Teenage Wasteland

Work hard, party harder. Ah, college, when it was ok to be so young, so dumb, and have so much fun.  Remember all the free food, all-nighters, and especially the huge parties? The parties with beer on the ground, dark corners, and unlimited alcohol for pretty freshman girls? Labor Day weekend was the prime kick-off school-year party time and I was nostalgic, almost.

Sitting in the drunk tank on the morning after the first big party weekend of the year, I had a full-house, but an unusually young one. The college girls had awoken and were giggling at the snoring homeless man between them. They had probably never been so close to one before. The drunk tank is a great equalizer in that respect.  Their expensive clothes were disheveled, their recently trimmed hair mussed, but they were still young, still beautiful, still able to recover gracefully from being blackout drunk.  They were also great socializers, still in the middle of that magical period of freshman year where everyone could potentially be your friend. They made fast friends amongst each other and discussed outfits, boyfriends, and the Iliad. They also attempted to needle me into letting them leave, as infrequent visitors to our fine establishment usually do when they have gotten bored of sitting in the drunk tank.

We had an assortment of students that day, male and female, ranging from the super pretentious schools to state schools to community colleges. They quickly fell into a hierarchy, the ringleader a clever-looking brunette from one of the most prestigious institutions in the country. Finding me sympathetic but impermeable to begging, she needled, wheedled, and stopped everyone who walked by with her sad story.  She flashed a bright smile and smoothed her hair, sitting rigidly upright with her hand raised as if she were in lecture. She was charming and I have to admit, I thought she was just in the wrong place at the wrong time...

After 2 hours of fruitless attempts, however, the underage little minx slouched down, sighing, "well, I might as well get comfortable since it looks like I won't be leaving anytime soon." Her whole countenance had been an act! I asked her nonchalantly what she meant and she grinned, explaining that people tend to do what you want them to do when you look pretty, neat, and are charming. "I wish I had a mirror. I probably look horrible, otherwise, I'd have been out of here if that resident thought I was cute," she sighed. She knew so much yet so little. She was well-practiced in the art of manipulation way beyond her years; perhaps that's how she came to matriculate at one of the most competitive undergraduate schools in the world.

People like my little patient often do slide around the rules- their increased intelligence and will to mislead do confer them advantages. For example, she did not get expelled that day like some of her drunk tank compatriots from state and community colleges. In fact, I would be surprised if she came off with more than a slap on the wrist.

I'm sure I won't see her again, but I know that she will be out there in society, slithering her way up to the top on the golden ivy-laced path.

S

The Stinky Details

It is the beginning of the month of June, the time of the month still ripe with the promise of nice weather, sunshine, medical school applications (again) and of course, welfare checks. The beginning of each month is a homeless feeding (drinking) frenzy that ends up irrevocably in the ER. Out of twenty patients at any given time today, eleven of them were drunk skunks. And I do mean skunks.

I never spoke with Mr. Stinkpot because when he came in from the rain this afternoon, he collapsed happily in the stretcher-bed and snored merrily throughout his whole stay. Barely rouse-able he would have flown entirely under the radar... but for his unfortunate feet. The pungent ripeness of dried feces, urine, and sweat from his caked-on jeans mixed with the rich earthiness of his socks that had been stuck to his fungus-covered feet too long.

Browned with concentric rings of yellow, the socks had holes where his feet would rub against well-worn shoes. However, this was no time to admire the joint effort of time and absolute poverty/slovenliness. The smell emanating from his room across the hallway and down the length of all the rooms on the section educed from passersby an extraordinary look of horror and disbelief, myself included.

It was hard not to keel over each time I walked by, which was potentially extremely unproductive, so I decided to take action. First, I found and aerated several bottles of peppermint spirits to clear the air as much as I could to abstain from gagging in close proximity. Then, I went in for the kill. Peeling the socks from his feet revealed much scaly sloughing and thick, yellow nails curled inward from lack of trimming. The janitoress yelled at me from down the hallway to seal the socks in an extra plastic bag before she disposed of them herself in a special container. I then took warm soapy water and a towel, cleaning the horned crevices between his toes of accumulated human filth. Drying the feet, covering them in fresh socks, then throwing a blanket over my efforts cleared the air, except when he shifted his position. Then, small pockets of noxious odors would accost those so unluckily positioned.

How did Mr. Stinkpot become this way? How could he stand to be so dirty? How could he just not care? No one becomes this way overnight; he fell into his situation from one drink too many, too many times. He could stand to be dirty because he had acclimatized to it. His nose no longer recognizes his own reek as foreign. And lastly, of course he doesn't care. To care would be excruciating. One phrase I hear most often amongst drunks is "I don't care/I don't give a ****/who the **** cares/what do you care/no one cares/other potentially impolite permutations. It is impossible to care when nobody in the world cares for you.

I am almost certain he will not notice his feet are clean when he wakes up. But my almost is by no means certain; perhaps in his depth of winter, he might yet discover within himself an invincible summer.

S

My Life in the ER: Musical Edition

Scene 1: S is walking to work in the afternoon and feeling great after spending the morning at the gym.

S: Oh, what a bright and lovely afternoon- I could break into song! The air is brisk, the sun is shining, nothing can bring me dowwwn. :musical interlude as she walks into ER:

Scene 2: Crowded ER treatment area

S: Oh my what a busy day it is,
oh my what a busy day.
The patients load is rather high and
The drunks are piled up that-a-way...

That man has a mesh bag on his head,
he must have tried to spit.
(Mesh bag head man: dramatic snore)
Those others also have been restrained,
just beware they also might spit.
(Drunk chorus: growls)

(change of key)
But I cannot complain- I'm not sitting,
and changes afoot are a-plenty.
I've got a pager now, and it rings a bell (riiing)
whenever my nurses need meeeeeeee-----

(change back into key)
Oh my Mr. Mesh bag man just woke,
oh my he just woke up now,
he's screaming that he needs to pee,
but no empty rooms I can see.

Mr Mesh bag head man (solo): I can't wait, I can't wait! I'll kill you all just wait!
Tech chorus: We have no room- just a sec- be patient and you'll go-
Mr. Mesh bag head man: I will wait, but just a sec- you need to take these off--
Tech chorus: You can pee with one hand, we won't release you-
Mr. Mesh bag head man: I can't ****ing take my pants off- you dirty *****sss-
Tech chorus: Then you will wait, Mr. MBHM, security is a-coming-
Mr. Mesh bag head man: I hate *****es!
Security: I'll help you sir, what do you need?
Mr. Mesh bag head man: Thank God!
Security: How can I help?
Mr. Mesh bag head man: I would like to be releaaased- I can't pull my pants dooown.
Security: I can help with the pants, but I won't hold it for you. (wink)

End Scene.

Scene 3: Ambulance bay

Ms. Drunk Pregnant woman (soprano): AAAAIEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEE
(scuffle ensues)

Nursing staff chorus (softly)
Oh my is that hot mess coming here,
Oh dear, she's rolling our way.
She's thrashing, yelling, cursing lots,
and a mesh bag is over her head.

Ms. Drunk Pregnant woman looks defiantly around and opens her mouth: AAAAAAAAAAAHHHHHHHHHHHHHHHHHHHHH
AHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHH
AIEYYYYYYYYYYYYYYYYYYYYYYYYYYYYAAAAAAAAAAAAAAAAAAa

(she continues)

New resident chorus:
What is that?
What could that be?
It is so hard
to believe THAT is a she.

Yet she must be,
though who would want
to impregnate
somebody like that.

Ms. Drunk Pregnant woman: AIIYEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEE
(solo)
Let me out! Let me out!
You *****es let me out!
You are all ****ing retarded
and I want to get out.
 AIIIEEEEEHHHHHHHHHHHHHHHHHHHHHHHHHH

What the ****, let me out!
what you n***** lookin' at?
Just shut the ****ing up
and let me ****out.

Bemused Very Tanned Drunk Guy:
Who you callin' a n****?

Ms. Drunk Pregnant Woman:
What the ****, shut your face,
who do you think you are,
when I get the ****ing out
of these restraints, I'll make you pay!

Mentally retarded patient in room 3: Gyahhhhhhhhhhh?

Doctor solo: Take her out as she so desires! To the ambulance bay she shall wander- until she can control her terrible mouth, she can get her ultrasound yonder. I believe I shall exercise my power, for your pleasure and your thanks, please make haste and open up- the most crude of all drunk tanks.
Nursing staff chorus: And be careful, she spits!

Scene 4: Treatment area
(from afar, synchronized trio
Ms. Drunk Pregnant woman: AYYEEEEEEEEEEEEEEEEEEEEEYAAAAAAAA
Tanned Drunk Man, Mesh Bag man and drunk chorus join in: AAAAAAAAAAHIIIIIIIYAAAAAAAAAAAAAA

repeat x200)

S: Oh my it has been a crazy day,
Oh my, I can't wait to go home-
I've got a candy bar waiting for me-
the sweetness will keep me warm!

Final Song:
When you go to the ER, guest,
be sure to bring ear plugs,
for though the chorus is plenty boist'rous,
you will still want to squash them like slugs.

The tale of the ER drunks must end,
for my morning is swiftly passing,
I must return to work again,
and therefore this passage is ending.

Normal Patient Chorus: Hey nurse, hey nurse, hey nurse! This place might be craaaaaayzeeeee.... But it is better than tvvvvvvvvv
Nursing Staff Chorus: It is, after all, the full moon, full moon, full moon moon.
Manager Solo: And in the eeeeend- patient satisfaction is our frieeend. Can you please stay, my favorite tech, to help patients find their way--- bring them upstairs and sign out laaaate?

S: I suppose... I ... caaaaaaannnnn.
(squeaky stretcher wheels fade into distance)
End Scene.

Burn-out

I was standing in the trauma room, wedged in a space between the trauma closet and another patient bed, holding the penis of a rotund drunk who could not reach it himself. He possessed a perfumed aura of fermented dairy products and neglected hygiene and graciously obliged us with a true-to-life rendition of his favorite soundtrack of mating large mammals. As I nimbly caught most of his interrupted spurts of diseased brown fluid in a deluxe male urinal, the techs who were gossiping on the other side of the trauma room looked at me in disgust. Then, they turned away and continued their analysis of a co-worker's perceived slight in hushed tones, lest I hear too much.  The absurdity almost made me laugh out loud.  It was my second time holding someone's genitals that day.

The first was a very weak old man who could not move much. From behind the curtain, I had heard the doctors musing, 'well we definitely need a urine on him' so I quickly fetched a urinal.  From across the room, I heard, 'Oh, sir, are you able to pee? Oh, he's going now.' Rushing in and pushing aside the curtain, I saw the doctors standing nonchalantly away from the bed. The looked at me and nodded as if it were a matter of course that I should be getting that urine sample now. I cut open the soaked diaper and despite that urine sprayed in uncertain spurts all over the bed, I managed to grab the slippery thing and get enough of a sample to send.  Unfortunately, Mr. Peed-on-Me was soiled and nobody would come in despite my pleas, so I moved him, cleaned him and changed his linens by myself.  As I was preparing to send the hard-won urine sample, a nurse popped her head in "Hey, what's your name again, can you go put bed 1 on a bedpan?" Before I could reply, she left, and the very obese lady in bed 1 refused to use the bedpan until I lugged a commode across the department to accommodate her. When I helped drag her body out of bed, I felt something in my mid thoracic back shift and twinge... so far, it's turned out to be nothing. (knock on wood)

The trauma room was uncomfortably warm and my drunk seemed to stop grunting.
"Are you about done, Mr. Drunk Half-Passed-Out?"
"LEAVE ME ALONE I WANNA SLEEP why won't you just... let me... go... ho... zZZZZzzzzzzzzzzzzzzzzzzz......"

I wheeled the sleeping Mr. DrunkHPO back to the hallway where I had first apprehended his "I NEED TO PEE NOW NOW NOW NOW NOW HURRY I NEED TO PEE NOW" request to find that the spot was already staked by a little old lady who looked like she had Death flexing his fingers over her shoulder.  I left Mr. DHPO in front of a closet to assess Lady Shriveled and a transporter yelled into the phone next to me "I'm sorry, but it's crazy down here, I can't find her. They've got people in hallway spots that aren't even spots! Does that even make sense?"

I had more than 12 patients in my section of critical care, several of whom needed labs, several more of whom needed to use the bathroom/had already gone in bed and needed to be cleaned, almost all of whom needed vital signs charted, urines dipped and sent, a transfusion to pick up from the blood bank, and the nurses from the other critical care section asking me to do quick blood assays.
What's more, patients just kept coming into my critical care section, one after another, with no end in sight.
With each patient comes a set of duties that should be performed immediately, such as the vital signs monitor, bloodwork and an EKG.

EKG's can be difficult to perform with certain patients, but each patient needs to have an EKG within 10 minutes of being triaged. In the time it takes to be registered, triaged, then brought to our section, I am left with only a few minutes to undress, expose, and perform the EKG with nurses and doctors at my elbows trying to assess the patient.  An EKG requires the patient to stay still, so this can be a challenging task if the patient is nervous and moving incontrollably.  As I was doing an EKG on Lady Shriveled, a student nurse sniffed at me, "we've got this, can you go put bed 3 on a bedpan?" Bed 3 was a code-brown.  As I gathered the materials to clean her/change her linens, a nurse from the other critical section team came to ask me to do a quick blood test.

I was wearing thin, and somehow, this helped me think more clearly.
S: "I can do it, but where is your tech?"
RN: "Tech Useful is doing an EKG in room 9."
S: "Wait, Tech Useful is extra today."
RN: "Oh, really? Who is our tech?"
S: "Actually, Tech Laid-Back is supposed to be in your section... Also, Trauma Tech Sour-face is supposed to be out here too.  You have 3 techs, and they only have me. Nobody has helped me out all day."
RN: "Hm, let me go check."

He walked around the department and looked at the assignment sheet- nobody else was to be found.  I ran the blood test anyway, but at least now, the charge nurse and team leader nurse became aware and concerned about the people missing in action, even prompting an overhead page, to no avail.

One patient began to code, and out of nowhere, Trauma Tech Sour-face, who had been hiding in the trauma room appeared, pushing us all aside to say, "I've got this," and jumped on the patient's chest to do compressions. Other techs appeared too, and suddenly, our department was full of dedicated, hard-working heroes. It wasn't the first time I laughed in absurdity that day.

It was, however, the first time I ever reported anyone to the managers.  Tech Laid-Back had tried to do damage control with me, saying that she accompanied a helipad transport. However, helipad transfers usually take 45 minutes and she was gone for more than 3 hours.   She offered me help when she finally appeared, but the rush was already over. My impending burn-out was still prescient, however, and it took all I had to finish the shift gracefully.

Believe it or not, the overall workload that night was only a bit heavier than it usually is for our busy sections.   I was only subjected to the abuse that night because of the lack of teamwork that night.  In my section, 2 of 3 nurses were new graduates and unused to the procedures and stress of treating of critical patients.  Their preceptors unfortunately took their training status as an opportunity to gossip instead of helping.  Between Tech Useful and me, the sections stayed functional, but barely.  If any of the other techs had done even the bare minimum instead of hiding wherever they were, we could have functioned very smoothly. The coding patient in 9 might even have been caught earlier had another pair of eyes been watching.  Ugh.

I carefully control my internal environment to exclude resentment, but it became very difficult that night last week.  It took me a week to work through these emotions and I can only hope the new nurses don't learn to become complacent like their preceptors.

Meanwhile, here's to the successful completion of another week in the life of a ERTech.

S

Dancing in the Moonlight

There is a superstition in Emergency Rooms... that when psychiatric patients suddenly collectively crawl out of the woodwork at once to overwhelm and abuse us, it is not a random act of terrorism but rather an organized, meaningful migration controlled by the phases of the moon. You may scoff at my apparent lunacy, but remember, I used to be just as logical and scientific as you are.  Back before I started working here, I didn't believe in ghosts, cold-blooded murderers, priapism, human cruelty, nor prolapsed urethras either.  Well, I still don't believe in ghosts, but I am otherwise that much more accepting of weird happenstances from my experiences in the ER.   

In any event, whether you believe in the correlation or not, last week's full moon coincided with one of the gnarliest weekends ever at the ER.   All surrounding hospitals, psychiatric treatment centers, urgent care facilities, even our own inpatient areas were totally overwhelmed. Patients were not moving and more kept pouring in. In our ambulance bay, plastic dividers were set up so patients didn't have to watch each other being sutured and otherwise cared for.  Psychiatric emergencies filled the corridors with jungle-like hoots and hollers.  

Mr. Man-child constantly made drawn-out whining noises like an opera student warming up and exhibited less self-control than an advanced dementia patient.  He was tied in 4-point restraints when I took over the job of sitting with him. 

"You's better get me out of these restraints. I'm gonna sue you like nobody's business. Enjoy your freedom now, ********, 'cause I'm gonna own ya when I sue you for all you're worth!"

Intoxicated and naked, he took another approach when I ignored him. "Fine, if you don't let me go, I'm gonna get naked." He tried to throw his blankets off him, though his 4 limbs were tied down. After a fuss and much struggling, he managed to expose his chest and copious rolls of fat.  Livid, he tried to stare me down. Nonchalantly, I ignored the large slitted eyes and closed the curtain to spare innocent passersby the unpleasant visage.  Then came the death threats. "When you walk out of here tonight, expect to get jumped, you ****, don't expect your kungfu skills will do you any good, cause ya know what? You're not bulletproof." 

(P.S. How scary is this... I usually do get affected by death threats like this because the possibility is a little too high to be ignored entirely...http://www.nytimes.com/2011/11/12/nyregion/when-gunfire-reaches-inside-the-hospital.html?ref=health)

As charmed as I was by his way with words, I had to put an end to the yelling. I met his fury with a calm, collected air, taking him by surprise.  "Mr. Man-child, you are running a fever of over 102 degrees, which is a dangerous condition. You are tied down because you're not making any sense. Think about it." He looked at me in nervous astonishment. "We are trying to help you. Please don't try to struggle and go home because this is really serious."  Careful not to sound like I was condescending to a child, I took him down layer by layer until his noise output was reduced to a quiet whimper every few minutes.  We had no opportunity to celebrate our small victory with Mr. Man-child, though, because Ms. Misogyny decided to start yelling at me to stop "doing a man's job, because you can't do it right. Just stand there and look pretty cause that's all you're good for."  

Twelve hours of this later, I was more than ready for a hot shower and the comfort of some peace and quiet.  

Walking into the brisk night on my way home, I saw the silvery full-moon slipping behind a cloud. Seeing is believing.  

S

Health-Care Team

For whatever reason, all my patients tonight were extraordinarily ill.  Intubation after intubation, respiratory emergency after respiratory emergency, significant chest pains, intestinal blockages, internal bleeding, traumas, ingestions, you name it- we were swamped.

Mr. Cat-eyes, one of my regular drunks who is here at least 3x a week was a critical patient today.  Because he was unresponsive (and still drunk), we pumped his stomach and fed him activated charcoal through that same oral-gastric tube.  Activated charcoal is pretty gross. It got all over my gloves, then on my bare hand when I removed the gloves. It's thick, sludgy, and tastes terrible, so I hear, except for one girl who took the pediatric cherry-flavored charcoal and said it tasted like cookies.  He was sweating profusely (diaphoretically) so I wiped his familiar face several times with a towel.  He wasn't clean- streaks of yellow exudate covered my towel.  The respiratory therapist was a nice young man.  He actually wiped a spot I had missed on the other side of Mr. Cat-eyes' face.  When Mr. Cat-eyes went upstairs, I couldn't help but wonder what had made him this way today. :(

In the other room, a nice old gentleman had come in for difficulty breathing.  Throughout the day, his eyes were half-closed, but he was fully aware and answered questions appropriately.  It reminded me of when animals are sick. They don't vocalize, but lie there, panting and staring through half-closed, glassy eyes.  I felt so bad for him and made it a point to go to his room often to shut off the constantly ringing alarm on his monitor. Both his heart rate and breathing rate were extraordinarily high.  The same respiratory tberapist from before came to find me because my LOM asked said to him "I feel so tired, but I wonder if I fall asleep if I'll ever wake up again." He made me promise to check on him often, which I was doing already. It really touched me to know that someone else was caring for patients. Not "caring" in the cold, clinical sense, but caring in the way that you move a lock of hair from somebody's face, or tuck a blanket around someone's bare neck.  This therapist even did something that I normally do; he came back when he was about to go home, to check on this LOM once more, to reassure him that he was in good hands, and that we were going to take care of him.  I think that my faith in humanity jumped a few points today.

I did my own mitzvah today after seeing the respiratory therapist with my LOM. An older man had come in for syncope.  Apparently, he had been fasting all day for Yom Kippur and fainted dead away after a glass of wine.  He and his wife were lovely people and very grateful for my detailed attentions to them despite the craziness of 2 intubations in the rooms around them and several patients down the hallway screaming from PCP use.  It was worth the extra effort to me. They were kind people- you can tell from the way their bright eyes crinkled when they smiled. After I changed out of my scrubs, I stopped in to see them one last time and wish them luck. Luck would have it that they were being discharged at that very moment and as my final work-related action of the night, I removed his IV and sent the pair of them out into the warm autumn night.  Work felt good tonight... Can't wait for 12 hours of trauma drama-rama tomorrow!

S

Forgiven... for Now

Mr. Mumble-de-Gook waved me down. "MRRRHHGNNNNG"
I looked at him warily.  The last time I saw him was when he almost clocked somebody with his cane.
http://talesofanemergencytech.blogspot.com/2011/08/fencing-er-style.html

"MMRRRH HUUUUUNGRY"
Oh, he was hungry again. I made it a point to never feed him when he came in.  Last time I gave him a sandwich, he ate it, then peed in the box before returning it for me to throw out.   Besides, there were no sandwiches in that fridge last night anyway. And I told him so, cheerily. Maybe too cheerily.

He cursed at me. "That ****errrrr therrre," he would cry, waving his arms whenever he saw me.
A nurse informed him that there were no sandwiches.  And miracle of miracles- he FELT BAD. He apologized for calling me a liar. Would you ever believe? He is still a scumbag for coming in to demand sandwiches, but wow to be apologized to... my eyes were ready to become pricked with tears, though they never came. It's the thought that counts.

When he did get a sandwich, he celebrated in the only way he knew how- "MMMMMMM. MRRRRRRMMMMM...." with a smile on his gap-toothed, cross-eyed face the whole time.

S

Adventures in Sitting: The One that Broke Me

There was a time, y'all, not too long ago, that I was living in the valley of kittens and rainbows. Every patient, regardless of ailment or creed would get a blanket, a sandwich, and a smile (if the medical situation allowed). People weren't incapable of evil- sometimes their disease states just made them grumpy. Even my rowdy drunks didn't mean any harm- their curses and threats were forgotten by them before the next time they request an urinal or sandwich. If you were kind to them, I thought, people would respond in kind.

Oh to be young and naive! A shift in the drunk tank soon cured me of that.

Entering my shift in the drunk tank, I was given report of my 3 patients. There was Ms. Opportunist in the middle, Mr. Passed Out in the back, and Mr. Two-faced in the corner. Mr. Passed Out was passed out, Ms. Opportunist was sitting comfortably, and Mr. Two-faced was sleeping in his stretcher- he had been like that all day, the tech told me. Ok, that's fine, I replied, anything I need to know? Nah, they've been quiet all day, she said.

I was all set. My cart was equipped with water, sandwiches, and whatever else. Mr. Two-faced rolled over and woke up.

Mr. TF: Hi, miss, can I get a drink of water?

S: Sure, here you go.

Mr. TF: Thanks a lot, you're really nice.

S: It's my job.

Mr. TF: Miss, can I get just another glass? I'm parched.

S: Sure.

Mr. TF: Thank you so much. That really hits the spot.

He was very polite and kept to himself- he was easy-going and quiet. He asked for a sandwich half an hour later, stating he hadn't eaten in a day or two. No problem. He was very thankful for it- so thankful, he asked for another one. Again, no problem. He was comfortable, I was comfortable, things were good.

I checked his vital signs and breathalyzer- he was on the cusp of sobriety where the residents might release him, but still a few points higher than the dogmatic new resident might like. He asked whether he was going home, so I let him know it would be a little while longer. No problem, he said.

He was as sober as was possible for a chronic drunk, I could tell, and was getting restless. I let him go to the bathroom. When he returned, he perched on the edge of his stretcher. He acquiesced when I asked him to sit back all the way, though.

Without warning, he got up and walked to the side of his stretcher. Warning bells sounded in my head.

S: Hey Mr. Two Faced, what are you doing?

Mr. Two Faced: Just looking to see my stuff is here.

S: When you're done, can you please sit in the stretcher?

Mr. Two Faced: Sure, honey, anything you ask. Where is my stuff?

S: Isn't it back there?

Mr. Two Faced: No, where is it?

S: Let me check in the back closet..

Mr. Two-Faced: is it there? My big bag full of all my clothes?

S: Hmm, no, I didn't see it. I will call the nurse to see if she saw anything in the section you came from.

Mr. Two-Faced: Aw ****, I can't believe you guys lost my ****. again! Twenty times I come here, twenty times I lose every *** **** thing I own. I am homeless, y'know, I dont have much. **** me. **** you.

S: I'm calling the nurse, hold on.

Mr. Two-Faced: No, Get a manager over here, right now.

S: Mr. Two-Faced, I am doing all I can to locate your belongings. Will you please give me a minute, sit for a bit and we'll see what's going on?

Mr. Two-Faced: All my clothes! I don't have nothin'. All my ******** clothes. You guys better have a lawyer, cause I'm suing your ******* ****** for all it's worth. Take my clothes, eh? You'll pay for it.

S: Nobody here wants your clothes, Mr. Two-Faced, we're searching for your stuff right now.

Mr. Two-Faced: **** you. All of you are losers. You're phony. You pretend like you care then you lose all my ****. Well **** you.

S: I didn't lose anything. You were here before I came in.

Mr. Two-Faced: You work here, you lost my ****. End of story. You don't give a **** if I live or die or if I lose all my ****. You rotten *****!

S in a soft voice: I do care, Mr. Two-Faced. I'm really sorry you lost your stuff- really, I am. We're doing our best to find it and it has only been a minute since I made that call. Please, just hold on and I'm sure your stuff won't just disappear. Nobody here would want your clothes.

Mr. Two-Faced: **** you. I want a manager. RIGHT NOW. Go on, do your job, call the ******* manager cause I am gonna sue all of you *******. Dirty ******, what are you waiting for?

At this moment, Ms. Opportunist- can I please go to the bathroom?

S: Sure, but come right back.

I watched her from the door as Mr. Two-Faced starts pacing and screaming at me again. I have never had anyone scream at me like that, voice breaking from all the strain. What did I do to deserve this? I FED him, I thought with revulsion. I am keeping homeless psychotics like this alive so they could abuse me and abuse the system.

Mr. Two-Faced: This place sucks! All you could do is feed me bull**** about how you care and ****, but you don't give a ****. None of you care. You're heartless ******* who don't care if I live or die.

S: I do care, Mr. Two-Faced. I'm sad you can't see it.

I watched Ms. Opportunist come back out of the bathroom... and run out the door. I had completely lost control. Backing out of the room as Mr. Two-Faced tried to swing at me, I called security, and to my horror, burst into tears.

He had turned a switch and I was unprepared for his sudden outburst, after 12 hours of mind-numbing work already. He had been testing me and knew exactly which buttons to press. I cried for you, Mr. Two-Faced. You are just too broken, biting the hand that you were so thankful for, that fed you not too long ago.

Security jumped on Ms. Opportunist, pinned her down, brought her back, and restrained her. Mr. Two-Faced was thrown out. Mr. Passed Out was still passed out. And I grew up a lot that day. I will never forget the screeching voice, the angry eyes, and the semblance of civility that he put on when I first met him. Should we meet again, I have some choice words for Mr. Two-Faced.

S

Drunk Tank Pentameter

The night was waning, shift was ending fast,

when charge had tracked me down with this request:

please open up the doors to yonder room,

where idiots who drink avoid arrest.

Thus far I *had* been very fortunate,

escaped the boring fate it is to sit.

Well bring them on, this can't be all that bad,

With forty minutes left, why not commit?

The dank and dim-lit room was prepped and set,

the stretcher sounds came drifting to my space,

a million miles away my mind had rest',

in girlish dreams of etiquette and lace.

Hi ho- the first intoxicated hailed,

but why and how did I end up o'er here?

You're drunk, the tech who brought him in had sneered,

with that, she turned her fat and ugly rear.

Come back! My resident had yelled- in vain,

and anger, seething, hot, and fueled by drinks-

induced the large and dang'rous brute to leap

from bed with limber strength to strike the minx.

Now I had no desire to be thus stuck-

though no immediate danger came my way.

against the wall I slunk to freedom safe,

escaping waving limbs and spittle spray.

Security came quickly at my call,

my boor became a gentleman in haste.

And all was peaceful, only for a while,

because the tech returned, smirk unerased.

Now I don't really mean to yell, she said,

the panic button, you have heard of it?

Stay *in* the room, and you will be okay,

Six years, I've worked and I have not been hit.

I thanked her with a smile upon my lips,

with irony appropriately placed.

When you're here, which will happen soon, I'm sure,

You might not boast an injury-less face.

When there is malice brooding in your breast,

don't instigate my drunks and cause a mess.

Naivete may seem to be my fault,

advice like yours, I could not ---

---regardless, shifts were changing very soon,

my soft and comfy bed was calling me to sleep,

which rare occasion is a cause for glee,

though even dreams are not immune from creeps.

S

Dalliances with Drunks

Mr. Slick began his ER hallway drunk-tank adventure as an explorer. He sailed through the halls, through uncharted wildernesses of unused stretchers and linen closets, stopping man and beast alike to chat and build local street cred. He sensed the triage nurses were inattentive and slow and he knew the system like the back of his hand. Eventually, he was caught by the native security guards and escorted back to his bed without being tied down. He tried to talk me out of his involuntary stay on his stretcher, but it was to no avail. Grumbling, he covered himself with a sheet and passed out for a few hours. His BAC was .380.

Mr. Scumbag then wheeled in with a BAC of .327. He refused to admit he drank anything and proceeded to ask directly for a sandwich as soon as he was settled on the stretcher. He also needed a glass of water and needed to go to the bathroom, too. Despite these needs, the floor was "too dirty to walk on" for him. Eventually someone fetched him a sandwich. He didn't eat a bite before he asked me to throw it out, "not to be a scumbag or anything." Winking at me, he kept making a come-hither sign, saying "hey, hey, pssst, come'ere." The first time, I did go near him and all he said was, "you're gorgeous." Uh, thanks. "Wait, come back, come'ere." He looked conspiratorial- "whatever you have to say to me, you can just say it out loud." "Tsk... no, really, come here, it's important." "You know you're into me." Half an hour later, he gave up, "you don't want to talk to me because you know I'm a scumbag." I did take him to the bathroom and suddenly, he put me in a bear-hug. Feeling his arm around my throat was not a good feeling, so I called security and he tried to laugh it off. He was escorted back to his stretcher and warned. He soon became bored and woke up Mr. Slick.

They became great buddies, feeding off each other. Mr. Slick knew our system well from coming in all the time and taught Mr. Scumbag what "AMA" means- against medical advice. This prompted a chorus of "I want to sign out AMA! I want to sign out AMA!" Of course, as I explained calmly, this was impossible considering they were intoxicated and therefore incompetent to make that decision. Then, Mr. Slick pulled out a cellphone, which was not allowed. I told the nurse, who totally undermined me by saying "I don't care if they have it if it makes them calmer." Way to go for standing up for your co-workers and workplace morale. Mr. Scumbag snatched the cell phone and tried to use it, too, to no avail. Our radiology department was next door and the leaded walls blocked out signal. Mr. Scumbag declared my explanation as "a crock of ****", and Mr. Slick became convinced the hospital was full of voodoo that blocked cellphone signals instead. "Hey, I'll give you $100 if you go get Burger King for me," Mr. Slick offered me. I laughed at him and turned to help the nurse with Mr. Scumbag.

A nurse tried to take vital signs on Mr. Scumbag. The cuff kept popping off. His arms weren't that big and I watched him to see why- he was flexing as the meter read and being a general d-bag. He started bragging "You can't take my blood pressure because they're DIESEL," posing for all to see. The nurse gave up. Soon, Mr. Scumbag realized nobody was watching him flex and he got bored, declaring "I just wanna go home and get laid."

Mr. Slick shook his head, deciding he did not like his new friend. That was when Mr. Slick's neighbor, Mr. Goldfish, wheeled in. Mr. Goldfish was looking for his phone, which was in his pocket the whole time. Security took it out and put it in the bag under his stretcher because he was not allowed a phone. He had some sort of short-term memory loss- he didn't remember anything that happened about 10 seconds before. So he kept asking for his phone. Pleading for it. Pleading for us to find it. So he could call our hospital. He did not stop and mournfully wailed for it, even crying large tears out of both eyes. Why are you crying, Mr. Goldfish? My mother died! he wailed. He continued crying inconsolably. He refused to breathalyze for about half an hour despite our most insistent nurse drilling at him. Finally, I asked him- when did your mother die? 20 years ago. Geez, the way he was crying, one would have thought it was yesterday. Soon, Mr. Goldfish was put in 2-point restraints because he kept flailing and refusing to sit back. When he was taken out of restraints, based on a verbal agreement that he'd behave, 30 seconds later, he had to be put back in. He didn't register there ever was any sort of agreement. Completely incapable of normal cognition, my hours with him wailing and asking for his phone really grated on my nerves.

"This is a sobering experience," observed Mr. Slick. "I wanna go get laid," interjected Mr. Scumbag. "WHERE IS MY PHONE? CAN I HAVE MY PHONE?" asked Mr. Goldfish.

8 Hours later, the noise level was still the same and I was beat. Drunk tank tech is done for the day. Time to go for a long run.

S

Fencing, ER-Style

Mr. Mumble-de-Gook is incomprehensible. He is one of my regular drunks that I ignore completely because the last time he begged me for a sandwich, he thanked me by eating it, then peeing in the box for me.

Ms. Prissy Regular comes in like clockwork- every week. There is usually nothing wrong with her, but she likes to come in for a nap and a sandwich under the guise of some problem related to her morbid obesity.

Our ER was full to capacity again last night and both of them were put in the same back hallway to await sobriety. The stage was set for disaster because Ms. Regular is spoiled and Mr. Mumble-de-Gook does not ever shut up. I have never understood a word he said except that time I figured out, he was saying "hungry" and gave him the sandwich.

Ms. Regular: Can you please be quiet?

Mr. Mumble-de-Gook: Hrrrrngh! muauambuleaa-aggh.

Mr. Mumble-de-Gook: Arrrm aerrddd nyumm uh huhh errdaastt meehh

Mr. Mumble-de-Good: auyumm aereeedsss miisssto miiiikkk meraamernumer astimurkat

Ms. Regular: What is wrong with you? I'm trying to sleep here.

Mr. Mumble-de-Gook: aghg-mummbrrr orrr ehhhh

Ms. Regular: I don't need to sit here and listen to you all night. You sound retarded.

Mr. Mumble-de-Gook: ARRR-EEMBB EEREM NYAN NYAN NYAN

He stands up and makes a menacing motion.

Ms. Regular: You get any closer I'm gonna clock you with my cane. (She swings it for effect)

Mr. Mumble-de-Gook swings out *his* cane and says the first comprehensible sentence I have ever heard from him: MMRM I'mmmm gonnarr knock mrrr your wigg offf.

There was to be a cane fight as both of them started brandishing the canes in menacingly, but I called security and Mr. MdG was released back onto the street because he was walking as steadily as he ever did. Oh, the joys of sitting...

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.

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

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.

S

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?

Answer:

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.

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

Panda-monium

My predictions were unfortunately accurate; the day after the 4th of July holiday weekend was unadulterated chaos. The waiting room had over twenty patients at any given time, the rooms and hallways were full, the center hallway was falling over itself with drunks. Great.

I was extra (unassigned), so I floated around to the critical care section, which was jam-packed with the most seriously ill patients. A new critical care patient was coming in, so I pulled Mr. Blegh, a quiet little-ol'-man (LOM) into the hallway in front of the secretary to free up his room. He was almost ready to be transported to his new room upstairs. The secretary was already besides herself with trying to move admitted patients upstairs into the wards to aid decongestion of the wing. She soon pulled strings to expedite his paperwork so I could take Mr. Blegh up myself. Mr. Blegh was polite, very diminutive, very quiet. I brought him into his room and raised the stretcher so he could climb into the hospital bed. I made sure his urinary drainage bag and IV bags were placed so he wouldn't pull on them when he moved. I began to wonder if I should have asked the nurses to come in and help move their new patient. Without warning, he said, I don't feel well, BLEGHHHHHHH. Mr. Blegh threw up copiously. Four times. Onto my pants. All over the floor. All over himself. During which, he also lost bowel control. After cleaning up, I came back downstairs to the ER and told the secretary about Mr. Blegh. "Oh, I just knew he was going to throw up. He had that look; I didn't want him to go up with just a transporter." ...... Oh well- that actually did make me feel better, since it meant that she trusted me to help Mr. Blegh if he got sick en route.

Charge nurse soon found me and put me to work in our ridiculously crowded and bs/drunk-filled triage bay. Among my favorites:

Mr. Smith:
Charge to me: "We need urine on Smith."

"Will patient Smith please report to the triage desk, Smith."

A boy walks up. I'm Smith.

"Hi Mr. Smith, what's going on?"

"My stomach hurts."

"In that case, we need a urine sample."

(looks shifty and uncomfortable) "Why do you need one?"

"We want to make sure that's not what's bothering you and making you sick."

"Umm, ok, I guess I'll try, but my stomach won't let me pee."

"Oh, ok, well here's the cup in case you can." My spidey senses tingled.

Charge to me: "Actually, we need bloodwork on Smith."

"Will patient Smith report to the triage desk again, Smith."

*no answer*

I walked out to find him. His family says, he's not here. Where is he? The bathroom.

I sprinted into the men's room. Someone was in the stall zipping up his pants.

"Mr. Smith?"

"Yeah, yeah, I'm here."

"We need a sample from you."

"Umm.... I was trying, see, and um.... I still can't"

He then flushes the toilet and comes out. What a sketcharoo. Then again, so am I, for following him into the men's room.
"Well, we need to draw blood from you too."

"What's the rush, man??"

"Excuse me?"

"Why you so in a hurry?"

"We've got a lot of sick patients here, Mr. Smith. We work fast."

I noticed he wasn't holding his stomach or groaning, that is, until we got back to the triage desk and he startled me with a sudden gasp of agony in front of the nurse.

Ah ha. A faker. Soon after, he left without being seen.

Ms. Lame

I called her up a few times to draw labs and for a urine sample. She suddenly decided she didn't want to walk anymore and plopped down in a wheelchair, refusing to get up again. I wheeled her to her bed, at which point she got up, rubbed her behind, walked to the bed as normally as anybody and said, "dang that doggone wheelchair gave me a pain in the a** cheek!"

Mr. Plug:

Stuck a q-tip too far into his ear. His was the first ear I've ever irrigated. I dislodged a large green, waxy plug occluding his eardrum. It took two rounds of blasting warm water in his ear to flush out what must have taken several years' worth of work to compact. He winked at me and said, I am ready for round 3 if you're the one doing it. Aww.

Mr. Sleepy:

He was just sleepy. He wasn't sure why the EMT's brought him in. He felt fine, really. Alert and Oriented x4, just really groggy. We were also wondering why he came in until the EMT's mentioned alcohol. He breathalyzed .443. Holy moly! He wins for the day.

All in all, a good day. See y'all tomorrow.

S

Rapid Triage and Friday Night Dance Party

A giant walked up the ambulance bay, flanked by 4 nervous-looking officers whose heads only reached the man's shoulders. He was smoking something, but thank goodness he was clinically sober. He didn't need to hop onto the stretcher at its full height, just bent his legs and sat down. The thing was higher than my natural waist. He also had to duck his head to come into our ambulance bay. Later, someone asked- he was 7'2"-7'4" plus 8" of fro. That was a lot of basketball potential, once upon a time.

Then we had 5 drunks in a row. One of them breathalyzed .413. My personal record breathalyzing a patient was .530. Keep going, sir, but you win for this evening.

People just kept pouring in. At one point, we had 6 people lined up on EMT stretchers with no space to go between them to take vital signs. The waiting room was filling up, and nurses from other sections kept trying to commandeer me to do things for them.

Someone changed my name on the assignment sheet again; I clearly saw someone else wrote my name in the drunk tank. I told charge, but she couldn't do anything about it- so ironically, without a dinner break of my own, I was feeding drunks who snapped their fingers at me and demanded food, then sneered at what I gave them. What entitled homeless bastards.

The mad urinator from last night was back. He pee'd himself again and stripped naked as the day he was born. We gave him paper scrubs so he could be on his way. I stopped him at the door, though, because he was carrying a restraint bag like a purse; he sighed, emptied it into his plastic patient belongings bag and walked out. Yup, nice try, but I caught you.

Everyone else back there was pretty much good-natured, except for the pretender. He came in, eyed me up and down, then suddenly yelled,

"Owwwwwwwwwwww! Owwwwww!! My appendix! My lung! My esophagus! Owwwwwww!"

He looked at me hopefully, then sighed, plopped on his side, and went to sleep. Apparently he faked a few seizures earlier.

Makes me wonder what happened to the singer... he was on visit 400something, but has since stopped coming in. Maybe for the best.

S

The Drunk Tank

"Oh ($@*#&, they put me in there again". My last name was written in pencil in the box. I was in the drunk tank again last night. I have been there almost every single shift for a month and I work 5 evenings/week.

The charge nurse saw me- hey, we need you to open the drunk tank now.
"Sure, but I need to make sure it's stocked first. Give me a few minutes."

"Everybody gets their drunk tank initiation," a wizened nurse commented as he watched me grudgingly walk to the isolated room in the back hallway.

It is a dimly lit room smelling of stale air, acid and alcohol, unwashed bodies, and wet socks. There were no gloves, no urinals, no food, stale water, no blankets. As I took this inventory, a nurse brought me my first patient.

"I'm not open yet, will be in 5 minutes. I will pick him up myself," I promised.

The nurse grumbled and informed the charge nurse, who burst in indignantly to ask me if I really sent a patient back, lecturing me on the importance of decongesting the hallway of extra patients.

Once upon a time, I might have apologized, but now I know better. The room is totally isolated; it is difficult to find someone walking by to fetch supplies. The patients must be constantly watched. As drunks, they are fall risks, and almost all of them try to walk around. Many of them are "frequent fliers" who know the system better than me. They press buttons to test the new person; but I'm impervious now. I have been since 2 weeks ago, the first time I cried.

The patients started coming in, regardless of whether I was ready or not, so I took notes:

Patient 1 was on his 148th visit; he laid in his stretcher and barely moved for the hours he was there with me. His BAC (blood alcohol content) was still .266 (legal limit= .080, it generally goes out of the system at about .010-.030/hour) at the 6th hour of his stay in the hospital.

Patient 2 was on his 134th visit; I had seen him many times. He was supposed to be going to detox but kept threatening to leave if they didn't give him ativan/valium immediately. I took his vital signs and he was tachycardic at 125bpm, at a BAC of .278!! He had no other symptoms of withdrawl, but after a few pills from the nurse, he quieted down until he felt like he wanted another pill. Then he raised a fuss again. He sneered at the food and refused to eat it; apparently it wasn't good enough for his homeless palate. The nurse asked me to take his blood sugar. Darn! I forgot the gloves. I looked in the hallway, no one was there. I yelled out desperately, but no one came. I finally just took his glucose, without gloves. The blood poured from his needle prick like water- thinned, no doubt by all that alcohol. I stemmed the flow, but felt horrified I touched his blood. Looking in his chart, I saw that he was contact precautions for VRE (multiple antibiotic-resistant organism). Great. I washed my hands in alcohol 4x.

Patient 3 was on his 72nd visit. In the waiting area, he got up from his stretcher several times and almost fell. Indignant that he wasn't getting any ativan/valium/food on command, he got up when the nurse turned her back and peed on the floor in our main hallway, right as my manager was walking by. This, coupled with his constant attempts at shaky ambulation was means to put him in 4 point restraints. He could still reach his pants, though, and pulled out his penis whenever anybody walked by. Someone threw a blanket over him, and that's how he came in.
He asked me to come over- I took his vital signs- fine. Breathalyzer- .230, blood sugar-149. "I'm diabetic, you know. I need to pee". I gave him a urinal.
He called me again- "I have this thing, it's called something like (thinks hard) spinal tendinitis- I really need medication for my back". he wouldn't have been cleared to come to the drunk tank if the ct scans or xrays showed anything, so I just noted it to the nurse.
He called me again- "can you take these restraints off?" not without doctor's orders. remember you peed on the floor?
He called again- "I'm hungry. Give me a sandwich." "Can you peel this orange for me?"
And again- "I need to pee again."
And again- "take these restraints off."
And again- "when am I going to get that pain medication?"
And again- "where is my nurse?"
And again- "what nationality are you?"
And again- "I'm in so much pain, please, give me meds now."
And again- "Do you have anything else to eat?"

I stopped answering. He was testing me. So he called- louder, and louder, and louder. Finally he yelled "If you don't answer me, I'm gonna pee on this #)($@*U floor." And so he did.

There were more people in line for getting cleared to come to this room before I was relieved by a colleague, one guy who was on his 180th visit. Regardless, it was actually a pretty good night there for me- nobody was spitting, screaming non-stop, or getting up to assault me.

Working this 4th of July weekend will be crazy, I'm sure. Updates and stories to come...
S