Saturday, December 1, 2012

Chip on my shoulder

"Hi sir, welcome to the emergency room at ____, my name is S and I'd like to know what brings you here today?"
"Well, I've got this pain in my tooth here." He winced as he pointed. So did I, in sympathy.
"That looks pretty painful- what happened?"
"I was eatin' potato chips and one of them got stuck. I can still feel it even." He winced again. So did I, but not in sympathy.
"On a scale of 1-10, 10 being the worst pain you've ever felt, what are you feeling now?"
"It is better than it was when it first happened, so it's like a 4 now. But earlier it was a 10."
"I see... Have a seat, a nurse will talk to you soon."
"Ok... can I get anything for the pain, ma'am? They wouldn't give me anything in the ambulance."
"I think the nurse will see you really soon, so I'd wait for her opinion."
"Oh, ok."

She had heard the exchange, gave me a look, and threw him unceremoniously into the pile of charts to go to urgent care and he was discharged 5 minutes later.

But really- calling an ambulance for a potato-chip induced dental pain? Really??

Adventures in sitting: The man inside the shell

He was a handsome man once; now his scrubby patches of untrimmed beard and age-taut skin were indicative of a strong man gone to seed.  His eyes were slightly mismatched, much like his thoughts which emerged form his brain in perfectly animated little phrases and movements. If you weren't listening to his words, you might not even notice that strung together, they made little sense. He babbled, cursed, cooed, laughed, and insulted, often incomprehensibly only to himself.  He would not stay clothed and was constantly reprimanded by the physicians to stay decent.  "Hey, it's hot in here, ain't it?" his eyes rolled wildly at me. "It feels ok to me." "Well, they wouldn't mind, *would they*?" and he would begin to tug his shorts down.  Halfway down, he would forget what he was doing and I would pull them back up.  When his sitter left for lunch, I knew that I was inevitably going to have to watch him.

He stared at me for a few minutes as I avoided eye contact (my rule number 1 when in close proximity with a psychiatric patient). Yet, he seemed harmless enough. "Hey, I'm hungry! I had a sandwich... like, I had... like here." I pointed to the half-eaten tray on his lap. He clapped his hands in excitement as he remembered. He suddenly proclaimed, "I feel, like, so lucky.  You're one of the good ones, aren't you?" Cackling and smacking his lips, he began to babble.  In the middle of his soliloquy, he suddenly turned to me. "HIV isn't real, right?" His large eyes focused on mine.  "It is, I'm afraid," I replied.  "I don't wanna die. Am I gonna die here?" "Not here, I don't think," I replied. "Oh, ok," he smiled, and bit into an orange without peeling it.  

"I need to go pee pee," he announced. I helped him as he grunted to his feet and he let me drape the faded johnny coat over his shoulders. He waited patiently as I scrambled for a urine cup and moved jerkily toward the bathroom. Halfway to the toilet, he had forgotten what he was doing there. Turning around to look at me, he asked conspiratorial way, "do you do drugs?" "Er, I can't say that I do." "Well I, I, I have... a secret..." "And you want to tell me?" He nodded, "I know I shouldn't... but... like... but..."

He had lost his train of thought again. As he gathered them, he twirled the urine cup in his hand like a wine glass, like he was at a party and he was trying to tell a story.  I motioned him toward the toilet and he dismissed it with an impatient wave of the urine cup, insistently trying to continue his story. "Yeah, yeah, ok... but anyway... yeah, like... you like music?" I smiled, "I do like music, a lot." His eyes sparkled, "oh, I do too, but you know, I never liked what's his name. Famous guy." "There's a lot of them." "Yeah, ok, you're right. But I was a pianist, you know and I can't get enough of Chopin."

I was still nodding and smiling, but I could not help but notice that his speech seemed more fluid as he talked about his passion.  "Ooooh, I just got a new cd of Chopin etudes, played by the BEST. You know who that is, right?"
"There are a lot of great ones out there," I replied, "you're going to have to give me a hint." '
"You're right, but he is the BEST. Arrau."
"Claudio Arrau?"
"Yeah. But I forget where is he from?"
"I really have no clue, sounds French."
"Oh, really? I thought he was from Brazil!"
Now I had to look it up. Wikipedia stated that Claudio Arrau was Chilean and I felt a chill- not just the chill that you feel when you realize that your neurosyphilic psychiatric patient high on meth is more with it than you are, but also the chill when you realize that you've made a real connection with someone.  He was no longer merely bemusing, but a tragedy of growing proportions.  I felt a pang of pain hearing the scars of his heart, seeing the scars of the drugs and hard-living on his body, and examining the scars of his rotting mind.

I gently led him back to his stretcher- he had forgotten to actually use the bathroom, but didn't seem to need to anymore. He bounded joyfully onto the bed still clutching his urine cup and immediately began to remove all his clothing. The sitter was back from lunch and I was relieved from my duty of watching him.  As I rejoined the world of the functional and cognizant- the same world of the judgmental and callous- I could not help but think about the descent of what used to be a handsome, cultured, and intelligent man into the meth-baked shell he had become. Often we can't see this downward cascade of events that is precipitated by first times- the first rush of a new drug, the first fun time at a bar with sketchy patrons, the first date with what will become a bad boyfriend. How can we avoid these poor life-changing decisions?

The more I think about it, the more I realize- we really can't. We are at the mercy of chance, whether we accept it or not.