Friday, September 24, 2010

A Third Look

I sometimes wonder what the commotion of our emergency department must look like through the eyes of a patient or their family. Imagine walking down the hallway to visit Aunt Lucy only to have a half-naked patient, his gown loosely-tied and his junk hanging out, walking at you from the other direction. Or seeing an unresponsive patient on a cot being rushed into a room with a paramedic sitting on top of him, performing CPR. Or hearing the drunk patient in the next room violently vomiting and gagging while filling-in the space between with obscenities.

The imagery and sounds that come from our busy shifts must haunt some of these visitors not familiar with the day-to-day workings of an ER.

Better yet, I wonder what these same patients and their families think when they see our staff's occasional blase' attitude. It has to be something pretty remarkable and out of the ordinary to get us to cringe or flinch or react, it seems. Which, I'm sure, comes across as uncaring to some. Trust me, though, it's not that the staff doesn't care, it's just that with the constant bombardment of these scenes, we have become somewhat immune to being caught off-guard.

When was the last time I did a double-take, you ask? Easy. It was two weeks ago. I had been standing at a counter in the nurses' station, finishing a chart, when I looked up to find one of our male techs helping a female patient stand from her cot. She had needed to go the bathroom and had insisted on using the hallway bathroom. She was a short but heavy woman, mid-forties, frosted blond hair, wearing a gown and nothing else. I presumed it had been tied up in the back.


As the tech helped this woman out of her room and down the hallway, away from me, I glanced to make sure she was steady on her feet. She was. But after what I saw, I wasn't. This woman's very robust ass was hanging out of her gown. Evidently, her gown hadn't been tied correctly. Now, I can handle the robust ass part. That's not a problem. If I've seen one robust ass in my career, I've seen a hundred. But what made me look twice at this one was the very tiny triangular patch of bright orange at the small of this patient's back.

"Noooooo," I thought to myself, "that can't be a thong. Can it?" A small part of me, although not a fan of them, hoped it was a "tramp stamp," a tattoo. For some reason, I would have accepted this a little better. As much as I hate tramp stamps, I hate thongs even that much more.

So, what did I do next? Heck yeah--I looked a third time. And disappointingly, I realized that the itsy-bitsy patch of orange was fabric. No tramp stamp for this classy patient. Straining my eyes, I couldn't see the rest of the thong, though, as it seemed to disappear among the fleshy cheeks.

With my mouth gaping, I watched the tech and the patient arrive at the bathroom, where he helped the patient in before stepping out and giving her some privacy. Afterwards, I looked behind where I was standing, only to find one nurse, one radiology tech, and two family members from another room (they had been asked to step into the hallway while a portable chest x-ray was being taken) standing in the hallway, watching the same scene I had just witnessed.

Their mouths were gaping, too.

I walked to the tech waiting outside the bathroom for this patient. "Hey, Mike," I said, "you have to cover up this patient when she comes out. Her backside and thong are hanging out for everybody to see."

"A thong?" he asked, "No way." I understood his amazement--this patient wasn't our typical, narcissistic thong wearer. "Trust me," I answered, pointing down to the family members looking our way, "they got a free show."

Mike ran and got one of our scratchy hospital-issued blankets and tried to cover up this patient's backside as she exited the bathroom, but she refused. "Get that thing off me," she yelled, "I don't care who sees me!" Good for her for being proud of her robust ass. If only we could all be that confident.

Mike earned his paycheck that day. As the patient walked back to her room, Mike grasped her elbow for support while using his other hand to hold the back edges of her gown together. No easy feat on his part, but he handled it like a champ. Single-handedly, he got this movie's rating reduced from an "R" to "PG.

Sometimes, the noise can be just as disturbing. Just a few days ago, we had a pleasantly demented elderly woman sent to us from a local nursing home for a variety of medical complaints. Usually, if we can, we place this type of patient near the nursing station to keep a closer watch on them (in the event they try to climb out of their beds). Unfortunately, though, this patient was prone to frequently screaming out "Help me!" Every few minutes. In a loud, high-pitched, shrilly voice. For three full hours. Behind her partially-closed glass doors.

Imagine being one of the patients or families who bore witness to these screams. After a few minutes, the staff easily got used to them (although I'm sure most of them would have preferred a little more quiet). I'll bet, though, that it was probably somewhat disconcerting for several families to think a patient was screaming out for help and not finding the staff reacting.

Unbelievably, about forty-five minutes before Ms. "Help me!" was discharged back to her nursing home, an elderly demented man was brought to our ER and placed in a parallel hallway near the same nursing station. And can you guess what he was prone to yelling out? "Owww!" Yes, "owww!" Drawn out in a raspy, deep, masculine voice.

Suddenly, we had these two patients prompting each other. "Help me!" was followed by "Owww!" "Owww!" was followed by "Help me!" This duo had impeccable, precise timing in their forty-five minutes of togetherness.

We all shook our heads. The hilarity of the moment, unfortunately, was tinged with some sadness to the reality of their situations. In another thirty years, I thought, that could be me uncontrollably yelling out something. Something suave, I can only hope.

After the woman was discharged, the elderly man continued with his "Owww"s for a few more minutes before tapering off completely. Maybe he realized, through his dementia, that he was Simon without his Garfunkel. Or Hall without his Oates. Better yet, Ike without his Tina.

As for the patients and families that heard this duo's chorus, we offered several reassurances that these patients were okay and not in any pain. Hopefully, the families we didn't get a chance to offer an explanation to won't be scared off from returning the next time they need emergency care.

The families that saw the orange thong, though? I don't expect we'll ever see them again...

As always, big thanks for reading. Any of you have a funny story to share? I hope you have a great weekend...


911RN said...

Yup, me too! Thong hater- agree- WAY worse than a tramp stamp. Never ceases to amaze me when I have to pull the pants off of some emesis covered drunk/OD female and behold, the thong! Usually lacey- black or red. Eeew!

Have not come across orange (yet)- guess those are reserved for the over 40, robust ass crowd!

Will say they require very little cutting with trauma scissors.Snip- things nearly spring off like a rubber band:)

Yes, seasoned ED folks have few "double take" moments but it DOES still happen. Thanks for great post.

Anonymous said...

Fifteen years, ago thongs were not so pervasive in America, and I was a visiting wound care nurse in Florida. Stopped to make several visits in a downtown "senior living" high-rise along with a orientee. We worked our way from floor to floor, changing infected surgical dressings and putting Una boots on ulcerated legs, meeting our usual assortment of seniors determined to stay OUT of the dreaded "nursing home".

Our final visit was the evaluation of a sacral wound on a little lady who could not have weighed 80 lbs, who met us on an August day in a heavy fleece sweatsuit and HAT in her un air-conditioned little apartment. After doing the usual assessment and moving on to the wound, I was very concerned when I saw a flash of red.....could this be a bleeding stage 4???

You guessed it....just a tiny little red lace thong covering the dressing on the boniest, saggy little butt in the universe. Ithought my student would need CPR from holding in his choked laughter on the other side of the bed!

Pattie, RN

WarmSocks said...

Vividly descriptive!

I've witnessed those outbursts you tell of, and you're right. Initially, it seems callous for medical personnel to ignore an old person's pleas for assistance. The nursing home we visit has quite a few dementia patients. It's quite disconcerting to walk up to the building and hear "Help me! Help me! Somebody help me!" over and over again through the open windows. It doesn't come across as appropriate, compassionate care when you then walk into the building and find all the staff ignoring those cries for help. It's a different story once you realize what's really going on, though. I've been in the same room with those patients yelling for help, and discovered that they really don't want or need help. The words just spring out involunarily. So sad.

Sharp Incisions said...

I've been spending most of my time with cancer patients, so funny stories have all been erased from my memory by the sad ones lately.

But I did want to comment and say, to any non-medicos who read this, that the 'blase' attitude is actually a good thing. It's less embarrassing for the patient to be treated by a team who've 'seen it all before', especially for 'below the belt' exams. And as far as we're concerned, if we're unfazed, we think more clearly and react faster and more appropriately - which is ultimately what's best for the patient.

As a medical student, I've deliberately tried to cultivate that 'seen it all' attitude. The first patient I saw naked had no idea that she was the first naked patient I'd seen. I'm sure it helped that she was comatose ;) - but even if she hadn't been, I hope that my practiced nonchalance would have been up to the task.

It actually didn't take too long for pretense to become reality. I haven't done even a mental double-take in a long time! (Though I'm not in the ED full time.)

Thanks for another great post, Dr Jim!

Anonymous said...

It's not just the ER - when a friend of mine was hospitalized, for several days the elderly man in the room next to her would incessantly call out "Nu-ur-ur-ur-ur-ur-ur-urse... Nu-ur-ur-ur-ur-urse". My husband on the one said "He sounds like a sheep". Actually, we sort of missed him after he left (I don't think the nurses did though).

Also, once at medical offices, consisting of many floors with the offices around the edges and the center entirely open, a handicapped young person at neurology would just shriek like a wild animal - his cries rang through the whole place, floors away. Patients and families really raised some eyebrows at that one.

Does that orange thong remind me of the orange that highway workers wear - perhaps a sort of hazard sign?

SilverNeurotic said...

When I was in college I had a fainting spell about a week before finals due to stress. Since I was living at home, my mother, a nurse, insisted on taking me to the local ER. It was really busy that night, and while I was given a bed right away-it was in the trauma area instead of a normal "room". A few minutes after I was settled into bed, an ambulance brought in this guy who had been involved in a Friday night bar fight...he got attacked by a machete. It was sad, but the commotion kept my mother and I pretty amused for awhile.

kristi said...

Thongs are just nasty, aren't they?

rlbates said...

Love the post and the comments!

tracy said...

Oh, dear.
My great shame is that i have been a horrible, screamiming, obnoxious (drunk, od'd and cut up) patient in my time. :*(

i think i would rather have had my a$$ hanging out.

i am sorry.

CeeCee said...

I'm old enough to remember when a thong was a sandal. :)

I wouldn't worry too much about what other patients are thinking. We live in a society where almost nothing phases us. Just about everyone I know has been to a nursing home or has cared for an elderly person with dementia before.
Thanks for being concerned though.
I hope you have a great weekend!

Kate said...

Thongs! On robust ass! Spectacular!

Katie said...

How about a school cafeteria story? Picture the president of the university speaking with an elderly woman who gets to audit (aka sleep through) any classes she desires and eat in the caf for free. A friend of mine caught him bent over lost deep within conversation while zealously picking his seat.

Or yesterday I stood to realize there was a huge rip in the rear of my jeans. How long at that been there? I don't even want to know.

<>< Katie

PS: I didn't memorize those sentences. I wrote them down. I don't like the "I'm going on an airplane and I'm taking..." game because let's face it, my name's Katie. I can take a kangaroo, a kiwi, and Kool-aid but that's about it.

emmy said...

I've recently been the family member walking through the emergency room and then the ICU. Neither is pleasant. Would it be too much bother to offer the patient two gowns, one to cover the front and one to cover the back? I always ask when it's me, but not everybody knows that they can ask.

Marc Bernard said...

Thanks for the great story - keep on singing for the sake of the thong. :)

terri c said...

Hmmm as to the two gowns, I think there are a lot of folks in the ED who don't want to wear ONE gown let alone two. So you could offer but the folks who need that second gown most might be the ones who would not want it! Sort of the reverse of Speedos, where the ones who want most to wear them are the ones who should not. Good post. My funniest story as a patient was listening to another patient in the ED who had been brought in by police. At one point he yelled, "I just want someone to treat me like a human being. I am NOT DUMB!! D-U-M!!! No!!! N-O!!!" Um, yeah.

Cal said...

I have not been in a regular ER for many years (knock on wood), thankfully. I did take my daughter a few times to a wonderful pediatric ER, and felt very guilty when once all the doctors suddenly rushed into one room where there was a very sick baby, as I knew my daughter was not terribly ill.

coulrophobic agnostic said...

I feel bad for giggling at the poor demented couple, but that's the kind of shit you just can't make up, you know?

Last time I was in the ER (a couple of years back), there was a patient who kept removing his clothing (hopefully not all of it; I couldn't really see) and climbing into bed with the other patients. That was pretty awkward. Oh, and the guy across from me (that ER didn't have those fancy private big room with 20 or so beds shoved practically on top of each other) loudly informed someone, over the course of a conversation, that if you have a sudden attack of diarrhea, looking at something orange will make the urge go away.

I wish I hadn't been essentially strapped to the bed, because I missed a lot of awesome goings-on. Sigh. The IV dealie was above my right shoulder and plugged into the awesome tunnel-like vein in my left arm. The pulse ox thingy and blood pressure dealie (I'm not a doctor, okay!) were on my left side and, of course, attached to my right arm. Basically I had to lie back or risk potentially ripping everything loose and pissing off a bunch of really nice nurses. (Also, I swear, not having insurance would have helped me that day. I had a kidney infection. A dog could have diagnosed it. I'd had UTI symptoms for about a week prior but my GYN said me pee was okay, so I ignored it. You'd think that would be a clue. But the doctor, who looked about 12, insisted on getting a contrast CT JUST IN CASE the lower back pain, high fever and mild but still embarrassing incontinence were caused by some kind of infected thing in my spine. Or my gallbladder. get my point. Obviously I'm being facetious; I'd rather be insured than not and get too much care than not enough, but holy fuck it was frustrating! It didn't help that I also had the flu, thanks to accidentally drinking someone else's beverage thinking it was my own. Apparently my white cell count was more than twice what someone who "just" had the flu's should be, so that necessitated MORE tests. They ended up admitting me at around 3 am, and guess what? By 7 or 8 or whenever they were doing the morning go-rounds, my blood tests were reasonable, my fever was gone and they sent me home without the spinal imaging whatever they wanted to do on me. Shocker!)

Tiff said...

Funny Story Jim!! I have one for ya. So, I volunteer in my local ER department for the past couple of years, and have seen some pretty funny moments. And like you and your ER staff, it takes a lot to really ruffle my feathers so to speak. But there have been a few times where I even took a double take.

So as a volunteer its my job to first greet the pt's that come into the ER, get their name, age, and reason for visit to give to the triage nurse. Its also my responsibility to perform basic first aid if there is a line to see the triage RN. Like quickly put a dressing on a bleeding finger, get ice for the broken leg, etc..

So anywho, One nite Im doing my usual shift, and this young girl comes in (around my age of 22) and she is dressed in a very short mini skirt, Really tight tight TIGHT shirt, gross hair extensions and her make up is streaming down her face from crying. She is holding her hand in a blood soaked towel. I ask her name, and age, and then asked what happened to her hand. Her response was "Well I got really drunk, and I was making a margarita in the blender with frozen strawberries, and one of the strawberries got stuck, so i tried to 'unstick' (swear to god thats the word she used) it with my finger while the blender was going, and well the blender got my finger." OMG!! like how do you react to this. My first response was like OW!! then my second response was like "are you stupid" (in my head of course) and then my third response was that i wanted to burst out laughing at her stupidity/drunkenness. But I was really nice and said "omg my dear, that must be throbbing like heck, lets get you into triage" and because I like gore I stayed around and helped the triage nurse with bandaging it. Lets just say that finger was like hamburgur meat. Dont think she will ever stick her hand in a running blender again, drunk or not.

So yes, I see your point as to how it takes a lot to get us ER folk ruffled. But the ones that do make us be "ruffled" provide the best stories, so i guess thats good. Anywho, thanks for the awesome post as always!!!


Heather said...

I bet she was wearing white pants too wasn't she?

I had my students to the nursing home for clinicals and we had a patient who screamed, "Ed, I'm dying!" over and over and over and over. Ed showed up, and she still screamed. My poor kids. They're still too green to see any humor in any of it! ;)

BC Cook said...

"Imagine...a half-naked patient, his gown loosely-tied and his junk hanging out, walking at you from the other direction. Or seeing an unresponsive [person] on a cot being rushed into a room with a paramedic sitting on top of him, performing CPR. Or hearing the the next room violently vomiting and gagging while filling-in the space between with obscenities."

I don't have to imagine it. It sounds like a typical Thanksgiving.

Wren said...

Wonderful post! You had me giggling over the woman with the thong--my goodness. People are so delightfully odd, aren't they. And the old lady and old man yelling ... what a hoot. Thanks for another great story, doc. :o)

CottonLady said...

Great post!! Back in the '80's when I was working in a nursing home, we had a gentlemen that had had a stroke. He could not talk at all EXCEPT when he needed something or couldn't sleep, he would yell "Ho Hum Harry!!" very plainly! That was all he ever spoke, but he could sure speak it loudly and often!


SeaSpray said...

Great post Jim!

You have such a way with writing ..that I was staring at her too. :)

Gosh ...I'd want to become one with the floor and disappear.

Saying Thank you and covering up would have been nice. Gee!

Years ago we had an ED doc come to the cafeteria one night for dinner and he couldn't get over how this one patient had these sexy panties on because they did not match his perception of her.

Dementia is just so sad. My mother got it severely the last 5 mos of her life but she didn't do that. And it had started earlier that year but her doc acted like it was not important. She called the staff by my name and forgot our names. But the worst thing was that she suddenly didn't remember how to use the remote, read, write or do anything but feed herself. She'd have bursts of recognition. they think she had mini stroKes that wouldn't show up on a CT, but they never took her for a CT.

And it was so sad to see the alzheimers patients, particular one woman was always in crisis mode. I wondered if it was because she had been a medical administrator and so somehow in that mode of constant tension.

I would just go along with them when they'd ask why we didn't go to that bank or tell me it was Christmas.

And your right ..we don't know how we will be in 30 years. It is an unnerving thought.

You'd be the storytellERdoc everyone would love. :)

I had an inpatient experience a few years ago in which I was desperate to get sleep because I had been awake almost 24 hrs at that point after the long nite in the ER. I git up there around 5:30 am and birds were beginning to sing. Just as the nurse had finally finished her intake info with me and left roommate began stirring, then the getting ready for change of shift and with the sunlite now coming in the windows elderly woman nearbu began making consistant loud nonverbal sounds every 3 seconds. Then from what sounded like the bottom outside corner of my room ..behind my stretcher and older man was calling out "Hellooooo!" "Hellooooo" non stop.

Not feeling well, exhausted, pain, and miserable from being on NPO when I hadn't had anything to eat 33 hours at that point because I didn't eat that day before I ended up in the hospital, I asked the nurse that just came on if I could have a sleeping pill and she said "Oh noooo..they won't want your sleep patterns messed up."

I was exhausted and could NOT sleep with all the commotion and noise.

All I wanted was to be knocked OUT!

G-31 Toastmasters said...

Grateful to say that I've only been in the ER a few times, but it seems like they were colorful episodes.

One visit for allergic reaction to bee sting (I got to be the "stat"... for a few minutes), a maniac came in wielding a gun and threatening every one in the place. Oh my, the excitement of my bee stings were pale compared to that excitement.

Another time I came to the ER via ambulance from an eye Dr's appt because I couldn't stay conscious or keep my BP up. I was in an ER that didn't have rooms but just bed after bed only separated by curtains. That day one of my neighbors was a police-guarded, venom-shouting, very loud, angry person. (Maybe it was the same guy as the bee sting day... but no gun!) Any way, I heard that, but the only thing I could REALLY hear was my five month-old ravenous nursling who wanted MAMA.

My husband asked if he could come see us. (Baby was not mollified by sips of apple juice dripped from a straw.) He could see me, but not with the baby. Um, what was he supposed to do with the baby? Hand it to a stranger in the waiting room? I asked if I could please nurse the baby (engorgement HURTS) and the docs said "NO WAY. TOO MANY GERMS IN HERE. BUT WE CAN GET YOU A PUMP FROM THE WOMEN'S/BABY'S HOSPITAL AND YOU CAN PUMP FOR THE BABY." Um, right. Like it's going to be any less germ-ridden to pump milk here in the ER (and have hubby feed Baby in the waiting room from a bottle) than it would be to put Baby directly on the spigot. Finally the doc's got a WOMEN'S/BABY'S Hospital Doc to come consult; that doc was delighted to meet a full-time nursing mom. She gave the approval for me to feed Baby in the ER. Baby was happy. I was happy. Hubby was happy. The whole ER was a lot quieter because Baby was happy.

I still remember the date... 9/7/01. Four days later my blood pressure issues seemed like NOTHING to worry about. :-(

type1medic said...

I have cut way to many thongs off!! uggh! and it is never on the young teen or young adult, ohh no it is some middle aged woman who def. needs to visit A drug rehab facility. Seriously what is the point of the thong? How is that cute??

Rogue Medic said...

In order to develop a classy chant, for the future (if there is not a cure/prevention for dementia first), I practice yelling, Pardon me. Do you have any Grey Poupon?