Emergency!

by Mark Brown, MD

  DASH FOR CASH: Helicopter transport of critically ill patients. These helicopters are often owned and run by private companies that charge big bucks.

  DEFIBRILLATION: Using a machine to shock a heart that is quivering (not beating) in order to try to normalize the heart’s electrical activity into a regular beat again. Also SHOCK.

  DFO: Done Fell Out (passed out).

  DOA: Dead On Arrival.

  DSB: Drug-Seeking Behavior—used to describe patients who come in with bogus complaints seeking narcotics in order to dull an otherwise unhappy life.

  DUMP: This word has several meanings: 1) When a nursing home, a community physician, or another hospital DUMPS a SICK patient, (usually NEGATIVE WALLET BIOPSY) on the ER to be cleaned up and cared for. 2) When a SICK patient goes bad, he DUMPS or CRASHES. 3) As a noun: “The GOMER was a DUMP.”

  DWINDLES, THE: Failure to thrive, especially in a GOMER.

  ECHOLALIA: The repetition of words spoken by others, as if echoing them (associated with mental illness).

  ECTOPIC PREGNANCY: The implantation of a fertilized egg somewhere in the body besides the uterus. Most commonly this abnormal location is the Fallopian tube; therefore it may also be called a tubal pregnancy. Ectopic pregnancies can rupture and cause life-threatening bleeding into the abdomen.

  EKG: Electrocardiogram—a tracing of the heart’s electrical activity.

  EMESIS: Vomiting.

  EMT: Emergency medical technician—a paramedic or an ambulance driver.

  EPI: Epinephrine, or Adrenalin—a drug used to help restart the heart.

  ET: Endotracheal tube; the plastic tube passed into the trachea (windpipe) when a patient is INTUBATED.

  ETA: Estimated time of arrival.

  FAMILY PLAN: One of the kids has a cold so the parents pack the whole family into the station wagon and bring them along to the ER “to be checked.” Often used in association with the MAGIC KINGDOM CARD.

  FEATHER COUNT: A measure of flakiness.

  FELLOW: A doctor in subspecialty training beyond residency.

  FEMORAL ARTERIES: The big arteries of the upper leg.

  FLAIL: A resuscitation that goes badly.

  FLATLINE: When the heart-monitor tracing no longer shows heart blips but only a flatline tracing reflecting the absence of heartbeat. See also ASYSTOLIC; CARDIAC ARREST.

  FLEA: An internist, particularly one who orders multiple test results to establish a list of multiple possible diseases so that multiple further tests can be done, thereby sucking a lot of blood from the patient with no discernable benefit.

  FLOG: A resuscitation on a patient who is essentially dead upon arrival to the emergency room.

  FLUORESCENT LIGHT THERAPY: This treatment is reserved for those patients whose unpleasant manner has offended the triage nurse, who makes the patient sit forever in the waiting room, basking in the harsh fluorescent light.

  FOLEY CATHETER: A rubber tube put into the bladder through the urethra to assure the flow of urine.

  FOS: Full Of Shit—a severely constipated patient with abdominal pain.

  FREQUENT FLYER: A regular ER visitor who comes in for drugs, minor problems, or social contact.

  FTD: Fixin’ To Die.

  FULL ARREST: See CARDIAC ARREST.

  GI: Gastrointestinal, or pertaining to the gut.

  GOK: God Only Knows. Used to refer to a puzzling set of symptoms.

  GOMER: Originally proposed by Dr. Samuel Shem to be a mnemonic meaning Get Out of My Emergency Room, but more generally used to refer to any debilitated, senile, elderly person. Also GOMED-OUT; GOMERTOSE.

  GOMERGRAM: Since the gomer by definition can’t describe her symptoms due to senility, a shotgun approach is used and every screening lab is ordered: EKG, CXR, CBC, Chem 7, UA, ABG, PT/PTT, LFT. This ordering of all possible tests is called a GOMERGRAM.

  GOOMBAH: A worrisome mass or tumor found on exam or X ray. For example, one might say after reviewing a patient’s head CAT scan: “He has a mean-looking GOOMBAH in the brain.”

  GORK: A patient who has sustained a brain injury resulting in severe mental impairment. One might say: “The patient is now a GORK (or GORKED OUT).”

  HEMATOMA: A blood-filled lump that forms after trauma; a “goose egg.”

  HOUSE STAFF: INTERNS and RESIDENTS at a teaching hospital.

  HYPOTENSION: Abnormally low blood pressure.

  HYPOTHERMIA: Abnormally low temperature.

  ICU: Intensive care unit. Also known as the “expensive care unit.” (Often the last stop on the way to the “eternal care unit.”)

  INTERN: A young doctor in the first year of training after medical school (100-hour work weeks).

  INTUBATE: To insert a plastic tube through the mouth (sometimes the nose) and into the trachea (windpipe) to help ventilate a patient.

  IV: Used to administer solutions intravenously (in the vein).

  LABS: Tests commonly used in evaluating a patient:

  CBC: Complete blood count of red and white blood cells.

  LYTES: Electrolyte levels.

  UA: Urine analysis.

  ABG: Arterial blood gas; checks the oxygen in the blood.

  CHEM 7: More blood chemistry.

  EKG: Electrocardiogram; measures the heart’s electrical activity.

  CXR: Chest X ray.

  PT/PTT: Blood coagulation measurements.

  LFT: Liver function test.

  LARYNGOSCOPE: A metal blade used to push the tongue aside and lift up the throat so that the windpipe can be seen.

  LINE: An IV line for access to circulating blood.

  LINE ’EM UP: To insert multiple lines in order to resuscitate and monitor a critically ill patient.

  LMP: Last menstrual period.

  LOL NAD: Little Old Lady, No Acute Distress. May or may not be a GOMER.

  LP (LUMBAR PUNCTURE): See SPINAL TAP.

  MAGIC KINGDOM CARD: A Medicaid card with monthly stickers. When an amusement park admission is free, the customer tends to come more often. Also known as “McStickers.”

  MI: Myocardial infarction—aka heart attack or “the big one,” as in, “Oh shit, he’s having the big one.”

  MICRODECKIA: “Micro” meaning small, “deck” as in a deck of cards—hence, playing with less than a full deck: “The patient is suffering from MICRODECKIA.”

  MONITOR: A cardiac monitor that displays the patient’s heart rhythm.

  NEGATIVE WALLET BIOPSY: Cash patient without funds. Also known as a no-cash patient.

  NEONATE: An infant less than a month old.

  NEURO: Relating to the neurological system (the brain and nerves).

  NO CODE: A classification of a patient (with the patient’s and family’s approval) that if the patient should go into cardiac arrest, no effort should be made to resuscitate him.

  NSR: Normal sinus rhythm—the normal pacemaker beating of the heart.

  OB/GYN: Obstetrics and gynecology.

  OR: Operating room.

  ORTHO: Orthopedic surgery—practiced by bone doctors. In medical school the folklore reported that the bottom 10 percent of the class would be pithed (have their little brains destroyed by a sharp instrument). Those that could crawl away went into OB/GYN. Those that couldn’t went into ORTHO. Hence the phrase “An orthopedic surgeon must be as strong as an ox, and twice as smart.”

  OTDMF: Out The Door, Mother Fucker.

  OXIMETRY: A monitor of the effectiveness of a patient’s breathing.

  PATH: Pathology—that specialty of medicine that examines tissues and dead people to determine the nature of the disease or the cause of death.

  PATHOLOGIST: A doctor who prefers the company of dead people and enjoys the smell of formaldehyde.

  PBAB: Pine Box At Bedside—a suggestion for patients who aren’t doing very well and are SICK.

  PERSEVERATION: Persistent repetition of an action or words.

  PHYSICIAN’S ASSISTANT: A licensed health care provider who does medical care under the supervision of a physician. Usually
called a P.A.

  PID: Pelvic inflammatory disease—a venereal gynocological infection.

  PIT: Frequently used to refer to the emergency room by the people who work in it.

  PLAYER: A patient.

  POP DROP: When a family drops their elderly, disabled, burdensome dad off at the emergency room so they can take a vacation. See also POSITIVE TAILLIGHT SIGN.

  PORCELAIN LEVEL: A term that stems from porcelain crockery, or a “crock,” as in “a crock of shit.” This is a fictitious blood test ordered at the bedside to communicate to a coworker that you think the patient is malingering and hence a DSB or TERRASPHERE.

  POS: Pre-Orgasmic Syndrome—the male equivalent of PMS. Also known as “Irritable Male Syndrome.”

  POSITIVE SUITCASE SIGN: Noted about a patient who arrives in the Emergency Department with a packed suitcase. Generally denotes a diagnosis of “Needs a place to stay.”

  POSITIVE TAILLIGHT SIGN: Noted when a patient is dropped off at the emergency room by the family and all we see are rapidly fading tail-lights as the family sedan speeds off into the night. Generally denotes a diagnosis of “Find him a place to stay.” See also POP DROP.

  POST: A postmortem, or autopsy.

  PREEMIE: A prematurely born infant.

  PRETERMINAL: Almost terminal, or nearly dead. See also CTD; STBD.

  PULMONARY EDEMA: Fluid in the lungs, most often occurring with CHF.

  PULMONARY EMBOLUS: A blood clot that forms in the body, breaks off, and travels to a lung, where it lodges, causing pain, shortness of breath, and, if it is big enough, death. Also referred to as a PE.

  PVC: Premature ventricular contraction—an abnormal heartbeat that may warn of impending VFIB or VTACH.

  Q SIGN: Usually found in debilitated patients (e.g., a GOMER) who are GORKED OUT. The mouth has slacked open into an O and the tongue hangs out to one side, forming a Q.

  RAY: A radiologist—i.e., a person who likes to work in the dark but not make any decisions. Radiologist’s national flower: the Hedge.

  RESIDENT: A HOUSE STAFF doctor; still in training, but beyond INTERN.

  RINGERS: An IV fluid used in resuscitation.

  ROCK GARDEN: When the emergency room fills up with ROCKS.

  ROCKS: Patients who can’t be moved out of the emergency room. Often a GOMER, the patient is not sick enough to put in the hospital, but the family refuses to take him home. Sometimes, however, it can be a patient with a NEGATIVE WALLET BIOPSY, and no staff physician will admit him and no other hospital will take him in transfer. The worst possible rock is known as a “diamond.”

  ROUNDING UP THE USUAL SUSPECTS: Ordering all the tests and studies that routinely get ordered on a given type of patient. May often coincide with a GOMERGRAM.

  ROUNDS: Usually occur at shift changes; the departing doctors and the newly arriving doctors go from patient to patient giving an update on each patient’s condition.

  SACRAL: Relating to the sacrum, which is the back wall of the pelvis (the tailbone).

  SCUT: The lowest form of HOUSE STAFF work—drawing blood, labeling tubes, carrying labs, pushing patients to X ray, etc.

  SCUT MONKEY: A medical student; one who performs scut.

  SHOCK: See DEFIBRILLATION.

  SICK: Sick. Real sick. May be CTD. Expect a CODE BLUE.

  SIDS: Sudden infant death syndrome. Babies in the first few months of life suddenly die while napping. The reason is unknown but sometimes is associated with sleeping on the stomach.

  SNOW: To give a patient high doses of morphine or Demerol when he is in a lot of pain.

  SPINAL TAP: Insertion of a needle between the lumbar vertebrae into the spinal canal to withdraw spinal fluid in order to check for infection or bleeding. Also LP (LUMBAR PUNCTURE).

  SPOTAS: People who come to the ER in hopes of obtaining a written excuse for not doing whatever it was that they were “spota” be doing: “I spota be in court right now, but every time the train goes by, my feet get numb.”

  STAT: At once; immediately.

  STBD: Soon To Be Dead. See also CTD, FTD, PBAB.

  STERNOTOMY: A procedure in which the chest is cut open through the sternum. See CRACK THE CHEST.

  STOOL MAGNET: An unlucky medical student who gets dumped on with the worst scut and the nastiest patients.

  TATTOO-TO-TOOTH RATIO: A prognostic indicator of a patient’s self-destructive potiential.

  TOURON: A term derived from “tourist” and “Klingon” used to denote a rude and irresponsible tourist.

  TERRASPHERE: From the Latin terra, meaning earth, and sphere, meaning ball; i.e., a “dirtball.” Useful when discussing the patient’s condition with someone else while in front of the patient.

  THORACOTOMY: A procedure in which the chest is cut open.

  THREE HOTS AND A COT: Three meals and a bed—what homeless patients seek when they show up in the ER with a bogus complaint like, “Every time the train goes by, my feet get numb.”

  TOON: A loony-toon; a crazy; a mental health patient.

  TRAIN WRECK: A patient with severe, complicated multisystem disease or injury.

  TREAT ’EM AND STREET ’EM: Rapid turnaround time in the ER.

  TRIAGE: To sort out according to severity of illness or injury, so that the more critically ill or injured patients are treated first. This runs contrary to our social custom of first come, first served, and can create resentment in the waiting room.

  TROLL: A patient found under a bridge, smelling of alcohol, without a history or name.

  TROLL THE LABS: To order a broad set of labs in an attempt to fish for a diagnosis in a GOMER who looks SICK but can’t communicate. See also GOMERGRAM.

  TROLLS NEVER DIE: A corollary of Murphy’s Law that suggests that terrible people cannot succeed in destroying themselves however hard they try. Evidenced by the inevitable survival of the drunk driver who wipes out an entire family on their way home from Sunday morning services. It is the inverse of nice people getting cancer.

  TUBED: Intubated.

  VFIB: Ventricular fibrillation—a life-threatening state in which the heart quivers instead of beats. The cure is to DEFIBRILLATE or SHOCK the patient.

  VTACH: Ventricular tachycardia. A rapid heart rate originating abnormally from the ventricle. Often a sign of impending VFIB or CARDIAC ARREST.

  WNL: Within normal limits. Often written as a summary for some part of the physical exam, but often sarcastically interpreted as We Never Looked.

  Special thanks to those who contributed to this section: Milton H. Anderson, Eve Boyd, Keith N. Byler, Bill Davis, John Dente, Edward Dickinson, Gary M. Flashner, Corky Gordon, Donald Graham, Mike Greenberg, Charles Hagen, Hugh F. Hill, Philip Levin, Thomas J. Motycka, Scott Oslund, Gregory D. Post, Campion E. Quinn, Sylvia Sydow.

  ACKNOWLEDGMENTS

  My thanks to Anita Jones. She is my editor, consultant, writer, rewriter, and friend.

  Thanks also to Frances Hall and Dartmouth Medical School. My father, the dusty professor, and his friend Nano kept me on track. Joe Bell and Sherry Angel put lots of red pencil to the stories. Readers and advisers included Steven Smith, Howard and Françoise Appel, Eve Boyd, Carol Castro, Phyllis Contini, Spencer Downing, Corky Gordon, Craig McIntyre, Barney Shapiro, Carolyn Sindell, Joe Veit, Jon Wild, and the Great Hansens: Raymond, Greg, and Theresa. Michael Eliasberg kept the lawyers at bay. Susan Sherba took care of all the paperwork. Jane Sindell and Matthew Snyder opened the door, and Andrew Blauner, Kim Witherspoon, and Craig Nelson liked the book and made me feel welcome. Special thanks to Theresa for being my companion and to Griffin for being my son.

  And thank you to the hundreds of other writers who took the time to send me their stories from the Pit. It was my pleasure to read them and my regret to have been unable to use more of them.

  ABOUT THE AUTHOR

  Mark W. Brown grew up in Montana. He graduated from Harvard Law School in 1970 and practiced law in Los Angeles for nine years. In 1982, he graduated from Dartmouth Medical School, and he has pract
iced emergency medicine ever since.