Friday, January 22, 2010

Shirley's Tumbler

I wish there was more reason and less rhyme in the ER.

For example, I might sign on to see a gentleman with urinary symptoms who ends up having an abdominal aortic aneurysm. Likewise, I might sign on to see an elderly woman with twenty medical problems who ultimately has nothing but some loneliness issues. Hug, please!

So when I signed on to treat a recently-retired man with back pain, chronic by history but exacerbated by recently lifting some grocery bags, I assumed it would be an easy, clear-cut case. "Me lift heavy bag, me back go 'crunch,' me try Tylenol but it no work, me come to ER." See how easy that can be? Wrong!

I walked into his room to introduce myself. I found a pleasant, mildly-distressed, sophisticated gentleman lying in his cot. In the corner chair, an equally sophisticated woman sat on edge. She introduced herself as his wife.

"Sir," I said after introductions, getting to the point, "I understand you hurt your back."

"Yes, he did," the woman jumped in. "It was stupid, really. He forgot to tell the grocery cashier not to put as many things in each bag. You know how they like to load those bags up when you ask for paper inside of plastic."

"Thank you, maam," I said, redirecting my questions and attention back to her husband. "And sir, did you have any trauma or falls or direct blows to your back recently."

Again, the woman answered. "No, he didn't." She waved her hand as if to dismiss his symptoms. "He does this all the time." She directed her attention from me back to her husband. "I warned you before you went shopping today, Leonard, not to let her do that." Leonard glared at his wife. I understood how he felt.

"Do you have any chest pain, shortness of breath, or abdominal pain, sir?" I asked.

I heard her grating voice again and, I must admit, I cringed. "No, he doesn't. But he has a trip planned to Vegas tomorrow and I want you to tell him he can't go, not in this condition. How the hell is he going to sit on a plane for three hours?" She looked at him and shook her head. "Stupid, I tell you."

"Well, maam," I said with restraint, "let me finish asking him some questions, do an exam, and then I'll be able to make that determination. And," I added, "I would like your husband to answer my questions from now on. When we are done, I'll give you a chance to share any more information that you feel is necessary."

From the look I got from her, I do believe she thought I had asked her for one of her lungs. That would be meaningless, though--she could still survive. Give me both of them, maam.

I looked from her to her husband, who was now glaring at his wife. And what do you know? The guy had a husky, deep, authoritative voice. "Shirley, just shut the hell up. You're embarrassing me. I don't know why you had to bring me here and I don't know why you just can't sit there and be quiet."

Uh, oh. I could smell the danger in their dynamics.

"Sir, I continued, trying to shortcut an argument, "let's get back to my questions. Do you have any traveling pain, numbness, or tingling or is the pain just sitting in your lower back?"

"Just right here, doctor," he said politely, placing his hand over his lower back region. "No where else." Well, I'll be damned--this guy finally got to answer a question! Sweet, golden silence emanated from the corner.

"Do you have any urinary symptoms at all? Burning? Going more frequently? Anything out of the ordi..."

I was interrupted by his wife. "No," she said, "Leonard doesn't have any problems pissing."

Okay, I had had enough now. "Maam," I said, giving her my undivided attention, "I appreciate you trying to help, but I am going to ask you to leave the room if you interrupt your husband and I one more time. You can't possibly know first-hand how he is urinating and, unless he can't talk, I want to know directly from him. Is that clear?" I got a huff and a dismissive look from Shirley, right before she turned her attention upward to a room corner--her way to let me know I was now going to be ignored. "Thank you," I said, refusing to be baited.

Leonard and I were able to finish reviewing his history without any further interruptions. I asked Shirley if she would like to add anything else, and she looked back from the room's corner to Leonard. "Oh, what? Now what I have to say is important? No thank you!" Poor Leonard--my heart went out to him, kind of the way your heart goes out to that baby wart hog that the lionesses trap in Africa.

Leonard's exam was consistent with a lumbar strain or, simply, a pulled back. I explained my findings to both Leonard and his wife and also explained that, with his history and age, I wanted to obtain both a urinalysis and some basic lumbar x-rays to make sure he didn't compress a vertebrae. I also had the nurse give him a pain shot to get him more comfortable. A big, big shot. He deserved it.

"Yeah, yeah, yeah," Shirley said impatiently, "but what about telling him he can't go to Vegas in the morning." Fingernails on a chalkboard, I tell you.

What I had to say next to Leonard, however, hurt me more than I'd care to admit. I took a deep breath. "Leonard," I said, putting my hand on his shoulder, trying not to gag on my words, "your wife is right." There, I got it out. "A fresh strain on your back is not going to let you enjoy this trip and, in fact, may hamper your healing to the point where you might do some worsening damage."

Leonard wore a look of extreme dejection. Who could blame him, really. This trip to Vegas was with "the guys" but, more importantly, without Shirley. I was proud of Leonard, actually, for holding back the tears I knew would be coming if this were my situation. I tried to imagine it--me, my big crocodile tears, and a box of tissues, hiding from Shirley in our house attic.

I finally left their room. Honestly, I was exhausted. Leonard's case was quite simple and the amount of energy I used in his room was unexpectedly huge. No rhyme or reason. I needed coffee, stat. I debated calling the grocery store to speak to the cashier. "WTF?" I was going to say, reminding her to put only one canned good in each bag. Really, though, you and I both know she was innocent, an easy target for my frustrations. I was above that, wasn't I?

Well, Shirley stepped out of the treatment room soon after I did. After his nurse, Natalie, gave him his pain shot, I explained to her how frustrated I had been from the interactions with Leonard's wife. "Did you get frustrated, too?" I asked Natalie.

"Yes, but it's about to get better soon," she said, knowing something I didn't.

I went in and checked on Leonard a short time later and, thankfully, he was alone and his pain was much improved. His tests had come back favorable and I explained these results to him.

"Thank you, doctor," he said, "and hey, I'm sorry for my wife's behavior. I don't know why she always has to be such a nag." Don't worry, I assured him, it was all good. I appreciated his acknowledgement, though.

After observing Leonard for about an hour, I went in to check on him and plan a discharge. And guess who was back? Yep, Shirley was, sitting in the corner chair, drinking from a big tumbler.

I reviewed Leonard's results with her and she didn't interrupt me once. Nada. She seemed genuinely pleased and happy with his results and treatment. "Thank you, doctor" she said, once I had finished. I staggered from her unexpected words and, thankfully, the wall behind me supported my sway. Of course I'm embellishing, but she did throw me for a loop. I wished Leonard the best, though, and after advising him of his treatment plan, left his room shaking my head.

"What happened in there?" I asked Natalie. "Why is she so calm and pleasant now?"

Natalie laughed at me. "Did you see her big tumbler?" I nodded yes. "Well, it's not water that's in there." Initially, I was puzzled at what Natalie was getting at but then, suddenly, lightening struck me and things became very clear. And sad.

"Alcohol?" I asked. "Of course," she said.

It seems Shirley and Leonard and their marriage were well-known to our ER staff, barring me, and several of their previous arguments had been quite memorable. Shirley's "tumbler run" was just as famous as those arguments. And necessary, Natalie assured me. "Otherwise," she said, "I think we'd have to get security involved. Possibly the police. Those two can go at it like you wouldn't believe."

I slowly nodded my head, not really sure what to make of Natalie's words or Shirley's tumbler. That tumbler was able to do the impossible--drown out Shirley's abrasiveness. Although my sympathies had always been there for Leonard, I now felt some creeping forward for Shirley.

"They were pretty tame today," Natalie continued, interrupting my thoughts, her smirk evident, "they must have liked you."

"Listen, Natalie, can you do me two favors?" She nodded and I continued. "One, get a social worker in there to discuss counseling options, both for their marriage and Shirley's drinking problem." Natalie nodded. "And two," I continued, "get someone to drive them home."

Natalie touched base with me a few minutes later. "All done," she said. "Their daughter Lisa and her husband are reluctantly coming to pick them up. And Shirley and Leonard kicked the social worker out of their room--they didn't have 'any God-damn problems, for Christ's sake.'"

Shirley and Leonard, my best to you. And a personal plea. The next time you come together to our ER, if I'm working, bring me a tumbler, too. For Christ's sake, I'll need it...

Enjoy your weekend. As always, thanks for reading. Next post will be on Monday, January 25.


Anonymous said...

This sounds like an episode from ER...

Lockup Doc said...

That's a great story! I really like your ability to see and focus on humor in an otherwise very frustrating situation. I think that's one of the keys to enjoying the practice of medicine (or any job for that matter) since challening personalities are always a part of it.

MGD said...

i can't believe you told this poor guy not to go to vegas b/c of a freaking back strain. just give him some nsaids and let him make his own decisions. seriously man, a back strain.

t. said...

Poor Leonard! I'm sure he needs a tumbler as much as Shirley.

Nice to see a conservative, carefully planned therapy. Going to Vegas with a back strain? That has "repeat visitor" (read: needless waste of resources) written all over it. He'd be back in your ER, or worse, some ER in Vegas where they don't know him or his history.

Cheers, Doc! I'm raising my own tumbler in your honor.

Anonymous said...

Necessity is the mother of invention..........................

Peter said...

I've had the same thing happen to me but what can you do? Yes, having the patience of a saint, as you showed here, surely helped.

Now, if only you could have given him the advise to come out of retirement to resolve his pain in the neck! Caused by you know who!

Take Care,

t. said...

Hey, Doc,

Thanks for your comment. Absolutely feel free to use the quote, though I don't know who to credit. If you figure it out, lemme know.

Though it approaches loss from a different life path than mine, I very much appreciated the book "Mourning Song," by Joyce Landorf Heatherley.

Also, there's the poem, "To Remember Me" by Robert Test. Powerful.


Carolynn said...

Oh, I could feel your pain. And Leonard's. Although, I confess, I did enjoy a few laughs at your expense. Well put.

Thank you for stopping by my place and leaving such a generous note on my doorstep. You're welcome to visit any time.


Maha said...

I should be the big bad ER nurse but sometimes I get really intimidated by overwhelming family members. I liked how you approached the patient. I've got to be a little more authoritative and failing that, offer a cooler of vodka!

SeaSpray said...

Ha ha! Well told. Love the lung part... and the grocery clerk and the whole post. :)

You never know what Leonard is like at home though. You might feel sorry for Shirley. ..well you might. :)

Cathy said...

This was a hilarious story. Poor Leonard. Poor Shirley. Poor Doc.