Emergency!

by Mark Brown, MD

  Now, as Carl was awakening from the fog, his mind told him not to panic. He had been here many times. I began to examine him to see what, if anything, was to be done. I requested blood tests to check medication levels. Pulling aside the gown to listen to Carl’s heart, I saw the waxy smooth, rippled scars of an old third-degree burn. They extended from the base of Carl’s neck, down the front of his chest wall, across his shoulders, and down onto his abdomen.

  “How did you get those scars? House fire?” I asked.

  “No, Doc, I got lit on fire.”

  “What do you mean ‘lit on fire’? Were you drunk or something? Or accidentally splashed with gasoline?”

  “Nope. Happened when I was a boy.”

  “Fireworks?”

  “No, Doc. I was set on fire.” Carl began his story:

  “When I was a boy, people like me with fits got sent to state hospitals for the insane. They’d keep us there because no one knew what to do with us. My poor parents were shamed into sending me. I remember my mom and dad fighting before I got sent away. The schools wouldn’t take me. They didn’t have to back then. A lot of good Christian people figured my parents must have done something evil and I was God’s punishment on them. The more upstanding, nonsuperstitious ones just figured I was a genetic misfit, kind of like a badly bred animal. Hell, back then some of them even thought I should be castrated so my bad genes couldn’t be passed on.

  “My mom, she tried to protect me. She’d take me out like a normal kid, dress me good and all that, but I’d have these fits. I’d just fall down jerking in stores, in church, you name it. Then everyone would stand around looking scared and uncomfortable and Mom would hear all these things—she’d hear them even if they weren’t said— about what a fool she was not to put me away, what a monster I was, and always the questions about what was wrong with me and why did I act like that. My dad didn’t understand any better than anyone else back then. He kept hoping I’d grow out of it. He even tried beating it out of me on occasion. When that didn’t work, he started giving up on me.

  “I had two brothers at home. Mom could see Dad getting more and more desperate and depressed. She’d try to cheer him up. She was a tough woman. She’d cajole and smile and try to keep going, but it finally just wore her down. I guess she figured that she had to raise the two who were normal and give up on me, even though it broke her heart. That woman really loved me. So she did what all the others did back then: She sent me to the state hospital for the mentally ill.

  “It was a hell of a place, Doc! They had wards of loonies, and kids with birth defects like you couldn’t believe! They had those kids with water on the brain, poor bastards. A lot of them were smart but they just had to lie there all the time because their necks wouldn’t hold up their heads. ‘Course, they got surgery for that now, but they didn’t back then. They had kids who screamed and ripped at themselves, and kids who just stared into the walls all day. A lot of them weren’t able to control their body functions, so the place smelled to high heaven, especially when it’d get hot. Some of us weren’t too bad off. We’d have our seizures, but the rest of the time we’d be like the cock-o’-the-walks. It was a hell of a place, but it was what I had and I was a kid, so I played.”

  “How did you get burned?”

  “Well, I didn’t have much, of course. My parents were sent a letter about me every now and then, telling them how many seizures I was having, kind of like a batting average, I guess. Back then you didn’t travel easily like you can today, so I never saw them. My mom did send me letters. Once every month I’d get something from her with a little news and a lot of love between the lines. I kept them in a shoe box under my bed, and when I felt like crying, I’d read them. You see, I couldn’t run and cry to my mom. She wasn’t there, but the letters were.

  “One day they decided to fumigate the place, kind of like spring cleaning. They went through everybody’s stuff, throwing away what they thought was junk. They figured a box of old letters wouldn’t mean anything to a kid with a brain defect, so they threw them all away. Didn’t ask or anything, just burned them all. Well, we got back into our ward that afternoon and it smelled of disinfectant. The walls had been washed, the windows were cracked open, the sheets were clean and stiff, the beds were all made. It looked better than it ever had, but it sure felt unfriendly. I think it bothered all of us. It was like someone coming into your house and rearranging all the furniture.

  “I felt so lonely, I went to read my letters from home. They were gone. I started shrieking and crying. I was beside myself. I caused so much uproar that soon the whole ward was screaming along with me. The orderlies pretty much ran the place. Usually I was easy to get along with, so they’d let me alone. But if you got out of line, or hassled them, they’d beat you up, put you in a padded cell for days, or tie you to your bed. They figured they’d have to get me out of there.

  “Two of them came in with a straightjacket for me, but I was so crazy I didn’t care. I wanted someone to hit me to take away the pain I was having inside. I wanted to be knocked out or something. I was so alone, so very alone. I kicked one in the face, broke his nose, before they got me tied up. Really pissed them off. They beat on me a bit, but I still was mad, so they figured they’d make me shut up. They poured rubbing alcohol all over me. I guess they thought the sting and smell would knock me down, but it didn’t. They beat on me some more, but I still wouldn’t quiet down, so they took me into one of them padded cells. They were getting desperate. Here was a guy who never hassled them totally out of control, and nothing they did would make me slow down.

  “Finally one of them, a mean son of a bitch, yelled, ‘If you’re going to act like the devil, you’d better remember what the fires of hell are like,’ and doused me with more alcohol. I just kept spitting away and fighting, so he said, ‘You just bought hell on earth, bastard!’ and lit me on fire. Now I started screaming in physical pain. A couple of them started arguing about putting me out or letting me burn. While they were arguing, a nurse came by. She’d smelled all the alcohol and heard the screams. She’d figured maybe the boys were having a drunken party. Anyway, she hollered and they sprayed me down with water. They took me off to a real hospital. What you see is left over from that.”

  I felt like crying. I felt my impotence. “I’m terribly sorry, Carl.”

  “Look, Doc, it’s something that happened. It caused a big stir at the time. It was a big scandal and it led to changing some of the ways they did things back then. It got me to a real hospital where they tried some new stuff on me and slowed down my seizures a whole lot. Doc, it was like that back then, but I can’t live back then all my life or I’d probably kill someone.” A shrug and a lopsided smile. “Probably myself. I can’t change what happened. Can I get dressed now and get out of here?”

  I assented, reviewed Carl’s labs and noted he’d gone off his antiseizure meds again, as he often did before having a seizure. As I counseled Carl that sooner or later it might kill him, my words sounded hollow compared to the story I’d just heard.

  Carl listened to my sermonette on medication, rose, and grasped my hand with his two burn-scarred hands. “Doc, thanks for listening. I know you’re young and don’t understand the way it was. You also don’t understand this: Whether you like it or not, no matter how painful or upsetting my life may seem to you, it is my life, my pain, and my road to travel. You have your own life, Doc. You will have your own pains to bear. You worry about your pains, and I’ll be praying for you. I’ve got my story, and, good or bad, I’ve learned it’s mine. Thank you for your good care, and now, if you’re through with me, I’ll be going.”

  I never saw him again.

  NICHOLAS M. TIMM, M.D.

  New Carlisle, Indiana

  PART

  FOUR

  A forty-year-old well-educated businessman appeared in the Emergency Department at 4 A.M. He was embarrassed. He reported that he and his wife had been fooling around with a large cucumber and had tried sticking it up his
butt. They went too far. The cucumber slipped into the rectum and the anal sphincter slammed shut, trapping it up inside him. So here he was, after many unsuccessful attempts and with filth under his fingernails from trying to snare the vegetable from its hiding place.

  He was reassured, given KY jelly and pain pills, and sent home to try and poop it out. Tired and slightly stooped, discharge instructions in hand, he walked by himself slowly down the hall toward the exit. One of our coffee-jacked, quick-witted veteran night nurses called after him: “Come on back this afternoon. We’re having a butt-luck supper.”

  Whether used as a shield for the self or as an outlet for personal pain and fear, humor is a key ingredient in the formula for sanity after years in the Pit. When people behave in a nutty fashion and it doesn’t work out, they often end up in the Emergency Department. And although they can be cared for with respect and compassion, they serve as the fodder for an ancient pastime of the Pit: making fun of the patient.

  JEEPERS, CREEPERS

  After discharging the last patient in the ER, I started for the sleep room at about 2 A.M. The nurse told me a moderately intoxicated man was coming in with a stuck contact lens. She offered to take it out with a suction lens remover and have me sign the chart in the morning. Half an hour later the ringing phone at the bedside told me she had not succeeded.

  Examination of the patient’s bloodshot eyes produced an immediate explanation: Neither eye had a contact lens in it. The patient had tried unsuccessfully to remove his cornea with his fingernails, and the nurse had failed to improve the situation with the suction cup.

  Unpersuaded by the facts, the patient repeatedly grasped his cornea between his thumb and middle fingernails and pulled until his grip slipped off the tented membrane. Each attempt produced the same exclamation, “Goddamn, that hurts. See, I can get it out to here but it always pops back.”

  Finally, I asked to see his contact lens case. I showed him the lenses in his case and asked, “Whose lenses are these?” Only then did he reluctantly admit he must have taken them out and forgotten.

  Two Tylenol No. 3’s got him through the night. A follow-up exam the next day revealed normal vision, healing corneal abrasions, a large subconjunctival hemorrhage, and an ugly hangover.

  PETER M. MIDGLEY, M.D.

  Loudersport, Pennsylvania

  DAMSEL IN DISTRESS

  In the privacy of their own home, a young couple were acting out a fantasy. She, the damsel in distress, was tied nude on the bed, spread-eagled and blindfolded. He, dressed only in mask and cape, was the superhero attempting to rescue his fair maiden. The hero climbed atop a dresser so he could “fly” to the bed and save his lover. He miscalculated his flight, struck the footboard, split his head open, and fell to the floor unconscious and bleeding. Our defenseless damsel yelled for help until neighbors investigated, only to find the house locked. They called firefighters, who kicked down the door and, with the neighbors following behind, rushed up the stairs to the bedroom.

  The firemen freed the damsel and brought her superhero to the Emergency Department in his mask and cape. Despite the red faces, all did well.

  BRENDA HILL, R.N.

  Syracuse, New York

  LAUNDER YOUR MONEY

  A thirty-six-year-old man was brought to the ER following a forty-eight-hour cocaine binge. After repeated seizures, he was unconscious and had a temperature of 104 degrees. We started IVs, monitored his heart, stopped his seizures, and placed him in a wooden cooling tub in an effort to get his temperature down. I had to place a catheter through his penis and into his bladder to monitor his urine output. As I pulled back his foreskin, a tightly folded twenty-dollar bill popped out. We laughed, and joked about never knowing where your money has been. I put it in the safe with his clothes. He was still in the ER when he finally regained consciousness. Now indignant that he had been brought to the hospital in the middle of his party, he demanded to leave. As I returned his belongings, I told him how I had found the twenty dollars in his foreskin and locked it up for him. His grateful reply: “It was a fifty, bitch!” In his dreams.

  DENISE ABADIE, R.N.

  Metairie, Louisiana

  UNSAFE SEX

  One day when examining a rape victim, I found pieces of napkin bearing a chicken restaurant logo protruding from her vagina. Later that same day we received a man with a gunshot wound to his leg. While preparing him for surgery, I pulled back his foreskin to insert a catheter and found shreds of napkin with the same restaurant logo. The police were notified and he was promptly arrested.

  DENISE ABADIE, R.N.

  Metairie, Louisiana

  THE HUMAN VINEYARD

  An elderly female comes to the Emergency Department complaining: “I got the green vines in my virginny.”

  The patient reports a two-week history of a vine growing from her vagina. On physical examination it is discovered that she does indeed have a vine growing out of her vagina, about six inches in length.

  A pelvic exam reveals a mass which is easily removed from the vaginal vault, vine still attached. Upon extraction, the patient reports that her uterus had been falling out and that she “put a potato in there to hold it up” and subsequently forgot about it.

  JOHN RIORDAN, M.D.

  Charlotte, North Carolina

  HARD COPY

  The gentleman looked quite uncomfortable as he slowly shuffled past us, following the triage nurse to his room. When the nurse returned and wrote down the pertinent information on the board, the nurses began to giggle. The chief complaint was “Penile laceration.”

  Upon entering the room, I found a middle-aged man sitting with his legs over the side of the gurney, his groin covered by a sheet, shaking his head to himself. I introduced myself and asked him what happened. His reply went something like this:

  “I am so embarrassed, Doc. You see, my boss has been riding my back for the longest time and I just decided I’d had enough. I decided to quit, but I wanted to show him how I really felt about him. So at five o’clock, when everyone had left for the day, I turned the copier back on and made a copy of my hand flipping the bird. I wrote a note at the bottom telling my boss to screw himself, and put it right in the middle of his desk. Then I decided that wasn’t good enough. I went back to the copier, checked again to make certain I was alone, dropped my pants, lifted up the cover, and put my manhood on the machine. But when I pushed the button to make the copy, the cover fell down!”

  The patient suffered only minor abrasions and contusions, fortunately. I never found out if he had the machine set for enlargements.

  NAME WITHHELD AT REQUEST OF AUTHOR

  SHORT TAKES I

  Back in the days when IUDs were more common, I had a woman come in asking to have a DC-7 inserted. Another woman told me she used condominiums for birth control.

  People come in to the ER for all sorts of strange reasons. I’m sure that my most nonemergent chief complaint will never be topped. A male adolescent came in at 2 A.M. with a complaint of lint in the belly button.

  ER staff deal with difficult families. There was a man who insisted that his mother-in-law be admitted to the hospital so that he could go on a fishing trip. He had his fishing gear on and was obnoxious. The mother-in-law was also obnoxious … but not sick.

  Two psychiatric patients had met in our hospital and married. They came in one night insisting that they had been sexually assaulted by aliens and requested an examination.

  · · ·

  A fifty-year-old woman came in to the ER with multiple problems, most of which were very difficult to solve. She had recently divorced her husband and married her twenty-year-old stepson. Her new husband sucked his thumb and was very weird. The more I inquired about the lady’s problems, the more bizarre the story became. I finally asked the lady what I could do to help her. Her answer: “Just sing me some country music.”

  SYLVIA SYDOW, M.D.

  Denver, Colorado

  CONSTIPATION

  One evening a middle-aged man wa
s brought in via ambulance with severe abdominal pain. He related a history of constipation unrelieved by Fleet enemas or laxatives. Frustrated, he gave himself an enema of his own special concoction—Drano! He went directly to surgery. The surgeons later told me that his entire colon was “charcoaled.” He lived for about two weeks before dying of overwhelming abdominal infection.

  DAVID VILABRERA, M.D.

  Holliswood, New York

  DOCTOR KNOWS BEST

  An adolescent female came to the Emergency Department with a complaint of lower abdominal pain. The emergency physician took a thorough history and did a complete physical examination, including a pelvic exam. All this was normal. Although the patient denied any sexual activity, the physician had been surprised before, so he sent off a serum pregnancy test. The test came back positive. The physician returned to the young woman’s room.

  DOCTOR: “The results of your pregnancy test came back positive. Are you sure you’re not sexually active?”

  PATIENT: “Sexually active? No, sir, I just lay there.”

  DOCTOR: “I see. Well, do you know who the father is?”

  PATIENT: “No. Who?”

  SCOTT OSLUND, M.D.

  Sunnyvale, California

  THE GRAPES OF WRATH

  A young woman signed in complaining of a purple discharge. I had heard of green, yellow, pink, and other assorted shades, but purple? She was taken back to one of the OB/GYN exam rooms, and the pertinent questions were asked: Are you pregnant? When was your last period? How many times have you been pregnant? And so on. One question drew an interesting response.