Monday, April 19, 2010

Pretty Gassy

I walked into the central nursing station to find the chart for Room 34, my next patient, and was greeted by Nurse Laurie.

"Dr Jim," she said, handing me the chart as a wave of smile splashed across her face, "I see you signed up to treat my new patient. Good luck. You're going to love this one."

Ugh. A statement like that can be a double-edged sword. And at 2:00 a.m., I could only hope that Laurie meant it in a good way. But, truth be told, her smile scared me a little.

I walked down the hallway, lightly knocked on the partially-opened door to the room, and entered. Lying in the cot, passed out, was a 22 y.o. college student. Beyond the room's dim lighting and this patient's evident sloppiness, I could still appreciate that this was a beautiful young woman.

She could have been a beauty queen. Or an actress. Or a model. Maybe she was a hero among us--a loving granddaughter who visited her grandmother every day in a nursing home or a big sister who watched closely over her younger siblings while she was growing up. Maybe she was that daughter who gave her daddy his laugh-lines.

Maybe. But right then and there, in our ER, she was just another drunk college student. Her hair was mussed up, some grass mixed within her blond, tangled curls. Her lipstick was disheveled and thick. Her mascara had bravely abandoned her lashes, streaking down to visit her jawbone. Her clothes were in a disarray of tucks and untucks. She was a drunken mess.

I turned on the room's overhead fluorescent lights before walking to the right side of the cot. I raised my voice. "Hey, Tiffany," I said, "it's time to wake up and talk to me."

She stirred slightly, moving her head away from my noxious voice and the overhead lighting. "Tiffany," I said, now rubbing her shoulder, "you need to wake up and tell me what brought you here tonight." I padded my khaki's pockets to see if I had any weekend ammonia capsules left. I didn't.

She stirred a little more, this time opening her eyes and focusing on me. I smiled at her. "Where am I?" she mumbled, trying to absorb her surroundings.

Before I could answer her, though, she brought her right hand up to her mouth. I thought she might be ready to vomit or have dry heaves, but she didn't. She simply belched. Big time. It was disgusting and, yet, thoroughly impressive. And as if to let me know that it was no fluke, she belched again. After the second belch, an inebriated giggle and grin escaped her.

Laurie walked in, the smile still frozen on her face. "I thought you could use some help," she said. Yeah, I thought, help me pencil in the eyebrows that this patient just smoked off of my face.

I had read Laurie's nursing notes on this patient but, since the patient wasn't capable to answer my questions, I had Laurie, who had been privy to the prehospital report, fill in all the blanks for me. It seems that this patient, at a local tavern, had just helped a friend celebrate a birthday by downing several shots. After leaving the bar, she simply laid down on a nearby lawn to "go to sleep." Her friends, worried for her, had called 911. She was transported to our ER.

Tiffany's exam, performed with Laurie present, was benign. Well, except for her obvious intoxication. Her vital signs were stable, she had no evidence of trauma, and all parts of her systemic exam were within the normal limits of my expectations. With enough prompting, she was able to talk to Laurie and I in a slurred voice, confirming that she had been out to the bars with friends that night, drinking just "a little bit." She pinched her thumb and index finger. "Just a little," she repeated. She giggled, as if she thought she were successfully fooling us. Upon pressing her, however, she remained amnestic to lying down on the grassy ground.

While Laurie and I got her more comfortably situated, Tiffany closed her eyes to continue her nap.

And that's when the shit hit the fan. No pun intended.

Without warning, while she was napping comfortably, Tiffany let out a long, muffled, fluttering fart. Seriously. It caused both Laurie and I to jump back. Again, like her belch, it was disgusting and, yet, thoroughly impressive. And within seconds, from the stench, I suddenly wished that I could lay claims to such bragging rights as this patient. Someone, please, call the producers of "America's Got Talent."

Laurie looked at me, her gaping mouth mirroring my own. "Oh no, she didn't just do that." I nodded yes, trying to stifle my amusement, as Laurie continued . "That's just gross. If she shits herself, I'm not changing her."

I knew better. If this patient needed cleaned and wiped up, I had every confidence that Laurie would indeed do the right thing. Maybe, to rebel, she would wipe back to front, but still, she would do it.

So, imagine it. This beautiful inebriated girl, all dolled up and resting comfortably in her cot, letting one rip. So unladylike. So disgusting. And yet, so impressive (have I said this already?). Trust me, in Tiffany's case, it was not "what's on the inside" that counted. Thanks to her sharing her insides with Laurie and I, we could confidently say that her outside was probably the better bargain.

Well, Miss Tiffany didn't stop there. Before we left the room, round two occurred. And, while a family from a nearby patient room waited in the hallway while their mother got her EKG done in privacy, Tiffany decided to rip round three. Rounds four and five happened, fortunately, while Tiffany was over in the radiology department getting a head CT. Rounds six, seven, and eight, though, occurred after she returned back to Room 34, much to the dismay of Laurie and all of the central station nurses. Despite her room being located about fifteen away, Tiffany still managed to make quite an impression on all of them.

Because it was a quiet night, we were able to keep Tiffany in her ER room and observe her frequently. Well, the nurses did. After reviewing her normal CT, I was content in just getting updated reports about her from Laurie. Who am I to come between Laurie and her excellent patient care?

Finally, after about three or so hours, Tiffany sobered up enough to walk our hallways and go to the bathroom on her own accord. She walked out of the bathroom shaking her head. "I look like shit."

I think we all bit our tongues over that easy set-up.

Prior to being discharged, I checked on Tiffany for one last, final exam. She checked out well.

"I'm sorry about bothering you last night, sir," she said, chalking up a point for her apology but losing it just as fast by calling me sir. "Sir" equals "old man" when I hear it spoken to me. "I hope I didn't do anything to embarrass myself," she added.

"Oh, no," I assured her, lying through my teeth, "you were perfectly behaved. Not a problem at all." I wanted to be honest with her, but I knew that the truth would have completely embarrassed her. What purpose would that have served? She had been the guiding foghorn on our dark, murky, overnight shift and would never know.

She smiled then, completely unaware of how awe-inspiring her performance had been. I wished I could have given her a standing ovation. Instead, I extended my hand to her and we shook. "Good luck to you, Tiffany." Yeah, I thought to myself, good luck in your pursuit of the 2010 Miss Flatulence title. You're a shoe-in. "Thank you, sir," she responded, gathering her possessions and folding her discharge instructions into her jean pocket.

Pretty and gassy. Pretty gassy.

A pretty vulgar combination, if you ask me.

Isn't a little Monday morning bathroom humor better than a strong cup of coffee? LOL As always, big thanks for reading. See you mid-week...


Chrysalis Angel said...

You are really kind! To answer about her behavior with,"Oh, no," I assured her, lying through my teeth, "you were perfectly behaved. Not a problem at all."

If only they had video with audio for cases like this. When she then asked her question, you could politely just turn over the tape for her.

Webster said...

Dr.Jim, you were too kind. She's much too young to be out drinking like that, a scenario likely to be repeated again and again. The humiliation might have given her enough pause to consider the ramifications of her behavior. Instead she'll just redo her make- up and go home and sleep it off some more.

Heather said...

I really hope that she finds this on the Internet someday! ;)

The whole foghorn in the ER...priceless! Love it!

Great way to start a Monday!

Katie said...

"She had been the guiding foghorn on our dark, murky, overnight shift and would never know."
Great sentence!

I'm glad to know "sir" is synonymous with "old man" for some. Of course, I grew up in the north where someone was trying to get out of big trouble if they said it, but now living in the south it still shocks me when it rolls easily out of my own mouth. I'll have to make sure to reign in my tongue when I go home. :-)

Have a good day, si-- I mean, Jim.

<>< Katie

rlbates said...


WarmSocks said...

Sir = old man?
Not when I say it. It's a title of respect.

Funny story. Thanks for writing another great one.

Jabulani said...

BOL. I'd like to meet this young lassie, to see if she's any competition at all for my own little Flower Petal of Sussex! My oh my can my sweet little angel of a daughter clear a room. You do NOT want to be travelling in a car with her when she "fluffs". Fluff?? Grief, if that is 'fluff' then heaven help us if she gets serious!! She is a deadly weapon.

Thank you for making me smile.

Jabulani said...

Oh and I agree with Warm Socks - if I call someone Sir, it's because I'm showing respect. If I don't, it's cuz I think you're a schmuck!

Maha said...

Even more hilarious than your story (which was pretty darn funny btw) are your labels - drunk, ER, farting, gas.

Add chunky vomit to the mix and those are the typical words I use to describe my weekend nights spent working in emerg!

Karen said...

Funny story. I just returned from visiting my daughter and granddaughter #2 (2 weeks old). This baby would probably win a farting contest with your patient. I've never heard such gas in all my life! LOL.

artdoctor said...

Lots of farting in the ER...hmmmm...

Katie said...

Ok, I'm back. After hours of contemplation I've decided I would rather be told I stunk up the place. Not only would it be a great story but it also would make my dad proud. (He would also laugh at the fact that I was that drunk because we know he was there a time or two during his college career).
<>< Katie

rheumablog said...

With any luck at all, Tiffany went on to suffer a horrific, and memorable hangover, one that will keep her from doing shots in the future. Funny story, Dr. Jim -- I loved the foghorn analogy, too. Your patients are lucky they get to be treated by such a compassionate doctor -- and one who has such a great sense of humor.

artdoctor said...

My cat has been farting after breakfast—really gross smell with a combination of liver, chicken, fish, beef in his food. Maybe he needs to come to your ER!?! You guys have a farting room? #2—LOL!

He gave me a smirk look after I told him he smells really bad... I think cats understand what we say, just don't bother to talk back—too cool.

Cathy said...

Love it. Call "America's Got Talent"...LOL

Anonymous said...

Hopefully the bill for the CT and ER visit will sober her up a bit.

SeaSpray said...

I'm torn. part of me thinks it was nice that you prevented her from experiencing humiliation ..but the other part thinks she should know and it might be a deterrent in the future.

I can't imagine anyone would tell her though. It's like OR staff is never gonna tell a patient what embarASSing thing they said or did while under influence of anesthesia.

belladawn said...

Front to back...LMAO! Be careful, she might end up back in the ER with a raging UTI!!

Who cut the cheese said...

'Fess up, Sir. Cases like this are the real reason you went to medical school and decided to specialize in emergency medicine, correct? Yes?

btw, why the CT of the head? SOP for drunks, or defensive medicine?

Sarah said...

As a woman who is 20 weeks pregnant with her third child, this post was funny enough to warrant a change of pants. 'Nuff said. Found your page through Heather's comment stream, and after reading 3 posts, I will definitely be back!

Val said...

Believe me, an intolerance to Jerusalem Artichoke produces the same results....