The following year, a woman in her late sixties was brought to the clinic in severe respiratory distress. She was initially attended to by a nurse and a respiratory therapist who were camping at the next campsite. The two followed the patient to the clinic to learn the outcome. I spoke to them and thanked them for their help. The nurse commented to her friend that she knew a cardiologist whose daughter had died in the clinic the year before. As it turned out, she was referring to the infant flown to us from Tenaya Lake.
I had not been in touch with the baby’s parents during the year following her death. I got their address from the nurse and wrote to the father. He soon wrote back saying he and his wife had had another child—a boy. The painful memories of the previous year so far prevented him and his family from returning to Yosemite; however, he hoped to be able to do so sometime in the future.
In my seven years in Yosemite, I participated in a total of six SIDS resuscitations. In five of those six cases, I felt that I was somehow able to maintain the balance of caring, compassion, and professionalism that comes with time. This case, however, was the worst and most devastating code in which I have ever been involved. The fact that the parents were physician and nurse—my colleagues, my professional family—seemed to drive the pain of this case much deeper. I still cry when I think about it.
GARY M. FLASHNER, M.D.
Wapwallopen, Pennsylvania
ALONE
At 4 A.M. the ER was finally quiet, except for the interrupted snores and snorts coming from room E, where the sole patient was dreaming drunken dreams after being “rescued” by emergency personnel from his pile of beer cans. Because in Utah the beer has only 3.2 percent alcohol content, it takes a case, drunken with swiftness and commitment, to get to the prized level of near-insensate stupor. I had to lean over a large yellow puddle to shake his shoulder. He grunted a somewhat underwater “Huh?” coughed once, then drifted back to his own, preferred world. Satisfied, I pulled up the blanket. The snore became muffled as I walked away.
“Here’s a call from someone who wants to speak only with the doctor.” Katie was holding the phone like it was a dead snake. I reached for it and drew up a chair at the long white desk. I have never liked “advice” calls because they take the staff’s time away from the patients. Especially at night they tend toward the macabre. This was no exception.
“Are you the doctor?” It was a whispering, feminine voice. “Is this totally confidential?”
“I can barely hear you. Yes, yes, go ahead.”
“I have to be quiet because my husband is in bed next to me sleeping.” The whisper held anxiety.
“I’m calling because my husband has AIDS and I just today got my test result back.” A pause. “It was positive.” Her voice choked, then became a monotone. “I don’t know what to do.”
“Have you gotten any counseling?”
“Noooo.” Silence, then: “Also, I’m pregnant and I’ve started to bleed. I … I want to keep this baby.” She began to cry quietly.
“Why don’t you come in and we can talk about it?” Suddenly I felt very alert.
“I can’t. You see, I work at the hospital. I’m a medical student. If anyone found out about me being HIV positive, I’d be kicked out of school and never be able to get a residency or a job.… But I feel like I need to tell someone.”
“Have you told your husband any of this?”
“No.” A sob, interrupted by silence. “You know, he was promiscuous. He got AIDS from a friend. I came home one night, early. And there he was in bed with another man. He told me he could sleep with whoever he wanted. He wants me to engage in anal intercourse, but I won’t because it’s not right.”
“That’s quite a burden you’re carrying around with you. Why don’t you come in tonight? No one else will know you’ve been here, just myself and the crisis worker.”
“I just want to feel better. I have twenty Percocets here. What would happen if I took them?”
“You know you’d hurt yourself. Are you threatening to hurt yourself?” I was beginning to feel manipulated. This wasn’t getting anywhere.
“I’m just asking you what I should do.”
“If you come in, I can help you. Otherwise, I can’t.”
“You’re not very understanding, Doctor. Sorry I bothered you.” With a click, her voice was gone. I looked at the white telephone in my hand, then placed it softly in its plastic cradle. I slid a new pen from the drawer, stared at it, and began to chart, wondering if I’d ever hear from her again. The next evening, while walking through the ER waiting room:
“Excuse me, are you the doctor?”
I knew it was the woman who had called. She had large, liquid eyes with brown pupils wide open, like a cat caught in the headlights of an onrushing car. Dark brown hair was pulled back, with a few tousled hairs meeting generous eyebrows. She wore pale green scrubs with trouser legs taped back in OR style. The V-top revealed two thin, gold chain necklaces which disappeared between the sides of two pale breasts. She wore a scrub gown loosely over her shoulders, like a shawl, only like a shawl designed by the Army. She pulled it tight over her chest with one hand, as if sensing a cool draft of night air. The movement revealed the curvature of her small breasts and flatness of her abdomen. She had the smooth skin of someone in her early twenties. Not a cat, I thought. She looked like nothing so much as a kitten waiting to be let in on a December night, tired and scared.
I suddenly wanted to put my arm around her.
“Come in, come in, what can I do for you?” I opened a door to the treatment area.
“Do you have a few minutes? In private? I don’t want to hold you if you’ve got someone you have to see.” I looked at the names on the board and fought the urge to be truthful.
“Should I come back later?”
I motioned her into a room. She closed the door, but sat next to it. I sat facing her. She leaned forward and stared at me with a dazed look and began to smile somewhat vacantly.
“I’ve got a question for you that I’ve never asked anyone before,” she said. I leaned forward. “Are you involved?”
“Yes,” I lied. The silence became uncomfortable. “I’m married.”
“I was going to ask if you’d like to go with me to the symphony tomorrow. Would you like to go anyway?”
“Are you the one who called last night?”
“Yes.” She looked downward, but for only a moment.
“Would you keep this confidential?” She reached into her backpack and produced an envelope addressed to me, only with my name spelled phonetically. “I’d like it back when you’ve read it.”
The handwriting was minuscule and the lines overlapped, but it was impossible to ignore the seductiveness of phrases such as “I want to be your lover.… You are so compassionate and understanding.…” It went on and on. I felt uncomfortable to be reading it.
She was smiling and looking at me. She brushed back her hair in a coquettish way. She was very attractive. She was waiting for an answer, but I could not translate my feelings into words. For a moment, it was tempting. Then I thought, that’s all I need right now is an affair with a married medical student who is pregnant. Then I recalled what she said the night before—with HIV.
“Was that true what you said about being HIV positive and a medical student and being pregnant and bleeding?” I sort of blurted it out.
“I wish it wasn’t,” she said. Then I noticed that her hands were scarred, like I had seen in crisis patients who must physically abuse themselves to “let out the tension.”
“I just need a friend right now,” she said plaintively. She began moving toward me.
I doubted that friendship was all she wanted. “I don’t feel worthy of your affection or competent to counsel you. Would you stay and speak with someone who’s trained in how to approach problems like yours?”
With a feline movement, her hand was on the doorknob. “I can’t stay, but I’ll leave you messages about how I’m doing.” In a flash of pale g
reen, she was gone.
I felt dazed and sad. I was drawn to her and felt that I’d blown it by being professional when she wanted a friend, by thinking of her as a patient rather than as a woman. Suddenly I wanted to find her again, to tell her that I cared and wanted to go out with her. The dean’s office would have her picture and from that I could get her name and telephone number. If I did, I knew that my personal involvement with her would not stop at having dinner or attending the symphony. Why was the thought of pleasing her as a man so exciting? Was it the poignancy of loving someone doomed to a premature, unnatural death?
I never found out who she was. She never left any messages. But I saw her again, two years later, in the reception area for lawyers’ offices. I was reading the newspaper while a contract was being reviewed when I heard a soft, whispering voice.
“Is anyone sitting there?” She indicated the chair next to mine. I motioned for her to sit, but was not able to place her for a few minutes. Her hair was drawn in a bun. She was wearing a gold necklace, white blouse, and dark slacks. She was still as attractive as when I saw her in scrubs, but looked less tentative, more self-assured and purposeful. She returned my look without emotion.
“Do you remember me?” I asked. “We spoke on the telephone, then met in the emergency room.” Her cheeks began to flush in recall.
“Well, how are you?” I asked.
She told me she was suing someone. At that moment, the receptionist announced that she could go in to see her attorney.
I have never seen her again, and never discovered whom she was suing. Maybe her husband, for giving her AIDS. She no longer looked vulnerable or afraid, perhaps because she and a lawyer were representing her interests. I felt simultaneously satisfied that she had become empowered, and sad that she had left me out of her life.
From that one early morning telephone call, I will always regret that one woman would not let me be her doctor and that I could not let myself be her friend.
ROBERT D. HERR, M.D.
Salt Lake City, Utah
PART
SEVEN
It was a quiet night and the nurses were sitting around the central work area drinking coffee and eating doughnuts. The doctor went to see the lone patient who had come in for rectal bleeding. The doctor’s job was to put his finger up the patient’s fanny and get some stool on the tip of his rubber glove, then smear a sample of the stool onto a testing card to see if it contained blood. He put on his rubber glove, disappeared into the patient’s room, smeared chocolate frosting onto the gloved fingertip, returned to the central work area, sat down with the nurses, and licked off the tip of his brown-tipped finger.
“Tastes like blood, all right,” he announced.
When the press of patients subsides, and the relative quiet allows the staff to relax and let their guard down, it calls forth the second most ancient pastime of the Pit: making fun of each other.
TURF
Turf: to transfer to another facility a troublesome patient.
One quickly learns how to “turf” in the ER. A gentleman in his seventies was brought in by his wife for worsening leg edema. The patient also suffered from organic brain syndrome (Alzheimer’s), making it difficult to obtain any history. The wife kept insisting that the patient was a World War II veteran and he should be transferred to the VA hospital. We called the VA and informed them that we would be transferring this patient. One of my colleagues decided to cement the transfer by placing a sign around the patient’s neck stating that he was a World War II veteran. We congratulated one another for successfully turfing the patient.
Toward the end of the shift, we saw our patient “bounce back” to the ER. He still had the sign around his neck, but there was a different message. It now read: NICE TRY. RIGHT WAR, WRONG SIDE! Upon further questioning of the wife, we found out that the patient had fought on the side of the Germans.
DAVID B. LEVY, D.O.
Pittsburgh, Pennsylvania
OWL’S WELL
On a quiet evening in our Emergency Department, the ambulance radio crackled to life: “This is Ellwood unit nine-five en route to your location. We have an eleven-year-old male with an awl attached to his arm.” Thinking some type of tool had penetrated the boy’s arm, I nonetheless asked them to repeat, as the story sounded peculiar. I asked if they had said “awl” or “owl,” and much to my amazement came the reply, “Owl. O-w-l!”
Two minutes later, the crew wheeled in a frightened young boy with a live young screech owl perched on his forearm, talons clamped firmly, and looking as petrified as the boy. Initial attempts to simply lift it off resulted in the owl tightening its grip and the boy screaming in pain. I not only was trying to separate the two, but hoped to prevent the comic nightmare of an owl flying free in our ER. Finally, while an assistant held the bird’s body and wings, I was able to unfurl the talons using a hemostat. My assistant had to grab each talon as it was released to prevent the owl from latching back on. The boy had only a few superficial puncture wounds, and the bird was unharmed.
The owl was returned to the original scene by the ambulance crew and set free. The boy was also set free, and as he skipped off into the night was heard to exclaim, “Owl’s well that ends well.”
DAVID J. SIMON, M.D.
Pittsburgh, Pennsylvania
THE ANGEL OF DEATH
The Angel and I are close acquaintances—perhaps friends, or even colleagues. We work at cross-purposes. We each have a job to do. With fifty years of contact—thirty years in the Army and twenty in the Pit—we have been involved together in more cases than I care to count. Ultimately, the Angel wins, but until the clock stops for the final score, I am willing to contend with him. Once, I beat him out of a sure thing by making him laugh.
One night in the Pit, things settled down to almost nothing at about 0300, and I went outside to stretch and smoke a cigar. Up drove an aging and worn Volvo. A woman—young but also worn—was lying in the reclining front passenger seat. She answered my question readily enough: “Vaginal bleeding.” As I pulled the seat erect to help her out, she went unconscious—now that’s orthostatic hypotension with a vengeance. I got her into a wheelchair and rolled her in with what the Supreme Court once described as “deliberate speed” so as not to alarm her husband any more than necessary. I slowed down at the nurses’ desk to announce, “I’m putting this vaginal bleed into room sixteen. Call GYN stat.” Rooms 5 and 6 are the GYN rooms, room 16 is the resuscitation suite. My resident got the clue and was on my heels when we entered. She took a quick look and said, “Her pad is not soaked through, but you said she was bleeding like a stuck hog?”
“No, I said she is breathing like a stuck hog.”
When it comes time to butcher hogs, you cut both carotid arteries, and they do bleed a lot, but in a few seconds unconsciousness takes over and they quit struggling. Until they die, though, they point their noses up to fight for air, because they have too little blood left to carry oxygen. The resident got the picture immediately, and did a fine job of resuscitation. GYN did respond stat. She was in the OR within minutes.
I knew they would save her, for when I made the remark “breathing like a stuck hog,” I heard a soft chuckle, felt a little swish of air, and got a whiff of sweat and feathers as the Angel turned and left.
DOUGLAS LINDSEY, M.D.
Tucson, Arizona
SAY WHAT?
One of the nurses who was picking up dirty linen noticed a pink wad of gum on a bedside table. She grabbed a paper towel, picked up the disgusting thing, and threw it in the trash. When the patient returned to his room from X-ray, he asked, “Has anyone seen my Miracle Ear?”
MYKA CLARK, R.N.
Green Bay, Wisconsin
SO WHAT ELSE IS NEW?
Not everyone reacts to pelvic exams in the same manner. I’ve noticed that many women tune out conversations or questions until the exam is over. In one such case, while the patient was in stirrups, the physician asked, “Are you sexually active with more than one partne
r?” The patient was staring at the wall, seemingly oblivious to the question. I was the nurse assisting the exam, and I touched her shoulder to bring her back to the conversation. She looked startled and said, “Oh, I thought he was talking to you.”
BRENDA HILL, R.N.
Syracuse, New York
BAPTISM
Prior to going to medical school I worked as a paramedic. We were dispatched one Saturday afternoon to a woman with a reported miscarriage. Upon arrival, we found the fire department EMTs already on the scene. They reported that the woman had induced an abortion with a coat hanger, and that the fetal remains were in the corner, covered with a towel. The woman was in shock, with a rapid heartbeat and marked hypotension as well as active vaginal bleeding. We followed trauma protocol and transported her to the local Catholic hospital, where she was taken immediately to the operating room for repair of massive vaginal lacerations. The EMTs had wrapped the aborted fetus in blue pads and brought that to the hospital as well.
As we were completing our paperwork, the hospital’s priest came into the ER. He went to the dirty utility room where the wrapped fetus had been placed. The priest baptized the fetus, anointing the blood-soaked towels with holy water, and then withdrew, leaving the charge nurse to handle the remains. The nurse put on gloves and, with a grim expression and a large pathology specimen-bucket, went into the dirty utility room. She carefully unwrapped the towel and blue pads from around the fetus, and paused. We watched her carefully inspect the specimen. She called a colleague in for consultation. Their examination was followed by an intense, low-voiced conversation. Finally, the nurse came to us and reported that what the woman had removed from her vagina with a coat hanger was, in fact, a swollen tampon.
Emergency! Page 12