Emergency!

by Mark Brown, MD

  Right after that, a guy working the night shift in a print shop uptown tried to remove a loose bolt from one of the presses while the machine was on. His right hand was crushed from the mid-forearm downward. The hand, surgeons said, was not salvageable, and the ortho residents removed the crushed part in the OR. They sent him back to the ER for a tetanus shot and a dose of antibiotics and said he should be discharged. This seemed cruel. I think that if you lose a major body part, you are entitled to at least one night in the hospital. I couldn’t reach his wife. She was working a night shift. I felt bad, the guy losing his hand and all, so I gave him some morphine and let him sleep in the already crowded ER. In his sleep, I noticed that he tried to scratch his scalp with the hand that was not there.

  Around 3 A.M. a woman came in with a complaint of “pelvic pain.” I noted on the chart that this twenty-eight-year-old white female listed “dentist” as her occupation. I made some introductory remarks about the field of dentistry, trying to break the ice before I invaded her body. She was an attractive blonde with short hair and round horn-rimmed glasses that gave her a studious, yuppie look. My soliloquy was interrupted by Miss Dentist requesting that she be examined by a female doctor. I took this as a warning sign, and shot a glance at the nurse in the room with me. ER litigation is filled with women reporting that doctors examined them in an improper fashion. Granted, they may not know what is proper, but this doesn’t stop a lawsuit from ruining a reputation. I wanted to run out of the room and get someone else to see her. I quickly explained that I was one of four male doctors in the ER, but if she wanted another doctor she could wait a few hours to be seen in the GYN clinic. She replied she was much too uncomfortable to wait and would agree to be examined by me if the nurse left the room.

  Now I was really frightened! No way! “State law says you have to have a chaperon for GYN exams, for your own protection,” I stated with gravity. This was bullshit, but I thought it sounded convincing.

  I left the room to have the nurse sound her out. After several minutes the nurse came out and pulled me to an area several yards from the door of the room. “She has something caught in her vagina,” she said.

  “Like what? A tampon? A condom? A diaphragm?”

  “No, something out of the ordinary.” She smiled.

  “A vibrator? A Coke bottle? A billy club?” I offered.

  “No,” she insisted, “out of the ordinary.”

  I thought, This nurse must be losing touch with reality or has spent too much time in the ER. I was really too tired for guessing games. “I give up.”

  “A room deodorizer.”

  “A what?”

  “You know, one of those mushroom-shaped things that keep your living room from smelling like your cat. She’s tried to get it out for two days, and now it’s getting painful. She drove all the way from Jersey to avoid seeing anyone she knew. She’s pretty embarrassed.”

  I knew better than to ask how the mushroom had gotten there; last year I had made the mistake of asking a young man how a teacup had found itself in his rectum. What followed was a long, totally startling story that I immediately regretted asking for. He told me he was painting the ceiling on a ladder, and fell onto a couch on which he had placed his cup and saucer. And well, you know, it just got stuck up there. Hmmm, let me picture this: You’re painting the ceiling. Nude. On a ladder. Intermittently sipping tea. Yeah. I can see it.

  I reentered the room. The dentist was crimson. I assumed my flattest affect. I really did feel sorry for her, and wanted this to be over for both of us. The deodorizer was removed easily with the help of a forceps. The floral design was still visible, but it was not emanating the “fragrant springtime bouquet” advertised on its side. It was placed in a sterile container and sent to pathology, as are all foreign objects removed from people’s bodies. I thought of my former classmate, a pathology resident, who would be examining this specimen in the morning. I decided to give him something to think about and jotted a quick note on the pathology request form. “Mushroom found on routine vaginal exam. Suspect new vaginal flora. Could this have grown there?”

  After the mushroom left the room, the dentist regained some of her composure and said she had a long ride back to Jersey. She said she wanted to pay in cash so her insurance company would not be notified. I told her to take it up with the registrar. She thanked me for my time and signed her discharge form, which suggested that she follow up with her private GYN and restrain herself from the future use of room deodorizers.

  The night went on. It was 5 A.M. and I was near crying. I couldn’t think clearly. I was drinking Coke by the liter, even though I had sworn off caffeine months before. It was a scary situation, like driving when you’re very sleepy. You can’t stop but you’re afraid that if you don’t you’ll crash. Eight o’clock came murderously slow. The patient flow had become a trickle. I was using the old dodge of ordering tests that would take hours to complete in order to delay decision-making till the next shift. That way I could sign out the case in the morning to someone fresh.

  When the troops did arrive, they seemed so awake and enthusiastic it made me sick. I was sullen during sign-out rounds, and explained in the fewest words possible events of the night before and conditions of the patients.

  When leaving the hospital I was so relieved I actually felt refreshed during the walk to the train station, and thought it might be a good idea to read about abdominal trauma on the ride home. I fell asleep to the rhythmic clacking of the train, and awoke at the end of the line, an hour past my home.

  Lately I’ve been moonlighting in an executive health clinic in downtown Manhattan. It is mostly people who want an excuse to go home and mistakenly think I will give it to them. When I’m working I take a personal interest in seeing that everyone else works too. I’ve so impressed the boss that he’s offered to underpay me on a permanent basis.

  Think I’ll go back to bed,

  Campion

  VII

  Dear Larry,

  This place is getting to be too much. Last week I was pulled from the ER to work on Unit Nine. This unit was conceived as an amenity to the ER and was marketed to local businesspeople as a place where they could receive prompt, courteous care by board-certified physicians for their sore throats and sprained ankles. The unit was painted in pastel colors and a few potted palm trees were purchased for ambiance. The marketing fell flat as the pressure in the main ER forced the less sick masses to overflow into the “corporate ER.” As a result, captains of industry in thousand-dollar suits sat cheek by jowl with the homeless and unwashed. This put a speedy end to the whole corporate clientele, but the pastel and the palms remain. I think the street people really enjoy them—along with the National Review and yachting magazines.

  I’d been tied up in the ER and by the time I arrived in the unit, there was an unruly crowd in the waiting room. They were backed up six to eight hours, due to the unusually large number of traumas resulting from a PLO demonstration/brawl the night before. Of course, my boss, Kleiner (the dyspeptic and dysfunctional graduate of a foreign medical school) decided to take me to task for my tardiness. I felt like I was back in school. I ignored him, which is how I usually deal with his inane comments, and went to work.

  The only bright spot in the place was the preternaturally pleasant nurse Maria. She was quick on her feet, fun to talk with, and spoke Spanish fluently, all great assets in the ER. Maria told me that my first case was Mr. Sullivan. She mentioned that he was a denizen of Penn Station (i.e., homeless) and was “pissed off” because he had been waiting for six hours to see a doctor.

  I entered the exam room and introduced myself to Mr. Sullivan, a forty-year-old white male with a medical history of alcohol abuse and ulcer disease. He said he had missed his clinic appointment and needed a drink, food, renewal of all his medications, and cab fare home to Penn Station. He further informed me that he had places to go and was not going to submit to an exam from some “snot-nose” young doctor. Being aware of the active black mark
et for prescription medications, I told him the rules were “no physical, no meds.” This did not have the desired effect. Mr. Sullivan became more aggressive and shouted that I was an “asswipe” and a “scumbag.”

  Usually, I’m pretty philosophical about these ad hominem attacks, even if they are ab irato. But cumulative events, combined with this morning’s, had exhausted my equanimity, and I spoke some phrases ab imo pectore (in keeping with this sudden Latin bent of mine). I got in his face and told him in no uncertain terms, and in a loud voice, that he was a sodden drunk and an obnoxious motherfucker. I added that if he did not leave this ER immediately I, with righteousness in my heart, would smite him (i.e., knock his fucking teeth down his throat), thus rendering him magnus mutas quam piscis (quieter than a fish).

  Mr. Sullivan evoked that classic Brooklyn comeback, “Go fuck yourself,” and said he was not going to leave till I had given him what he came for. He waived his Patient’s Rights Handbook in my face and told me he didn’t have to leave if he didn’t want to. I could feel my face getting red, and it was all I could do to keep myself from throttling him and throwing his body out on Seventh Avenue. He then threw himself on the floor and demanded to speak to his Patient’s Rights Advocate, whom he mentioned by name. I could no longer control myself. I grabbed him by the collar and the seat of his pants and carried him to the waiting room, where I tossed him on the floor in the general direction of the exit. Now completely out of control, I screamed, “I’ll kill you if I ever see you in this waiting room again.”

  A deathly silence fell on the usually lively waiting-room crowd. I looked into their faces, and for several long seconds not a word was spoken by anyone. Then I shouted into the assembled crowd, “NEXT!” No one came in for thirty minutes.

  Stop by the hospital sometime and I’ll meet you for dinner.

  Vale, valeo,

  Campion E. Quinn, M.D.

  VIII

  Dear Larry,

  3 A.M. Another attack of insomnia. The baby is well—she’s hardly a baby anymore. Cathy and her sister are sleeping soundly. Maryanne is a frequent houseguest. She is a great cook, so we’re always pleased when she comes to visit.

  Yesterday morning was unpleasant. I spent it making phone calls to follow up the letters I mailed out several weeks ago to the biotech companies: fifty-three letters sent, fifty-two no’s and one we’ll-get-back-to-you, by a secretary. My ego is at an all-time low. My anxiety level is climbing in response. The following story will give you an idea of how things are going.

  I was called into the office by Dr. Kleiner, director of the ER (I believe I’ve mentioned him before). He’s a man with an unreasonably low opinion of me and quite an overinflated, undeserved opinion of himself. He’s never worked in an ER before, but through political savvy and callow maggotry he wangled the directorship for himself. This has provided him with a salary, status, and virtually no responsibility. He has been able to maintain his internal medicine practice while his secretary handles all the ER administrative work. He is known as much for his lack of knowledge about the workings of the ER as he is for his inability to communicate with or to effectively manage the forty or so doctors for whom he is responsible.

  With no preamble he informed me we were to make an appearance in the vice-president’s office in response to a letter of complaint. The letter was received from a patient that I had treated for gonorrhea. He produced the letter, hand-written on yellow legal paper. It went thusly:

  “Dear Director of the ER:

  I am writing to inform you of an occurrence which occurred at St. Alban’s and has been detrimental to my life. I had the misfortune to come under the incompetent care of one of your doctors, C. Quinn. I had gone to the ER for treatment on May third …”

  The letter went on to document his version of how he had come to the ER with complaints of a burning on urination and a dripping from his penis. I had told him he had gonorrhea and had treated him. I told him that he should tell all his sexual partners to come in and get checked. He told his fiancée, and then subsequently found out that the urethral cultures for gonorrhea were negative. This has led to much discord in his relationship with his new bride. This was all Dr. Quinn’s fault.

  What he failed to mention was that two days prior to his entering the ER he had been out with his friends celebrating his bachelor party. There had been strippers, who for a fee had engaged in sexual congress with him and his friends. This fun and games continued, with consumption of several “eight balls” of cocaine and much switching of partners, in what during the sixties was known as an orgy. The end result was that he had engaged in intercourse with four prostitutes in the same evening. This patient (let’s call him Mr. Johnson) understood the significance of his symptoms, which is why he did not go to his regular doctor. What he did not realize is that he should not have had sex with his fiancée. He had hoped that he could have been treated and released, and never thought about it again. I told him that she was at risk for a serious pelvic infection that might make her sterile or kill her, and yet have no symptoms. This put Mr. Johnson in a real sweat. He asked me if I could tell her that he had contracted this infection while on Army Reserve training upstate from bad water or a tick bite. I refused, and thought that if she left him it would be the best thing for everyone involved. He left the ER with a prescription and a heavy conscience.

  The urethral culture had sat on the desk of the ward clerk for twenty-four hours before going to the incubator, and therefore all the little gonorrhea germs in the culture tube had died off while waiting. It came as a surprise to no one that the results were negative. The results were sent to the patient, and this prompted much vilification of my name in the six-page letter. The castigation continued, calling for my resignation, suggesting removal of my license to practice medicine, etc. “How dare Dr. Quinn accuse me of having VD after only one chaste kiss from a cocktail hostess,” he wrote.

  After further castigation from the VP, who was not a physician by the way, I was told, “You are dealing with people’s lives here, Dr. Quinn, and you should be more careful.” He asked for no explanation and I was discharged from the office. Walking down the hall, I asked my boss why he hadn’t backed me up in there with the VP. He gave me one of his pat answers. He has about three that he uses for all occasions. “Campion, when treating patients, remember that courtesy, competence, and caring are essential, and in that order.” He followed up with number two: “Further, Campion, part of the job of emergency medicine is consuming a regular diet of humiliation that must be accepted for the benefit of the patients and the hospital.”

  Fresh from this, I was forced to call the fire department to assist in the removal of cock rings. Cock rings are devices that I’ve learned about since coming to St. Alban’s. I suppose that anyone could use them, but here they are exclusively the province of the homosexual community. The rings are stainless steel and are placed at the base of the penis. They interfere with the blood exiting the veins of the penis, and so help maintain an erection. This can backfire and cause swelling that does not allow the cock rings to be removed. This is such a common problem that we have a schedule posted that tells us which days we can call the fire department or the police department to bring in the Whizzer Saw. It is a diamond-tipped saw that can cut through the steel rings. The patient reported abdominal pain and asked for a male doctor. I examined him. Whoa! His penis was swollen to the size and color of an eggplant. Violaceous, tender, and quite painful, he had hoped that ice packs and time would reduce the swelling. It had only gotten worse. He was not a West Side “leather man” or anything. He had quite a respectable job, and was very embarrassed. He wanted me to cut them off so he could leave. I told him that the three rings were quite a project and would require the fire department to cut them off. He moaned at the prospect. When the fire department did arrive, they all came off the truck, dressed in the turnout coats, fire helmets, and smelling of smoke. They were carrying the saw and associated equipment. Apparently they do not share the p
hysicians’ sense of propriety, and laughed loud and long when they entered the room. The patient’s face was as purple as his penis, but he just looked at the wall and was quiet. The fire department was all business after a few moments. They turned off all the oxygen and set up a water line. The saw blade and the rings would have to be irrigated to keep them from burning his penis. When they started cutting, a great plume of sparks flew from the rings. I guess that’s why they turned off the oxygen. The patient shouted in fear but was restrained by the burly firemen. The procedure took about ten minutes. The firemen told him to be a good boy in the future, and laughed as they carried their equipment out. The patient was asked to stay for urological evaluation, but signed out against medical advice. No guts, I guess.

  Can I write myself a prescription for sleeping pills?

  Campion

  IX