“Are you using any type of birth control?” she was asked.
“Yes,” she responded, “a diaphragm.” I was delighted. It seemed so few of our patients did use contraceptives.
“But I’ve only been using it a few days,” she added. I nodded.
“So tell me about the purple discharge,” I continued.
“Ain’t much to tell. I got the prescription filled for the diaphragm that the doctor gave me and the discharge started almost right away. I thought maybe I was allergic to it or something.”
“So the discharge started almost as soon as you began using the diaphragm,” I reiterated. She nodded affirmatively. “And you’re using the spermicide jelly with it?” I asked.
“Look. The doctor told me to use the diaphragm and the jelly with it, and I did,” she said.
I nodded understanding, then had a sudden flash of insight.
“What kind of jelly are you using in the diaphragm?”
“I don’t remember—I think it was grape.”
BARBARA NUTINI, R.N.
Independence, Kentucky
THE LONG WAY HOME
A ninety-two-year-old woman suffered a full cardiac arrest at home and her family called for an ambulance. The ambulance transported the patient with CPR in progress.
She arrived in our ER and, after thirty minutes, we were unable to resuscitate her. I pronounced her dead and went out to tell her seventy-eight-year-old daughter.
I looked at her gently and said, “I’m sorry, ma’am, but your mother didn’t make it.”
Shocked, she looked at me and shouted, “Didn’t make it? Where could they be? She left in the ambulance forty-five minutes ago!”
GEORGE R. DREW, D.O.
Rockford, Michigan
COLOSTOMY
A thirty-five-year-old female came to my Emergency Department with a complaint of mild abdominal pain. The patient had a colostomy from surgery for a previous gunshot wound to the abdomen. While reviewing her social and employment histories, I saw that the patient had stated, “I work the street.” I asked her to clarify what she meant. She replied, “I get money for having sex—twenty-five dollars for a guy to do me [points to her vagina] and ten dollars for a guy to do it [points to her colostomy].”
RICHARD A. OYLER, M.D.
Mobile, Alabama
YESTERDAY
One spring day while at work in the Emergency Department, we received word on the radio of a big-rig accident with serious injuries to the driver. The patient was brought into the department barely alive, and after an hour of attempted resuscitation was pronounced dead. The staff involved dispersed to their other duties, the body was taken to the morgue, and the cleanup crew arrived to restore the trauma room. Exhausted, I went to the physicians’ dictation area to complete the chart and notify the next of kin.
While sitting there, I heard a distorted, metallic-sounding melody coming from the direction of our clerk, seated behind me. It repeated over and over until I finally had to turn and ask, “Pat, what is that sound?” She held up a manila envelope containing the deceased’s personal belongings. She looked at me oddly, pointing to the envelope. A tune was coming from inside. She answered, “It’s his watch.” She opened the envelope and produced a small novelty watch, capable of playing a selection of three or four tunes. Though the watch was smashed, it repeatedly chimed the old Beatles tune, “Yesterday … all my troubles seemed so far away.…”
MICHAEL M. KNOTT, M.D.
Tahoe City, California
THE SPECIMEN
A newly arrived Mexican immigrant, knowing not a word of English, arrived in the ER indicating pain in his abdomen. He was a handsome and macho young man, with a tight T-shirt to show off his well-muscled body. We tried to develop the young man’s story through pointing and gestures. A physical exam showed some low abdominal tenderness. I wanted some lab tests. I pointed to his forearm for a blood test that I would order, and I pointed to his groin for a urine test. I handed him a small plastic bottle and led him to the toilet to produce a urine specimen. After ten minutes, he still had not emerged from the bathroom. One of the nurses needed the bathroom so she knocked on the door. After some rustling, the young man appeared, flushed and sweating, but beaming proudly. He handed the nurse his specimen container. It was filled with semen.
B. TOMKIW, JR., M.D.
Fair Oaks, California
DO NO HARM
The man had suffered chest pains for days but had resisted his wife’s urging that he seek help. Finally, she drove him to the ambulatory ER entrance. At the curb, we recommended a stretcher, and, when he refused that, a wheelchair. But he was cranky and insisted on walking. At the door he collapsed, unconscious. One of our physicians countershocked the patient, brought him back to life, and quickly stabilized and transferred him to the cardiac unit. Out of the hospital in two weeks, the man sued the ER and the physician because he had broken his nose and cut his lip in the fall.
HUGH F. HILL III, M.D.
Bethesda, Maryland
OUT OF STEP
A young farmer caught his right leg in a farm implement, severing it above the ankle. He was brought in by ambulance in intense pain and anguish but otherwise was stable.
Meanwhile, back on the farm, the other farmhands thought it prudent to find the severed foot, which they did. It was still in its work boot, still warm. They jumped in the truck and drove off toward the hospital.
In their haste, they crashed the truck. Although no one was injured, the truck was disabled. Desperate to have the body part transported to the hospital, they flagged down the next car, which was driven by a plump woman in hair curlers and a housecoat on her way to the market. The farmers rushed up to her with the bloody stump sticking out of the top of the boot, handed it to her through the window, and pleaded for her to take it to the hospital.
I happened to be in the hallway near the door when she walked in. “Here,” she said with a cigarette in one hand and the foot in the other. “Someone asked me to bring this foot up here.” I thanked her and took the foot up to the OR.
KIRK V. DAHL, M.D.
Eau Claire, Wisconsin
PERSEVERANCE
A young male entered the walk-in entrance to our ER one busy Sunday afternoon shift, holding a hand over a bloodstained shirt. When the overwhelmed triage nurse didn’t acknowledge him for several minutes, he calmly walked to the registration desk and informed the startled clerk that he had been shot in the chest. After the man was rushed into our trauma room, his unluckiest-ever story unfolded.
It seems that he had been depressed for several weeks, and two days earlier had decided to commit suicide. He took a bottle of Valium and a fifth of vodka and fell asleep in his bed, fully intending to never wake up again. Unfortunately, the combination was not lethal, and he did wake up, albeit thirty-six hours later, with a tremendous hangover. Deciding that something else was needed to complete the job, he filled up the bathtub, got in, and slit both wrists with a razor blade. Alas, the bleeding was all venous and clotted off after several minutes, leaving him sitting in a pink-tinged lukewarm bathtub.
He climbed out of the bathtub and decided to hang himself from the dining-room light fixture using his belt. The light fixture tore from the ceiling and he crashed to the floor with such force that he fell through the dining-room floor into the basement. Battered but not beaten, he looked around the basement for something to finish the job. He found a .22 caliber bullet but no gun. He decided to hold the bullet with a pair of pliers and, pressing it against his sternum, took several whacks at the compression end of it with a ball-peen hammer. On the third whack the bullet went off. He fell to the floor and looked down to see a bullet hole on the left side of his chest. After lying on the floor for twenty minutes, he decided that maybe he really did not want to die and drove himself to the ER.
Our evaluation showed that the bullet had harmlessly bounced off a rib and was lying in the subcutaneous tissue of the left chest.
JAMES DOUGHERTY, M.D
.
Akron, Ohio
SHORT TAKES II
A patient said: “Doc, my wife has a rat in her pussy and every time I do her, my dick hurts.”
“A rat?”
“Yeah, a rat that bites me whenever I get in there.”
I did a pelvic exam and found a needle in her vagina left there by the surgeon who had performed her hysterectomy. Ouch.
A thirty-year-old male in custody has swallowed a bag of cocaine. We give him charcoal and sorbitol to make him poop it out. When it comes out, he tries to grab it and hide it. The police see him and run over and try to get the bag. They start fighting over it. Charcoal, cocaine, and shit go flying everywhere. What a mess.
A thirty-five-year-old male comes in with a deformed right forearm that is swollen and extremely tender. He says he just fell off a ladder.
“Doc, this is killing me, can I get some pain meds before I get an X ray?” I say, “Sure.” When I have a chance, I look at his X ray. There’s a fracture, but it’s at least a year old—well healed, but at an angle. I walk back from X-ray to discuss this with him and he’s gone. Outsmarted by a drug addict.
A forty-year-old female came in after jumping into a tree from the third-story window of a burning house. She was obviously high on something, but she said she felt fine. She had a normal physical exam, with the exception of a nick to her left flank and a small bump on the right side of her chest. I asked her how long the bump had been there. She replied, “I ain’t got no bump on my side.”
Her blood pressure suddenly began to drop, so I ordered X rays. They revealed a tree branch lodged diagonally through her torso. The surgeon later told me what he had found. The branch had entered her left flank, caught her spleen, punctured her diaphragm, and was pushing on her right chest wall.
She was right. Prior to that jump, she didn’t have no bump on her side.
KENNETH A. WALLACE III, M.D.
Detroit, Michigan
THEFTPROOF
One night while I was working in a trauma center in Detroit, paramedics brought in a young man who had been hit in the head with a pipe. He looked dazed and smelled as though incontinent of stool. We undressed him, and our eyes confirmed what our noses had suspected. We were surprised to find a car key in the stool in his shorts. We asked him how this key had happened to find its way to such an unlikely location. He replied, “They were trying to steal my car, so I put my key down there and shit myself. That’s when they hit me in the head.”
Commending him on both his quick thinking and his ability to defecate at will, we agreed that without a good cup of coffee and a newspaper we would be pedestrians.
CHRIS PFAENDTNER, M.D.
Janesville, Wisconsin
REGISTRATION
It was a busy afternoon at the Emergency Department, Saint Mary’s Hospital, Knoxville, Tennessee. The department doors opened and a pretty and prim young lady walked up to the reception desk. The receptionist, as was her custom, not looking at the patient asked:
“Name”—and typed.
“Address”—and typed.
“Zip code”—and typed.
“Phone”—and typed.
“Religion”—and typed.
“Sex”—(no answer) …
“SEX”—(no answer) …
“SEX”—(pause) …
Finally, the young lady said, “Well, if it’s any of your business—two times in Chattanooga.”
A. L. JENKINS, M.D.
Knoxville, Tennessee
PART
FIVE
I was sent a story by a nurse, David Fox, called “Theo’s Dream,” in which he recalls a meeting between the ER night-shift charge nurse, Bunny Bradford, and a cocky new intern.
Bunny welcomed the morning. The night had been long and tedious, made more tedious by the presence of the new intern, Len. Early in the shift, Len had made the mistake of thinking that a nurse named Bunny must be an airhead. He held that thought only briefly before Bunny took time to remind him that she had been working in the ER when he was still raising his hand for permission to pee. Without a pause, she further informed Len that Bunny was a name chosen by her misguided parents, and that as yet, he was too new and inexperienced to do anything more complicated than ask, “How may I help you?”
Hearing their exchange, the chief resident only grinned and shook his head.
Len blushed and stared at the chart in his hand. “Fucking ER nurses,” he mumbled to himself, “they think they’re hot shit.”
He was right.
ER nurses are the Top Guns of their profession. In few other areas do nurses practice with such autonomy and responsibility as they do in the Pit. They have a reputation for being independent, assertive, and tough.
New ER nurses think the hardest part of the job will be the rapid pace and the trauma. But those who stay soon realize that the true challenge is the human misery. It’s wearing. The demands and complaints are many and the thank-you’s are few. It’s easy to feel used up.
So to survive, ER nurses develop a protective shield. They learn to parcel out caring when needed, but to save some for the next guy.
They also learn to save a little for themselves.
NURSING
Anita Jones, R.N.
Lancaster, California
The request has come from hospital administration. The gift foundation is planning a fund-raising event for the emergency room. They need some heartwarming ER nursing stories to share at the program. Sounds easy. I’ve been here a long time. I’ve kept a journal of my experiences. I’ll just flip through and pull out some good ones.
Heartwarming stories from the ER. I search. I read. I’m stunned. I can’t find any.
There are scores of stories in the ER every day—heartbreaking, heart numbing, heart tickling, heart stopping—but heartwarming? Not really, not the warm fuzzy kind. It’s scary. Have I become so cynical that I can’t see anything warm in my work?
I read them again, seeing them as they are. I cry. I laugh. All my memories and the feelings they revive begin to warm my heart.
It feels good.
Here are some of the stories I found.
THE SAVE
About the best feeling I have is when we get a “save.” A guy walks in—obvious heart attack. Pale. Clammy. Chest pain. Looks bad.
The team kicks in. Get him in bed. Heart monitor on. Get vital signs. Start the IV, oxygen. Get a second IV. Blood for labs.
We’re working on both sides of the bed when I hear a funny breath. I glance up at the patient. He’s fading. Glance up at the monitor. He’s in VTach.
No chance to speak, just react—thump! Hit him in the sternum.
Glance at the monitor. He’s converted. Regular rhythm restored. Breathing goes back to normal.
We look at each other across the bed. Surprise. Relief. Success!
I look at the patient. There’s confusion on his face. “Hey, are you OK? Sorry I had to hit you.”
And back we go. Start the meds. Call the cardiologist. Get an EKG. This guy got here just in time! Yeah, team!
It’s not always like that.
Sometimes someone comes in talking to you and then just dies. You’re doing the same things. You hear the funny breath that tells you the breathing is stopping. You react, do all the right things, and he dies anyway.
It’s harder then. Different than when someone comes in dead or near dead. More personal.
You always hear the same comment, “He was just talking to me!”
Maybe he was just hanging on till he got someplace where he felt safe enough to let go.
When someone comes in with resuscitation in full swing, we usually just jump in, do a job. We don’t think of the person—at least not till later, when we face the family’s grief.
THREE BROTHERS
It was a week before Christmas during the coldest spell we’d had in years. Three little brothers, ages one to four, were brought in by the sheriff. They’d been alone in their unheated house for possibly
five days. Their dad was in jail, and Mom was who knows where.
The oldest one, a chatty kid, said they hadn’t eaten for at least two days. The baby’s wet feet were white with cold. The middle brother’s feet stank so bad when we took off his shoes that I felt nauseated. I wondered what their lives had been like during that cold December week. We hustled those boys into a warm bath.
A message was sent to the kitchen that we needed food for three kids who hadn’t eaten in days. Usually it takes thirty to forty minutes to get a food tray from the kitchen. This time, in less than five minutes, three ladies personally delivered food to the room.
The four-year-old gobbled it down. Baby brother cuddled up with his bottle. The three-year-old just fell asleep after his bath. I called a friend with kids near their ages and asked for some hand-me-downs. She hurried right over with clean clothes for all.
Charting our treatments for them brought tears to my eyes. The treatments were so simple, something every kid deserves. Heat. Nourishment. Hygiene.
But the warm fuzzies end there. The deputy came back later in the week to tell us Mom was in jail and the brothers were placed, separately, in foster homes. They’d stuck it out for a cold lonely week but they wouldn’t be together at Christmas.
LIFE AFTER DEATH
Sometimes our duties extend beyond life.
We have just completed a Code Blue, a resuscitation attempt on a youthful senior citizen.
It was a futile effort. We knew that when we started.
She was the innocent victim of a drunk driver.
Emergency! Page 8