Of Butterflies and Roaches

Every once in a while, I check back into a more comfortable reality, as if the realer-than-real life that I have been living in the ER has been a farce. The darkness of humanity will seem to be only a nightmare that dissipates with the morning light of the waking world.

I was pulled from my section to sit for a college freshman who had ingested 20-60 liquid advil in an attempt to harm herself. Oh boy... I've seen enough disturbing cases of these to be totally on my guard.  Young, "alternative", wearing black lace tights, and thick dark eyeliner, she commanded an adult appearance way beyond her years.  Yet, she surprised me. Polite, meek, apologetic, it was as if she got caught in high school for skipping class and was in detention.  She didn't even object to having a "sitter." She took it as her due.  It made me wonder about all the combative, abusive, spitting, terrible people I have sat with hitherto, and how little effort it took to sit with Ms. Advil.  She did everything we asked and more, even replacing the blood pressure cuff herself when she came back to the bed.

Instinct told me to reach out to her- she was a little overwhelmed and completely new to the hospital environment and asked me what "butterflies" were.  The more I talked to her, the easier it was to look through the smeared make-up at the very young soul in front of me. It became more and more apparent just how young she was, with baby fat still lightly gracing her jowls. She hadn't succumbed yet to the college-girl quest for angular chins and improbable diets.

"So what happened that brought you in here?"
"Well, I was going out with this guy Nick, and I was mean to him, but I didn't think I'd push him away. So when he told me he wanted a break, I got mad and lost my temper."
"Did you want to hurt yourself?"
"Yeah, but not anymore. I just love him so much."

I let her babble on about Nick and she thanked me for listening, for it made her feel better.  She was curious about the charcoal we had her drink to deactivate as much of the drug as we could. She didn't mind when her mother and grandparents came in to sit and stay with her.  I've had young patients fight tooth and nail to avoid their parents, but they were apparently a very loving, supportive family.

They had raised a good girl, albeit a little spoiled and impulsive.  They were also very protective, asking for every little detail, whether this IV should be hurting or if the bag should be changed, or if she could have ice chips and a toothbrush/toothpaste to brush her teeth, etc etc...

Sitting with them made me feel safe- removed somehow from the adult world of lies, manipulations, agendas, gambles, real psychiatric problems.  She was just being a pouty kid.

I heard a scream down the hallway from the PCP-ingestion that was heading my way. In stark contrast, this young girl was a brash young hellion with emotional problems and the will to harm.

My few hours of peaceful counsel with the Advil girl was ended by the arrival of the ugly character of the new patient next door, who brought me swiftly back to my adult reality as she started spitting at us. Sigh, just another day in the life.

S

Sleep Deprived

"Hello sir, my name is S and I'm a technician here. What brings you in today?"

"Uh... Well, I haven't slept in 2 days and want to kill somebody." He made violent hand gestures.

"Oh, right. Ok. Err... Can I take your vital signs?"

"I just want to sleep. And if you can't make me sleep, I want to kill you too." He stared at me weirdly.  I backed away from his bed.

I guess the wrong thing to say would have been, "buck up, son, two days ain't a lot.  I've gone months of 2-3 hours/night." I didn't, but I wanted to. Within a safe distance, of course.

S

Disappearing into the Background

It was dark and still outside- the wee hours of a late summer night. A man limped through a long outdoor hallway lined with construction tarp and concrete into a brightly lit room. It was large room and had many chair and several people- he chose one in the very back where no one would pay much attention to him. Nobody saw him, or rather, nobody paid attention to him. Scruffy, muddy, and quiet, he hid in a chair that could not be seen by the triage desk. The people sitting around him paid him no mind. They were too worried about getting into our busy emergency room, never mind the bundle over there in the corner. A storm was coming, you see, and everyone wanted to avoid going outside.

The last time I saw this man- his pseudo-scholarly build, straight nose, glasses, beard, balding head, khaki shorts and polo-style shirt- he was covered in feces in critical care. The last time I saw him before that, he was stealing my things. Mr. Poopy was the stuff of legend in my mind. I felt guilty, but I disliked him on a personal level. I recoil at the thought that he had touched my life by touching my things. He was an unwelcome and dangerous intruder once to my polite academic community at a prestigious research institution and given me nightmares (before I became the tough old cat I am now from working in the ER). He was a homeless man in academic garb, a total counterfeit, opportunist and leech of the system. My co-workers know him on first-name basis because he had been there so many times. My tech hated him- called him the scum of the earth... yet, my tech died, and this cucaracha continued to live. I am ashamed to admit thinking these unbecoming thoughts last week in critical care, but I won't lie- I didn't have even a single reason to like the guy.

No one paid attention to Mr. Poopy (Tales of an Emergency Tech: Coming Back Full Circle) as he sat down in that chair, huddled down in the middle of the night. Maybe he felt pain- he had an extensive cardiac history... More likely, he might have just wanted to take refuge in a place he had been hundreds of times, away from the churning winds and penetrating wet. He curled up and closed his eyes, as he was apt to do. He was a very quiet man- shy, and addled in some ways. He couldn't answer questions quite the way you wanted him to. In any event, he probably went to sleep. It was going to be a long wait.

It was mid-morning before someone realized that he died in that chair in the corner. He was already blue- had probably been so for about 10 hours. And nobody noticed... not the triage nurses, not the visitors to the ER, not the security officers... Who would have thunk?? His body was taken to a private room for a last chance revival- but I'm sure it didn't last long.

Suddenly, a name, a face, a smell we've known hundreds of times, permanently seared into our memories- was gone. He was swiftly wiped from the face of the earth with no further questions nor inquiries. There was a general feeling, more of relief than sadness- the expensive interventions and work-ups he received gratis wouldn't happen anymore, we were minus 200 visits/year on our census, and the city was minus a limping, quiet, and creepy old homeless man. Just like that, he became a memory, if anybody else remembers, that is. How terrible and profoundly sad it is to die like that.

Rest in peace, Mr. Poopy. I hope wherever you are now is better than where you were.

S

Wormy or Crazy?

Through the 8 hours I spent with her, Ms. Wormy was a hot mess.

She had fallen after fainting and couldn't bear any light to touch her eyes. I put a rolled towel over her eyes, much to her relief, and began taking her clothing off to put her on the monitor. My gloved hands were orange after touching her. I realized with a jolt that it was her heavy dose of spray-tan.

She recounted the story of how she fell, then calmly interjected "I know it sounds crazy, but I have worms under my skin." She showed us the pockmarks from where they 'broke out of her skin'. They came out in a ball from her reproductive tract, and when she stuck a (gloved, she added) finger up her anus, she found them there too.

She told us about how she would cover her legs with paper towels at night, then find puncture marks in her skin where the worms would break out during the night. They looked like fingernail picking pockmarks, but I just watched the spectacle of her trying to convince the doctors about her worm problem.

In order to get urine, we had to walk her to the bathroom so she could use a straight stick catheter- apparently, this is how she always urinated.

A nurse commented that Ms. Wormy was the kind of crazy that should be locked behind padded walls. I wasn't sure- but I sure wanted to see the worms she was talking about!

Ms. Wormy wore dentures at an age most women still can have children. She was a near impossible stick, but I got her labs using our smallest gauge needle. She showed us her ileostomy, pulling it tight so we could see all the fibrous material floating about. They were worms, she insisted, I pass thousands of them a day. She pulled my hand to feel the coarse roughness under her skin where "worms were nesting."

How did such a young woman end up with so many problems? I didn't know, but I kept stopping by her room to listen to her terror about the worms infesting her body.

When I left 8 hours later, nobody had lifted a finger to examine her for these worms she kept talking about coming out of her nether regions. Was I the only one who fell for some sort of joke? She seemed too genuinely scared to be making it all up...

Nevertheless, I took an extra hot shower when I got home. All her talk of worms made me scrub harder than usual... you know, in case the crazy was catching.

S

Edit: Later, I looked up some symptoms. She might be a meth addict- it would explain the anxiety, itching under the skin, and dentures... but I don't know. So strange.

Manipulative Manics

All was well this morning. The rain was pouring outside where I couldn't see it anyway :-), the patient load was still low :-), I was saved from being in the drunk tank yet again :-) :-)... Then, around noon, I heard a commotion coming from our waiting room. Never one to miss the action, I stuck my head around the corner to see a normally chill nurse flip out at somebody.

Mr. M&M was young- around my age- with a baby face.
Mr. M&M: "All I want is my wallet. That's why I'm here. I want my wallet."

Nurse: "Ok, we'll call the psychiatric unit you were in, just stay right there."

He took steps forward, "but I want my wallet. I have everything in there- my whole life is in that wallet."

Nurse: "I already told you, I'm calling- look I have the phone."

Mr. M&M: "It might be in the bathroom, it might be in the room, it might be anywhere. Maybe you locked it in those security lockers."

Nurse: "They don't have those kind of lockers in that unit, but they said they'll take a look for you."

Mr. M&M: "Ok, thank you, can I go back in?"

Nurse: "No, sir, you were discharged this morning."

Mr. M&M: "But there is something wrong with me."

Nurse: "There is nothing wrong with you. That's why you were discharged."

Mr. M&M: "Well, how could you just say that there's nothing wrong with me? What if there was? I am going to sit here," He sat defiantly in the triage chair, "and wait."

Nurse: "You can't sit there. There are patients that need to sit there."
Mr. M&M: "Well I'm a patient."

Nurse: "No, you're not, you were discharged this morning."
Mr. M&M: "My legs and back hurt real bad. I can't walk. Can you admit me as a patient?"

Nurse: "No!"

Mr. M&M: "Then I want to hurt myself. I want to kill myself."

Nurse: "Don't say that..."

Mr. M&M: "I mean, I don't actually want to, but that will get me in as a patient, right?"

Nurse, eyeing all the people lined up: "Uh, no, please get out of the chair. There were other people who signed in before you."

Mr. M&M: "I'm not moving out of this chair."

Psychiatric Nurse: "You definitely did not leave your wallet back there with us. Please leave- we're not going to see you again today... you just left a few hours ago."

Mr. M&M: "Wait, you're kicking me out?"

Nurse: "Get security."

S: "Hey, sir, since your back and legs hurt and all, do you want to sit in this wheelchair?"

Mr. M&M: "Sure. Thanks a lot."

Nurse: "Wheel him faaaar back over there."

S: "Ok."

Mr. M&M: "You don't have to, I was going to go outside for a cigarette anyway."

S: "... Oh... Ok, whatever you like."
Mr. M&M: "What's your name?"

S: "S."

Mr. M&M: "Thanks, S."

I turned around and suddenly heard a scuffle. Mr. M&M was trying to wheel himself outside to smoke a cigarette. Security caught up to him and made him get up and get out. We thought it was the last we'd see of him....

Around 1400, I heard the ambulance bay doors open and then a nurse say "you've got to be KIDDING me."

"Nope," I heard an EMT reply. I rushed, out, and there was Mr. M&M sitting on an EMS stretcher, staring at us.

Mr. M&M: "So since I came in by ambulance, I can get admitted, right?"

Nurse: "No, no, no. Get out. Seriously. The exit is over there."

Mr. M&M: "I can't believe you're refusing me. What if there was something wrong with me?"
Nurse: "Get off the stretcher. We're not dealing with you again. You were discharged this morning, you came back a few hours later, and now you called an ambulance to come here again. Please leave."

Mr. M&M: "I'm not getting off this stretcher!"

EMT: "Come on, man, we need this stretcher."

Mr. M&M opened his mouth and started wailing. The ER came to a standstill as everybody heard and wondered what was going on in the ambulance bay.

Mr. M&M: "I want to kill myself! End it all! I mean, I don't really want to, but I tried before, see this?" He pointed to a small scar on his arm. "I did this to myself when my grandmother died! I could hurt myself out there!"

Nurse: "You gotta get off that stretcher right now."

Mr. M&M: "I want to hurt other people. I want to kill them."
Nurse: "Why are you saying that now? Do you really want to hurt other people?"
Mr. M&M: "Saying that will get me back in the psych unit, right?"
Nurse: "Uh, that will get you arrested, actually."

Mr. M&M: "So arrest me! Do it now!"

Nurse: "Ok, I'm getting a headache. Just go sit on that stretcher over there. We'll ask the mental health team to come talk to you one last time."

Mr. M&M cheerfully hopped onto the stretcher. "Why aren't you guys doing your jobs? Aren't you supposed to register me? Don't I need a new name-band?" He took one out of his pocket. "This was from when I was admitted yesterday. Hey, aren't you going to take my vital signs? Oh, God I don't want to live a life of crime! Don't let me back out on the streets! I need to live! Please admit me!!!!!!!" He was roundly ignored.

Meanwhile, patients had been coming in and I was completely ignoring him. "Hey, S." Mr. M&M called- "Yessir?" Despite it all, he still looked wide-eyed and a bit naive/slow to me, so I humored him and answered him.

Mr. M&M: "Why are those security officers and all those nurses talking to me like I'm garbage?"

S: "Well... when you say you want to kill yourself and you don't- is that right? You don't want to kill yourself?"

Mr. M&M: "Well, no, I don't, but nobody takes me seriously unless I say that."
S: "Well, when you say things like that and you don't mean it, don't you think that comes off a little... manipulative?"
Mr. M&M: "Well I don't mean to be manipulative or anything..."

S: "I'm only pointing out that that's how you come across."

Mr. M&M: "I appreciate that. You're the only one here that talks sense."

S: "Mmm..."

I was a little disturbed to be the only one that made sense to him. Soon, he was carted off, once again, to the sidewalk. He might have tried to come back a few more times, but I was off on another shift area by then.

S

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?"

"Sure"

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.

S

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.

S

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...

S

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.

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?

Ms. E: TWENTY-BILLION.

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:

BUT WHAT IF I'M PREGNANT????

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.

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!"

"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??"
"Nah."

"Doesn't it make you sick or throw up?"

"Nah"

"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?"

"Yeah."
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."

"...Thanks."

"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.

S

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.

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...

S

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.

S

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.

S

Adventures in Sitting: The One Who Got Away

Occasionally- though lately it has been more often than not- I have had to sit. That's what we call it when a patient comes in for "psychiatric illness", or "suicidal ideation", or "ingestion", or "homicidal intent", etc, and a technician leaves off normal duties to make sure s/he is watched while in our facility. Either the patient has proven to be a danger to him/herself or others or has said the magic words "I want to hurt myself." Then s/he is granted the privileges of having someone watching them one-on-one for all the uncomfortable hours spent in the ER, of having that same lucky companion to accompany any trips to the bathroom, and facilitate the removal of all plastic cutlery from meal trays before eating. Apparently plastic knives have been an issue with cutters.

I hate sitting. It is an unwanted break from the action of treating emergent medical issues; it also makes me really tired, even though I'm not doing anything. My heart rate drops, my adrenaline gets used up, it's all sorts of terrible and useless. At least, that's how I felt, until I didn't meet my Mr. Towga.

One ordinary day, upon seeing me arrive to my shift, the tech I relieved sprang up happily, gave me a hug, and ran off to live his life. I was not informed that I was supposed to be sitting for two patients: one who had ingested a bottle and a half of aspirin, the other, usually a regular drunk, who had jumped into the river in an attempt to harm himself. I went about my duties, stocking and checking up on my new patients, when I heard "He went that way!"

"Were you sitting with that patient??" A nurse rushed up to accuse me. I looked at the rumpled empty stretcher.

"No, I was definitely not," I replied.

"Then who was? He jumped in the river yesterday. If he jumps in again, someone's head is going to roll. Are you sure you were not sitting with him?"

"I was never told I was."

"Then what are these?" She discovers sitter forms on the counter; it was a scary moment when I realized I was supposed to be sitting for both my ingestion lady and Mr. Towga.

"I was never informed I was sitting. I've never seen the man in my life."

"Well, we'll see about this," she huffed.

Mr. Towga took off in several wrong directions in his clumsy escape and was not wearing a hospital gown, only street clothes. Several seasoned nurses pointed him in the right direction of our exit. The last people to wave him goodbye were the security officers out front. It was only when he took off running that people got suspicious and realized he was a psychiatric patient.

The police were informed and a search was performed, but Mr. Towga was long gone. I didn't get in trouble because I was given improper (nonexistent) report, or so they say. I have a feeling it was more that some of our oldest and crankiest nurses were the gracious souls who showed him the way to the exit.

I take sitting duty very seriously now. Woe be to the uncooperative patient under my watchful eye! Mr. Towga came in again a few weeks later, thank goodness, and only as a drunk this time. I made sure to get a good look at him. Nice to finally meet you.

S

Too Sweet

"Hey, can you go to pedi side and find me numbing cream so I can start an IV?" A nurse asked me.

Uh, sure... it was an odd request, but interesting. I came back to see the child it was for.

Just kidding, it was for room 9, a man in his 60's. The nurse and I walked in to see his glaring face.

"Now I'm gunna tell yous right now, I ain't gonna be nobody's pincushion. There won't be no stick stick stickin', you got that? I won't do it without numbing cream, so yous better go and get it now. And after this, tell the doc I'm ready to go home."

"Well, sir, I just brought the numbing cream. Please be patient with us because we're trying to help you." I said in my most calming voice. He glared.

Oh boy.

The patient has a baseline blood sugar of 400mg/dl every day. For normal people, the range is 70-100mg/dl. He came in today because his sugar hit over 500. Having such a high baseline is extremely dangerous and can cause raging infections and organ failure. His limbs were swollen to at least twice their size, scaly like old tree trunks, and darkened, like he had stuck them in molasses, then Oreo cookie crumbs. There were numerous open sores, like ulcers, pink and unlikely to heal. He didn't seem to care, though, and thoroughly resented being in a hospital. "I'm fine," he snarled, "can't wait to sign myself out of this ****hole."

It was already late in the evening, almost 2100, but in trudged some family members and a young toddler as we were going to begin the process. He ignored us now (thankfully) and started cooing to his grandson.

Grandpa: "Come 'ere. You's a bad boy, y'know that? A bad boy. But it's ok, if anybody messes with you, you say **** 'em."

"**** em," the boy repeats

Grandpa: "Ahaha, that's right, **** them"

Boy:"**** them" (stop saying that! says the mother)

Grandpa:"Pay 'em no mind. you can say **** them too"

Boy:"**** them."

Grandpa: "**** 'em."

Boy: "**** 'em."

The nurse I was with was losing his cool. He had young children at home. I watched the red slowly creep up his face at the exchange. "**** 'em!" "**** 'em!" "**** them all!" "**** them all!"He was still searching for a good vein, finally finding one on the wrist. He cleaned the site, but couldn't take it anymore.

"Excuse me sir, there are some very sick patients next door, please stop yelling- they don't need to hear that."

Our patient jerked his hand away, and shoved his blanket aside, pulling out his penis. "I'm gonna pee. now"

I ran for a urinal, and he peed, nonchalantly, in front of everybody. Finished, he handed it to me with a huff, as if it disgusted him, then went back to cooing at his grandson. The urine dipped positive for lots of proteins (bad sign for kidney filtering), ketones , lots of glucose, and blood.

I handed my 'numbing cream' to the nurse. It is actually quite cool- a refrigerant, if you will;

It temporarily freezes the area of contact, turning the skin white, distracting children from the pain of an IV insertion.

"**** that's cold!"

He barely felt the IV, which is good, but unfortunately it was only good enough to draw some labs, not good enough to use for fluids.

The nurse went out to the hall and recruited another nurse. We returned for round 2.

The patient rolled his eyes, yelled loudly about how terrible this place was, flailed, but to no avail. The doctor came in once more to cajole him and his family did too.

"I'm a let you know- this is the LAST time I'm gonna get stuck, you hear that?"

The nurse looked for a site, cleaning the skin with an alcohol wipe. Filthy! He showed it to me. Sixteen alcohol pads later with furious scrubbing, the alcohol wipes were still coming back black and dirt-like.

"What are you doing? Scrubbin my skin off?"

"Sir, it needs to be sterile."

"You don't need to scrub so hard."

"Well, sir, it's dirty." Oh boy, this nurse had a snarky sense of humor.

He jerked his hand back again and screamed some profanities. "Sir," I ventured, "we are really doing this for you- you really don't want to develop an infection, ok? We're trying to help you. It'll be over really quick, and look, we'll use the numbing stuff again."

He pulled the blanket down again. "I'm gonna doo doo."

"Come on, sir, are you really gonna whip that out in front of everybody?" The exasperated nurse asked. The family took this as a cue to say good night to grandpa.

I rushed out to look for a scat pan.

Coming back, we were to try again.

"So, where are you from?" I tried to distract him.

Grandpa: "Down South."

"Oh, I love it down there, people are so nice."

"You got that right," he smiled, "where you from?"

"well, I grew up right around here."

Grandpa: "really??"

"yeah, hard to tell, right?"

Grandpa: "I grew up here. I got the **** outta here when I could, boyyyy, ain't never comin' back. I'm here to see the family, then gettin the **** outta here."

"I see."

By now, the nurse successfully inserted an IV in the finger and drew the rest of the labs. Unfortunately, he was going to need another IV site- perhaps by ultrasound. Speak of the devil- the transporter was there to take him to x-ray and ultrasound. He left the room and we all looked forward to trying again when he got back.

I sprayed the numbing canister at the back of a co-worker's scrub pants and heard a yelp as the cold seeped through. I think I found a new toy. :-)

S