avail; he stayed in custody and stayed in our facilities for the night.

Nice try, hipster kid.
The happy hipster is an oxymoron. The smiling one is just a snake in the grass.
Bye Alex, best of luck, because you really are a smart kid. Here are some discharge instructions from another facility that says it perfectly:

Till tomorrow!

Problem Solving

Here's a real life riddle for you:

If you were a homeless drunk and it was unbearably hot/cold outside, what can you do to stay in the comfortable Emergency Room drunk tank indefinitely without getting kicked out/sober?


In the shuffle at the ambulance bay when you're being registered, discreetly stow a handle of vodka under your stretcher. Sleep through the tests and scans and become medically cleared for everything but drunkenness. This is how you get to the drunk tank.
Warning: don't get caught trying to access your liquor in order to spike your apple/cranberry juice that comes with your free turkey sandwich lunchbox. The technician will call security, have your alcohol removed, and have a good laugh with everybody at your expense.

True story.


Saturday, July 9, 2011

Adventures in Sitting: The Core of a Human Being

The whole section was full, which was not an uncommon occurrence in my Emergency Room. The rooms were all occupied and the hallway was crowded with stretchers. I was making my rounds by looking in the rooms to see who were my sickest patients. Out of the corner of my eye, I saw a large grin. I looked up to see a patient waving at me, smiling.

The closer I came to him, the stranger the sight. His forearms were wrapped in bloody bandages and he looked to be sitting in coarse black soil. His hands were black, and on closer inspection, I realized they were black from dried blood. The "soil" was also dried blood. He was covered from head to toe in it, like a cracked body-suit of red-black paint chips. Juxtaposed with his bright smile under a baseball cap, it was grotesque and macabre, like an evil clown. He waved at me each time I walked by, with the same grin, perhaps to unsettle me. I grinned and waved back, playing his dark little game.

Soonafter, I heard the words I expected from a nurse: S, we need you to sit. I already knew who it was for. I pulled up a chair in front of him and introduced myself, asking if he needed anything at the moment. He studied me with narrowed eyes under a baseball cap. His smile didn't reach his eyes. Oh, no, thank you- again he grinned. And I sat down.

"So what's your role here in the Emergency Room?" he asked, "By the way, call me Chris."
"OK Chris, I am an Emergency Tech, which means I am an EMT stationed in the hospital."
"So that means that you are pretty useless, since you're not a nurse or a doctor or anybody important."
"According to that definition, I guess am pretty useless, Chris."
He smiled at this, realizing he would have to try harder to get to me.

A nurse walked by, her normal ponytail in a bun. It was a nice look for her. "Hey, I like your hair that way," I commented.
"Thanks!" She said.
Chris suddenly interjected, "C---liar----ough", grinning.
"How do you know, Chris?" I looked at him.
"Because none of you really care."
"We wouldn't be working here if we didn't. We'd burn out so fast."
"I've been here enough times to know for myself."
"If you say so," I replied.

Suddenly his eyes grew wide. "I know what you are!"
"What's that, Chris?"
"You're the watcher!"
I exaggerated the motion of my eyes toward his bandages, then met his eyes. "Would you say that it's unwarranted?"
"No, I guess not." He muttered, de-escalated for the moment.

Chris was the calmest (awake) person I had ever sat for. He made no motion to get up or make a fuss. He just fixed his steady gaze on me. I realized that not only was I watching him, but he was watching me.

I soon found that I was the only one he tolerated; he made several nasty, sarcastic remarks to the friendly nurse and others who came in to take vital signs and breathalyzer tests. Never once did his eyes leave my face, which I kept neutral, to his disappointment.

"So what are you thinking about? Aren't you supposed to be watching me?" he asked, watching my eyes move with the action of the room around me. He didn't realize I've been watching him continuously in my peripheral vision for the past hour.
"So how did they find you?" I turned to face him.
He looked into my eyes. "Because I let them." They were unflinching, aggressive, and challenging, as if to dare me to look deeper into the darkness he believed his soul to be.
"Do you regret it?"
"It's not the first time." He grinned. "But I have to say, it's never been this bad."
"I see. Well, blow into this straw for me." He breathalyzed clinically sober and it was time for him to move into a room for the doctor to see him.

"Cut off his bandages and clean the wounds before I look at them," instructed the doctor.
I emptied a bottle of sterile water and peroxide into a sterile basin, gathered a few plastic pads and containers of sterile gauze.
Under the bandages, in three different places, he had cut his forearm into ribbons, exposing torn muscle, tendons, and strips of skin. Seeing his wounds temporarily took the grin off his face as he examined them with a bemused smirk. "S***, I really ****ed myself up this time."

"Does this hurt?" I gently wet the gauze and towels and set to work, easing the dried blood from and around the wounds. He shook his head no. He watched me much more somberly now as I worked carefully to avoid pulling on the delicate strips of dislodged skin. The wounds cleaned, now I wet a towel with warm water and set to work on his black hands. "Oh, you don't need to do those." I ignored him and cleaned his fingers, one by one. I also wiped the dried blood from his face.

"Can I bring you a clean blanket?" His was bloodied.
"It doesn't matter." I brought one anyway.
"Are you hungry?"
"Maybe a little."
"Let me ask your doctor if you can eat something."

When he saw that I brought him a sandwich, his demeanor changed. "You are the only one in this ******* place that gives a ****. Look at them. Most of them wouldn't care if I died right here. Why do you care? Why do you care so much? How do you care?"
"It's my job," I replied dryly, hiding the stab of sadness I suddenly felt at his questions.
"Well, you do a good job."
"... Thanks, I guess..."
"No, I mean it." I thanked him and examined him once more- this damaged person that took a knife to his own body in such a violent way.

Over a hundred stitches and a few hours later, he was medically cleared to go to the psychiatric section of the hospital. Weeks later, a security guard referenced the guy who sliced his arm open in a horrific way. I knew immediately who it was. They were almost certain he would be restrained given how violent he was upon entering our Emergency Room and surprised he calmed down. The nurse remembered his rudeness and everyone commented on his strange affect. I kept quiet, for better or worse, because I didn't think his demeanor was strange... maybe that is why he chose to talk to me normally and let me see his damaged core- he realized I wouldn't judge him, that I knew that his passive-aggressive acting-out was just his way of dealing with his emotional crisis.

I still think of Chris often and sincerely wish that he has found found at least a temporary peace.


Thursday, July 7, 2011

Adventures in Sitting: Sundown Showdown

"Hey S, we're going to give you another one."
Aw man. I looked up and saw a quiet little old man (LOM) sitting demurely on a stretcher in the ambulance bay. I already had 3 patients I was sitting with. One had been smoking funny stuff and got violently combative in the ambulance bay. He was in 4 pt velcro locking restraints and medically knocked out, snoring. Hopefully he wouldn't wake up anytime soon. I had one suicide watch who was shifty, and another psychiatric issue lady, who was looking around nervously. At least this new LOM looked quiet.

My LOM shook my hand and called me dear when he was brought over. He was very polite and asked if I would hear his story- they were moving him from hospital to hospital, he told me, listing the hospitals. Maybe because they didn't know what to do with him, he sighed. This was strange to me- I wondered why none of those facilities could resolve his problems. That and, he just seemed so nice. "Well, sir, just sit back in your stretcher and a doctor will come see you soon." "Thank you for listening, dear, you are very kind." He sat back and watched me. His eyes were lively despite his muted demeanor and turned up at the corners. His manners suggested a high level of education.

For the first hour, he just sat, with his hands folded in his lap, pondering his situation, occasionally staring over at me. I smiled at him and asked him if he was comfortable. "Oh yes, I'm fine." Under "patient behavior", I wrote "calm".

At the two hour mark, he began to shift around. He started moving forward in his stretcher. This put me on alert, and I asked him, Sir, where are you going?
"Well my dear, I'm over 80 years old and sitting in one position is making me very stiff! May I just sit at the edge of this bed just so I could move my joints a little?"
It seemed a reasonable request, albeit one I don't normally acquiesce to, but he really was just a LOM.
"Just stay there, though, and move back when you feel better, Mr. LOM. I don't want you go get run over by a stretcher."
"Of course, dear."

I watched him more closely now. His eyes were shifting and his hands moving. He shifted his weight again and I saw he was going to stand up. "Just to stretch my legs, dear"
"Sure, sir, but you're not supposed to be up."
He sat back down.
He stood up again, then sat back down a few times. I relaxed a little. Poor guy, his legs must be sore.
Under "patient behavior", I wrote "restless".

"What's the weather like outside? Is it raining?" He suddenly asked.
"I don't know either, sir, as you can see, I've been here with you and have not been outside or near a window in a few hours."
"I think I'm going to walk and take a look."
"Sorry sir, you can't do that. I am watching 3 other people here. It's not safe. Can you please sit down?"

He stood up and walked a few steps. Seeing me watching, he said, I just need to take a few steps, that's all. I just nodded and watched him sit back down on his stretcher. Soon enough, he got up again, and started talking to the secretary.

It was a very busy day in trauma. Stretchers, x-ray machines, ultrasound machines, technicians, trauma surgeons were all milling about. We were right in front of the trauma room and the secretary was dealing with a lot of paperwork from the rest of the department.

"Sir, I'm going to ask you to sit down for your own safety. As you can see, there are many people and machines rolling around here. I don't want you to be injured."
"Young lady, I signed myself in here and I can sign myself out. Don't tell me to sit down." His demeanor changed completely.
"Sir, please sit on your stretcher and lie back all the way."

He ignored me and continued harassing the secretary.
"Mr. LOM, I know it's uncomfortable, but you could really get hit by a stretcher there. Can you just sit and wait for the doctor?"
"There was a statute passed last week that says I can sign myself out if I want to! You can't make me sit!"
"Believe me, if such a thing were passed, we'd be the first to know. Now, you're here for a psychiatric evaluation and you should not be wandering. This is my job on the line if you get hit." I tried to de-escalate the situation, but it didn't work.

He suddenly came at me and I took a step back. He towered over me a few inches from my face. "Do you understand English? I won't sit down. Call security if you have to."
He returned to have a perfectly civil conversation with the secretary once more.

Two officers came at my call; Mr. LOM introduced himself to each of them, shaking their hands and telling them how confused he was to be treated this way. He ignored me and the officers spent twenty minutes talking with him. However, when coaxed to sit on the stretcher to talk, he grew agitated and again refused, trying to state various articles of newly written statutes about his rights in the hospital. It was almost kind of funny how the way he looped the security officers around in non-sequitur or circular arguments.

I decided to take a look in his chart to see why he needed a psych evaluation. Apparently, he had attacked an aide at the nursing facility and was pushed from hospital to hospital for his misbehavior until he came here. This was someone who has been and could become dangerous.

The security officers requested doctor's orders for restraints; Mr. LOM was obviously not going to cooperate, so I called his doctor and nurse over. Mr. LOM took each by the hand and introduced himself, smiling and insisting that he was being misunderstood.

He seemed so nice, but reality bites.
The doctor didn't want to put him in restraints, but when I told the story of what really happened, Mr. LOM lunged at me, security caught him in mid-air, and they threw the old man onto the stretcher and put him in 4pt locking restraints. He let loose a litany of curses and threats as I've rarely heard in my sojourn sitting, but to no avail. He was soon sent to the psychiatric ward, so he didn't have the restraints on for long.

A security officer pulled me aside later and told me: Mr. LOM was once a very prominent, well-known lawyer who was lately placed into a nursing home for advancing dementia.

The doctor told me that it was a classic case of sundown syndrome.
Very scary. What an awful drop he has made from being at the top of the world.

This is a story that replays in my mind fairly often. I remember his intelligent eyes that bent up at the corners and his unrepentant fury. I hope he finds peace and dignity.

After Mr. LOM left, my PCP patient woke up, winked at me and asked me in every way he could think possible for my number/email/contact information for the two more hours I had to sit with him. "This city's a small place, you know, I'll find you." What a creepy job on a creepy day!