Why did she have to show me that picture! Now he is real.
I liked it better when we were strangers.
SCREAMING
It’s the middle of the afternoon.
There’s been an auto accident. Ambulances have brought the injured to the ER. The gurneys are already full, but we quickly shuffle beds around to find places for the new arrivals and go about our work, assessing their injuries, cleaning them up. They’re all kids. Siblings.
None is badly hurt.
Mom’s coming in with the sheriffs. We hear she ran a red light and hit an earthmover. We hear one kid was killed. The eight-year-old sister tells us the details. The kids were in the backseat. After the crash, she looked over to her little brother.
“He didn’t have a head,” she whimpers.
We cringe inside, horrified at what this little girl had to witness.
We try to hide our distress to the kids, to each other, and to the other patients.
We calmly offer care and comfort as though nothing unusual has happened.
Inside we are sick.
Mom arrives in custody. She was driving under the influence. Not the first time for her.
We tell her about the kids we have. We let her know they’re OK. The deputies tell her about her other son.
The ER is pierced by female shrieks.
The sound is unnerving, unrelenting, chilling. It is the sound of raw grief from the depths of a shattered heart. It leaves goose bumps.
Mom is inconsolable. She screams his name. Screams denial. Screams she’s sorry. Sedatives and closed doors do little to muffle her cries.
Outside the doors, we try to practice business as usual. We act as though her shrieks don’t exist. Patients and visitors hear her pain and look at us questioningly. We smile reassuringly. They must think we’re deaf. Some ask what’s wrong and we offer some bland explanation.
The only clue to our distress is in the lack of our usual chitchat and in the looks we give each other.
Finally, she’s gone—but it takes some time for her cries to leave our heads.
OOPS!
We are comfortable with body parts, touching, viewing, discussing. It’s part of the job. No big deal.
We ask people to disrobe, then listen and probe without a second thought.
We casually discuss baseball scores and recipes while engrossed in intimate patient contact.
Sometimes we get a little too casual, seeming to forget just where we are.
It was noon.
The lady on the pelvic table was undressed and draped, feet in stirrups, knees apart. Ready to be viewed.
The nurse stood at her side.
The doctor sat on his rolling stool, speculum poised and glistening with lubricant. He was moving into position to take a look when his stomach gave a loud rumble. “Time to eat!” he proclaimed.
LAB TECH
We three nurses are bustling around the gurney of an elderly, heavyset, comatose woman, assessing, administering, efficiently doing our job.
The young male lab tech at her side has just finished drawing blood when he abruptly falls forward, face in her crotch, and begins making loud snorting noises.
As a group we recoil in shock. What is he doing?
It’s one of those moments that seem to last forever.
Snuffle. Snuffle. Long snort. His head trembles. Is he a pervert? What is he doing? Can’t he control himself?
We look at each other in disbelief.
We look back at him. Snort. Snort.
Reason eventually penetrates our brains. We realize he has fainted and the snorts are his attempts to breathe with his nose buried in her fleshy folds.
Lying him flat on the floor produces a rapid recovery.
He makes a quick exit, totally embarrassed, muttering that he has been feeling ill all day and begging us not to tell his boss.
We don’t.
WINTER MORNING TRAUMA
It’s a cold winter morning. The paramedic reports there are five victims—two women and three small kids.
Their car is upside down in a ditch.
The report is brief but exact. It’s obvious the rescuers are swamped.
While they sort patients, we sort hospitals.
Kids One and Two sound critical. They’ll fly with a doc to Children’s Hospital sixty miles away. One mom and her child can go to a nearby ER—they aren’t too serious.
Victim Number Five is still in the upside-down car. The paramedics figure another twenty minutes to extricate and twenty more to the regional trauma center. We hope she can make it there, and we tell the trauma team to expect her.
No go.
Though she was talking when the paramedics first got to her, their efforts to keep her going are futile. They have to watch her fade while they struggle to free her body. The trauma center’s too far. She needs a closer ER.
Victim Number Five is flying to us.
She arrives, CPR in full swing. She’s young. Pump the blood in. She deserves our full effort. Circulate the drugs. There’s a pulse now. Check her pressure. Only a few bruises and scrapes are visible. Her chest looks OK. Get more blood.
Pulse is gone. What else can we do?
This isn’t working. Has it already been an hour?
“She’s the same age as me,” someone says while pumping her heart.
During that hour details dribble in. The boy and girl at the trauma center are hers. They’re not doing well.
She was driving and overcorrected when her wheels left the road.
Her husband is on his way here from the other ER.
We get a name. Is it really her name?
We finally stop. 11:55 A.M.
There’s nothing more to do but fill out papers and prepare her for her family. In a few minutes the chaotic, bloody room is cleared.
We cover the holes where bones punctured her skin. We wash blood from her hands and lay them on top of the sheet covering her body. We place a clean pad under her head to hide the blood-soaked sheets.
We’re thinking of her children—of our children.
Finally her husband’s here. He’s alone. He has no idea. In the family room the doc tells him. No fancy words, just that she has been killed.
We sit with him, the doc’s hand on his shoulder as he sobs silently, shoulders shaking, tears dripping from his face.
I wonder if he can feel our sadness. Does it help him that we’re here?
Slowly he absorbs reality, asks questions.
We explain what we know about the accident and his children.
He goes to her and the sobbing begins again. He verifies her name. He can’t remember her birthday. They had breakfast together a couple of hours ago. It was raining so he hadn’t gone to work.
She was traveling to pick up his mother. He was the one who was supposed to have picked up his mother.
She was three months pregnant. She had an OB appointment today.
They’d been married seven years.
He has to go to his children now. No, he can’t wait for someone to go with him. We’re worried about him driving sixty miles alone. OK, he’ll pick up his brother. Where is the children’s hospital?
He kisses her face and walks out.
We zip up the shroud. We look at each other. It’s hard to believe.
In one brief morning a young family has been obliterated.
THEY JUST KEEP COMING
And always, the show must go on.
While someone is dying in one room, the broken arms, rashes, and headaches in the other rooms are still there and need attention.
The gurneys rarely cool off.
We care about the patients.
We complain about the patients.
We like each other.
We complain about each other—we’re like siblings.
We love the action. We really love the action!
We complain about the action.
And when it is slow,
We wonder what’s wrong.
SIX
A young man about fifteen years old was brought in awash with the feeling of dread and exhaustion that comes at the end of a methamphetamine binge. He lay on the gurney shirtless while his prim mother sat sternly at his bedside. An exam reassured me that he was in no immediate danger, but I was concerned for his future. He told me he had been injecting the “crank” in his veins. The needles were shared with his friends.
I hoped to lead him into a realization of the dangers of sharing needles. So I asked him, “Can you think of anything you have been doing that might cause you to get AIDS?”
Worry came over his face. He knew I had something in mind. With a frown, he took a moment to survey his catalog of misdeeds, searching for the correct answer. At last he brightened and looked at me, and said questioningly, “I’ve been fucking the dog?”
Lightbulbs, vegetables, garden hoses, coke bottles, silverware, pencils, money, candles, golf balls, telephones, spark plugs, paper clips, and flashlights are just a few of the things that people have come to the emergency room to have removed from their private parts. These parts are called private because our cultural approach to our sexuality requires a little mystery and gossamer. Shyness and discretion carry some allure.
But when these private parts become public and are probed and inspected under glaring light day after day, what becomes of our own sense of mystery?
SPUD
A sixty-seven-year-old gentleman came in complaining of lower abdominal pain. He reported that he had been constipated and a friend told him that a sweet potato placed in the rectum would act as a suppository and help relieve him. About twenty-four hours after following his friend’s advice, he found that the sweet potato had done nothing to relieve his constipation and now he felt even more uncomfortable.
On rectal exam I felt what could have been the tip of a sweet potato about four inches up inside the rectum. Extraction with any sharp instruments or towel clamps would have been too dangerous. We decided to place a Foley catheter up past the potato, inflate the balloon on the tip of the catheter, and then pull it out, bringing the potato along with it. While pulling on the catheter, the sweet potato moved down to the anal sphincter. The patient suddenly grunted and bore down, abruptly expelling the potato. The potato flew through the curtains surrounding the patient’s bed, whizzed past a candy striper, careened across the tile floor, and came to a rest in the X-ray waiting room, where the patients eyed it suspiciously.
The potato was tracked down and captured by the nurse who was assisting in the procedure. To our surprise, the potato was eight inches long and of equal circumference. For lack of a better idea, it was carefully wrapped and sent to pathology. The patient was sent home with a mild laxative.
JAMES AUGUSTINE, M.D.
Dayton, Ohio
DOGGIE-STYLE
I am the nurse in triage, screening the cases as they come in to determine their level of severity. A tall gentleman comes in and tells me he has a problem. It’s August, about ninety-two degrees outside, and he has on an overcoat. When I ask what the problem is, he replies, “It’s personal. I have to show you.”
I take him behind a screen, where he opens his overcoat. He is naked underneath, except for his penis. On this man’s penis is a dog. A live toy poodle. His penis is in the dog’s butt. His problem is that he can’t get it off. The dog’s anal sphincter is serving as a cock ring, trapping the blood in the man’s penis and causing it to swell grotesquely within the dog’s body. The dog is whimpering and gasping. I go back and tell the resident. He looks tired. He’s seen everything in the Emergency Department rotation. He gives the dog a muscle relaxant and pries it off. The dog is already in shock and soon dies.
I would have suggested a different way to cut the dog free. I think the wrong animal died.
CARMEN DIAZ, R.N.
Brandon, Florida
LIFE AND DEATH
Two patients came in today at about the same time. Both were critical.
The first was a young man who had a history of severe allergy to almonds. He was very careful about his diet because the last time he had eaten almonds he had nearly died. Today he was again in a full allergic crisis: face red and puffy, welts covering his body, eyes swollen shut, throat closing off, lungs in spasm with wheezing, blood pressure dropping. He was suffocating and his circulation was collapsing. IVs, fluids, steroids, intravenous adrenaline—he began to turn around and do better. As he improved, I was struck by the intensity of his desire to live: heart pounding, eyes alert, fighting for breath, determined to survive. He did, and was fine. It turned out that his girlfriend had been eating baklava for lunch and had a small piece of almond stuck in her teeth. The two of them had been necking and he had been exposed to the almond. It was nearly the kiss of death.
The second was a young woman who had taken handfuls of different drugs in an effort to end her life. She arrived in a coma, with a falling blood pressure and cardiac dysfunction. She soon went into full cardiac arrest and we were unable to revive her. She died within thirty minutes of arriving in the department. She left a suicide note that read, “If any one of you care for me, never let my daughter know what a low-life failure I was.”
I was struck by the contrast of how some people cling to life while others fear the thought of facing another day.
JAMES WEBER, D.O.
Royal Oak, Michigan
PISSED OFF
My first experience with emergency medicine came approximately fifteen years ago, when I was young, fresh, and thought that I could handle just about anything. At this stage of my new career, I enjoyed working nights because I found that the patients who frequented the ER during the early morning hours were a more interesting group.
It was 3 A.M. We had emptied out the ER and were looking forward to a few hours of relaxation. One of our nurses was sitting at the triage desk sorting through eighty charts from the preceding twenty-four-hour period. As she was working there, a filthy man appeared and stated that he wanted to be seen by the doctor. He was disheveled and smelled fetid and drunk. The nurse excused herself to fetch a stethoscope, and when she returned seconds later she found the would-be patient standing up on the triage desk, urinating all over the eighty charts.
I was in the ER treatment area and heard her scream. I arrived just in time to hear her reprimanding the gentleman for his lack of self-control. She was obviously upset, and speculated aloud that his parents might not be married. He subsequently told both of us to commit acts that are not anatomically possible, and stumbled out of the ER.
Once we recovered from the shock of the unpleasant encounter, we set ourselves to the task of preserving the eighty urine-soaked charts. We concluded that the best way to dry them was to lay them out one page at a time on all the available ER counter space.
Seven o’clock rolled around and the day-shift personnel began to arrive. I sat in the triage area and watched the expressions on their faces as they entered what smelled like a ballpark men’s room. Knowing very well that I would be leaving for home within minutes, I jokingly taunted my coworkers with comments about working in a urinal all day. Then, one of the staff arrived and yelled out to me, “Hey, Doc! There’s somebody sleeping in your Jeep.”
I could feel my scrotum contract. My Jeep was a brand-new canvas-top Golden Eagle. I loved that car. I raced into the parking lot. I got to my Jeep and opened the passenger door. Cigarette smoke billowed out. There, stretched out across the front seats of my pristine automobile, slept the drooling, drunken, dirty, urine-soaked body of Mr. 3 A.M.
B. RICHARD STILES, D.O.
West Chester, Pennsylvania
ADOLESCENCE
The fifteen-year-old girl averted her eyes as I entered the examining room. Grandma was fat and paced like a ferret. I had interrupted some passion play and the tension made the room seem smaller than it was.
“I’m Dr. O’Malley, what can I do for you?”
My patient didn’t answer.
“Tell him
what you here for. Tell him what that boy done to you.”
I thought that my patient was going to throw up, but she began quietly crying. I gently asked Grandma to wait outside, and left her cussing at some paramedics in their ready room. When I returned to the examining room, my patient had stopped crying and was nervously tugging at a shoelace. She wore a T-shirt with PUBLIC ENEMY on it. I have all their CDs, and I suddenly felt very old.
My patient was an honors student. Her posture was perfect. She was enrolled in summer school for advanced college-placement credits. Her lower abdominal pain had begun several days ago, one week after her first sexual experience. He was an older boy from around the block that she knew from the neighborhood. The diagnosis wasn’t particularly difficult. The disposition was.
I allowed my patient to remain clothed. I sat on a low stool in a far corner of the closet-sized room. I explained to her the intricacies of a pelvic exam—an experience I would need to introduce her to. From her position atop the exam table, she listened politely to my explanations about adnexa and cultures and specula, and gave an occasional sigh. As the conversation turned to infections, she grew deathly quiet and her attention became rapt. For a while she held her breath.
“You know, if you have sex with someone and you don’t use a condom, getting pregnant isn’t all you have to worry about.”
“I know.”
“Besides syphilis, gonorrhea, and venereal warts, there are other diseases that our … uh, your generation has to worry about.” My patient was silent. “Do you know what disease I’m talking about?”
My patient gasped softly and began to sob. “Yes.” She sniffed. “AIDS.”
“Do you love this guy?”
“I don’t know.”
“That’s OK.” I asked her to undress and I went for a nurse.
Emergency! Page 10
